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Modificările hemodinamice la pacienţii cu pielonefrită cronică în diferite stadii de insuficienţă renală cronică


Author: Petru Cepoida
Degree:doctor of medicine
Speciality: 14.00.05 - Internal Diseases (with specification: Pulmonology, Gastroenterology, Hepatology, Nephrology, Functional Diagnostics and Endoscopy)
Year:2007
Scientific adviser: Constantin Babiuc
doctor, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific consultant: Aurel Grosu
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Institution:
Scientific council:

Status

The thesis was presented on the 31 October, 2007
Approved by NCAA on the 20 December, 2007

Abstract

Adobe PDF document0.46 Mb / in romanian

Thesis

CZU 616.61-002.3-036.12+616.61-008.64

Adobe PDF document 1.38 Mb / in romanian
130 pages


Keywords

chronic kidney failure; chronic infectious tubulo-interstitial nephritis; superior urinary infection; hemodynamic modifications; cardiovascular system; arterial hypertension; congestive heart failure; risk factors; calcitonine; parathormone; renine; angiotensine; aldosterone; echocardiography; ultrasonography; renal dopplerography

Summary

This study comprises 132 patients with chronic pyelonephritis in different stages of chronic kidney disease: 1st – 26 (19,7%), 2nd – 38 (28,8%), 3rd – 41 (31,1%) , 4th – 12 (9,1%), 5th – 15 (11,3%). These patients were subjects of the routine clinical and nephrological examinations, as well as of transthoracic echocardiography, doppler examination of renal arteries, ophthalmological investigation, lower limbs reovasography, both renin-angiotensine-aldosterone and phosphorecalcium metabolism system testing.

Correlation, multiple regression and multifactorial analysis have demonstrated that functional changes precede organic ones and progress simultaneously in all cardiovasular system compartments depending on the chronic kidney disease stage, the last being an independent pathogenetic factor. Haemodynamics showed an increase in circulating blood volume, heart work and power against the background of increased vascular resistance, except hypertensive subjects, and lower heart work efficiency. The major echocardiographic lesions comprise left ventricle hypertrophy, its diastolic dysfunction associated with left atrium dilation, pulmonary hypertension and right heart enlargement, aortic, mitral, tricuspid valve fibrosis abd polyvalvular regurgitation aggravation. Ophthalmological pathology secondary to chronic kidney disease were similar ones caused by arterial hypertension except vascular complications. Lower limbs reovasography and renal arteries dopplerography demonstrated a decrease in regional blood flow. Starting from the 3rd grade chronic kidney disease these modifications suffer a qualitative shift manifested in their significant aggravation that points out the necessity of the preventive treatment institution.

Hormonal study one more time confirmed the role of the renin-angiotensine-aldosterone system in left ventricle hypertrophy as well as microvascular complications development. PTH demonstrated the role of an important heart “toxin”, correlating with the majority of studied indices of central, peripheral and microcirulatory haemodynamics. Left ventricle diastolic dysfunction correlated with renin, aldosterone and PTH level, while being responsible together with polyvalvular dysfunction and increased circulatory volume for right heart modifications.

Moreover, a special score of retinian damage was introduced in medical practice. It helps in objective evaluation of retinopathy, while well correlating with Keith-Wagener-Barker classification grade. For the first time a number of ultrasonographic indices gave us the possblity to determine direct correlation between kidney morphometry and both functional and organic modifications in cardiovascular system caused by chronic kidney disease.