In biopsy-proven glomerulonephritis, higher systolic blood pressure is closely associated with chronic intrarenal vascular lesions, particularly arteriolosclerosis, which independently predicts renal function decline and adverse cardiorenal outcomes.
Patients with arteriolosclerosis had significantly higher systolic blood pressure than those without arteriolosclerosis.
SBP greater than 130 mmHg was associated with multiple histopathological lesions in glomerulonephritis.
Arteriolosclerosis was associated with a steeper decline in estimated glomerular filtration rate (eGFR) over the 36-month follow-up period.
Arteriolosclerosis independently predicted the composite renal and cardiovascular outcome in logistic regression analysis.
During the 36-month follow-up, proteinuria significantly decreased while systolic blood pressure remained stable.
The study found no associations between diastolic blood pressure and any of the histopathological lesions examined.
This research examined the relationship between office blood pressure measurements and kidney tissue damage in 66 patients with biopsy-confirmed kidney inflammation (glomerulonephritis), following them for three years. The study found that higher systolic blood pressure (the top number in a blood pressure reading) was strongly linked to specific types of scarring in the small blood vessels of the kidneys, particularly a condition called arteriolosclerosis — a hardening and thickening of the small arteries. Interestingly, the bottom number (diastolic blood pressure) was not associated with any of these tissue changes, suggesting that systolic pressure may be the more important factor in kidney vessel damage. The study also found that patients who had arteriolosclerosis visible on their kidney biopsy experienced a much faster loss of kidney function over time, losing approximately 4.91 mL/min/1.73 m² of kidney filtering capacity per follow-up interval compared to those without this finding. Additionally, arteriolosclerosis was associated with a more than six-fold increased risk of experiencing a combined kidney or cardiovascular adverse event (OR 6.67), even after accounting for other factors. Proteinuria (protein in the urine, a marker of kidney damage) decreased significantly over the follow-up, but systolic blood pressure levels did not change, suggesting blood pressure control remained a persistent challenge. This research suggests that kidney biopsies in glomerulonephritis patients provide important prognostic information beyond just the primary kidney diagnosis — specifically, the presence of arteriolosclerosis on biopsy may help identify patients at highest risk for worsening kidney function and cardiovascular events. These findings support using arteriolosclerosis as a tissue-based risk marker that could guide more aggressive or individualized blood pressure management strategies in this patient population.
Gigante A, Trombacco A, Galanti G, Pellicano C, Sorato G, Cascone R, et al.. (2026). Office Blood Pressure and Arteriolosclerosis in Biopsy-Proven Glomerulonephritis: Association With Renal Function Decline and Clinical Outcomes.. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70367