Concurrent analogous organ damage in the brain, eyes, and kidneys in malignant hypertension: reversible encephalopathy, serous retinal detachment, and proteinuria
Concurrent analogous organ damage in the brain, eyes, and kidneys in malignant hypertension: reversible encephalopathy, serous retinal detachment, and proteinuria
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DOI：
10.1038/s41440-020-0521-2
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发表时间：
2020-07-27
影响因子：
5.4
通讯作者：
Abe, Takaaki
中科院分区：
文献类型：
--
作者：
Mishima, Eikan;Funayama, Yukino;Abe, Takaaki
恶性高血压是高血压急症的一种形式，会导致大脑、眼睛和肾脏等重要器官的急性损伤。我们的目的是检查靶器官急性高血压损伤的并发性，以阐明潜在的类似病理生理学。这项单中心回顾性研究评估了 2008 年至 2019 年间治疗的恶性高血压患者的器官损伤特征、短期临床病程和器官间关系。符合纳入标准的 20 名患者的基线特征为平均年龄 48 +/- 13 岁，血压 222 +/- 18/142 +/- 16 mmHg；中位估计肾小球滤过率和尿蛋白水平分别为49 mL/min/1.73 m(2)（四分位数间距[IQR] 27-79）和1.9 g/g肌酐（IQR 0.2-4.0）。 60% 的患者患有可逆性后部脑病综合征 (PRES)，其脑干有多种分布模式。在眼底，60%的患者发现浆液性视网膜脱离。 PRES 和浆液性视网膜脱离患者的尿蛋白水平高于无症状患者（分别为 P = 0.007 和 0.02），并且蛋白尿 >1 g/g 肌酐使 PRES 和浆液性视网膜脱离高度复杂化（91%）。矩阵分析还表明，这三种症状彼此高度相关。这些结果表明，高血压急性器官损伤与大脑、眼睛和肾脏的密切关系和并发性。常见的类似机制，例如每个器官中过度灌注引起的毛细血管渗漏，暗示了 PRES、浆液性视网膜脱离和蛋白尿的潜在病理生理学。
Malignant hypertension, a form of hypertensive emergency, causes acute damage in vital organs such as the brain, eyes, and kidneys. We aimed to examine the concurrency of acute hypertensive damage across the target organs to elucidate the underlying analogous pathophysiology. This single-center retrospective study evaluated the characteristics of organ damage, short-term clinical course, and interorgan relationships in patients with malignant hypertension treated between 2008 and 2019. Baseline characteristics of 20 patients who met our inclusion criteria were mean age 48 +/- 13 years and blood pressure 222 +/- 18/142 +/- 16 mmHg; the median estimated glomerular filtration rate and urinary protein level were 49 mL/min/1.73 m(2)(interquartile range [IQR] 27-79) and 1.9 g/g creatinine (IQR 0.2-4.0), respectively. Posterior reversible encephalopathy syndrome (PRES) was found in 60% of patients with major involvement and a wide variety of distribution patterns in the brainstem. In the fundus, serous retinal detachment was found in 60% of patients. Patients with PRES and serous retinal detachment showed higher levels of urinary protein than those without symptoms (P = 0.007 and 0.02, respectively), and proteinuria >1 g/g creatinine highly complicated both PRES and serous retinal detachment (91%). Matrix analysis also showed that the three symptoms were highly associated with each other. These results demonstrate the close relationship and concurrency of hypertensive acute organ damage in the brain, eyes, and kidneys. A common analogous mechanism, such as hyperperfusion-induced capillary leakage in each organ, implies an underlying pathophysiology of PRES, serous retinal detachment, and proteinuria.