Preview

Nephrology (Saint-Petersburg)

Advanced search

FEATURES OF THE STRUCTURAL AND THE FUNCTIONAL STATE OF KIDNEYS AND THE FUNCTION OF ENDOTHELIUM IN HYPERTENSIVE PATIENTS WITH METABOLIC DISTURBANCES

https://doi.org/10.24884/1561-6274-2017-21-5-5-18

Abstract

THE AIM: to study the features of the structural and the functional state of the kidneys in relation to the functional state of the endothelium in patients with arterial hypertension (AH) in combination with metabolic disorders.

PATIENTS AND METHODS. The study included 351 patients with AH in the age from 40 to 70 years old with unachieved target values of arterial blood pressure (BP). Patients were divided into four groups, comparable in age, sex, frequency of smoking, duration of AH, the level of office systolic blood pressure (SBP) and diastolic blood pressure (DBP), depending on the presence of concomitant diseases: obesity, MS, type 2 diabetes. Clinical examination with analysis of the body composition was performed, structural and functional parameters of the kidneys, functional state of the endothelium were determined.

RESULTS. The study revealed regular features of changes in the structural and functional parameters of the kidneys in patients with “isolated” AH and in individuals with AH in combination with comorbid pathology in the form of a statistically significant increase of kidney volume, percentage of patients with an uneven contour of the kidneys, impaired structure and changes in echogenicity of the parenchyma, decrease tubular and glomerular functions of the kidneys when AH combines with metabolic disorders. We noted parallelism in structural and functional changes of the when MS components were attached to the AH.

CONCLUSION. The revealed reliable correlation relationships between the structural and functional state of the kidneys and endothelial dysfunction confirm the progression of renal and endothelial damage when MS components are associated with AH. 

About the Authors

M. E. Statsenko
Volgograd State Medical University
Russian Federation

Prof., MD, PhD, DmedSci., Vice-Rector for Research, Head of the Department of Internal Medicine: Pediatric faculty / Dental faculty,

400131, Pavshih Bortscov sqr., 1, Volgograd



M. V. Derevyanchenko
Volgograd State Medical University
Russian Federation

MD, PhD, assistant of Professor, Department of Internal Medicine: Pediatric faculty / Dental faculty

400001, Pugachevskaya str., app. 5G, flat 2, Volgograd



References

1. Диспансерное наблюдение больных хроническими неинфекционными заболеваниями и пациентов с высоким риском их развития: Метод. реком., ред. Бойцов СА и Чучалин АГ. М., 2014; 112 с. Интернет-ресурс: http://www.gnicpm.ru, http://www.ropniz.ru. [Clinical follow-up of patients with chronic non-infectious diseases and patients at high risk of their development. Guidelines. Ed. Boytsova SA and Chuchalina AG. Moscow, 2014; 112 pp. Internet resource: http://www.gnicpm.ru, http://www.ropniz.ru (In Russ.)]

2. Российские рекомендации по диагностике и лечению артериальной гипертензии (4 пересмотр). Системные гипертензии 2010; 3: 5–26 [Russian recommendations on the diagnosis and treatment of hypertension (4 revision). Sistemnyye gipertenzii 2010; 3: 5-26 (In Russ.)]

3. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159–2219. doi:10.1093/eurheartj/eht151

4. Казымов МС, Фишман ББ, Вебер ВР и др. Половозрастные характеристики распространенности артериальной гипертензии у больных сахарным диабетом 2 типа с ожирением. Тер Арх 2009; 81 (4): 73-75 [Kazymov MS, Fishman BB, Veber VR i dr. Sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetes mellitus patients with obesity. Ter Arkh 2009;81(4):73-5 (In Russ.)]

5. Нестеров ЮИ, Полтавцева ОВ, Лазарева ОА, Тепляков АТ. Метаболический синдром: распространенность среди амбулаторных больных с артериальной гипертензией, эффективность лечения. Клин Мед (Москва). 2008; 86 (2): 67-70 [Nesterov IuI, Poltavtseva OV, Lazareva OA, Tepliakov AT. Metabolic syndrome: prevalence among outpatients with arterial hypertension, the efficacy of treatment. Klin med (Moscow) 2008;86(2):67-70 (In Russ.)]

6. Стаценко МЕ, Деревянченко МВ, Титаренко МН, Пастухова ОР. Кардиоренальные взаимоотношения у больных артериальной гипертензией в сочетании с сахарным диабетом 2 типа. Нефрология 2014; 18(5): 44-51 [Statsenko ME, Derevyanchenko MV, Titarenko MN, Pastukhova OR. Cardiorenal relationships in patients with arterial hypertension and type 2 diabetes. Nephrology 2014; 18 (5): 44-51 (In Russ.)]

7. Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612

8. Маколкин ВИ, Подзолков ВИ, Павлов ВИ. Состояние микроциркуляции при гипертонической болезни. Кардиология 2002; 7: 36–40 [Makolkin VI, Podzolkov VI, Pavlov VI. The state of microcirculation in hypertensive disease. Kardiologiya 2002; 7: 36-40 (In Russ.)]

9. Илюхин ОВ, Илюхина МВ, Калганова ЕЛ и др. Скорость распространения пульсовой волны в оценке эндотелиальной дисфункции у больных с хронической сердечной недостаточностью ишемической этиологии. Сердечная недостаточность 2005; 1: 16-18 [Ilyukhin OB, Ilyukhina MV, Kalganova EL i dr. Rate of pulse wave propagation in the evaluation of endothelial dysfunction in patients with chronic heart failure of ischemic etiology. Serdechnaya nedostatochnost’ 2005; 1: 16-18 (In Russ.)]

