Počki (Feb 2017)
Changes in Renal Vascular Endothelium and Indicators of Endothelial Vascular Dysfunction in Systemic Autoimmune Rheumatic Diseases
Abstract
Background. The renal endothelium is the primary barrier which reacts to systemic endothelial vascular dysfunction in patients with rheumatic diseases. The objective of the work was to evaluate the nature of morphological changes in the endothelium of renal capillaries and arterioles in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), hemorrhagic vasculitis (HV) and microscopic polyangiitis (MPA), the relationship with clinical and laboratory factors of the disease course and the impact of systemic vascular endothelial dysfunction. Materials and Methods. Retrospective analysis of nephrobiopsy results in comparison with laboratory findings of endothelial vascular dysfunction (EVD) was performed in 94 patients (41 subjects with SLE, 17 — RA, 24 — HV and 12 — MPA). Results. EVD takes place in 39 patients with SLE, 35 — RA, 52 HV and MPA, and in 100 % of those who develop nephropathy. It is closely associated with systemic clinical and instrumental manifestations of angiopathy, and proliferation of capillary endothelium and renal arterioles, depositions in it of immunoglobulins and complement components; depending on the clinical entities of systemic autoimmune rheumatic diseases it determines the blood levels of vascular endothelial growth factor (VEGF), endothelin 1 (ET1), homocysteine, E- and P-selectin. EVD in the form of an imbalance of VEGF, ET1, thromboxane A2 (TxA2) and prostacyclin (PgI2) vasodilators occurs in 35 % of RA patients with renal damage, 39 % have SLE, 52 % — HV and 100 % — MPA. Three-dimensional integrated histograms of vasoconstrictors (VEGF + ET1 + TxA2) in patients with renal failure are presented. Conclusions. EVD is probably participating in the pathogenesis of endothelial changes in capillaries, glomeruli and arterioles. Morphological endothelium damage of the renal vessels is closely related to the severity of the clinical and instrumental features of systemic extrarenal angiopathy (damage to the skin, mucous membranes and peripheral nervous system, parameters of biomicroscopy of the vessels of the conjunctiva and vasodilation of the brachial artery). Proliferation of the glomerular endothelium in patients with MPA determines the serum concentration of VEGF; ET1 and ESel are involved in the development of renal immune endothelial deposits (IgA, IgG, IgM, C3, C1q) in lupus glomerulonephritis.
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