Diagnóstico de nefrosclerosis en fallecidos autopsiados / Diagnosis of nephrosclerosis in autopsied deceased

Introducción: La nefrosclerosis se produce debido al daño de la microvasculatura glomerular. El daño vascular a nivel glomerular, reduce su capacidad funcional y el daño se acelera debido a la hipertensión arterial, diabetes mellitus, obesidad y otros causantes de daño renal. Objetivo: Identificar el diagnóstico histopatológico de nefrosclerosis y describir características de fallecidos autopsiados con esta entidad. Métodos: Fueron analizados 135 449 fallecidos autopsiados en Cuba, de 15 o más años de edad, entre los años 1963 y 2015, se revisaron los diagnósticos histopatológicos de nefrosclerosis. Se precisaron además los diagnósticos de causa directa de muerte y de causa básica de muerte, así como su asociación con otras entidades. Se analizó además: edad, sexo, diagnóstico histopatológico de nefrosclerosis, diagnósticos de causa directa y básica de muerte, y asociación con otras entidades patológicas. Resultados: Hubo diagnóstico histopatológico de nefrosclerosis en 56 422 (40,2 por ciento), de ellos el 91,8 por ciento tenían 55 o más años de edad, el 52,9 por ciento fue del sexo masculino y el 47,0 por ciento femenino. La bronconeumonía (25,88 por ciento) fue la principal causa directa de muerte, los trastornos ateroscleróticos y la hipertensión arterial se identificaron como las principales causas básicas de muerte. Conclusiones: Hubo un elevado porcentaje de diagnósticos de nefrosclerosis en los fallecidos autopsiados en Cuba, en un período de 52 años. Predominaron los pacientes mayores de 55 años, del sexo masculino, así como la asociación con enfermedades básicas ateroscleróticas e hipertensión arterial(AU)

Introduction: Nephrosclerosis occurs due to damage to the glomerular microvasculature. Vascular damage at the glomerular level reduces its functional capacity and the damage is accelerated due to high blood pressure, diabetes mellitus, obesity and other causes of kidney damage. Objective: To identify the histopathological diagnosis of nephrosclerosis and describe characteristics of autopsied deceased with this entity. Methods: 135,449 autopsied deceased in Cuba, aged 15 or over, between 1963 and 2015 were analyzed, the histopathological diagnoses of nephrosclerosis were reviewed. The diagnoses of direct cause of death and basic cause of death were also specified, as well as their association with other entities. It was also analyzed: age, sex, histopathological diagnosis of nephrosclerosis, diagnoses of direct and basic cause of death, and association with other pathological entities. Results: There was a histopathological diagnosis of nephrosclerosis in 56,422 (40.2 percent), of them 91.8 percent were 55 years of age or older, 52.9 percent were male and 47.0 percent female. Bronchopneumonia (25.88 percent) was the main direct cause of death, atherosclerotic disorders and arterial hypertension were identified as the main basic causes of death. Conclusions: There was a high percentage of nephrosclerosis diagnoses in autopsied deceased in Cuba, in a period of 52 years. Male patients over 55 years of age predominated, as well as the association with basic atherosclerotic diseases and arterial hypertension(AU)

Role of alternative complement pathway overactivation in malignant nephrosclerosis / 中华肾脏病杂志

