nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2009-13-3-39-41nefr-1176Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESКАЛЬЦИНОЗ БРЮШНОЙ АОРТЫ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ БОЛЕЗНЬЮ ПОЧЕКCALCIFICATION OF ABDOMINAL AORTA IN PATIENTS WITH CHRONIC KIDNEY DISEASEВолковМ. М.VolkovM. M.

кафедра пропедевтики внутренних болезней

197022, Санкт-Петербург, ул. Л.Толстого, 17, СПбГМУ им. акад. И.П. Павлова, Нефрокорпус, тел.: (812)-234-69-46.

vmm58@mail.ruГордееваЛ. А.GordeyevaL. A.

Научно-исследовательский институт нефрологии

СмирновА. В.SmirnovA. V.

Научно-исследовательский институт нефрологии,

кафедра пропедевтики внутренних болезней

Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian Federation2009100320091333941Copyright © Волков М.М., Гордеева Л.А., Смирнов А.В., 20092009Волков М.М., Гордеева Л.А., Смирнов А.В.Volkov M.M., Gordeyeva L.A., Smirnov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1176

Сосудистая кальцификация у пациентов с хронической болезнью почек (ХБП) прогрессирует значительно быстрее и существенно ухудшает их выживаемость. Кальцификация является активным процессом, сходным с костеобразованием, обусловленным трансформацией гладкомышечных клеток в остеобластоподобные под влиянием неблагоприятных факторов, связанных с ХБП. Выраженность кальциноза можно оценить количественно с помощью простого и информативного рентгенологического исследования брюшной аорты. По нашим данным у пациентов с ХБП 1–5 стадий тяжесть кальциноза брюшной аорты (КБА) нарастает при снижении скорости клубочковой фильтрации и связана с прогрессирующим атеросклерозом и факторами его риска, в свою очередь, сопряженными с нарушением фосфорно-кальциевого баланса; последние факторы доминируют в генезе кальциноза у пациентов с ХБП 5Д ст., находящихся на гемодиализе. Впервые обнаружено, что более выраженный КБА взаимосвязан со снижением минеральной плотности костей. Длительная терапия активными формами витамина D сочетается с меньшей тяжестью КБА у пациентов, получающих гемодиализ.

Vascular calcification in patients with chronic kidney disease (CKD) progresses much faster and essentially worsens their survival rate. Calcification is an active process similar to bone formation, caused by transformation of smooth muscle cells in osteoblast-like ones under the influence of the adverse factors connected with CKD. The extent of calcification can be evaluated quantitatively by means of simple and informative X-ray examination of abdominal aorta. According to our data the severity of abdominal aorta calcification (AAC) in patients with CKD of 1-5 stages increases along with a decrease of glomerular filtration rate and is connected with progressive atherosclerosis and its risk factors, which in their turn, are associated with phosphorus-calcium imbalance. These factors dominate in calcification genesis in patients with CKD of 5d stage being on a hemodialysis. For the first time it is revealed, that more expressed AAC is interrelated with a decrease of mineral bone density. The long-term treatment by active forms of vitamin D is associated with the lessening of AAC extent in the patients receiving a hemodialysis.

