8例高血压急症相关性肾损害的临床病理分析

Hypertensive Emergency-Related Nephropathy: Clinical and Pathological Analysis of 8 Cases

目的探讨高血压急症相关肾损害的临床、病理特点和预后。方法回顾性分析2003年1月至2014年1月我院明确诊断的8例高血压急症相关性肾损害患者,所有患者均行肾活检病理检查,及相关实验室及影像学检查。结果患者初始平均收缩压/舒张压（232±30/140±13）mm Hg,平均血肌酐值（452±172）μmol/L（190-922）μmol/L。光镜检查显示：所有的肾活检标本均有小动脉洋葱皮样增厚,及肾小球毛细血管袢缺血皱缩,然而未见到小动脉纤维素样坏死。降血压治疗对所有患者有效,并明显改善患者肾功能。结论高血压急症相关肾损害最常见的病理表现是小动脉洋葱皮样增厚和肾小球毛细血管袢缺血性皱缩;严格控制血压可显著改善高血压急症相关肾损害的预后。

Objective The aim of this study was to investigate the clinical/pathological features and prognosis ofhypertensive emergency-related nephropathy.Methods The clinical and pathological, laboratory and diagnostic imaging datas of 8 patientswith hypertensive emergency-related nephropathy were retrospectivelyanalyzed, those patient were diagnosed in our hospital during January 2003 to January 2014. Results The initial systolic/diastolic blood pressure were （ 232 ±30 ） and （ 140 ±13 ） mmHg, and serum creatinine level were（452 ±172） μmol/l （190-922 μmol/l）.All the arterioles specimens showed onion skin patterns thickeningand glomerulus were ischemic wrinkling, but no fibrinoid necrosis of small arteries was observed.Antihypertensive therapywas effective andrenal functionwere improved.Conclusions Onion skin pattern thickening of arterioles and ischemic wrinkling of glomerulus were pathological features of patients with hypertensive emergency-related nephropathy.Strictly control the pressure can obviously improve the prognosis of patients withhypertensive emergency-related nephropathy.