[Cardiorenal syndrome in ischemic renal disease (atherosclerotic renovascular hypertension)].
OBJECTIVE
To characterize cardiorenal syndrome in ischemic renal disease (IRD).


METHODS
In examination of 105 IRD patients (63 males and 42 females, mean age 63.8 +/- 5.1 years) we estimated body mass index (BMI), indices of peripheral blood and urine, blood biochemistry, glomerular filtration rate (GFR). Plasmic homocystein concentration was measured in 30 patients. We also studied incidence of some cardiovascular risk factors, clinical variants of atherosclerosis and their correlation with GFR.


RESULTS
IRD patients most frequently had hypertriglyceridemia (67.6%), hypercholesterinemia (53.3%), smoking (47.1%), obesity (41.9%), metabolic syndrome (38.1%), type 2 diabetes mellitus, arterial hypertension of the third degree (70.6%), isolated systolic arterial hypertension (46.7%). GFR was significantly lower in smokers (p < 0.001), arterial hypertension of the third degree (p < 0.05), isolated systolic arterial hypertension (p < 0.001) and type 2 diabetes mellitus (p < 0.05). In GFR < 40 ml/min homocysteinemia increased significantly (p < 0.01). Coronary artery disease in IRD occurred in 52.4%, cerebrovascular diseases (brain stroke, transitory ischemic attacks)--in 29.5%, intermittent claudication--in 19.0%, aneurism of the abdominal aorta--in 7.6%, documented atherosclerotic affection of the upper limb arteries--in 2.8%. Patients with intermittent claudication were characterized by significantly less GFR compared to that in patients without clinical symptoms of affected arteries of the lower limbs (38.6 +/- 8.2 and 44.6 +/- 7.3 ml/min, respectively; p < 0.01).


CONCLUSIONS
Basic symptoms of cardiorenal syndrome in IRD are high rate of cardiovascular risk factors, some of them provoke aggravation of glomerular endotheliocyte dysfunction and deterioration of intrarenal hemodynamics leading to GFR reduction underlying appearance of new endothelium-tropic risk factors (hyperhomocysteinemia), and progression of atherosclerotic process with formation of its special clinical forms (intermittent claudication).
Mukhin
N A
NA
Fomin
V V
VV
Moiseev
S V
SV
Shvetsov
M Iu
MIu
Kutyrina
I M
IM
Zaĭtsev
A Iu
AIu
Taronishvili
O I
OI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology* / Q000503:physiopathology; D007511:Ischemia / Q000150:complications* / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome