Background Chronical kidney disease (CKD) is the polymorbidity condition characterized by progressive renal function loss. Large NHANES (National Health and Nutrition examination Survey) registry data suggest an prevalence of kidney disease in adult population to be 13% with only the quarter of patients with depressed glomerular filtration rate (GFR) has been informed if they have CKD. Renal involvement in SSc occurs in the form of acute and chronic nephropathy. The feature of nephropathy in SSc is olygosymptomatic disease course. Nephropathy clinical signs manifest only on latest stages then renal processes become irreversible. Using simple diagnostic technique (GFR measurement) nephropathy debute revelation and clinical outcome exert should be possible.
Objectives To study the prevalence of CKD in patients with systemic scleroderma.
Methods Retrospective study of glomerular filtration rate by the MDRD (Modification of Diet in Renal Disease Study) formula in 87 patients with systemic scleroderma (7 male and 80 female, mean age 48.72±7.78 years) without previously diagnostic kidney disease, without coronary artery disease, no smoking.
Results GFR ≥ 90 ml/min (1 group) revealed in 19 (22 %) persons, GFR 60- 89 ml/min (2 group) – 52 (59,7%) persons, GFR <60 ml/min (3 group) – 16 (18,3%) persons. Arterial hypertension (blood pressure >140/90 mm Hg) was noted in 31 (36%) patients. Frequency of Arterial hypertension in 3 groups of patients was the same.
Changes in urinalysis, typical for tubulointerstitial lesion (specific density loss, microhematuria, moderate proteinuria) were found in 16 patients of 1 group, in 25 patients in 2 group and in 16 patients in 3 one, thus CKD of 2 and 3 stages accordingly should be predicated in this patients.
We noted correlations between GFR and age (r=-0.32, p<0.05), presence respiratory symptoms (cough) (R=-0.42, p<0.05). Also we noted correlations between stage of CKD and VC (R=-0.43, p<0.001), FEV1/VC (R=0.35, p<0.01), CRP (R=0.25, p<0.05). We noted interrelations between renal disturbance and pulmonary hypertension: systolic pulmonary pressure and GFR (R=-0.21, p<0.05), CKD stage (R=0.25, p<0.05), right ventricular end-diastolic diameter and creatinine (R=0.27, p<0.01), GFR (R=-0.31, p<0.01). Also we noted correlations between total cholesterol and GFR (R=-0.63, p<0.05), CKD stage (R=0.75, p<0.05). We didn`t noted significantly correlations between arterial hypertension and creatinine, GFR, CKD stage. But we noted correlations between GFR and systolic BP (R=-0.54, p<0.05), central BP (R=-0.55, p<0.05).
Conclusions Thus, 57 patients (65.5%) with systemic scleroderma had chronic kidney disease. Attention is drawn to the correlation of renal dysfunction with involvement of other organs (restrictive disorders of lung function, pulmonary hypertension), disease activity (CRP). The study suggested high renal involvement prevalence that is an unfavorable prognosis for SSc. Therefore the creatinine measurement necessity in SSc patients is clearly evident. Renoproprotective theraphy directed at prevention of CKD progression may be recommended to patients with existing nephropathy signs.
Disclosure of Interest None Declared