{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:12:29Z","timestamp":1788567149197,"version":"build-2803163510"},"reference-count":51,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. Med."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Hypertensive nephrosclerosis is the presumed underlying cause in many end\u2010stage kidney disease (ESKD) patients, but the diagnosis is disputed and based on clinical criteria with low diagnostic accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate and improve the diagnostic process for nephrosclerosis patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included adults from the population\u2010based HUNT study (<jats:italic>n<\/jats:italic>\u00a0=\u00a050\u00a0552), Norwegian CKD patients referred for kidney biopsy 1988\u20132012 (<jats:italic>n<\/jats:italic>\u00a0=\u00a07261), and unselected nephrology clinic patients (<jats:italic>n<\/jats:italic>\u00a0=\u00a0193) used for matching. Decision tree analysis and ROC curve\u2010based methods of optimal cut\u2010offs were used to improve clinical nephrosclerosis criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nephrosclerosis prevalence was 2.7% in the general population, and eGFR decline and risk for kidney\u2010related hospital admissions and ESKD were comparable to patients with diabetic kidney disease. In the biopsy cohort, current clinical criteria had very low sensitivity (0.13) but high specificity (0.94) for biopsy\u2010verified arterionephrosclerosis. A new optimized diagnostic algorithm based on proteinuria (&lt;0.75\u00a0g\u00a0d<jats:sup>\u22121<\/jats:sup>), systolic blood pressure (&gt;155\u00a0mm\u00a0Hg) and age (&gt;75\u00a0years) only marginally improved diagnostic accuracy (sensitivity 0.19, specificity 0.96). Likewise, there were still false\u2010positive cases with treatable diagnoses like glomerulonephritis, interstitial nephritis and others (40% of all test positive). Decision curve analysis showed that the new criteria can lead to higher clinical utility, especially for patients considering the potential harms to be close to the potential benefits, while the more risk\u2010tolerant ones (harm:benefit ratio\u00a0&lt;\u00a01:4) should consider kidney biopsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Further improvements of the current clinical criteria seem difficult, so risks and benefits of kidney biopsy could be more actively discussed with selected patients to reduce misclassification and direct treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13146","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T08:11:23Z","timestamp":1593677483000},"page":"69-83","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Hypertensive nephrosclerosis: wider kidney biopsy indications may be needed to improve diagnostics"],"prefix":"10.1111","volume":"289","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9045-3569","authenticated-orcid":false,"given":"S. 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