No 1 (2017)

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. a high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

Aim. To assess standard and alternate laboratory markers of CKD in the early diagnosis of CKD in patients with chronic obstructive pulmonary disease (COPD). Material and methods. The study comprised 226 patients of KCH № 2, who were allocated to four main groups depending on COPD severity (Gold, 2014) and a control group. For all patients glomerular filtration rate (GFR) was estimated using both the creatinine-based CKD-EPI equation and cystatin C-based equation. Results. When calculating GFR using creatinine-based equation, the percentage of COPD patients with normal GFR (>90 ml/min/1.73 m2) was significantly higher than for cystatin C-based equation (37.1 vs 12.6%, respectively; x2=52.97, p=0.005). Patients with reduced glomerular filtration rate in the range of 59-45 ml/min/1.73 m2 had the opposite results. Among them the proportion of patients with normal GFR calculated by cystatin C-based equation was significantly higher (34.3 vs 1%, respectively; x2=48.87, p=0.002). Similar results were seen in GFR declined to 44-30 ml/min/1.73 m2 (12.1% FOR CYSTATIN C-based equation vs 0% for creatinine based equation; x2=28.97, P=0.03) and TO 29-15 ml/min/1.73 m2 (5.1% CYSTATIN C-based equation vs 0% FOR CREATININE based equation; x2=5.13, P=0.045). In minimally decreased GFR (89-60 ml/min/1.73 m2) no significant differences were observed between the equations used for calculating GFR (51% for the creatinine vs 35.8% FOR CYSTATIN C; x2=2.95, p>0.05). Conclusions. Cystatin C-based equation to estimate GFR is preferred for patients with COPD, as cystatin C is independent of muscle mass and anthropometric parameters.

Aim. To investigate renal function and cardio-renal syndrome in patients with primary hypothyroidism and concurrent arterial hypertension. Material and methods. a total of 59 female patients aged from 45 to 75 years with primary manifest hypothyroidism of various etiologies were examined. The patients were divided into 2 groups depending on the level of blood pressure (BP). All patients underwent a complete physical examination and were tested for serum creatinine, uric acid, cholesterol, triglycerides, LDL and HDL, glomerular filtration rate (GFR) by the endogenous creatinine clearance based on a 24-hour urine sample, clearance of uric acid and 24-hour albuminuria. Patients were tested for renal functional reserve after protein loading. Main hemodynamic parameters such as left ventricular mass index, the relative thickness of left ventricular wall, ejection fraction and endothelial function were measured. Results. Patients with manifest hypothyroidism and concurrent arterial hypertension had greater renal functional impairment than patients with normal blood pressure. They had a significantly greater decrease in GFR, higher diurnal albuminuria and decreased clearance of uric acid. All patients were found to have hemodynamic changes such as left ventricular hypertrophy, diastolic dysfunction, endothelium-dependent endothelial dysfunction and increased intima-media thickness. There was a significant negative correlation between GFR and the level of blood thyroid stimulating hormone, GFR and total blood cholesterol level, age and GFR, GFR and systolic and diastolic blood pressure. Conclusion. Patients with primary hypothyroidism and concurrent arterial hypertension need to be followed for changes in the renal filtration function and characteristics of the cardiovascular system. Achieving target blood pressure is of utmost importance to preserve renal function and prevent chronic kidney disease.

Aim. To develop a new marker for early screening for adverse circadian blood pressure profile. Material and methods. The study comprised 375 patients who self-referred to the Health centre. The mean age of the patients was 46±8 years. All patients reported salt consumption of over 6 g/day, 56% of them had abdominal obesity. «Office» bp measurements showed mean SBP 144±12.8 mm HG and DBP 89±7 mm HG. 36%, і9.2%, 42.4% and 2.4% of patients had «non-dipper», «night-peaker», «dipper» and «over-dipper» circadian blood pressure profiles, respectively. Urine conductivity and natriuresis were measured in a single urine sample collected in the morning (08: 00-10: 00), DAYTIME (12: 00-14: 00) AND EVENING (18: 00-20: 00) HOURS. Results. The findings showed interrelationship between natriuresis and urine conductivity: correlation coefficients between natriuresis and urine conductivity in the morning, daytime and evening urine samples were R=0.987, P<0.0001, R=0.982, P<0.0001 AND R=0.989, P<0.0001, RESPECTIVELY. PATIENTS WITH «NIGHT-PEAKER» AD profile were found to have a sharp rise in the level of natriuresis and urine conductivity («peak»). Examining the likelihood of adverse circadian blood pressure profile depending on the «peak» of sodium excretion and urine conductivity showed that evening «peak» of natriuresis and urine conductivity increases the possibility of 24-hour «night-peaker» (to a greater extent) and «non-dipper» ad profiles. Conclusion. Natriuresis, which reflects the functional state of renal TIT and its circadian disturbances, is able to most fully reveal the risk of adverse blood pressure profile. Screening of natriuresis by measuring urine conductivity in the evening hours allows adverse blood pressure profiles to be predicted with high probability.

Malignant arterial hypertension is a life-threatening condition accompanied by acute renal failure, which in most cases results in irreversible loss of renal function. The morphological substrate of the disease is often thrombotic microangiopathy the mechanism of which in malignant hypertension is not fully understood. The article presents clinical observations of patients with malignant hypertension and renal dysfunction who had renal biopsy-proven thrombotic microangiopathy. The characteristic feature of both observations is the lack of specific hematologic signs of thrombotic microangiopathy syndrome, which creates diagnostic difficulties. Factors attributed to the lack of microangiopathic hemolysis and thrombocytopenia are described. Potential mechanisms of developing thrombotic microangiopathy in malignant hypertension are discussed.

The article presents insights into the diagnosis and treatment of secondary thrombotic microangiopathy (ТМА) and the specific features of differential diagnosis of aHUS from other forms of ТМА. Contemporary principles of aHUS management and genetic characteristics of the disease are discussed in details.

Hyperphosphatemia in patients with chronic kidney disease (CKD) undergoing hemodialysis is associated with a high risk of cardiovascular morbidity and mortality. Controlling serum phosphorus has long been recognized as one of the key objectives in managing CKD patients. The main strategies in preventing and managing hyperphosphatemia are hypophosphorous diet, adequate dialysis and the use of phosphate binders. The article reviews the most commonly used phosphate binders. It discusses the pharmacokinetics, side effects, initial and maintenance doses, phosphate-binding capacity and contraindications for phosphate binders. New approaches to monitoring the serum phosphorus level in CKD patients undergoing dialysis are presented. The review describes the principles of administering phosphate binders based on their efficacy and tolerability, and considering the phosphorus load, comorbidities and contraindications. The authors present an algorithm and the results of the comparative assessment of the phosphate-binding capacity of phosphate binders based on using relative phosphate binding ratio and phosphate-binding equivalent dose to facilitate selecting the dosage of phosphate binders. High phosphate-binding capacity of phosphate binders improves the effectiveness of correcting hyperphosphatemia, decreases the medication load and improves patient's adherence to the prescribed therapy.