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No 2 (2016)
- Year: 2016
- Articles: 11
- URL: https://journals.eco-vector.com/2075-3594/issue/view/6515
Articles
Predicting cardiovascular complications in patients in late post-acute coronary syndrome period considering the body water imbalance and renal dysfunction
Abstract
Objective. To evaluate the impact of the body water imbalance on the risk of cardiovascular complications in Acs patients after myocardial revascularization, taking into account renal risk factors. Materials and methods. The study involved 120 patients with Acs who underwent myocardial revascularization. The assessment of traditional and renal risk factors (albuminuria 30-300 mg/L, GFR), as well as body water parameters was carried out. To estimate the effect of the studied risk factors, the endpoints were established upon completing the raw data processing. The endpoints included recurrent acute coronary syndrome or death registered 6 months after myocardial revascularization. Results. The study findings showed that smoking history and total cholesterol level impacted the likelihood of developing cardiovascular events (CVE). Increased intracellular fluid volume in all patients and in patients with albuminuria was found to increase the likelihood of CVE. Other indicators of the body water distribution disturbances did not produce a significant effect on the risk under study. The decrease in left ventricular ejection fraction and an increase in intracellular fluid were found to predict CVE 6 months after myocardial revascularization in Acs patients. Conclusion. In patients with ACS and myocardial revascularization, traditional risk factors were found to influence the probability of CVE. The study showed the prognostic impact of the body water distribution disturbances, determined at different stages of the study, on the risk of CVE.
Clinical nephrology. 2016;(2):3-7
3-7
Urine Conductivity a New Marker for Adverse Circadian Blood Pressure Profile
Abstract
Patients with abnormal renal tubulointersticial tissue (TIT) have been known to have a high risk of adverse blood pressure profile such as «non-dipper» and «night-peaker». In this regard it is of interest to search for new markers associated with changes in function of renal tit. In hypertensive patients it is associated with impaired reabsorption of electrolytes, primarily with changes in natriuresis, and hence in blood pressure profile. Aim. To establish relationship between changes in natriuresis, urine conductivity and 24h blood pressure profile in patients with arterial hypertension (Ah) stage I. Material and methods. The study was conducted at Moscow's health centers. The study included patients (n=375) with stage I ah. All patients were examined to determine salt intake, urine conductivity and natriuresis in a single portion of urine collected in the morning, afternoon and evening hours. Results. There was the interrelation of the level of urine conductivity and natriuresis in a single portion of urine at different time intervals. Adverse 24h profiles of blood pressure were characterized by the increased urine conductivity in the evening, whereas 24h blood pressure profile with blood pressure drop at night, on the contrary, was characterized by lower urine conductivity. Conclusion. Our study suggests that increased urine conductivity in «evening» hours is predictive for an adverse blood pressure profile. This finding implies that patients with ah stage I and high «evening» urine conductivity (more than 40 mS/cm) need ambulatory blood pressure monitoring to identify adverse diurnal blood pressure profile («non-dipper», «night-peaker»).
Clinical nephrology. 2016;(2):8-14
8-14
Using different equations for estimating glomerular filtration rate in patients with type 1 diabetes
Abstract
Aim. To compare different methods of estimating GFR calculated by creatinine and cystatin С in patients with type 1 diabetes with normal and moderately decreased renal filtration function. Material and methods. The study involved 57 patients with type 1 diabetes, 37 men and 20 women, aged from 21 to 57 years (median ЗО years), with disease duration after diagnosis from 33 to 2 years (median 8 years). The control group comprised 15 non-diabetic people aged 19 to 42 years (median - 28 years), with normal levels of abuminuria and blood creatinine. The majority of patients with type 1 diabetes were found to have decompensated diabetes mellitus. The mean value of glycated hemoglobin in patients was 8%. The renal glomerular function was estimated by level of GFR and triple testing of urine albumin excretion. Renal tubular function in type 1 diabetes was tested by examining serum cystatin С. Results. GFR estimating equations, which did not include serum of cystatin С produced higher GFR. As a result, the majority of patients had normal or elevated GFR showing hyperfiltration. Using cystatin-C-based equations resulted in a several-fold reduction in the number of patients with hyperfiltration and increased number of cases with GFR below 90 ml/min/m2. The assessment of the relationship between SDMA and GFR showed negative correlation with both cystatin-C-based and creatinine-based equations. Conclusion. These findings revealed that GFR estimating equations based on both creatinine and cystatin С produce more accurate results compared with the reference estimating equations.
