Clinical and pathological features of benign hypertensive nephrosclerosis

doi:10.3877/cma.j.issn.2095-3216.2012.02.009

Abstract

Abstract:

Objective

To analyze the clinical and pathological features of benign hypertensive nephrosclerosis (BHN), and to clarify the influence of blood pressure to clinical and pathological parameters on BHN.

Methods

Forty-eight patients diagnosesed as benign hypertensive nephrosclerosis proved by renal biopsy were retrospectively analyzed from 1995 to 2011 in our hospital. The clinical data included the age, blood presser and laboratory test indicators, and pathological data were measured by semi-quantitative, analyze the features of glomerular lesions, tubulointerstitial lesions (including interstitial inflammatory cell infiltration, interstitial fibrosis and tubular atrophy), and renal arterioles lesions (hyalinization, the endomysium hypertrophy). The features of renal arterioles, glomeruli and tubulointerstitial lesions were analyzed. Spearman rank correlation is used to analyze the correlation between the blood pressure and the clinical pathological data. Logistic regression is used to analyze the relationship between the clinical and pathological data. One-way ANOVA is used to compare differences among multi groups. SPSS17.0 software is used to take all statistical analysis. The correlation between blood pressure level and clinical or pathological parameters were analyzed.

Results

The ratio of male to female was 3.8∶1.0, and the average age was (46.56±9.59) years. Thirty-three patients (68.7%) showed blood pressure ＞ 140/90 mm Hg(1 mm Hg = 0.133 kPa), and 26 (54.1%) disclosed urinary protein excretion ＜ 1 g/24 h. 24 patients (50.0%) had eGFR ＜ 60 ml/(min . 1.73 m²) at the time of admission.Number of myointimal hypertrophy arterioles was 100 (22.8%), and that of arterioles hyalinization was 84(19.2%). Ischemic lesions was the most common type of glomeruli damage, and the number is 293 (32.9%)including 180 obsolescent glomeruli (20.20%) and 113 ischemic wrinkled glomeruli (12.7%). Systolic blood pressure showed significant positive correlation with myointimal hypertrophy (r = 0.35, P = 0.02),tubulointerstitial lesion (r = 0.295, P = 0.04), but showed significant negative relation with eGFR (r =- 0.333, P = 0.021). Proteinuria was an independent influence factor for global sclerosis. Metabolic disorders had no influences on pathological changes.

Conclusions

Ischemic lesion was the most common type of glomerular damage. Percentage of myointimal hypertrophy increased and eGFR decreased as a result of hypertension, and proteinuria was an independent risk factor for global sclerosis. These results suggested that blood pressure control and reduction of proteinuria were the key for prevention and treatment of BHN.

Key words: Arteriolosclerosis, Hypertension, Pathology, clinical, Proteinuria

Jia KOU, Guang-yan CAI, Xue-guang ZHANG, Jie WU, Pu CHEN, Shu-wen LIU, Yan ZHANG, Zhong YIN, Suo-zhu SHI, Xiang-mei CHEN. Clinical and pathological features of benign hypertensive nephrosclerosis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2012, 01(02): 103-108.

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https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2012/V01/I02/103

Figures/Tables 3

病理指标	0分	1分	2分	3分	4分
病理指标	例数(%)	例数(%)	例数(%)	例数(%)	例数(%)
狭窄肾小动脉	20(41.6)	0(0)	17(35.4)	11(22.9)	-
透明变性肾小动脉	18(37.5)	0(0)	13(27.0)	17(35.4)	-
球性硬化肾小球	3(6.2)	4(8.3)	10(20.8)	20(41.6)	11(22.9)
病变肾小球	0(0)	6(12.5)	4(8.3)	12(25.0)	26(54.1)

组别	例数	年龄（岁， $\bar{x}$ ±s）	男女比例	BMI（kg/m²， $\bar{x}$ ±s）	eGFR[ml/(min·1.73m²)]	血尿酸（μmol/L， $\bar{x}$ ±s）	总胆固醇（mmol/L， $\bar{x}$ ±s）	三酰甘油（mmol/L， $\bar{x}$ ±s）
血压正常	15	47.93±11.14	11/4	27.80±1.50	72.06±30.07	432.67±113.17	4.61±0.91	2.68±1.21
高血压
1级	16	48.56±9.74	12/4	26.50±3.60	60.26±26.63	391.79±132.87	4.93±0.92	2.11±0.73
2级	8	44.38±8.02	6/2	28.00±2.90	87.57±36.21	380.51±98.52	4.16±0.69	2.49±1.21
3级	9	42.67±7.47	9/0	29.80±3.60	58.15±26.62	420.52±79.91	4.70±1.09	2.09±1.10
F值		0.966	2.931	1.902	1.976	0.525	1.281	1.163
组间P值		0.417	0.429	0.147	0.131	0.667	0.34	0.4
组别	例数	24h尿蛋白定量（g/24h， $\bar{x}$ ±s）	肾脏病理检测指标评分（ $\bar{x}$ ±s）
组别	例数	24h尿蛋白定量（g/24h， $\bar{x}$ ±s）	狭窄肾小动脉评分	透明变性肾小动脉评分	病变肾小球评分	球性硬化肾小球评分	肾小管间质损伤程度
血压正常	15	1.22±1.17	0.60±1.06	1.73±1.33	3.00±1.13	2.60±1.50	1.67±0.82
高血压
1级	16	0.85±0.73	1.81±1.17^a	1.44±1.36	3.06±1.29	2.44±0.89	1.81±0.75
2级	8	0.67±0.55	1.75±1.16^a	1.75±1.49	3.50±0.76	2.88±0.99	1.75±0.89
3级	9	0.92±0.54	1.67±1.32^a	1.56±1.24	3.56±0.53	3.00±0.87	2.33±0.87
F值		0.892	3.434	0.161	0.823	0.586	1.357
组间P值		0.453	0.021	0.922	0.488	0.627	0.268

