CC BY
15
Akhmedova Nilufar Sharipovna, Scientific applicant Bukhara State Medical Institute E-mail: nilu74@list.ru
CURRENT APPROACHES TO EARLY DIAGNOSTICS OF CHRONIC KIDNEY DISEASE AND EVALUATED RISK FACTORS
Abstract. Chronic kidney disease (CKD) in adults is a common condition and a major public health issue worldwide. Given the increasing incidence of CKD and the availability of effective therapeutic measures, is of vital importance perform early detection of risk factors (RF), in order to delay or prevent progression to ESRD. The optimal cost-effective strategy seems to be an investigation aimed at patients with one or more risk factors for CKD. In order to detect early indicators of CKD and associated risk factors, we conducted a study in an adult population.
Keywords: adult, albuminuria. chronic kidney disease; early detection of risk factors for CKD.
The prevalence of diseases in which chronic kidney disease (CKD) develops is significant and currently continues to increase. Chronic kidney disease is a serious public health problem, characterized by a higher incidence and progression [3].
An important aspect of the study of chronic kidney disease in the population is the early detection of the disease and appropriate treatment. If we take into account the fact that this pathology still does not have a tendency to decrease among persons of different ages, then the determination of factors contributing to the formation and development of this pathology is relevant [1; 6].
It is known that the number of factors contributing to the formation and development of CKD is many, but the level of their influence on the development of this disease is varied [5].
The prevalence of chronic kidney disease (CKD) is comparable to such socially significant diseases as hypertension and diabetes, as well as obesity and metabolic syndrome. Signs of kidney damage and / or a decrease in glomerular filtration rate are detected, at least, in every tenth representative of the general population. At the same time, comparable figures were obtained both in industrialized countries with a high standard of living, and in developing countries with medium and low incomes of the population [4; 6].
The problem of screening for CKD is very serious. Its solution is possible only with close cooperation of doctors of different specialties. On the other hand, it is necessary to integrate nephrology and primary health care, as well as other specialties in order to carry out extensive preventive measures, early diagnosis of CKD, ensuring continuity of treatment and effective use of available resources. There are several ways to identify CKD, among which is the determination of CKD markers in patients undergoing screening for various diseases. One of the important ways to identify CKD is to examine a conditionally healthy population in which they have risk factors for the development of CKD [2; 7].
Given this fact, the determination of the degree of influence of each factor contributing to the formation and development of the disease and the so-called "risk factors" still remains in demand in modern nephrology.
When conducting research at this stage of work, it was taken into account that the effect of risk factors on the human body is individual and the likelihood of developing CKD depends on the compensatory-adaptive capabilities of this organism. The intensity of risk factors in prenosological diagnostics was investigated in relation to the various functional states of the patients.
Therefore, the purpose of this stage of work was to identify and assess the risk factors associated with albuminuria affecting the development of CKD. Based on the interpretation of the data, a methodical approach was used by a number of researchers who used it to evaluate various factors. In this case, 21 factors were selected for analysis, which occupied a definite place in the onset and development of CKD. These included: the age of the patient over 60 years of age, overweight; obesity, arterial hypertension; coronary heart disease; diabetes; rheumatic diseases; hyperlipidemia; pathology of the urinary tract; ischemic heart disease in straight line relatives; hypertension in relatives of the direct line; diabetes in direct line relatives; nephropathy in pregnant women with a history of women; hypertension in pregnant women with a history of women; a history of proteinuria; a dysuria of not clear etiology in the anamnesis; bad habits, smoking and drinking alcohol; abuse of drugs like NSAIDs and antibiotics; the presence of a chronic infection; history of acute allergic reactions; a history of acute bleeding and/or hypovolemic shock;
In this regard, all patients were divided into two groups according to the level of microalbuminuria and the functional state of the kidneys. The group of patients was distributed in such a way, since in the previous chapter we established the diagnostic value of these parameters.
CURRENT APPROACHES TO EARLY DIAGNOSTICS OF CHRONIC KIDNEY DISEASE AND EVALUATED RISK FACTORS
All selected 317 patients were divided into the following groups:
Group 1 - examined with MAU > 30g/ml (above the normal limit) with impaired renal filtration function (GFR < 90 ml/min/1.73 m2) n = 91. "This group includes the parameters of microalbuminuria 30-80 mg/l (medium increase) and 80-150 mg (high level).
2 - group - examined with MAU > 30g/ml (above the normal limit) with preservation of the filtration function of the kidneys (GFR > 120 ml/min/1.73 m2)n = 226. This group includes the parameters of microalbuminuria 30-80 mg/l (medium increase) and 80-150 mg (high level). In addition, this group also included the examined microalbuminuria indicators in the border of the norm (MAU = 10 mg/l), but albumin / creatinine ratio (ACR) with pathological deviation (Abnormal - pathology and Highabnormal - pronounced pathology), which has a diagnostic value in early CKD determination.
