恶性高血压为主要表现的IgA肾病的临床和病理特点分析

目的探讨以恶性高血压（MHT）为主要表现的IgA肾病（IgAN）的临床、病理特点和预后。方法对32例主要表现为MHT的IgAN患者（IgAN-MHT组）的临床、病理资料进行回顾性分析,随访其预后。并与30例无MHT的IgAN患者（IgAN组）进行比较。结果 IgAN-MHT组13例表现为急性肾损伤,8例为肾病综合征,7例为肉眼血尿。随访期内多数病例均表现为进行性肾功能损害。IgAN组4例表现为肾病综合征,3例呈肉眼血尿。随访期内肾功能无明显进展。IgAN-MHT组前驱感染发生率明显高于IgAN组（P〈0.05）,从发病至肾活检的时间明显较IgAN组短（P〈0.01）,血清肌酐、尿酸、C-反应蛋白及尿蛋白水平均较对照组明显升高（P〈0.01）。肾活检病理示IgAN-MHT组肾小球、间质、血管病变明显较IgAN组重,IgAN-MHT组Lee’s分级≥Ⅲ级所占比例明显较IgAN组高（100%比53.3%,P〈0.01）。结论主要表现为MHT的IgAN临床病情及肾脏病变严重,预后差。影响肾功能转归的因素可能包括肾活检前MHT持续的时间、肾活检时血肌酐值、肾脏病变的严重程度和降压治疗是否达标。

Clinical and pathologic characteristics analysis of IgA nephropathy with malig nant hypertension

Objective To analyze the clinicopathological characteristics and prognosis of IgA nephropathy （IgAN） with malignant hypertension （MHT）. Methods The clinical and histological data of 32 cases with IgAN accompanied with MHT were analyzed retrospectively （ IgAN-MHT group） and compared with 30 IgAN cases without MHT in control group （ IgAN gourp）. Results Of the 32 patients of IgAN-MHT group, acute kidney injure was the most common clinical manifestation （ 13 cases） , 8 were nephritic syndrome, 7 presented gross hematuria. Most of IgAN-MHT group patients showed accelerated kidney function loss during followup. In IgAN gourp ,4 cases showed nephritic syndrome ,3 cases showed gross hematuria. There was no obviously deteriorated tenden- cy of kidney function during follow-up. The incidence of prodromal infection in IgAN-MHT patients was higher than that in controls （ P 〈 0.05 ）. Duration from discomforts to renal biopsy of IgAN-MHT patients was much longer than that of IgAN group （ P 〈 0.01 ）. Compare with controls, serum creatinine, urieacid, and C-reactive protein levels were significantly increased in IgAN-MHT patients （P 〈 0.01 ）. Serious pathological changes of glomeruli, renal interstitium and interstitum vascular were found in IgAN- MHT patients. According to Lee classification, the pathological classifications more than grades m account for 100% in IgAN-MHT group, while 53.3% in controls （ P 〈 0.01 ）. Conclusion Renal lesion in IgAN with MHT is serious, the condition is severer and the prognosis is worse. The prognosis may depend on duration, serum creatinine level at the time of biopsy, the degree of pathological damage and whether antihypertensive treatment reaches standards.