COPD and Kidneys: Two Sides of the One Problem

Abstract

The problems of diagnosis, treatment, prevention of chronic obstructive pulmonary disease remain relevant due to the increase in morbidity, disability and mortality of patients. Recently, the level of renal dysfunction in the progression of chronic obstructive pulmonary disease has increased. The purpose of research was to study the indicators of renal dysfunction in chronic obstructive pulmonary disease, depending on the severity and frequency of chronic obstructive pulmonary disease exacerbations, comorbidity, respiratory function, morphological and functional state of the myocardium to optimize the diagnosis and prognosis of chronic obstructive pulmonary disease. Material and methods. The article presents the results of examination of 81 patients in different groups of chronic obstructive pulmonary disease (BCD) with comorbidity (arterial hypertension in 49 patients, diabetes mellitus type 2 – in 16, postinfarction cardiosclerosis – in 6, diffuse cardiosclerosis – in 53, angina pectoris – in 5 patients). The external respiration function was made by using a computer spirograph. The morphological and functional state of the myocardium was studied by the standard ultrasound examination. Glomerular filtration rate was estimated by using the Cockcroft-Gault formula. The A/C ratio, microalbuminuria in the morning urine portion, and the level of C-reactive protein were also studied. The results of the studies were analyzed by methods of nonparametric statistics with an assessment of differences between groups of patients using the Mann-Whitney U-test; to assess the parameters of the relationship between indicators, the method of pair rank correlation by Spearman was used. Results and discussion. Signs of renal dysfunction, hypoxia (SpO2), systemic inflammation of low intensity C-reactive protein were found only in group D of patients with chronic obstructive pulmonary disease. In the same group, the greatest number of correlations of indicators of renal dysfunction and SpO2 with various indicators of the morphofunctional state of the myocardium according to echocardiography, the frequency of exacerbations, and comorbidity with hypertension, diffuse and postinfarction cardiosclerosis was revealed. In group B and C, no correlations of indicators of renal dysfunction with other indicators were found. In the group of patients with GFR less than 90 ml/min/1.73m2, there were correlations of the A/C ratio with the frequency of exacerbations, C-reactive protein, correlations between microalbuminuria and dyspnea, daily proteinuria, and SPPA. Conclusion. In the future, it is necessary to continue the search for early specific available biomarkers of renal dysfunction that can be used for early prescription of pleiotropic therapy, and timely initiation of nephroprotection from the standpoint of network medicine