Nagayama Yoshikuni, Inoue Yoshihiko, Inui Kiyoko, Yoshimura Ashio
Department of Internal Medicine IV, Teikyo University School of medicine, University Hospital, Kawasaki, Japan.
Nephron. 2017;137(3):197-204. doi: 10.1159/000479073. Epub 2017 Aug 18.
BACKGROUND/AIMS: Although microangiopathic hemolysis (MAH) is a well-known complication of malignant phase hypertension (MPH), only less data on whether MAH in MPH predicts renal outcome exist. Therefore, we evaluated whether MAH was associated with the renal outcome in patients with MPH.
We conducted a single-center, retrospective, cohort study. Data from 35 patients diagnosed with MPH between October 1998 and January 2015 were analyzed. MPH was defined as the presence of a diastolic blood pressure of ≥120 mm Hg and grades III/IV hypertensive retinopathy according to the Keith-Wagener-Barker classification. MAH was defined as the presence of a low platelet count (<150 × 109/L) together with either an elevated level of lactate dehydrogenase (LDH; >220 U/L), or the presence of schistocytes, or both and the normalization of platelet and LDH level or schistocyte levels after adequate blood pressure control was achieved. The primary outcome was dialysis induction.
Fifteen patients had MAH. Those with MAH had significantly severe renal dysfunction at the onset of MPH. The length of follow-up (median, interquartile range) of patients with MAH and those without MAH were 30 (16-94) and 48 (25-115) months, respectively. Dialysis was induced in 9 of 15 patients with MAH and in 6 of 20 patients without MAH. Renal survival in patients with MAH was worse than that in those without, but this was not statistically significant (p = 0.08). By multivariate Cox regression analysis, MAH was not shown to contribute to dialysis induction.
MAH did not predict renal outcome in MPH.
背景/目的：尽管微血管病性溶血（MAH）是恶性高血压（MPH）的一种众所周知的并发症，但关于MPH中的MAH是否能预测肾脏结局的数据较少。因此，我们评估了MAH是否与MPH患者的肾脏结局相关。
我们进行了一项单中心、回顾性队列研究。分析了1998年10月至2015年1月期间诊断为MPH的35例患者的数据。MPH根据Keith-Wagener-Barker分类定义为舒张压≥120 mmHg且伴有III/IV级高血压性视网膜病变。MAH定义为血小板计数低（<150×10⁹/L），同时伴有乳酸脱氢酶（LDH）水平升高（>220 U/L），或存在裂体细胞，或两者兼有，并且在血压得到充分控制后血小板、LDH水平或裂体细胞水平恢复正常。主要结局是开始透析。
15例患者发生MAH。发生MAH的患者在MPH发病时肾功能明显更差。发生MAH和未发生MAH的患者的随访时间（中位数，四分位间距）分别为30（16 - 94）个月和48（25 - 115）个月。15例发生MAH的患者中有9例开始透析，20例未发生MAH的患者中有6例开始透析。发生MAH的患者的肾脏生存率低于未发生MAH的患者，但差异无统计学意义（p = 0.08）。通过多因素Cox回归分析，未显示MAH对开始透析有影响。
MAH不能预测MPH的肾脏结局。
