Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1053, USA.
Curr Opin Nephrol Hypertens. 2010 May;19(3):235-41. doi: 10.1097/MNH.0b013e3283366344.
Treating mild-to-moderate essential hypertension in nondiabetic African Americans fails to halt nephropathy progression, whereas hypertension control slows nephropathy progression in European Americans. The pathogenesis of these disparate renal syndromes is reviewed.
The nonmuscle myosin heavy chain 9 gene (MYH9) is associated with a spectrum of kidney diseases in African Americans, including idiopathic focal global glomerulosclerosis historically attributed to hypertension, idiopathic focal segmental glomerulosclerosis, and the collapsing variant of focal segmental glomerulosclerosis [HIV-associated nephropathy (HIVAN)]. Risk variants in MYH9 likely contribute to the failure of hypertension control to slow progressive kidney disease in nondiabetic African Americans.
Early and intensive hypertension control fails to halt progression of 'hypertensive nephropathy' in African Americans. Genetic analyses in patients with essential hypertension and nephropathy attributed to hypertension, focal segmental glomerulosclerosis and HIVAN reveal that MYH9 gene polymorphisms are associated with a spectrum of kidney diseases in this ethnic group. Mild to moderate hypertension may cause nephropathy in European Americans with intrarenal vascular disease improved by the treatment of hypertension, hyperlipidemia and smoking cessation.
目的综述：治疗非糖尿病的非裔美国人的轻中度原发性高血压未能阻止肾病进展，而控制高血压可减缓欧洲裔美国人的肾病进展。现就这些不同的肾脏综合征的发病机制进行综述。
最近发现：非肌肉肌球蛋白重链 9 基因（MYH9）与非裔美国人一系列的肾脏疾病相关，包括历史上归因于高血压的特发性局灶性肾小球硬化症、特发性局灶节段性肾小球硬化症和局灶节段性肾小球硬化症的塌陷型[人类免疫缺陷病毒相关性肾病（HIVAN）]。MYH9 的风险变异可能导致控制高血压未能减缓非糖尿病的非裔美国人的进行性肾病。
总结：早期和强化的高血压控制未能阻止非裔美国人的“高血压性肾病”进展。对原发性高血压和高血压性肾病、局灶节段性肾小球硬化症和 HIVAN 患者的基因分析显示，MYH9 基因突变与该族裔人群的一系列肾脏疾病相关。在存在肾内血管疾病的欧洲裔美国人中，轻中度高血压可能导致肾病，通过治疗高血压、高血脂和戒烟可改善高血压。
