Vol 9, No 3 (2023)

Arterial hypertension (AH) is a common cause of chronic kidney disease (CKD) and its progression to end-stage kidney failure. Prevalence of CKD in patients with hypertension is significantly higher than the average in the adult population and is comparable to that in high-risk groups (diabetes mellitus, cardiovascular disease).

The aim of the research is to study the prevalence of CKD, comorbid diseases, risk factors, progression rates in outpatients with stage II–III of AH.

Material and methods. 968 outpatients with stage II–III of essential hypertension were examined for the presence of CKD according to the following criteria: albuminuria >30 mg/day and/or albumin/creatinine (A/Cr) in a single portion of urine >30 mg/g and/or GFR <60 ml/min/m² according to CKD-EPI. In the groups of patients without CKD (n=71) and with CKD (n=49), a survey was performed, including an assessment of CKD risk factors, the structure and function of the kidneys; in 43 patients with CKD in the dynamics after 5 years, the clinic, renal function and the rate of progression of CKD were studied.

Results. CKD was detected in 18,7% of outpatients with hypertension, GFR was 71 ml/min/m². The duration of hypertension in patients with CKD was longer, the duration of hypertension before CKD was 11,3±1,3 years, and the onset of hypertension was earlier (at 40,5 years) comparatively to the group without CKD (46,3 years). The levels of blood pressure, atherogenic lipids, the proportion of smokers, smoking index, BMI in the group with CKD were higher comparatively to the group without CKD.

Conclusion. The rate of decrease in GFR in patients with AH and CKD before being taken under observation was 12,05 ml/min/year. Risk factors for the development of CKD were identified: they are LDL, SBP, BMI, smoking index, earlier onset of AH and longer duration of AH. A formula for calculating the probability of developing CKD under the influence of these factors has been developed. After 5 years of observation and treatment, the level of blood pressure remained insufficiently controlled, for other risk factors there was a slight positive tendency without reaching the target levels. GFR for 5 years decreased from 71+3,1 to 45,2±1,6 ml/min/m². The rate of progression of CKD slowed down to 5,7 ml/min/year, but still indicated CKD progression.

Arterial hypertension (AH) is one of the risk factors for the development of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD).

The aim of the research is to evaluate the parameters of ABPM in patients receiving treatment with program hemodialysis, depending on the structural and functional heart condition.

Material and methods. 179 patients with stage 5d CKD (79 males and 100 females) were examined. Average age of participants was 56,9±12,2 years, their dialysis experience was 5,7±3,5 years. All patients underwent ABPM and Echo-KG examination.

Results. In examined patients, circadian rhythms of BP of the Non-dipper and Night Peaker types were revealed in SBP (81,6%; p <0,001) and DBP (73,2%; p <0,001). A correlation was fixed between the degree of nighttime decrease in SBP and DBP with LVM (r=-0,45, p <0,01; r=-0,51, p <0,01), LVMI (r=-0,55, p <0,001; r=-0,53, p <0,01). Pulse wave velocity was associated with interdialysis weight gain (r=0,55, p<0,001) and medium fibers shortening fraction (r=0,4, p<0,05). In 116 (64,8%) patients, a moderate increase in arterial stiffness index (p <0,001) was observed, which correlated with LVM (r=0.34, p<0.05) and SBP (r=0.39, p <0,05). In 135 (75,4%) patients with CKD, parasympathicotonia predominated (p <0,001). A correlation was found between the vegetative index and LVMI (r=-0,51, p<0,001) and LVMI (r=-0,44, p<0,01).

Conclusion. Most patients with stage 5d CKD have predominating parasympathicotonia, which is associated with LVMI. Moderate increase in arterial stiffness index, correlating with interdialytic weight gain takes place. BP circadian rhythm disturbance was associated with LVMI, DBP level correlated with right ventricular thickness.

There is information in the literature about the association of hyperuricemia (HU) with a wide range of chronic non-infectious diseases. At the same time, the prevalence of HU and its correlation with a decrease in glomerular filtration rate (GFR) among the population of the Nizhny Novgorod region has not been studied enough.

The aim of the research is to evaluate the prevalence of HU and its correlation with GFR decrease and some cardiovascular risk factors among the population of Nizhny Novgorod region.

Material and methods. 2501 persons aged 35–74 among the population of Nizhny Novgorod region were examined. In all of them anthropometric parameters, blood pressure and heart rate were measured. A laboratory study was carried out, it included measurement of indexes of the lipid spectrum, glucose, creatinine, uric acid (UA), acute phase proteins. GFR was calculated using the CKD-EPI formula. The binary logistic regression method was used to build a predictive model of HU risk.

Results. HU was detected in 23,1% of the adult population of the Nizhny Novgorod region. The group of respondents with HU had a worse metabolic and clinical profile comparatively to those individuals whose UA levels were within the normal range. GFR index in this category of persons turned out to be lower than in those surveyed who had no HU. The following factors turned out to be the most prognosticating for the risk of HU: reduced GFR in the respondent (OR 3,383; 95% CI: 2,334–4,903; p <0,001), presence of arterial hypertension (OR 1,767; 95% CI: 1,384–2,254; p< 0,001), elevated levels of highly sensitive C-reactive protein (OR 1,936; 95% CI: 1,546–2,425; p <0,001).

Conclusion. A significant number of Nizhny Novgorod region residents had an elevated level of UA. The risk factors most closely associated with HU were reduced GFR, presence of arterial hypertension, and elevated levels of highly sensitive C-reactive protein.

Strategy and tactics of antimicrobial therapy for urinary tract infections (UTIs) have undergone significant changes in the last 10 years due to the global increase of infectious agents’ resistance to antibiotics. In the last decade, opinions on many seemingly unshakable truths in this area have changed. Now is accepted that urine is not sterile, but contains many microbes that make up the microbiome, while asymptomatic bacteriuria (ASB) is not considered to be a disease and in most cases is not treated. The UTI therapy strategy has changed: if in acute forms of this infection (cystitis, pyelonephritis) the aim is clinical and microbiological recovery, then in recurrent and chronic UTIs, therapy is aimed at reducing the frequency of relapses and lengthening the interrecurrent period, and it is allowed to achieve clinical recovery without microbiological, i.e. with the preservation of ASB. Rational choice of empiric antimicrobial therapy plays the main role in solving these problems. In addition, the strategy for the prevention and treatment of continuously recurrent UTIs has changed: previously used long-term courses of therapy with subtherapeutic doses of antimicrobials are currently not recommended due to the high risk of resistant microflora formation.

Chronic delta hepatitis is still remaining an unresolved global health care problem. Current analytical review discusses the possibility of treating this disease with medicaments aimed at suppressing various stages of hepatitis delta virus (HDV) reproduction. The data obtained in clinical trials of new medicines and the results of their use in real clinical practice are also analyzed.

Lupus nephritis is a classic immunocomplex glomerulonephritis. Kidney damage associated with antineutrophil cytoplasmic antibodies is a low-immune focal and segmental necrotizing/lunate glomerulonephritis that could be developed both separately and as part of systemic vasculitis. The aim of the research is to present and analyze an extremely rare clinical observation of female patient with systemic lupus erythematosus, identified antibodies to the cytoplasm of neutrophils and morphologically verified low-immune glomerulonephritis. The choice of treatment tactics in current clinical situation is substantiated.

In this clinical example, attention is focused on the features of differential diagnosis in order to verify the diagnosis in the group of diseases of diabetes insipidus and the use of vasopressin analogs for the treatment. It should be noted that central diabetes insipidus (CDI), nephrogenic diabetes insipidus (NDI) and primary polydipsia/dipsogenic diabetes insipidus have similar clinical manifestations, but different causes and, accordingly, different approaches to treatment. With primary polydipsia, there is no deficiency or decrease in the action of antidiuretic hormone (ADH), unlike CND/NND, but there is a decrease in the sensitivity of the thirst center (thirst bothers the patient even with a low level of electrolytes), and increased fluid intake is associated with a compulsive desire to drink on the background of psychiatric diseases. Thus, in primary polydipsia, polyuria is a consequence of polydipsia, in contrast to CDI and NDI, where polyuria induces polydipsia. The appointment of desmopressin is justified only in cases of proven ADH deficiency, and in the absence of indications, it can lead to critical conditions up to death.

