Arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg: qual a diferença? / Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis: what is the difference?

Resumo A principal causa de óbito na contemporaneidade são as doenças cardiovasculares. Arteriosclerose, aterosclerose, arteriolosclerose e arteriosclerose de Monckeberg são termos frequentemente utilizados como sinônimos, mas traduzem alterações distintas. O objetivo desta revisão foi discutir os conceitos de arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg. O termo arteriosclerose é considerado mais genérico, significando o enrijecimento e a consequente perda de elasticidade da parede arterial, abarcando os demais tipos. A aterosclerose é uma doença inflamatória secundária a lesões na camada íntima, que tem como principal complicação obstrução crônica e aguda do lúmen arterial. A arteriolosclerose se refere ao espessamento das arteríolas, particularmente relacionada à hipertensão arterial sistêmica. Já a esclerose calcificante da média de Monckeberg designa a calcificação, não obstrutiva, da lâmina elástica interna ou da túnica média de artérias musculares. As calcificações vasculares, que incluem lesões ateroscleróticas e a esclerose calcificante da média de Monckeberg, vêm sendo estudadas como um fator de risco para a morbimortalidade cardiovascular.

Abstract Cardiovascular diseases are the main cause of death in contemporary times. Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg's arteriosclerosis are terms that are often used interchangeably, but they refer to different vascular pathologies. The objective of this study is to review the concepts of atherosclerosis, atherosclerosis, arteriosclerosis and Monckeberg medial calcific sclerosis (MMCS). The term arteriosclerosis is more generic, meaning the stiffening and consequent loss of elasticity of the arterial wall, and encompasses the other terms. Atherosclerosis is an inflammatory disease secondary to lesions in the intimal layer and whose main complication is acute and chronic obstruction of the arterial lumen. Arteriolosclerosis refers to thickening of arterioles, particularly in association with systemic arterial hypertension. MMCS refers to non-obstructive calcification in the internal elastic lamina or the tunica media of muscular arteries. Vascular calcifications, which include atherosclerotic lesions and MMCS, have been studied as a risk factor for cardiovascular morbidity and mortality.

Hypertension in Chronic Glomerulonephritis

Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be or =30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of or =30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN.

Are Vascular Aging and Atherosclerosis Synonymous?

The development of plaques along the inner layer of arterial walls is known as atherosclerosis. Atherosclerotic plaques can become hardened by calcium deposition and fibrous tissue of the arterial wall may proliferate leading to arteriosclerosis. In a typical textbook, arteriosclerosis only has three categories-atherosclerosis, Monckeberg medial calcific sclerosis, and arteriolosclerosis, leaving out vascular aging when in fact, aging is the strongest risk factor for atherosclerosis. Thus, vascular aging is often confused with atherosclerosis. Up to now, there has been no appropriate pathological term for vascular aging. And arteriosclerosis is different from vascular aging, as atherosclerosis includes some components of pathologic aging. But in actuality, physiological aging and pathological aging can not be clearly distinguished. Therefore, in terms of aging, arteriosclerosis is included in vascular aging. More research is required to define vascular aging.

Vitaminas antioxidantes e prevenção da arteriosclerose na infância / Antioxidant vitamins and prevention of atherosclerosis in childhood

OBJETIVO: Revisar os potenciais efeitos antioxidantes das vitaminas A, C e E na prevenção do desenvolvimento da arteriosclerose na infância, com ênfase na prevenção da dislipidemia. FONTES DE DADOS: Pesquisa bibliográfica em revistas científicas, livros técnicos e publicações de órgãos oficiais dos últimos 20 anos. Utilizaram-se as bases de dados Lilacs, SciELo e Medline em português, inglês e espanhol, com as palavras-chave: "antioxidantes", "arteriosclerose", "dislipidemias", "peroxidação de lipídeos", "infância", "vitamina A", "vitamina C" e "vitamina E". SÍNTESE DE DADOS: A prevalência de dislipidemia na infância e na adolescência mostra frequência crescente, provavelmente relacionada às mudanças dos hábitos alimentares e à redução na prática de atividades físicas. O elevado nível plasmático da lipoproteína de baixa densidade (LDL-c) é fator de risco para o desenvolvimento da arteriosclerose. O consumo de frutas, verduras e legumes, ricos em antioxidantes, é um dos fatores de maior importância na prevenção da peroxidação lipídica. A baixa ingestão dessas fontes naturais de antioxidantes sugere a necessidade de intervenção nutricional para atingir as metas diárias de consumo de vitaminas A, C e E, não sendo preconizada a sua suplementação medicamentosa. CONCLUSÕES: O pediatra e o nutricionista devem orientar as famílias sobre o consumo de alimentos saudáveis, principalmente frutas, verduras e legumes, por seu potencial efeito antioxidante, especialmente nos primeiros anos de vida.

