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Multifactoral analysis of determinators for renal injury in essential hypertension

Journal of Human Hypertension volume 20, pages 93–95 (2006)Cite this article

The long-standing essential hypertension causes renal injury.1 There is no doubt, however, that other factors besides elevated blood pressure contribute to the development and progression of hypertensive nephropathy (HN).2 To shed more light on this issue, we performed a case–control, cross-sectional study to identify determinants of renal complications of essential hypertension correlating them with surrogate markers of kidney injury in hypertensives presenting microalbuminuria or proteinuria. To assess the enhancement of kidney involvement, von Willebrand factor (vWf) plasma activity, albuminuria and N-acetyl-β-D-glucosaminidase (NAG) excretion were determined as markers of endothelial, glomerular and tubular injury, respectively. The excess of kidney fibrosis was indirectly evaluated by urine excretion of transforming growth factor β-1 (TGF-β1), the most potent profibrotic cytokine.3, 4, 5

The detailed screening of medical history of over 6000 patients from four renal outpatient centers in Austria and Poland was performed. The main inclusion criteria were as follows: in the history: long-standing essential hypertension preceding the onset of proteinuria by minimum 10 years, proteinuria below 2.0 g/24 h, normal urine sediment, the presence of either hypertensive retinopathy or hypertensive left-ventricular hypertrophy; at the time of evaluation: the presence of microalbuminuria or macroalbuminuria in two independent urine spot samples. Only subjects whose antihypertensive regimens and lipid-lowering agents doses were not modified in the past 6 months and those with serum creatinine level below 1.5 mg/dl were included. Patients with diabetes, chronic pyelonephritis, primary glomerulonephritis, and peripheral arterial disease were excluded. Finally, 82 patients were recruited to the case group defined arbitrary as HN. In 23 of 82 individuals, the diagnosis of HN was confirmed in the histological examination demonstrating nephroangiosclerosis. The control group contains 41 age- and sex-matched healthy subjects (2 : 1 relationship), without hypertension and any signs of kidney damage. There were 52 current smokers in the case group and 23 among controls.

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Authors and Affiliations

  1. Department of Nephrology Transplantology and Internal Medicine, Medical University, Gdańsk, Poland

    L Tylicki, P Rutkowski, T Nieweglowski & B Rutkowski

  2. Division of Nephrology and Dialysis, Department of Medicine III, University Hospital, Vienna, Austria

    H Puttinger & W H Hörl

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  1. L Tylicki
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  2. H Puttinger
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  3. P Rutkowski
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  4. T Nieweglowski
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  5. B Rutkowski
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  6. W H Hörl
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Tylicki, L., Puttinger, H., Rutkowski, P. et al. Multifactoral analysis of determinators for renal injury in essential hypertension. J Hum Hypertens 20, 93–95 (2006). https://doi.org/10.1038/sj.jhh.1001935

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