10. Стаценко МЕ, Туркина СВ, Тыщенко ИА и др. Висцеральное ожирение как маркер риска мультиорганного поражения. Вестник Волгоградского государственного медицинского университета 2017; 1(61):10-15 [Statsenko ME, Turkina SV, Tyshchenko IA i dr. Visceral obesity as a marker of multi-organ damage risk. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta 2017; 1 (61): 10-15 (In Russ.)]

11. Foster MT, Pagliassotti MJ. Metabolic alterations following visceral fat removal and expansion: Beyond anatomic location. Adipocyte 2012;1(4):192-199

12. Kovesdy CP, Furth SL, Zoccali C. World Kidney Day Steering Committee. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Am J Nephrol 2017;45(3):283-291. doi: 10.1159/000458467

13. Navarro Díaz M. Consequences of morbid obesity on the kidney. Where are we going? Clin Kidney J 2016;9(6):782-787

14. Hall JE, da Silva AA, do Carmo JM et al. Obesity-induced hypertension: role of sympathetic nervous system, leptin, and melanocortins. J Biol Chem 2010;285:17271–17276

15. Hall ME, do Carmo JM, da Silva AA et al. Obesity, hypertension, and chronic kidney disease. Int J Nephrol Renovasc Dis 2014; 7:75–88

16. Artunc F, Schleicher E, Weigert C et al. The impact of insulin resistance on the kidney and vasculature. Nature Reviews Nephrology 2016;12, 721–737 doi:10.1038/nrneph.2016.145

17. Olsen N, Iseki K, Kramer H et al. Kidney disease and obesity: epidemiology, mechanisms and treatment. Nature Reviews Nephrology 2017;13,181–190 doi:10.1038/nrneph.2016.191

18. Agati V, Chagnac A, de Vries APJ et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nature Reviews Nephrology 2016;12,453–471 doi:10.1038/nrneph.2016.75; http://www.nature.com/nrneph/journal/v12/n8/full/nrneph.2016.75.html

19. Стаценко МЕ, Деревянченко МВ, Шилина НН, и др. Функциональное состояние почек у больных с сердечно-сосудистыми заболеваниями и ожирением Нефрология 2016;20(5):43-49 [Statsenko ME, Derevyanchenko MV, Shilina NN i dr. Functional state of the kidneys in patients with cardiovascular diseases and obesity Nephrology. 2016; 20 (5): 43-49 (In Russ.)]

20. Румянцев АШ, Шишкин АН, Минкин СР, Шевелева МА. Особенности кардиоренального континуума у пациентов с метаболическим синдромом. Нефрология 2016;20(5):75-83 [Rumyantsev AS, Shishkin AN, Minkin SR, Sheveleva MA. Features of cardiorenal relationships in patients with metabolic syndrome. Nephrology (Saint-Petersburg). 2016;20(5):75-83. (In Russ.)]

21. Gunter W, Ziyadeh Fuad N. Leptin and renal fibrosis. W. Gunter (ed.): Obesity and the kidney. Contr Nephrol Basel Karger 2006; 151: 175-183

22. Hall JE, do Carmo JM, da Silva AA et al. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res 2015;13;116(6):991-1006. doi: 10.1161/CIRCRESAHA.116.305697

23. Dwyer TM, Bigler SA, Moore NA et al. The altered structure of renal papillary outflow tracts in obesity. Ultrastruct Pathol 2000;24:251–257

24. Henegar JR, Bigler SA, Henegar LK et al. Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol 2001: 12:1211-1217

25. Wickman C, Kramer H. Obesity and kidney disease: potential mechanisms. Semin Nephrol 2013; 33(1):14-22. doi: 10.1016/j.semnephrol.2012.12.006

26. D'Elia, Roshan JA, Maski B. Manifestation of renal disease in obesity: pathophysiology of obesity-related dysfunction of the kidney. International Journal of Nephrology and Renovascular Disease 2009:2: 39-49

27. Стаценко МЕ, Деревянченко МВ, Титаренко МН, Пастухова ОР. Нарушения микроциркуляции кожи у больных артериальной гипертензией в сочетании с сахарным диабетом 2 типа в зависимости от стадии хронической болезни почек. Нефрология 2015:19(5):57-63 [Statsenko ME, Derevyanchenko MV, Titarenko MN, Pastukhova OR. Disturbances of microcirculation of the skin in patients with arterial hypertension in combination with type 2 diabetes mellitus depending on the stage of chronic kidney disease. Nephrology 2015: 19 (5): 57-63 (In Russ.)]

28. Крупаткин АИ, Сидоров ВВ. Лазерная допплеровская флоуметрия микроциркуляции крови. М., 2005. – 256 с [Krupatkin AI, Sidorov VV. Laser Doppler flowmetry of microcirculation. Moscow 2005. – 256 p. (In Russ.)]

29. Козлов ВИ. Система микроциркуляции крови: клинико-морфологические аспекты изучения. Регионарное кровообращение и микроциркуляция 2006; 5(2): 84-101 [Kozlov VI. The system of blood microcirculation: clinical and morphological aspects of the study. Regional circulation and microcirculation. 2006; 5 (2): 84-101]


Review

For citations:


Statsenko M.E., Derevyanchenko M.V. FEATURES OF THE STRUCTURAL AND THE FUNCTIONAL STATE OF KIDNEYS AND THE FUNCTION OF ENDOTHELIUM IN HYPERTENSIVE PATIENTS WITH METABOLIC DISTURBANCES. Nephrology (Saint-Petersburg). 2017;21(5):14-21. (In Russ.) https://doi.org/10.24884/1561-6274-2017-21-5-5-18

Views: 1417


ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)