OBJECTIVE: To review the potential antioxidant effects of vitamins A, C and E in the prevention of atherosclerosis development during childhood, emphasizing the prevention of dyslipidemia. DATA SOURCES: Bibliographic search in scientific journals, technical books and official publications of the last 20 years. Lilacs, SciElo and Medline databases were searched for articles in Portuguese, Spanish and English using a combination of the following terms: "antioxidants", "atherosclerosis", "dyslipidemia", "lipid peroxidation", "childhood", "vitamin A", "vitamin C" and "vitamin E". DATA SYNTHESIS: There is an increasing prevalence of dyslipidemia in children and adolescents, probably related to changes in dietary habits and to the reduced practice of physical activities. The high plasma concentration of low-density lipoprotein (LDL-c) is a risk factor for atherosclerosis development. The consumption of nutrients rich in antioxidants, such as fruits and vegetables, is very important to prevent lipid peroxidation. The low intake of these natural antioxidants sources suggests the need for nutritional intervention to achieve the daily ingestion targets of vitamins A, C and E. Vitamin supplementation is not recommended. CONCLUSIONS: Children should be encouraged to increase ingestion of fruits and vegetables due to their potential antioxidant effect, especially in the first years of life.

Biomechanical properties of artery in spontaneously hypertensive rats after treating with tetrahydrobiopterin / 中国应用生理学杂志

<p><b>AIM</b>To explore the effect of remodeling and biomechanical properties after chronic treating with tetrahydrobiopterin (BH4) in spontaneously hypertensive rats.</p><p><b>METHODS</b>The spontaneously hypertensive rat(SHR) were given with BH4 chronically. The opening angle in the zero-stress state , wall-to-lumen area ratios (W/L) of thoracic aorta and the relationship between pressure and diameter (P-D) of mesenteric artery were measured by computer image analysis in 4, 16, and 26 week-old respectively.</p><p><b>RESULTS</b>Treating with BH4 chronically from 4 weeks-old in SHR, there was a significant decrease in morphometric parameters of the thoracic aorta and an increase in the zero-stress state of opening angle of elastic artery. The P-D curve of mesenteric artery moved upward.</p><p><b>CONCLUSION</b>Treating with BH4 prevented the structure and function of artery from abnormal changing, including to attenuate the resistant vascular hypertrophy and recover the vascular elasticity and expansibility.</p>

O papel dos produtos finais da glicação avançada (AGEs) no desencadeamento das complicações vasculares do diabetes: [revisão] / The role of advanced glycation end-products (AGEs) in the development of vascular diabetic complications: [review]

Os produtos finais da glicação avançada (AGEs [do inglês, Advanced Glycation End-products]) constituem uma classe de moléculas heterogêneas formadas a partir de reações aminocarbonilo de natureza não-enzimática, que ocorrem aceleradamente no estado hiperglicêmico do diabetes. Considerados importantes mediadores patogênicos das complicações diabéticas, os AGEs são capazes de modificar, irreversivelmente, as propriedades químicas e funcionais das mais diversas estruturas biológicas. Na presente revisão, são apresentados os dados recentes da literatura que descrevem as vias de formação de AGEs, seu metabolismo, os principais mecanismos de ação dessas substâncias no desencadeamento dos processos patológicos, bem como os métodos de determinação de AGEs em amostras biológicas. Este artigo aponta, ainda, novas perspectivas de terapias anti-AGEs, a exemplo de estudos envolvendo a ação de compostos naturais dos alimentos, que podem oferecer potencial terapêutico para os portadores de diabetes ou de outras patologias associadas ao acúmulo degenerativo de AGEs.

