{"title":"肾小球血尿作为恶性高血压合并血栓性微血管病变患者肾脏预后的预测因子：基于活检的队列研究的倾向评分匹配分析","authors":"Zhaocai Zhou, Wanxin Shi, Shengyou Yu, Jianwen Yu, Naya Huang, Zhong Zhong, Fengxian Huang, Wei Chen, Feng He, Jianbo Li","doi":"10.1159/000541332","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA.</p><p><strong>Methods: </strong>This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis.</p><p><strong>Results: </strong>A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29-0.89, <i>p</i> = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28-0.91, <i>p</i> = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06-5.66, <i>p</i> < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34-4.33, <i>p</i> = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria.</p><p><strong>Conclusion: </strong>Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"479-491"},"PeriodicalIF":3.2000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631104/pdf/","citationCount":"0","resultStr":"{\"title\":\"Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study.\",\"authors\":\"Zhaocai Zhou, Wanxin Shi, Shengyou Yu, Jianwen Yu, Naya Huang, Zhong Zhong, Fengxian Huang, Wei Chen, Feng He, Jianbo Li\",\"doi\":\"10.1159/000541332\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA.</p><p><strong>Methods: </strong>This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis.</p><p><strong>Results: </strong>A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29-0.89, <i>p</i> = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28-0.91, <i>p</i> = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06-5.66, <i>p</i> < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34-4.33, <i>p</i> = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria.</p><p><strong>Conclusion: </strong>Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.</p>\",\"PeriodicalId\":17830,\"journal\":{\"name\":\"Kidney Diseases\",\"volume\":\"10 6\",\"pages\":\"479-491\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631104/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000541332\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000541332","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
恶性高血压（mHTN）是一种高血压急症。血栓性微血管病（TMA）是mHTN的广泛并发症。很少有研究评估肾小球血尿是否为mhtn相关TMA患者的肾功能障碍提供预后信息。方法：这项观察性队列研究纳入了292例基于肾活检的mhtn相关TMA患者。进行倾向评分匹配（PSM）分析，以调整肾小球血尿和非肾小球血尿患者的临床特征。采用Cox回归分析确定影响肾脏预后的危险因素。结果：共有70例肾小球性血尿患者与222例非肾小球性血尿患者进行了比较。PSM后，配对67对mhtn相关TMA患者。与非肾小球性血尿患者相比，肾小球性血尿患者血清白蛋白水平较低，24小时蛋白尿较高，肾小球硬化患病率较高。与非肾小球性血尿相比，肾小球性血尿与肾功能恶化独立相关(HR: 0.51；95% CI: 0.29-0.89, p = 0.019)。这种关联在PSM后仍然显著(HR: 0.51；95% CI: 0.28-0.91, p = 0.022)。此外，肾小球血尿与肾替代治疗（RRT）独立相关(HR: 3.14；95% CI: 2.06-5.66, p < 0.001)。PSM比较后，这一差异仍然显著(HR: 2.41；95% CI: 1.34-4.33, p = 0.003)。此外，尽管加强血压控制，肾小球血尿患者的RRT发生率较高，肾功能恢复较差，特别是肌酐水平降低25%，与非肾小球血尿患者相比。结论：肾小球血尿与mhtn相关TMA患者肾脏不良结局的风险增加显著相关。
Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study.
Introduction: Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA.
Methods: This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis.
Results: A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29-0.89, p = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28-0.91, p = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06-5.66, p < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34-4.33, p = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria.
Conclusion: Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.
期刊介绍：
''Kidney Diseases'' aims to provide a platform for Asian and Western research to further and support communication and exchange of knowledge. Review articles cover the most recent clinical and basic science relevant to the entire field of nephrological disorders, including glomerular diseases, acute and chronic kidney injury, tubulo-interstitial disease, hypertension and metabolism-related disorders, end-stage renal disease, and genetic kidney disease. Special articles are prepared by two authors, one from East and one from West, which compare genetics, epidemiology, diagnosis methods, and treatment options of a disease.
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