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УДК: 616.61-036.12-005-073.43: 616.155.1
Novychenko S.D., Kovalenko S. V.
Higher State Educational Establishment of Ukraine "Bukovinian state medical university" DOI: 10.24411/2520-6990-2020-12010 PECULIARITIES OF THE INFLUENCE OF MORPHOLOGICAL-FUNCTIONAL CONDITION OF RED BLOOD CELLS ON THE STATE OF DOPPLER-GRAPHIC INDICES OF THE RENAL BLOOD FLOW IN PATIENTS SUFFERING FROM CHRONIC DISEASE OF KIDNEYS I-II STAGE AND
ARTERIAL HYPERTENSION
Abstract.
The object of this work was to investigate correlation between indices of the morphological-functional state of erythrocytes and Doppler-graphic indices in patients suffering from CKD I-II stage (pyelonephritis, glomeru-lonephritis, diabetic nephropathy) with AH II stage.
Keywords: chronic kidney disease, color duplex Doppler-graphy, renal circulation, morphological-functional properties of red blood cells.
With an enlargement of the inflammatory process activity in the kidneys, penetration of the vascular wall of the capillaries and the small renal vessels increases, blood flow rate becomes slower, rheological blood properties deteriorate, being of great significance in pathogenesis of chronic renal disease, especially at presence of CP, CGN with its immune inflammation, that still more worsens penetration of the vascular wall and strengthens displacement of the aggregation processes and depression of all properties of the blood erythrocytes. But at DM presence and DNP, which arose on its base, all the processes, cited above, maximum increase, as against a background of the oppressed immunity and significant derangement of the metabolic processes in the patient's organism, disturbances of the renal blood supply suffer still more [3, 4, 9, 12].
At the same time, activated free radical processes lead to disturbance of the morphological functional properties of erythrocytes' membrane, what may promote disorder of the microcirculatory processes in patients with chronic disease of kidneys. Changes in the morphological-functional state of erythrocytes largely provide normal processes of vital activity of the kidney, they influence not only upon rheological blood properties, but participate in various regulatory processes, providing hem microcirculation of kidneys. Pathological changes of the morphological functional properties of erythrocytes influence upon membrane-receptor apparatus of the kidney cells, and due to it cause negative disorders of their vital activity and functioning [13, 14].
The presence of arterial hypertension in patients with CKD worsens blood flow in small kidney vessels, decreases blood flow rate in them. Thus, problems arising from the side of the morphological functional state of erythrocytes in such patients and correlation of these changes with Doppler-graphic indices of the renal blood flow, are still not studied at present.
The purpose of this work was to investigate correlation between indices of the morphological functional state of erythrocytes and Doppler-graphic indices in patients suffering from CKD I-II stage (pyelonephritis, glomerulonephritis, diabetic nephropathy) with AH II stage. 131 complex ultrasound investigation using ultrasound duplex color scanning of the kidney vessels has been carried out in patients with CKD at presence of rhinoparenchyma AH, who were at inpatient treatment in the nephrology department of RCH "Regional clinical hospital", Chernivtsi. The duration of the diseases was 5-10 years from the moment of making a diagnosis. The patients were at the age of 29-65 years, the average age - 46.50±2.25 years. Among the patients under study were 55 men (41.98%) and 76 women (58.02%). The patients were divided into groups: group I - patients with CKD I-II st. at CP presence (47 persons), group II - patients with CKD I-IIst. and DHP IV st. presence (48 patients), group III - patients with CKD I-II st. with CGN presence (36 patients). In order to form the group of comparison 20 practically healthy persons of the corresponding age category were examined. Each group of patients was divided into 2 sub-
.1).
groups - patients with AH and without AH (fig
100% 50% 0%
ж
22
25
ж
27
21
Ж
19
17
з АГ без АГ
Iгрупа
II група
III група
Fig. 1.Division of patients into groups to be studied
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All patients underwent color duplex renal scanning. Investigation was carried out in triplex regimen (P - regimen, color duplex investigation, mapping, spectral analysis of Doppler rate displacement), peak systolic rate (Vs), final diastolic (Vd) and maximum blood flow rate (TAMX) averaged by time were measured and volumetric flow rate (V vol) and index resistance (IR) were calculated. Curve recording was carried out under conditions of breathing inhibition of the patient. All values were calculated automatically by means of 3D-system of ultrasound apparatus. In the laboratory indices of ESRV, EPH, erythrocytes deforma-bility index were determined in all patients.
