BIOCHEMICAL STUDY OF THE DEVELOPMENT OF CHRONIC VIRAL HEPATITIS WITH COMORBID COURSE OF CHRONIC GLOMERULONEPHRITIS

Аннотация

Вторичные клубочковые поражения при вирусных гепатитах протекают медленно, однако у трети больных процесс неуклонно прогрессирует и проявляется нефротическим синдромом, ухудшает состояние больного с проявлениями почечной недостаточности. Цель данного исследования изучить клинические и биохимические аспекты поражения функционального состояния почек при хроническом вирусном гепатите В и С. В исследование включено 198 пациентов с положительными серологическими маркерами ВГВ и ВГС и клинико-- лабораторными синдромами поражения почек. Ключевые слова: Хронический гломерулонефрит, хронический гепатит В и С. Annotation. Secondary glomerular lesions in viral hepatitis occur slowly, but in a third of patients the process progresses steadily and manifests as nephrotic syndrome, worsening the patient's condition with manifestations of renal failure. The purpose of this study is to study the clinical and biochemical aspects of the damage to the functional state of the kidneys in chronic viral hepatitis B and C.The study included 198 patients with positive serological markers of HBV and HCV and clinical-renal syndrome of kidney damage. Key words: Chronic glomerulonephritis, chronic hepatitis B and C. Relevance. Chronic viral hepatitis B, C, which occupies a dominant place among all liver diseases, is one of the most important problems of modern hepatology due to its widespread distribution and high incidence rate. According to WHO, there are about 15% of carriers of hepatitis B virus (HBV) in the world and 10% of carriers of viral hepatitis C (HCV) of the entire population of the globe [2,5]. In the pathogenesis of parenteral hepatitis, course and outcomes, the leading role is given to immune mechanisms. The characteristic “escape” of hepatitis viruses from “immune surveillance”, due to the inferiority of the 86 SOLUTION OF SOCIAL PROBLEMS IN MANAGEMENT AND ECONOMY International scientific-online conference immune response, determines the persistence of the pathogen and the formation of a chronic course of infection. Circulating immune complexes in chronic viral liver pathology can cause the appearance of extrahepatic lesions of organs and systems. It is believed that the hepatitis B virus may play a role in the development of glomerulonephritis. As evidence of this position, the following are considered: an increased frequency of detection of markers of infection with the hepatitis B virus, and primarily HBsAg, among patients with various forms of glomerulonephritis; detection of HBsAg deposits in the glomeruli of the kidneys and immune complexes HBsAg - anti-HBs, which are of primary importance in kidney damage. According to some researchers, HBsAg carriage is regarded as a risk factor for the development of glomerulonephritis [6]. Among patients with hepatitis B with the presence of glomerulonephritis, its morphological variants are recorded: membranous, membranous- proliferative, endo - and extracapillary, etc. The mechanism of renal damage associated with viral hepatitis B has not been fully determined. Several assumptions have been made related to: the direct effect of the HBsAg-anti-HBs immunocomplexes; immunocomplexes containing anti-HBc, HBeAg, anti-HBe; with the action of components of destroyed hepatocytes and autoantibodies produced on them during the disease process. In the structure of renal pathology, one of the leading places belongs to glomerulonephritis (GN), due to the severity of complications, difficulties of diagnosis, imperfect therapy, and poor prognosis of most of its chronic forms. GN today is a kidney disease, which, in addition to the primary one, often acquires the significance of a secondary lesion that develops within the framework of a certain systemic or metabolic-endocrine pathology, the spectrum of which is extremely wide. The systemic nature of the process involving the kidneys is inherent in blood-borne viral hepatitis, in particular HBV and HCV. In adults, secondary glomerular lesions due to viral hepatitis proceed slowly, but in a third of patients the process steadily progresses, may manifest as nephrotic syndrome, worsen the patient’s condition with manifestations of renal failure, is difficult to respond to anti-inflammatory therapy, and requires the use of extracorporeal methods of treating immune complex pathology (plasmopharesis, hemosorption) [1,2]. 87 SOLUTION OF SOCIAL PROBLEMS IN MANAGEMENT AND ECONOMY International scientific-online conference The purpose of this study is to study the clinical and biochemical aspects of damage to the functional state of the kidneys in chronic viral hepatitis B and C. Material and methods. The present study included 198 patients with positive serological markers of HBV and HCV and clinical and laboratory syndromes of kidney damage (glomerulonephritis). Among them, men accounted for 47.8% (95 people), women 52.2% (103 people). The average age of those examined was 52±3.7 years. To compare the course of the disease, glomerulonephritis associ