Objective@#To study the role of alternative complement pathway overactivation in malignant nephrosclerosis.@*Methods@#(1) Fifty patients with confirmed malignant nephrosclerosis by renal needle biopsy were enrolled. Meanwhile, twenty-five cases of time-zero renal needle biopsy were enrolled as control subjects. Enzyme linked immunosorbent assay (ELISA) was used to detect alternative complement pathway of the complement initiation factor B, positive regulation factor P, negative regulation factor H, and the complement end products C3a and C5a in the plasma and urine. (2) Immunohistochemistry was used to detect the deposition of the complement end product C5b-9, C4d and mannan binding lectin (MBL) of lectin pathway in the renal biopsies. Double immunofluorescence labeling method was used to assay the deposition of C5b-9 and CD34 (endothelial cell marker) in the arteriolar endothelium and glomerular capillary endothelium.@*Results@#(1) The plasma and urine levels of complement factor B, factor P, C3a and C5a in malignant nephrosclerosis patients were significantly higher than those in control subjects (all P<0.05), while the plasma and urine levels of complement factor H in malignant nephrosclerosis patients were lower than those in control subjects (all P<0.05). (2) The plasma level of factor P was positively correlated with 24 h urine protein (rs=0.465, P=0.001). Urinary factor B/urinary creatinine, urinary factor P/urinary creatinine and urinary C3a/urinary creatinine were positively correlated with serum creatinine in malignant nephrosclerosis patients (rs=0.483, P<0.001; rs=0.352, P=0.012; rs=0.319, P=0.024), while urinary factor H/urinary creatinine was negatively correlated with serum creatinine and 24 h urine protein (rs=-0.299, P=0.035; rs=-0.342, P=0.015). Urinary C5a/urinary creatinine was positively correlated with serum creatinine and 24 h urine protein (rs=0.525, P<0.001; rs=0.496, P<0.001). (3) Immunohistochemical results showed that there were C5b-9 deposited in the arterioles and glomerular capillary wall in malignant nephrosclerosis patients, and no deposition in control renal tissues. Meanwhile, the semi-quantitative scores showed that C5b-9 deposition intensity was positively correlated with serum creatinine and 24 h urine protein (rs=0.791, P<0.001; rs=0.345, P=0.014). The double immunofluorescence labeling analysis showed that the C5b-9 and CD34 deposited in the arteriolar endothelium and glomerular capillary endothelium. (4) Plasma level of factor B in malignant nephrosclerosis patients was positively correlated with plasma C3a level (r=0.331, P=0.022). Plasma level of factor P was positively correlated with C5b-9 score (rs=0.300, P=0.034). Urinary B was positively correlated with urinary C3a, C5a and C5b-9 score (rs=0.311, P=0.028; rs=0.465, P=0.001; rs=0.428, P=0.002). Urinary factor P was also positively correlated with urinary C3a and C5a (rs=0.307, P=0.030; rs=0.442, P=0.001). Immunohistochemical result showed that there were C4d deposited in the arterioles and glomerular, and no deposition of MBL.@*Conclusion@#Complement activation via the alternative pathway may be involved in malignant nephrosclerosis and related to the severity of the disease.

Combined Administration of Shinbuto and Boiogito Prevents the Progression of Chronic Kidney Disease with Minimal Proteinuria in the Long-term (Part 2) / 日本東洋医学雑誌

We previously reported that combined administration of shinbuto and boiogito extracts prevented the pro­gression of chronic kidney disease (CKD) over an observation period of 6 months. In the current study, we ex­tended the observation period to 60 months to investigate the long­-term effect of combined drug treatment. The subjects were 24 outpatients with CKD (14 men and 10 women ; mean age, 75.9 years) at the Department of Nephrology of Kagawaken Saiseikai Hospital. Shinbuto extract granules 5 g and boiogito extract granules 5 g were prescribed in two divided doses daily (before breakfast and dinner). Laboratory tests were performed before and 12, 24, 36, 48, and 60 months after drug administration. Although the treatment was discontinued in 14 patients because of reasons including patients' own volition, transfer to other hospitals, and emergence of proteinuria, 10 patients completed 60 months of treatment. Both the mean serum creatinine level (1.78 mg/dL before treatment ; 1.75 mg/dL after 60 months of treatment) and estimated glomerular filtration rate level (30.20 mL/min before treatment ; 34.39 mL/min after 60 months of treatment) did not deteriorate during the study period. Kidney test results persistently and significantly improved compared to the pre-­treatment results in 7 patients in whom the activities of daily living was stabilized. Taken together, we believe that long­-term treatment with shinbuto and boiogito extracts is effective for preventing the progression of CKD, which may be associated with nephrosclerosis, to advanced kidney failure.