The results of the study show that the number of the most significant risk factors increases in the examined 1 - group and reaches 8 factors: a history of proteinuria (48.35 ± 4.99, n = 44); drug abuse as NSAIDs and antibiotics (50.55 ± 4.99, n = 46); overweight (53.84 ± 4.98, n = 49); a dysuria of unclear etiology in the anamnesis (52.75 ± 4.99, n = 48); hyper-lipidemia (69.23 ± 4.61, n = 63); hypertension in a straight
It was established that among the examined patients with a moderate CKD development index was 38.9 ± 4.87%(n = = 88), with an average risk with a "Warning" of 46.5 ± 4.98% (n = 105) and with a high risk and "unfavorable prognosis" 14.6 ± 3.53% (n = 33).
MAU < 150g/l among the surveyed risk groups were not found. MAU < 10g/l - a low level of microalbuminuria with a pathological albumin/creatinine ratio in the urine (abnormal ACR).
The most numerous was the group surveyed with an average risk index. The main identified risk factors for
line relative (69.23 ± 4.61, n = 63); arterial hypertension (79.12 ± 4.06, n = 72); the presence of chronic foci of infection, such as chronic tonsillitis, caries, chronic otitis media (90.11 ± 2.98, n = 82).
In group 2, the picture is somewhat different, since the most significant factors were 6 and they are the following overweight (53.98 ± 4.98, n = 122) hyperlipidemia (57.52 ± ± 4.94, n = 130); arterial hypertension (58.41 ± 4.92, n = 132); abuse of drugs like NSAIDs and antibiotics (58.85 ± 4.92, n = 133); the presence of chronic foci of infection, such as chronic tonsillitis, caries, chronic otitis media (92.04 ± 2.7, n = 208).
Between 1 and 2 groups of coincidence or recurrence of the most significant risk factors were the following parameters: arterial hypertension, hyperlipidemia, overweight, abuse of drugs like NSAIDs and antibiotics; presence of chronic foci of infection.
On the basis of these data, a mathematical model has been developed that allows calculating the risk index (IR) for the development of CKD.
Given the natural separation of the studied, according to the studied risk factors, we calculated the risk ranges. For this weight, the risk range was divided into three subranges and the boundaries of the patients with a risk of development were determined (tab. 1).
CKD in this group were arterial hypertension, coronary heart disease, overweight, diabetes, drug abuse (NSAIDs and antibiotics). Among women in this group, proteinuria was more common in the history (nephropathy of pregnant women).
Taking into account the position of screening the population to identify CKD, as well as the high cost and labo-riousness of conducting laboratory tests when conducting mass surveys in population groups, it is proposed to conduct an interview to identify prognostically significant risk factors with the subsequent calculation of the risk index for CKD.
Table 1. - Evaluation of CKD risk index (in points)
Risk Index Risk Limits Risk Group
Moderate 5.99-4.1 favorable forecast"
Average 7.89-6.0 "Warning"
High 7.9-9.6 "Unfavorable forecast"
References:
1. Bang H., Vupputuri S., Shoham D., Klemmer P. S. et al. Creening for Occult REnal Disease (SCORED). A Simple Prediction Model for Chronic Kidney Disease // Arch Intern Med. 2007.- No. 167.- P. 374-381.
2. Bello A. K., Peters J., Wight J., de Zeeuw D., E.l Nahas M. A Population-Based Screening for Microalbuminuria Among Relatives of CKD Patients: The Kidney Evaluation and Awareness Program in Sheffield (KEAPS) // American Journal of Kidney Diseases, 2008. 52 (3),- P. 434-443.
3. Gambaro G., Bonfante L., Abaterusso C., Gemelli A., Ferraro P. M., Marchesini S., De Conti, G., DAngelo A., Lupo A. High chronic nephropathy detection yield in CKD subjects identified by the combination of albuminuria and estimated GFR // Nephrology Dialysis Transplantation, 2012. 27(2),- P. 746-751.
4. Gunzler D., Bleyer A. J., Thomas R. L., et.al Diabetic nephropathy in a sibling and albuminuria predict early GFR decline: A prospective cohort study // BMC Nephrology, 14(1). 2013.- P. 72-80.
5. Robaina J., Fayad A., Forlano C., Leguizamon L., De Rosa M., Vavich R., Rossello P., Marini A. Detection of risk factors and early indicators of chronic kidney disease in an adult population during a kidney health campaign // Revista de Nefrologia, Dialisis y Trasplante, 013 33 (4),- P. 196-214.
6. Vassalotti J. A., Li S., Chen S-C. et al. Screening populations at increased risk of CKD: the Kidney Early Evaluation Program (KEEP) and the public health problem // American Journal of Kidney Diseases. 2009.- No. 53.- P. 107-114.
7. Iseki K. Role of urinalysis in the diagnosis of chronic kidney disease (CKD) // Japan Medical Association Journal, 2011. 5(1),- P. 27-30.
