Pub Date : 2024-07-12DOI: 10.36485/1561-6274-2024-28-2-23-30
V. A. Fedulkina, A. A. Artamonova
The impact of COVID-19 on the course of chronic kidney disease (CKD) has already been confirmed by researchers around the world. Basically, studying kidney damage in COVID-19, the authors pay attention to the new coronavirus infection in terms of the development of acute kidney injury (AKI) or mortality from it in patients with existing CKD, especially patients receiving hemodialysis or having a transplanted kidney, providing an analysis of mortality, risks and forecasts. However, there is still no published description of how this infection can affect the function of kidneys that did not have signs of CKD before COVID-19. Currently, studies devoted to the analysis of long-term results of observation and treatment of such patients are especially scarce. The review examines foreign and domestic studies concerning both the influence of chronic kidney disease on the severity of coronavirus infection and the risks of developing kidney disease after COVID-19, including the development of acute kidney injury and in the long term. This approach can highlight the relevance of timely identification of patients with developing CKD in the early stages among patients with COVID-19 for the purpose of their further follow-up and timely prescription of nephroprotective therapy. The search for literature sources was carried out using PubMed, Science Direct, eLibrary using the keywords “coronavirus”, “COVID-19”, “SARS-CoV-2”, “acute kidney injury”, “chronic kidney disease” and their combinations covering publications from 2019 to 2023 in Russian and English.
{"title":"Unobvious long-term effects of COVID-19 for kidneys. The literature review","authors":"V. A. Fedulkina, A. A. Artamonova","doi":"10.36485/1561-6274-2024-28-2-23-30","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-2-23-30","url":null,"abstract":"The impact of COVID-19 on the course of chronic kidney disease (CKD) has already been confirmed by researchers around the world. Basically, studying kidney damage in COVID-19, the authors pay attention to the new coronavirus infection in terms of the development of acute kidney injury (AKI) or mortality from it in patients with existing CKD, especially patients receiving hemodialysis or having a transplanted kidney, providing an analysis of mortality, risks and forecasts. However, there is still no published description of how this infection can affect the function of kidneys that did not have signs of CKD before COVID-19. Currently, studies devoted to the analysis of long-term results of observation and treatment of such patients are especially scarce. The review examines foreign and domestic studies concerning both the influence of chronic kidney disease on the severity of coronavirus infection and the risks of developing kidney disease after COVID-19, including the development of acute kidney injury and in the long term. This approach can highlight the relevance of timely identification of patients with developing CKD in the early stages among patients with COVID-19 for the purpose of their further follow-up and timely prescription of nephroprotective therapy. The search for literature sources was carried out using PubMed, Science Direct, eLibrary using the keywords “coronavirus”, “COVID-19”, “SARS-CoV-2”, “acute kidney injury”, “chronic kidney disease” and their combinations covering publications from 2019 to 2023 in Russian and English.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"13 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.36485/1561-6274-2024-28-1-105-115
G. Ivanova, M. Khasun, M. Parastaeva, A. S. Rumyantsev, O. Beresneva
Background. Cardiovascular complications are common in chronic kidney disease (CKD). The relationship between the cardiovascular system and the kidneys is complex and diverse, but the question of the mechanisms of the influence of excess NaCl consumption on the functional state of blood vessels during renal dysfunction remains relevant.The aim: to evaluate the effect of a high-salt diet on the functional state of microcirculatory vessels (MCR) of the skin in rats at an early stage of renal dysfunction.Material and Methods. The study was conducted on Wistar rats. The first SO group included animals subjected to sham surgery (SO) and receiving a standard diet (0.34% NaCl); in the second, HS group – animals that also underwent a sham operation, but received a high-salt diet (4% NaCl); in the third, NE group – rats subjected to ¾ nephrectomy (NE) and receiving a standard diet; the fourth, HS+ NE group included rats subjected to ¾ NE and fed a high-salt diet (4% NaCl). Blood pressure (BP) was measured in the tail using the cuff method (Sistola, Russia), MCR was assessed using laser Doppler flowmetry (LDF). The reactivity of skin microvessels was assessed by changes in the MCR index before and after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (NP). Based on the assessment of the spectral characteristics of fluctuations in the MCR index obtained using Wavelet analysis, the value of endothelial, neurogenic and myogenic microvascular tone was calculated.Results. 4 months after ¾ NE, rats showed a decrease in the excretory function of the kidneys. In rats on a highsalt diet, an increase in blood urea levels was noted. The blood pressure in rats of the SO+HS group did not significantly differ from the control animals of the SO group (131 ± 8 and 125 ± 4 mmHg, respectively, NS), NE led to a significant increase in blood pressure (135 ± 5 mmHg in rats of the NE group, and 145 ± 7 mmHg – in the NE+HS group). The average MCR was higher in rats receiving a high-salt diet (SO+HS and NE+HS groups), compared with animals of the corresponding group receiving a standard diet. The combination of NE and high-salt load has an inhibitory effect on the amplitude of fluctuations in the intensity of perfusion in all studied ranges: endothelial, neurogenic and myogenic, while the calculated value of skin microvascular tone in three ranges was the highest in NE+HS group rats. In all experimental groups, the reactivity to AH was reduced compared with the SO group, and after NP iontophoresis, the average perfusion rate significantly decreased only in groups of animals receiving a high-salt diet: SO+HS and NE+HS.Conclusion. A high-salt diet in rats with an initial stage of renal dysfunction contributes to an increase in blood pressure and a decrease in natriuresis compared with animals with NE who received a standard diet. With excessive consumption of table salt in rats after NE, the intensity of cutaneous MCR increases, while reducing the variability of the M