Role of alternative complement pathway overactivation in malignant nephrosclerosis / 中华肾脏病杂志

Objective To study the role of alternative complement pathway overactivation in malignant nephrosclerosis.Methods (1) Fifty patients with confirmed malignant nephrosclerosis by renal needle biopsy were enrolled.Meanwhile,twenty-five cases of time-zero renal needle biopsy were enrolled as control subjects.Enzyme linked immunosorbent assay (ELISA) was used to detect alternative complement pathway of the complement initiation factor B,positive regulation factor P,negative regulation factor H,and the complement end products C3a and C5a in the plasma and urine.(2) Immunohistochemistry was used to detect the deposition of the complement end product C5b-9,C4d and mannan binding lectin (MBL) of lectin pathway in the renal biopsies.Double immunofluorescence labeling method was used to assay the deposition of C5b-9 and CD34 (endothelial cell marker) in the arteriolar endothelium and glomerular capillary endothelium.Results (1) The plasma and urine levels of complement factor B,factor P,C3a and C5a in malignant nephrosclerosis patients were significantly higher than those in control subjects (all P ＜ 0.05),while the plasma and urine levels of complement factor H in malignant nephrosclerosis patients were lower than those in control subjects (all P ＜ 0.05).(2) The plasma level of factor P was positively correlated with 24 h urine protein (rs=0.465,P=0.001).Urinary factor B/urinary creatinine,urinary factor P/urinary creatinine and urinary C3a/urinary creatinine were positively correlated with serum creatinine in malignant nephrosclerosis patients (rs=0.483,P ＜ 0.001;rs=0.352,P=0.012;rs=0.319,P=0.024),while urinary factor H/urinary creatinine was negatively correlated with serum creatinine and 24 h urine protein (rs=-0.299,P=0.035;rs=-0.342,P=0.015).Urinary C5a/urinary creatinine was positively correlated with serum creatinine and 24 h urine protein (rs=0.525,P ＜ 0.001;rs=0.496,P ＜ 0.001).(3) Immunohistochemical results showed that there were C5b-9 deposited in the arterioles and glomerular capillary wall in malignant nephrosclerosis patients,and no deposition in control renal tissues.Meanwhile,the semi-quantitative scores showed that C5b-9 deposition intensity was positively correlated with serum creatinine and 24 h urine protein (rs=0.791,P＜ 0.001;rs=0.345,P=0.014).The double immunofluorescence labeling analysis showed that the C5b-9 and CD34 deposited in the arteriolar endothelium and glomerular capillary endothelium.(4) Plasma level of factor B in malignant nephrosclerosis patients was positively correlated with plasma C3a level (r=0.331,P=0.022).Plasma level of factor P was positively correlated with C5b-9 score (rs=0.300,P=0.034).Urinary B was positively correlated with urinary C3a,C5a and C5b-9 score (rs=0.311,P=0.028;rs=0.465,P=0.001;rs=0.428,P=0.002).Urinary factor P was also positively correlated with urinary C3a and C5a (rs=0.307,P=0.030;rs=0.442,P=0.001).Immunohistochemical result showed that there were C4d deposited in the arterioles and glomerular,and no deposition of MBL.Conclusion Complement activation via the alternative pathway may be involved in malignant nephrosclerosis and related to the severity of the disease.

APOL1 risk variants and kidney disease: what we know so far / Variantes de risco APOL1 e doença renal: o que sabemos até agora

ABSTRACT There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.

RESUMO Existem importantes diferenças na doença renal crônica entre caucasianos e afrodescendentes. Foi amplamente aceito que isso ocorreu devido a fatores socioeconômicos, mas estudos recentes mostraram que as variantes gênicas da apolipoproteína L-1 (APOL1) estão fortemente associadas à glomeruloesclerose segmentar e focal, nefropatia associada ao HIV, nefroesclerose hipertensiva e nefrite lúpica na população afrodescendente. Essas variantes chegaram à América do Sul através do tráfico intercontinental de escravos, e proporcionaram uma vantagem evolutiva aos portadores, protegendo contra formas de tripanossomíase, mas à custa de um maior risco de doença renal. O efeito das variantes não parece estar relacionado à sua concentração sérica, mas sim à sua ação local sobre os podócitos. Variantes de risco também são importantes no transplante renal, já que enxertos de doadores com variantes de risco apresentam pior sobrevida.

Cambios estructurales renales en el riñón con el envejecimiento: con énfasis en glomeruloesclerosis / Renal structural changes in the kidney with aging: with emphasis on glomerulosclerosis

Resumen Es conocido que el proceso de envejecimiento conlleva, en la mayoría de individuos, una serie de cambios tanto estructurales como funcionales en diferentes órganos y sistemas. A nivel renal se reconoce que estos cambios tienden a ser los mismos que los observados en la presencia de algunas enfermedades crónicas sistémicas por lo que determinar la línea que divide lo patológico y fisiológico se torna importante. En este artículo se abordarán los diferentes cambios que ocasiona el proceso de envejecimiento en la morfología renal que ultimadamente conllevan a glomeruloesclerosis, interviniendo en forma esquematizada sobre las diferentes estructuras que conforman el sistema en forma tanto macroscópica y microscópica.

Abstract It is known that the aging process entails, in most individuals, a series of structural and functional changes in different organs and systems. As in the renal system, it is recognized that these changes tend to be the same as those observed with the presence of some chronic systemic diseases, so determining the line that divides the pathological and physiological status becomes important. In this article we will discuss the different changes that the aging process causes in the renal morphology that ultimately lead to glomerulosclerosis, intervening in a schematic form on the different structures that make up the system in macroscopic and microscopic form.

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients / 中华肾脏病杂志

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival.Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical data and renal biopsy samples were carefully studied.CD34 staining was performed to evaluate the PTC area,using Benign nephrosclerosis (BN,n=17) patients and glomerular minimal lesions (GML,n=19) patients as controls.Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival.Results Fifty-two MN patients were enrolled.The sex ratio of male to female was 12:1 and the average age was (34.0±8.2) years.The maximum blood pressure (SBP/DBP) was (230.4 ± 25.0)/(156.4 ± 20.6) mmHg,companied with significant loss of eGFR and proteinuria.Glomerular sclerosis index,tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria (P ＜ 0.05).After aggressive treatment,BP control rate improved significantly (76.9％ vs 3.7％,P ＜0.01),Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L,Wilcoxon test,P＜ 0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04± 1.26) g/24 h,P ＜ 0.01,n=21] also improved.PTC area in MN patients was significantly lower than those in BN patients and GML patients,and it correlated well with Scr (r=-0.553,P=0.001) and eGFR (r=0.476,P=0.004).The median follow-up time was 74 months,the cumulative renal survival rate at 1 year,5 year and 10 year was 90％,64％ and 23％,respectively.Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8± 12.4) months vs (63.0±8.3) months, x2=5.312,P ＜ 0.05].Univariate Cox proportional hazard model found that unsatisfied BP control,eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge,lower PTC area,severer tubular-interstitial damage and anemia were associated with poor renal outcome.Multivariate Cox model showed that unsatisfied BP control (RR=3.89,95％ CI 1.75-8.65,P=0.001),eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge (RR=4.27,95％ CI 1.40-13.09,P=0.011) were independent risk factors for long-term renal survival.Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes.Unsatisfied BP control and eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.

Peritubular capillaries injury and its association with clinical characteristics and long term renal survival in primary malignant nephrosclerosis patients / 中华肾脏病杂志

Objective To analyze the clinic-pathological data and peritubular capillary (PTC) injuries of malignant nephrosclerosis (MN) patients and their correlations with the long term renal survival.Methods This was a retrospective cohort study of 52 MN patients in Peking Union Medical College Hospital from January 2003 to March 2012.Their clinical data and renal biopsy samples were carefully studied.CD34 staining was performed to evaluate the PTC area,using Benign nephrosclerosis (BN,n=17) patients and glomerular minimal lesions (GML,n=19) patients as controls.Multivariate Cox proportional hazard model was used to identify the potential independent risk factors for long term renal survival.Results Fifty-two MN patients were enrolled.The sex ratio of male to female was 12:1 and the average age was (34.0±8.2) years.The maximum blood pressure (SBP/DBP) was (230.4 ± 25.0)/(156.4 ± 20.6) mmHg,companied with significant loss of eGFR and proteinuria.Glomerular sclerosis index,tubular atrophy and interstitial fibrosis correlated with eGFR and proteinuria (P ＜ 0.05).After aggressive treatment,BP control rate improved significantly (76.9％ vs 3.7％,P ＜0.01),Scr [(376.4±263.8) μmol/L vs (486.8±375.7) μmol/L,Wilcoxon test,P＜ 0.01] and proteinuria [(1.10±0.70) g/24 h vs (2.04± 1.26) g/24 h,P ＜ 0.01,n=21] also improved.PTC area in MN patients was significantly lower than those in BN patients and GML patients,and it correlated well with Scr (r=-0.553,P=0.001) and eGFR (r=0.476,P=0.004).The median follow-up time was 74 months,the cumulative renal survival rate at 1 year,5 year and 10 year was 90％,64％ and 23％,respectively.Kaplan-Meier analysis showed that the patients with higher PTC area had longer renal survival time [(114.8± 12.4) months vs (63.0±8.3) months, x2=5.312,P ＜ 0.05].Univariate Cox proportional hazard model found that unsatisfied BP control,eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge,lower PTC area,severer tubular-interstitial damage and anemia were associated with poor renal outcome.Multivariate Cox model showed that unsatisfied BP control (RR=3.89,95％ CI 1.75-8.65,P=0.001),eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge (RR=4.27,95％ CI 1.40-13.09,P=0.011) were independent risk factors for long-term renal survival.Conclusions The correlation between PTC area and renal functions in MN patients are much better than that of classic vascular changes.Unsatisfied BP control and eGFR ＜ 30 ml · min-1 · (1.73 m2)-1 upon discharge are independent risk factors for long-term renal survival.

