Early diagnosis of renaldamage in hypertensive patients


Aim. To determine early criteria of renal affection in hypertensive patients for improvement of diagnosis and treatment of hypertensive nephropathy.
Material and methods. 148 patients with essential hypertension (EH) were examined (82 males, 66
females, mean age 43.64 ± 11.35 years). Of them, 46 patients (24 young males among them) had EH
of new onset (NOH) and 102 patients had EH of long duration (LDEH). The examination included
investigation of lipid, carbohydrate, uric acid metabolism, renal function, microalbuminuria, intrarenal hemodynamics (color dopplerography on ALOKA SSD-2000 MultiView.
Results. 50% of NOH and 90% of LDEH patients had metabolic disorders: excessive body weight,
hypercholesterolemia, hypertriglyceridemia, uric acid disbolism, impaired glucose tolerance. These disorders, except uric acid metabolism, correlated in severity with duration and severity of EH. Intensity
of microalbuminuria depends on EH duration, severity of concomitant metabolic defects. Markers of
early renal damage in EH patients are increased intrarenal peripheral vascular resistance and microalbuminuria. These alterations are detectable in 30% NOH patients (at the disease onset). Treatment
with ACE inhibitors eliminates microalbuminuria, diminished hype/filtration and improved intrarenal
circulation. This justifies use of ACE inhibitors for nephroprotection in EH patients.
Conclusion. Monitoring of the above early markers of renal damage and metabolic shifts is essential
for assessing progression of hypertensive nephropathy and control over efficacy of antihypertensive
treatment including ACE inhibitors.


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