Focal segmental glomerulosclerosis in malignant hypertension.
OBJECTIVE
Focal segmental glomerulosclerosis (FSG) may occur in primary malignant hypertension (MHT) either as a result of glomerular hyperfiltration or fibrinoid necrosis (FN), and may contribute to renal dysfunction. To determine the frequency of occurrence and distribution of FSG in primary MHT we studied renal biopsy specimens from 38 black Africans--30 postmortem and 8 needle-biopsy specimens.


METHODS
There were 31 male subjects and 7 female, with a mean age of 46 (+/- 7) years.


RESULTS
Mean blood pressure (BP) was 206 +/- 15/137 +/- 9 mmHg, median 24-hour proteinuria (interquartile (IQ) range) was 5.1 g (3.3-6.5 g), median serum albumin 3.4 g (3.2-3.8 g) and median serum creatinine 540 mumol/l (425-752 mumol/l). Mucoid intimal proliferation was present in all the sections but FN was seen in 29 (76%). Glomerulosclerosis was present in all the sections, and was axially distributed in 7 (18%), segmentally in 22 (58%), and globally in 9 (24%). Median 24-hour proteinuria was 2.8 g (0.8-3.5 g IQ range), 5.6 g (1.7-8.1 g) and 3.4 g (2.6-4.0 g) respectively, and corresponding values of serum creatinine were 770 mumol/l (106-1,274 mumol/l IQ range), 522 mumol/l (248-991 mumol/l) and 1,230 mumol/l (920-1,558 mumol/l) respectively.


CONCLUSIONS
The distribution of glomerulosclerosis did not appear to relate to proteinuria or serum creatinine, although cases with segmentally distributed glomerulosclerosis appeared to have the highest proteinuria, and those with global glomerulosclerosis appeared to have the highest serum creatinine levels. FSG therefore occurs prominently in primary MHT and may contribute to renal dysfunction.
Kadiri
S
S
Department of Medicine, University College Hospital, Ibadan, Nigeria.
Thomas
J O
JO
D000328:Adult; D001741:Black or African American; D044383:Black People; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D016008:Statistical Distributions