CIRCADIAN RHYTHMS OF ARTERIAL PRESSURE IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS AND DIABETIC NEPHROPATHY IN THE STAGE OF CHRONIC RENAL FAILURE

THE AIM of the investigation was to assess the role of impairments of circadian rhythms of arterial pressure (AP) in progression of renal failure in patients with chronic glomerulonephritis (CGN) and diabetic nephropathy (DN), their interrelation with activity of reninangiotensin aldosteron system. PATIENTS AND METHODS. Examination of 63 patients with different degrees of renal failure included 34 women and 29 men. There were 33 patients (52%) with CGN and 30 (48%) with DN. All the patients received antihypertensive therapy in order to reduce average AP .to the level of 92 mm Hg (125/75 mm Hg). Circadian monitoring of AD (CMAD) was performed in all the patients. On the day of CMAD plasma renin activity was specified. The rate of progressing chronic renal failure (CRF) was specified by the time of doubling the blood creatinin level. RESULTS. Patients with DN and CRF did not differ by the main laboratory parameters with the exception of more pronounced proteinuria in diabetics. In dipers with DN the rate of progression of CRF was 27.8+3.7 months, with the impaired circadian rhythm of AP 21.2+4.4 months. In the group of patients with CGN the rate of progression of CRF was substantially slower in dipers than in patients with impaired circadian profile of AP (44.0±5.5 and 24.3±7.6 months respectively). Patients with CGN and DN with the impaired circadian rhythm had approximately similar rate of progression of CRF (24.3±7.6 and 21.2±4.4 months respectively; MannWhitney U test; Z = 1.0; p= 0.9). The rate of progression of CRF in dipers with DN was 27.8±3.7 months, with CGN 44.0±5.5 months (MannWhitney U test; Z = 2.0; p=0.04). The same regularity was also observed in cases of the achieved and not achieved required level of AP (25.4±6.4 and 20.4±3.5 months respectively; MannWhitney U test; Z = 0.34; p=0.74). CONCLUSION. The rate of progression of CRF in patients with DN was higher than with CGN with the normal circadian rhythm or the achieved required level of AP. Patients with CGN and DN with the impaired circadian rhythm or not achieved required level of AP had approximately similar rate of progression of CRF.

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