Хроническая болезнь почек у больных ревматоидным артритом: частота, факторы риска, варианты поражения почек

Чеботарева Н.В., Гуляев С.В., Андросова Т.В., Милованова Л.Ю. Хроническая болезнь почек у больных ревматоидным артритом: частота, факторы риска, варианты поражения почек. Терапевтический архив. 2019; 91 (5): 129–133. DOI: 10.26442/00403660.2019.05.000255

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Chebotareva N.V., Guliaev S.V., Androsova T.V., Milivanova L.U. Сhronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants. Therapeutic Archive. 2019; 91 (5): 129–133. DOI: 10.26442/00403660.2019.05.000255

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Аннотация

Настоящий обзор посвящен характеристике факторов риска поражения почек у больных ревматоидным артритом (РА). Согласно данным исследований последних лет, хроническая болезнь почек (ХБП) у пациентов с РА отмечается достоверно чаще, чем у пациентов без РА, и тесно связана с риском сердечно-сосудистых осложнений и высокой летальностью. Помимо влияния общепопуляционных факторов риска ХБП, независимым предиктором снижения скорости клубочковой фильтрации <60 мл/мин/1,73 м2 у больных РА является активность самого заболевания. Также рассмотрены возможные морфологические варианты и механизмы поражения почек. Внедрение фармакотерапии базисными противовоспалительными и инновационными генно-инженерными и таргетными препаратами в последние годы изменило течение и исходы РА, включая частоту и структуру почечных проявлений.

Ключевые слова: ревматоидный артрит, амилоидоз, хронический гломерулонефрит, хроническая болезнь почек, базисная терапия.

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The present review is focused on risk factors of chronic kidney disease in rheumatoid arthritis (RA). According to recent data, the chronic kidney disease (CKD) in RA patients is more often than at patients without RA. It is closely associated with risk of cardiovascular disease and high mortality. Besides of general population risk factors of CKD, the activity of the disease is independent predictors of reduction in glomerular filtration rate less than 60 ml/min/1.73 m2. In the review, histopathological variants and mechanisms of CKD on basis of international experience are also considered. Suppression of inflammation by basic therapy of RA and biological therapy have changed outcomes RA, prevalence, and structure of kidney involvement in recent years.

Keywords: rheumatoid arthritis, amyloidosis, chronic glomerulonephritis, chronic kidney disease, basic therapy.

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24. Boers M, Croonen AM, Dijkmans BA, et al. Renal findings in rheumatoid arthritis: clinical aspects of 132 necropsies. Ann Rheum Dis. 1987;46:658-63.
25. Shankar A, Sun L, Klein BE, Lee KE, Muntner P, Nieto FJ, et al. Markers of inflammation predict the long-term risk of developing chronic kidney disease: a population-based cohort study. Kidney Int. 2011;80(11):1231-8. doi: 10.1038/ki. 2011.283
26. Kiseleva AG, Orlova GM, Berdnikova IA, Ferreferova NM. Chronic kidney disease in patients with rheumatoid arthritis. Siberian Medical Journal. 2007;7:90-2 (In Russ.).
27. Nakahara C, Kanemoto K, Saito N, Oyake Y, Kamoda T, Nagata M, et al. C-reactive protein frequently localizes in the kidney in glomerular diseases. Clin Nephrol. 2001;55(5):365-70.
28. Schwedler SB, Guderian F, Dämmrich J, Potempa LA, Wanner C. Tubular staining of modified C-reactive protein in diabetic chronic kidney disease. Nephrol Dial Transplant. 2003;18(11):2300-7.
29. Li Z, Chung ACK, Zhou L, Huang XR, Liu F, Fu P, et al. C-reactive protein promotes acute renal inflammation and fibrosis in unilateral ureteral obstructive nephropathy in mice. Laboratory Investigation [Article]. 2011;91(6):837-51. doi: 10.1038/labinvest.2011.42
30. Galarraga B, Khan F, Kumar P, Pullar T, Belch JJ. C-reactive protein: the underlying cause of microvascular dysfunction in rheumatoid arthritis. Rheumatology (Oxford). 2008;47(12):1780-4.
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Авторы

Н.В. Чеботарева, С.В. Гуляев, Т.В. Андросова, Л.Ю. Милованова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), кафедра внутренних, профессиональных болезней и ревматологии медико-профилактического факультета, Москва, Россия

________________________________________________

N.V. Chebotareva, S.V. Guliaev, T.V. Androsova, L.U. Milivanova

I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Department of Internal, Occupational diseases and Rheumatology, Moscow, Russia

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