Clinical and pathogenetic aspects of formation, early diagnosis, and medicated correction of cardiorenal disorders in men with hypertension against the background of purine metabolism disturbance

Abstract

Aim: to review literary sources and analyse the modern view of the mechanisms of development of kidney and heart damage in patients with combination of hypertension (HP) and hyperuricemia and methods of their medicated correction. Materials and methods. A review of the scientific literature for the last 10 years was done. It demonstrates that today high levels of uric acid (UA) are considered not only as a consequence of deteriorating renal function, but also as one of the factors of renal damage. The role of the kidneys in the pathogenesis and development of hypertension is the subject of a lively debate, whose significance is determined by the presence of a long period of latent renal dysfunction. According to the literature, in patients with essential hypertension, a direct correlation was found between the uric acids level and the left ventricular diastolic dysfunction (LVDD). Early diagnosis of heart lesions is possible using speckle-tracking echocardiography, which is an innovative technology for studying myocardial deformation, allowing subclinical diagnosis of heart muscle lesions. This technique is informative in hypertension even in the absence of hypertrophy and LVDD. The article also elucidates modern methods for diagnosing kidney damage against the background of hypertension, in particular, lipocalin associated with neutrophil gelatinase (NGAL). However, the significance of this biomarker in impaired renal function under conditions of hyperuricemia has not been studied. According to the literature, cystatin C is a marker of early diagnosis of cardiovascular events and a marker of renal glomerular function in the absence of an increase in serum creatinine levels. The role of this marker has been proven for many diseases of the kidneys and the cardiovascular system; however, there are no data on their definition as markers of damage to the heart and kidneys in hypertension in conditions of hyperuricemia. Conclusions. The identification of causal relationships and mechanisms of complications in hypertensive patients with purine metabolism disturbance needs further study. Therefore, early diagnosis of structural and functional changes in the main target organs (in particular, the heart and kidneys) and the determination of biochemical markers (NGAL, cystatin C) to identify their functional disturbances at the preclinical stage are important.