Antoniv A. The features of the comorbid course and pathogenic mechanisms of mutual burden of non-alcoholic fatty liver disease and chronic kidney disease, justification of differentiated treatment.

The dissertation is devoted to the study of the features of the clinical course, morphological changes in the liver and kidneys, metabolic disorders and their adipokines regulation, the intensity of bacterial endotoxemia, nitro-oxidative stress, endothelial dysfunction, apoptosis intensity (cytokeratin-18), liver fibrosis and their regulation of hydrogen sulfide in non-alcoholic fatty liver disease (NAFLD) for comorbidity with obesity and chronic kidney disease (CKD), and a new solution to the scientific practical problem – improvement of treatment efficacy and prevention of progression of non-alcoholic steatosis of the liver and steatohepatitis on the background of obesity and chronic kidney disease, which consists in the substantiation of a new direction of differentiated treatment depending on the form of non-alcoholic fatty liver disease, the degree of activity, the degree of liver steatosis, the stage of liver fibrosis, the degree of endothelium dysfunction, colon dysbiosis, endotoxemia, hydrogen sulfide deficiency, the stage of comorbid chronic kidney disease and kidney functional reserve. Multifactorial study of the role of changes in the system of connective tissue, metabolic processes and adipokinic components and their regulation, endotoxicosis, apoptosis and liver fibrosis processes, endothelial dysfunction in the mechanisms of development and progression of nonalcoholic liver steatosis and steatohepatitis, which deepens in proportion to the growth of the chronic kidney disease stage, was conducted for the first time. Priority is given to the results of studies of the intensity of apoptosis in hepatocytes with an increase in the content of cytokractin-18 in blood and its relationship with the content of homocysteine, bacterial endotoxin, and hydrogen sulfide, which correlates with the intensity of fibrosing reactions in the liver.The efficacy of complex therapy with S-adenosylmethionine, heparisin, meldonium in combination with probiotic yogurt with the probable stable stabilization of carbohydrate, lipid metabolism, decrease in the degree of liver steatosis and elimination of endotoxicosis syndrome.