Aka Jean Astrid, Guei Cyr Monlet, Konan Serge Didier, Diopoh Patrick Sery, Sanogo Syndou, Yao Hubert Kouamé
Service de Néphrologie - Médecine Interne D, Centre Hospitalier Universitaire de Treichville, Boulevard de Marseille, Abidjan, Côte d´Ivoire.
Service de Néphrologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire.
Pan Afr Med J. 2021 Mar 24;38:305. doi: 10.11604/pamj.2021.38.305.21303. eCollection 2021.
malignant arterial hypertension (MAH) is a nosologic disorder which has not been described in Nephrology. The purpose of this study was to describe the profile of patients with MAH in the Division of Nephrology and to identify prognostic factors.
we conducted a retrospective, descriptive and analytical study from January 2013 to December 2018 in the Unit of Nephrology of the University Hospital Center in Treichville. The diagnosis of MAH was retained in patients with diastolic blood pressure (DBP) ≥ 130 mmHg, Keith Wegener grade III/IV hypertensive retinopathy, one or multiple visceral, cardiac and/or brain and/or renal diseases.
we collected data from 168 patients. The average age of patients was 41.10 ± 14.86 years, with male predominance (sex ratio 1.54). Cardiovascular risk factors were AH (79.20%), alcohol (32.10%), tobacco (19.60%), chronic kidney disease (15.30%) and diabetes (11.30%). They were admitted with dyspnea (39.29%), hypertensive crisis (26.16%), consciousness disorders (10.12%). Clinical examination showed anemia (82.10%), lower limb edema (63.10%), acute pulmonary edema (37.50%). Arterial hypertension resulted in renal failure (95,9%), left ventricular hypertrophy (92.81%), stroke (16,67%), and cardiac and renal involvement (85%). Renal failure was chronic in 78% of cases. The causes of MAH were essential AH (56,8%), chronic glomerulonephritis (29.8%), and diabetes (6%). Outcome was favorable in 66,7% of cases and overall mortality rate was 25.6%. In multivariate analysis uremia ≥ 2g/l [OR=5,07; 95%CI = 2,39-10.75; p = 0.0001], hperkalaemia [OR = 3.50; 95% CI = 1.70 - 7.19; p = 0.001], hyponatremia [OR = 2.90; 95% CI= 1.40 - 6.03; p = 0.004], haemoglobin level < 12g/dl [OR=5,91; 95% CI=1,34-26,00; p=0,019] and end-stage renal disease [OR = 6.06; 95% CI = 2.04 - 18.18; p = 0.001] were factors associated with the occurrence of death.
MAH is a consequence of poorly treated or untreated AH. It mainly affects young adults with multivisceral complications. In our Hospital, these were dominated by end-stage chronic renal disease. Hence the importance of early diagnosis and adequate management in patients with AH.
恶性动脉高血压（MAH）是一种在肾脏病学中未被描述的疾病分类障碍。本研究的目的是描述肾脏病科MAH患者的特征并确定预后因素。
我们于2013年1月至2018年12月在特雷奇维尔大学医院中心肾脏病科进行了一项回顾性、描述性和分析性研究。MAH的诊断标准为舒张压（DBP）≥130mmHg、Keith Wegener III/IV级高血压性视网膜病变、一种或多种内脏、心脏和/或脑部和/或肾脏疾病。
我们收集了168例患者的数据。患者的平均年龄为41.10±14.86岁，以男性为主（性别比为1.54）。心血管危险因素包括动脉高血压（AH，79.20%）、酒精（32.10%）、烟草（19.60%）、慢性肾脏病（15.30%）和糖尿病（11.30%）。他们因呼吸困难（39.29%）、高血压危象（26.16%）、意识障碍（10.12%）入院。临床检查显示贫血（82.10%）、下肢水肿（63.10%）、急性肺水肿（37.50%）。动脉高血压导致肾衰竭（95.9%）、左心室肥厚（92.81%）、中风（16.67%）以及心脏和肾脏受累（85%）。78%的病例中肾衰竭为慢性。MAH的病因包括原发性AH（56.8%）、慢性肾小球肾炎（29.8%）和糖尿病（6%）。66.7%的病例预后良好，总死亡率为25.6%。多因素分析显示，血尿素氮≥2g/l [比值比（OR）=5.07；95%置信区间（CI）=2.39 - 10.75；p = 0.0001]、高钾血症[OR = 3.50；95% CI = 1.70 - 7.19；p = 0.001]、低钠血症[OR = 2.90；95% CI = 1.40 - 6.03；p = 0.004]、血红蛋白水平<12g/dl [OR = 5.91；95% CI = 1.34 - 26.00；p = 0.019]和终末期肾病[OR = 6.06；95% CI = 2.04 - 18.18；p = 0.001]是与死亡发生相关的因素。
MAH是AH治疗不当或未治疗的结果。它主要影响患有多脏器并发症的年轻人。在我们医院，这些并发症主要以终末期慢性肾脏病为主。因此，对AH患者进行早期诊断和适当管理非常重要。
