Benign Nephroangiosclerosis: Diagnostic Criteria of Bamako, Mali

Abstract

Introduction: Long-standing and inadequately controlled high blood pressure (HBP) can cause a chronic kidney disease called benign nephroangiosclerosis (BNAS). Objective: To determine the frequency of BNS using clinical and paraclinical criteria adapted to our practice setting, where renal biopsy was not routinely performed. These criteria will now serve as diagnostic criteria for benign nephroangiosclerosis. Methodology: Retrospective descriptive study from January 1, 2021, to December 31, 2022, focusing on patients hospitalized in the nephrology and hemodialysis department of the Point G University Hospital during that period. Our criteria for defining BNS were: chronic kidney disease (CKD) at the stage of chronic renal failure (CRF) (defined as an eGFR < 60 ml/min/1.73 m 2 for more than 3 months) resulting from untreated or poorly treated hypertension for at least 3 years, associated with minimal proteinuria ≤ 1g/24h with normal urinary sediment, harmoniously reduced kidney size, hypertensive retinopathy, and/or left ventricular hypertrophy. Results: Among 1511 patients, 139 met our criteria, representing a frequency of 9.2%. The sex ratio was 1.27. The average age was 43.45 ± 13.47 years. Symptoms included vomiting (81.3%). CKD was in the end-stage in 92.80% of cases. Grade III hypertension was present in 51.62%. Proteinuria was minimal in 90.52%. Urinary sediment was normal in 52.5%. LVH was present in 73.72% on ECG. Hypertensive retinopathy was present in 67% of cases. The kidneys were atrophied in 88.72% of cases. Antihypertensive drugs were used in 95.7% of cases. Patients underwent hemodialysis in 93.53% of cases. The mortality rate was 15.1%. Conclusion: This study shows that benign nephroangiosclerosis is common in hospitals. These clinical and paraclinical criteria will enable rapid diagnosis in the absence of other potential causes of CKD. It affects young, highly active individuals, which is why national community programmes must be developed in Africa, particularly in Mali, for a broad campaign of prevention, early detection, and effective and appropriate management of hypertension in order to effectively and significantly reduce this high incidence of chronic kidney disease.