{"title":"Influence of excessive salt consumption on the functional state of microvascular vessels of the skin of rats with renal dysfunction","authors":"G. Ivanova, M. Khasun, M. Parastaeva, A. S. Rumyantsev, O. Beresneva","doi":"10.36485/1561-6274-2024-28-1-105-115","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-105-115","url":null,"abstract":"Background. Cardiovascular complications are common in chronic kidney disease (CKD). The relationship between the cardiovascular system and the kidneys is complex and diverse, but the question of the mechanisms of the influence of excess NaCl consumption on the functional state of blood vessels during renal dysfunction remains relevant.The aim: to evaluate the effect of a high-salt diet on the functional state of microcirculatory vessels (MCR) of the skin in rats at an early stage of renal dysfunction.Material and Methods. The study was conducted on Wistar rats. The first SO group included animals subjected to sham surgery (SO) and receiving a standard diet (0.34% NaCl); in the second, HS group – animals that also underwent a sham operation, but received a high-salt diet (4% NaCl); in the third, NE group – rats subjected to ¾ nephrectomy (NE) and receiving a standard diet; the fourth, HS+ NE group included rats subjected to ¾ NE and fed a high-salt diet (4% NaCl). Blood pressure (BP) was measured in the tail using the cuff method (Sistola, Russia), MCR was assessed using laser Doppler flowmetry (LDF). The reactivity of skin microvessels was assessed by changes in the MCR index before and after iontophoresis of acetylcholine (ACh) and sodium nitroprusside (NP). Based on the assessment of the spectral characteristics of fluctuations in the MCR index obtained using Wavelet analysis, the value of endothelial, neurogenic and myogenic microvascular tone was calculated.Results. 4 months after ¾ NE, rats showed a decrease in the excretory function of the kidneys. In rats on a highsalt diet, an increase in blood urea levels was noted. The blood pressure in rats of the SO+HS group did not significantly differ from the control animals of the SO group (131 ± 8 and 125 ± 4 mmHg, respectively, NS), NE led to a significant increase in blood pressure (135 ± 5 mmHg in rats of the NE group, and 145 ± 7 mmHg – in the NE+HS group). The average MCR was higher in rats receiving a high-salt diet (SO+HS and NE+HS groups), compared with animals of the corresponding group receiving a standard diet. The combination of NE and high-salt load has an inhibitory effect on the amplitude of fluctuations in the intensity of perfusion in all studied ranges: endothelial, neurogenic and myogenic, while the calculated value of skin microvascular tone in three ranges was the highest in NE+HS group rats. In all experimental groups, the reactivity to AH was reduced compared with the SO group, and after NP iontophoresis, the average perfusion rate significantly decreased only in groups of animals receiving a high-salt diet: SO+HS and NE+HS.Conclusion. A high-salt diet in rats with an initial stage of renal dysfunction contributes to an increase in blood pressure and a decrease in natriuresis compared with animals with NE who received a standard diet. With excessive consumption of table salt in rats after NE, the intensity of cutaneous MCR increases, while reducing the variability of the M","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"21 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140261010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-07DOI: 10.36485/1561-6274-2024-28-1-96-104
O. Beresneva, M. Parastaeva, G. Ivanova, A. Ivanova, O. G. Ognev, A. Kucher
The aim: to evaluate functional and structural changes in blood vessels and myocardium in Wistar rats at different stages of the formation of experimental kidney dysfunction.Materials and Methods. Four groups of animals were studied. The first two groups consisted of rats subjected to 5/6 nephrectomy (NE). The period after NE is 2 or 4 months. The third and fourth groups included sham-operated (SO) animals of a similar observation period. After the end of the experiment, blood pressure was measured in rats, the left ventricular mass index (LVMI) was calculated, a biochemical blood test, histological, immunohistochemical and electron microscopic examination of the myocardium were performed, and the contractile activity of the portal vein was recorded for a period of 2 months (in vitro).Results. 2 months after NE, an increase in blood pressure, LVMI, and a decrease in the autorhythmic contractile activity of the portal vein were detected in rats. At the histological level, thickening of cardiomyocytes and arterial vessel walls and the presence of perivascular fibrosis were noted. After 4 months, in rats with NE, the increase in blood pressure, cardiomyocyte hypertrophy and perivascular fibrosis progressed. The thickness of cardiomyocytes was 14.1±3.11 μm, which was significantly greater than in the group with NE for 2 months (12.5±1.5 μm; p=0.008). At this period of observation, electron microscopic examination revealed deintegration of myofibrils, disruption of myofibril stacking and z-disk structure, and changes in the shape of mitochondria. 2 months after NE, an increase in the area of open capillaries was detected in rats (1902.8±202.9 μm²) compared to the corresponding LO animals (730.4±58.2 μm²; p=0.000). As renal dysfunction develops, the capillary area tends to increase (2139.1±396.5 μm²; p =0.120).Conclusion. In Wistar rats with renal dysfunction, changes were detected not only in the level of blood pressure, but also in the functional activity of the intravenous fluid, as well as in the structural components of the myocardium – cardiomyocytes, stroma and blood vessels. The increase in myocardial mass at the histological level was manifested by a significant increase in the thickness of cardiomyocytes, the volume of connective tissue, and the thickness of the wall of arterial vessels, reaching a maximum value at a longer period after NE.
