CC BY
12
Section 7. Medicine
Akhmedova Nilufar Sharipovna, Researcher of the Department of Faculty and Hospital Therapy of the Bukhara State Medical Institute,
Bukhara, Uzbekistan E-mail: nilu74@list.ru
THE IMPORTANCE OF PROTEINURIA AS A PREDICTOR OF DIAGNOSIS AND A RISK FACTOR FOR THE DEVELOPMENT OF CHRONIC KIDNEY DISEASE
Abstract: Proteinuria, which is a predictor of early diagnosis of chronic kidney disease, is also a risk factor for the development and progression of renal disease. The interdependence has a multi-faceted nature, and are built according to the type of feedback. On the one hand, the kidney can act as a target organ for most of the risk factors such as arterial hypertension, coronary heart disease, diabetes, age, obesity associated with albuminuria. On the other hand, a decrease in renal function and pronounced albuminuria is an important cause of the accelerated development of the terminal stage of chronic kidney disease.
Keywords: proteinuria, albuminuria, chronic kidney disease, risk factors.
Chronic kidney disease (CKD) - this is the problem with deep social and economic consequences associated with the prevalence among people, disability and death due to renal failure (RF) and cardiovascular events (CVE) [2, 3].
The prevalence of CKD occurs as often as hypertensive disease (HD), diabetes mellitus (DM), obesity and metabolic syndrome (MS). Relationships renal dysfunction and CAS changes are multifaceted and line feedback type [5].
Currently installed the role of proteinuria/microalbu-minuria (PU/MAU) as a marker of activity and independent factor of progression of CKD.
The aim of the work - to estimate the value of the PU/ MAU as a marker of early diagnosis and risk factors (RF), the progression of CKD
Material and methods. The study included 317 patients: 99 (31.2%) men, 118 (68.8%) women aged 17-80 years.
The study was conducted in two different family polyclinics in the Bukhara region. The study included persons not previously observed at the nephrologist. Among these, 103 (32.5%) of the person does not consulted a doctor and had no complaints of the renal.
To assess the potential risk factors of CKD in all subjects performed a survey. We calculated the body mass index (BMI) formula Ketle, depending on what was recovered normal weight with BMI <25; overweight - a BMI of 25-30, obesity - BMI > 30.
All surveyed analyzed urine using test strips Combina 13 («Human GmbH", Germany). Test for measuring microalbuminuria (MAU) in the urine is based on the principle of the indicator color change under the influence of proteins. MAU level was determined according to the following scale: 10 mg/l norm (NAU), 10-30 mg/l - initial increase, 30-80 mg/l - average increase, 80-150 mg/l - high level. To verify
the probability of MAU was determined with albumin/creati-nine ratio (ACR). The ACR was evaluated on the following scale: Normal - normal; Abnormal - pathology; High abnormal - severe pathology. Kidney function was assessed by glomerular filtration rate (GFR).
Results and discussion. The detection rate of MAU (up to 10 mg/l) was 27.7%, but of these, 11.2% ACR was Abnormal. The initial increase MAU (10-30 mg/l) is determined at 47% average increase (30-80 mg/l) - in 21.8% MAU and high level (80-150 mg/l) - 3.5%.
The incidence of MAU> 30 mg/L in men was higher (68.6%) than in women (46.6%). When analyzing the detection of the frequency of MAU> 30 mg/L in different age groups, it was found that in the elderly (<60 years) the MAU was more frequent (40.6%) than the average (29.8%) and young (13, 8%) of the age of the contingent (p<0.001).