组别	例数	年龄（岁， $\bar{x}$ ±s）	男女比例	BMI（kg/m²， $\bar{x}$ ±s）	eGFR[ml/(min·1.73m²)]	血尿酸（μmol/L， $\bar{x}$ ±s）	总胆固醇（mmol/L， $\bar{x}$ ±s）	三酰甘油（mmol/L， $\bar{x}$ ±s）
血压正常	15	47.93±11.14	11/4	27.80±1.50	72.06±30.07	432.67±113.17	4.61±0.91	2.68±1.21
高血压
1级	16	48.56±9.74	12/4	26.50±3.60	60.26±26.63	391.79±132.87	4.93±0.92	2.11±0.73
2级	8	44.38±8.02	6/2	28.00±2.90	87.57±36.21	380.51±98.52	4.16±0.69	2.49±1.21
3级	9	42.67±7.47	9/0	29.80±3.60	58.15±26.62	420.52±79.91	4.70±1.09	2.09±1.10
F值		0.966	2.931	1.902	1.976	0.525	1.281	1.163
组间P值		0.417	0.429	0.147	0.131	0.667	0.34	0.4
组别	例数	24h尿蛋白定量（g/24h， $\bar{x}$ ±s）	肾脏病理检测指标评分（ $\bar{x}$ ±s）
组别	例数	24h尿蛋白定量（g/24h， $\bar{x}$ ±s）	狭窄肾小动脉评分	透明变性肾小动脉评分	病变肾小球评分	球性硬化肾小球评分	肾小管间质损伤程度
血压正常	15	1.22±1.17	0.60±1.06	1.73±1.33	3.00±1.13	2.60±1.50	1.67±0.82
高血压
1级	16	0.85±0.73	1.81±1.17^a	1.44±1.36	3.06±1.29	2.44±0.89	1.81±0.75
2级	8	0.67±0.55	1.75±1.16^a	1.75±1.49	3.50±0.76	2.88±0.99	1.75±0.89
3级	9	0.92±0.54	1.67±1.32^a	1.56±1.24	3.56±0.53	3.00±0.87	2.33±0.87
F值		0.892	3.434	0.161	0.823	0.586	1.357
组间P值		0.453	0.021	0.922	0.488	0.627	0.268

项目	收缩压		舒张压		平均动脉压		脉压
项目	r值	P值	r值	P值	r值	P值	r值	P值
年龄（岁）	-0.123	0.406	-0.148	0.314	-0.150	0.309	-0.021	0.886
身体质量指数	0.009	0.955	0.230	0.159	0.182	0.267	-0.266	0.101
估算的肾小球滤过率	-0.333	0.021	-0.015	0.918	-0.158	0.284	-0.432	0.002
血尿酸（μmol/L）	-0.136	0.363	-0.001	0.996	-0.062	0.679	-0.178	0.232
总胆固醇（mmol/L）	-0.035	0.818	0.009	0.953	-0.004	0.981	-0.057	0.709
三酰甘油（mmol/L）	-0.199	0.180	-0.032	0.832	-0.112	0.455	-0.232	0.117
尿蛋白定量（g/24h）	-0.009	0.950	-0.200	0.173	-0.133	0.368	0.181	0.218
狭窄肾小动脉评分	0.350	0.020	0.230	0.120	0.300	0.040	0.170	0.240
透明变性肾小动脉评分	-0.220	0.130	0.040	0.780	-0.070	0.660	-0.320	0.750
病变肾小球评分	0.170	0.240	0.150	0.320	0.170	0.240	-0.030	0.820
球性硬化肾小球评分	0.240	0.090	0.040	0.790	0.100	0.480	0.230	0.110
肾小管间质损伤程度	0.295	0.040	0.020	0.870	0.130	0.370	0.250	0.090

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