NATRIURETIC PEPTIDES LEVEL AND THE STATUS OF THE RENIN – ANGIOTENSIN-ALDOSTERONE SYSTEM IN CHRONIC KIDNEY DISEASE IN PATIENTS WITH CONGENITAL MALFORMATIONS OF THE URINARY SYSTEM

THE AIM. To determine the concentration of natriuretic peptide in the blood serum in children with congenital malformations of the urinary system (CM US) and to compare with the activity of renin-angiotensin-aldosterone system (RAAS).

MATERIALS AND METHODS. 119 patients with CM US aged 3 to 18 years were examined. A control group of 10 clinically healthy children. 3 groups were assigned: group I – 55 children with  congenital vesicoureteral reflux, and group II – 34 children with  congenital hydronephrosis and ureterohydronephrosis, III group – 30 children with other forms of dysembryogenesis of the US. Following indicators were identified by ELISA in the blood: renin, aldosterone,  N – terminal propeptide natriuretic hormone (NT-рroВNР).

RESULTS. NT-рroВNР, renin and aldosterone hyperproduction were diagnosed in 59,6%, 69,7%, 54.6 % of sick children relatively. Concentrations were higher in all variants of  malformations in comparison with the control group. Significant  differences were revealed in obstructive species, where arterial  hypertension (AH) was diagnosed more often. Patients with AH  recorded significantly higher concentrations of NT-proВNР and renin.

CONCLUSION. The key point in pathological processes development
and progression in the cardiovascular system and kidneys is the  activation of RAAS. The system of natriuretic factors is important in maintaining the compensated state of patients due to the blockade of RAAS.

1. Смирнов АВ, Шилов ЕМ, Добронравов ВА и др. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Левша, СПб., 2013: 51. [Smirnov AV, Shilov EM, Dobronravov VA. National recommendations. Chronic kidney disease: the basic principles of screening, diagnosis, prevention, and approaches to treatment. Levsha, St. Petersburg, 2013: 51p.]

2. Шилов ЕМ, Швецов МЮ, Бобкова ИН и др. Хроническая болезнь почек и нефропротективная терапия: метод. руководство для врачей. М., 2012: 76 с. [Shilov EM, Shvetsov MYu, Bobkova IN. Chronic kidney disease and Nephroprotective therapy: method. a guide for physicians. M., 2012: 76 p.]

3. Эрман МВ. Нефрология детского возраста: руководство для врачей. 2-е издание, Спец.Лит., СПб., 2010: 683. [Erman MV. Nephrology of childhood: a guide for doctors. 2nd edition, Special Lit., St. Petersburg, 2010: 683p]

4. Папаян АВ, Савенкова НД. Клиническая нефрология детского возраста. Руководство для врачей. Левша, СПб., 2008: 600. [Papayan AV, Savenkova ND. Clinical Nephrology of Childhood. A guide for doctors. Lefty, St. Petersburg, 2008: 600p]

5. North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 2008 Annual report. 2008. The EMMES Corporation, Rockville, MD. URL: https://web.emmes.com/study/ped annlrept/Annual%20Report%20-2008.pdf webcite. Accessed 24/01/2014.

6. Смирнов АВ, Добронравов ВА, Каюков ИГ. Кардиоренальный континуум: патогенетические основы превентивной нефрологии. Нефрология 2005; 9(3): 7-15 [Smirnov AV, Dobronravov VA. Cardio-Renal Continuum: Pathogenetic Basics of Preventive Nephrology. Nephrology 2005; 9(3): 7-15 (In Russ.)]

7. Смирнов АВ, Седов ВМ, Од-Эрдэне ЛИ др. Снижение скорости клубочковой фильтрации как независимый фактор риска сердечно-сосудистой болезни. Нефрология 2006;10(4):7-17. https://doi.org/10.24884/1561-6274-2006-10-4-7-17 [Smirnov AV, Sedov VM, Od-Erdene L et al. Reduction of the glomerular filtration rate as an independent risk factor of the cardio-vascular disease. Nephrology (Saint-Petersburg). 2006;10(4):7-17. (In Russ.) https://doi.org/10.24884/1561-6274-2006-10-4-7-17]

8. Мухин НА, Моисеев ВС, Кобалава ЖД и др. Кардиоренальные взаимодействия: клиническое значение и роль в патогенезе заболеваний сердечно-сосудистой системы и почек. Тер Арх 2004; (6):39-46 [Mukhin NA, Moiseev VS, Kobalava ZD et al. Cardiorenal interactions: clinical significance and role in the pathogenesis of diseases of the cardiovascular system and kidneys. Ter Arch 2004; (6): 39-46]

9. Иванова ИЕ. Хроническая болезнь почек у детей и подростков. Здравоохранение Чувашии 2013; 2: 38–45 [Ivanova IE. Chronic kidney disease in children and adolescents. Healthcare of Chuvashia 2013; 2: 38-45]

10. Сергеева ТВ. Клинико-функциональные параллели при хронической болезни почек у детей. Педиатр фармакол 2012; 4: 64–68 [Sergeeva ТV. Clinical and functional parallels in chronic kidney disease in children. Pediatric Pharmacologist 2012; 4: 64-68]

11. Ртищева ОВ, Калев ОФ. Структурно-функциональное ремоделирование миокарда у больных с хроническими болезнями почек. Медицинский альманах 2011; 3 (16): 158– 161 [Rtishcheva OV, Kalev OF. Structural and functional remodeling of the myocardium in patients with chronic kidney disease. Medical Almanac 2011; 3 (16): 158-161]

12. Есаян АМ. Тканевая ренин-ангиотензиновая система почки. Новая стратегия нефропротекции. Нефрология 2008; 6(3): 8-16 [Esayan AM. Tissue renin-angiotensin system of the kidney. New strategy of nephroprotection. Nephrology 2008; 6 (3): 8-16]

13. Нефрология. Национальное руководство. Под ред. НА Мухина. ГЭОТАР Медиа, М., 2009: 720 с [Mukhin NA, Ed. Nephrology. National leadership. GEOTAR Media, M., 2009: 720p]

14. Celedon CG, Bitsori M, Tullus K. Progression of chronic renal failure in children with dysplastic kidneys. Pediatric Nephrol 2007; (22): 1014-1020

15. Титов ВН. Инверсия представлений о биологической роли системы ренин- ангиотензинальдостерон и функции артериального давления как регулятора метаболизма. Клин лаб диагностика 2015; (2): 4-13 [Titov VN. Inversion of ideas about the biological role of the renin-angiotensin-dosterone system and the function of arterial pressure as a regulator of metabolism. Clin lab diagnostic 2015; (2): 4-13]

16. Титов ВН. Филогенетическая теория общей патологии. Патогенез медицинских пандемий. Инфра-М, М., 2014; 223 [Titov VN. Phylogenetic theory of general pathology. Pathogenesis of medical pandemics. Infra-M, M., 2014; 223 p]

17. Диагностика, лечение и профилактика артериальной гипертензии у детей и подростков. Кардиоваскулярная терапия и профилактика 2009; 8(4): 1-75 [Diagnosis, treatment and prevention of hypertension in children and adolescents. Cardiovascular therapy and prevention 2009; 8 (4): 1-75]

18. Титов ВН, Ощепкова ЕВ, Дмитриев ВА. С-реактивный белок, микроальбуминурия, эндогенное воспаление и артериальная гипертония. РГГУ, М., 2009; 376 [Titov VN, Oschepkova EV, Dmitriev VA. C-reactive protein, microalbuminuria, endogenous inflammation and arterial hypertension. RSUH, M., 2009: 376 p]