Konishi Y, Imanishi M, Okamura M, Yoshioka K, Okumura M, Okada N, Tanaka S, Fujii S, Kimura G
Department of Internal Medicine, Osaka City General Hospital, Osaka, Japan.
J Hypertens. 2000 Jan;18(1):103-9. doi: 10.1097/00004872-200018010-00015.
Studies of experimental animals show glomerular hypertension to be important in the progression of glomerular disease. We evaluated this connection clinically by examining the relationship between glomerular hemodynamics and histological changes in patients with immunoglobulin (Ig)A nephropathy.
The subjects were 23 patients with IgA nephropathy. All patients underwent renal biopsies. Glomerular hemodynamics, in terms of glomerular capillary hydraulic pressure (PGC) and the whole-kidney ultrafiltration coefficient, were calculated from the renal clearance, plasma total protein concentration, and pressure-natriuresis relationship. The severity of glomerulosclerosis, tubulointerstitial damage and mesangial matrix expansion was evaluated semiquantitatively.
PGC ranged from 33-69 mm Hg, and the mean arterial pressure (MAP) from 79-112 mm Hg. Their correlation was not significant (r= 0.29, P= 0.18). PGC was significantly correlated with the glomerulosclerosis score, and also with the score for tubulointerstitial damage (r= 0.65, P < 0.001 and rs = 0.59, P = 0.007, respectively), but not with the score for mesangial matrix expansion (r= 0.08, P= 0.72). MAP was significantly correlated only with the score for tubulointerstitial damage (rs = 0.63, P = 0.004). In multiple linear regression analysis of the histological changes and hemodynamics, the glomerulosclerosis score and the score for tubulointerstitial damage were correlated with PGC, but not with MAP.
These clinical results support the speculation that glomerular hypertension is involved in the glomerulosclerosis and tubulointerstitial damage that occurs in IgA nephropathy.
对实验动物的研究表明，肾小球高血压在肾小球疾病进展中起重要作用。我们通过检查免疫球蛋白（Ig）A肾病患者的肾小球血流动力学与组织学变化之间的关系，对这种联系进行了临床评估。
研究对象为23例IgA肾病患者。所有患者均接受了肾活检。根据肾脏清除率、血浆总蛋白浓度和压力-利钠关系，计算肾小球毛细血管液压（PGC）和全肾超滤系数方面的肾小球血流动力学。对肾小球硬化、肾小管间质损伤和系膜基质扩张的严重程度进行半定量评估。
PGC范围为33 - 69 mmHg，平均动脉压（MAP）范围为79 - 112 mmHg。它们之间的相关性不显著（r = 0.29，P = 0.18）。PGC与肾小球硬化评分显著相关，也与肾小管间质损伤评分显著相关（分别为r = 0.65，P < 0.001和rs = 0.59，P = 0.007），但与系膜基质扩张评分无关（r = 0.08，P = 0.72）。MAP仅与肾小管间质损伤评分显著相关（rs = 0.63，P = 0.004）。在组织学变化和血流动力学的多元线性回归分析中，肾小球硬化评分和肾小管间质损伤评分与PGC相关，但与MAP无关。
这些临床结果支持了肾小球高血压参与IgA肾病中发生的肾小球硬化和肾小管间质损伤这一推测。
