Primary Malignant Hypertension With Renal Damage:Study On Clinical And Pathological Characteristics,Treatment And Prognosis

Objective Our retrospective study analyzed the clinical features and pathological characteristics of primary malignant hypertension(MHT)with renal damage,in order to improve the awareness of MHT related renal damage and to further discuss the prognosis of different therapeutic regimens.Method 65 patients with primary MHT confirmed by renal biopsies in Rui Jin Hospital Shanghai Jiao Tong University School of Medicine from January 2009 to December 2014 were reviewed and analyzed their clinical,pathological,treatment and follow-up data and features.The divisiory standard of patients as follows,based on the outcome of treatment,the patients were divided to the effictive and ineffective groups,the patients were divided into antihypertensive agents only group and antihypertensive combined with other agents group,according to the treatment wether include corticorsteroids and/or immunosuppresives.In accordance with the treatment includes BeraprostSodium or not to divide the patients into study and control group.By analysis the data of each group,to assess the clinical and pathological characteristics and therapeutical outcome.Results The demographic date of enrolled patients’(age35.9±7.56),male to femal ratio: 5.5:1.The most common incentive cause is poorly controlled hypertension(33.9%),the second place of cause is infection(26.5%),followed by fatigue(18.5%).However,the infection is the leading incentive cause(38.7%)in those without history of hypertension.Among all the infections,the 86.4% is respiratory infecion.The common onset symptoms were chest distress,anhelation and unable to keep horizontal position,dizzy,headache,blurred vision.The duration of onset to hospital visit varied between 5 days to 6 months.At administration,the mean blood pressure of 65 patients is systolic 219.8±24.8mmHg,diastolic 145.1±21.7mmHg.However 12 patients’ diastolic blood pressure only between 100~125mmHg.52.3% patients have history of hypertension,41.% have family history of hypertension.The maximum serum creatinine at visit is 304μmol/L.The MDRD-eGFR/EPI-GFR of all the patients revealed renal insufficiency at varying stages.Proteinuria occurred in all patients,with 20% nephrotic syndrome.26.2% patients have macroscopic hematuria,10.8% have paroxysml gross hematuria.38.5% of the 65 patients are overweight,36.9% are obesity.35.4% of patients have anemia,yet only one case of thrombocytopenia.Renal pathological features showed different stages of glomerular ischemia and sclerosis.The tubular atrophy,interstitial fibrosis and inflammatory cell infiltration were severe.The pathological manifestation of microvacular damage includes fibrinoid exudation(98.5%),lumen occlusion(90.8%),intimal hyperplasia(80.0%)and mucoid changes(56.9%)were common,while fibrinoid necrosis rarely observed(4.6%).The mean follow-up time of 40 patients eligible for survival analysis were 28 months.5 came to death or maintainance renal replacement therapy,35 achieved renal suvival.The ratio of significant effective 25.0%(10),effective 37.5%(15),and ineffective 37.5%(15).The total effective rate is 62.5%.The accumulated renal survival rate at 1,2,3 and 4 year was100%,99%,95% and 86%,respectively.The rate of achieve optimal blood pressure in effective group is significantly higher than in the ineffctive group(P<0.001).The effective rate of the corticosteroids and/or immunosuppresive group is higher than the antihypertensive agents only group(73.3% vs 56.0%).The effective rate of the BeraprostSodium group is higher than the controll group(77.8% vs 50.0%),although no statistic significance in these two groups.the type of combination medication use in BeraprostSodium group is less than in the controll group(P<0.05).Conclusions The primary MHT usually occurs in middle-aged male patients.The most common incentive causes include poorly controlled hypertension and infection.The overwight and obesity people at high risk of MHT with the kidneys being most commonly invloved among other organs.To diagnose the MHT only based the ocular fundus change and hypertension might lead to misdiagnosis of those patients with kidney and other organs involvement.That requires we shall carefuly make the diagnosis on the consideration of clinical and pathological findings.The mechanism of MHT may be different to the(HUS/TTP).The effectively controlled blood pressure is in great favor of renal survial improvement.The application of BeraprostSodium reduced kind of oral antihypertensive agents in the MHT treatment.