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ROLE OF STUDY RENAL BLOOD FLOW AND CONCENTRATION OF URIC ACID IN BLOOD AND URINE IN THE DIAGNOSIS OF
PREECLAMPSIA
AKHMEDOV FARHOD KAHRAMONOVICH
PhD, Senior teacher in the Department of obstetrics and gynecology, Bukhara medical Institute. Bukhara, Republic of Uzbekistan. ORCID ID 0000-0003-0104-4980.
ABSTRACT
Purpose of the study: Assessment of the role the study of renal blood flow and the concentration of uric acid in the early diagnosis of preeclampsia. We have a detailed study of the state of renal blood flow and the concentration of uric acid in the blood and in the urine of 200 pregnant women at 30-34 weeks of gestation. A comprehensive study of the parameters of the organ (kidney) blood flow and metabolic markers of indicators can reveal the essence of the mechanisms of circulatory hemodynamic disturbances occurring in pregnant in PE, which is essential to the management of pregnancy, labor, and time and method of delivery. Based on the results of the study, we have developed an algorithm to predict the development of PE, select the step management of pregnant women with this pathology
Keywords: Doppler, preeclampsia, renal blood flow, uric acid.
РОЛЬ ИЗУЧЕНИЯ ПОЧЕЧНОГО КРОВОТОКА И КОНЦЕНТРАЦИИ МОЧЕВОЙ КИСЛОТЫ В КРОВИ И МОЧЕ В ДИАГНОСТИКЕ
ПРЕЭКЛАМПСИИ
АХМЕДОВ ФАРХОД КАХРАМОНОВИЧ
PhD, старший преподаватель кафедры акушерство и гинекологии, Бухарский Государственный медицинский институт
имени Абу Али Ибн Сино. город Бухара Республика Узбекистан.
ОИСЮ Ю 0000-0003-0104-4980 АННОТАЦИЯ
Цель исследования: Оценка роли изучении почечного кровотока и концентрации мочевой кислоты в ранней диагностике преэклампсии. Нами было детально изучения состояние почечного кровотока и концентрации мочевой кислоты в сыворотке крови и в моче у 200 беременных женщин в сроке гестации 30-34 недель. Комплексное изучение параметров органного (почечного) кровотока и показателей метаболических маркеров могут раскрыть суть механизмов циркуляторных гемодинамических нарушений, происходящих в организме беременной при ПЭ, что имеет принципиальное значение для тактики ведения беременности, родов, также времени и метода родоразрешения. На основании результатов исследования нами разработать алгоритм, позволяющий прогнозировать развитие ПЭ, выбрать ступенчатую тактику ведения беременных с данной патологией
Ключевые слова: допплерометрия, преэклампсия, почечного кровотока, мочевая кислота.
ПРЕЭКЛАМПСИЯНИ ТАШХИСЛАШДА БУЙРАКДАГИ КОН АЙЛАНИШИ, СИЙДИК КИСЛОТАСИНИНГ СИЙДИК ВА КОНДАГИ МИКДОРИНИ АНИКЛАШНИНГ А^АМИЯТИ
АХМЕДОВ ФАРХОД КАХРАМОНОВИЧ
т.ф.ф.д, акушерлик ва гинекология кафедраси катта ук^итувчиси, Бухоро давлат тиббиёт институти. Бухоро шахри.
Узбекистон Республикаси. ORCID Ю 0000-0003-0104-4980
АННОТАЦИЯ
Тадцицот мацсади: преэклампсияни эрта ташхислашда буйракдаги цон айланиши, сийдик кислотасининг мицдорини
анинлашнинг ацамиятини бацолаш. Биз 30-34 %афталик цомиладорлик муддатларидаги 200 та цомиладор аёлда буйракдаги нон айланиши, сийдик кислотасининг сийдик ва нондаги миндорини анинладик. Аъзодаги (буйрак) нон айланиши ва метаболик маркер-ларнинг курсаткичларини комплекс урганиш преэклампсияда цомиладор аёл организмида кузатилувчи циркулятор гемодинамик бузилишлар механизмини анинлашга имкон беради. Бу эса бундай беморларни олиб боришда, тугрун вантини ва шаклини анинлашда жуда муцим саналади. Таднинот натижаларига таяниб биз преэклампсия нандай ривожланишини тахмин нилувчи, шу патология билан цомиладор аёлларни олиб бориш алгоритмини яратдик.
