Histopathological Association between Vascular Hypertensive Changes and Different Types of Glomerulopathies.
BACKGROUND
The term hypertensive nephrosclerosis has traditionally been used to describe a clinical syndrome characterized by long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy, minimal proteinuria, and progressive renal insufficiency. In the absence of renal biopsy, the diagnosis of hypertensive nephrosclerosis is one of exclusion.


METHODS
We retrospectively studied 735 patients who had renal biopsies at Ain Shams University Hospitals between January 2008 and Dec 2010. The prevalence of vascular hypertensive changes was studied in relation to clinical presentation and the glomerular pathology pattern.


RESULTS
Male to female ratio was 1:1 and the mean age was 27±17 years. No vascular hypertensive changes were found in 44.5% of biopsies while mild, moderate and severe changes were found in 28%, 22% and 4.2% respectively. Malignant hypertensive changes were seen in 1.2% of biopsies. Lupus nephritis was the most common etiology representing 18.9% of all cases, followed by focal segmental glomerulosclerosis (FSGS) (13.5%), membranoproliferative glomerulonephritis (13.3%) and membranous glomerulonephritis (8.2%). Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other glomerulopathies. Hypertensive nephrosclerosis as the sole cause of renal failure represented only 1.6% of cases. Significant associations were found between the degree of vascular hypertensive changes and the grade of hypertension. Patients with severe vascular hypertensive changes were significantly older and had significantly higher serum creatinine levels compared to other groups.


CONCLUSIONS
History and grade of hypertension significantly influence the degree of vascular hypertensive changes in renal biopsy. Moderate to severe vascular hypertensive changes were more common in biopsies with FSGS compared to other pathologies.


BACKGROUND
Hypertension; Nephroangiosclerosis; Renal Biopsies.
Departments of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Aber Halim
AH
Baki
Departments of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Yasser
Y
Soliman
Departments of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Elham Ibrahim
EI
Seif
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D000075222:Essential Hypertension; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000473:pathology; D015433:Glomerulonephritis, Membranous / Q000473:pathology*; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007678:Kidney Glomerulus / Q000473:pathology; D008181:Lupus Nephritis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000473:pathology*; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult