The Study of Kidney Function in Patients with a Comorbid Course of Reactive Arthritis And Chronic Kidney Disease

Zaliavska O. V., Gorbatyuk I. B., Voyevidka D. C.

CONTENTS

Scentific article

Aim: To study the renal function in patients with a comorbid course of reactive arthritis and chronic kidney disease (CKD): pyelonephritis (CP) the exacerbation phase. Materials and methods: It was examined 53 patients. They were divided into two groups: the 1st group with diagnosed reactive arthritis (ReA) and comorbidity of chronic pyelonephritis (n=32) and 2rd group with diagnosed CKD: pyelonephritis, urinary syndrome (n=20). Study included patients with average disease duration for 4,0 ± 0,94 years. The control group was formed of 20 healthy persons (HP). Kidneys function study was performed by the depletion method in terms of spontaneous 12-hour diuresis (Shyuk O., 1981). The concentration of potassium and sodium in urine was determined by flame photometry on “FPL-1” creatinine in plasma and urine – the reaction of picric acid on photocalorimetr “CFC-2” and the spectophotometer “SF-46”. Glomerular filtration rate (GFR) was calculated by using a formula of Cockroft-Gault (Cockroft, Gault, 1976). The concentration of nitrites in urine (me- tabolites of nitric oxide) were studied using a reducing redactor («Nitrate redactor»), which contains cadmium and copper, and measurements were performed on a spectrophotometer (“SF-46”, Russia) at λ=540 nm. To assess the levels of fibronectin and β2-microglobulin in urine – reader «PR2100-Sanofi» (France). Results: The study of complete blood count was established significantly higher levels of ESR in patients of the 1-st group in comparison with indexes in the 2-nd group (p <0. 05). The study has described the results of protein level reduction in urine: in the 1-st group 0,23±0,023 g/day, and in the 2-nd group 0,28±0,08 g/day. In patients of the 1-st group was identified leucocyturia in 100% (it was small in 78,1% (n=25) of patient) and hematuria – in 15,6% (n=5) of patients. In the 1-st group was detected increased fibronectin and nitrite in the urine in comparison with indexes in the group of patients with chronic pyelonephritis (p<0. 05) and a maximal increase β2-microglobulin in the urine. Was established increased diuresis for 45. 4% (p<0. 05) and GFR at 45,7% (p<0. 05), the concentration of po- tassium in the urine decreased for 46. 5% and simultaneously tubular reabsorption reduced (p<0. 05) in patients of the 1-st group in comparison with indexes in the control group. Conclusions. In patients with a comorbid course of reactive arthritis and chronic pyelonephritis was established increased diuresis, reduction in the concentration of potassium and sodium in the urine, clearance and the excre- tion of fraction sodium increased, decreased GFR and tubular reabsorption in comparison with indexes in the con- trol group (p<0. 05). In patients with a comorbid course of reactive arthritis and chronic pyelonephritis was established kidney dam- age as tubular and glomerular-vascular apparatus which was manifested by increased fibronectin and nitrite in the urine (р<0,05), decrease the creatinine level in urine (р<0,05) and GFR (р<0,05) in comparison with indexes in the group of patients with chronic pyelonephritis. Future research prospects: to construct practical recommendations in diagnosis of reactive arthritis aimed at prevention of pathogen persistence and stimulation of systemic immune response, to study the effectiveness of antibiotic therapy.

reactive arthritis, renal function, chronic kidney disease, chronic pyelonephritis, glomerular filtra- tion rate.

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