INDIVIDUALIZATION OF RENOPROTECTION IN DEPENDENCE FROM ESTIMATED GLOMERULAR FILTRATION RATE AND RENAL FUNCTIONAL RESERVE
https://doi.org/10.24884/1561-6274-2019-23-1-9-14
Abstract
Renoprotection – a system of measures primarily pharmacological control, contributing to the continued preservation of renal function. Any medical activity or medicines that lead to a slowdown, suspension or reversion of eGFR could be considered as renoprotective. Currently, renoprotective drugs with evidence-based efficacy include angiotensin-converting enzyme inhibitors (ACEIs), and recently SGLT2 inhibitors. It is known that the therapeutic efficacy of renoprotective drugs depends on the initial eGFR. Hence, choosing renoprotection medicines, it is necessary to consider not only the estimated GFR (using the EPI formula), but also a functional renal reserve. Physiologically sound is the method of determining the renal reserve with oral administration of 0.45-0.50% sodium chloride solution at the rate of 0.5% of body weight. The definition of a renal reserve based on this technique, as a routine method for examining nephrological patients, provides additional information not only on the number of functioning nephrons, but also on their condition. Based on a retrospective analysis of more than 15 years of using ACEIs and studying the functional renal reserve, we proposed a differentiated approach to the appointment of renoprotective medicines in mono regime or drugs combination, taking into account the stage of the disease and the functional renal reserve for maximum preservation of functioning nephrons. This approach has been used by us for the past three years in clinical practice.
About the Authors
D. D. Ivanov
National Medical Academy of Postgraduate Education named after P.L. Shupyk, Kyiv
Ukraine
Ukraine
Prof. Dmytro D.Ivanov, MD, PhD, DMedSci
604112 Ukraine, Kiev Dorogozhytska str, 9, Shupyk National Medical Academy of Postgraduate Education, Head of Nephrology and RRT Dep.; Phone: +380504448788
A. I. Gozhenko
State enterprise «Ukrainian Scientific Research Institute of Transport of MH of Ukraine», Odesa
Ukraine
Ukraine
Prof. Anatoly I. Gozhenko, MD, PhD, DMedSci
65000, Ukraine Odessa, Kanatnaya Street 92, Ukrainian Research Institute of Medicine of Transport of the Ministry of Health of Ukraine, Director; Phone: +380487225364
L. M. Savytska
Municipal institution of Kyiv Regional Council "Kyiv Regional Hospital № 2", Kyiv
Ukraine
Ukraine
Рostgraduate student Lyubov N. Savitskaya, MD
604053 Ukraine, Kiev, pr. Nesterovsky, 13/19, Shupyk National Medical Academy of Postgraduate Education; Dep Nephrology and RRT; Municipal policlinic of the Kiev Regional Council "Kiev Regional Hospital № 2"; Phone: +380636910895
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Review
For citations:
Ivanov D.D., Gozhenko A.I., Savytska L.M. INDIVIDUALIZATION OF RENOPROTECTION IN DEPENDENCE FROM ESTIMATED GLOMERULAR FILTRATION RATE AND RENAL FUNCTIONAL RESERVE. Nephrology (Saint-Petersburg). 2019;23(1):9-14. (In Russ.) https://doi.org/10.24884/1561-6274-2019-23-1-9-14
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