Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study

Background: Although malignant hypertension begets multiple target organ damage, there is limited data on patients with severe renal injury and evident malignant hypertension in renal histopathology. Methods: We assessed the baseline demographic, histopathological findings and clinical outcomes in t...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Satish Haridasan, P S Priyamvada, Dhanin Puthiyottil, Arjun Pradeep, Sreejith Parameswaran, B H Srinivas, Rajesh Nachiappa Ganesh
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer Medknow Publications 2021
Materias:	creatinine crescent fibrinoid malignant hypertension outcome Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/44a4da96578c4397b41f4fdd2be7010a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:44a4da96578c4397b41f4fdd2be7010a
record_format	dspace
spelling	oai:doaj.org-article:44a4da96578c4397b41f4fdd2be7010a2021-12-02T17:49:11ZCharacteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study0971-40651998-366210.4103/ijn.IJN_187_20https://doaj.org/article/44a4da96578c4397b41f4fdd2be7010a2021-01-01T00:00:00Zhttp://www.indianjnephrol.org/article.asp?issn=0971-4065;year=2021;volume=31;issue=5;spage=467;epage=473;aulast=Haridasanhttps://doaj.org/toc/0971-4065https://doaj.org/toc/1998-3662Background: Although malignant hypertension begets multiple target organ damage, there is limited data on patients with severe renal injury and evident malignant hypertension in renal histopathology. Methods: We assessed the baseline demographic, histopathological findings and clinical outcomes in this retrospective analysis of patients with biopsy-proven malignant hypertension. Results: Thirty cases were analysed, the mean age of patients was 40 ± 11.5 years, 28 (93.3%) were males and the average systolic and diastolic blood pressures at hospitalisation were 197.04 ± 24.14 and 117.41 ± 18.31 mmHg, respectively. Severe retinopathy was seen in 10 (33.3%). The median eGFR at admission was 6.3 (IQR 4.4–9.15) mL/min and 21 (72.4%) needed dialysis. Nine (30%) cases with glomerular crescents were having the primary glomerular disease (7 IgAN, 1 C3 glomerulonephritis, 1 membranoproliferative glomerulonephritis) and 17 (56.6%) had thrombotic microangiopathy. Three-month ESRD free survival was 34.5% (n = 10) and the ESRD cohort had more incidence of dialysis requiring kidney injury at presentation (94.4% vs. 40% in the non-ESRD cohort). Patient survival at 1 year was 50%. Isolated malignant hypertension, differed from others with regard to lesser incidence of severe retinopathy, less glomerular sclerosis (29.61 ± 15.86 vs. 48.45% ± 30.78; P = 0.03), absence of crescents (P = 0.02), more incidence of tuft wrinkling (100% vs. 35%, P = 0.00) and total vessel occlusion (P = 0.02). Conclusion: Clinicopathologically, accelerated essential hypertension differs from hypertension of glomerular disease. Degree of kidney injury at presentation is risk predictor for long-term morbidity in malignant hypertension.Satish HaridasanP S PriyamvadaDhanin PuthiyottilArjun PradeepSreejith ParameswaranB H SrinivasRajesh Nachiappa GaneshWolters Kluwer Medknow Publicationsarticlecreatininecrescentfibrinoidmalignant hypertensionoutcomeDiseases of the genitourinary system. UrologyRC870-923ENIndian Journal of Nephrology, Vol 31, Iss 5, Pp 467-473 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	creatinine crescent fibrinoid malignant hypertension outcome Diseases of the genitourinary system. Urology RC870-923
spellingShingle	creatinine crescent fibrinoid malignant hypertension outcome Diseases of the genitourinary system. Urology RC870-923 Satish Haridasan P S Priyamvada Dhanin Puthiyottil Arjun Pradeep Sreejith Parameswaran B H Srinivas Rajesh Nachiappa Ganesh Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
description	Background: Although malignant hypertension begets multiple target organ damage, there is limited data on patients with severe renal injury and evident malignant hypertension in renal histopathology. Methods: We assessed the baseline demographic, histopathological findings and clinical outcomes in this retrospective analysis of patients with biopsy-proven malignant hypertension. Results: Thirty cases were analysed, the mean age of patients was 40 ± 11.5 years, 28 (93.3%) were males and the average systolic and diastolic blood pressures at hospitalisation were 197.04 ± 24.14 and 117.41 ± 18.31 mmHg, respectively. Severe retinopathy was seen in 10 (33.3%). The median eGFR at admission was 6.3 (IQR 4.4–9.15) mL/min and 21 (72.4%) needed dialysis. Nine (30%) cases with glomerular crescents were having the primary glomerular disease (7 IgAN, 1 C3 glomerulonephritis, 1 membranoproliferative glomerulonephritis) and 17 (56.6%) had thrombotic microangiopathy. Three-month ESRD free survival was 34.5% (n = 10) and the ESRD cohort had more incidence of dialysis requiring kidney injury at presentation (94.4% vs. 40% in the non-ESRD cohort). Patient survival at 1 year was 50%. Isolated malignant hypertension, differed from others with regard to lesser incidence of severe retinopathy, less glomerular sclerosis (29.61 ± 15.86 vs. 48.45% ± 30.78; P = 0.03), absence of crescents (P = 0.02), more incidence of tuft wrinkling (100% vs. 35%, P = 0.00) and total vessel occlusion (P = 0.02). Conclusion: Clinicopathologically, accelerated essential hypertension differs from hypertension of glomerular disease. Degree of kidney injury at presentation is risk predictor for long-term morbidity in malignant hypertension.
format	article
author	Satish Haridasan P S Priyamvada Dhanin Puthiyottil Arjun Pradeep Sreejith Parameswaran B H Srinivas Rajesh Nachiappa Ganesh
author_facet	Satish Haridasan P S Priyamvada Dhanin Puthiyottil Arjun Pradeep Sreejith Parameswaran B H Srinivas Rajesh Nachiappa Ganesh
author_sort	Satish Haridasan
title	Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
title_short	Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
title_full	Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
title_fullStr	Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
title_full_unstemmed	Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study
title_sort	characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: a retrospective study
publisher	Wolters Kluwer Medknow Publications
publishDate	2021
url	https://doaj.org/article/44a4da96578c4397b41f4fdd2be7010a
work_keys_str_mv	AT satishharidasan characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT pspriyamvada characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT dhaninputhiyottil characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT arjunpradeep characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT sreejithparameswaran characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT bhsrinivas characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy AT rajeshnachiappaganesh characteristicsandoutcomeofbiopsyprovenmalignanthypertensionwithseverekidneyinjuryaretrospectivestudy
_version_	1718379462220840960

Characteristics and outcome of biopsy-proven malignant hypertension with severe kidney injury: A retrospective study

Ejemplares similares