Office Blood Pressure and Arteriolosclerosis in Biopsy-Proven Glomerulonephritis: Association With Renal Function Decline and Clinical Outcomes.

Hypertension is a major determinant of chronic kidney disease progression, yet the relationship between standardized office blood pressure measurements (OBPM), chronic vascular lesions, and prognosis in biopsy-proven glomerulonephritis (GN) remains poorly defined. We investigated the association between OBPM and renal histopathological lesions, focusing on arteriolosclerosis, and assessed their prognostic significance. This retrospective longitudinal study included 66 adults with biopsy-proven GN. All patients underwent standardized OBPM, laboratory evaluation, and renal biopsy. Histopathological assessment included glomerular, vascular, tubular, and interstitial lesions. Patients were followed for 36 months. Mixed-effects models evaluated longitudinal changes in blood pressure, proteinuria, and estimated glomerular filtration rate (eGFR), while logistic regression identified predictors of renal and cardiovascular outcomes. Patients with arteriolosclerosis had significantly higher systolic blood pressure (SBP) than those without (130 vs. 120 mmHg, p = 0.032). SBP > 130 mmHg was associated with arteriolosclerosis (p = 0.004), arterial intimal fibrosis (p = 0.005), crescentic lesions (p = 0.033), and glomerulosclerotic changes (p = 0.048), whereas no associations were observed for diastolic blood pressure (DBP). During follow-up, proteinuria significantly decreased (p < 0.001), whereas SBP remained stable. Arteriolosclerosis was associated with a steeper decline in eGFR over time (interaction β = -4.91 mL/min/1.73 m2 per follow-up interval, p = 0.023) and independently predicted the composite renal and cardiovascular outcome (OR 6.67, 95% CI 1.01-44.31; p = 0.049). In biopsy-proven GN, higher SBP is closely associated with chronic intrarenal vascular lesions, particularly arteriolosclerosis. Arteriolosclerosis independently predicts renal function decline and adverse cardiorenal outcomes, supporting its value as a histopathological marker for risk stratification and individualized blood pressure management.