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CHARACTERISTICS OF THE LIPID SPECTRUM VALUES IN THE PATIENTS WITH CHRONIC RENAL DISEASES
Daminov B. T., Makhmudova N. R., Tashkent Pediatric Medical Institute E-mail: mbshakur@mail.ru
CHARACTERISTICS OF THE LIPID SPECTRUM VALUES IN THE PATIENTS WITH CHRONIC RENAL DISEASES
Abstract: Metabolic disorders in chronic renal diseases can be considered as a lipid distress syndrome, which is a systemic pathological reaction of the organism that arises on the basis ofviolations of lipid metabolism. The detection of initial manifestations of lipid metabolism disorders in patients with CRD allows the identification of high-risk groups with an unfavorable outcome.
Keywords: chronic renal disease, diagnosis, lipid spectrum.
Chronic renal disease is widely spread pathology and was determined as damage of kidneys with any etiology and/ it is met in developed countries in 10-11% of population or decrease of its function, registered within three or more
[2; 6]. Urgency of the study of lipid metabolism in nephrology is conditioned by the proven participation of kidneys in lipid exchange, increase of atherosclerosis specific weight among the reasons of invalidation and death of patients with renal diseases, completely negative impact of some drugs (glucocorticoids, cytostatics, diurrhetics, hypotensive agents, etc) used for the therapy of nephrologic patients on lipid exchange [1; 5]. It is known, developed dyslipoproteinemia (DLP) leads to lesion of endothelium of capillaries in glomerula and accumulation of lipids in mesangial cells, which link and oxidize low density lipoproteins (LDLP), and that stimulates proliferation of mesangium and development of glomerular sclerosis. Besides that, lipoproteins filtrated in glomerula, are accumulated in channels, they induce tubular interstitial processes, interstitial sclerosis, and development of chronic renal failure (CRF) [4].
In case of nephropathies energetic demands of kidneys, covered mostly by means of lipid oxidation, where the basic source of energy for a complete perfused kidney are free fatty acids (FA), suffer the most [7]. It is clear, that basic renal syndromes (nephrotic, hypertensive) determine formation and progress of DLP, though these are often diagnosed at late stages, when there are CRF manifestations [8; 9].
Detection of predictors of development and progression of renal lesion will provide effective performance of primary and secondary nephroprotection, by these means inhibiting development of nephrosclerosis progression.
The objective: to study the values of lipid spectrum in patients with CRD dependently on the stage.
Materials and research methods. The study involved 51 patients (21 men and 30 women) with CRD I-IV stages, mostly parenchymal renal diseases (chronic glomerulonephri-tis, chronic recurrent pyelonephritis, etc) in the age from 30 to 74 years old, the average age was 52 ± 10 years old. CRD
months. CRD stages were determined in compliance with the National Kidney Fund classification, USA (NKF K/DOQI, 2002) dependently on the GFV rate and presence of renal damage markers [3].
All patients had standard clinical laboratory and instrumental tests.
GFV was calculated using shortened MDRD (Modification of Diet in Renal Disease Study) formula. For the performance of the basic analysis all patients were divided to two groups: the 1st group involved 20 people with CRP I-II stages; 2nd group 31 people with CRP III and IV stages.
CRD criterion was considered to be the velocity of glomerula filtration below 60 ml/min/1.73m2 lasting 3 months and more with or without renal lesion symptoms. Renal lesion is structural and functional renal abnormalities revealed in the analysis of blood, urine or by visual examinations [9].
The study did not include patients with CRD V stage (terminal renal failure); lupus, systemic vasculitis; severe cardiac-vascular pathology, developed prior to the start of renal disease; renal failure; hypothyroids or thyrotoxicosis; patients with neural degenerative or demyelinating pathologies and neural infections diagnosed earlier.
Control group consisted of 20 examined people: 10 women and 10 men, the average age ofwhom was 48.2 ± 8.8 years old; somatically healthy people in the history of which there was cardiac-vascular pathology and disorders of carbohydrate exchange. Comparison group was compatible in age and gender parameters. When the members of the control group were checked again using N. S. Korotkov's method we registered AP rates below 140/90 mm.m.c.
For the detection of proteinuria (PU) a test with sulfur salicylic acid was done with further qualitative definition of protein using photometer R0KI-2002 (Olvex Diagnosticum Ltd., Russia).
Section 7. Medicine
We also determined amount of total cholesterol (TC) in blood, triglycerides (TG), cholesterol of high density lipo-proteids (HDLP C), cholesterol of low density lipoproteids (LDLP C), and atherogenecity coefficient (AC).
The results of the study were evaluated using parametric and non-parametric methods with the help of a set of applied programs of STATISTICA 7.0.
Results of the study. Most of the patients with CRD are patients with GFV below 60 ml/min (31 out of 51 (60.8%)). In the general group the part of patients with renal failure is great 43.1% (22 out of 51).
Part of the patients with SAP 150 mm.m.c. and more (167.3 ± 1.4 mm.m.c.) is reliably bigger in the group of patients with CRD III and IV stages compared to the patients with CRD I—II stages (134.4 ± 1.4 mm.m.c). Average duration of AH in the patients of the 2nd group was significantly longer than in the patients ofthe 1st group (8.6 ± 0.5 years and 4.9 ± 0.3 years, respectively; P < 0.05).
The number of patients with cerebral vascular diseases with atherosclerotic nature (AFCC, THA) was reliably bigger in the 2nd group of patients 21.3% (7 out of 31), compared to the 1st group - 10% (2 out of 20; P < 0.05). there was a tendency for revealing a greater frequency of cerebral vascular pathologies in the 2nd group compared to the 1st one (19.4% (5 out of 31) versus 10.0% (2 out of 20); though there was no statistically significant difference.
Assessment of average values of the studied lipid ofblood serum in the group of patients with CRD revealed that the maj ority of analyzed values differed from the values in healthy
group. Compared to healthy people patients with CRD had TC higher to 27.0% (p < 0.01), LDLP C to 46.4% (p < 0.01), and atherogenic potential of blood serum, calculated according to AC, was 6 folds increased (p < 0.05).
The study of correlation analysis revealed that the values of lipid spectrum were interrelated with the values of GFV in the patients with CRD. There was correlation feedback with the values of TC (r = -0.628), LDLP C (r= -0.518), TG (r= =-0.499) and with HDLP C (r = 0.510). The achieved data prove that misbalance of lipid spectrum leads to progression of CRD.
Thus, the character of dyslipidemia in the patients with CRD differs dependently on the stage of the process. Patients with CRD had hypertriglyceridemia due to the decrease of enzyme processing of TG, conditioned by the decrease of li-poproteid lipase and hepatic triglyceridlipase activity [4]. Besides that, patients with CRD were characterized by low values of anti-atherogenic HDLP, promoted by low concentration and activity of lecithin-cholesterol-acyltransferase, leading to disorder of the synthesis, transport of HDLP and accelerated degradation of HDLP [1; 4].
Metabolic disorders in case of CRD can be considered as lipid distress-syndrome, representing systemic pathologic reaction, appearing on the basis of disorder of lipid exchange and promoting appearance of new or progression of existing pathologies.
Revealing of initial manifestations of lipid exchange disorder in the patients with CRD provides definition of the high risk group with unfavorable outcome.
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