кальциноз брюшной аортыхроническая болезнь почекгемодиализфосфорно-кальциевый балансатеросклерозabdominal aortacalcificationchronic kidney diseasehemodialisisphosphorus-calcium balanceatherosclerosisReferencesKramer H, Toto R, Peshock R et al. Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study. J Am Soc Nephrol 2005;16(2):507–513Kramer H, Toto R, Peshock R et al. Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study. J Am Soc Nephrol 2005;16(2):507–513Blacher J, Guerin AP, Pannier B et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001;38(4):938–942Blacher J, Guerin AP, Pannier B et al. Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001;38(4):938–942Ketteler M, Gross ML, Ritz E. Calcification and cardiovascular problems in renal failure. Kidney Int Suppl 2005; (94):S120–S127Ketteler M, Gross ML, Ritz E. Calcification and cardiovascular problems in renal failure. Kidney Int Suppl 2005; (94):S120–S127London GM, Guerin AP, Marchais SJ et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18(9):1731–1740London GM, Guerin AP, Marchais SJ et al. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003; 18(9):1731–1740London GM, Guerin A. Influence of arterial pulse and reflective waves on systolic blood pressure and cardiac function. J Hypertens Suppl 1999;17(2):S3–S6London GM, Guerin A. Influence of arterial pulse and reflective waves on systolic blood pressure and cardiac function. J Hypertens Suppl 1999;17(2):S3–S6Buckberg GD, Fixler DE, Archie JP, Hoffman JI. Experimental subendocardial ischemia in dogs with normal coronary arteries. Circ Res 1972;30(1):67–81Buckberg GD, Fixler DE, Archie JP, Hoffman JI. Experimental subendocardial ischemia in dogs with normal coronary arteries. Circ Res 1972;30(1):67–81Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y. Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994;24(5):1406–1414Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y. Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994;24(5):1406–1414Shroff RC, Shanahan CM. The vascular biology of calcification. Semin Dial 2007;20(2):103–109Shroff RC, Shanahan CM. The vascular biology of calcification. Semin Dial 2007;20(2):103–109Honkanen E, Kauppila L, Wikstrom B et al. Abdominal aortic calcification in dialysis patients: results of the CORD study. Nephrol Dial Transplant 2008;23(12):4009–4015Honkanen E, Kauppila L, Wikstrom B et al. Abdominal aortic calcification in dialysis patients: results of the CORD study. Nephrol Dial Transplant 2008;23(12):4009–4015Wilson PW, Kauppila LI, O’Donnell CJ et al. Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 2001;103(11):1529–1534Wilson PW, Kauppila LI, O’Donnell CJ et al. Abdominal aortic calcific deposits are an important predictor of vascular morbidity and mortality. Circulation 2001;103(11):1529–1534Kushiya F, Wada H, Sakakura M et al. Prognostic impact of aortic calcification index and ankle-arm blood pressure index in patients under hemodialysis. Clin Appl Thromb Hemost 2005;11(2):161–119Kushiya F, Wada H, Sakakura M et al. Prognostic impact of aortic calcification index and ankle-arm blood pressure index in patients under hemodialysis. Clin Appl Thromb Hemost 2005;11(2):161–119Muntner P, Ferramosca E, Bellasi A et al. Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients. Nephrol Dial Transplant 2007; 22(2):508–514Muntner P, Ferramosca E, Bellasi A et al. Development of a cardiovascular calcification index using simple imaging tools in haemodialysis patients. Nephrol Dial Transplant 2007; 22(2):508–514Hak AE, Pols HA, van Hemert AM et al. Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. Arterioscler Thromb Vasc Biol 2000;20(8):1926–1931Hak AE, Pols HA, van Hemert AM et al. Progression of aortic calcification is associated with metacarpal bone loss during menopause: a population-based longitudinal study. Arterioscler Thromb Vasc Biol 2000;20(8):1926–1931Taniwaki H, Ishimura E, Tabata T et al. Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transplant 2005; 20(11):2472–2478Taniwaki H, Ishimura E, Tabata T et al. Aortic calcification in haemodialysis patients with diabetes mellitus. Nephrol Dial Transplant 2005; 20(11):2472–2478Kimura K, Saika Y, Otani H et al. Factors associated with calcification of the abdominal aorta in hemodialysis patients. Kidney Int Suppl 1999; 71:S238–S241Kimura K, Saika Y, Otani H et al. Factors associated with calcification of the abdominal aorta in hemodialysis patients. Kidney Int Suppl 1999; 71:S238–S241Ishimura E, Okuno S, Kitatani K et al. C-reactive protein is a significant predictor of vascular calcification of both aorta and hand arteries. Semin Nephrol 2004; 24(5):408–412Ishimura E, Okuno S, Kitatani K et al. C-reactive protein is a significant predictor of vascular calcification of both aorta and hand arteries. Semin Nephrol 2004; 24(5):408–412Porter CJ, Stavroulopoulos A, Roe SD et al. Detection of coronary and peripheral artery calcification in patients with chronic kidney disease stages 3 and 4, with and without diabetes. Nephrol Dial Transplant 2007; 22(11):3208–3213Porter CJ, Stavroulopoulos A, Roe SD et al. Detection of coronary and peripheral artery calcification in patients with chronic kidney disease stages 3 and 4, with and without diabetes. Nephrol Dial Transplant 2007; 22(11):3208–3213

The authors declare that there are no conflicts of interest present.