肾小球性血尿作为恶性高血压合并血栓性微血管病患者肾脏预后的预测指标：一项基于活检队列研究的倾向评分匹配分析
Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study.
作者信息
Zhou Zhaocai, Shi Wanxin, Yu Shengyou, Yu Jianwen, Huang Naya, Zhong Zhong, Huang Fengxian, Chen Wei, He Feng, Li Jianbo
机构信息
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.
出版信息
Kidney Dis (Basel). 2024 Sep 12;10(6):479-491. doi: 10.1159/000541332. eCollection 2024 Dec.
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSION
Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.
引言
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。
方法
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。
结果
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%。
结论
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。
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