CC BY
13
https://doi.org/10.29013/ESR-20-1.2-45-47
Umarova Zamira Fakhrievna, Candidate of Medical Sciences, Associate Professor Makhsumakhon Khairullaevna Tashpulatova,
Masters
Nakrzikulova Madina Shavkat Kizi,
Masters
Tashkent Medical Academy Е-mаil: [email protected]; [email protected]
DIAGNOSTIC QUESTIONS OF KIDNEY DISEASE IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION
Abstract. the article describes the main problems in diagnosing kidney damage in patients aged 60 to 75 years and above. The goals and objectives of the study, materials and applied research methods are given. Based on the results obtained, recommendations for the treatment of patients in this category have been developed.
Keywords: chronic kidney disease, arterial hypertension, disease, activity, quality of life.
Of the total population of the republic, the pro- insurance program, and are paid by local authorities.
portion of people 60 years and older is 19.2%. In this regard, society is interested in continuing a full life, first of all, in lengthening the period of human activity in the elderly and senile. The quality of life of the elderly largely depends not only on the conditions and lifestyle, but also on the effective treatment of a number of diseases of the elderly and the early prevention of their complications.
Chronic kidney disease (CKD) is a significant factor that significantly increases the risk of adverse outcomes in elderly patients with diabetes mellitus, hypertension, heart disease and stroke, each ofwhich, in turn, is the main cause of death and disability. Recent statistics indicate in most developed countries a steady trend towards a steady increase in the number of people with a persistent decline in kidney function. This is a general population problem, because terminal chronic renal failure requiring active treatment methods (programmed hemodialysis and / or kidney transplantation) are extremely expensive treatment methods, are not included in the compulsory medical
Which, of course, places a heavy burden on the small budget of many regions [1-3].
Ischemic nephropathy is also a danger to elderly patients. This independent disease, unfortunately, often develops gradually, without visible clinical manifestations, against a background of decreased renal function. And only a timely blood or urine test can reveal anemia, an increase in nitrogenous toxins, albuminuria, which allows you to diagnose CPD [4; 5].
According to large population registers, the prevalence of chronic kidney disease (CKD) in certain categories of individuals (elderly, type 2 diabetes mellitus) reaches up to 20%. Arterial hypertension (AH) is one of the most common causes of impaired renal function. In patients with arterial hypertension, renal damage is up to 25%. In this regard, the search for markers of early kidney damage in hypertension is one of the urgent problems ofmodern nephrology and geriatrics.
The development of modern medical science and pharmacology has allowed the development of new affordable and highly effective methods of
Section 3. Medical science
prevention that can significantly slow down the progression of chronic renal diseases, reduce the risk of complications and the cost of treating patients with CKD. Interest in the preventive direction is also associated with the fact that impaired renal function and increased albuminuria are associated with the progression of cardiovascular diseases.
Objective: To study the incidence of CKD in patients with arterial hypertension in Tashkent. Assess the effectiveness of markers for the early diagnosis of CKD.
Materials and research methods: The study included patients 55-70 years old, who were treated in the nephrology department of the multidisciplinary clinic of the Tashkent Medical Academy. During the study, the analysis of medical documentation data and anamnesis was carried out, screening methods of instrumental and laboratory diagnostics were performed. The degree of renal impairment was determined using the Cockroft-Gault and MDRD formulas developed by the Nephrological Associations and proposed in the EAG / EOC2007 Recommendations and National Kidney Foundation K / DOQI, 2002.
Research results and discussion: Studies have shown that over the indicated period 103 patients were treated in the nephrology department, of which 45% (57 people) were 55-70 years old. The average age of these patients was 52.3 ± 1.2 years (from 55 to 70 years). Among diseases of the older age group in 56% of cases (56 people).
During the same period, at the reception of the multidisciplinary clinic of the Tashkent Medical Academy 157 patients were admitted to nephrology, among them 76 people at the initial appointment. The group ofpatients over 60 years old was 59 people: among the patients of the initial admission, there were 72 (60%) people. The average age of the patients was 52.3 ± 1.2 years (40 to 70 years). The main diseases for which elderly and senile patients addressed in 83% were hypertension and various forms of coronary heart disease (42 people). Hy-
pertension, as the main disease in elderly patients of the study group, was 85 people or 61.1% of all cardiac patients.