Effects of KIM-1 on high glucose induced the expression of MCP-1 and FN in rat tubular epithelial cells / 中华肾脏病杂志

Objective To evaluate the effects of KIM-1 on high glucose induced the expression of MCP-1 and FN in rat tubular epithelial cells and to explore the possible mechanisms of KIM-1 involved in renal interstitial fibrosis of DN.Methods The rat renal tubular epithelial cells (NRK52E) were cultured in vitro and divided into five groups:Normal control group (D-glucose 5.6 mmol/L),Hypertonic group (D-glucose 5.6 mmol/L + D-mannitol 24.4 mmol/L),High glucose group (Dglucose 30 rmmol/L),Control siRNA group,KIM-1 siRNA group.ELISA assay was used to assess the levels of MCP-1 and FN in the cells supernatant; Western blotting was used to detect the protein expression of KIM-1; RT-PCR was used to detect mRNA expression of KIM-1,MCP-1 and FN.Results Compared with the control group,the protein and mRNA expression of KIM-1 in the high glucose group were increased at 12 h (P ＜ 0.05),and reached the peak at 48 h (P ＜ 0.05); the protein and mRNA expression of MCP-1 and FN in high glucose group were increased at 24 h significantly (P ＜ 0.05),and peaked at 48 h (P ＜ 0.05).Compared with the high glucose group,the protein and mRNA expressions of MCP-1 and FN in KIM-1 siRNA group were decreased (P＜0.05).Conclusions Down-regulating the expression of KIM-1 can significantly inhibit the expression of MCP-1 and FN,which suggests that KIM-1 may be involved in renal interstitial fibrosis of DN by regulating expression of MCP-1 and FN.

<b>Kampo Medicine Treatments in Nephrology </b> / 日本東洋医学雑誌

It has been popular to group various renal disorders under chronic kidney disease (CKD). And, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) drugs are used as the first choice for treatment of CKD with hypertension. Here, however, I review some Kampo treatments. To begin with, shichimotsukokato is a promising formula for the treatment of CKD in combination with ACE inhibitors/ARBs. The effects of hachimijiogan show promise for the inhibition of diabetic nephropathy through basic studies using experimental models. And, recent evaluations have revealed the efficacy and usefulness of saireito, in reducing steroid dose for the treatment of glomerulonephritis and primary nephrotic syndrome. Moreover, when considering disease backgrounds, saibokuto is useful in the patients with IgA nephropathy accompanied by frequent episodes of upper respiratory infection, while saireito is occasionally effective for nephrotic syndrome with allergic disorder. Saireito has also been reported to be effective in childhood IgA nephropathy in a prospective controlled study. The effects of onpito, on the other hand, are reported to prevent or postpone the introduction of dialysis in pre-dialysis patients with chronic renal failure. And furthermore, for the treatment of hemodialysis patients, goreisan efficacy has been reported for the difficulty of fluid removal, while saireito is promising for the treatment of peritoneal fibrosis due to peritoneal dialysis.

