Hypertensive risk factors in kidney disease in African Americans

African Americans with hypertension more commonly develop renal insufficiency compared to Caucasians. The African American Study of Kidney Disease (AASK) included a renal biopsy pilot study that demonstrated that the clinical diagnosis of so-called hypertensive nephrosclerosis in these African American patients indeed was accurate. This biopsy study demonstrated extensive global glomerulosclerosis, far exceeding that expected for patients' age. We further compared our clinically indicated renal biopsies to determine if any phenotypic differences were present in hypertensive nephrosclerosis in African Americans versus Caucasians. These studies point to an excess of the solidified type of global glomerulosclerosis (GS) (also called decompensated benign nephrosclerosis) in African Americans compared to more obsolescent type GS in Caucasians. We speculate that these phenotypic differences might reflect differing mechanisms of tissue injury in hypertensive African Americans versus Caucasians, and discuss possible contributors to this injury.