Impact of Hypertension and Hypertension-Related Vascular Lesions in IgA Nephropathy

Ikee, Ryota; Kobayashi, Shuzo; Saigusa, Takamitsu; Namikoshi, Tamehachi; Yamada, Muneharu; Hemmi, Noriaki; Imakiire, Toshihiko; Kikuchi, Yasufumi; Suzuki, Shigenobu; Miura, Soichiro

doi:10.1291/hypres.29.15

Cited by 27 publications

(24 citation statements)

References 18 publications

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“…According to the study for patients with biopsy-proven IgA nephropathy, patients with hypertension, defined as BP Ն140/90 mmHg, had more severe glomerular sclerosis, interstitial fibrosis/tubular atrophy, interstitial infiltration, and atherosclerosis compared with those without hypertension. 17 In a similar biopsy study for IgA nephropathy, prehypertension (BP 120 to 139/80 to 89 mmHg) was associated significantly with the severity of mesangial proliferation and arteriolar changes, including intimal thickening, intimal duplication or hyalinosis, but not glomerular sclerosis. 18 These findings are in accordance with those of our study.…”

Section: Discussionmentioning

confidence: 92%

Prehypertension Increases the Risk for Renal Arteriosclerosis in Autopsies

Ninomiya¹,

Kubo²,

Doi

et al. 2007

Journal of the American Society of Nephrology

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Information regarding the association between prehypertension BP level and renal arteriosclerosis is limited. In 652 consecutive population-based autopsy samples without hypertension treatment before death, the relationship between the severity of renal arteriosclerosis and BP levels classified according to the criteria of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure was examined. The age-and gender-adjusted frequencies of renal arteriosclerosis linearly increased with elevating BP levels; both hypertensive and prehypertensive subjects had significantly higher frequencies of renal arteriosclerosis than subjects with normal BP (normal 11.9%; prehypertension 28.5%; stage 1 hypertension 32.9%; stage 2 hypertension 58.2%; all P Ͻ 0.01 versus normal). In a logistic regression model, prehypertension was significantly associated with renal arteriosclerosis after adjustment for other cardiovascular risk factors (prehypertension multivariate-adjusted odds ratio [mOR] . This significant association was observed for all renal arterial sizes. The similar association was also observed for arteriolar hyalinosis. When the subjects were divided into those with and those without target organ damage, the impact of prehypertension on renal arteriosclerosis was similar for both groups (subjects without target organ damage mOR 5.04 [95% CI 1.36 to 18.62]; subjects with target organ damage mOR 6.42 [95% CI 1.29 to 32.04]). These findings suggest that both hypertension and prehypertension are associated significantly with the severity of renal arteriosclerosis, regardless of the presence or absence of target organ damage.

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Section: Discussionmentioning

confidence: 92%

Prehypertension Increases the Risk for Renal Arteriosclerosis in Autopsies

Ninomiya¹,

Kubo²,

Doi

et al. 2007

Journal of the American Society of Nephrology

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“…8 Among these pathological changes, renal arterio-arteriolosclerosis is important, because it is known to be related to renal function and prognosis. [9][10][11][12] However, whether clinical factors other than hypertension have an impact on renal arterioarteriolosclerosis remains to be elucidated. Therefore, we noted glucose metabolism/insulin resistance as a cause of renal arterioarteriolosclerosis in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Hypertension is known to have an important function in the pathogenesis of renal arterio-arteriolosclerosis. [12][13][14] In clinical practice, however, the evidence of renal arterio-arteriolosclerosis is sometimes found even in renal biopsy specimens of patients without hypertension. For example, Wu et al 11 reported that 42 of 191 normotensive patients with IgA nephropathy had moderate to severe renal arterio-arteriolosclerosis.…”

