FEATURES OF LIPID BLOOD SPECTRUM IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASES IN CHILDREN
About the author:
Frolova T. V., Kononenko O. V., Atamanova O. V., Stryukova I. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Among the non-immune factors of nephropathy progression, special attention is paid to the violation of lipid metabolism and endothelial dysfunction. Experimental and clinical data prove lipid effects on the structure and function of the kidneys, and lipids are considered as one of the factors of chronic kidney disease (CKD) progression. Endothelial dysfunction occurs under the influence of various factors, which include hypercholesterolemia. Endothelium also produces NO. Reduction of NO production is associated with the pathogenesis of renal tissue decrease as a result of kidney damage. Purpose of the research: the study of features of lipid blood violations spectrum, changes in levels of nitric oxide metabolites and the interrelation of these indicators at different stages of CKD in children. Object and methods of the research. 77 children aged 3 to 18 years with different degrees of CKD and 38 healthy children of the same age who formed the control group have been examined. Patients, depending on the degree of renal dysfunction, were divided into three groups. The 1st group included 54 children with CKD of the 1st grade without impaired renal function. The 2nd group included 11 children with CKD of the 2nd grade with a slight degree of renal dysfunction. The 3d group included 12 children with CKD of the III-V grades with moderate to severe renal impairment. The own data of the control group with healthy children were used as a normative standard. Research results and their discussion. In children of the 1st group a significant (P <0.001) increase in the level of total blood serum phospholipids (PL) up to 33.5 ± 4.13 μmol / L as compared with the norm (4.84 ± 0.39 μmol / L) has been detected. In children of the 2nd group, there was also a significant (P <0.001) increase in the level of total blood serum phospholipids (PL) up to 38.4 ± 12.3 μmol /l, as well as in the 3rd group of children – a significant (P <0.001) increase in the in the level of total blood serum phospholipids (PL) up to 62.5 ± 14.55 μmol / l. With the progression of CKD further accumulation of total PL in the body has been detected. In children both of 1st and 2nd groups the levels of cholesterol, low density lipoprotein (LDL), triglycerides in blood serum were in the normal range. The children of the 3d group had cholesterol levels (4.92 ± 0.34 mmol / l), LDL (65.89±8.83 mmol) above normal range, which may indicate violation in the lipid blood spectrum, possible rise of atherosclerotic processes and progression kidney damage. Increase of the PL level in the blood of children with different degrees of CKD, a significant increase of this indicator in children with severe level of renal impairment indicates a violation of PL metabolism and is secondary and may indicate damage to cell membranes of nephrothelium. The level of NO (NO2 and NO3 metabolites) in the blood is reduced in the patients of all groups. A significant decrease in these rates occurs in patients of 3d group, indicating the presence and progression of endothelial dysfunction with severe renal impairment, and leads to the development of atherosclerotic processes. The conducted correlation analysis has revealed a negative correlation between nitrogen oxide metabolites and lipid spectrum indicators in children of all groups, which may prove a possible connection of endothelial dysfunction and lipid metabolism disorders that affects the progression of atherosclerotic changes in children with CKD. Conclusions. In children with initial manifestations of kidney diseases and their normal excretory function, the plasma level of general PL is significantly increased; therefore their concentration is taken into account in various atherogenic diseases. An even more significant increase in the concentration of total PL, elevated level of cholesterol and LDL in blood serum in children with moderate to severe renal impairment may indicate the presence of membrane-destructive processes in kidneys and onset of vascular arteriosclerosis in these children, as the emphasis in the development of atherosclerosis is placed at present not so much to hypercholesterolemia, as to the violation of the lipoproteins exchange.
lipid metabolism, cholesterol, Nitric oxide, chronic kidney diseases, children
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 2 (143), 2018 year, 211-215 pages, index UDK 616.31-036.12-053.4/.6-07:616.15-078:577.115.088.6