THE COURSE OF CHRONIC KIDNEY DISEASE (CHRONIC PYELONEPHRITIS) IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND OBESITY

The aim of the research: to investigate the features of the comorbid course of chronic kidney disease (CKD) (chronic pyelonephritis), non-alcoholic fatty liver disease and obesity, depending on the stage of CKD. To achieve this goal, 250 patients with chronic kidney disease (CKD) (chronic bilateral pyelonephritis) stage I–III were examined, of which 160 patients had concomitant NASH and class 1 obesity (1 group) and 90 people had CKD stage I–III without NASH and obesity (group 2). Depending on the stage of CKD, patients of group 1 were divided into 3 subgroups: with CKD stage I – 63 patients, with CKD stage II – 52 patients, with CKD stage III – 45 patients. Patients of group 2 were also divided into 3 subgroups: with CKD stage I – 32 patients, with CKD stage II – 31 patients, with CKD stage III – 27 patients. The control group included 30 apparently healthy individuals (AHIs). The average age of patients was 49.8 ± 5.8 years. The study did not include patients with CKD stage I–III with nephrotic syndrome and patients with chronic uncomplicated pyelonephritis in the phase of exacerbation. According to the results of our study, we noted a probable effect of nonalcoholic steatosis and steatohepatitis on the functional state of the kidneys in patients with stage I–III CKD: significant changes in glomerular filtration rate, nitrogen excretory function, increased hypoalbuminemia, increased protein in the urine, erythrocytes, leukocytes, the presence of bacteria, compared with patients with CKD without comorbidity. There was a significant correlation between a decrease in glomerular filtration rate (GFR), an increase in the intensity of oxidative stress, a decrease in blood glutathione, hydrogen sulfide, hyperproduction of homocysteine, cytokeratin-18, connective tissue components (collagen, sialic acids). In patients with CKD stage I–II without comorbid NASH and obesity, we found a significantly higher renal functional reserve in response to water-electrolyte stimulation, which is sufficient in both groups of patients (increase in GFR by 28–37% vs. 19–31% for comorbidity with NASH). In patients with CKD stage III with nonalcoholic steatohepatitis we found a significantly reduced functional reserve of the kidneys (increase in GFR by 8.9% vs. 17.5% in patients without NASH), and in 4.9% of patients with comorbidity ­– no functional reserve of the kidneys (p > 0.05), indicating irreversible changes in the functional state of the kidneys.