GLOMERULAR FILTRATION RATE IN ELDERLY AND SENILE PATIENTS WITH DISCIRCULATORY ENCEPHALOPATHY, SURVIVORS OF THE SIEGE OF LENINGRAD

THE AIM. The comparative analysis of informativenes of calculated methods of evaluation of glomerular filtration rate in the people of elderly and senile age, survivors of the Siege of Leningrad with discirculatory encephalopathy (DE). PATIENTS AND METHODS: the investigation was performed on 138 patients (age 65-92) with DE of stage 2. 2 groups have undergone to the analysis: 100 patients – survivors of the Siege of Leningrad and 38 patients who were not exposed at child’s age to multifactorial stress («not residents of the Siege»). Middle age was 74,63 + 5,25 and 74,71+6,9 years accordingly. Glomerular filtration rate (GFR) was defined by two settlement methods: – Coсkcroft and Gault equation and MDRD. At 17 patients (residents of the Siege) – middle age – 75,08 +2,3, and at 24 patients («not resident of the Siege») – middle age 74,5 + 6,25 concentration of melatonin in a saliva was investigated. RESULTS. GFR at technique use on Coсkcroft and Gault and MDRD at «residents of the Siege» was authentically more low, than at comparison group, lower levels at use of Coсkcroft and Gault equation. Stages of chronic kidney disease (CKD) were defined in research. At residents of the Siege close direct correlation dependences between concentration of salva melatonin, age and a technique of definition of GFR by Kokroft-Galt equation have been revealed. While at «not residents of the Siege» close correlation dependence was registered only between age of patients and of Kokroft-Galt equation. Authentic correlation dependence on age and a technique of calculation GFR under formula MDRD has been received only in «residents of the Siege» group. CONCLUSION. Results of the research testify on more informative settlement of GFR screening definition with use of the Kokraft-Galt equation at patients of elderly and senile age with DE, and also at a special contingent – patients endured the Siege of Leningrad. The hypofiltration registered at «residents of the Siege» is a specific phenomenon, instead of an equivalent of higher degree CKD. The given phenomenon, most likely, is caused by morphofunctional features of kidneys after the transferred multifactorial stress in the childhood – the Siege of Leningrad.

1. Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron1976; 16: 31-41

2. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med1999; 130:461-70

3. Levey AS, Greene T, Kusek JW, Beck GJ. A simplified equation to predict glomerular filtration rate from serum creatinine. Am Soc Nephrol 2000; ll: A0828

4. Foundation NK: K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis 2002; 39:S1-S000

5. Функциональное состояние почек и прогнозирование сердечно-сосудистого риска. Кардиоваскулярная терапия и профилактика 2008; 7 (6), Приложение 3

6. Laroche M-L, Charmes J-P, Marcheix A, Bouthier F, Merle L. Estimation of glomerular filtration rate in the elderly: Cockcroft-Gault formula versus Modification of Diet in Renal Disease formula. Pharmacotherapy 2006;26(7):1041–1046

7. Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P. Predictive performance of the modification of diet in renal disease and Cockroft–Gault equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763–773

8. Lamb EJ, Tomson CRV, Roderick PJ. Estimating kidney function in adults using formulae. 2005 Ann Clin Biochem;42: 321–345

9. Garcia-Naveiro R, Rodriguez-Carmona A, Perez-Fontan M. Agreement between two routine methods of estimation of glomerular filtration rate in patients with advanced and terminal chronic renal failure. Clin Nephrol 2005; 64:271–280

10. J-C Lee, I-M Kang, C-Y Chou, Y-H Tseng, C-C Huang, C-M Shih, W Chen. Difference between estimated glomerulofiltration rate by Modification of Diet in Renal Diseases and Cockcroft-Gault formula in general population. J Ann intern med 2009; 20,148-154

11. Gill J, Malyuk R, O, Djurdjev, A. Levin Use of GFR equations to adjust drug doses in an elderly multi-ethnic group – a cautionary tale. Nephrol Dial Transplant 2007; 22(10):2894-2899

12. Стоякина ЕВ, Арьев АЛ. Сопоставительный анализ расчетных методов определения скорости клубочковой фильтрации у пациентов пожилого и старческого возраста с ишемической болезнью сердца. Клиническая геронтология, 2008; 9(14):51

13. Singh NP, Ingle GK, Saini VK, Jami A, Beniwal P, Lal M, Meena GS. Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-Gault and Modification of Diet in Renal Disease equation: an observational, cross-sectional study BMC Nephrology 2009, 10:4

14. Viktorsdottir O, Palsson R, Andresdottir MB, Aspelund TV, Gudnason OS. Prevalence of chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults. Nephrol Dial Transplant 2005; 20(9):1799-1807

15. Арьева ГТ, Арьев АЛ. Взаимосвязи концентрации мелатонина в слюне и рядом клинических характеристик пациентов старших возрастных групп амбулаторного хирургического стоматологического профиля. I международная науч.-практ. конф. «Пушковские чтения». Сборник трудов. СПб., 2005:135-137

16. Arieva GT, Ariev AL, Kvetnaia, TV, Kvetnoy IM. Melatonin, siege of Leningrad, comorbidity, dental pathology Advances in Gerontology/ VI European congress 5-8 July, 2007//Abstract book 2007; 3(20): 83-84

17. Арьева ГТ. Мелатонин в клиническом обосновании эффективности ксефокама при одонтогенном периостите у пациентов пожилого и старческого возраста. Автореф. дис. … канд. мед. наук. СПб., 2006

18. Iguchi Н, Kato KL, Ibayashi H et al. Age-dependent reduction in serum melatonin concentrations in healthy human subjects. J Clin Endocrine Metab 1982; 55: 287-297

19. Arendt J. Melatonin and the mammalian pineal gland. London, 1995; 331

20. Reppert SM, Weaver DR, Ebisawa T et al. Cloning and characterization of a mammalian melatonin receptor that mediated reproductive and circadian responses. Neuron 1994; 13:1177-1185

21. Steinhilber D, Brungs M, Werz 0 et al. The nuclear receptor for melatonin represses 5-lipooxygenase expressionin human В lymphocytes. J Biol Chem 1995; 270: 7073-7040

22. Pevet P. Melatonin and biological rhythms. Therapie 1998; 53: 411-420

23. Овсянникова НА, Арьев АЛ. Новое понятие – цереброкардиоренальный континуум. Клиническая геронтология 2009;15(8-9): 72-73

24. Зайцев ЕЮ, Арьев АЛ. Кардиоренальный континуум у жителей блокадного Ленинграда, ретроспектива и современность. Особенности диагностики и лечения соматической патологии и ассоциированных болезней у жителей блокадного Ленинграда, их потомков и лиц пожилого возраста. Материалы науч.- практ. конф.. СПб, 2010: 58-64

25. Zhao F, Liu Z.-Q, Wu D. Antioxidative effect of melatonin on DNA and erythrocytes against free radical-induced oxidation. Chem Phys Lipids 2008; 151:77-84

26. Reiter RJ. The pineal gland and melatonin in relation to aging: a summary of the theories and the data. Exp Gerontol 1995; 30: 199-212