A research team from the Medical University of Vienna has uncovered early kidney structural alterations associated with high blood pressure independent of diabetes. Their findings reveal that arterial hypertension alone may initiate damage to podocytes — the specialised cells responsible for the kidney’s filtration barrier — even without comorbid conditions such as type 2 diabetes. Published in the journal Hypertension, the study underscores the critical need for timely detection and rigorous management of elevated blood pressure to mitigate the risk of renal impairment.
The investigation, led by Christopher Paschen and Rainer Oberbauer of the Clinical Division of Nephrology and Dialysis (Department of Medicine III) and Heinz Regele of the Clinical Department of Pathology, analysed the renal tissue from 99 individuals. These participants either had coexisting hypertension and type 2 diabetes or were free from both conditions, thereby allowing the researchers to isolate the independent effects of high blood pressure. The samples were derived from non-pathological areas of kidneys surgically removed for tumour treatment (tumour nephrectomies) performed between 2013 and 2018.
Advanced imaging techniques and computer-assisted analysis were employed to evaluate the structure of the renal corpuscles (glomeruli) and their associated podocytes. As essential components of the glomerular filtration barrier, podocytes are pivotal in maintaining renal function. Their size and density serve as key indicators of early renal damage. The research incorporated artificial intelligence through deep learning algorithms, enabling precise, automated analysis of digital tissue sections. This method allowed for high-resolution quantification of podocyte morphology and glomerular volume.
The results revealed a marked reduction in podocyte density among patients with hypertension and a noticeable enlargement of the cell nuclei compared with healthy controls. These morphological changes were consistent regardless of whether type 2 diabetes was also present, suggesting that hypertension alone is sufficient to initiate structural kidney damage. “Our findings suggest that these alterations represent the first microscopically detectable stage of kidney dysfunction,” said first author Christopher Paschen. The researchers interpret this as a potential precursor to clinically apparent renal disease, emphasising the importance of preemptive intervention.
Study leaders Rainer Oberbauer and Heinz Regele further highlighted the implications of these results: “Early identification and consistent treatment of high blood pressure could help decelerate the progression of chronic kidney disease and prevent permanent renal damage.” The evidence supports the notion that even before symptoms become apparent, hypertension may quietly compromise kidney integrity through changes to the podocyte network. This finding could shift current screening and management strategies.
Chronic kidney disease is frequently attributed to hypertension and type 2 diabetes, two of the most prevalent global health challenges. While the mechanisms by which diabetes leads to nephropathy are well understood, the direct impact of hypertension on renal structure—particularly in the absence of diabetes—has remained less clear. This study offers new clarity on the subject, providing compelling evidence that hypertension alone can induce measurable changes in kidney architecture. These insights may significantly impact early diagnostic protocols and therapeutic planning, potentially influencing future nephrology and primary care guidelines.
In sum, the Vienna-based team’s work contributes vital new knowledge to the field of renal medicine, illustrating that damage to the kidney’s delicate filtration system may occur earlier than previously recognised and in patient populations not typically flagged for heightened renal risk. Their integration of AI-driven analysis further demonstrates the value of digital pathology in uncovering subtle yet meaningful physiological shifts. As hypertension rises globally, the study reinforces the urgent necessity of proactive cardiovascular and renal health monitoring.
More information: Christopher Paschen et al, Association of Podometrics Findings in Patients With Hypertension and Type 2 Diabetes: A Retrospective Analysis, Hypertension. DOI: 10.1161/HYPERTENSIONAHA.124.24379
Journal information: Hypertension Provided by Medical University of Vienna
