Clinical features and prognostic factors of chronic glomerulonephritis with malignant hypertension / 中华肾脏病杂志

ABSTRACT

Objective To find out the clinical characteristics and prognostic risk factors of malignant hypertension (MHT) with pre existed chronic glomerulonephritis.Method The clinical and renal pathological data of 38 chronic glomerulonephritis patients with MHT hospitalized in our department from 1990 to 2002,and the associated factors for renal prognosis were analyzed. Results All the patients suffered from chronic glomerulonephritis.The ratio of male to female was 3 75∶1.The average age was (29 5?7 74)years old. The rates of recognition, therapy and control of hypertension before MHT onset were 75 7%, 13 5%and 5 4%respectively. IgA nephropathy was the most common pathological type.Of 38 cases,3 maintained normal renal function, 6 presented acute renal failure,13 presented chronic renal failure, and 16 had acute attack based on chronic renal failure. Twenty four patients were followed up for 1～6 months after antihypertensive therapy and renal function of 10(41 7%) was improved. 1 year renal survival rate of 20 patients was 55%. The analysis of risk factors showed that those patients who were possessed of positive hypertension family history(P=0 03), high SBP/DBP levels(P=0 023,0 047), and high scores of chronic index of renal pathology(P=0 032) had worse prognosis. The level of highest serum creatinine and the scores of chronic index of renal pathology were associated with 1 year renal survival(P=0 031,0 037).Conclusions MHT occuring in young patients with chronic glomerulonephritis is not rare, which becomes an important reason inducing rapidly decrease of renal function, especially in patients with IgA nephropathy. Actively antihypertensive therapy is helpful for renal function recovery. The low rates of recognition, therapy and control of pre existed renal hypertension may play key roles in the development of MHT. It is important to recognize and treat the hypertension at early stage of renal disease to improve the renal survival.