title: Clinical and pathological evaluation of hypertensive emergency-related nephropathy.
abstract: OBJECTIVE
  The prognosis of patients with hypertensive emergencies has recently improved dramatically owing to the development of effective antihypertensive therapy. We examined the histological and clinical features of patients with hypertensive emergency-related nephropathy.
  
  
  METHODS
  Twelve patients (11 men and one woman) were diagnosed as having hypertensive emergencies with acute renal failure according to the Joint National Committee-7 classification of blood pressure for adults and underwent renal biopsies at our hospital between 1995 and 2008. These patients were enrolled in this retrospective study.
  
  
  RESULTS
  The age of the subjects was 40.1±9.8 years. At presentation, the mean systolic/diastolic blood pressure was 232±32/146±12 mmHg and none of the patients were being treated with antihypertensive drugs, although 10 patients had histories of hypertension. The mean serum creatinine level was 6.1±4.7 mg/dL. All 12 patients showed left ventricular hypertrophy on echocardiography. On light microscopy of the renal biopsy specimens, all 12 patients showed onion skin patterns of the arterioles; however, no fibrinoid necrosis of the small arteries was found. Electron microscopy revealed electron-lucent widening of the subendothelial zone of the glomerular capillary walls in seven patients. One of the 12 patients did not respond to medical therapy and required regular dialysis. The other 11 patients responded to treatment.
  
  
  CONCLUSIONS
  An onion skin pattern of the arterioles is the most frequent histological finding in patients with hypertensive emergency-related nephropathy. Long-standing hypertension might contribute to this arteriolar change, since left ventricular hypertrophy was also seen in these patients. With strict control of hypertension using antihypertensive medications, the prognosis of patients with hypertensive emergency-related nephropathy can be improved.
authors.affiliation: Nephrology Center, Toranomon Hospital, Japan. knonaka@juntendo.ac.jp
authors.forename: Kanae
authors.initials: K
authors.lastname: Nonaka
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Oohashi
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D001795:Blood Pressure Determination; D015331:Cohort Studies; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D006974:Hypertension, Malignant / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D007150:Immunohistochemistry; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D016482:Urinalysis
chemical_list: D000959:Antihypertensive Agents