腎臓学と治療学ジャーナル

Secondary Arterial Hypertension to Primary Glomerulopathies in Senegal

Abstract

Maria Faye1, Ahmed Tall Lemrabott1*, Alex Ismaël Keita1, Moustapha Faye1, Mansour Mbengue2, Niakhaleen Keita1, Bacary Ba1, Seynabou Diagne1, Abdou Niang2 and El Hadji Fary Ka1

Introduction: Hypertension is a major public health problem. Parenchymal nephropathy is the leading cause of secondary hypertension, with glomerulopathy leading the way. In sub-Saharan Africa, little data are available on hypertension secondary to primary glomerulopathy.

Aim: To describe the epidemiological, diagnostic, therapeutic and progressive aspects of hypertension during primary glomerulopathy and to investigate the factors associated with the occurrence of this hypertension.

Patients and methods: This was a seven-year descriptive and analytical retrospective study carried out within the Nephrology Department of the Aristide Le Dantec University Hospital. We collected epidemiologic, clinical, paraclinical, therapeutic and progressive data from records of patients with hypertension caused by primary glomerulopathy.

Results: We included 172 patients. The prevalence of hypertension was 46%. The mean age was 33.9 ± 13.7 years and the sex ratio was 2.07. The mean systolic blood pressure was 158.93 ± 21.57 mmHg. The mean diastolic blood pressure was 98.23 ± 14.8 mmHg. The most frequent HBP grade was grade II, noted in 36% of cases. The most observed sign of hypertension was headache in 53.8% of cases followed by acute lung oedema in 38.5% of cases. Renal oedema was noted in 80.8% of cases. End-stage renal disease was found in 45.9% of cases. Nephrotic syndrome was noted in 62.7% of cases. Left ventricular hypertrophy was noted in 42.8% of cardiac ultrasound cases. Focal and Segmental Glomerulosclerosis (FSGS) was the most frequent lesion observed in 48.7% of cases. Angiotensin Converting Enzyme inhibitors (ACE inhibitors) were prescribed in 79% of cases. Combination therapy was prescribed in 64.5% of cases. Triple therapy was prescribed in 25% of cases. The evolution of hypertension at 1 month was favorable in 29.8% of cases and unfavorable in 47% of cases; at 12 months, this was favorable in 84.6% of cases and unfavorable in 11.5% of cases. Factors associated with the occurrence of hypertension were hypoalbuminemia below 30 g/L (P=0.018) and stage 1 chronic kidney disease (P=0.0001).

Conclusion: Hypertension secondary to glomerulopathy was common in our study. Nephrotic syndrome was the most commonly observed glomerular syndrome. The histological lesion most involved was FSGS. This hypertension can develop on its own account, leading to complications, hence the importance of screening for it as soon as possible.