Калит сузлар: допплерометрия, преэклампсия, буйракда нон айланиши, сийдик кислотаси
It is known that with PE, pathological changes in the function of various organs of the mother occur. Among them, the kidneys are more often involved in this process, as well as in its earlier stages - [1; 2; 7; 12]. The most significant effect of PE on the mother and fetus in many cases depends on the course and extent of the processes occurring in the kidneys. As a result of functional insufficiency of the organ, first of all that forms in the vascular system and persistently developing spasm it leads to impaired perfusion of organs and systems, fetal uterine circulation, and, above all, the kidneys, accompanied by a decrease in glomerular filtration and renal disease, which leads to proteinuria - [1; 3; 5; 6].
One of the results of spasm and ischemia of organs and systems of the mother's body should be considered an increase in the concentration of uric acid in the blood (hyperurekimia> 5.5 mg %), which is the final product of purine metabolism. It is known that uric acid is synthesized mainly in the spleen and excreted by the kidneys (J. D Kobalava et al.,
2002). Therefore, an increase in its concentration in plasma, a decrease in urine can, serves as an indicator of the severity of renal dysfunction, an indicator of the development of hypertension during pregnancy - [4; 8; 11].
Given the multifactorial nature of hyperuremia, K. P. Williams, T. Gallernoau (2002) specified that hyperuremia in excess of 5.5 mg% should be considered an indicator of the development of hypertension during pregnancy, as well as a cause of increased perinatal losses. Similar opinions were expressed by V.C. Warwe O.O. Abudu (1999), who believes that hyperuremia> 5.5 mg% allows women to be identified with a high probability of PE.
According to the authors, even in the absence of proteinuria, the risk of premature birth, low gestational age of the fetus at birth, maternal and prenatal mortality in women with gestational hypertension and hyperuricemia is extremely high - [9; 10].
Purpose of the study: To assess the role of the study of renal blood flow and uric acid concentration in the early diagnosis of preeclampsia.
Material and methods.
We studied in detail the state of renal blood flow and the concentration of uric acid in blood serum and urine in 200 pregnant women at a gestational age of 30-34 weeks. Of these, 50 women with physiological pregnancy (group 1), 100 patients (group 2) with layering of light PE and 50 pregnant women with severe PE (group 3).
The study of renal blood flow during gestation of 30-34 weeks by the Doppler method was carried out by us in all pregnant women of the above groups. Renal blood flow was studied using duplex scanning in the mode of pulse-wave and color Doppler. Dopplerometric parameters were determined at the level of segmental, interlobar, distal arteries. Dopplerometry was performed with an ultrasound machine with a Doppler attachment on a Sono-scape SSI 5000 device (China model), with a
convex sensor with 3.5 MHz, which makes it possible to study renal blood flow. Used the following indicators: RI.
Uric acid was determined by enzymatic - colometric method. Used reagent composition kits 4x100ml enzymatic reagent. Instrumental studies all observed patients underwent a complete clinical examination in a hospital setting.
Results and discussion Given the wide variety of indicators obtained by dopplerometry of the renal vessels, as well as the prevalence of generalized spasm of resistive vessels in PE pathogenesis with an increase in total peripheral resistance and, to a greater extent, these changes occur in the kidneys, we considered it possible to dwell only on the dopplerometric indicator RI characterizing the resistance of the renal vascular system.
To judge the predominant place of changes in renal vascular resistance, we determined the RI in the distal segment of the renal artery at the level of segmental and interlobar arteries.
The table below reflects the state of renal vascular resistance and the level of uric acid in blood serum and urine in the pregnant women examined by us with physiological pregnancy, mild and severe preeclampsia.