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial / Predictors of chronic renal failure in patients of a hypertension center

OBJETIVO: Testar variáveis clínicas relacionadas à evolução para insuficiência renal crônica avaliadas rotineiramente em hipertensos e que possam ser utilizadas como instrumento preditivo, possibilitando seu acesso em qualquer nível de assistência. MÉTODOS: Foram avaliados 358 pacientes do Centro de Hipertensão Arterial da Faculdade de Medicina de Botucatu -UNESP. Destes, 210 apresentavam uma segunda avaliação da filtração glomerular e foram utilizados na análise. Aplicou-se regressão logística para identificar características clínicas que se associassem de maneira independente com o desfecho filtração glomerular final igual ou inferior a 60 ml/min. RESULTADOS: No total da casuística, apenas a proteinúria à urina I associou-se de maneira independente ao desfecho. Entre os 175 pacientes com filtração glomerular inicial superior a 60 ml/min, a presença de proteinúria à urina I, o gênero feminino e a idade igual ou superior a 50 anos foram preditores da evolução para filtração glomerular final igual ou inferior a 60 ml/min. CONCLUSÃO: A proteinúria avaliada à urina I foi um fator de risco associado ao desenvolvimento de insuficiência renal crônica independente de outros co-fatores analisados. Hipertensos primários com proteinúria à urina I devem receber atenção redobrada no sentido de prevenir a evolução para insuficiência renal crônica.

PURPOSE: to verify which clinical variables can predict the evolution to chronic renal insufficiency in routinely evaluated hypertensives. METHODS: 358 patients from the Hypertension Center of the Botucatu School of Medicine (São Paulo State University) were evaluated. Sequential evaluation of glomerular filtration rate was detected in 210 patients, who were analyzed. Logistic regression was applied to identify clinical variables independently associated with the development of chronic renal insufficiency with a final glomerular filtration rate equal to or below 60 ml/min. RESULTS: in routine urinalysis only proteinuria was independently associated with the outcome. Among 175 patients with initial glomerular filtration rate above 60 ml/min, proteinuria, female gender and age of 50 years or more were predictors of the evolution to a final glomerular filtration rate equal to or below 60 ml/min. CONCLUSION: the presence of proteinuria in simple urinalysis was a risk factor and a reliable predictor associated with the development of chronic renal insufficiency among hypertensives.

Valor preditivo do exame de fundo de olho na detecção da nefropatia hipertensiva / Predictive value of the fundoscopy in hypertensive nephropathy

JUSTIFICATIVA E OBJETIVOS: A hipertensão arterial sistêmica (HAS) é conhecidamente uma das principais doenças relacionadas à doença renal crônica. Muitos estudos têm demonstrado uma correlação entre as lesões ateroscleróticas no fundo do olho e o grau de aterosclerose renal, secundário à hipertensão arterial, validando este dado como uma importante rotina semiotécnica para a depuração de nefropatias em hipertensos. O objetivo deste estudo foi verificar a presença de correlação entre esses dois acometimentos. MÉTODO: Foram selecionados 30 pacientes baseados nos critérios de inclusão do estudo. A depuração da creatinina e a microalbuminúria foram utilizadas para avaliar a presença de nefropatia. Alterações retinianas foram estabelecidas pela oftalmoscopia indireta. As correlações foram estudadas pelo método de Spearmam. Análise de múltipla Variância e o teste do Qui-quadrado foram empregados para estabelecer o impacto dos diversos fatores sobre as variáveis. RESULTADOS: 68,2% dos pacientes com retinopatia apresentaram nefropatia hipertensiva (NH), enquanto que 41,7% dos nefropatas tinham também retinopatia hipertensiva (RH) (x2 = 4,75; p < 0,05). Fatores de risco para aterosclerose, fármacos utilizados e os sintomas nefrológicos não diferiram entre os grupos. Pacientes com concomitância de NH e RH, apresentaram valores mais elevados de microalbuminúria quando comparados ao grupo sem acometimento e ao grupo com NH. Detectou-se correlação significativa entre essas complicações (r = 0,42; p < 0,05). CONCLUSÃO: A retinopatia hipertensiva na população estudada, apresentou correlação com a ocorrência da nefropatia hipertensiva. O encontro de alterações microvasculares em pacientes hipertensos, na fundoscopia, sugere investigação da lesão renal.(AU)

