Morphological Indicators of Hypertensive Nephropathy: A Case–Control Study



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Abstract

BACKGROUND: The diagnosis of hypertensive nephropathy is primarily based on the clinical diagnostic criteria for detecting renal dysfunction in hypertension. However, in some cases, these criteria are insufficient for establishing an accurate diagnosis.

AIM: To determine the morphometric ranges of various renal structures that can serve as criteria for detecting hypertensive nephropathy.

METHODS: Histological and morphometric analyses were performed on renal tissue samples obtained postmortem from 138 patients (one sample per individual). The patients were divided into two groups: the study group, which included 61 individuals with hypertension and laboratory signs of hypertensive nephropathy, and the comparison group, which comprised 77 patients with hypertension but without clinical or laboratory signs of nephropathy. ROC analysis was conducted to determine optimal threshold values for the percentage of sclerotic glomeruli and the Kernohan index of interlobular arteries that distinguish between patient groups with and without hypertensive nephropathy. Data distribution was assessed using the Kolmogorov–Smirnov test. For nonparametric variables, the median and interquartile range (25th–75th percentiles) were calculated. The groups were compared using the Mann–Whitney U test. The critical level of statistical significance for hypothesis testing was set at p = 0.05.

RESULTS: In patients with hypertensive nephropathy, the following renal parameters were altered: kidney mass decreased by 11% (p = 0.036); the percentage of sclerotic glomeruli increased 1.75-fold (p = 0.027); the Kernohan index of interlobular arteries increased 1.4-fold (p = 0.001); and the connective tissue area in the cortical and medullary layers increased by 1.4 (p = 0.022) and 1.8 times (p = 0.001), respectively. ROC analysis identified the threshold values for differentiating patients with and without hypertensive nephropathy: for the percentage of sclerotic glomeruli, 11.11% (the Youden index, 0.57; specificity, 0.854 [0.761–0.909]; and sensitivity, 0.732 [0.596–0.867]), and for the Kernohan index of interlobular arteries, 0.24 (the Youden index, 0.56; specificity, 0.824 [0.746–0.902]; and sensitivity, 0.739 [0.612–0.866]).

CONCLUSION: The percentage of sclerotic glomeruli and the Kernohan index of interlobular arteries can be used as diagnostic criteria for hypertensive nephropathy.

About the authors

Tatiana M. Cherdantseva

Ryazan State Medical University

Email: cherdan.morf@yandex.ru
ORCID iD: 0000-0002-7292-4996
SPIN-code: 3773-8785

MD, Dr. Sci. (Medicine), Professor, Head, Depart. of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

Viktor V. Shelomentsev

Ryazan State Medical University

Author for correspondence.
Email: shelvit94@gmail.com
ORCID iD: 0000-0003-2617-8707
SPIN-code: 8499-0269

Assistant, Depart. of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

Il'ya B. Glukhovets

Ryazan State Medical University

Email: gluhoveci@gmail.com
ORCID iD: 0000-0003-1435-4865
SPIN-code: 5261-5174

MD, Cand. Sci. (Medicine), Assistant Professor, Depart. of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

Il’ya I. Vinogradov

Ryazan State Medical University

Email: compot1707@yandex.ru
ORCID iD: 0000-0002-4341-6992
SPIN-code: 3889-1000

MD, Cand. Sci. (Medicine), Assistant Professor, Depart. of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

Galina P. Kazanceva

Ryazan State Medical University

Email: kazantseva.45@mail.ru
ORCID iD: 0009-0006-1654-010X
SPIN-code: 1765-7000

MD, Cand. Sci. (Medicine), Assistant Professor, Depart. of Histology, Pathological Anatomy and Medical Genetics

Russian Federation, Ryazan

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