ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 26 of 60
УЖМБС 2019, 4(6): 186–193
Clinical Medicine

Renal Function in Non-Alcoholic Liver Disease and in its Combority with Arterial Hypertension

Prosolenko K. O.

Today, it is recognized that non-alcoholic fatty liver disease is a polymorbid disease. In particular, close relationships between non-alcoholic fatty liver disease and heart and kidney damage have been demonstrated. The purpose of the work was to study the status of renal function in patients with non-alcoholic fatty liver disease and its comorbidity with hypertension or renoparechymal arterial hypertension, with determination of the most important factors that may influence the progression of these diseases. Material and methods. The study object was 329 patients, including non-alcoholic fatty liver disease in 60 patients, co-morbidity non-alcoholic fatty liver disease and essential hypertension in 121 patients, co-morbidity non-alcoholic fatty liver disease and renoparechymal arterial hypertension in 88 patients, 30 patients with renoparenchymal arterial hypertension, 30 patients with essential arterial hypertension. The control group consisted of 20 healthy individuals. Clinical examination of patients included evaluation of objective examination parameters, including anthropometric data and blood pressure by standard methods. We also conducted ultrasound examination of the liver and blood vessels. Blood biochemical parameters were determined by standard conventional methods. In the course of study we determined: gamma-glutamyltranspeptidase, insulin levels with determination of HOMA index, creatinine, total cholesterol, adiponectin levels, malondialdehyde, tumor necrosis factor-α. Fibromax test was performed in some patients. Results and discussion. A significant increase in blood creatinine and a decrease in glomerular filtration rate were observed in all three groups of patients with non-alcoholic fatty liver disease relative to the control group (p <0.001). When comparing the renal impairment between groups of patients with essential hypertension with and without comorbidity with non-alcoholic fatty liver disease, we found out that there was no significant difference in microalbuminuria and glomerular filtration rate. But blood creatinine was higher in the comorbidity group. The situation was similar when comparing groups of patients with renoparenchymal arterial hypertension with and without comorbidity with non-alcoholic fatty liver disease. We detected the presence of different strengths of correlation in all three groups between the speed of glomerular filtration and duration of non-alcoholic fatty liver disease, body mass index, endothelium-dependent vasodilation, tumor necrosis factor-alpha, malondialdehyde, FibroTest. We found a significant difference between the groups in terms of blood pressure, gamma-glutamyltranspeptidase, total cholesterol, HOMA index and adiponectin. ANOVA analysis proved the significant influence of factor “liver steatosis” and factor “arterial hypertension”on renal function. Conclusion. Renal function is impaired in patients with non-alcoholic fatty liver disease. Comorbidity with essential hypertension or renoparenchymal arterial hypertension makes these disorders more significant, which can have an important aggravating role in the pathogenesis of this comorbidity. Blood creatinine levels and glomerular filtration rates are correlated with the duration of non-alcoholic fatty liver disease and hypertension, obesity, oxidative stress and inflammation, markers of hepatic impairment, blood pressure, dyslipidemia. The range of these correlations varies depending on the presence and type of comorbidity that can significantly affect the pathogenesis of these conditions.

Keywords: renal dysfunction, non-alcoholic fatty liver disease, hypertension

Full text: PDF (Ukr) 246K

  1. Stepanov Yu.M. Rezultati observatsiynogo perehresnogo doslidzhennya PRELID 2 (2015–2016). Chastina 1. Poshirenist nealkogolnoyi zhirovoyi hvorobi pechinki, harakteristika suputnoyi patologiyi, metabolichnogo sindromu ta yogo okremih kriteriyiv u patsientiv, yaki zvertayutsya do terapevtiv i gastroenterologiv v Ukrayini. [Results of the PRELID 2 observational cross-sectional study (2015–2016). Part 1. Prevalence of non-alcoholic fatty liver disease, characteristics of concomitant pathology, metabolic syndrome, and its individual criteria in patients seeking treatment in therapists and gastroenterologists in Ukraine]. Gastroenterol. 2019; 53(1). [Ukrainian]
  2. Bidani AK, Griffin KA Pathophysiology of hypertensive renal damage. Implications for therapy. Hypertension. 2004; 44: 595–601.
  3. Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017; 66(6): 1138-53.
  4. Danford CJ, Lai M. NAFLD: a multisystem disease that requires a multidisciplinary approach. Frontline Gastroenterology. 2019;10: 328-9.
  5. Jang HR, Kang D, Sinn DH, Gu S, Cho SJ, Lee JE, et al. Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease: a cohort study. Sci Rep. 2018 Mar 16; 8(1): 4718.
  6. Mantovani A, Zaza G, Byrne CD, Lonardo A, Zoppini G1, Bonora E, Targher G. Nonalcoholic fatty liver disease increases risk of incident chronic kidney disease: A systematic review and meta-analysis. Metabolism. 2018 Feb; 79: 64-76.
  7. Musso G, Cassader M, Cohney S, Pinach S, Saba F, Gambino R. Emerging Liver-Kidney Interactions in Nonalcoholic Fatty Liver Disease. Trends Mol Med. 2015 Oct; 21(10): 645-62.