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South African Medical Journal

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Focal segmental glomerulosclerosis in malignant hypertension

S Kadiri, JO Thomas

Abstract


Objective. Focal segmental glomerulosclerosis (FSG) may occur in primary malignant hypertension (MHT) either as a result of glomerular hyperfi1tration 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 needlebiopsy 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 pmol/1 (425752 pmol!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 pmol/l (106 - 1 274umol/l IQ range), 522 umol/l (248 - 991 umol/l) and 1 230 pmol!l (920 - 1 558 pmol/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 priinary MHT and may contribute to renal dysfunction.




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