Clinicopathological Features And Influencing Factors Analysis Of Malignant Hypertension Renal Damage

BackgroundKidney is one of the most affected organs of malignant hypertension(MHT).The prevalence of MHT renal damage was on the rise in recent years,so it is necessary to understand the clinicopathological features and the influencing factors to end-stage renal disease(ESRD)with renal replacement therapy(RRT)of MHT renal damage.ObjectiveTo analyze the clinicopathological characteristics of MHT renal damage,know the influcing factors of MHT renal damage progressing toward ESRD with RRT.MethodsWe enrolled 99 patients who were pathologically diagnosed Malignant Hypertension(MHT)renal damage from 2012 to 2018 in the First Affiliated Hospital of Zhengzhou University.The patients were divided into 3 groups according to the pathology.Group A: primary MHT renal damage;Group B: IgA nephropathy(IgAN)with MHT renal damage;Group C: other renal parenchyma disease with malignant hypertension renal damage.Clinical and pathological characteristics were compared in group A and group B.Binary Logistic regression was used to analyze the risk factors of MHT renal damage processing toward ESRD with RRT.Results1 Distribution of pathological types in patients with MHT renal damage: 99 patients were included in the study.Primary MHT renal damage accounted for 70.71%,IgAN with MHT renal damage to 19.19%,other renal parenchyma disease with MHT renal damage to 10.10%.2 The average age of group A was 34(12)years old,and the average age of group B was 30(9)years old,most of the patients were young and middle-aged men.There were no significant differences in age,gender,BMI and the related medical history(smoking history,drinking history,history of "hypertension",history of " diabetes mellitus",history of "hepatitis" and family history of hypertension)between the two groups.3 The common causes of MHT renal damage patients were fatigue,cold and withdrawal of antihypertensive drugs.The common initial symptoms of MHT renal damage patients were dizziness,headache,nausea,blurred vision,discomfort in the eyes,cough,chest tightness or palpitation.4 Among group A,19 patients' diastolic blood pressure were less than 130 mmHg,but these patients were accompanied with significant renal pathological damage of MHT and related target organ damage.Among group B,7 patients had diastolic blood pressure less than 130 mmHg,but with significant renal pathological damage of MHT and related target organ damage.The highest systolic blood pressure in the primary MHT kidney damage group was higher than that in the staging group with MHT kidney damage(P=0.009).5 The usual electrocardiogram of MHT renal damage were ST-T change,left ventricular hypertrophy,left ventricular high voltage or over-load of left ventricle.In group A,ST-T change accounted for 72.2%,ST-T change of group B accounted for 40.0%,the ST-T change in group A was more than group B(P = 0.02).Heart doppler ultrasound showed that left atrial diameter of group A was greater than group B(P = 0.022),left ventricular posterior wall thickness of group A was thicker than group B(P = 0.005).6 The 24 hours urine protein in group A was lower than group B(P = 0.017).Renal doppler ultrasound showed that showed Diffuse echo changes in both group,renal artery flow rate slowed down,and renal blood perfusion decreased,some patients' kidney volume had decreased.7 Pathological changes: MHT renal damage glomerular lesions mainly ischemic changes,patients with ischemia and shrinkage in group A accounted for 97.1%,in group B for 63.2%.Group A with ischemia and shrinkage was higher than that of group B(P < 0.001),mesangial cells and matrix hyperplasia was lower than that of group B(P < 0.001).All MHT renal damage had renal tubular interstitial lesions.Small artery lesions including small artery wall thickening,mucoid degeneration,hyaline arteriolosclerosis,onion skin lesion,fibrinoid necrosis and thrombin in arteriole lumen.The thrombus in group A was lower than that in group B(P = 0.024).8 Antihypertensive drugs in patients with MHT renal damage mainly include calcium channel blockers receptor blockers,beta-receptor-blocking agents,selective adrenergic alpha receptor blockers,angiotensin converting enzyme inhibitors and angiotensin II receptor blockers.The application rate of calcium channel blockers was 100%9 Binary Logistic regression showed that Normal systolic pressure,smoking history,anemia and 24 hours urine protein were the risk factors for the ESRD with renal replacement therapy in patients with MHT renal damage.ConclusionThere were differences in clinical and pathological characteristics between primary MHT renal damage and the IgAN with MHT renal damage.Normal systolic pressure,smoking history,anemia and 24 hours urine protein were the risk factors for the ESRD with RRT in patients with MHT renal damage.