Chronic kidney disease (CKD) often progresses to the end stage with complete loss of kidneys function, requiring dialysis or renal transplantation. At the same time, the mortality of CKD patients rapidly increases, primarily from cardiovascular causes, as the glomerular filtration rate decreases and protein (albumin) excretion in the urine gets more intensive. The progression of the disease can be slowed down by the use of a set of renoprotective therapy measures, including lifestyle changes, diet, and special drug classes use. Lecture presents the process of making medical decisions concerning CKD treatment with an emphasis at them aspects relevant to primary care physicians.

Review contains the points of diagnosis and treatment of patients with chronic cardiorenal syndrome. Practical algorithms for the use of drugs blocking renin-angiotensin-aldosterone system (RAAS), aspects of safety and efficacy of therapy from the standpoint of cardio- and nephroprotection are discussed. The main problems of prescribing RAAS-blocking medicaments, which are arising during a therapeutic appointment in real clinical practice, are discussed.

Among the causes of renovascular hypertension (RVH), fibromuscular dysplasia (FMD) of the renal arteries takes second place, second only to atherosclerotic lesions. The presence of renal arteries FMD can cause refractory hypertension, increase the risk of adverse cardiovascular events, and lead to a decrease in glomerular filtration rate. With the beginning of the use of interventional methods in RVH treatment, it became possible to significantly modify the patients’ prognosis. In young patients, the use of balloon angioplasty lets to achieve normalization of blood pressure or medical control of arterial hypertension. The article presents a 10-year clinical follow-up of a patient with renal artery FMD treated with balloon angioplasty. The significance of the presented observation consists in demonstrating the possibilities of endovascular methods for FMD treatment to improve the RVH course.

An increase in serum uric acid is an independent cardiovascular risk factor.

The aim: to describe cases of glomerular filtration rate (GFR) increasing in patients with chronic kidney disease (CKD) stage 3C with a high cardiovascular risk in the setting of persistent normalization of the level of uric acid in the blood serum due to febuxostat intake.

Material and methods. We observed patients born in 1958 and 1943 who had a decrease in GFR to 37 and 38,9 ml/min/1,73 m2 during 5 and 8 years, respectively.

Results. The genesis of kidney damage in patients was complex – in both cases there was arterial hypertension, diabetes mellitus, widespread atherosclerosis, obesity, dyslipidemia. The level of uric acid in the blood serum of both observed persons exceeded 500 µmol/l for at least 5 years. Nephritis, other autoimmune and inflammatory diseases as the cause of CKD were absent. The results of prescribing febuxostat (80/120 mg/day) against the background of a low-purine and low-calorie diet were the normalization of uric acid levels, a decrease in body weight, stabilization of blood pressure with a decrease in the need for antihypertensive therapy, which in combination led to a steady increase in GFR from 37 and 38,9 to 55 and 64.4 ml/min/1,73 m², respectively.

Conclusion. Persistent normalization of serum uric acid levels may be associated with a decrease in the severity of CKD in patients with high cardiovascular risk, in case there is no primary kidney damage leading to hyperuricemia.

Article contains the discussion about the role of non-alcoholic fatty liver disease (NAFLD) in patients with obesity and other metabolic disorders in the risk of type 2 diabetes mellitus (DM2) and cardiovascular disease development. Modern data on the prevalence of NAFLD in Russia and other countries are presented. Particular attention is paid to the assessment of the etiological factors leading to the development of NAFLD and its progression from fatty hepatosis and non-alcoholic steatohepatitis to fibrosis and cirrhosis of liver. The results of clinical studies from last years, indicating a high risk of DM2 developing and cardiovascular morbidity and mortality in the presence of the metabolic syndrome in combination with NAFLD are analyzed. Approaches to the diagnosis and treatment of NAFLD patients are presented in accordance with current advisory and consensus documents. The possibilities of using ursodeoxycholic acid in the complex therapy of patients with metabolic syndrome, dyslipidemia, and NAFLD are discussed.

The article is devoted to the digest of interregional scientific and practical events under the aegis or with the participation of RSMSIM (March-April 2023)