Patologìâ (Dec 2015)
The state of the hemomicrocirculation system and predictive capacity of parameters characterizing it in patients with hypertensive nephropathy
Abstract
Today the diagnostics of microcirculatory disorders in patients with hypertensive nephropathy (HN) is an extremely important issue. Aim. To evaluate the functional state of hemomicrocirculatory (HMC) system and to analyze predictive capacity of parameters characterizing it in patients with essential hypertension (EH) of II stage accompanied with manifestations of nephropathy. Methods and results. 155 patients were examined including two main groups of patients with stage II EH of second (n=31) and third (n=31) degree of arterial hypertension (AH) with early signs of nephropathy as well as three comparison groups including patients with essential hypertension stage II of the second (n=31) and third (n=31) degree of hypertension with preserved renal function, and practically healthy individuals (n=31). Albumin/creatinine ratio in urine greater that 30 mg/g was taken as the marker of kidney disorder. The function of HMC system was evaluated by means of laser Doppler flowmetry. It was found that it is typical for patients with HN to show the reduction in tissue perfusion, variability of peripheral blood flow, apparent dysfunctional disorders of the microvascular endothelium, significant neurogenic and myogenic tonus increase. The significant loss of elastic properties of microvessels and pronounced signs of stagnation of blood in the postcapillary segment of microvasculature were also noted. Patients with HN accompanied with the sharp reduction of normocirculatory microcirculation hemodynamic type (HTM) showed increase in the cases of spastic and stagnant-stasis HTM. Conclusions. Among the analyzed parameters which characterize HMC system, A max E and A max C appeared to be the most qualitative predictors of the HN in hypertensive patients and had a joint predictive potential.
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