Clinical nephrology. 2016;(2):15-19
15-19
The study on the causes of resistance to antihypertensive therapy in patients with chronic glomerulonephritis
Abstract
Aim. To identify risk factors for resistant arterial hypertension (Rah) in patients with chronic glomerulonephritis (CGN). Material and methods. Analysis of the data of 421 patients included clinical and laboratory findings, details of therapeutic regimen (drug class, dosage of antihypertensive drugs, accompanying conservative treatment). Discriminative analysis using semi-automatic scoring was conducted. Results. Several indicators having the greatest predictive value were identified. They included the use of dihydropyridine calcium channel blockers (DHP-CCB) and beta-blockers, increased triglyceride level, clinical variant of CGN, decreased GFR CKD-ЕРІ, the stage of CKD and blood creatinine concentration. The final scoring model comprised the data of drug scheme: DHP-CCB, beta-blockers, loop and thiazide diuretics. The results showed the crucial importance of drug therapy in rah. The high prevalence of the so-called pseudo resistant hypertension in our sample implies the importance of the individualized selection of therapy in CGN. Conclusions. Currently DHP-CCB and beta-blockers are undervalued drugs in terms of antihypertensive therapy in CGN patients with rah. Our work shows the potential effectiveness of these medications. Other criteria, such as the stage of CKD, creatinine level, and a new prognostic factor - the level of triglycerides - were confirmed to be of high value in the prognosis for rah.
Clinical nephrology. 2016;(2):20-26
20-26
The kidney as a target organ of hypertension among residents of Mountain Shoria
Abstract
Aim. To determine the relationship between the main cardiovascular risk factors and elevated levels of albuminuria and estimated glomerular filtration rate (eGFR) in patients with arterial hypertension (Ah) among indigenous and non-indigenous residents of Mountain Shoria. Material and methods. The study comprised 465 non-indigenous adults living in Mountain Shoria, of which 214 had hypertension, and 721 indigenous nationals, of which 288 had hypertension, matched by sex and age. Initial examination included the lipid profile, anthropometric data, the level of urine albumin and eGFR. Statistical analysis was conducted using variation statistics. Results. Non-indigenous people were more likely to have hypertension: 46.і% versus 39.9% in Shorians on account of the male population. The incidence of high-level albuminuria in patients with hypertension did not differ significantly and amounted to 23.4% of Shorians and 23.7% among non-indigenous ethnic group. The risk of developing high-level albuminuria in hypertensive patients in Shorians was associated with the severity and duration of the disease, age, hypertriglyceridemia and decreased HDL cholesterol, while in the group of non-indigenous residents with age and obesity, including abdominal. In hypertensive indigenous nationals there was the relationship between decreased eGFR of less than 90 mL/min/1.73m2, duration of hypertension, age, overweight and obesity, smoking and elevated blood triglyceride levels. In non-indigenous participants decreased eGFR was associated only with age and ah grade. Conclusion. These findings allow predicting renal dysfunction among the hypertensive population living in Mountain Shoria.
