Correlates of Renal Dysfunction in Hypertensive Chronic Biopsied non Diabetic Glomerulonephritis
Kerbala Journal of Medicine,
2014, Volume 7, Issue 1, Pages 1760-1770
Abstractbackground: Hypertension is a chronic disease that is increasing in prevalence worldwide and spans race and gender lines. The worldwide prevalence of hypertension was estimated from 2005 systematic review of published literature to be 26%with a projected 60% increase by the year 2025.Arterial hypertension is (with age, sex, race, proteinuria, hyperlipidaemia, smoking, etc.) also one of the main causes of the progression of diabetic and non-diabetic chronic kidney failure. This progressive kidney failure develops especially in patients with glomerular kidney disease who clinically manifest proteinuria. This process is slow in general, but sometimes the damage to the kidneys can develop very rapidly, with an immediate need for dialysis. The effects of glomerulonephritis onrenal prognosis may be also negatively influenced by several factors present at the time of patient’s diagnosis. Among them, arterial hypertension is one of the most important factor, the negative influence of arterial hypertension on glomerulonephritis kidney prognosis may be mediated preferentially by kidney failure itself, the former being possibly a result of the latter when this one is severe enough, than by hypertension itself.
Aims: The aims of this study are to analyze arterial hypertension prevalence in chronic non diabetic glomerulonephritis at the time of performance of kidney biopsy and for the following 36 months after the biopsy. The prognostic value of arterial hypertension as a progression factor to end stage kidney disease is to be analyzed.
Patients and methods: Sixty one patients have been studied. The inclusion criteria for kidney biopsy were: nephrotic syndrome, persistent sub-nephrotic proteinuria, and unexplained abnormal kidney function test when kidney sizes in ultrasound were within normal range, acute kidney injury, acute nephritic presentation, hematuria after excluding urological causes. Demographical data have been gathered, such as patients’ particulars, date of kidney biopsy, age and gender. We considered hypertensive those patients with arterial blood pressure figures higher than 140/90 mm-Hg, or those treated with antihypertensive drugs, and kidney failure measured as glomerular filtration rate by means of creatinine clearance less than 60ml/minute. Kidney function survival, computed as the time elapsed from the date of kidney biopsy to definitive loss of kidney function, defined as creatinine clearance <60 ml/minute. For the analysis of the prognosis and kidney survival, Kaplan-Meier curves and the Log-Rank test were used.
Results & Discussion: Of the 58 patients,30 (51.7%) are men and 28 (48.3%) are women and men: women ratio was 1.07:1.The patients, ages range from 2-55 years with an average mean age of 25.38 ± 14.65 years. The global prevalence of hypertension was 44.8%.
When we compare the kidney log survival function curves between overall hypertensive and normotensive patients, we observe a significant effects with a trend toward a worse clinical course regarding kidney failure in over all hypertensive patients with a P value of 0.018 and a DF of 1 and in focal segmental glomerulosclerosisa P value of 0.024.
Conclusions: We conclude that high arterial hypertension prevalence in primary biopsied non diabetic glomerulonephritis, considering that we deal with young patients, with lowerarterial hypertension prevalence in the general population of the same age. Arterial hypertension presence at the time of biopsy is already a negative clinical prognostic marker, even before the occurrence of end stage kidney disease, being especially significant in focal segmental glomerulosclerosis.
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