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Abstract
Hypertensive Renal Damage Has Becom One Of The Most Important Causes Of End-Stage Renal Failure (ESRF). Affected Patients Rarely Have A Kidney Biopsy And Their Diagnosis Therefore Remain Uncertain (Vikse Etal., 2003).
The Topic Of Hypertension And Renal Injury Has Received Growing Interest In The Decade Mostly Due To The Data Offered By The End-Stage Renal Disease (ESRD) Registries.
Aim Of The Work
The Objective Of This Study Is To Determine The Factors That May Affecting The Appearance Of Microalbuminuria In Essential Hypertensive Patients, And The Histopathological Changes That May Occur In The Kidneys Of These Patients.Introduction Hypertension is the first leading cause of renal failure in Egypt and there were many studies have been taken to discover the relationship between hypertension and renal failure and if essential hypertension per se can lead to this renal impairment or there are other renal injuries other than resulted from primary hypertension that lead to this impairment.
Aim of the work The aim of this study is to determine the factors affecting the appearance of microalbuminuria in essential hypertensive patients, and the histopathological changes that occur in kidneys in these patients.
Subjects and methods All the patients concluded in our study underwent the classic clinical and biochemical examination, then all the patients underwent screening of presence of microalbuminuria.
All patients with microalbuminuria underwent estimation of 24 h urinary protein excretion and then a renal biopsy was taken from every microalbuminuric patient. All renal biopsies examined by light microscope and then five of them examined by electron microscope.
Results The results of this study showed that patients without microalbuminuria comprised 38 patients and patients with microalbuminuria comprise 12patients with a percentage of 24% of all essential hypertensive patients had microalbuminuria , statistically highly significant increase in the mean values +SD of age (years ) , of duration of hypertension (years ), systolic blood pressure (mmHg) and of serum creatinine (mg/dl) in microalbuminuric patients as compared to nonalbuminuric ones and there are significant increase in the mean values +SD of diastolic blood pressure(mmHg) and of serum uric acid (mg/dl) while there is no significant difference in the mean values +SD of body mass index and of blood urea (mg/dl) , from the microalbuminuric patients there were eight patients had a renal biopsy of hypertensive nephrosclerosis and the remaining four had a normal renal biopsy with significant increase in the mean values +SD of duration of hypertension (years ), blood uric acid(mg/dl) and 24 h urinary protein excretion (mg) between the two subgroups.
Conclusion This microalbuminuria associated with increase in the age of the patient, the duration of hypertension, the degree of systolic blood pressure, the degree of diastolic blood pressure and the level of serum creatinine.
The histopathological finding associated with microalbuminuria was consistent with nephrosclerosis as appeared by light microscope examination (hyaline casts and thick walled hyalinised blood vessels) and by electron microscope examination (thickening of glomerular basement membrane and collagen deposition).