All patients with cardiovascular disease underwent screening laboratory tests, including: a general urine test (with an emphasis on the presence of albuminuria), a general blood test, creatinine and blood urea, total blood protein, ECG, blood cholesterol. An ultrasound examination of the kidneys was performed for all patients with changes in the analysis of urine and / or GFR, with the detection of anemia.
The identification of constantly elevated blood pressure or episodes of its increase has led to a more in-depth examination. All patients with AH used a complex of modern instrumental methods of research: echocardiography, ultrasound duplex scanning, ultrasound dopplerography.
In order to exclude the secondary (renal) genesis of hypertension, an additional examination was performed: urine tests according to Nechiporenko, a sample according to Zimnyatsky, a biochemical blood test, ultrasound examination of the kidneys, dopplerography of the kidney vessels, and, if necessary, examination by narrow specialists - a neurologist, nephrologist, endocrinologist, and oculist.
Further, the study included patients with hypertension in whom, according to laboratory and instrumental methods of research, no primary organic diseases from the kidneys were detected. This group was 27 people.
Among the examined in this group, the average level of systolic pressure was 159.21 ± 6.68 mm RT. Art., diastolic pressure 90 ± 6.13 mm RT. Art.
An analysis of the data showed that of the total number of patients in the older age group with hypertension (67 patients), 21 patients (31.5%) had signs of chronic kidney disease.
At the same time, 65% (63 patients) of them had blood creatinine and blood urea indices within normal limits. In 9.5% (19 people), the level of creatinine was clinically significant and was in the range of200-380 ^mol / L. In the remaining 12 patients, creatinine
level was slightly increased to 130 ^mol / L. Urinary excretion of albumin above 20 mg /L was detected in 36 people, which amounted to 47.9%. Moreover, microalbuminuria has been observed in these patients for a long time. However, the examination to determine its causes and preventive treatment has not been previously conducted.
In addition, in 12 patients with elevated creati-nine levels, there was a varying degree of a decrease in red blood counts - hemoglobin and red blood cell counts.
Based on the data obtained, 21 patients with hypertension were diagnosed for the first time with chronic kidney disease, of which 11 patients with the development of chronic renal failure of varying severity.
Conclusions:
1. All patients with hypertension have a high risk of developing CKD. At least a third of patients with hypertension have chronic kidney disease. This circumstance should be taken into account when examining patients, for example, when performing coronary angiography.
2. It is necessary to screen patients with cardiac pathology, including hypertension, with the aim of early detection of CKD, timely initiation of nephro-protection, delaying the onset of chronic renal failure, and inhibiting the growth of patients requiring PST.
3. Blood creatinine level in patients with underlying extrarenal pathology is not always a reflection of the development of CKD.
4. When screening patients with cardiovascular disease, it is necessary to conduct a urine test for albuminuria and blood to detect anemia. The determination of MAU should be an obligatory part of the examination of patients with arterial hypertension with the aim of early detection of impaired renal function in hypertension and possible prevention of their progression.
5. When treating patients, it is necessary to focus not only on the recommendations of societies of ne-phrologists, but also cardiologists, in particular, this applies to the treatment of arterial hypertension and anemia, as well as other measures for nephro- and cardioprotection.
References:
1. Березин А. Е. Кардиоренальный синдром. Новости медицины и фармации. 2011; 359: 24-31.
2. Гарегинян H. А. Микроальбуминурия как ранний фактор риска развития кардиоренального синдрома. - Ереван. 2016.- 11 p.
3. Мухин Н. А., Моисеев В. С. Кардиоренальные соотношения и риск сердечно-сосудистых заболеваний. Вестник Российской академии медицинских наук. 2003; (1): 50-56.
4. Мухин Н. А., Балкаров И. М., Моисеев В. С. и др. Хронические прогрессирующие нефропатии и образ жизни современного человека. Тер арх. 2004; 76 (9): 5-10.
5. Резник Е. В. Хроническая болезнь почек у больных с хронической сердечной недостаточностью (Обзор литературы). Нефрология и диализ. 2010; 12(1): 13-24.
