Wright J R, Duggal A, Thomas R, Reeve R, Roberts I S, Kalra P A
Department of Renal Medicine, Hope Hospital, Salford, UK.
Nephrol Dial Transplant. 2001 Apr;16(4):765-70. doi: 10.1093/ndt/16.4.765.
Atherosclerotic renovascular disease (ARVD) is commonly associated with renal failure. It is now recognized that intrarenal damage, (ischaemic or atherosclerotic nephropathy) is a major contributor to the renal impairment in these patients. In this study the impact of histological changes upon renal functional outcome was investigated in patients with atherosclerotic nephropathy.
The Hope Hospital renal biopsy database (1985-1998) was interrogated for patients with histology compatible with atherosclerotic nephropathy. Case-note review enabled the assessment of several clinical parameters and outcomes, including change in creatinine clearance per year (DeltaCrCl (ml/min/year)), blood pressure control, dialysis need, and death. Renal parenchymal damage was analysed by morphometric analysis (of interstitial fibrosis and glomerulosclerosis) and a semi-quantitative chronic damage score (score 0-3 (normal-severe) for each of glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis; maximum=12). Patients were stratified into two groups who had either deteriorating (group 1) or stable (group 2) renal function during follow-up.
Twenty-five patients (age 64.7+/-10.5, range 43-83 years; 17 male, eight female) were identified. Sixteen patients had undergone angiography; two had significant (>50%) renal artery stenosis. Mean follow-up was 25.6+/-14.8 (range 5-50) months. Group 1 patients had DeltaCrCl -7.4+/-6.8 ml/min/year, n=14 and group 2 patients had DeltaCrCl 4.8+/-7.0 ml/min/year, n=11. Four patients in group 1 developed end-stage renal disease and five patients died (three in group 1 and two in group 2). At study entry, group 1 patients had worse renal function (CrCl 27.6+/-17.6 vs 36.0+/-33.9, NS), greater proteinuria (1.2 vs 0.5 g/24 h, NS), and higher systolic blood pressure (167.1+/-30.8 mmHg vs 150.6+/-37.8, NS) compared with group 2 patients. Group 1 patients showed more glomerulosclerosis (51.6 vs 24.9%, P:<0.01), greater proportional interstitial volume (44.9 vs 33.9%, P:<0.02), and higher overall chronic damage score (P:<0.05) than those in group 2. There was a significant correlation between renal functional outcome and chronic damage score, glomerulosclerosis and proportional interstitial volume for the entire patient cohort.
In patients with atherosclerotic nephropathy the severity of histopathological damage is an important determinant and predictor of renal functional outcome.
动脉粥样硬化性肾血管疾病（ARVD）常与肾衰竭相关。目前已认识到肾内损害（缺血性或动脉粥样硬化性肾病）是这些患者肾功能损害的主要原因。本研究调查了动脉粥样硬化性肾病患者组织学改变对肾功能转归的影响。
查询霍普医院肾活检数据库（1985 - 1998年）中组织学与动脉粥样硬化性肾病相符的患者。病历回顾有助于评估多个临床参数和转归，包括每年肌酐清除率的变化（ΔCrCl（ml/分钟/年））、血压控制情况、透析需求和死亡情况。通过形态计量分析（间质纤维化和肾小球硬化）和半定量慢性损害评分（肾小球硬化、间质纤维化、肾小管萎缩和小动脉玻璃样变每项评分为0 - 3分（正常 - 重度）；最高分为12分）分析肾实质损害。患者被分为两组，在随访期间肾功能恶化的为第1组，肾功能稳定的为第2组。
共确定25例患者（年龄64.7±10.5岁，范围43 - 83岁；男性17例，女性8例）。16例患者接受了血管造影；2例有显著（>50%）肾动脉狭窄。平均随访时间为25.6±14.8（范围5 - 50）个月。第1组患者的ΔCrCl为 - 7.4±6.8 ml/分钟/年，n = 14；第2组患者的ΔCrCl为4.8±7.0 ml/分钟/年，n = 11。第1组4例患者发展为终末期肾病，5例患者死亡（第1组3例，第2组2例）。研究开始时，与第2组患者相比，第1组患者肾功能更差（肌酐清除率27.6±17.6 vs 36.0±33.9，无统计学差异）、蛋白尿更多（1.2 vs 0.5 g/24小时，无统计学差异）、收缩压更高（167.1±30.8 mmHg vs 150.6±37.8，无统计学差异）。与第2组患者相比，第1组患者肾小球硬化更严重（51.6% vs 24.9%，P < 0.01）、间质体积比例更大（44.9% vs 33.9%，P < 0.02）、总体慢性损害评分更高（P < 0.05）。整个患者队列的肾功能转归与慢性损害评分、肾小球硬化和间质体积比例之间存在显著相关性。
在动脉粥样硬化性肾病患者中，组织病理学损害严重程度是肾功能转归的重要决定因素和预测指标。
