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Focal segmental glomerulosclerosis in malignant hypertension
1Department of Medicine, University College Hospital, Ibadan, Nigeria.
Objective:
Focal segmental glomerulosclerosis (FSG) may occur in primary malignant hypertension (MHT) either as a result of glomerular hyperfiltration or fibrinoid necrosis (FN), and may contribute to renal dysfunction. To determine the frequency of occurrence and distribution of FSG in primary MHT we studied renal biopsy specimens from 38 black Africans--30 postmortem and 8 needle-biopsy specimens.
Subjects:
There were 31 male subjects and 7 female, with a mean age of 46 (+/- 7) years.
Results:
Mean blood pressure (BP) was 206 +/- 15/137 +/- 9 mmHg, median 24-hour proteinuria (interquartile (IQ) range) was 5.1 g (3.3-6.5 g), median serum albumin 3.4 g (3.2-3.8 g) and median serum creatinine 540 mumol/l (425-752 mumol/l). Mucoid intimal proliferation was present in all the sections but FN was seen in 29 (76%). Glomerulosclerosis was present in all the sections, and was axially distributed in 7 (18%), segmentally in 22 (58%), and globally in 9 (24%). Median 24-hour proteinuria was 2.8 g (0.8-3.5 g IQ range), 5.6 g (1.7-8.1 g) and 3.4 g (2.6-4.0 g) respectively, and corresponding values of serum creatinine were 770 mumol/l (106-1,274 mumol/l IQ range), 522 mumol/l (248-991 mumol/l) and 1,230 mumol/l (920-1,558 mumol/l) respectively.
Conclusion:
The distribution of glomerulosclerosis did not appear to relate to proteinuria or serum creatinine, although cases with segmentally distributed glomerulosclerosis appeared to have the highest proteinuria, and those with global glomerulosclerosis appeared to have the highest serum creatinine levels. FSG therefore occurs prominently in primary MHT and may contribute to renal dysfunction.
Insights
Focal segmental glomerulosclerosis (FSG) is common in primary malignant hypertension (MHT) and may cause kidney damage. This study found FSG in all examined biopsy specimens, highlighting its role in renal dysfunction.
Area of Science:
- Nephrology
- Pathology
- Hypertension Research
Background:
- Focal segmental glomerulosclerosis (FSG) is a potential complication of primary malignant hypertension (MHT).
- FSG can arise from glomerular hyperfiltration or fibrinoid necrosis (FN), contributing to renal dysfunction.
- Understanding the prevalence and patterns of FSG in MHT is crucial for patient management.
Purpose of the Study:
- To determine the frequency and distribution of FSG in renal biopsy specimens from patients with primary MHT.
- To investigate the relationship between FSG patterns and indicators of renal dysfunction, such as proteinuria and serum creatinine levels.
Main Methods:
- Analysis of renal biopsy specimens from 38 Black African subjects (30 postmortem, 8 needle biopsies).
- Histopathological examination to identify FSG, fibrinoid necrosis (FN), and mucoid intimal proliferation.
- Correlation of glomerulosclerosis distribution (axial, segmental, global) with clinical data including blood pressure, 24-hour proteinuria, serum albumin, and serum creatinine.
Main Results:
- Mucoid intimal proliferation was observed in all specimens; FN was present in 76%.
- Glomerulosclerosis was universally present, with segmental distribution in 58% of cases.
- While overall distribution showed no clear relation to proteinuria or creatinine, segmental FSG correlated with higher proteinuria, and global FSG with higher serum creatinine.
Conclusions:
- Focal segmental glomerulosclerosis (FSG) occurs prominently in primary malignant hypertension (MHT).
- The distribution of FSG, particularly segmental and global patterns, may be associated with the severity of renal dysfunction.
- FSG is a significant contributor to renal impairment in patients with primary MHT.