Abstract
Background and Aims
The definition of subclinical renal damage markers in patients with metabolic syndrome (MS) and evaluation the relations between the indicators of subclinical renal injury and endothelial dysfunction.
Method
The study included 62 patients with MS, 32 (51.6%) men and 30 (48.4%) women aged 51.2±5.4 years. The control group included 25 practically healthy individuals, 13 (52.0%) men and 12 (48.0%) women, aged 47.3±6.1 years. All patients were underwent clinical and laboratory examination, calculation of glomerular filtration rate (GFR) using the formula CKD-EPI, ultrasound of the carotid arteries, determination of the insulin resistance index (IR) (HOMA-IR), as well as determination of the content of endothelin-1 (ET-1) in serum and albumin excretion in a single portion of urine by IFA.
Results
When calculating GFR, hyperfiltration was detected in 10 (16.1%), optimal filtration - in 23 (37.1%), slightly reduced - in 29 (46.8%). At the same time, in patients with MS, a statistically significant excess of urinary albumin excretion (UAE) in a single dose was revealed compared with the control group (26.6±5.8 mcg/ml and 9.2±3.4 mcg/ml, respectively; p <0.001).
Based on the increase in level (ET-1) in patients of the main group, compared with the control (6.3±3.2 fmol/ml and 3.4±1.0 fmol/ml, respectively; p=0.03) may indicate the development in patients of the main group of endothelial dysfunction. A correlation analysis revealed a direct correlation between the level of UAE and ET-1 (R = 0.45; p = 0.005).
A direct correlation was found between UAE and IR-HOMA (R = 0.68; p <0.007), interventricular septum thickness (R = 0.71; p <0.001), and intima–media thickness (IMT) (R = 0.49; p <0.008) and systolic blood pressure (R = 0.47; p = 0.026). Similar associations were noted also for the ET-1 level: IR-HOMA2 (R = 0.78; p <0.001), with the thickness of the interventricular septum (R = 0.76; p = 0.001), IMT (R = 0.46; p <0.033) and systolic blood pressure (R = 0.45; p = 0.035).
Conclusion
In patients with metabolic syndrome, in addition to the well-known manifestations, in the early stages, may be a violation of renal function and endothelium, manifested by the change of glomerular filtration rate, increased levels of UAE and increased concentration of ET-1 in the blood. Direct correlation of the level of UAE and ET-1 level, and the coincidence of the correlation relationships of these indicators with a number of clinical and laboratory indicators of the metabolic syndrome will make it possible to consider an increasing of the level of UAE as one of the markers of endothelial dysfunction.
Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy