Хроническая болезнь почек у детей: проблемы артериальной гипертензии

В обзоре приведены материалы течения хронической болезни почек (ХБП) у детей с артериальной гипертензией (АГ). Показана взаимосвязь между ХБП и АГ, где установлено ускорение прогрессирования ХБП до терминальной стадии почечной недостаточности при наличии АГ. Регулирование АГ у детей является обязательным в лечении ХБП в связи с тем, что АГ своевременно не устанавливается, недостаточно контролируется и зачастую маскируется. Нарушение регуляции сосудов, перегрузка жидкостью, повышенный сердечный выброс и периферическое сосудистое сопротивление в отдельности или в комбинации могут привести к АГ при ХБП. Использование современных методов для мониторинга и контроля АД имеет решающее значение для улучшения управления АГ и предотвращения повреждения органов-мишеней у детей. Круглосуточные измерения АД являются важным инструментом в определении прогноза и лечения детей с ХБП. Для выявления нарушения функции почек при ХБП используются большое количество биомаркеров. Скорость клубочковой фильтрации (СКФ), креатинин сыворотки и цистатин С сегодня используются в качестве биомаркеров почечной недостаточности. В последнее время биомаркеры, включая KIM-1, LFABP, NGAL и IL-18, предложены как маркеры острого повреждения почек, и они могут оказаться полезными в будущем при раннем выявлении прогрессирования ХБП у детей. У новорожденных и детей раннего и старшего возраста АГ появляется из-за реноваскулярных и паренхиматозных заболеваний.

АГ считается маркером тяжести ХБП и является фактором риска при прогрессирующем ухудшении функции почек, а также развитии сердечно-сосудистых заболеваний. Симпатическая гиперактивность, избыточное образование свободных радикалов, уменьшенная биодоступность оксида азота (NO) и чрезмерное продуцирование ангиотензина II приводит к повышению АД. Ожирение или увеличение индекса массы тела (ИМТ) в настоящее время рассматривают как фактор риска не только для сердечно-сосудистых заболеваний и диабета, но также и для ХБП. Гиперурикемия и ХБП тесно связаны между собой, так как накопление мочевой кислоты связано с АГ, метаболическим синдромом и микроальбуминурией, которые также являются факторами риска прогрессирования ХБП. АГ оказывает пагубное воздействие на органы-мишени, включая почки, глаза и сердце. Модификации образа жизни, контроль массы тела, здоровое питание, снижение потребления натрия, поддерживающие упражнения и основная лекарственная терапия с использованием ингибиторов ангиотензинпревращающего фермента (ИАПФ), блокаторов рецепторов ангиотензина (БРА) могут замедлить прогрессирование ХБП у детей.

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