Optimization of the diagnosis of preclinical renal dysfunction in arterial hypertension and its combination with type 2 diabetes mellitus.

Hajibabirova Lala Mehman

Scientific Research Institute of Cardiology named after J. Abdullayev, Baku.

In order to optimize the diagnosis of early renal dysfunction in patients with arterial hypertension and its combination with type 2 diabetes mellitus, we examined 100 patients aged 35 to 58 years (mean age 46.8 ± 0.68). The first group included 50 patients with AH of the 1st and 2nd degrees, the 2nd group consisted of 50 patients with a combination of AH and type 2 diabetes. In all patients, the concentration of creatinine, cystatin C, uric acid was determined, and the glomerular filtration rate was calculated using the formulas of KokroftGault, MDRD, CKD EPI, Hoek. Along with this, the degree of albuminuria was determined, ultrasound and the dopplerography of the renal vessels was performed to determine the biometric parameters of the kidneys. Both in patients with AH and in its combination with type 2 diabetes, an increase in the level of cystatin C and uric acid in the blood was detected. The calculation of GFR by various formulas more often revealed an insignificant decrease in renal function when using the formula based on cystatin as opposed to the calculation based on creatinine.When the degree of albuminuria was detected in 9% of patients with AH of 1st degree and in 21% of patients with AH of 2nd degree, albuminuria of A2 grading was revealed. In the 2nd group, albuminuria of A2 gradation was detected in 36%, and in 4% — gradation A3. Ultrasound revealed a significant increase in renal volume (224.6 ± 3.17 cm3, p <0.001) in patients of group 2. Doppler sonography in both groups revealed a decrease in speed indicators and an increase in resistance and pulsation indices. Thus, a set of methods, including the determination of the level of cystatin C and uric acid in the blood, the calculation of GFR for cystatin C, the identification of the degree of albuminuria and ultrasound of the kidneys is important for the diagnosis of preclinical kidney damage in patients with hypertension and hypertension with an adjacent course with type 2 diabetes.

Key words: arterial hypertension, type 2 diabetes mellitus, glomerular filtration rate, cystatin C, category A2 albuminuria, renal ultrasound.

https://dx.doi.org/10.15407/internalmed2021.01.116

Download.PDF (rus)

Cite:

1. Гаджибабирова, Л.М. Оптимизация диагностики доклинической дисфункции почек при артериальной гипертензии и ее сочетании с сахарным диабетом 2 типа // Східноєвропейський журнал внутрішньої та сімейної медицини. – 2021. – №1. – С. 116-120. doi: 10.15407/internalmed2021.01.116

2. Hajibabirova LM. [Optimization of the diagnosis of preclinical renal dysfunction in arterial hypertension and its combination with type 2 diabetes mellitus]. Shidnoevr. z. vnutr. simejnoi med. 2021;1:116-120. Russian. doi: 10.15407/internalmed2021.01.116

References:

1. Grjaznov AV. Osobennosti kliniko-funkcional’nogo sostojanija pochek u bol’nyh jessencial’noj arterial’noj gipertoniej. Avtoreferat diss kand. Med nauk 2007. Russian

2. Gendlin GE, Jettinger OA, Reznik EV. Ul’trazvukovoe issledovanie pochek: vozmozhnosti i granicy metoda. Klinicheskaja nefrologija. 2009;2:17-25. Russian

3. Grinshtejn JuN, Shabalin VV. Gipertenzivnaja nefropatija: vstrechaemost’ i diagnosticheskie markery. Rossijskie medicinskie vesti. 2011;4:30-32. Russian

4. Kajukov IG, Smirnov AV, Jemanujel’ VL. Cistatin v sovremennoj medicine. Nefrologija. 2012;1: 22-35. Russian

5. Kobalava ZhD, Villeval’de SV, Efremovceva MA. Samostojatel’noe diagnosticheskoe znachenie mikroal’buminurii i raschetnoj skorosti klubochkovoj fil’tracii u bol’nyh arterial’noj gipertoniej dlja vyjavlenija subklinicheskogo porazhenija pochek. Kardiologija. 2010;4:12-17. Russian

6. Jakimenko IL. Giperurikemija, arterial’naja gipertenzija i hronicheskaja bolezn’ pochek: interpretacija vzaimosvjazi i strategija dejstvij. Klin. Nefrologija. 2010;4:17-25. Russian

7. Matsushita K, Velde M. Astor Association of estimated glomerular filtration rate and albuminuria with allcause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet, 2010;375:2073-2081
https://doi.org/10.1016/S0140-6736(10)60674-5

8. Buch A, Dharmadhikari М. Microalbuminuria: an early detector of diabetic and hypertensive nephropathy. International Journal of Basic and Applied Medical Sciences. 2012;2:218-225.

9. Maisel A, Katz N, Hillege H. Biomarkers in kidney and heart disease. Nephrology Dialysis Transplantation. 2011; 26(1):62-74.
https://doi.org/10.1093/ndt/gfq647

10. Cockcroft D, Gault H. Prediction of Creatinine Clearance from Serum Creatinine. Nephron. 1976;16(1):31-41. http://dx.doi.org/10.1159/000180580
https://doi.org/10.1159/000180580

11. Andrew S . CKD-EPI (Chronic Kidney Desease Epidemiology Collaboration). A New Equation to Estimate Glomerular Filtration Rate. Ann Inter Med.2009;5:604-12.
https://doi.org/10.7326/0003-4819-150-9-200905050-00006

12. Stevens L, Claybon M, Schmid C, Chen J, Horio M, Imai E, Nelson R, Van Deventer M, Wang H, Zuo L, Zhang Y, Levey A. Evaluation of the Chronic Kidney Disease Epidemiology Collaboration equation for estimating the glomerular filtration rate in multiple ethnicities. Kidney International. 2011;79(5):555-562. http://dx.doi.org/10.1038/ki.2010.462
https://doi.org/10.1038/ki.2010.462

13. Hoek F. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrology Dialysis Transplantation. 2003;18(10):2024-2031. http://dx.doi.org/10.1093/ndt/gfg349
https://doi.org/10.1093/ndt/gfg349

14. Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. Suppl. 2013;3:1-150

15. Levey A. A simplified equation to predict glomerular filtration rate from serum creatinine. J.Am. Soc.Nephrol. 2000;11:155.

16. Shalomai G. Assesment of target organ damage in the evaluation and follow-up of hypertensive patients. The Journal of clinical hypertension. 2013;15(10):742-747.
https://doi.org/10.1111/jch.12185