In our study the main risk factors CKD had hypertensive disease in 53.6% of cases, and coronary heart disease (ischemic heart disease) in 18.3% of cases. The most sensitive predictors were the following factors, such as, history of proteinuria and abuse of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (44.8% and 34.2%). The detection rate of MAU>30 mg/l in patients with hypertension was 67.6%, in patients with coronary artery disease and diabetes, 52.7% and 83.5%, respectively. In women who had a history of proteinuria (nephropathy during pregnancy), MAU > 30 mg/l was detected in 58.7%. MAU> 30 mg/l, associated with abuse of analgesics and NSAIDs, was 47.4% (p<0.01). The detection rate MAU>30mg/l in those with normal BMI was 22.3%, overweight (BMI>25) - 49.8% (p<0.01). Among the examined persons CKD was detected in 28.7% (91 people). The distribution of the stages of CKD was as follows: 1 st.-4.4%, 2 st.- 84.6%, 3 st.- 11% (p<0.001). CKD with 4 and 5
THE IMPORTANCE OF PROTEINURIA AS A PREDICTOR OF DIAGNOSIS AND A RISK FACTOR FOR THE DEVELOPMENT OF CHRONIC KIDNEY DISEASE
st. not detected. To assess the role of the PU/MAU as the development of CKD risk factors, we assigned patients on a scale of MAU and analyzed their frequency of occurrence stage of CKD and its associated risk factors. Thus, a high level of MAU (80-150 mg/l) was detected in 11 people, 45.5% of them had 3 stage of CKD, 54.5% had 2 st. of CKD. The average increase in MAU (30-80 mg/l) was revealed in 69 people, among them CKD3 st. - in 7.2% of cases, 2 st - in 43.4%, 1 st. - in 1.4%. Initial increase of MAU (10-30 mg/l) was determined in 149 people, among them CKD3 st.- 1,3%, 2 st.- 23.5%, 1 st.- 3,4%. (p<0.01)
In the course of our studies, we established the relationship of CKD with general population characteristics - sex and age. Numerous studies have shown that CRF in men progresses more rapidly than in women. In our studies, this was also confirmed: the expressed MAU (<150 mg/l) and the third stage of CKD, were most pronounced among men - 76.9%.
Elderly age is also one of the risk factors of CKD. The prevalence of MAU and CKD increased with age in our work. The most frequently occurring risk factors of CKD were MS and hypercholesterolemia. Obesity is risk factors of chronic disease, such as, II type of debate millets, coronary heart disease and HD. Simultaneously, these diseases are risk factors for the development of renal disease [5, 6].
Thus, the definition of MAU and GFR is of diagnostic importance and allows earlier detection of patients with different risk groups with CKD. Determining the MAU in an outpatient setting will allow early diagnosis and prevention of CKD.
PU/MAU, which is a predictor of CKD diagnosis, is simultaneously a developmental factor of CKD. Hypercholesterolemia worsens the prognosis of CKD. Given the close link between MS with MAU and HD, it can be concluded that there is a particular significance for MS in development and progression of CKD.
References:
1. Agranovich N. V. The basis and effectiveness of prevention and treatment of patients with chronic kidney disease in outpatient and polyclinic conditions // Nephrology. 2013; 17(5): 43-8. (In Russian).
2. Vialkova A. A., Lebedeva E. N., Krasikov S. I. et al. Clinic-pathogenetic aspects of kidney damage in obesity // Nephrology. St. Petersburg 2014; 18(3): 24-33. (In Russian).
3. Nagaytseva S. S., Shvetsov M. Yu., Shalyagin Yu.D. et al. Evaluation of albuminuria by the method of test strips for the purpose of early detection of chronic kidney disease in persons with different degrees of risk (experience of the Moscow Region Health Centers) // Therapeutic archive. 2013; 26: 38-43. (In Russian).
4. Smirnov A. V., Shilov E. M., Dobronravov V. A. et al. National recommendations. Chronic kidney disease: the basic principles of screening, diagnosis, prevention, and approaches to treatment // Clinical Nephrology. Moscow. 2012; 4: 4-26. (In Russian).
5. Smirnov A. V., Dobronravov V. A., Kayukov I. G. et al. Chronic kidney disease: the basic principles of screening, diagnosis, prevention, and approaches to treatment. National recommendations // Nephrology. 2012; 1: 89-115.
6. Manns L., Scott-Douglas N., Tonelli M. et al. A Population-Based Analysis of Quality Indicators in CKD // Clin J Am SocNephrol 2017; 12: 727-33.
7. Mills K.T., Xu Y., Zhang W., Bundy J.D. et al. A systematic analysis of worldwide population-based data on the global burden of chronic kidney disease in 2010 // Kidney Int 2015; 88: 950-957.