目的：评估 Wistar 大鼠在实验性肾功能不全形成的不同阶段血管和心肌的功能和结构变化。研究了四组动物。前两组由接受 5/6 肾切除术（NE）的大鼠组成。肾切除术后的时间为 2 个月或 4 个月。第三组和第四组包括观察期相似的假手术（SO）动物。实验结束后，测量大鼠血压，计算左心室质量指数（LVMI），进行血液生化检查、心肌组织学、免疫组化和电子显微镜检查，并记录门静脉收缩活动2个月（体外）。大鼠接受 NE 治疗 2 个月后，血压、左心室指数和门静脉自律性收缩活动均有所下降。在组织学层面，发现心肌细胞和动脉血管壁增厚，血管周围出现纤维化。4 个月后，使用 NE 的大鼠血压升高，心肌细胞肥大，血管周围纤维化。心肌细胞厚度为 14.1±3.11 μm，明显大于 NE 组 2 个月（12.5±1.5 μm；P=0.008）。在此观察期间，电镜检查发现肌原纤维解体、肌原纤维堆积和 Z 盘结构破坏以及线粒体形状的变化。NE 2 个月后，与相应的 LO 动物（730.4±58.2 μm²；p=0.000）相比，大鼠开放毛细血管的面积有所增加（1902.8±202.9 μm²）。结论：随着肾功能障碍的发展，毛细血管面积趋于增加（2139.1±396.5 μm²；p=0.120）。在肾功能不全的 Wistar 大鼠中，不仅血压水平发生了变化，静脉注射液的功能活性也发生了变化，心肌的结构成分--心肌细胞、基质和血管也发生了变化。组织学层面的心肌质量增加表现为心肌细胞厚度、结缔组织体积和动脉血管壁厚度的显著增加，在 NE 后较长时间内达到最大值。
{"title":"Condition of the cardiovascular system in Wistar rats with experimental renal dysfunction","authors":"O. Beresneva, M. Parastaeva, G. Ivanova, A. Ivanova, O. G. Ognev, A. Kucher","doi":"10.36485/1561-6274-2024-28-1-96-104","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-96-104","url":null,"abstract":"The aim: to evaluate functional and structural changes in blood vessels and myocardium in Wistar rats at different stages of the formation of experimental kidney dysfunction.Materials and Methods. Four groups of animals were studied. The first two groups consisted of rats subjected to 5/6 nephrectomy (NE). The period after NE is 2 or 4 months. The third and fourth groups included sham-operated (SO) animals of a similar observation period. After the end of the experiment, blood pressure was measured in rats, the left ventricular mass index (LVMI) was calculated, a biochemical blood test, histological, immunohistochemical and electron microscopic examination of the myocardium were performed, and the contractile activity of the portal vein was recorded for a period of 2 months (in vitro).Results. 2 months after NE, an increase in blood pressure, LVMI, and a decrease in the autorhythmic contractile activity of the portal vein were detected in rats. At the histological level, thickening of cardiomyocytes and arterial vessel walls and the presence of perivascular fibrosis were noted. After 4 months, in rats with NE, the increase in blood pressure, cardiomyocyte hypertrophy and perivascular fibrosis progressed. The thickness of cardiomyocytes was 14.1±3.11 μm, which was significantly greater than in the group with NE for 2 months (12.5±1.5 μm; p=0.008). At this period of observation, electron microscopic examination revealed deintegration of myofibrils, disruption of myofibril stacking and z-disk structure, and changes in the shape of mitochondria. 2 months after NE, an increase in the area of open capillaries was detected in rats (1902.8±202.9 μm²) compared to the corresponding LO animals (730.4±58.2 μm²; p=0.000). As renal dysfunction develops, the capillary area tends to increase (2139.1±396.5 μm²; p =0.120).Conclusion. In Wistar rats with renal dysfunction, changes were detected not only in the level of blood pressure, but also in the functional activity of the intravenous fluid, as well as in the structural components of the myocardium – cardiomyocytes, stroma and blood vessels. The increase in myocardial mass at the histological level was manifested by a significant increase in the thickness of cardiomyocytes, the volume of connective tissue, and the thickness of the wall of arterial vessels, reaching a maximum value at a longer period after NE.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"18 89","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140260238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.36485/1561-6274-2024-28-1-80-89
T. N. Markova, V. O. Yavorskaya, A. I. Ushakova, V. A. Berdinsky, T. V. Ibragimova, L. A. Kumakhova, A. D. Orlova, A. D. Markov, S. S. Usatiuk
Background. Patients with diabetes mellitus (DM) on renal replacement therapy (RRT) have high glycaemia variability (GV), the severity of which may depend on the dialysis method.The aim: To study GV in patients with type 1 diabetes and type 2 diabetes (on baseline-bolus insulin therapy) receiving RRT with programmed hemodialysis (PHD) and continuous ambulatory peritoneal dialysis (CAPD).Patients and Methods: Twenty-seven patients with terminal chronic renal failure and DM receiving RRT from July 2022 to March 2023 were studied. Patients underwent flash glucose monitoring (FGM) using FreeStyle Librе portable system with further evaluation of GV parameters and indices, median days of measurement – 14.Results. In the total group, 7 patients (23,3 %) had TIR > 70 %, mean TIR value was 56,3 %±22,0 %, 66,7 % of patients had CV > 36 %, mean CV value was 38,5 %±9,6 %. All indices of GV (MAGE, LBGI, HBGI, M-value, J-index, Conga, LI) exceeded the reference values. When comparing GV indices in patients on PHD and CAPD, it was revealed that LBGI in PHD group was 10,1±5,71 vs CAPD – 5,58±4,22, p=0,025. The critical point of glucose reduction on PHD was the fourth hour from the beginning of the procedure (57.1 % of patients had glycemia < 3.9 mmol/l). Higher median glucose values were found in the first three days of FGM compared to the last three days in both PHD group (p=0.002) and CAPD group (p=0.022).Conclusions. Patients with diabetes on RRT have high GV, low percentage of achieving TIR due to high risk of hypoglycemic conditions in patients on PHD. The critical point of glycaemia reduction is fourth hour after the start of the PHD session. Patients on CAPD have a lower risk of hypoglycemia. FGM improves glycaemic control.
{"title":"Effect of renal replacement therapy on glycaemic variability and indices of carbohydrate metabolism in patients with diabetes mellitus","authors":"T. N. Markova, V. O. Yavorskaya, A. I. Ushakova, V. A. Berdinsky, T. V. Ibragimova, L. A. Kumakhova, A. D. Orlova, A. D. Markov, S. S. Usatiuk","doi":"10.36485/1561-6274-2024-28-1-80-89","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-80-89","url":null,"abstract":"Background. Patients with diabetes mellitus (DM) on renal replacement therapy (RRT) have high glycaemia variability (GV), the severity of which may depend on the dialysis method.The aim: To study GV in patients with type 1 diabetes and type 2 diabetes (on baseline-bolus insulin therapy) receiving RRT with programmed hemodialysis (PHD) and continuous ambulatory peritoneal dialysis (CAPD).Patients and Methods: Twenty-seven patients with terminal chronic renal failure and DM receiving RRT from July 2022 to March 2023 were studied. Patients underwent flash glucose monitoring (FGM) using FreeStyle Librе portable system with further evaluation of GV parameters and indices, median days of measurement – 14.Results. In the total group, 7 patients (23,3 %) had TIR > 70 %, mean TIR value was 56,3 %±22,0 %, 66,7 % of patients had CV > 36 %, mean CV value was 38,5 %±9,6 %. All indices of GV (MAGE, LBGI, HBGI, M-value, J-index, Conga, LI) exceeded the reference values. When comparing GV indices in patients on PHD and CAPD, it was revealed that LBGI in PHD group was 10,1±5,71 vs CAPD – 5,58±4,22, p=0,025. The critical point of glucose reduction on PHD was the fourth hour from the beginning of the procedure (57.1 % of patients had glycemia < 3.9 mmol/l). Higher median glucose values were found in the first three days of FGM compared to the last three days in both PHD group (p=0.002) and CAPD group (p=0.022).Conclusions. Patients with diabetes on RRT have high GV, low percentage of achieving TIR due to high risk of hypoglycemic conditions in patients on PHD. The critical point of glycaemia reduction is fourth hour after the start of the PHD session. Patients on CAPD have a lower risk of hypoglycemia. FGM improves glycaemic control.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"35 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140264599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.36485/1561-6274-2024-28-1-72-79
A. G. Gadaev, R. K. Dadabayeva
The aim: to study of the relationship of biological markers reflecting damage of the kidneys with its functional state, as well as with clinical, metabolic, hormonal parameters and immunoinflammatory processes in obesity phenotypes.Patients and Methods: The study involved 224 obese Uzbek women who were divided into 2 groups according to the recommended criteria for metabolic syndrome: group 1 consisted of 133 women diagnosed with metabolic complicated obesity, average age 42.0±0.5; Group 2 consisted of 91 women diagnosed with metabolic healthy obesity, average age 41.7±0.7. The control group consisted of 45 healthy volunteers (women, mean age 43.2±0.8, body mass index ˂ 30 kg/m2, waist circumference less than 80 cm). In the observation groups, anthropometric indicators, blood pressure, biochemical tests and blood lipid spectrum, levels of leptin, insulin, cystatin C and uromodulin in the blood serum, gradations of microalbuminuria in urine were determined, the glomerular filtration rate was calculated for cystatin C and creatinine and the obtained indicators were compared.Results. In both obesity phenotypes, the amount of microalbuminuria and cystatin C significantly increased in group 1 compared to these indicators in group 2 and the control group, and the amount of uromodulin in the blood serum, on the contrary, decreased compared to the indicators in group 2 and control group (r ˂ 0.001) . An increase in the gradation of microalbuminuria and cystatin C and a decrease in the amount of uromodulin in the blood serum in both groups was expressed by a decrease in the estimated glomerular filtration rate, which was clearly expressed in group 1 (χ2 = 4.5, r = 0.034). Also, an increase in body mass index was characterized by an increase in cardiometabolic disorders, an increase in the gradation of microalbuminuria, a decrease in the level of uromodulin in the blood serum and cytokinemia (p ˂ 0.001).Conclusion. In both obesity phenotypes, an increase in the degree of obesity was manifested by an increase in the level of cardiometabolic risk, as well as an increase in subclinical kidney damage. It is considered appropriate to determine the amount of uromodulin and cystatin C in blood serum and assess the gradation of microalbuminuria in the early diagnosis of renal dysfunction in obesity.
目的：研究肥胖表型中反映肾脏损伤的生物标志物与肾脏功能状态的关系，以及与临床、代谢、激素参数和免疫炎症过程的关系：研究涉及 224 名肥胖的乌兹别克妇女，根据代谢综合征的推荐标准将她们分为两组：第一组包括 133 名被诊断为代谢性复杂肥胖的妇女，平均年龄为（42.0±0.5）岁；第二组包括 91 名被诊断为代谢性健康肥胖的妇女，平均年龄为（41.7±0.7）岁。对照组包括 45 名健康志愿者（女性，平均年龄（43.2±0.8）岁，体重指数 ˂ 30 kg/m2，腰围小于 80 厘米）。在观察组中，测定了人体测量指标、血压、生化检查和血脂谱、血清中瘦素、胰岛素、胱抑素 C 和尿肌蛋白的水平、尿液中微量白蛋白尿的等级，计算了胱抑素 C 和肌酐的肾小球滤过率，并对所得指标进行了比较。在两种肥胖表型中，与第 2 组和对照组的指标相比，第 1 组的微量白蛋白尿和胱抑素 C 的量明显增加，而与第 2 组和对照组的指标相比，血清中尿肌酐的量反而减少（r ˂ 0.001）。两组微量白蛋白尿和胱抑素 C 分级的增加以及血清中尿肌球蛋白量的减少都表现为估计肾小球滤过率的下降，这在第 1 组中表现明显（χ2 = 4.5，r = 0.034）。此外，体重指数的增加还表现为心脏代谢紊乱的增加、微量白蛋白尿分级的增加、血清中尿蛋白水平的降低和细胞因子血症（p ˂0.001）。在这两种肥胖表型中，肥胖程度的增加表现为心脏代谢风险水平的增加，以及亚临床肾损伤的增加。在肥胖症肾功能障碍的早期诊断中，测定血清中尿蛋白和胱抑素 C 的含量并评估微量白蛋白尿的分级是适当的。
{"title":"Assessment of the role of albuminuria and uromodulin in the early diagnosis of renal function disorders in some types of obesity phenotypes","authors":"A. G. Gadaev, R. K. Dadabayeva","doi":"10.36485/1561-6274-2024-28-1-72-79","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-72-79","url":null,"abstract":"The aim: to study of the relationship of biological markers reflecting damage of the kidneys with its functional state, as well as with clinical, metabolic, hormonal parameters and immunoinflammatory processes in obesity phenotypes.Patients and Methods: The study involved 224 obese Uzbek women who were divided into 2 groups according to the recommended criteria for metabolic syndrome: group 1 consisted of 133 women diagnosed with metabolic complicated obesity, average age 42.0±0.5; Group 2 consisted of 91 women diagnosed with metabolic healthy obesity, average age 41.7±0.7. The control group consisted of 45 healthy volunteers (women, mean age 43.2±0.8, body mass index ˂ 30 kg/m2, waist circumference less than 80 cm). In the observation