The conducted investigations have been fulfilled keeping the GCP main regulations of the European Council Convention (1996) about person's rights and biomedicine (dated the fourth April 1997), Helsinki Declaration of the World medical association about ethic principles of carrying out the scientific medical investigations with participation of a person (19642000) and by order of MPH of Ukraine №»690 dated the 23rd September, 2009, where a person comes forward as an object.
We have studied morphological functional properties of erythrocytes in patients suffering from CKD III stage with AH II degree (table 6.1).
Changes have been revealed in all groups of patients in comparison with a standard when evaluating the results of the research. But the most pronounced EDI decrease was in patients suffering from DN with AH and CGN with AH accordingly (p<0.05). It is necessary to note that within the group of patients with AH difference of indices between subgroups of investigation was the most pronounced in comparison with all groups (p< 0.001). The most pronounced increase of ESRV and EPH levels were also found in the given category of patients in comparison of the results with indices of other groups accordingly (p<0.05). Indices
were changed irrespective of AH presence or absence, but almost in all groups under study indices of morphological -functional properties of erythrocytes veritably differed in subgroups of patients, id.est in patients without AH II st. ESRV and EPH indices were veritably lower than in patients with AH II degree accordingly (p<0.05), and EDI index was veritably lower in patients with AH than in subgroup without AH II degree presence (p<0.05)
Thus, the state of the examined patients with CKD I-II stage (CP, DN, CGN) is accompanied with the marked disorders of the morphological-functional properties of erythrocytes and in patients with AH presence disorders become more profound that manifested, particularly, in the group of patients with DN and AH II st. presence. The revealed ESRV and EPH disorders in patients with CGN at AH presence were also profound and did not differ from the corresponding data in the group with DN and AH - thus, at CGN presence with AH the value constituted 2.49±0.05 un. that in comparison with the data of ESRV group with DN and AH (2.59±0.07 Un) was not veritable (p>0.05), and also EPH index in CGN patients with AH constituted 8.89±0.14%, that in comparison with the same index in patients with DN and AH was (9.19±0.15%), veritably also did not differ (p>0.05). Hence, in patients with dN and AH, and with CGN at AH presence as well, morphological functional properties of erythrocytes suffer almost to the same extent, causing rapid CKD development in this category of patients.
We have studied the presence of correlative relations between indices of the morphological functional properties of the blood erythrocytes and main functions of kidneys in patients with CKD and AH II degree under study. The strongest relations were observed between indices of the main factors of progression of CKD and ESRV and EPH of the blood (fig.2.)
Fig 2. Correlative relations between indices of the morphological-functional properties of the red blood cells
and main factors of CKD progression.
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Thus, strong correlation feedbacks between GFR level and ESRV index (r=-0.83) (p<0.05) and EPH index (r= -0.79), as well as a direct correlative connection of the average strength between GFR and EDI index (r=0.48)(p<0.05) have been found by us.
Also strong direct correlative relation was revealed between quantitative index of the daily proteinuria and EPH (r=0.89) at (p<0.05) and direct connection of the average strength between quantitative index of the daily proteinuria and ESRV (r=0.66)
(p<0.05). Correlative feedback of the average strength was also determined between index of daily proteinuria and EDI (r=-0.49) at (p<0.05).
We have carried out investigation of interdependence between the main morphological-functional indices, which correlated with the main factors of the CKD development (ESRV and EPH) in patients with CKD III st. at AH II st. presence with the main indices of the renal blood flow (Vs, Vd and IR) in the best way. (fig. 3).
Fig. 3. Correlative relations between morphological-functional properties of erythrocytes and main indices of
the renal blood flow on a.interlobaris level.
So, in figure 2 we can see that the strongest direct correlative connection is observed between index of ESRV and IR (r=0.89)(p<0.05), strong feedback was between index of ESRV and Vs (r=-0.75)(p<0.05) and Vd (r = -0.74) (p<0.05) as well.
Strong direct correlative connection was noted between EPH and IR (r=0.76)(p,0.05), and strong feedbacks were also marked between EPH and maximum systolic and minimum diastolic blood flow rates on a.interlobaris level that correspondingly constituted (r=-0.68) at (p<0.05) and (r=-0.71) (p<0.05).
There is also a confirmation of the correct level of the renal blood flow investigation - a.interlobaris, chosen by us, that is sufficient for studying the role of the blood flow state of the small vessels in CKD progression at parenchymatous kidney diseases with AH.
Thus, in our view, disorders of the morphological-functional properties of erythrocytes are also of great significance in creation of conditions for the renal microcirculation disorder and, in future, for CKD progression with AH II degree presence.
So, analyzing changes of the morphological-functional properties of erythrocytes as a whole, it has been revealed that ESRV and EPH indices reliably increase at CKD I-II stage and to a great extent they are manifested in patients with DN, even without AH II degree presence, but at AH presence the changes acquire progressive character.
It should be mentioned that dynamics of the disorders of the morphological-functional properties of erythrocytes in patients with CGN and CP is similar, but more pronounced pathological changes still occur in CGN patients. AH II degree presence makes deeper the afore-said displacements, manifesting to a significant extent in patients with CGN.
Indices of EDI decrease in all patients with CKD I-II stage, but veritably significant changes occur at AHII degree presence. This indicates the important role of disturbances of the given mechanisms for the micro-circulatory disorders in this category of patients.
Multiple strong correlative relations, revealed by us, between indices of the morphological-functional properties of erythrocytes, particularly ESRV and EPH levels with the main Doppler-graphic indices of the renal blood flow on the level of the small renal vessels, namely a,interlobaris, prove our presumption about extreme importance and informational content of the noninvasive method of diagnostics of CKD of the progressive character at AH presence - color duplex Doppler-graphy of the renal vessels on a.interlobaris level.Changes of the morphological functional properties of erythrocytes in patients suffering from CKD I-II stage with AH II degree influence upon deterioration of the blood flow in renal parenchyma. When estimating the results of the research changes, in comparison with standard, have been revealed in all groups of patients.
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But the most pronounced EDI decrease occurred in DM (DN) patients with AH and CGN with AH presence correspondingly (p<0.05). In patients without AH II degree presence ESRV and EDI indices were veritably lower than in patients with AH II degree correspondingly (p<0.05), but EDI index was probably lower in patients with AH, than in the subgroup without AH II degree presence (p<0.05).ESRV increase is associated with a gradual TAMX decrease that, in our opinion, mutually confirms a significant role of these markers in CKD progression. Correctly chosen by us the research level of the renal blood flow - a.interlobaris, being sufficient for studying the role of the blood flow condition of the small renal vessels in CKD development at par-enchymatous renal disease with AH, is also confirmed. Thus, derangements of the morphological-functional properties of erythrocytes, in our view, is also of great significance in creation of the conditions for disorders of the renal microcirculation and, in future, for CKD progression at AH II degree presence.Multiple strong correlative relations, revealed by us, between indices of the morphological-functional properties of erythrocytes, in particular ESRV and EPH levels with the main Doppler-graphic indices of the renal blood flow on the level of the small renal vessels, namely a.interlobaris, prove our presumption about the extreme significance and informational content of the non-invasive method of diagnostics of the progressive character of CKD with AH presence - color duplex Dopplergraphy of the renal vessels on a. interlobaris level.
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