| Objective: To investigate the expression of angiotensin receptors(AT1,AT2,and MAS)in renal biopsy tissues of malignant hypertension patients,and to study whether there are differences in renal local receptor expression of patients with renal malignant hypertension,and the their correlation with clinical significance as well as renal pathological damage.Methods: Selected 81 malignant hypertension patients confirmed by Renal puncture biopsy from 2006 to 2015 of China-Japan Friendship Hospital and enrolled them in a study group.Among the patients,36 cases had primary malignant hypertension,and 45 cases suffered IgA nephropathy secondary malignant hypertension.Collected the clinical indicators of patients(age,systolic blood pressure,diastolic blood pressure,mean arterial pressure,urine routine,24 h urinary protein,blood routine,blood urea nitrogen,creatinine,uric acid,serum albumin,total protein,complement,immunoglobulin),and analyzed the correlation between clinical indicators and primary malignant hypertension,IgA nephropathy secondary malignant hypertension and minimal change nephropathy.Detected the expression of angiotensin receptors(AT1,AT2 and MAS)in three groups of renal biopsy with immunohistochemical methods,and analyzed the correlation between the above receptor expression levels and clinical indicators.Results:1.The experimental group includes 36 cases of primary malignant hypertension,and 45 cases of IgA nephropathy secondary to malignant hypertension.Established a control group of twenty cases with minimally pathological nephropathy,which the results showed that the malignant hypertension were mainly occurred among young and middle-aged of the two groups,and the number of males was significantly higher than that of females.Anemia,thrombocytopenia,serum creatinine and uric acid were all significantly increased in both groups,and there was statistical significance between the two groups(P<0.01).The systolic blood pressure,diastolic blood pressure and mean arterial blood pressure in the primary malignant hypertension group were significantly higher than those in the IgA nephropathy secondary malignant hypertension group.however,The 24-hour urine protein quantitation and urinary red blood cell level were significantly lower than those in the IgA nephropathy secondary malignant group(P<0.01,or P<0.05).The diastolic blood pressure and mean arterial pressure in the primary malignant hypertension group were negatively correlated with age and positively correlated with blood uric acid level(P<0.05).No statistically significant correlation was found between the clinical parameters of the control group.2.Among the expression of RAS receptor in the Local kidney of the control group,AT1 receptor is mainly distributed in renal tubules,and then glomerular,AT2,MAS receptors mainly distribute renal tubules as well,followed by renal blood vessels.In the PMHT group,AT1 receptor is mainly expressed in renal tubules,followed by glomerular.The expression of AT2 receptor is mainly expressed in renal tubules and glomerular,and the expression of renal blood vessels is also obvious.The expression of three receptors in glomerular,renal tubules and renal blood vessels was significantly higher than that in the control group,in which AT1 receptor was in glomerular,AT2 receptor was in renal tubule,glomerular,and MAS receptor was in renal tubule.There was statistical significance of glomerular expression(P<0.05).In the IgANMHT group,the AT1 receptor is mainly expressed in the renal tubules,followed by the glomerular.The AT2 receptor is mainly expressed in the renal tubules,followed by the glomerular and the expression of renal blood vessels is significantly reduced.MAS receptors are mainly expressed in the renal tubules.Apart from that the expression of AT2 receptor in renal blood vessels was lower than that of the control group,the expression of AT2 receptor in glomerular and renal tubules and the expression of AT1,MAS receptors in glomerular,renal tubules and renal blood vessels were significantly higher than that of the control group.The expression of AT1 and MAS receptors in renal tubules,glomerular and renal blood vessels was statistically significant(P<0.05).In that case,the RAS activation and receptor overexpression phenomenon did exist in local malignant hypertension kidney.Conclusion:1.High expression of angiotensin receptor was found in renal biopsies of patients with primary malignant hypertension and IgA nephropathy secondary to malignant hypertension.Except for the decreased distribution of AT2 receptors in renal vessels in IgA nephropathy secondary to malignant hypertension,the expression of other receptors in the kidney was increased.2.There was a significant correlation between the expression of AT1,AT2 and MAS receptors and some clinical indicators in the kidney of patients with malignant hypertension,which showed that angiotensin receptor overexpression plays an important role in renal damage of malignant hypertension. |
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