ArticleHypertension research : official journal of the Japanese Society of Hypertension2026
Synergistic effect of obesity on hypertensive renal arteriosclerosis in individuals without chronic kidney disease: A zero-hour biopsy-based cohort study.
Article in Hypertension research : official journal of the Japanese Society of Hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Nephrosclerosis, influenced by aging and elevated blood pressure (BP), including prehypertensive levels, is a major contributor to end-stage kidney disease. However, the relationship between these risk factors and early renal pathological alterations remains insufficiently characterized. This study aimed to examine age- and BP-related renal pathology in individuals without chronic kidney disease (CKD). We analyzed zero-hour biopsies from 520 living kidney donors without CKD at Kyushu University Hospital (2008-2018). Donors were stratified by BP (Normal, Stage I, Stage II) and age ( < 40, 40-49, 50-59, 60-79 years). The primary outcomes were arteriolosclerotic change, specifically arteriolar hyalinization (AH), atherosclerotic change, characterized by intimal thickening of small- to medium-sized arteries (IT) and global glomerulosclerosis. All lesions increased with age and BP. Adjusted odds ratios (ORs) for AH were 1.25 [0.74-2.12] for Stage I and 1.63 [1.02-2.61] for Stage II hypertension (vs. normal BP). IT was significantly increased in individuals aged 50-59 (OR 3.56 [1.27-9.98]) and 60-79 years (OR 5.61 [1.81-17.41]) compared to those <40 years. A significant interaction between BP and obesity was observed for AH (p = 0.03): among obese individuals, both Stage I and Stage II hypertension were associated with AH (ORs 3.72 [1.06-13.1] and 4.05 [1.38-11.85], respectively), but not among non-obese individuals. In conclusion, subclinical nephrosclerosis begins in middle age, primarily driven by age-related vascular changes. Obesity significantly enhances BP-related arteriolar damage, even at prehypertensive levels. These findings support stratified hypertension management based on both BP and metabolic status.
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