CLINICAL AND LABORATORY FEATURES OF CARDIORENAL SYNDROME ON THE BACKGROUND OF CARBOHYDRATE EXCHANGE DISORDERS

Аннотация

Violation of the kidney filtration function is common enough among patients with cardiovascular disease (CVD), especially against disorders of carbohydrate metabolism (IGM). Renal dysfunction (PD) is associated with more frequent development of cardiovascular complications. In turn, the probability of development of renal disease in patients with cardiovascular disease is significantly higher than in general population. This bidirectional pathogenetic mechanisms existing between cardiovascular and kidney diseases were the basis for the formation of cardiorenal syndrome concept. The review discusses the general parts of pathogenesis within the cardiovascular continuum. In addition, it shows the effect on metabolic disorders during CVD combined with renal dysfunction. The review reveals a recent view on the main mechanisms of cardiorenal syndrome. Key words: cardiorenal syndrome, systemic inflammation, endothelial dysfunction, insulin resistance. Cardiorenal Metabolic interactions are one of the most actual and discussed problems of modern medicine. It is related to steadfast increase in the prevalence of cardiovascular pathology, high morbidity with diabetes mellitus (DM) (388 million people) [4,12] and also to raise in the frequency of detecting renal dysfunction (RD). So, chronic kidney disease (CKD) is detected in 45-60% of cases among patients with chronic heart failure (CHF) [9]. The epidemiologic research has revealed high prevalence of RD among patients with acute forms of ischemic heart disease as well (30.5-43.9%) [13]. Тhe basis for the formation of the concept of the cardiorenal continuum was high risk of complications in patients with comorbid pathology, two-way connections that exist between cardiovascular disease (CVD) and RD [2]. Over the last decades, results of scientific research have confirmed the correctness of the proposed concept, however, the mechanisms underlying the relationship between CVD, renal pathology, and diabetes mellitus have not been fully understood. Researchers are currently considering pathophysiologic mechanisms, including endothelial dysfunction, systemic inflammation, insulin resistance (IR), dyslipidemia, hypercoagulability, and https://scientific-jl.com/wsrj 3 1 9 Volume-40_Issue-1_June-2025 World scientific research journal increased platelet aggregation. Systemic inflammation takes a significant role in the basis of cardiovascular complications in patients with diabetes mellitus and RD. As researches of past years show high level of C-reactive protein(CRP) is a powerful predictor of cardiovascular events [11, 12], the prognostic value of which significantly exceeds the level of low-density lipoproteins (LDLP). During the investigation of indicators of oxidative stress in patients with myocardial infarction (MI), it was revealed that patients with complicated postinfarction period are characterized by a significant increase in the activity of lipid peroxidation (LPO) and a decrease in antioxidant protection[2] .The predictive role of systemic inflammation in hyperglycemic conditions is confirmed by a number of studies. So it was found that patients after an episode of unstable angina pectoris in combination with diabetes had higher values of indicators of inflammation markers, which were associated with a complicated course of the hospital period, in contrast to patients without carbohydrate metabolism disorders (CMD) [1]. Moreover, role of complex immune reactions in the processes of atherogenesis is beyond doubt. Systemic inflammation is a potential mechanism for the development of endothelial dysfunction, which in turn is given a leading role in the formation of cardiorenal syndrome [7]. Analyzing the possible mechanisms of the effect of CVD on the development of renal dysfunction (cardiorenal syndromes of the 1st and 2nd types), it is important to note the mechanism of renal perfusion disturbance, which is characterized by pronounced neurohumoral changes and is accompanied by endothelial dysfunction, oxidative stress. Confirmation of the close relationship between diseases of the cardiovascular system (CVS) and kidneys is also the fact that with a pronounced impairment of the contractility of the left ventricular (LV) myocardium, a decrease in the glomerular filtration rate (GFR), as a rule, coincides with the appearance of another unfavorable predictor - an increase in natriuretic peptides[15]. Decreased cardiac output in MI is accompanied by impaired renal perfusion and increased venous pressure[12]. We have previously shown that in patients with ST- segment elevation myocardial infarction, acute heart failure (AHF) class II-IV according to Killip is an independent predictor of RD development [3]. The study by C. Jeon (2016) also found that class III-IV AHF according to Killip was a significant factor in the deterioration of renal function along with such diseases as arterial hypertension (AH), obesity[14]. Hypertensive disease is one of the most common cause