groups, anthropometric indicators, blood pressure, biochemical tests and blood lipid spectrum, levels of leptin, insulin, cystatin C and uromodulin in the blood serum, gradations of microalbuminuria in urine were determined, the glomerular filtration rate was calculated for cystatin C and creatinine and the obtained indicators were compared.Results. In both obesity phenotypes, the amount of microalbuminuria and cystatin C significantly increased in group 1 compared to these indicators in group 2 and the control group, and the amount of uromodulin in the blood serum, on the contrary, decreased compared to the indicators in group 2 and control group (r ˂ 0.001) . An increase in the gradation of microalbuminuria and cystatin C and a decrease in the amount of uromodulin in the blood serum in both groups was expressed by a decrease in the estimated glomerular filtration rate, which was clearly expressed in group 1 (χ2 = 4.5, r = 0.034). Also, an increase in body mass index was characterized by an increase in cardiometabolic disorders, an increase in the gradation of microalbuminuria, a decrease in the level of uromodulin in the blood serum and cytokinemia (p ˂ 0.001).Conclusion. In both obesity phenotypes, an increase in the degree of obesity was manifested by an increase in the level of cardiometabolic risk, as well as an increase in subclinical kidney damage. It is considered appropriate to determine the amount of uromodulin and cystatin C in blood serum and assess the gradation of microalbuminuria in the early diagnosis of renal dysfunction in obesity.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140263247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.36485/1561-6274-2024-28-1-90-95
T. A. Garkusha, E. S. Stolyarevich, V. Khorzhevskii, S. V. Ivliev, M. Firsov
Background. Malignant neoplasms, including those of the kidneys, are widespread in the world. The main treatment for kidney tumors is surgery, one of its options is nephrectomy. Malignant tumors of various localizations can lead to a variety of kidney damage. Glomerulopathies of various origins are often asymptomatic, and therefore, patients do not seek medical help. For the diagnosis of glomerulopathies, it is necessary to assess morphological changes with the formulation of an immunofluorescence reaction and electron microscopy.The aim: to analyze the clinical manifestations, frequency and structure of glomerulopathies in kidney neoplasms.Patients and Methods. The study included 141 patients. The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p<0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies. CONCLUSION. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist Keywords: tumor, glomerulonephritis, diabetic nephropathy, glomerular filtration rate> ˂ 0.05.Results. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies.Conclusion. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage th
{"title":"Analysis of glomerulopathies in kidney neoplasms","authors":"T. A. Garkusha, E. S. Stolyarevich, V. Khorzhevskii, S. V. Ivliev, M. Firsov","doi":"10.36485/1561-6274-2024-28-1-90-95","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-90-95","url":null,"abstract":"Background. Malignant neoplasms, including those of the kidneys, are widespread in the world. The main treatment for kidney tumors is surgery, one of its options is nephrectomy. Malignant tumors of various localizations can lead to a variety of kidney damage. Glomerulopathies of various origins are often asymptomatic, and therefore, patients do not seek medical help. For the diagnosis of glomerulopathies, it is necessary to assess morphological changes with the formulation of an immunofluorescence reaction and electron microscopy.The aim: to analyze the clinical manifestations, frequency and structure of glomerulopathies in kidney neoplasms.Patients and Methods. The study included 141 patients. The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p<0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies. CONCLUSION. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist Keywords: tumor, glomerulonephritis, diabetic nephropathy, glomerular filtration rate> ˂ 0.05.Results. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies.Conclusion. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage th","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"44 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140264467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.36485/1561-6274-2024-28-1-63-71
L. A. Arutyunyan, L. V. Kremneva, L. I. Gapon, S. Shalaev
The aim was to assess the incidence of hospital complications in patients with acute kidney injury (AKI) after coronary artery bypass grafting (CABG).Patients and Methods. The study included 77 patients with stable angina who underwent CABG, aged 65 (61-69) years, 77,9 % men. The number of patients with arterial hypertension was 96,1 %, with carbohydrate metabolism disorders 45,5 %, with chronic kidney disease (CKD) 22,1 %, and with myocardial infarction (MI) 57,1 %. CABG on the working heart was performed in 28,6 %, bimammary CABG in 49,4 %. The duration of artificial circulation was 64 (55-82) minutes; the number of shunts implanted was 2,7+0,7 units. CKD was diagnosed when the glomerular filtration rate was less than 60 ml/min. The development of AKI was assessed according to the KDIGO criteria (2012).Results. CABG related AKI was detected in 10 (13 %) patients, of which grade 1 in 9 (11,7 %), grade 2 in 1 (1,3 %). The indicators associated with AKI after CABG were more severe initial CKD (stages 3b and 4 CKD – 20 % vs 1,5 %, p=0,043), a higher incidence of acute heart failure (in terms of adrenaline requirement – 30 % vs 5,9 %, p=0,043), more occluded coronary arteries (in the groups with and without CABG: one occlusion 70 % and 52,2 %, two occlusions 0 % and 13,4 %, three occlusions 10 % and 0 %, respectively, p=0,028). More severe CKD (stages 3b and 4) statistically significantly increased the relative risk of AKI after CABG by an average of 2,9 times. Among patients with AKI compared to patients without AKI after CABG, there was a higher incidence of cardiac death (20 % vs 0 %, p=0,015), intraoperative MI (60 % vs 8,9 %, p=0,001), acute heart failure (30 % vs 5,9 %, p=0,043).Conclusion. The incidence of AKI following CABG was 13 %. The development of AKI was associated with more severe initial CKD. Patients with postoperative AKI had a poor hospital prognosis.
