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Abstract: TH-PO473

Pericytes Detachment and Peritubular Capillaries Injury in Malignant Hypertensive Nephrosclerosis Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Xia, Peng, Peking Union Medical College Hospital, Beijing, China
  • Lang, Jiaxin, Peking Union Medical College Hospital, Beijing, China
  • Lin, Min, Peking Union Medical College, Beijing, China
  • Wen, Yubing, Peking Union Medical College Hospital, Beijing, China
  • Shi, Xiaoxiao, Peking Union Medical College Hospital, Beijing, China
  • Xu, Lubin, Peking Union Medical College Hospital, Beijing, China
  • Zhao, Yumo, Peking Union Medical College, Beijing, China
  • Li, Ming-Xi, Peking Union Medical College Hospital, Beijing, China
  • Li, Xuemei, Peking Union Medical College Hospital, Beijing, China
  • Li, Xuewang, Peking Union Medical College Hospital, Beijing, China
  • Chen, Limeng, Peking Union Medical College Hospital, Beijing, China
Background

Peritubular capillary (PTC) injury contributes to the progression of various kidney disease. However, its impact on renal prognosis has not been well reported in malignant hypertensive nephrosclerosis (MHN) patients. The disintegration of interstitial pericytes may cause PTC loss and expansion of interstitium. This study investigated the role of PTC loss and pericytes distribution in MHN patients.

Methods

One hundred patients with essential MHN confirmed by renal biopsy from Jan. 2003 to Jun. 2016 in Peking Union Medical College Hospital were recruited. Clinical data and pathologic findings carefully reviewed. IHC and immunofluorescence staining of CD34 and PDGFRβ were used to evaluate PTC loss and pericytes distribution. The primary end point was defined as renal replacement therapy, kidney transplant as well as death. Cox regression was used to identify factors related to prognosis.

Results

The patients were mostly young males (male 88%; age 34.9±8.5ys) with significantly elevated blood pressure (225.2±26.4/152.0±25.0 mmHg), decreased eGFR (22.1±15.2 mL/min/1.73 m2) and proteinuria (median 1.4 g/d). Remarkable tubular atrophy (62.8±19.1%) and interstitial fibrosis (65.0±17.8%) were observed. PTC loss evaluated by CD34 staining was more significant in MHN patients (n=70), compared with benign hypertensive nephrosclerosis (n=17, P=0.025) and glomerular minimal lesion patients (n=17, P=0.001). PTC area correlated well with eGFR (r=0.496, P<0.001) and proteinuria (r=-0.351, P=0.006). Tubulointerstitial PDGFRβ expression (n=36) was higher than BHN (n=15, P=0.035) and GML patients (n=10, P=0.01). Immunofluorescence double staining of CD34 and PDGFRβ showed detachment of pericytes from PTC in tubulointerstitium. After 60.5±38.7 months’ follow up of 92 eligible subjects, the cumulative renal survival rate at 1, 3, 5, and 10 years was 94.6%, 84.1%, and 69.2%, and 31.2%, respectively. Multivariate COX regression indicated PTC injury, inadequate blood pressure control and proteinuria>1g/d are associated with poor renal prognosis.

Conclusion

PTC injury predicted the long-term renal outcome in patients with MHN. Detachment of pericytes from endothelial cells might play a role of the PTC injury.