Haridasan Satish, Priyamvada P S, Puthiyottil Dhanin, Pradeep Arjun, Parameswaran Sreejith, Srinivas B H, Ganesh Rajesh Nachiappa
Department of Nephrology, JIPMER, Puducherry, India.
Daya General Hospital, Thrissur, Kerala, India.
Indian J Nephrol. 2021 Sep-Oct;31(5):467-473. doi: 10.4103/ijn.IJN_187_20. Epub 2021 Apr 10.
Although malignant hypertension begets multiple target organ damage, there is limited data on patients with severe renal injury and evident malignant hypertension in renal histopathology.
We assessed the baseline demographic, histopathological findings and clinical outcomes in this retrospective analysis of patients with biopsy-proven malignant hypertension.
Thirty cases were analysed, the mean age of patients was 40 ± 11.5 years, 28 (93.3%) were males and the average systolic and diastolic blood pressures at hospitalisation were 197.04 ± 24.14 and 117.41 ± 18.31 mmHg, respectively. Severe retinopathy was seen in 10 (33.3%). The median eGFR at admission was 6.3 (IQR 4.4-9.15) mL/min and 21 (72.4%) needed dialysis. Nine (30%) cases with glomerular crescents were having the primary glomerular disease (7 IgAN, 1 C3 glomerulonephritis, 1 membranoproliferative glomerulonephritis) and 17 (56.6%) had thrombotic microangiopathy. Three-month ESRD free survival was 34.5% ( = 10) and the ESRD cohort had more incidence of dialysis requiring kidney injury at presentation (94.4% vs. 40% in the non-ESRD cohort). Patient survival at 1 year was 50%. Isolated malignant hypertension, differed from others with regard to lesser incidence of severe retinopathy, less glomerular sclerosis (29.61 ± 15.86 vs. 48.45% ± 30.78; = 0.03), absence of crescents ( = 0.02), more incidence of tuft wrinkling (100% vs. 35%, = 0.00) and total vessel occlusion ( = 0.02).
Clinicopathologically, accelerated essential hypertension differs from hypertension of glomerular disease. Degree of kidney injury at presentation is risk predictor for long-term morbidity in malignant hypertension.
尽管恶性高血压会导致多靶器官损害，但关于肾组织病理学中存在严重肾损伤及明显恶性高血压患者的数据有限。
在这项对经活检证实为恶性高血压患者的回顾性分析中，我们评估了基线人口统计学、组织病理学结果及临床结局。
分析了30例患者，患者的平均年龄为40±11.5岁，28例（93.3%）为男性，住院时平均收缩压和舒张压分别为197.04±24.14 mmHg和117.41±18.31 mmHg。10例（33.3%）出现严重视网膜病变。入院时中位估算肾小球滤过率（eGFR）为6.3（四分位间距4.4 - 9.15）mL/分钟，21例（72.4%）需要透析。9例（30%）有肾小球新月体形成的病例患有原发性肾小球疾病（7例IgA肾病、1例C3肾小球肾炎、1例膜增生性肾小球肾炎），17例（56.6%）有血栓性微血管病。3个月无终末期肾病（ESRD）生存率为34.5%（n = 10），ESRD队列在就诊时需要透析的肾损伤发生率更高（94.4% vs.非ESRD队列中的40%）。1年时患者生存率为50%。孤立性恶性高血压与其他类型在严重视网膜病变发生率较低、肾小球硬化较少（29.61±15.86 vs. 48.45%±30.78；P = 0.03）、无新月体形成（P = 0.02）、毛细血管襻皱缩发生率更高（100% vs. 35%，P = 0.00）及小血管完全闭塞（P = 0.02）方面存在差异。
在临床病理方面，急进性原发性高血压与肾小球疾病性高血压不同。就诊时的肾损伤程度是恶性高血压长期发病的风险预测指标。
