COMPREHENSIVE ASSESSMENT OF THE FUNCTIONAL STATE OF THE KIDNEYS AND HEMODYNAMICS IN THE PROGNOSIS OF CARDIOVASCULAR RISK IN PATIENTS WITH CHRONIC PYELONEPHRITIS AND ARTERIAL HYPERTENSION

Abstract

BACKGROUND . In recent years, there has been an increase in the number of patients with chronic kidney disease (CKD), including due to the prevalence of arterial hypertension (AH). In chronic pyelonephritis, the accelerated development of changes in the cardiovascular system at the background of a decrease in glomerular filtration rate may be due to arterial hypertension (AH). THE AIM : to assess the state of central hemodynamics, indicators of secretory and excretory kidney function, in patients with a combination of secondary chronic pyelonephritis and AH. PATIENTS AND METHODS . 81 patients with secondary chronic pyelonephritis caused by nephrolithiasis in combination with hypertension in the phase of incomplete clinical and laboratory remission were examined. The age of patients is from 25 to 60 years. A comprehensive assessment of the functional state of the kidneys and hemodynamics was carried out, taking into account the data of anamnesis, clinical and paraclinical examination methods. RESULTS . According to the data of dynamic nephroscintigraphy, an elongation of the excretory phase was revealed with the preservation of the secretory phase in both kidneys. A decrease in the estimated glomerular filtration rate was noted already at AG1 degree. According to echocardiography, violations of LV diastolic function were noted with preserved systolic function of the left ventricle. CONCLUSION . We found that in stage 1 CKD, the preservation of secretory function is combined with a slowdown in the excretory function of both kidneys, which may be associated with the processes of sclerosis of the tubulo-interstitial zone of the kidneys at the background of a chronic inflammatory process. The data obtained allow us to express the idea of the expediency of complex cardiorenal dynamic control already in the debut of CKD, which will contribute to improving the effectiveness of nephro- and cardioprotective measures in this cohort of patients.