Lee Ji Yung, Ihm Hyung-Seok, Kim Jin Sug, Hwang Hyeon Seok, Jeong Kyung Hwan, Ihm Chun-Gyoo
Department of Nephrology, Kyung-Hee University Hospital, Kyung-Hee University School of Medicine, Seoul, Korea.
Electrolyte Blood Press. 2019 Dec;17(2):54-61. doi: 10.5049/EBP.2019.17.2.54. Epub 2019 Dec 31.
Several factors had been suggested to contribute to the development of hypertension in chronic glomerulonephritis (GN). This study was conducted to find the association of baseline blood pressure (BP) with pathophysiologic findings and later renal progression in chronic GN.
Clinico-pathological findings including serum creatinine (Cr), proteinuria, pathological findings, and urinary Na excretion were analyzed in a total of 233 patients with IgA nephropathy from The Kyung-Hee Cohort of GN. Glomerular surface area (GSA) was measured by imaging analysis and urine angiotensinogen (AGT) concentrations by human ELISA kits.
Systolic BP was ≥130mmHg in 124 patients (53%). Systolic BP was negatively correlated with follow-up eGFR (r=-0.32, p<0.0001) and positively serum uric acid concentrations, while it had no significant relationships with initial serum Cr and eGFR. As compared with patients with systolic BP<130 mmHg, those with ≥130 mmHg were older and showed higher serum Cr, proteinuria, 24 hr urinary Na excretion, mean GSA, and T-I fibrosis, lower follow-up eGFR, and steeper decline in slope of eGFR. The results in patients with normal serum Cr concentrations were comparable to those in whole group. Systolic BP was positively correlated with age, baseline and follow-up proteinuria, serum uric acid concentrations and IgM deposit and negatively with follow-up eGFR. In subgroup analysis, systolic BP was also positively correlated with mean GSA and urinary AGT concentrations.
This study showed that baseline systolic BP is related to urinary Na excretion, glomerulomegaly, T-I fibrosis and later renal progression in patients with IgA nephropathy.
已有多种因素被认为与慢性肾小球肾炎（GN）高血压的发生有关。本研究旨在探讨慢性GN患者基线血压（BP）与病理生理结果及后期肾脏进展之间的关系。
对京畿道GN队列中总共233例IgA肾病患者的临床病理结果进行分析，包括血清肌酐（Cr）、蛋白尿、病理结果和尿钠排泄。通过图像分析测量肾小球表面积（GSA），使用人ELISA试剂盒检测尿血管紧张素原（AGT）浓度。
124例患者（53%）的收缩压≥130mmHg。收缩压与随访估算肾小球滤过率（eGFR）呈负相关（r=-0.32，p<0.0001），与血清尿酸浓度呈正相关，而与初始血清Cr和eGFR无显著关系。与收缩压<130mmHg的患者相比，收缩压≥130mmHg的患者年龄更大，血清Cr、蛋白尿、24小时尿钠排泄、平均GSA和T-I纤维化更高，随访eGFR更低，eGFR斜率下降更陡。血清Cr浓度正常患者的结果与全组结果相当。收缩压与年龄、基线和随访蛋白尿、血清尿酸浓度及IgM沉积呈正相关，与随访eGFR呈负相关。在亚组分析中，收缩压也与平均GSA和尿AGT浓度呈正相关。
本研究表明，IgA肾病患者的基线收缩压与尿钠排泄、肾小球肥大、T-I纤维化及后期肾脏进展有关。