The advanced glycation end-products (AGEs) constitute a class of heterogeneous molecules formed by amino-carbonyl reactions of a non-enzymatic nature, which occur at an accelerated rate in the hyperglycemic state of diabetes. Considered important pathogenic mediators of diabetic complications, AGEs are capable of irreversibly modifying the chemical properties and functions of diverse biological structures. In this review, recent data from literature is presented describing the pathways of AGEs formation, their metabolism, the main mechanisms of action of these substances in the triggering of pathological processes associated with diabetes, as well as methods of AGEs determination in biological samples. This text also points to new perspectives in anti-AGE therapies, an example of which is the studies involved with the action of natural compounds of food, which can represent a potential coadjuvant therapy for people with diabetes or other pathologies associated with the degenerative accumulation of AGEs.

Clinicopathologic Findings in Obesity-related Glomerulopathy / 대한신장학회지

PURPOSE: Recently, obesity with metabolic syndrome is considered as an important risk factor in the development and progression of chronic kidney disease (CKD). Glomerulomegaly and focal segmental glomerulosclerosis (FSGS) are found in the obese patients, suggesting that investigation of structural- functional relationship in the obesity-related glomerulopathy (ORG) is needed to prevent CKD. Thus, we report here clinical and pathologic characteristics of ORG and its association with other clinical variables. METHODS: Obesity was defined by body mass index >25 kg/m2 and ORG morphologically by FSGS and glomerulomegaly or glomerulomegaly alone. Clinicopathologic findings and glomerular sizes of ORG (14 cases) were compared with age-matched controls with thin basement membrane disease. Multiple variable analysis was performed between glomerular size and clinical variables. RESULTS: There was no nephrotic syndrome or pretibial pitting edema in all obese patients. Mean glomerular diameter was increased in obese patients compared to controls (240+/-21 micrometer vs 197+/-21 micrometer, p=0.001). Seven cases had lesions with FSGS with glomerulomegaly and seven cases glomerulomegaly alone. Mild tubular atrophy, interstitial fibrosis and arteriolosclerosis were observed in more than half of patients. In obese patients, seven patients with FSGS had more elevated systolic blood pressure and tubular interstitial fibrosis compared to patients with glomerulomegaly only. Patients' systolic blood pressure and waist circumference were independent risk factors influencing the glomerular size in obese patients. CONCLUSION: FSGS or glomerulomegaly are prominent even in the mild obesity with insignificant clinical symptoms. This indicates that the clinical attention to glomerular disease is needed in obese patients.

Apo B/Apo A-I ratio in central and peripheral arterial diseases

BACKGROUND: The apo B/apo A-I ratio represents the balance between atherogenic particles, rich in apo B, and the antiatherogenic ones, apo A-I rich. This study investigated the association between atherosclerotic diseases in different anatomical sites and apo B/apo A-I ratio. METHODS: Lipids, lipoproteins, and apolipoproteins A-I and B were assessed in 30 subjects with coronary artery disease (CAD), 26 with ischemic stroke (IS), 30 with peripheral arterial obstructive disease (PAOD), and 38 healthy subjects (controls). RESULTS: HDLc and Apo A-I were significantly lower in PAOD and CAD groups, respectively, than in other groups. Significantly higher levels of triglycerides were observed for CAD and PAOD groups than for controls. Apo B was significantly higher in IS group than in control and PAOD groups. The apo B/apo A-I ratio showed significantly higher in CAD and IS groups when compared to control and PAOD groups (p < 0.001). CONCLUSION: The apo B/apo A-I ratio was important for identifying an increased trend for coronary and cerebral atherosclerosis. In spite of the increased trend for apo B/apo A-I ratio in IS and CAD groups, the studied variables cannot be considered in an isolated way, given as those parameters were analyzed together by a binary logistic regression, no association has been demonstrated.

INTRODUÇÃO: O índice apo B/apo A-I representa o balanço entre partículas de colesterol potencialmente aterogênicas ricas em apo B e partículas anti-aterogênicas ricas em apo A-I. O objetivo deste estudo foi investigar a associação entre doenças ateroscleróticas em diferentes sítios anatômicos e o índice apo B/apo A-I. MÉTODOS: Lípides, lipoproteínas e apolipoproteínas A-I e B foram quantificados em 30 indivíduos apresentando doença arterial coronariana (DAC), 26 com acidente vascular cerebral (AVC), 34 apresentando doença arterial obstrutiva periférica (DAOP) e 38 indivíduos hígidos (grupo controle). RESULTADOS: HDLc e apo A-I apresentaram-se significativamente mais baixos nos grupos DAOP e DAC, respectivamente, quando comparados com os demais grupos. Níveis de triglicérides foram significativamente mais elevados nos grupos DAC e PAOD quando comparados com o grupo controle. Apo B foi significativamente mais elevada no grupo AVC quando comparado com os grupos controle e DAOP. O índice apo B/apo A-I se mostrou significativamente elevado nos grupos DAC e AVC quando comparados com os demais (p < 0,001). CONCLUSÃO: O índice apo B/apo A-I foi importante para identificar uma tendência aumentada para aterosclerose coronariana e cerebral. No entanto, os parâmetros avaliados não podem ser considerados de forma isolada, considerando que nenhuma associação foi demonstrada quando os dados foram analisados pelo modelo de regressão logística binária.

A Case of Idiopathic Nodular Glomerulosclerosis Presenting Rapid Progressive Renal Failure / 대한신장학회잡지

Idiopathic nodular glomerulosclerosis is an unusual entity with histopathologic features resembling nodular diabetic glomerulosclerosis but occurs in non diabetic patients and predominantly in older males with smoking and long standing hypertension. It is characterized histologically by nodular mesangial sclerosis, glomerular basement membrane thickening, and arteriolosclerosis in the absence of immune-type deposit, and clinical presentations typically include renal insufficiency and severe proteinuria with relatively poor prognosis. We experienced a rare case of idiopathic nodular glomerulosclerosis presenting rapid progressive renal failure in a 42-year-old man without clinical evidence of diabetes. He was admitted with peripheral edema and renal insufficiency. He had a history of hypertension for 2 years and chronic hepatitis B for 5 years. Funduscopy and renal ultrasound were normal. HbA1c and oral glucose tolerance test were normal and on serum and urine electrophoresis, M-spike was not found. Light microscopic examination demonstrated the characteristic features of lobular glomerulonephritis showing glomerular hypertrophy and nodular mesangial sclerosis. Immunofluorescence was negative for immune-type deposits. Electron microscopy showed marked increase of mesangial matrix, mesangial cell proliferation, moderate effacement of foot processes, and glomerular basement thickening without electron-dense deposits or other specific fibrils. Idiopathic nodular glomerulosclerosis was diagnosed. After discharge, he continued smoking and his blood pressure was not controlled. Three months after first biopsy, second biopsy was performed because of increasement of serum creatinine and specimens showed progression of tubulointerstitial change and nodular mesangial sclerosis. Subsequent serum creatinine was progressively increased and hemodialysis was started 13 months after diagnosis.

Molecular Genetics in Ischemic Stroke / 대한뇌혈관외과학회지

Ischemic stroke is a heterogeneous disease caused by different pathogenic mechanisms, of which small artery and large artery stroke are the most common. Although the identification of the genes involved is unclear, genetic factors are increasingly recognized as influencing risk for atherosclerosis or arteriolosclerosis directly and indirectly. Genetic makeup may influence the development of major vascular risk factors or alter susceptibility of the cerebral vasculature to these risk factors. Some researchers have reported that atherosclerosis is high in people with functional variants of genes related to matrix deposition (matrix metalloproteinase 3), inflammation (interleukin-6), and lipid metabolism (hepatic lipase, apolipoprotein E, cholesteryl ester transfer protein, and paraoxonase) and clotting (factor V Leiden, fibrinogen). More recently, newly identified risk factors for atherosclerosis, such as plasma homocysteine (5,10-methylenetetrahydrofolate reductase). In this review, we assess the robustness of these associations and examine whether there is any evidence of risk modifications by factors, such as smoking.

Clinical Analysis Of Iga Nephropathy In Patients Over 50 Years Of Age / 대한내과학회지

BACKGROUND: IgA nephropathy is recognized as a disease affecting primarily young men under 30 years of age but it is relatively uncommon over 50 years of age. Findings on clinical and histological presentation and outcome of over 50 years of age have rarely published in Korea. METHODS: Between Febrary 1994 and July 2003, one hundred and thirty nine IgAN patients were recruited over 8 years. Nineteen patients over age 50 were compared to one hundred and twenty patients under age 50 clinical, histological findings, 5-Yr renal survival rate. Mean post-biopsy follow-up month was 23.8 +/- 23.5 months. RESULTS: Both group of patients were similar to baseline for gross hematuria, Male and female ratio. But older patients had a higher incidence of daily for 24 hour urine protein (p=0.010), systolic and diastolic blood pressure (p=0.010, p<0.01), serum C3 (p=0.001) and serum C4 (p=0.003). Albumin (p=0.011), creatinine clearance (p<0.01) were significantly lower in the older patients at the time of renal biopsy. Histologic grade IV was more common in the older patients (p=0.001). Moderate to severe mesangial proliferation (p=0.001) and crescent formation (p=0.043), arteriolosclerosis (p=0.006) were more common in older patients. Mesangial small deposition of IgA (p=0.007) and glomerular peripheral deposition of IgG, IgA, C1q (p=0.024, p=0.014, p=0.009) were more common in older patients than in under 50 years of age. Mesangial small electron dense deposits were more common in older patients than in younger patients (p=0.031). CRF (Ccr < 60 mL/min) was confirmed 55.6% over age 50 and 27.4% under age 50 (p=0.017). Renal replacement therapy was done 15.8% over age 50 and 4.3% under age 50 (p=0.048). 5-Year renal survival curves showed that kidney survival rate was 44.4% over age 50 and 72.6% under age 50 (p=0.0248). CONCLUSION: Poor prognostic factors were more common over age 50 than under age 50. CRF and renal replacement therapy were more common over age 50. Analysis of renal survival curves shows that the probability of developing ESRF increase after age 50. But, prolonged prospective follow-up is necessary to confirm this trend.

The Relationship between the Histological Findings and beta ig-h3 in IgA Nephropathy / 대한신장학회잡지

BACKGROUND: TGF-beta is involved in the pathogenesis of various kidney diseases characterized by glomerulosclerosis and tubulointerstitial fibrosis. It is reported that urinary TGF-beta reflects the grade of interstitial fibrosis in glomerular disease. Here, we evaluated the relationship between the histological findings and beta ig-h3 in IgA nephropathy. METHODS: In patients with IgA nephropathy, we measured blood pressure (BP), serum creatinine, 24-hour urinary protein excretion (UTp), creatinine clearance (Ccr), serum and urine beta ig-h3 levels, and urine TGF-beta levels at the time of renal biopsy. Histologic findings were semiquantitively scored according to the extent of glomerulosclerosis (GG), tubulointerstitial fibrosis (TIG) and hyaline arteriolosclerosis (HA) by the criteria suggested by To. Semiquantitive scoring of immunohistochemistry for beta ig-h3 was done. RESULTS: Mean BP 95.4+/-14.5 mmHg, serum creatinine 1.06+/-0.35 mg/dL, 24-hour UTp 1, 423+/-1, 439 mg/day, and Ccr was 97.84+/-59.73 mL/min. The number of patients that showed GG 3 were 5, GG 2 was 1, GG 1 were 12. And, the number of patients that showed TIG 3 were 2, TIG 2 were 5, TIG 1 were 11. HA was shown in 4 patients. beta ig-h3 immunostaining was observed in glomerular Bowman's capsules and basement membrane of proximal tubules. The degree of beta ig-h3 immunostaining was positively correlated with the degree of glomerulosclerosis (r=0.72, p<0.001), interstitial fibrosis (r=0.91, p<0.001), serum creatinine (r=0.592, p<0.05) and Ccr (r=-0.626, p<0.05), but not with 24-hour UTp. Serum and urine beta ig-h3 levels did not correlate with any of these parameters. CONCLUSION: Renal beta ig-h3 expression in patients with IgA nephropathy may be related to glomerulosclerosis and interstitial fibrosis. However, urinary beta ig-h3 levels did not represent the pathologic changes of IgA nephropathy. Long-term study to measure renal beta ig-h3 expression and urinary beta ig-h3 is required to elucidate the roles of beta ig-h3 in IgA nephropathy.

