Kulynych R. Hypertensive nephropathy: pathogenic role of endothelial dysfunction, mechanisms of formation, differential treatment

The dissertation is devoted to the study of main mechanisms of renal function abnormalities in the patients with essential hypertension (EH), evaluation of endothelial dysfunction role in hypertensive nephropathy development and estimation of renal protection properties of antihypertensive therapy. Study results show, that renal function violation is associated and significantly related to endothelial dysfunction markers (sICAM-1 and endothelin-1) by one-way ANOVA. Factor analysis demonstrated significant role of endothelial dysfunction, arterial hypertension, impairment of intrarenal hemodynamic, age and disease duration, presence of target organ damage and association with high cardiovascular risk as basic pathogenetic mechanisms in hypertensive nephropathy development at EH. Shows that ?2microglobulinuria and reduced renal reserve are early signs of subclinical renal dysfunction. Study results demonstrated, that despite comparable antihypertensive effect of treatment, treatment groups differed in their renoprotective properties. The maximum significant reduction of microproteins excretion, as well as normalization of intrarenal hemodynamics, were registered in the "ACEI+ARA+Indapamide" group. It was proved that vascular endothelial dysfunction and intraglomerular hypertension are main "targets" of nephroprotection strategy at EH.