Analysis of clinicopathological characteristics and prognosis of malignant hypertensive nephrosclerosis

doi:10.3969/j.issn.1006-7795.2024.05.014

Abstract

Abstract: Objective To explore the clinicopathological and prognostic characteristics of patients with primary malignant hypertensive nephrosclerosis (MHTN) and identify the key factors influencing the prognosis of MHTN patients. Methods The pathological and clinical data of hypertensive nephropathy patients diagnosed by renal biopsy in Xijing Hospital of Air Force Medical University from December 2012 to June 2023, were collected. Patients were distinguished into MHTN and benign arteriolosclerosis nephrosclerosis (BAN) groups based on pathological results. Univariate and multivariate Cox regression analyses were performed to identify the risk factors affecting renal prognosis in MHTN patients. Kaplan-Meier survival curves were used to calculate renal cumulative survival rates. The study endpoint was defined as a composite endpoint of end-stage renal disease or death. Results A total of 231 patients with primary hypertensive nephropathy were included in the study, of which 75 were MHTN patients. The median follow-up time was 20.8 (13.2, 47.1) months, and 36 (52.0%) patients reached the renal composite endpoint. Compared with BAN patients, MHTN patients had more severe clinical manifestations, worse prognosis, and younger average age. Univariate Cox analysis showed that estimated glomerular filtration rate (eGFR), urinary microalbumin creatinine ratio, urinary N-acetyl-β-D-glucosaminidase, plasma albumin, serum calcium, cystatin C (Cys-C), hemoglobin (Hb), fibrinogen (FIB), and total renal chronic pathological score (TRCS) were associated with an increased risk of renal composite endpoints in MHTN patients. Multivariate Cox regression after adjusting for pathological scores revealed that Cys-C (HR=1.490, 95% CI: 1.144-1.942, P=0.003), Hb (HR=0.981, 95% CI: 0.963-0.999, P=0.042), FIB (HR=1.650, 95% CI: 1.125-2.419, P=0.010), and TRCS (HR=1.317, 95% CI: 1.057-1.640, P=0.014) were independent risk factors for renal prognosis in MHTN patients. Conclusions In MHTN patients, elevated Cys-C and FIB levels, decreased Hb, and severe pathological changes predict adverse renal outcomes. Further increasing the rate of renal biopsy in MHTN patients during clinical diagnosis and treatment can help assess their prognosis.

Key words: alignant hypertensive nephrosclerosis, benign renal arteriosclerosis, chronic kidney disease, risk factors, prognosis of kidney

CLC Number:

Qin Yunlong, Zhou Jin, Liu Meng, Luo Kaifa, Wang Anjing, Wang Di, Zhao Jin, Sun Shiren. Analysis of clinicopathological characteristics and prognosis of malignant hypertensive nephrosclerosis[J]. Journal of Capital Medical University, 2024, 45(5): 838-845.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2024.05.014

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2024/V45/I5/838

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