Clinical nephrology. 2016;(2):27-32
27-32
Comparative informativeness of proteinuria tests in patients with chronic obstructive pulmonary disease
Abstract
Objective. To evaluate the incidence of albuminuria among patients with COPD and assess the informativeness of different proteinuria tests. Material and methods. The study included 200 patients of Krasnodar KCH №2 diagnosed with COPD. The patients were divided into four groups depending on the frequency and severity of exacerbations. All patients were tested for proteinuria using different tests: semi-quantitative «method of dry chemistry», quantification of protein with pyrogallol red, urinary albumin excretion, ß2-MICROGLOBULIN, and protein-creatinine and albumin-creatinine ratios. Results. The semiquantitative method detected proteinuria in 7.5% of patients with COPD, the quantitative method in 15%, the protein-creatinine ratio in 20%, the albumin-creatinine ratio - in 22.5%. Significant inverse correlation was found between the severity of airflow obstruction and urinary excretion of ß2-MICR0GL0BULIN and albumin. Conclusion. The most important marker of early renal dysfunction in patients with COPD is the albumin-creatinine ratio. The highest mean levels of albuminuria, protein-creatinine and albumin-creatinine ratios and the marker of tubular dysfunction ß2-MICR0GL0BULIN WERE OBSERVED IN COPD PATIENTS WITH FREQUENT EXACERBATIONS. THERE WAS A SIGNIFICANT INVERSE CORRELATION BETWEEN THE SEVERITY OF AIRFLOW OBSTRUCTION AND ß2-MICR0GL0BULIN AND albuminuria.
Clinical nephrology. 2016;(2):33-37
33-37
Simultaneous cancer in renal transplant recipient
Abstract
The article reports a case of two histogenetically different cancers occurring in a patient after kidney transplantation. The authors discuss the incidence, the time-frame of development, clinical and histological features, and methods for treating tumors of the transplanted kidney.
Clinical nephrology. 2016;(2):38-45
38-45
Predicting Outcomes of Renal Transplantation
Abstract
Aim. To identify the main predictors of patient and allograft survival and devise mathematical models to predict the outcomes after renal allotransplantation (ATP). Material and methods. Observational data of 350 patients undergoing kidney transplantation were analyzed. The post-transplant follow-up averaged 79.1±3.4 months. 229 (65.4%) patients were males. Mean age of the patients was 37.i±0.6 years. 342 (97.7%) patients underwent cadaveric kidney transplantation. Three protocols of immunosuppressive therapy (1ST) were used: tacrolimus+prednisone+azathioprine; tacrolimus+prednisone+myco phenolate; tacrolimus+prednisone+mycophenolate. Part of the patients (59.4%) received prophylactic antiviral treatment with valganciclovir. The following outcomes of kidney transplantation were examined: 1 - the patient is alive with a functioning graft, 2 - the patient is alive, but resumed dialysis due to graft failure, 3 - death. Analysis of patient and allograft survival was conducted. Any graft failure was estimated as a loss of the graft. The mathematical analysis was conducted using SPSS statistical software. The main statistical methods were descriptive statistics, tests for comparing means, the correlation analysis and survival analysis (Cox regression). Results. Cox regression model was used to identify significant predictors (p<0.05) of ATP outcomes for the patient's life: hemoglobin levels before and 1 month after the ATP, albumin level before surgery, alt level 1 month after the ATP, prophylactic antiviral therapy, method of immunological selection, smoking after ATP and compliance. Significant predictors (p<0.05) of ATP results for the graft functioning were: hemoglobin level before ATP, ALT level 1 month after the ATP, smoking before ATP, method of immunological selection, prophylactic antiviral therapy and compliance.
Clinical nephrology. 2016;(2):46-55
46-55
56-64
Modern strategy for erythropoiesis-stimulating therapy in chronic kidney disease
Abstract
Anemic syndrome is closely linked with chronic kidney disease (CKD). Erythropoiesis-stimulating agents, preparations of erythropoietin, are a pathogenetic component of comprehensive therapy of renal anemia. The article discusses the current strategy of erythropoiesis-stimulating therapy in patients with CKD, based on an individual approach to establishing the target hemoglobin level and to the choice of the recombinant human erythropoietin preparation.
Clinical nephrology. 2016;(2):65-70
65-70
Congratulations to Andrei Grigor'evich Iankovoi
Clinical nephrology. 2016;(2):71-71
71-71