Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: A report from the African American Study of Kidney Disease (AASK) Trial
Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: A report from the African American Study of Kidney Disease (AASK) Trial
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DOI：
10.1038/ki.1997.29
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发表时间：
1997-01-01
影响因子：
19.6
通讯作者：
Wright, JT
中科院分区：
文献类型：
--
作者：
Fogo, A;Breyer, JA;Wright, JT
与白人相比，非裔美国人有过度高血压和终末期肾病，推测是由于高血压所致。AASK旨在检查抗高血压治疗和两种水平的血压控制对假定患有高血压肾病的非裔美国人GFR下降率的影响。在试验的初步阶段，要求合格的受试者接受肾活检，以评估该人群的基础病变。88例高血压（舒张压> 95 mm Hg）非糖尿病非裔美国人患者，年龄在18至70岁之间，GFR在25至70 ml/min/1.73 m（2）之间，无明显蛋白尿，评估可能的肾活检。43例患者因拒绝或禁忌症未接受肾活检。其余46例患者中有39例获得了充分的肾活检。分析活检结果，然后与临床参数进行比较。研究的39名患者，29名男性和10名女性，平均年龄为53.0 ± 11.0岁，平均动脉压为109 ± 15 mm Hg，GFR为51.7 ± 13.6 ml/min/1.73 m2（与未活检患者无显著差异）。这39例活检中有38例显示动脉硬化和/或小动脉硬化，严重程度平均分别为1.5 +/- 0.9和1.5 +/- 0.8，评分范围为0至3+。间质纤维化为中度，1.3 ± 0.9（0至3+量表）。节段性肾小球硬化症存在于5例活检，在一个病人，活检和临床表现与特发性局灶节段性肾小球硬化症一致。其他病变包括1例患者的系膜性肾小球肾炎，1例提示糖尿病肾病的基底膜增厚，2例胆固醇栓塞。小动脉硬化与动脉硬化密切相关，并与间质纤维化和肌酐的倒数相关。肾小球硬化广泛，平均累及43 +/- 26%的肾小球。病变程度与小动脉或动脉增厚程度无关，但与收缩压（P = 0.0174）、血清肌酐（P = 0.0009）、血清胆固醇（P = 0.0129）和间质纤维化（P < 0.0001）相关。这些数据强调，在非糖尿病高血压非裔美国人的肾活检中，在没有明显蛋白尿的情况下，轻度至中度肾功能不全，绝大多数可能显示与高血压肾硬化症的临床诊断一致的肾血管病变。
African Americans have excess hypertension and end-stage renal disease presumed due to hypertension compared to Caucasians. The AASK was designed to examine the impact of antihypertensive therapies and two levels of blood pressure control on the rate of decline of GFR in African Americans with presumed hypertensive renal disease. During the pilot phase of the trial, eligible participants were requested to undergo renal biopsy to assess the underlying lesions in this population. Eighty-eight hypertensive (diastolic BP > 95 mm Hg) non-diabetic African American patients between the ages of 18 to 70 years, with GFR between 25 to 70 ml/min/1.73 m(2) and without marked proteinuria were assessed for possible renal biopsy. Forty-three patients did not undergo renal biopsy due to refusal or contraindications. Adequate renal biopsies were obtained in 39 of the remaining 46 patients. Biopsy findings were analyzed and then compared to clinical parameters. The 39 patients studied, 29 men and 10 women, were on average 53.0 +/- 11.0 years old, and had a MAP of 109 +/- 15 mm Hg and GFR 51.7 +/- 13.6 ml/min/1.73 m(2) (not significantly different from nonbiopsied patients). Thirty-eight of these 39 biopsies showed arteriosclerosis and/or arteriolosclerosis, severity on average 1.5 +/- 0.9 and 1.5 +/- 0.8, respectively on a 0 to 3+ scale. Interstitial fibrosis was moderate, 1.3 +/- 0.9 (0 to 3+ scale). Segmental glomerulosclerosis was present in five biopsies, and in one patient, biopsy and clinical findings were consistent with idiopathic focal segmental glomerulosclerosis. Additional lesions included mesangiopathic glomerulonephritis in one patient, basement membrane thickening suggestive of diabetic nephropathy in one, and cholesterol emboli in two cases. Arteriolar and arterial sclerosis were tightly linked, and correlated with interstitial fibrosis and the reciprocal of scrum creatinine. Global glomerulosclerosis was extensive, involving on average 43 +/- 26% of glomeruli. The extent of this lesion did not correlate with degree of arteriolar or arterial thickening, but did correlate with systolic blood pressure (P = 0.0174), the reciprocal of serum creatinine (P = 0.0009), serum cholesterol (P = 0.0129) and interstitial fibrosis (P < 0.0001). These data underscore that renal biopsies in non-diabetic hypertensive African-Americans with mild to moderate renal insufficiently in the absence of marked proteinuria are overwhelmingly likely to show renal vascular lesions consistent with the clinical diagnosis of hypertensive nephrosclerosis.