Analysis of clinical and pathological features in biopsy-proven ischemic renal injury patients
10.3760/cma.j.issn.1001-7097.2020.01.002
- VernacularTitle: 缺血性肾损伤患者临床及病理特点分析
- Author:
Xuejing CHEN
1
,
2
,
3
;
Xiaojuan YU
1
,
2
,
3
;
Suxia WANG
4
;
Yu WANG
1
,
2
,
3
Author Information
1. Renal Division, Department of Medicine, Peking University First Hospital
2. Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China
3. Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
4. Laboratory of Electron Microscopy, Peking University First Hospital, Beijing 100034, China
- Publication Type:Clinical Trail
- Keywords:
Hypertension;
Obesity;
Complement C3;
Ischemia renal injury
- From:
Chinese Journal of Nephrology
2020;36(1):6-12
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical and pathological features of ischemia renal injury.
Methods:Patients with biopsy-proven ischemia renal injury in the Department of Nephrology, Peking University First Hospital from 2010 to 2018 were retrospectively enrolled in the present study. The demographic information and laboratory data were collected. And the severity of pathologic changes including glomeruli, arteriole and tubulo-interstitial fibrosis (IFTA) were semi-quantitatively scored. Arterioles with a ratio of inner/outer luminal diameter greater than 0.5 without hyalinosis were diagnosed as normal ones. The relationships between estimated glomerular filtration rate (eGFR), urine protein excretion and pathological changes were analyzed.
Results:A total of 52 patients were enrolled in the study, including 39 males (75.0%). The age of the patients was (45.0±12.7) years at biopsy. Among them, 50 patients (96.2%) had a history of hypertension with a median duration of 66 (24, 138) months. Forty-one patients (78.9%) were overweight or obese. The median urinary protein excretion was 0.75 (0.27, 1.32) g/d with 3 cases over 3 g/d. Fifteen patients (28.8%) presented with microhematuria and twenty-seven patients (51.9%) with eGFR lower than 60 ml·min-1·(1.73 m2)-1, respectively. The ratio of arteriolar inner/outer luminal diameter was 0.43±0.05 and the percentage of normal arterioles was 29.0%±17.0%. There were 21 patients (40.4%) found with arteriole hyalinosis. The ratio of arteriolar inner/outer luminal diameter correlated with the percentage of glomerular lesions (rs=-0.312, P=0.024), the semiquantitative scale of IFTA (rs=-0.291, P=0.037) and eGFR (r=0.339, P=0.014), respectively. Hypertension duration and body mass index (BMI) showed a negative correlation with the ratio of arteriolar inner/outer luminal diameter (rs=-0.303, P=0.029 and rs=-0.274, P=0.050, respectively) and a positive correlation with serum complement 3 level (rs=0.358, P=0.020 and rs=0.432, P=0.004, respectively).
Conclusions:Renal ischemia injury may be found in young and middle-aged patients. The characteristic of clinical features is mild to moderate proteinuria accompanied with a certain degree of eGFR decline, while a small number of patients may have microhematuria and marked proteinuria. The ratio of arteriolar inner/outer luminal diameter has a negative correlation with the percentage of glomerular lesions and the semiquantitative scale of IFTA and a positive correlation with eGFR, respectively. Hypertension and obesity are closely related to vascular lesions.
