Clinico-Functional Characteristics of Left Ventricular Dysfunction in Patients with Glomerulopathies and Their Relationship to Morphological Changes in The Kidneys

Aiypova Dinara¹*, Beishebaeva Nasira², Sarybaev Akpay³ and Kaliev Rysbaek⁴

Received: June 03, 2018;   Published: July 02, 2018

DOI: 10.32474/JUNS.2018.01.000105

Full Text PDF

To view the Full Article   Peer-reviewed Article PDF

Abstract

Purpose: To study the possible association of cardiac function with morphological changes of the kidneys in glomerulopathies.

Materials and Methods: 55 patients with GP were examined (32 men, 23 women) aged from 17 to 58 (on the average 32.76 ± 10.3) years. Given the high prevalence left ventricular systolic diastolic dysfunction in patients with GP with impaired renal function, analyzed the data of patients with CKD stages 1-3. The mean GFR was 87.92 ± 28.2 ml / min / 1.73 m2. Histology, immunofluorescence and electron microscopic method of investigation were used in the study of nephrobiopsy data.

Results: Analysis of the frequency of morphological types of nephropathy in the examined patients made it possible to detect the prevalence of membranous glomerulonephritis (MG), which accounted for 43.6% of observations. IgA nephropathy was detected in 36.4% of cases. Focal-segmental glomerulosclerosis and minimal-change disease were much less common and in an equal proportion (7.3% of cases). Less often (in 5,4%) was marked by membrane-proliferative glomerulonephritis. Damage to glomerulus and endothelial proliferation significantly influenced the delay in the flow of early diastolic filling of the left ventricle deceleration and isovolumic relaxation time.

The Conclusion: The causes of the development of diastolic dysfunction of the heart are the damage of glomerulus, endothelial proliferation, deposits of the complement fraction C3 in GP.

Chronic kidney disease (hereinafter CKD) is an actual medical and social problem all over the world due to its significant increase in prevalence and adverse outcomes [1]. The mortality from cardiovascular diseases (hereinafter CVD) in patients with CKD is 15- 30 times higher than in the general population [2,3]. The achievements of modern nephrology have identified new approaches to the clinical analysis of complications of glomerulopathies (HP). A comparison of the CKD clinic with the frequency of complications showed that 74% of patients starting dialysis treatment are diagnosed with cardiac pathology [4]. So, in the work of Paoletti E [5] there is a decrease in survival due to an increase in the number of fatal and non-fatal complications in the presence of CVD in patients with chronic renal insufficiency. As for the pre-dialysis population, Weiner DE [6] analysis of four large studies (2,423 patients), with the definition of glomerular filtration rate (GFR) (15 to 60 mL / min / 1.73 m2) showed the dependence of the mortality rate on CVD in patients with CKD. In a study by Cai Q Z [7] significant changes in the side of deterioration of the cardiac structure were detected already in the first year of the disease in patients with CKD 3-5 stages. The authors explain this fact by the prolonged increase in the mass and volume of the left ventricle (LV) and the presence of diastolic (LVDM), rather than systolic LV dysfunction (LVDS). In the experimental work of Li K-L [8] it was found that maintaining normal diastolic function of the left ventricle in patients with CKD prevented the appearance of heart failure with reduced renal function. Modern methods of nephrobiopsy and improvement of immunomorfologic methods of analysis have opened the possibility to the study of live morphology of the kidney tissues more deeply, as well as to determine the role of the immune mechanism in the development of complications, including CVD [9]. Thanks to these data, the treatment of the disease, approaches to therapy and prevention of complications will change in the future [9]. However, at present, there are many unsolved issues in this area. There is still no clear correlation between clinical data and morphological manifestations of GP.

Objective: To study the features of the association of cardiac dysfunction with morphological changes in the kidneys with HP.

Abbrevations: CKD: Chronic Kidney Disease; GFR: Glomerular Filtration Rate; ECHOKG: Echocardiography; DBP: Diastolic Blood Pressure; SBP: Systolic Blood Pressure; FSG: Focal-Segmental Glomerulosclerosis; IMC: Minimal-Change Disease; MPGN: MembraneProliferative Glomerulonephritis

Abstract| Materials and Methods| Histopathological Analysis| Results and Discussion| Conclusion| References|