#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Clinico-pathological characteristics and outcomes of patients with biopsy-proven hypertensive nephrosclerosis: a retrospective cohort study


Background:
This study aimed to investigate renal outcomes and their predictors in biopsy-proven hypertensive nephrosclerosis (HN) patients and to compare clinico-pathological characteristics and prognoses between benign nephrosclerosis (BN) and malignant nephrosclerosis (MN) patients.

Methods:
Data for biopsy-proven HN patients were retrospectively analyzed. Renal survival rates and relationships between clinico-pathological characteristics and outcomes were assessed.

Results:
A total of 194 patients were enrolled; the mean age at biopsy was 43.8 years, and male gender predominated (82.5 %). The median duration of hypertension was 5.0 years, and the mean systolic and diastolic blood pressures were 195 ± 37 and 126 ± 26 mmHg, respectively. The median serum creatinine (Scr) level, estimated glomerular filtration rate (eGFR), and proteinuria level were 1.61 mg/dl, 49.6 ml/min/1.73 m2, and 0.80 g/24 h, respectively. BN and MN were found by renal biopsy in 55.2 % and 44.8 % of patients, respectively. At biopsy, MN patients were younger, and had higher median Scr and proteinuria levels, higher incidences of anemia, hypertensive heart disease and hypertensive retinopathy, and worse renal outcomes than BN patients. During a median follow-up period of 3.0 years, 36 patients (18.6 %) reached end-stage renal disease (ESRD), and the 5- and 10-year cumulative renal survival rates for HN patients were 84.5 % and 48.9 %, respectively. A decreased baseline eGFR, an increased baseline proteinuria level, anemia, increased percentage of global glomerulosclerosis and tubular atrophy and interstitial fibrosis (TAIF) were independent predictors of future ESRD.

Conclusions:
The clinico-pathological characteristics and prognoses were significantly different between the MN and BN patients. The renal outcomes of HN patients were independently associated with the baseline eGFR and proteinuria level, anemia, percentage of global glomerulosclerosis and TAIF.

Keywords:
Hypertension, Benign nephrosclerosis, Malignant nephrosclerosis, Risk factors, Renal survival


Autoři: Shaoshan Liang *;  Weibo Le;  Dandan Liang;  Hao Chen;  Feng Xu;  Huiping Chen;  Zhihong Liu;  Caihong Zeng *
Vyšlo v časopise: BMC Nefrol 2016, 17:42
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12882-016-0254-2

© 2016 Liang et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-016-0254-2

Souhrn

Background:
This study aimed to investigate renal outcomes and their predictors in biopsy-proven hypertensive nephrosclerosis (HN) patients and to compare clinico-pathological characteristics and prognoses between benign nephrosclerosis (BN) and malignant nephrosclerosis (MN) patients.

Methods:
Data for biopsy-proven HN patients were retrospectively analyzed. Renal survival rates and relationships between clinico-pathological characteristics and outcomes were assessed.

Results:
A total of 194 patients were enrolled; the mean age at biopsy was 43.8 years, and male gender predominated (82.5 %). The median duration of hypertension was 5.0 years, and the mean systolic and diastolic blood pressures were 195 ± 37 and 126 ± 26 mmHg, respectively. The median serum creatinine (Scr) level, estimated glomerular filtration rate (eGFR), and proteinuria level were 1.61 mg/dl, 49.6 ml/min/1.73 m2, and 0.80 g/24 h, respectively. BN and MN were found by renal biopsy in 55.2 % and 44.8 % of patients, respectively. At biopsy, MN patients were younger, and had higher median Scr and proteinuria levels, higher incidences of anemia, hypertensive heart disease and hypertensive retinopathy, and worse renal outcomes than BN patients. During a median follow-up period of 3.0 years, 36 patients (18.6 %) reached end-stage renal disease (ESRD), and the 5- and 10-year cumulative renal survival rates for HN patients were 84.5 % and 48.9 %, respectively. A decreased baseline eGFR, an increased baseline proteinuria level, anemia, increased percentage of global glomerulosclerosis and tubular atrophy and interstitial fibrosis (TAIF) were independent predictors of future ESRD.

Conclusions:
The clinico-pathological characteristics and prognoses were significantly different between the MN and BN patients. The renal outcomes of HN patients were independently associated with the baseline eGFR and proteinuria level, anemia, percentage of global glomerulosclerosis and TAIF.

