EARLYDIAGNOSIS OFINTRARENAL BLOOD FLOW DISORDERSIN PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION

Abstract

Summary. Among the causes of end-stage renal failure essential arterial (EAH) hypertension has a leading place. One of thepathogenic mechanisms of hypertensive nephropathy is a violation of intrarenal blood flow. The purpose of this study was to conduct an early diagnosis of intrarenal blood flow disorders using Doppler examination and comparison of these data with the standard criteria of nephropathy in EAH.

Materials and methods. 80patients with stage II EAH were examined.

Results. In patients with grade II and III EAH noted depletion of intrarenal blood flow, characterized by low Vmax and Vmin, while there was an increase IR characterizing renal vascular resistance. Hyper phase in hypertensive nephropathy was characterized by a relative increase in hemodynamic indices at the level of the trunk of the renal artery and segmental artery with a reduction in the small arteries to the level in healthy people. Hypofiltration phase was characterized by a significant reduction of velocity indexes that accompanied by a decreasing of vascular resistance (theirpseudonormalization). In assessing renal hemodynamics in patients with EAH and microalbuminuria showed a decreasening of Vmin and increasening of IR. A inverse correlation between the level of night BP decreasing and IR segmental artery (r = - 0,61, p<0,05).

Conclusions: 1. In patients with essential hypertension grade IIand IIImarked depletion of intrarenal blood flow characterized by a decrease in peak systolic and minimum diastolic velocity. At the same time there is increasing resistance indices characterizing renal vascular resistance. 2. Early stage of fypertensive nephropathy criteria before the development of microalbuminuria, hyperfiltration can be the increase in the indices at the level of resistance of main and segmental arteries according to Doppler examination of renal vessels. 3. In patients with essential hypertension and microalbuminuria there is a decrease in diastolic velocity and resistive index increase, indicating an increase in intrarenal vascular resistance and may also be a diagnostic criterion of nephropathy. 4. The inverse correlation between the level of nighttime decrease in blood pressure and segmental artery resistance index indicate the negative impact of the lack of night reduction in blood pressure to renal function in hypertension.