Clinical And Pathological Study Of Hypertensive Renal Damage

BackgroundThe major part of the hypertensive kidney injury is benign hypertensive nephrosclerosis, which is the most important cause of ESRD, and the clinical diagnose isn’t always match with the pathological diagnose. Lots of research has figured out that the level of system blood pressure is not correlated with the damage of the hypertensive kidney injury, which is involved with various kinds of factors.ObjectiveTo analyze the clinical and pathological features of patients with hypertensive nephrosclerosis and find predictive clinical features favoring the pathological diagnosis.MethodsCase selection:the diagnosed hypertensive nephrosclerosis patients who undergoing renal biopsy in PUMCH between2001and2008, with intact clinical and pathological data. Groups:Benign hypertensive nephrosclerosis (BHN, n=30), Malignant hypertensive nephrosclerosis (MHN, n=24), focal segmental glomerulosclerosis (FSGS, n=19), obesity related glomerulosclerosis (ORG, n=15), primary nephritis (PN, n=50). This retrospective study compared the clinical and pathological features and evaluated the value of clinical features to predict the pathological diagnosis.Results(1) Among138patients,30(21.7%) patients were classified as BHN,19(13.8%) as MHN,24(17.4%) as FSGS,15(10.9%) as ORG, and50(36.2%) as PN. The diagnose accordance rate of hypertensive kidney injury is35.5%.(2) Among the BANS, MHN and PN groups, the BMI and obesity ratio of BANS is higher, the SBP, DBP, MAP, UA, Scr, BUN and LVMI of MHN is higher, the eGFR of MHN is lower, the tubule atrophy index, interstitial index and vascular index of MHN is higher, and the segmental glomerulosclerosis rate of MHN is lower.(4) Among the BHN, FSGS and ORG groups, the BMI, obesity ratio and eGFR of ORG is higher, MAP and DBP of ORG is lower, Scr of BHN is higher, the global glomerulosclerosis rate of BHN, the segmental glomerulosclerosis rate of FSGS, the glomerular volume of ORG is higher.(4) In BHN group, eGFR is correlated with the global glomerulosclerosis rate, the tubule atrophy index, interstitial index and vascular index, the level of proteinuria is correlated with the global glomerulosclerosis rate, BMI is correlated with the segmental glomerulosclerosis rate; in ORG group, GFR is correlated with the global glomerulosclerosis rate, the level of proteinuria is correlated with the global glomerulosclerosis rate. MAP is independent with the pathological damage.(5) The relative density of podocyte is obviously lower in BHN, FSGS and ORG group. In BANS groups, the relative density of podocyte is correlated with GFR. The relative density of podocyte is independent with the level proteinuria.Conclusions(1) The diagnose accordance rate of hypertensive kidney injury is low, and the renal biopsy is recommended;(2) The pathology feature of BHN, FSGS and ORG is similar, besides homodynamic, metabolite is another important factor, and the two factor have a different ratio among groups;(3) Body mass index (BMI) is a good predictor of BANS, eGFR and proteinuria is correlated with the pathological damage of BHN group, MAP is not correlated with the pathological damage of BANS group;(4) The relative density of podocyte is decrease in the hypertensive kidney injury, which is not related with eGFR.