Keywords:
Hypertension, Benign nephrosclerosis, Malignant nephrosclerosis, Risk factors, Renal survival


Zdroje

1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.

2. U.S. Renal Data System, USRDS 2013 Annual Data Report. Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2013.

3. Reynolds K, Gu D, Muntner P, Kusek JW, Chen J, Wu X, Duan X, Chen CS, Klag MJ, Whelton PK, et al. A population-based, prospective study of blood pressure and risk for end-stage renal disease in China. J Am Soc Nephrol. 2007;18(6):1928–35.

4. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J. End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA. 1997;277(16):1293–8.

5. Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, Schneider KA. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension. 1989;13(5 Suppl):I80–93.

6. Tanner RM, Calhoun DA, Bell EK, Bowling CB, Gutierrez OM, Irvin MR, Lackland DT, Oparil S, McClellan W, Warnock DG, et al. Incident ESRD and treatment-resistant hypertension: the reasons for geographic and racial differences in stroke (REGARDS) study. Am J Kidney Dis. 2014;63(5):781–8.

7. Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S. Blood pressure predicts risk of developing end-stage renal disease in men and women. Hypertension. 2003;41(6):1341–5.

8. Perry Jr HM, Miller JP, Fornoff JR, Baty JD, Sambhi MP, Rutan G, Moskowitz DW, Carmody SE. Early predictors of 15-year end-stage renal disease in hypertensive patients. Hypertension. 1995;25(4 Pt 1):587–94.

9. De Nicola L, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Bellizzi V, Nappi F, Conte G, Minutolo R. Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. J Am Coll Cardiol. 2013;

61(24):2461–7.

10. Vikse BE, Aasarod K, Bostad L, Iversen BM. Clinical prognostic factors in biopsy-proven benign nephrosclerosis. Nephrol Dial Transplant. 2003;18(3):517–23.

11. Norris KC, Greene T, Kopple J, Lea J, Lewis J, Lipkowitz M, Miller P, Richardson A, Rostand S, Wang X, et al. Baseline predictors of renal disease progression in the African American Study of Hypertension and Kidney Disease. J Am Soc Nephrol. 2006;17(10):2928–36.

12. Dasgupta I, Porter C, Innes A, Burden R. "Benign" hypertensive nephrosclerosis. QJM. 2007;100(2):113–9.

13. Wehrmann M, Bohle A. The long-term prognosis of benign nephrosclerosis accompanied by focal glomerulosclerosis and renal cortical interstitial fibrosis, designated so-called decompensated benign nephrosclerosis by Fahr, Bohle and Ratscheck. Pathol Res Pract. 1998;194(8):571–6.

14. McClellan WM, Langston RD, Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease. J Am Soc Nephrol. 2004;15(7):1912–9.

15. Marin R, Gorostidi M, Fernandez-Vega F, Alvarez-Navascues R. Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis. Kidney Int Suppl. 2005;99:S52–56.

16. Amraoui F, Bos S, Vogt L, van den Born BJ. Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study. BMC Nephrol. 2012;13:71.

17. Gonzalez R, Morales E, Segura J, Ruilope LM, Praga M. Long-term renal survival in malignant hypertension. Nephrol Dial Transplant. 2010;25(10):3266–72.

18. Zucchelli P, Zuccala A. Progression of renal failure and hypertensive nephrosclerosis. Kidney Int Suppl. 1998;68:S55–59.

19. Zarif L, Covic A, Iyengar S, Sehgal AR, Sedor JR, Schelling JR. Inaccuracy of clinical phenotyping parameters for hypertensive nephrosclerosis. Nephrol Dial Transplant. 2000;15(11):1801–7.

20. Fogo A, Breyer JA, Smith MC, Cleveland WH, Agodoa L, Kirk KA, Glassock R. Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: a report from the African American Study of Kidney Disease (AASK) Trial. AASK Pilot Study Investigators. Kidney Int. 1997;51(1):244–52.

21. Takebayashi S, Kiyoshi Y, Hisano S, Uesugi N, Sasatomi Y, Meng J, Sakata N. Benign nephrosclerosis: incidence, morphology and prognosis. Clin Nephrol. 2001;55(5):349–56.

22. Marcantoni C, Ma LJ, Federspiel C, Fogo AB. Hypertensive nephrosclerosis in African Americans versus Caucasians. Kidney Int. 2002;62(1):172–80.

