恶性高血压肾损害的临床及病理分析

A Clinical and Pathological Analysis of Malignant Hypertension Presenting with Renal Damage

目的:分析恶性高血压(malignanthypertention ,MHT)肾脏损害的临床和病理特点。方法:对以肾脏损害为主要临床表现的MHT患者进行回顾分析,对其中原发性及肾实质性高血压患者的临床表现进行比较,并通过病理评分的方法分析各自的病理特点。结果:2 4例患者中,原发性、肾实质性及不明原因者分别为11例、11例和2例。原发性组患者2 4h尿蛋白排泄率明显低于肾实质性组,肾脏病理以小叶间动脉壁“洋葱皮”样改变或纤维素样坏死为主,肾小球病变轻。肾实质性组尿蛋白排泄率高,病理以肾小球病变为主,小叶间动脉壁“洋葱皮”样改变或纤维素样坏死较少见。两组间肾间质病变病理评分无差异。结论:原发性恶性高血压与肾实质性恶性高血压在临床表现、肾脏病理方面均有所不同。

Objective:To evaluate the clinical features and pathological characteristics of malignant hypertension presenting with renal damage. Methods:24 malignant hypertension patients mainly presented with renal damage were retrospectively analyzed. The clinical features of the primary group were compared with those of renal parenchymal group. All renal biopsy specimen were scored for the pathological changes of glomeruli and tubules.Results:There were 11 cases of primary hypertension,11 cases of renal parenchymal hypertension and 2 case of undetermined hypertension. Urinary protein excretion was lower in the primary group than that in the renal parenchymal group.“Onion skin” like change and fibroid necrosis in the walls of lobular arterioles were the characteristic features in renal biopsy for the primary group while glomerular changes were primary and severe for the renal parenchymal group.There is no significant difference in the pathological scores of tubule between the two groups.Conclusion:There were some differences in the clinical features and pathological characteristics between the primary and renal parenchymal malignant hypertension presenting with renal damage.