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9S. Smiyan doctor of medicine, professor I. Horbachevsky Ternopil State Medical University
M. Franchuk master of medicine, postgraduate student I. Horbachevsky Ternopil State Medical University
R. Komorovsky philosophy doctor, associate professor I. Horbachevsky Ternopil State Medical University
OBESITY AS A RISK FACTOR FOR KIDNEY DAMAGE IN PATIENTS WITH GOUT
Summary: a frequent combination of gouty arthritis with concomitant pathology leads to a reduction in the effectiveness of treatment, with rapid progression of complications and an increase of mortality. Kidney damage in patients with gouty arthritis is characterized by a prolonged subclinical course.
The present one-center cohort retrospective study included 117 patients with gouty arthritis. In addition to all scheduled procedures, microalbumin and a1-microglobulin levels in urine were assessed.
Most patients in both groups have been diagnosed with obesity stage 1 with prevalence in patients without subclinical gouty nephropathy. In the rest, obesity of the stage 2 was detected, and obesity of the stage 3 was established only in patients with subclinical gouty nephropathy.
Obese patients with subclinical gouty nephropathy have been found to have significantly higher levels of total cholesterol, low density lipoprotein cholesterol and triglycerides.
Key words: gout, gouty nephropathy, obesity, metabolic syndrome
INTRODUCTION. Gout is considered to be the most common inflammatory disease of joints in men, affecting up to 2% of the adult population of the planet. Besides, it is a major cause of loss of work ability, limitation of professional capacity, early disability resulting in a significant social and economic burden for the country. For example, the annual cost of treatment for new cases of acute gouty arthritis in the United States is estimated at 27,4 million dollars.
The problem of gout treatment is still relevant. Despite the wide arsenal of medicines, gouty arthritis therapy is in practice restricted to diet, the use of non-ste-roidal anti-inflammatory drugs and allopurinol.
This disease becomes even more challenging due to its comorbidities. A frequent combination of gouty arthritis with concomitant pathology (kidney damage and obesity) leads to a reduction in the effectiveness of treatment, with rapid progression of complications and an increase of mortality. Kidney damage in patients with gouty arthritis ("gouty nephropathy") is characterized by a prolonged subclinical course. Several studies have shown that the only marker of kidney damage can be asymptomatic microproteinuria, with uncontrolled hyperuricemia being a risk factor. But to date it is not clear whether hyperuricemia is a risk factor for gouty nephropathy or vice versa.
Also, the issue of treatment of obesity and subclin-ical gouty nephropathy (SGN) is not sufficiently highlighted in literature, therefore, the problem of diagnosis and the choice of optimal treatment remains relevant.
MATERIALS AND METHODS. The present one-center cohort retrospective study included 117 patients with gouty arthritis, who were on a scheduled inpatient treatment in Rheumatology Department of Ternopil University Hospital between 2015 and 2018.
In addition to all scheduled procedures, microalbumin and a1 -microglobulin levels in urine were assessed.
Of 117 patients who agreed to participate in the study, 103 were found to have obesity of varying degrees. Therefore, we decided to exclude patients with normal body weight for more reliable statistical data processing.
According to the study design, all patients were divided into two groups, depending on presence/absence of microproteinuria. The I group of patients (n = 58) included those with elevated levels of microproteins (microalbumin and a1-microglobulin) in urine. Detection of microproteins in urine of patients with gouty arthritis who had no history of gouty nephropathy, no abnormalities in kidney function tests, no proteinuria, and who had never received nephroprotective treatment permitted to suspect subclinical gouty nephropathy (SGN). The II group of patients (n = 45) with normal microprotein levels was defined as the control group.
RESULTS AND DISCUSSION. All subjects participating in the sudy were males aged 50,8 ± 8,05 years, and the mean disease duration was 9,31 ± 5,02 years. During the study the mean in-hospital stay of patients was 10,51 ± 2,03 days. Also, in most patients tophi (72,8%) and loss of ability to work (56,7%) were detected. In more than half of the patients, the moderate disease severity and the second radiological stage of gouty arthritis were diagnosed.
With regard to the affected joints, their minimum number of the involved joints was three, and the maximum - 36 joints with an average value of 12,48 ± 5,01 joints. The structure of concomitant diseases is shown in Fig. 1.
Fig. 1
Most patients were able-bodied of working age. SGN. In the rest, obesity of the stage 2 was detected, Most patients in both groups have been diagnosed with and obesity of the stage 3 was established only in pa-obesity stage 1 with prevalence in patients without tients with SGN (Fig. 2).
Gradation by BMI
Fig. 2
Assessing the intensity of pain for visual analog scale (VAS), the following values were obtained: patients of the I group - 75,3 ± 8,2 mm, and in the II group -63,7 ± 12,4 mm (Fig. 3).
group
Fig. 3
A significantly higher proportion of dyslipidemia was found in patients with obesity and subclinical gouty nephropathy (94,7 % vs. 75,5 % in group II patients, p=0,006) characterized by elevated levels of to-
tal cholesterol (TC), low density lipoproteins cholesterol (LDL) and triglycerides. The highest TC and LDL levels were observed patients aged >60 years in both groups and the highest triglyceride levels were seen in patients with obesity and SGN (Fig. 4).
Fig. 4
With the increase of disease duration, the TC and LDL levels in patients with obesity and SGN were increasing proportionately in both groups (Fig. 5).
Fig. 5
Also were detected significant correlations between subclinical gouty nephropathy and total cholesterol (r = 0,43), LDL (r = 0,77), triglyceride (r = 0,84) levels (Fig. 6).
Fig. 6
CONCLUSION. Obese patients with subclinical gouty nephropathy have been found to have significantly higher levels of total cholesterol, low density lipoprotein cholesterol and triglycerides. Lipid profile abnormalities were becoming more prominent with increasing age and longer duration of the disease. Also, significant correlations between subclinical gouty nephropathy and total cholesterol, low density lipopro-tein cholesterol, triglycerides have been detected. Therefore we suggest that obesity may be considered as a risk factor for kidney damage in patients with gout.
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