Prevalence of immunecomplex-associated glomerulonephritis in hypertensive subjects

Glomerulonephritis demonstrable by immunohistochemistry may be present at post mortem in many patients without overt renal diseases. Systematic renal biopsies in severely hypertensive patients have shown a high prevalence of clinically undiagnosed glomerulonephritis. We have examined the kidneys of 423 consecutive subjects who came to post mortem and full-filled criteria for the diagnosis of hypertension. Patients were considered to be hypertensive if this had been clinically documented during life or if the heart weight/body weight ratio was > 0.005 in the absence of known other causes of cardiac hypertrophy. Normotensive controls were selected on the basis of clinically documented normal BP or a heart weight/body weight ratio of < 0.001. Kidneys were examined by immunohistology (PAP technique using human IgA, IgG, IgM antibodies). Excluding cases with liver cirrhosis, only two of the 337 patients with hypertension (= 0.6%) and none of the 49 normotensive patients had mesangial IgA deposits (P = 0.77). This finding argues against the frequent occurrence of latent glomerulonephritis in elderly patients with manifest hypertension.