Table 1
Indicators of renal vascular resistance and uric acid concentration in the blood serum and urine of pregnant women in the studied groups, during gestation 30-34 weeks (n = 200)
Indicators 1 group (n = 49) 2 group (n = 87) 3 group (n = 64)
RI
- distal renal artery 0,66±0,02 (0,63-0,69) 0,65±0,01 (0,60-0,69) 0,67±0,01 (0,58-0,76)
- segmental arteries 0,61±0,01 (0,59-0,63) 0,67±0,02** (0,62-0,72) 0,69±0,01*** (0,63-0,75)
- interlobar arteries 0,53±0,02 (0,49-0,57) 0,61±0,02** (0,57-0,65) 0,63±0,01*** (0,57-0,69)
Uric acid evel
- blood serum, mcmol / l 184,0±5,9 (113-253) 368,9±2,4*** (332-405) 454±6,9***ллл (364-540)
- in urine, mmol / hour 2,9±0,10 (1,8-4,0) 3,1±0,08 (1,9-4,3) 3,4±0,04***лл (2,9-3,9)
Note: in parentheses is the scatter of the studied indicators in groups; * - differences relative to group 1 data are significant (** - P <0.01, *** - P <0.001), A - differences relative to group 2 data are significant (AA -P <0.01, aaa - p <0.001)
Analyzing the data on the renal vascular resistance index, it can be noted that in patients with a physiologically ongoing pregnancy, the tone of the distal renal arteries significantly exceeds the resistance of the intrarenal vessels (segmental and interlobar arteries).
That is, the resistance of the intrarenal arteries during a normal pregnancy is relatively low, does not interfere with the intrarenal blood flow. In this regard, our data are consistent with those of many authors (Akperbekova S.A., Gadirov A.V., 2010; Verzakova I.V., Setoyan M.A., 2010; Mazurska N.M., 2004; Gyselaers W., 2010; Eyabalan J. A., Conrad KP, 2007).
With layering of light PE, the index of renal vascular resistance generally increases: interlobar by 15.1% (P <0.01). An increase in the tone of the segmental renal arteries was 9.8% (P <0.01), while the resistance index of the distal segment of the renal artery remained almost unchanged.
With increasing severity of PE, resistance of the intrarenal segmental and interlobar arteries continued to increase. RI of segmental, interlobar, and intrarenal arteries in women with severe PE was increased relative to those of the 2 groups by 3.3%, respectively (in both cases, P> 0.05).
The RI of the distal renal arteries, remaining unchanged, was 5.8% lower than this index of the intrarenal segmental arteries and 3.2% lower than the resistance of the intrarenal interlobar arteries. All of the above indicated a significant increase in the resistance of the intrarenal arteries, which led to a decrease in renal blood flow, a decrease in the renal threshold in albumin excretion, and deterioration in renal function, in particular, filtration and concentration.
This was evidenced by a decrease in urine output and relative density of urine.
Our parallel study of the concentration of uric acid in blood serum and urine, as can be seen from the data given in table No. 1, with the addition of PE and an increase in its severity, an increase in the concentration of uric acid in the blood serum was significantly higher than normal with a decrease in the degree of concentration in the urine.
Hyperuricemia in the group of women with mild PE exceeded the level of uric acid in the blood of women in the control group by 100.5% (P <0.001), and in severe PE by 146.7% (P <0.001).
When analyzing urinary acid excretion in urine into groups, a false impression is created about the increase in its content in patients with mild and severe PE. The falsity of this impression becomes visible when calculating the percentage of uric acid excretion in the ratio of blood: urine.
So, if in pregnant women of the control group, the concentration of uric acid in the blood was 184.0±5,9 mmol / l, and in the urine 2.9±0,10 mmol / h, then the concentration index, blood excretion: urine is 1,02 % In
women with mild PE with uric acid concentration in the urine of 3,1 mmol / h, the concentration index of excretion was 0,84%.
In women with severe PE with a seemingly higher concentration of uric acid in the urine (3,4+0.4 mmol / h), the concentration index of excretion was 0,74%, that is, it was lower than in pregnant women with a mild PE.
This is due to the rapid increase in the concentration of uric acid in blood serum in parallel with the severity of PE due to significant metabolic disorders and a clear decrease in its excretion in the urine.
Our data make it possible to consider that not the absolute values of urinary acid excretion mmol / hour, but its percentage in the blood-urine system are a more indicative test with increasing severity of PE, with deterioration of renal function.
Thus, a comprehensive study of the parameters of the organ (renal) blood flow and indicators of metabolic markers can reveal the essence of the mechanisms of circulatory hemodynamic disturbances that occur in the pregnant woman's body with PE, which is of fundamental importance for the tactics of managing pregnancy, childbirth, and also the time and method of delivery. Based on the results of the study, we develop an algorithm to predict the development of PE, choose stepwise management tactics for pregnant women with this pathology.
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