目的是评估冠状动脉旁路移植术（CABG）后急性肾损伤（AKI）患者住院并发症的发生率。研究对象包括77名接受CABG手术的稳定型心绞痛患者，年龄为65（61-69）岁，77.9%为男性。动脉高血压患者占 96.1%，碳水化合物代谢紊乱患者占 45.5%，慢性肾病患者占 22.1%，心肌梗死患者占 57.1%。28.6%的患者在工作心脏上进行了 CABG，49.4%的患者进行了双乳 CABG。人工循环持续时间为 64 (55-82) 分钟；植入的分流器数量为 2.7+0.7 个。肾小球滤过率低于 60 毫升/分钟时可诊断为慢性肾功能衰竭。根据 KDIGO 标准（2012 年）评估 AKI 的发展情况。10例（13%）患者出现了与CABG相关的AKI，其中9例（11.7%）为1级，1例（1.3%）为2级。与 CABG 术后 AKI 相关的指标有：更严重的初始 CKD（3b 和 4 期 CKD - 20% vs 1,5%，P=0,043）、更高的急性心力衰竭发生率（从肾上腺素需求量来看 - 30% vs 5,9%，P=0,043）、更多的冠状动脉闭塞（在进行和未进行 CABG 的组别中：一次闭塞的比例分别为 70% 和 52.2%，两次闭塞的比例分别为 0% 和 13.4%，三次闭塞的比例分别为 10% 和 0%，P=0.028）。据统计，更严重的慢性肾脏病（3b 和 4 期）会显著增加 CABG 术后发生 AKI 的相对风险，平均增加 2.9 倍。与 CABG 术后无 AKI 患者相比，有 AKI 患者的心源性死亡（20% vs 0%，P=0,015）、术中心肌梗死（60% vs 8,9%，P=0,001）和急性心力衰竭（30% vs 5,9%，P=0,043）发生率更高。CABG 术后 AKI 的发生率为 13%。AKI的发生与初始严重的慢性肾脏病有关。术后出现 AKI 的患者住院预后较差。
{"title":"Hospital complications in patients with acute kidney injury after coronary artery bypass grafting","authors":"L. A. Arutyunyan, L. V. Kremneva, L. I. Gapon, S. Shalaev","doi":"10.36485/1561-6274-2024-28-1-63-71","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-63-71","url":null,"abstract":"The aim was to assess the incidence of hospital complications in patients with acute kidney injury (AKI) after coronary artery bypass grafting (CABG).Patients and Methods. The study included 77 patients with stable angina who underwent CABG, aged 65 (61-69) years, 77,9 % men. The number of patients with arterial hypertension was 96,1 %, with carbohydrate metabolism disorders 45,5 %, with chronic kidney disease (CKD) 22,1 %, and with myocardial infarction (MI) 57,1 %. CABG on the working heart was performed in 28,6 %, bimammary CABG in 49,4 %. The duration of artificial circulation was 64 (55-82) minutes; the number of shunts implanted was 2,7+0,7 units. CKD was diagnosed when the glomerular filtration rate was less than 60 ml/min. The development of AKI was assessed according to the KDIGO criteria (2012).Results. CABG related AKI was detected in 10 (13 %) patients, of which grade 1 in 9 (11,7 %), grade 2 in 1 (1,3 %). The indicators associated with AKI after CABG were more severe initial CKD (stages 3b and 4 CKD – 20 % vs 1,5 %, p=0,043), a higher incidence of acute heart failure (in terms of adrenaline requirement – 30 % vs 5,9 %, p=0,043), more occluded coronary arteries (in the groups with and without CABG: one occlusion 70 % and 52,2 %, two occlusions 0 % and 13,4 %, three occlusions 10 % and 0 %, respectively, p=0,028). More severe CKD (stages 3b and 4) statistically significantly increased the relative risk of AKI after CABG by an average of 2,9 times. Among patients with AKI compared to patients without AKI after CABG, there was a higher incidence of cardiac death (20 % vs 0 %, p=0,015), intraoperative MI (60 % vs 8,9 %, p=0,001), acute heart failure (30 % vs 5,9 %, p=0,043).Conclusion. The incidence of AKI following CABG was 13 %. The development of AKI was associated with more severe initial CKD. Patients with postoperative AKI had a poor hospital prognosis.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140266603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.36485/1561-6274-2024-28-1-43-49
I. Karimdzhanov, G. A. Yusupova, G. Iskanova, N. A. Isrаilova
The review is devoted to the development of end-stage renal failure (ESRD) in children with congenital anomalies of the kidneys and urinary tract (CAKUT syndrome. In this regard, measures to slow the progression of chronic kidney disease (CKD) are important. One of the independent risk factors for a decrease in excretory renal function is arterial hypertension (AH), the correction of which is a mandatory component of nephroprotection. CAKUT syndrome is associated with a congenital decrease of the mass of active nephrons, which inevitably leads to hyperfiltration, the main cause of the development of ESRD has a high prevalence in CACUT syndrome and plays a special role in maintaining hyperfiltration. The presence of cysts, nephrosclerosis sites, and endothelial dysfunction contribute to the activation of renin secretion with a further increase in the role of the renin-angiotensin-aldosterone system (RAAS). Angiotensin II is not only a powerful vasoconstrictor. Its effects on sympathetic stimulation of dense spot, hyperplasia of smooth muscle cells, increased expression of several growth factors, cytokines and chemokines is known. The result of the interaction of this complex is the development of glomerular hypertrophy, tubulointerstitial inflammation and fibrosis. Blood pressure correction should begin with lifestyle modification. It is recommended to start taking antihypertensive drugs in children with blood pressure > 90 percentile. Among the first-line pharmacological drugs for the treatment of hypertension, angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II type I receptor blockers (ARBs) play a major role. Unlike adults, a combination of them is possible.