Section: Introductionmentioning

confidence: 99%

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

et al. 2010

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Hypertension has an important function in the formation of renal arterio-arteriolosclerosis. However, renal arterioarteriolosclerosis is sometimes found in biopsy specimens of normotensive patients, which indicates unknown factors may contribute to renal arterio-arteriolosclerosis. In this study, we aimed to evaluate the effects of glucose metabolism/insulin resistance on renal arterio-arteriolosclerosis. Forty-eight patients with biopsy-proven non-diabetic chronic glomerular disease were included. Renal arterio-arteriolosclerosis was evaluated as the percentage of vessels showing hyaline changes or wall thickening. We correlated renal arterio-arteriolosclerosis with clinical parameters including indices obtained by 75 g oral glucose tolerance test. Of the 48 patients, 30 had hypertension. The results of univariate analysis showed significant association of renal arterio-arteriolosclerosis with hypertension, increased serum creatinine (S-Cr), hypertriglyceridemia, increased 2-h plasma glucose (PG) and increased 2-h plasma insulin (PI). In stepwise multiple regression analysis, hypertension (b¼0.344, P¼0.009), S-Cr (b¼0.287, P¼0.03) and 2-h PG (b¼0.274, P¼0.03) were independently associated with renal arterioarteriolosclerosis. Eleven of the 30 hypertensive patients did not have renal arterio-arteriolosclerosis. The hypertensive patients with renal arterio-arteriolosclerosis showed significantly higher 2-h PG (134 ± 25 vs. 106 ± 26 mg per 100 ml, P¼0.008) and higher 2-h PI (67.7 ± 34.9 vs. 48.3 ± 30.0 lU ml À1 , P¼0.04) compared with those without renal arterio-arteriolosclerosis, but the difference in S-Cr was not significant. Postprandial hyperglycemia and hyperinsulinemia may contribute to the formation of renal arterio-arteriolosclerosis independently of hypertension.

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“…Arterio-arteriolosclerosis is another marker of renal function and prognosis in CKD [27, 33]. Therefore, it is of interest that 2-h PG correlated with arterio-arteriolosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Glucose Metabolism, Insulin Resistance, and Renal Pathology in Non-Diabetic Chronic Kidney Disease

et al. 2008

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Background: The relation between insulin resistance and atherosclerosis is widely recognized, but it remains unknown whether glucose metabolism/insulin resistance is related to renal pathology in humans. Methods: We quantitatively evaluated pathological changes in the glomeruli, tubulointerstitium, and vessels in renal biopsy specimens from 23 patients with non-diabetic chronic kidney disease (CKD), all of whom took a 75-gram oral glucose tolerance test. We correlated the renal pathological changes with fasting plasma glucose (FPG), fasting plasma insulin, 2-hour plasma glucose (2-h PG), 2-hour plasma insulin (2-h PI), homeostasis model assessment of insulin resistance (HOMA-IR), and body mass index. Results: HOMA-IR exceeded 1.73 in 11 patients (47.8%), and 2-h PI exceeded 64.0 µU/ml in 14 (60.9%). FPG significantly correlated with interstitial fibrosis (r = 0.532, p = 0.009). The significance was marginal in the correlation between FPG and tubular atrophy and arterio-arteriolosclerosis. Statistically significant correlation was also found between 2-h PG and arterio-arteriolosclerosis (r = 0.422, p = 0.04) and between HOMA-IR and interstitial fibrosis (r = 0.416, p = 0.04). Conclusion: Although precise mechanisms remain unknown, glucose metabolism/insulin resistance seem to play pathogenic roles in formation and progression of renal pathological changes, especially tubulointerstitial and vascular lesions, in non-diabetic CKD.

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Impact of Hypertension and Hypertension-Related Vascular Lesions in IgA Nephropathy

Cited by 27 publications

References 18 publications

Prehypertension Increases the Risk for Renal Arteriosclerosis in Autopsies

Prehypertension Increases the Risk for Renal Arteriosclerosis in Autopsies

Postprandial hyperglycemia and hyperinsulinemia associated with renal arterio-arteriolosclerosis in chronic kidney disease

Glucose Metabolism, Insulin Resistance, and Renal Pathology in Non-Diabetic Chronic Kidney Disease

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