23. Le W, Liang S, Hu Y, Deng K, Bao H, Zeng C, Liu Z. Long-term renal survival and related risk factors in patients with IgA nephropathy: results from a cohort of 1155 cases in a Chinese adult population. Nephrol Dial Transplant. 2012;27(4):1479–85.

24. D'Agati VD, Fogo AB, Bruijn JA, Jennette JC. Pathologic classification of focal segmental glomerulosclerosis: a working proposal. Am J Kidney Dis. 2004;43(2):368–82.

25. Liang Y, Liu R, Du S, Qiu C. Trends in incidence of hypertension in Chinese adults, 1991–2009: The China Health and Nutrition Survey. Int J Cardiol. 2014.

26. Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13,519 renal biopsies. Kidney Int. 2004;66(3):920–3.

27. Sugiyama H, Yokoyama H, Sato H, Saito T, Kohda Y, Nishi S, Tsuruya K, Kiyomoto H, Iida H, Sasaki T, et al. Japan renal biopsy registry and Japan kidney disease registry: committee report for 2009 and 2010. Clin Exp Nephrol. 2013;17(2):155–73.

28. Caetano ER, Zatz R, Saldanha LB, Praxedes JN. Hypertensive nephrosclerosis as a relevant cause of chronic renal failure. Hypertension. 2001;38(2):171–6.

29. Bohle A, Wehrmann M, Greschniok A, Junghans R. Renal morphology in essential hypertension: analysis of 1177 unselected cases. Kidney Int Suppl. 1998;67:S205–206.

30. Ratschek M, Ratschek E, Bohle A. Decompensated benign nephrosclerosis and secondary malignant nephrosclerosis. Clin Nephrol. 1986;25(5):221–6.

31. Akimoto T, Muto S, Ito C, Takahashi H, Takeda S, Ando Y, Kusano E. Clinical features of malignant hypertension with thrombotic microangiopathy. Clin Exp Hypertens. 2011;33(2):77–83.

32. van den Born BJH, Honnebier UPF, Koopmans RP, van Montfrans GA. Microangiopathic hemolysis and renal failure in malignant hypertension. Hypertension. 2004;45(2):246–51.

33. Nzerue C, Oluwole K, Adejorin D, Paueksakon P, Fremont R, Akatue R, Faulkner M. Malignant hypertension with thrombotic microangiopathy and persistent acute kidney injury (AKI). Clinical kidney journal. 2014;7(6):586–9.

34. Pitcock JA, Johnson JG, Hatch FE, Acchiardo S, Muirhead EE, Brown PS. Malignant hypertension in blacks. Malignant intrarenal arterial disease as observed by light and electron microscopy. Hum Pathol. 1976;7(3):333–46.

35. Laszik ZG, Silva FG. Hemolytic Uremic Syndrome, Thrombotic Thrombocytopenic Purpura, and Other Thrombotic Microangiopathies. In: Jennette JC, Olson JL, Schwartz MM, Silva FG, editors. Hepinstall's Pathology of the Kidney, vol. 1. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 701–64.

36. Luke RG. Hypertensive nephrosclerosis: pathogenesis and prevalence. Essential hypertension is an important cause of end-stage renal disease. Nephrol Dial Transplant. 1999;14(10):2271–8.

37. Nangaku M. Chronic hypoxia and tubulointerstitial injury: a final common pathway to end-stage renal failure. J Am Soc Nephrol. 2006;17(1):17–25.

38. Fine LG, Orphanides C, Norman JT. Progressive renal disease: the chronic hypoxia hypothesis. Kidney Int Suppl. 1998;65:S74–78.

39. Yu XJ, Yu F, Song D, Wang SX, Song Y, Liu G, Zhao MH. Clinical and renal biopsy findings predicting outcome in renal thrombotic microangiopathy: a large cohort study from a single institute in China. The Scientific World Journal. 2014;2014:680502.

40. Gudbrandsson T, Hansson L, Herlitz H, Andren L. Malignant hypertension– improving prognosis in a rare disease. Acta medica Scandinavica. 1979; 206(6):495–9.

41. Zeng CH, Le W, Ni Z, Zhang M, Miao L, Luo P, Wang R, Lv Z, Chen J, Tian J, et al. A multicenter application and evaluation of the oxford classification of IgA nephropathy in adult chinese patients. Am J Kidney Dis. 2012;60(5):812–20.

Štítky
Detská nefrológia Nefrológia
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#