这篇综述专门讨论患有先天性肾脏和泌尿道异常（CAKUT 综合征）的儿童终末期肾衰竭（ESRD）的发展。在这方面，减缓慢性肾病（CKD）进展的措施非常重要。肾脏排泄功能下降的独立风险因素之一是动脉高血压（AH），而纠正动脉高血压是肾脏保护的必要组成部分。CAKUT 综合征与先天性活性肾小球数量减少有关，这不可避免地会导致高滤过，而高滤过是导致 ESRD 的主要原因，在 CACUT 综合征中发病率很高，并在维持高滤过方面发挥着特殊作用。肾囊肿、肾硬化部位和内皮功能障碍的存在有助于激活肾素分泌，进一步增强肾素-血管紧张素-醛固酮系统（RAAS）的作用。血管紧张素 II 不仅是一种强有力的血管收缩剂。众所周知，它对交感神经刺激致密斑、平滑肌细胞增生、多种生长因子、细胞因子和趋化因子的表达增加都有影响。这种复合物相互作用的结果是肾小球肥大、肾小管间质炎症和纤维化的发展。纠正血压应从改变生活方式开始。建议血压高于 90% 的儿童开始服用降压药。在治疗高血压的一线药物中，血管紧张素转换酶抑制剂（ACE 抑制剂）和血管紧张素 II I 型受体阻滞剂（ARB）发挥着重要作用。与成人不同的是，这两种药物可以联合使用。
{"title":"Arterial hypertension as a risk factor for the development of CKD in children with CAKUT syndrome and its correction","authors":"I. Karimdzhanov, G. A. Yusupova, G. Iskanova, N. A. Isrаilova","doi":"10.36485/1561-6274-2024-28-1-43-49","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-43-49","url":null,"abstract":"The review is devoted to the development of end-stage renal failure (ESRD) in children with congenital anomalies of the kidneys and urinary tract (CAKUT syndrome. In this regard, measures to slow the progression of chronic kidney disease (CKD) are important. One of the independent risk factors for a decrease in excretory renal function is arterial hypertension (AH), the correction of which is a mandatory component of nephroprotection. CAKUT syndrome is associated with a congenital decrease of the mass of active nephrons, which inevitably leads to hyperfiltration, the main cause of the development of ESRD has a high prevalence in CACUT syndrome and plays a special role in maintaining hyperfiltration. The presence of cysts, nephrosclerosis sites, and endothelial dysfunction contribute to the activation of renin secretion with a further increase in the role of the renin-angiotensin-aldosterone system (RAAS). Angiotensin II is not only a powerful vasoconstrictor. Its effects on sympathetic stimulation of dense spot, hyperplasia of smooth muscle cells, increased expression of several growth factors, cytokines and chemokines is known. The result of the interaction of this complex is the development of glomerular hypertrophy, tubulointerstitial inflammation and fibrosis. Blood pressure correction should begin with lifestyle modification. It is recommended to start taking antihypertensive drugs in children with blood pressure > 90 percentile. Among the first-line pharmacological drugs for the treatment of hypertension, angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II type I receptor blockers (ARBs) play a major role. Unlike adults, a combination of them is possible.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"12 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140266489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-04DOI: 10.36485/1561-6274-2024-28-1-50-62
I. Murkamilov, K. Aitbaev, V. V. Fomin, J. A. Murkamilova, P. Astanin, T. Yusupova, Z. Yusupova, F. Yusupov, N. N. Mamatov, D. Ymankulov, I. Kudaibergenova
Background. Currently, in most countries of the world, there is a tendency for an annual increase in the proportion of overweight people (OW). Studies performed in various age groups and devoted to the relationship of OW with the functional state of the kidneys show contradictory results.The aim: to study the functional state of the kidneys and the prevalence of risk factors for cardiovascular complications in OW, taking into account gender differences.Patients and Methods. A cross–sectional single-center study was conducted with the participation of 154 patients (73 men and 81 women) with body mass index (BMI) 25.0–29.9 kg/m2), whose average age was 53.9±12.6 years. Anthropometric and biochemical parameters were evaluated in all patients, the functional state of the kidneys (according to serum creatinine and cystatin C) was studied, and an analysis of cardiovascular risk factors was carried out.Results. Analysis of excretory renal function by cystatin C showed that in most of the examined individuals, regardless of gender, there was a decrease in eGFR to CKD stages 2 and 3a. OW among men was statistically significantly more often associated with hypertriglyceridemia (32.8 %), tachycardia (38.3 %) and atherosclerotic lesion of the carotid arteries (24.6 %). In the subgroup of women with ischemic heart disease, the average age, the content of low-density lipoproteins, the double product index, the frequency of hypercholesterolemia, dyslipidemia and hypertrophy of the left ventricle (LVH), mainly of the eccentric type, were significantly higher, and the hemoglobin content and the number of red blood cells were significantly lower. Significant correlations of eGFR with concentrations of hemoglobin and C-reactive protein, as well as with the value of the left ventricular myocardial mass index (LVMI) were found in men with ischemic heart disease. Correlations of eGFR with the levels of systolic, mean, pulse and central blood pressure, index of functional changes, LDL-C, triglycerides, hemoglobin, fibrinogen, metabolic index, as well as LVMI were found in women with ischemic heart disease. The value of LVH in women was significantly associated with the level of central blood pressure, cystatin C, LDL, hemolobin, fibrinogen, metabolic index, and eGFR. In the general sample of patients with ischemic heart disease, the content of serum cystatin C was positively correlated with LVH and inversely with eGFR calculated by cystatin C. There was a weak negative relationship between the level of central arterial pressure and eGFR by cystatin C.Conclusion. Evaluation of excretory renal function, according to cystatin C and serum creatinine, in individuals with ISM has a higher diagnostic value than evaluation using methods based on the use of serum creatinine alone. In males, the presence of OW is associated with tachycardia, hypertriglyceridemia, a significant decrease in GFR and an increase in the frequency of atherosclerotic changes in the carotid arteries. Th
背景。目前，在世界大多数国家，超重人群（OW）的比例呈逐年上升趋势。目的：研究超重人群的肾脏功能状态和心血管并发症风险因素的发生率，同时考虑性别差异。该研究是一项横断面单中心研究，共有 154 名患者（73 名男性和 81 名女性）参与，他们的体重指数（BMI）为 25.0-29.9 kg/m2，平均年龄为 53.9±12.6 岁。对所有患者的人体测量和生化指标进行了评估，研究了肾功能状况（根据血清肌酐和胱抑素 C），并对心血管风险因素进行了分析。根据胱抑素 C 对肾脏排泄功能进行的分析表明，在大多数受检者中，无论男女，eGFR 都下降到了 CKD 2 期和 3a 期。据统计，男性的 OW 多与高甘油三酯血症（32.8%）、心动过速（38.3%）和颈动脉粥样硬化病变（24.6%）有关。在患有缺血性心脏病的妇女亚组中，平均年龄、低密度脂蛋白含量、双乘积指数、高胆固醇血症、血脂异常和左心室肥厚（主要是偏心型）的频率明显较高，血红蛋白含量和红细胞数量明显较低。在患有缺血性心脏病的男性中，eGFR 与血红蛋白和 C 反应蛋白的浓度以及左心室心肌质量指数（LVMI）的值有明显的相关性。在患有缺血性心脏病的女性中，发现 eGFR 与收缩压、平均血压、脉搏和中心血压水平、功能改变指数、低密度脂蛋白胆固醇、甘油三酯、血红蛋白、纤维蛋白原、代谢指数以及 LVMI 存在相关性。女性 LVH 值与中心血压、胱抑素 C、低密度脂蛋白、血红蛋白、纤维蛋白原、代谢指数和 eGFR 水平显著相关。在缺血性心脏病患者的一般样本中，血清胱抑素 C 的含量与 LVH 呈正相关，与用胱抑素 C 计算的 eGFR 呈反相关。根据胱抑素 C 和血清肌酐对 ISM 患者的肾脏排泄功能进行评估，比仅使用血清肌酐进行评估具有更高的诊断价值。在男性中，OW 的存在与心动过速、高甘油三酯血症、肾小球滤过率显著下降和颈动脉粥样硬化病变频率增加有关。妇女患缺血性心脏病与以下心血管风险因素有关：高龄、贫血、纤维蛋白原浓度增高、血脂异常、双乘积指数、代谢指数和功能变化指数值增高，以及血液动力学和左心室舒张功能参数。
