Fogo A, Breyer J A, Smith M C, Cleveland W H, Agodoa L, Kirk K A, Glassock R
Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kidney Int. 1997 Jan;51(1):244-52. doi: 10.1038/ki.1997.29.
African Americans have excess hypertension and end-stage renal disease presumed due to hypertension compared to Caucasians. The AASK was designed to examine the impact of antihypertensive therapies and two levels of blood pressure control on the rate of decline of GFR in African Americans with presumed hypertensive renal disease. During the pilot phase of the trial, eligible participants were requested to undergo renal biopsy to assess the underlying lesions in this population. Eighty-eight hypertensive (diastolic BP > 95 mm Hg) non-diabetic African American patients between the ages of 18 to 70 years, with GFR between 25 to 70 ml/min/1.73 m2 and without marked proteinuria were assessed for possible renal biopsy. Forty-three patients did not undergo renal biopsy due to refusal or contraindications. Adequate renal biopsies were obtained in 39 of the remaining 46 patients. Biopsy findings were analyzed and then compared to clinical parameters. The 39 patients studied, 29 men and 10 women, were on average 53.0 +/- 11.0 years old, and had a MAP of 109 +/- 15 mm Hg and GFR 51.7 +/- 13.6 ml/min/1.73 m2 (not significantly different from nonbiopsied patients). Thirty-eight of these 39 biopsies showed arteriosclerosis and/or arteriolosclerosis, severity on average 1.5 +/- 0.9 and 1.5 +/- 0.8, respectively on a 0 to 3+ scale. Interstitial fibrosis was moderate, 1.3 +/- 0.9 (0 to 3+ scale). Segmental glomerulosclerosis was present in five biopsies, and in one patient, biopsy and clinical findings were consistent with idiopathic focal segmental glomerulosclerosis. Additional lesions included mesangiopathic glomerulonephritis in one patient, basement membrane thickening suggestive of diabetic nephropathy in one, and cholesterol emboli in two cases. Arteriolar and arterial sclerosis were tightly linked, and correlated with interstitial fibrosis and the reciprocal of serum creatinine. Global glomerulosclerosis was extensive, involving on average 43 +/- 26% of glomeruli. The extent of this lesion did not correlate with degree of arteriolar or arterial thickening, but did correlate with systolic blood pressure (P = 0.0174), the reciprocal of serum creatinine (P = 0.0009), serum cholesterol (P = 0.0129) and interstitial fibrosis (P < 0.0001). These data underscore that renal biopsies in non-diabetic hypertensive African-Americans with mild to moderate renal insufficiency in the absence of marked proteinuria are overwhelmingly likely to show renal vascular lesions consistent with the clinical diagnosis of hypertensive nephrosclerosis.
与白种人相比，非裔美国人患高血压及因高血压导致的终末期肾病的情况更为普遍。非洲裔美国人肾脏疾病与高血压研究（AASK）旨在研究抗高血压治疗以及两种血压控制水平对疑似高血压性肾病的非裔美国人肾小球滤过率（GFR）下降速率的影响。在试验的试点阶段，符合条件的参与者被要求进行肾活检，以评估该人群的潜在病变。对88名年龄在18至70岁之间、GFR在25至70 ml/min/1.73 m²之间且无明显蛋白尿的高血压（舒张压>95 mmHg）非糖尿病非裔美国患者进行了肾活检可能性评估。43名患者因拒绝或存在禁忌证未进行肾活检。其余46名患者中有39名获得了足够的肾活检样本。对活检结果进行分析，然后与临床参数进行比较。所研究的39名患者中，29名男性和10名女性，平均年龄为53.0±11.0岁，平均动脉压为109±15 mmHg，GFR为51.7±13.6 ml/min/1.73 m²（与未进行活检的患者无显著差异）。这39份活检样本中有38份显示有动脉硬化和/或小动脉硬化，严重程度在0至3+分级上平均分别为1.5±0.9和1.5±0.8。间质纤维化程度为中度，1.3±0.9（0至3+分级）。5份活检样本中有节段性肾小球硬化，1名患者的活检和临床结果符合特发性局灶节段性肾小球硬化。其他病变包括1名患者患有系膜性肾小球肾炎，1名患者有提示糖尿病肾病的基底膜增厚，2例有胆固醇栓子。小动脉硬化和动脉硬化紧密相关，并与间质纤维化及血清肌酐的倒数相关。全球肾小球硬化广泛，平均累及43±26%的肾小球。该病变的程度与小动脉或动脉增厚程度无关，但与收缩压（P = 0.0174）、血清肌酐的倒数（P = 0.0009）、血清胆固醇（P = 0.0129）和间质纤维化（P < 0.0001）相关。这些数据强调，在无明显蛋白尿的情况下，患有轻度至中度肾功能不全的非糖尿病高血压非裔美国人进行肾活检，极有可能显示出与高血压性肾硬化临床诊断相符的肾血管病变。
