Renal damage in patients with arterial hypertension and hyperuricemia: personalised approach to prognosis


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Abstract

Purpose. Based on the evaluation of the urine biomarkers of tubulointerstitial damage (MCP-1 and β2-MG), and the levels of systemic and locally-renal markers of endothelial dysfunction (Mau, et-1), the identification of the factors of progression of renal disease in hypertensive patients with DUAM for prognosis and selection of optimal management tactics. Materials and methods. The study included 81 patients with arterial hypertension of 1 degree, without associated clinical conditions, diabetes mellitus, and metabolic syndrome. Three groups of study were identified: group 1 - with hyperuricosuria (n = 7), group 2 - with hyperuricemia (n = 53), group 3 - with hyperuricemia and renal failure (n = 6). The control group consisted of 15 patients with AH without metabolic imbalance of uric acid, matched by age and sex to study groups. Results. Compared with patients in the control group, hypertensive patients with hyperuricemia (group 2) have higher rates of MAU (P = 0.009), and urinary excretion of β2-MG (P = 0.010), MCP-1 (P = 0.030), as well as the plasma ET-1 levels (p = 0.003). There is a direct correlation between all biomarkers studied and the degree of URICEMIA (Rs = 0.411, p <0.001; Rs = 0.537, P <0.001; Rs = 0,318, P = 0.004; and Rs = 0.453, P <0.001, respectively). Multivariate analysis of the studied clinical and laboratory parameters (multiple linear regression) has confirmed the role of MCP-1, β2-MG, UIA, serum creatinine levels as independent predictors of decreasing the relative density of urine - clinical sign of tubulointerstitial injury/fibrosis; and a wider range of indicators - MAU, interventricular septum thickness, glomerular filtration rate, relative density of urine, systolic blood pressure, MCP-1, low density lipoproteind - as risk factors for progression of renal failure. Conclusion. Identified relationship of urinary biomarkers mau, β2-MG, MCP-1, and plasma ET-1 concentrations with biochemical indices and signs of organ damage in hypertensive patients with hyperuricemia allow to personalize prognosis of renal disease in these patients.

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References

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