{"title":"Renal function and cardiovascular risk in overweight patients","authors":"I. Murkamilov, K. Aitbaev, V. V. Fomin, J. A. Murkamilova, P. Astanin, T. Yusupova, Z. Yusupova, F. Yusupov, N. N. Mamatov, D. Ymankulov, I. Kudaibergenova","doi":"10.36485/1561-6274-2024-28-1-50-62","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-50-62","url":null,"abstract":"Background. Currently, in most countries of the world, there is a tendency for an annual increase in the proportion of overweight people (OW). Studies performed in various age groups and devoted to the relationship of OW with the functional state of the kidneys show contradictory results.The aim: to study the functional state of the kidneys and the prevalence of risk factors for cardiovascular complications in OW, taking into account gender differences.Patients and Methods. A cross–sectional single-center study was conducted with the participation of 154 patients (73 men and 81 women) with body mass index (BMI) 25.0–29.9 kg/m2), whose average age was 53.9±12.6 years. Anthropometric and biochemical parameters were evaluated in all patients, the functional state of the kidneys (according to serum creatinine and cystatin C) was studied, and an analysis of cardiovascular risk factors was carried out.Results. Analysis of excretory renal function by cystatin C showed that in most of the examined individuals, regardless of gender, there was a decrease in eGFR to CKD stages 2 and 3a. OW among men was statistically significantly more often associated with hypertriglyceridemia (32.8 %), tachycardia (38.3 %) and atherosclerotic lesion of the carotid arteries (24.6 %). In the subgroup of women with ischemic heart disease, the average age, the content of low-density lipoproteins, the double product index, the frequency of hypercholesterolemia, dyslipidemia and hypertrophy of the left ventricle (LVH), mainly of the eccentric type, were significantly higher, and the hemoglobin content and the number of red blood cells were significantly lower. Significant correlations of eGFR with concentrations of hemoglobin and C-reactive protein, as well as with the value of the left ventricular myocardial mass index (LVMI) were found in men with ischemic heart disease. Correlations of eGFR with the levels of systolic, mean, pulse and central blood pressure, index of functional changes, LDL-C, triglycerides, hemoglobin, fibrinogen, metabolic index, as well as LVMI were found in women with ischemic heart disease. The value of LVH in women was significantly associated with the level of central blood pressure, cystatin C, LDL, hemolobin, fibrinogen, metabolic index, and eGFR. In the general sample of patients with ischemic heart disease, the content of serum cystatin C was positively correlated with LVH and inversely with eGFR calculated by cystatin C. There was a weak negative relationship between the level of central arterial pressure and eGFR by cystatin C.Conclusion. Evaluation of excretory renal function, according to cystatin C and serum creatinine, in individuals with ISM has a higher diagnostic value than evaluation using methods based on the use of serum creatinine alone. In males, the presence of OW is associated with tachycardia, hypertriglyceridemia, a significant decrease in GFR and an increase in the frequency of atherosclerotic changes in the carotid arteries. Th","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"96 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140079753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-03DOI: 10.36485/1561-6274-2024-28-1-30-42
V. V. Snopkov, S. Baiko
Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. The difficulty of diagnosis and timely administration of adequate therapy is associated with differences in the clinical course of the disease in different age groups, localization of the infectious process (upper and lower urinary tract), methods of urine collection and interpretation of the obtained results. The possibility and amount of instrumental diagnostics also varies depending on the region and the specifics of the organization of the healthcare system. The problem of increasing resistance of microorganisms is aggravated by the often-excessive prescription of antimicrobial chemotherapy drugs, which leads to a narrowing of the range of available drugs and the possibility of their use in appropriate age groups. All of the above explains the lack of uniform approaches and the existence of many international and local clinical recommendations on the problem of UTI. This review highlights the features of urine collection in non- and toilet-trained children and also discusses the assumptions and limitations of using screening methods for urinalysis. Indications for urine culture and differences in the interpretation of results depending on the method of obtaining a urine sample are presented, as well as data on modern instrumental diagnostic methods and strategies for their use in practice. A comparative description of current international clinical recommendations for the diagnosis, treatment and prevention of UTIs in children is provided.
{"title":"Review of clinical guidelines for the diagnosis, treatment and prevention of urinary tract infection in children","authors":"V. V. Snopkov, S. Baiko","doi":"10.36485/1561-6274-2024-28-1-30-42","DOIUrl":"https://doi.org/10.36485/1561-6274-2024-28-1-30-42","url":null,"abstract":"Urinary tract infection (UTI) is one of the most common bacterial diseases in childhood. The difficulty of diagnosis and timely administration of adequate therapy is associated with differences in the clinical course of the disease in different age groups, localization of the infectious process (upper and lower urinary tract), methods of urine collection and interpretation of the obtained results. The possibility and amount of instrumental diagnostics also varies depending on the region and the specifics of the organization of the healthcare system. The problem of increasing resistance of microorganisms is aggravated by the often-excessive prescription of antimicrobial chemotherapy drugs, which leads to a narrowing of the range of available drugs and the possibility of their use in appropriate age groups. All of the above explains the lack of uniform approaches and the existence of many international and local clinical recommendations on the problem of UTI. This review highlights the features of urine collection in non- and toilet-trained children and also discusses the assumptions and limitations of using screening methods for urinalysis. Indications for urine culture and differences in the interpretation of results depending on the method of obtaining a urine sample are presented, as well as data on modern instrumental diagnostic methods and strategies for their use in practice. A comparative description of current international clinical recommendations for the diagnosis, treatment and prevention of UTIs in children is provided.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140267178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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