Amplified Association Between Blood Pressure and Albuminuria in Overweight Patients With Biopsy-Proven Hypertensive Nephrosclerosis
Amplified Association Between Blood Pressure and Albuminuria in Overweight Patients With Biopsy-Proven Hypertensive Nephrosclerosis
复制标题
活检证实患有高血压肾硬化的超重患者血压与蛋白尿之间的关联性增强
DOI：
10.1093/ajh/hpz010
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发表时间：
2019
影响因子：
3.2
通讯作者：
Wada Takashi et al.
中科院分区：
文献类型：
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作者：
Kohagura Kentaro;Furuichi Kengo;Kochi Masako;Shimizu Miho;Yuzawa Yukio;Hara Akinori;Toyama Tadashi;Kitamura Hiroshi;Suzuki Yoshiki;Sato Hiroshi;Uesugi Noriko;Ubara Yoshifumi;Hoshino Junichi;Hisano Satoshi;Ueda Yoshihiko;Nishi Shinichi;Wada Takashi et al.
背景超重的人患高血压肾损伤的风险很高。在组织学诊断的高血压肾硬化患者中，体重对收缩压 (SBP) 和蛋白尿之间关系的影响仍不清楚。方法从日本 13 个中心招募了 97 名活检确诊的高血压肾硬化患者。我们研究了超重（体重指数≥25 kg/m2）和非超重患者的收缩压和蛋白尿之间的关系。我们检查了基线时体重和 SBP 与白蛋白尿的相互作用，以及观察期间估计肾小球滤过率 (eGFR) 变化的相互作用。 结果我们的结果包括平均年龄（54 岁）、血压（138/80）、eGFR（53 ml/min/1.73 m2）和尿白蛋白水平（0.2 g/天）。与非超重患者 (n = 59) 相比，超重患者 (n = 38) 的 SBP 与对数转换尿白蛋白水平显着相关 (r = 0.4，P = 0.01)。多元回归分析显示，超重和 SBP 与白蛋白尿之间的交互作用与对数转换的尿白蛋白水平显着相关（β = 0.39，P = 0.047），并且与年龄、性别和潜在混杂因素无关。体重和 SBP ≥140 mm Hg 之间的相互作用与随后 3 年内 eGFR 的大幅下降显着相关。 结论 超重可能会增加高血压肾小球损伤的易感性，并最终可能导致高血压肾硬化患者的肾脏进展。
BACKGROUNDAn overweight person is at high risk for hypertensive renal damage. The effect of weight on the association between systolic blood pressure (SBP) and albuminuria remains unknown in patients with histologically diagnosed hypertensive nephrosclerosis.METHODSA total of 97 patients with biopsy-confirmed hypertensive nephrosclerosis were recruited from 13 centers throughout Japan. We examined the relationship between SBP and proteinuria among those who were overweight, which is defined as a body mass index ≥25 kg/m2, and those who were not. We examined the interaction of weight and SBP with albuminuria at baseline and with the changes in estimated glomerular filtration rate (eGFR) during the observational period.RESULTSOur results included mean age (54 years old), blood pressure (138/80), eGFR (53 ml/min/1.73 m2), and urine albumin levels (0.2 g/day). SBP was significantly correlated with log-transformed urine albumin levels (r= 0.4,P= 0.01) in patients who were overweight (n= 38) compared with patients who were not overweight (n= 59). Multiple regression analysis revealed that the interaction between being overweight and SBP with respect to albuminuria was significantly correlated with the log-transformed urine albumin level (β= 0.39,P= 0.047) and was independent of age, sex, and potential confounding factors. The interaction between weight and SBP ≥140 mm Hg was significantly associated with a greater decrease in eGFR in the following 3 years.CONCLUSIONSBeing overweight may enhance susceptibility to hypertensive glomerular damage and may eventually lead to renal progression in patients with hypertensive nephrosclerosis.