Zhou Zhaocai, Shi Wanxin, Yu Shengyou, Yu Jianwen, Huang Naya, Zhong Zhong, Huang Fengxian, Chen Wei, He Feng, Li Jianbo
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Clinical Nephrology (Sun Yat-sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China.
Kidney Dis (Basel). 2024 Sep 12;10(6):479-491. doi: 10.1159/000541332. eCollection 2024 Dec.
Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA.
This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis.
A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29-0.89, = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28-0.91, = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06-5.66, < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34-4.33, = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria.
Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.
恶性高血压（mHTN）是一种高血压急症。血栓性微血管病（TMA）是mHTN的一种常见并发症。很少有研究评估肾小球性血尿是否能为mHTN相关TMA患者的肾功能障碍提供预后信息。
这项观察性队列研究纳入了292例经肾活检确诊为mHTN相关TMA的患者。进行倾向评分匹配（PSM）分析以调整有和无肾小球性血尿患者之间的临床特征。采用Cox回归确定肾脏预后的危险因素。
总共70例有肾小球性血尿的患者与222例无肾小球性血尿的患者进行比较。PSM后，匹配了67对mHTN相关TMA患者。与无肾小球性血尿的患者相比，有肾小球性血尿的患者血清白蛋白水平更低、24小时蛋白尿更高，且肾小球硬化患病率更高。与无肾小球性血尿相比，肾小球性血尿与肾功能恶化独立相关（风险比：0.51；95%置信区间：0.29 - 0.89，P = 0.019）。PSM后这种关联仍然显著（风险比：0.51；95%置信区间：0.28 - 0.91，P = 0.022）。此外，肾小球性血尿与肾脏替代治疗（RRT）独立相关（风险比：3.14；95%置信区间：2.06 - 5.66，P < 0.001）。PSM比较后这种差异仍然显著（风险比：2.41；95%置信区间：1.34 - 4.33，P = 0.003）。此外，尽管进行了强化血压控制，但与无肾小球性血尿的患者相比，有肾小球性血尿的患者RRT发生率更高，肾功能恢复更差，具体表现为肌酐水平降低25%。
肾小球性血尿与mHTN相关TMA患者不良肾脏结局风险增加显著相关。