BACKGROUND AND OBJECTIVES: Hypertension is a commonly cited cause for declining renal function. Presence of retinal arteriolar abnormalities has been postulated to represent an indicative of systemic microcirculatory damage and renal dysfunction secondary to hypertension. Demonstration of this microvascular damage may provide a useful indicator of at-risk individuals for progressive renal function decline. The purpose of this investigation is to describe the associations between these abnormalities. METHODS: Thirteen patients were recruited based in the inclusion conditions of the study. Glomerular filtration rate and the microalbuminuria were used to evaluate the nephropathy presence. Retinal arteriolar abnormalities were evaluated by using indirect fundoscopy. Correlations were examined by using Spearman correlation test. Test of Multiple Variance and Chi-square test were used to establish the impact of the several factors on the variables. RESULTS: 68.2% of patients with retinopathy showed hypertensive nephropathy (HN), while 41.7% of patients with nephropathy also had hypertensive retinopathy (HR) (x2 = 4.75; p < 0.05). Risk factors for arteriosclerosis, used medications and the nephrological symptoms did not differ among the groups. Cases with both complications (HN + HR), presented higher values of microalbuminuria as comparedto those without HR, with or without HN. Significant correlation was detected between the 2 complications (r = 0.42; p < 0.05). CONCLUSION: This investigation shows correlation between the presence of HR and HN. Presence in the fundoscopy of such retinal microvascular abnormalities, in hypertensive patients, suggests screening for renal dysfunction.(AU)

Primary Aldosteronism Complicated with Chronic Renal Failure / 대한신장학회잡지

Primary aldosteronism is a disease entity characterized by hypertension, hypokalemia, metabolic alkalosis and muscle weakness. Aldosteronoma is the most common cause of primary aldosteronism. The prevalence of primary aldosteronism in patients with hypertension appears to be low, less than 1%. However, primary aldosteronism is the one of common cause of secondary hypertension that is one of a few potentially curable forms of hypertension by surgical treament. The malignant hypertension in primary aldosteronism is very rare and the renal vascular damage due to hypertension seldom occurs. There has been no known reports about primary aldosteronism complicated with chronic renal failure in Korea. We report the rare case of primary aldosteronism in patient with hypokalemia, metabolic alkalosis complicated with chronic renal failure due to malignant hypertension with evident nephrosclerosis.

Apoptosis and expression of apoptosis-related genes in kidneys of the rats with 5/6 nephrectomy / 中国病理生理杂志

AIM: To establish a model of subtotal nephrectomy (SNx) and investigate the changes of apoptosis and apoptosis-related genes (Bax, bcl-2, caspase-3, caspase-8 and caspase-9) in the rat remnant kidney. METHODS: Remnant kidneys were produced in adult male SD rats by 5/6 nephrectomy. The renal function and histopathological changes were evaluated at 1, 2, 4, 8, 12, 16, 26 and 40 weeks after operation. The tissues of remnant kidneys were collected to detect apoptosis cells by in situ end-labeling of cleaved DNA (TUNEL) and proliferating cells by determining the proliferating cell nuclear antigen (PCNA). The expression of Bax, bcl-2, caspase-3, caspase-8 and caspase-9 was measured by RT-PCR and Western blotting. The proteins were detected by immunohistochemistry staining. The relation between apoptosis, proliferation, glomerulosclerosis and renal interstitial fibrosis was also observed. RESULTS: The results showed the renal pathological dynamic changes in 5/6 nephrectomy remnant kidneys were tubule-interstitial inflammation and fibrosis, as well as glomerulosclerosis. There were transient increases in both proliferating and apoptotic processes in glomerulus, tubules and interstitium. Apoptosis was increased and most of apoptotic cells were detected in tubular epithelial cells and interstitial area. The mRNA and protein expression of Bax, caspase-3, caspase-8 and caspase-9 were increased in all course, and peaked at week 4 and 40 in the SNX rats. The successive changes of these parameters were parallel to the level of focal inflammation in interstitium. Glomerulosclerosis index was related with focal inflammation cells and 24 hours urine protein (r=0.788, 0.822; P