EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Introduction and Aims: Hypertensive renal damage has become one of the most important causes of end-stage renal disease and renal replacement therapy. Affected patients rarely have a kidney biopsy and their diagnoses therefore remain uncertain. Moreover, in the case of hypertensive patients with mild proteinuria, nephrologists tend to make a diagnosis of benign nephrosclerosis without renal biopsy.

The objective of the present study was to examine patients suspected of renal glomerular disease, which at biopsy proved to have isolated benign nephrosclerosis or mesangioproliferative glomerulonephritis (MPGN).

Methods: We performed semi quantitative histopathological analysis in 81 patients (M:F 45:36) with hypertension and mild proteinuria of less than 2.0 g/day. According to light microscopy results patients were divided into to 2 groups: group 1 patients with isolated benign nephrosclerosis (n = 42; M:F 22:20), and group 2 patients with MPGN (n = 39; M:F 23:16).

We related histopathological parameters and some clinical data: systolic blood pressure (sBP), diastolic BP (dBP), mean BP (mBP), glomerular filtration rate (GFR), using abbreviated MDRD formula, and daily proteinuria, in studied groups.

Resuts: There was no significant difference in mean proteinuria (meanSE) between group 1 and 2 (1.050.18 and 0.780.10 g/day, respectively; P=0.2). However, the age of patients (48.41.5 #1080; 39.62.04 yrs; respectively, P=0.007), duration of hypertension (13.61.5 and 5.90.7 yrs, respectively; P<0.005), sBP (1724 and 1494 mm Hg, respectively; P=0.0005), dBP (1012 and 932, respectively; P=0.01), and mBP (1252 and 1122, respectively; P=0.002) were significantly higher in group 1 than in group 2. At the same time mean GFR was lower in group 1 (61.8+4.4 and 80.7+4.5 mL/min, respectively; P=0.004).

The percentage of globally sclerotic glomeruli was significantly higher in group 1, comparing with group 2 (23.43.4 and 8.12.1, respectively; P=0.0003), as well as the percentages of glomeruli with periglomerular sclerosis (11.73.7% and 0.0%, respectively; P=0.0026). The grades of tubular atrophy (0.890.15 and 0.380.08, respectively; P=0.009), interstitial fibrosis (1.340.17 and 0.870.11, respectively; P=0.02), arterial intima elastofibrosis (0.550.14 and 0.130.07, respectively; P= 0.02), and arteriolar hyalinosis (1.250.18 and 0.380.11, respectively; P<0.0001) were also higher in group 1.

Conclusions:

In mild proteinuria renal histopathological changes are more severe in hypertension than in MPGN, possibly because of higher age, duration of hypertension and levels of BP in patients with essential hypertension.