Relationship between Diabetic Retinopathy and Arteriolosclerosis in Patients with NIDDM (Non-insulin-dependent diabetes mellitus)

PURPOSE: To evaluate the correlation between diabetic retinopathy (DR) and arteriolosclerosis in patients with NIDDM (non-insulin-dependent diabetes mellitus), to investigate the risk factors of DR, and to assess the change of the correlation according to the risk factors. METHODS: The study subjects were selected from consecutive routine clinical visits by random sampling from July 2002 to June 2003. The patients were divided into two groups according to the presence of DR, and the patients' charts, fundus examination and blood test were retrospectively reviewed. ETDRS (Early Treatment DR Study) classification for DR and Scheie classification for arteriolosclerosis were used. Statistical analysis was conducted with SPSS program (version 10.0). The confidence interval was set to 95%, and the level of significance was set at p=0.05. RESULTS: DR had a statistically significant correlation with arteriolosclerosis, especially according to duration of diabetes mellitus (p<0.05). Risk factors including diabetes mellitus duration, HgA1c level, and LDL (low-density lipoprotein) cholesterol level showed statistically significant difference (p<0.05). CONCLUSIONS: From the result of analysis, DR has a statistically significant correlation with arteriolosclerosis, especially according to the duration of diabetes mellitus. To prevent vision-threatening complications of DR, the degree of arteriolosclerosis as well as risk factors such as diabetes mellitus duration, serum HgA1c level, and LDL (low-density lipoprotein) cholesterol level should be carefully considered and monitored in the evaluation, progression, and treatment of DR.

The Influences of Arteriosclerosis on the Development and Progression of Diabetic Retinopathy

To evaluate the relationship between arteriolosclerosis and diabetic retinopathy, we graded the levels of diabetic retinopathy and arteriolosclerosis and compared each other in 255 patients with non-insulin dependent diabetes. And we also measured serum lipid levels and checked other risk fac-tors for diabetic retinopathy. SPSS was used for statistical analysis. Patients with advanced arteriolosclerosis were at higher risk of severe diabetic retinopathy. And patients with elevated plasma total cholesterol, LDL-C, TG had more severe levels of diabetic retinopathy than whose lipid levels were normal. These results suggested that advanced arteriolosclerosis and elevated serum lipid levels are associated with severe diabetic retinopathy. For preventing visual threatening complications of diabetic retinopathy, the degree of arteriolosclerosis and serum lipid levels should be carefully monitored in the evaluation of diabetic retinopathy.

A Study on Histogenesis of Glomerular Obsolescence in Renal Tuberculosis: An Appraisal for the Clarification of Low Prevalence of Hypertension / 대한비뇨기과학회지

Glomerular obsolescence is a common histologic feature in various renal diseases, of which histogenesis remains unclarified especially in renal tuberculosis, and little has been attributed for the postulation of low prevalence of hypertension in such occasion. One hundred and fifty consecutive nephrectomy specimens with renal tuberculosis under the age of 50 were histopathologically analyzed along with comparison of 18 cases of chronic pyelonephritis, 15 hydronephrosis and 10 acute traumatic kidneys. Glomerular sclerosis following tuberculous glomerulitis seemed little significant in its histogenesis except in one case, which presented epitheliold cell reaction and crescent formation. Wrinkling and thickening of glomerular basement membrane and subsequent simplification of tufts with mesangiolysis(Stage I and II) represented the major alternative glomerulopathy in nodular renal tuberculosis, whereas in confluent ulcero-cavitary lesion the development of hyalin-knot within the Bowman's space and collapse of the tufts (Stage III and IV) comprised the bulk, aside from frequent intraglomerular shunt formation between afferent and efferent arterioles mostly in autonephrectomized cases, Arteriolosclerosis was found in 17.2 % among nodular type, while 26.7% in ulcero-cavitary, variety, partly responsible for the histogenesis of glomerular obsolescence. Those cases with moderate arterio and arteriolar sclerosis showed a high tendency of transformation into stage III-IV obsolescence especially in ulcero-cavitary tuberculosis. Relative prevalence rate of systolic hypertension in ulcerocavitary tuberculosis was 5.8%, two times higher than nodular type, but in only one case the post-operative blood pressure returned to normal range. With the above findings it is assumed that glomerular oboslescence of so-called hypertensive glomerulopathy is a subtype of ischemic nature, and induced not only by vascular is chemic changes but also compromised through the intra-renal tubular obstruction and intraglomerular capillary shunt formaion may attribute to the development of secondary hypertension, though rare, in renal tuberculosis associated with arteriosclerot ic changes as well.