nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical Universitynefr-87Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES CLINICAL STUDIESУромодулин и выраженность тубулоинтерстициальных повреждений у пациентов с нефропатиямиUromodulin and severity of tubulointerstitial lesions in patients with nephropathiesСмирновА. В.SmirnovA. V.noemail@neicon.ruХасунМ. .KhasunM. .noemail@neicon.ruКаюковИ. Г.KayukovI. G.kvaka55@mail.ruСиповскийВ. Г.SipovskyV. G.noemail@neicon.ruГалкинаО. В.GalkinaO. V.noemail@neicon.ruЗубинаИ. М.ZubinaI. M.noemail@neicon.ruКучерА. Г.KucherA. G.noemail@neicon.ruЗверьковР. В.ZverkovR. V.noemail@neicon.ruКаруннаяА. В.KarunnayaH. V.noemail@neicon.ruПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаРоссияPavlov First Saint Petersburg State Medical UniversityRussian Federation2015010320151924954Copyright © Смирнов А.В., Хасун М..., Каюков И.Г., Сиповский В.Г., Галкина О.В., Зубина И.М., Кучер А.Г., Зверьков Р.В., Карунная А.В., 20152015Смирнов А.В., Хасун М..., Каюков И.Г., Сиповский В.Г., Галкина О.В., Зубина И.М., Кучер А.Г., Зверьков Р.В., Карунная А.В.Smirnov A.V., Khasun M..., Kayukov I.G., Sipovsky V.G., Galkina O.V., Zubina I.M., Kucher A.G., Zverkov R.V., Karunnaya H.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/87

ЦЕЛЬ ИССЛЕДОВАНИЯ. Традиционно считается, что уромодулин (Умо) может участвовать в камнеобразовании. Однако появились данные о том, что Умо может быть задействован еще в целом ряде механизмов, в том числе определяющих развитие и прогрессирование повреждений почек (прежде всего, тубулоинтерстициального компартмента) и формирование артериальной гипертензии. Поэтому целью настоящей работы было сопоставление уровней концентраций Умо в моче и сыворотке крови с морфологическими характеристиками повреждений почек и некоторыми клиникофункциональными параметрам у пациентов с различными нефропатиями. ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 28 пациентов (М: Ж 11: 17) c различными нефропатиями в возрасте от 24 до 78 лет. У всех была выполнена нефробиопсия c полуколичественной оценкой выраженности повреждений почек на основе светооптического исследования, измерение концентраций Умо, креатинина, мочевины в сыворотке крови, Умо и белка - в моче, рассчитана величина скорости клубочковой фильтрации (рСКФ; CKD-EPI). У 20 пациентов проведено суточное мониторирование артериального давления (АД). РЕЗУЛЬТАТЫ. Концентрация Умо в моче значимо обратно коррелировала (коэффициент ранговой корреляции Спирмена) с выраженностью тубулярной атрофии (ТА; Rs=-0,39; р=0,038), мононуклеарной инфильтрации интерстиция (Rs=-0,37; р=0,05) и величиной среднего систолического АД в дневные часы (срСАДд; Rs=-0,49; р=0,028). Концентрация Умо в сыворотке была прямо связана с рСКФ (Rs=0,53; р=0,007) и обратно - с выраженностью атрофии канальцев (Rs=-0,39; р=0,038), периваскулярного фиброза стромы (Rs=-0,44; р=0,019) сывороточными концентрациями креатинина (Rs=-0,64; р<0,001) и мочевины (Rs=-0,60; р<0,002). ТА прямо коррелировала с срСАДд (Rs=-0,50; р<0,001) Не было выявлено отчетливых ассоциаций между концентрациями Умо в сыворотке крови или моче с повреждениями гломерул или протеинурией. Концентрации Умо в сыворотке крови и моче не коррелировали между собой. При наличии гиалиновых цилиндров в просвете почечных канальцев сывороточный уровень Умо оказывался значимо ниже по сравнению с пациентами с отсутствием данного феномена. ЗАКЛЮЧЕНИЕ. Концентрации Умо как в моче, так и сыворотке крови ассоциируются с выраженностью тубулоинтерстициальных повреждений у пациентов с различными нефропатиями. Снижение концентраций Умо как в сыворотке крови, так и моче может отражать и уменьшение массы действующих нефронов и более локальные поражения тубулоинтерстициального компартмента.

AIM OF THE STUDY. It is traditionally believed that uromodulin (Umo) may participate in urinary stone formation. However, there is evidence that Umo can be operated in other mechanisms, especially damaging tubulointerstitial renal compartment and promotional arterial hypertension. In this regard, we attempt to compare the levels of the Umo in urine and blood serum with the morphological characteristics of kidney lesions and some clinical functional parameters in patients with various nephropathies. PATIENTS AND METHODS. Twenty eight patients (Pts; M: F 11: 17) with various nephropathies, aged 28 - 74 years were examined. Everybody was performed renal biopsy with semi-quantitative assessment of renal injury severity using light-optic analysis. There were measured UMO, creatinine and urea levels in blood serum, UMO and protein concentration in urine, was estimated glomerular filtration rate (eGFR; CKD-EPI). In twenty Pts 24-hour blood pressure monitoring was performed. RESULTS. Urinary Umo concentration significantly inverse correlated (Spearmen rank correlation coefficient) with degree of tubular atrophy (TA; Rs=-0.39; P=0.038), mononuclear infiltration of interstitium (Rs=-0,37; P=0,05) and mean systolic BP at the day time (mSBPday; Rs=-0.49; P=0.028). Serum Umo concentration was directly associated with eGFR (Rs=0.53; P=0.007) and inverse - with tubular atrophy (Rs=-0.39; P=0.038), degree of perivascular stromal fibrosis (Rs=-0.44; P=0.019), Scr (Rs=-0.64; P<0.001) and serum creatinine and urea concentration (Rs=-0.60; P<0.002). TA directly correlated with mSBPday (Rs=-0.50; P<0.001). There were no associations between serum Umo concentration or urine Umo concentration and glomerular lesions or proteinuria. Serum and urine Umo concentrations didn’t correlate between each other. In the case of hyaline casts in the tubular lumen serum Umo level was significantly lower than in Pts with no casts. CONCLUSION. Umo concentrations in urine and serum are associated with the severity of tubulointerstitial lesions in patients with different nephropathies. Reduction of the urinary and serum Umo levels may reflect a decrease of nephron mass and more local tubulointerstitial lesions.

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