Оптимизация диагностики доклинической дисфункции почек при артериальной гипертензии и ее сочетании с сахарным диабетом 2 типа

Abstract

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.