THE COURSE OF CHRONIC KIDNEY DISEASE (CHRONIC PYELONEPHRITIS) IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND OBESITY

Aliona A. Antoniv; Zoriana Ya. Kotsyubiychuk; Volodymyr V. Vivsyanyk; Vitaliy S. Smandych; Lyudmyla V. Kanyovska; Olga Ye. Mandryk; Oksana D. Liakhovych

doi:10.21272/eumj.2021;9(3):228-237

Aliona A. Antoniv Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Zoriana Ya. Kotsyubiychuk Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Volodymyr V. Vivsyanyk Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Vitaliy S. Smandych Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Lyudmyla V. Kanyovska Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Olga Ye. Mandryk Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine
Oksana D. Liakhovych Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

DOI: https://doi.org/10.21272/eumj.2021;9(3):228-237

Keywords: chronic kidney disease, chronic pyelonephritis, non-alcoholic liver steatosis, non-alcoholic steatohepatitis

Abstract

The aim of the research: to investigate the features of the comorbid course of chronic kidney disease (CKD) (chronic pyelonephritis), non-alcoholic fatty liver disease and obesity, depending on the stage of CKD.

Material and methods of research. To achieve this goal, 250 patients with chronic kidney disease (CKD) (chronic bilateral pyelonephritis) stage I–III were examined, of which 160 patients had concomitant NASH and class 1 obesity (1 group) and 90 people had CKD stage I–III without NASH and obesity (group 2). Depending on the stage of CKD, patients of group 1 were divided into 3 subgroups: with CKD stage I – 63 patients, with CKD stage II – 52 patients, with CKD stage III – 45 patients. Patients of group 2 were also divided into 3 subgroups: with CKD stage I – 32 patients, with CKD stage II – 31 patients, with CKD stage III – 27 patients.

The control group included 30 apparently healthy individuals (AHIs). The average age of patients was 49.8 ± 5.8 years. The study did not include patients with CKD stage I–III with nephrotic syndrome and patients with chronic uncomplicated pyelonephritis in the phase of exacerbation.

Research results. According to the results of our study, we noted a probable effect of nonalcoholic steatosis and steatohepatitis on the functional state of the kidneys in patients with stage I–III CKD: significant changes in glomerular filtration rate, nitrogen excretory function, increased hypoalbuminemia, increased protein in the urine, erythrocytes, leukocytes, the presence of bacteria, compared with patients with CKD without comorbidity. There was a significant correlation between a decrease in glomerular filtration rate (GFR), an increase in the intensity of oxidative stress, a decrease in blood glutathione, hydrogen sulfide, hyperproduction of homocysteine, cytokeratin-18, connective tissue components (collagen, sialic acids).

Conclusion. In patients with CKD stage I–II without comorbid NASH and obesity, we found a significantly higher renal functional reserve in response to water-electrolyte stimulation, which is sufficient in both groups of patients (increase in GFR by 28–37% vs. 19–31% for comorbidity with NASH). In patients with CKD stage III with nonalcoholic steatohepatitis we found a significantly reduced functional reserve of the kidneys (increase in GFR by 8.9% vs. 17.5% in patients without NASH), and in 4.9% of patients with comorbidity – no functional reserve of the kidneys (p > 0.05), indicating irreversible changes in the functional state of the kidneys.

Author Biographies

Aliona A. Antoniv, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

док. мед. наук, професор кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Zoriana Ya. Kotsyubiychuk, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

асистент кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Volodymyr V. Vivsyanyk, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

к-т мед. наук, асистент кафедри внутрішньої медицини та інфекційних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Vitaliy S. Smandych, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

к-т мед. наук, асистент кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Lyudmyla V. Kanyovska, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

к-т мед. наук, доцент кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Olga Ye. Mandryk, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

к-т мед. наук, асистент кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

Oksana D. Liakhovych, Department of Internal Medicine, Clinical Pharmacology, and Occupational Diseases, Bukovinian State Medical University, Chernivtsi, Ukraine

к-т мед. наук, асистент кафедри внутрішньої медицини, клінічної фармакології та професійних хвороб, Буковинський державний медичний університет, Театральна пл., 2, м. Чернівці, Україна, 58002

References

1. Ammirati AL. Chronic Kidney Disease. Rev Assoc Med Bras (1992). 2020 Jan 13;66 Suppl 1(Suppl 1):03-s09. doi: 10.1590/1806-9282.66
2. Girndt M. Diagnosis and treatment of chronic kidney disease. Internist (Berl). 2017 Mar;58(3):243-256. doi: 10.1007/s00108-017-0195-2
3. Musso G, Cassader M, Cohney S, De Michieli F, Pinach S, Saba F, Gambino R. Fatty Liver and Chronic Kidney Disease: Novel mechanistic insights and therapeutic opportunities. Diabetes Care. 2016 Oct;39(10):1830-45. doi: 10.2337/dc15-1182
4. Sun DQ, Jin Y, Wang TY, Zheng KI, et al. MAFLD and risk of CKD. Metabolism. 2021 Feb;115:154433. doi: 10.1016/j.metabol.2020.154433
5. Kiapidou SL, Liava SM, Kalogirou MN. Chronic kidney disease in patients with non-alcoholic fatty liver disease: What the Hepatologist should know? Ann Hepatol. 2020;19(2):134-144. doi: 10.1016/j.aohep.2019.07.013
6. Mikolasevic IS, Racki SV, Bubic ID, et al. Chronic kidney disease and nonalcoholic fatty liver disease proven by transient elastography. Kidney Blood Press Res. 2013;37(4-5):305-10. doi: 10.1159/000350158
7. Chinnadurai R, Ritchie J, Green D, Kalra PA. Non-alcoholic fatty liver disease and clinical outcomes in chronic kidney disease. Nephrol Dial Transplant. 2019 Mar 1;34(3):449-457. doi: 10.1093/ndt/gfx381.
8. Kovesdy CP, Furth SL, Zoccali CN. Obesity and kidney disease: hidden consequences of the epidemic. Future Sci OA. 2017;3(3):FSO159. doi: 10.4155/fsoa-2016-0081
9. Jang HR, Kang D, Sinn DH, et al. Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease: a cohort study. Sci Rep. 2018;8(1):4718. doi: 10.1038/s41598-018-23014-0
10. Khukhlina OS, Antoniv AA, Kanovska LV, et al. The intensity of the antioxidant protection system and oxidative stress factors in patients with non-alcoholic steatohepatitis depending on the form of chronic kidney disease. Georgian Medical News. 2018; 3(276):71-76
11. Lee SJ, Lee HJ, Oh HJ, et al. Metabolic syndrome status over 2 years predicts incident chronic kidney disease in mid-life adults: a 10-year prospective cohort study. Sci Rep. 2018 Aug 16;8(1):12237. doi:10.1038/s41598-018-29958-7