Treatment and prognosis of malignant hypertension complicated with thrombotic microangiopathy for young IgAN patients

doi:10.3969/j.issn.1004-583X.2021.03.014

Abstract

Abstract:

Objective To observe the treatment and prognosis of malignant hypertension(MHT) complicated with thrombotic microangiopathy(TMA) for young patients with IgA nephropathy(IgAN), and its relationship with the expression level of angiotensin receptors in the kidney (AT1R, AT2R, MASR ), aldosterone receptors and renin. Methods The clinicopathological data of 13 cases of MHT complicated with TMA for young IgAN patients were analyzed, related factors affecting the prognosis were discussed, and the expression of AT1R, AT2R, MASR, AldR and renin in renal tissues were observed by immunohistochemistry(IHC). Results Ten patients entered the primary endpoint with a median follow-up of 11 months. Independent risk factors affecting prognosis for patients involved anemia, 24-hour proteinuria ≥ 1.0 g/d, decreased eGFR during renal biopsy and pathological capillary proliferative lesions. The expression of AT1R and AT2R in glomerulus, tubulointerstitium and renal vessels of the experimental group were significantly higher than those of the control group (P<0.01), and the expression of MASR in the glomerulus and renal vessels and the expression of AldR in the renal tubulointerstitium and renal vessels were significantly higher than those in the control group (P<0.01). There was significant positive correlation between the degree of proliferation in capillaries and the expression of AldR in renal tubules, and the expression of renin was positively correlated with the level of serum creatinine. Conclusion Young IgAN patients with MHT and TMA have poor prognosis, and those are all the main factors of disease progression, such as anemia, 24-hour proteinuria ≥ 1.0 g/d, and renal pathological severe damage. The activation of renin angiotensin aldosterone system plays an important role in the pathogenesis and progression of the disease.

Key words: glomerulonephritis, IgA, hypertension, malignant, thromboembolism, receptors, angiotensin, aldosterone

CLC Number:

R692

Di Dingxin, Zhang Zheng, Li Yetong, Zou Guming, Gao Hongmei, Li Wenge. Treatment and prognosis of malignant hypertension complicated with thrombotic microangiopathy for young IgAN patients[J]. Clinical Focus, 2021, 36(3): 256-261.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.03.014

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I3/256

Figures/Tables 7

References 24

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编号	年龄 (岁)	性别	入院血压 (mmHg)	HGB (g/L)	PLT (×10⁹/L)	SCr (μmol/L)	24h-UPRO (g/d)	尿红细胞 (个/HPF)	eGFR^*	进入 ESRD	眼底(高血压性视网膜病变)
1	33	男	210/110	85	149	2170.0	1.73	30.0	2.35	是	双眼4级
2	27	男	240/140	150	220	129.0	0.21	0.2	60.22	否	右眼3级,左眼2级
3	32	男	190/120	136	213	268.0	3.13	1.9	27.39	否	双眼2级
4	24	男	206/100	121	212	269.2	1.80	23.8	23.82	否	右眼3级,左眼2级
5	34	男	190/140	155	208	149.5	0.50	6.1	53.14	否	双眼4级
6	26	男	180/140	156	282	178.3	4.40	17.7	41.82	否	右眼3级,左眼4级
7	28	男	200/130	120	148	541.6	7.58	8.5	11.37	是	右眼3级,左眼4级
8	25	男	195/150	68	136	1412.0	2.19	6.9	4.33	是	双眼3级
9	33	女	180/100	117	190	330.3	4.44	31.1	14.82	是	双眼3级
10	30	男	225/130	104	175	872.8	4.52	32.6	7.06	是	双眼3级
11	27	女	200/110	89	160	598.4	3.81	54.5	8.51	是	双眼3级
12	29	男	200/160	136	194	319.3	5.78	7.0	22.67	否	双眼4级
13	28	女	207/140	98	271	333.6	2.64	17.8	14.86	是	右眼2级,左眼3级

编号	年龄 (岁)	性别	入院血压 (mmHg)	HGB (g/L)	PLT (×10⁹/L)	SCr (μmol/L)	24h-UPRO (g/d)	尿红细胞 (个/HPF)	eGFR^*	进入 ESRD	眼底(高血压性视网膜病变)
1	33	男	210/110	85	149	2170.0	1.73	30.0	2.35	是	双眼4级
2	27	男	240/140	150	220	129.0	0.21	0.2	60.22	否	右眼3级,左眼2级
3	32	男	190/120	136	213	268.0	3.13	1.9	27.39	否	双眼2级
4	24	男	206/100	121	212	269.2	1.80	23.8	23.82	否	右眼3级,左眼2级
5	34	男	190/140	155	208	149.5	0.50	6.1	53.14	否	双眼4级
6	26	男	180/140	156	282	178.3	4.40	17.7	41.82	否	右眼3级,左眼4级
7	28	男	200/130	120	148	541.6	7.58	8.5	11.37	是	右眼3级,左眼4级
8	25	男	195/150	68	136	1412.0	2.19	6.9	4.33	是	双眼3级
9	33	女	180/100	117	190	330.3	4.44	31.1	14.82	是	双眼3级
10	30	男	225/130	104	175	872.8	4.52	32.6	7.06	是	双眼3级
11	27	女	200/110	89	160	598.4	3.81	54.5	8.51	是	双眼3级
12	29	男	200/160	136	194	319.3	5.78	7.0	22.67	否	双眼4级
13	28	女	207/140	98	271	333.6	2.64	17.8	14.86	是	右眼2级,左眼3级

临床指标	值
年龄(岁)	28.92±3.25
性别(男/女,例)	10/3
SBP(mmHg)	201.77±16.82
DBP(mmHg)	128.46±19.08
尿红细胞(个/HPF)	17.7(6.50, 30.55)^*
24h-UPRO(g/24 h)	3.13(1.77, 4.48)^*
SCr(μmol/L)	330.3(223.2, 735.6)^*
尿酸(μmol/L)	533.31±150.58
HGB(g/L)	118.08±28.173
PLT(×10⁹/L)	196.77±44.88
血清IgA(mg/dL)	276.5±91.4
补体C3(mg/dL)	80.7±18.1

临床指标	值
年龄(岁)	28.92±3.25
性别(男/女,例)	10/3
SBP(mmHg)	201.77±16.82
DBP(mmHg)	128.46±19.08
尿红细胞(个/HPF)	17.7(6.50, 30.55)^*
24h-UPRO(g/24 h)	3.13(1.77, 4.48)^*
SCr(μmol/L)	330.3(223.2, 735.6)^*
尿酸(μmol/L)	533.31±150.58
HGB(g/L)	118.08±28.173
PLT(×10⁹/L)	196.77±44.88
血清IgA(mg/dL)	276.5±91.4
补体C3(mg/dL)	80.7±18.1

牛津分型病理指标	分型	例(%)
系膜细胞增生(M)	M0	4(30.8)
	M1	9(69.2)
肾小球节段硬化/球囊黏连(S)	S0	4(30.8)
	S1	9(69.2)
毛细血管内增生(E)	E0	7(53.8)
	E1	6(46.2)
肾小管萎缩/间质纤维化(T)	T0	1(7.7)
	T1	3(23.1)
	T2	9(69.2)
新月体形成(C)	C0	2(15.4)
	C1	10(76.9)
	C2	1(7.7)