Guo Yun-shan, Yuan Wei-jie, Yu Jian-ping, Mei Xiao-bin, Ye Han-yang, Bian Qi, Xu Jing
Department of Nephrology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2006 May;34(5):391-5.
To investigate the clinical and pathological characteristics of patients with clinically presumed hypertensive nephrosclerosis (HN).
Clinical data and renal biopsy results were obtained in 63 patients diagnosed clinically as HN (primary hypertension plus renal injury).
HN was confirmed by biopsy in 47 out of 63 patients (74.6%, 12 malignant nephrosclerosis and 35 benign nephrosclerosis). Primary nephritis (PN) was diagnosed by biopsy in 10 patients (7 IgA nephropathy, 2 mesangial proliferative nephritis, 1 chronic interstitial nephritis) and focal and segmental glomerulosclerosis (FSGS) in 6 patients. Blood pressure, body mass index, GFR and blood lipids were similar among groups. HN patients were related to higher age, more frequent family history of hypertension, longer hypertension duration, higher left ventricular mass index, lower serum creatinine and lower incidence of microscopic hematuria. Most patients with malignant nephrosclerosis and FSGS patients showed grades III and IV retinopathy.
Our results show that HN was misdiagnosed in nearly 25% patients in this cohort. Since the clinical features are similar between HN, PN and FSGS, renal biopsy is needed to establish the diagnosis of HN.
探讨临床诊断为高血压性肾硬化（HN）患者的临床及病理特征。
收集63例临床诊断为HN（原发性高血压合并肾损害）患者的临床资料及肾活检结果。
63例患者中47例经活检确诊为HN（74.6%，其中12例为恶性肾硬化，35例为良性肾硬化）。10例患者经活检诊断为原发性肾炎（PN）（7例IgA肾病，2例系膜增生性肾炎，1例慢性间质性肾炎），6例为局灶节段性肾小球硬化（FSGS）。各组间血压、体重指数、肾小球滤过率及血脂相似。HN患者年龄较大、高血压家族史更常见、高血压病程更长、左心室质量指数更高、血清肌酐更低、镜下血尿发生率更低。大多数恶性肾硬化患者和FSGS患者表现为III级和IV级视网膜病变。
我们的结果表明，该队列中近25%的患者被误诊为HN。由于HN、PN和FSGS的临床特征相似，因此需要进行肾活检以确诊HN。
