The scientific data on the comorbid course of chronic kidney disease against the background of the pathology of the gastrointestinal tract were deepened. For the first time, the clinical and pathogenetic features of the course of chronic kidney disease of stages I-III against the background of malabsorption syndrome were studied. It was found that in the presence of kidney damage against the background of malabsorption syndrome, the proportion of patients with oxaluria increases. A violation of renal blood flow was revealed, which increases with the increasing stage of CKD, especially in the presence of oxaluria, and has a relationship with the severity of the malabsorption syndrome.
Added scientific data on the study of calcium-phosphorus homeostasis disorders, the content of calcium-regulating hormones (parathyroid hormone, calcitonin) and osteocalcin in the presence of chronic kidney disease. An imbalance of total and ionized calcium in patients with chronic kidney disease against the background of malabsorption syndrome and an increase in the level of the latter in patients with CKD-III stage was proven. with oxaluria against the background of malabsorption syndrome. Interrelationships between indicators of phosphorus-calcium metabolism and the degree of morphological manifestations of malabsorption syndrome in patients with kidney damage and the presence of malabsorption syndrome were revealed.
It has been clarified that in patients with chronic kidney disease and malabsorption syndrome, there is an imbalance in the processes of free radical oxidation of lipids, proteins and antioxidant protection. It has been proven that when both pathological processes are combined, this imbalance deepens and is most pronounced in patients with chronic kidney disease of the 3rd century. with oxaluria against the background of malabsorption syndrome.
Added scientific data on the study of β2-microglobulin content of blood and urine in patients with chronic kidney disease. An increase in its level in the blood was determined when chronic kidney disease was combined with malabsorption syndrome. Interrelationships between blood and urine β2-microglobulin indicators and GFR, proteinuria, and oxalaturia were revealed.
For the first time, it was found that the level of ionized calcium can be a marker of the progression of CKD in the presence of malabsorption syndrome, and the presence of oxaluria can increase the progression of CKD and worsen the course of the malabsorption syndrome.
For the first time, the effectiveness of medical correction with the differentiated use of vitamin A and preparations based on tribulus in the complex therapy of patients with kidney damage and the presence of malabsorption syndrome has been substantiated.
It has been clarified that the addition of vitamin A to the complex treatment of malabsorption syndrome in combination with CKD for 1 month improves the assimilation of vitamin D and does not require the addition of the latter to the complex therapy, and also improves the state of antioxidant protection, helps to reduce the level of β2-microglobulin in the blood.
It is clarified that the addition of tribulus preparations to the complex therapy of patients with CKD against the background of malabsorption syndrome improves the imbalance of the oxidant-antioxidant system, helps to reduce the level of β2-microglobulin in blood and urine, improves calcium-phosphorus homeostasis and, as a result, the balance of calcium-regulating hormones, improves the functional state kidney.
The practical significance of the obtained results, their implementation in practice. Based on the obtained data, new methods of diagnosis and prediction of the development and severe course of CKD with malabsorption syndrome were developed for the first time. Determination of oxalates in urine, total and ionized calcium, β2-microglobulin in blood and urine, as well as a Doppler examination of the kidneys to assess the progression of this combined pathology are recommended.
It is suggested that CKD patients with malabsorption syndrome should include vitamin A at 33,000 IU per day for 1 month and tribulus-based preparations (Tribex) at 1 tablet three times a day after meals for at least 2 months.
