Özet:

Introduction. The nature of the lesion and the pathogenesis of kidney vessels damage in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Henoch-Schönlein purpura (HSP) and microscopic polyangiitis (MPA) remains not enough studied, although the severity of such vasculopathy determines the prognosis of systemic autoimmune rheumatic diseases. The aim and purpose of the work was to evaluate the nature of morphological changes in the endothelium of the capillaries and arterioles of the kidneys in SLE, RA, VHS and MPA, connection with clinical and laboratory factors of the diseases' course and the influence of systemic vascular endothelial dysfunction. Materials and methods. The kidney biopsy results and data of laboratory analysis of vascular endothelial function were analysed in 94 patients, among which 41 persons suffered from SLE, 17 – RA, 24 - HSP and 12 – MPA. The ratio of men and women in these groups was respectively 1:7, 1:2, 2:1 and 1:3, the average age of the patients - 38, 50, 28 and 41 years, duration of disease from its manifestation - 12, 12, 10 and 4 years, the distribution of patients I, II and III degree of activity of the pathological process - as a 1:2:3, 1:2:2, 2:1:1, 1:2:9. Kidney biopsy is performed only in patients with the presence of proteinuria (excluded patients with AA amyloidosis). Carried out echocardiography, doppler ultrasound of the vessels and biomicroscopy of the conjunctiva vessels; by immune-enzyme analysis were studied indicators of vascular endothelial growth factor, endothelin-1, thromboxane-A2, homocysteine, prostacyclin, cyclic guanosine monophosphate, E- and P-selectin. Histological sections of the kidneys were stained with hematoxylin-eosin, alcian blue and van Gieson, becoming the PAS-reaction. In addition, the immune-enzyme (with peroxidase label) and fluorescence immunoassay methods of research of kidney tissue were performed. Results. The proliferation of capillary endothelium was peculiar with a greater extent to SLE and MPA, and arteriolar endothelium - only to MPA, whereas these changes were not peculiar to RA. Deposits of immunoglobulin (Ig) A in the blood vessels were the most typical for HSP and C1q-complement component - for SLE and MPA. The lesions of the endothelium of the capillaries and arterioles of the kidneys depend on the severity of the skin syndrome, peripheral neuropathy, leukocytoclastic enantemy and hands and feet capillaritis. Vascular endothelial dysfunction as vasodilators and vasoconstrictors imbalance occurs in 35 % of RA patients with renal disease, in 39 % SLE, 52 % HSP and 100 % MPA. Morphological lesions of the renal vascular endothelium are closely related to the severity of instrumental signs of extrarenal systemic angiopathy. Plasma levels of vascular endothelial growth factor determine proliferation of glomerular endothelium in patients with MPA, and in the development of renal immune endothelial deposits (IgA, IgG, IgM, C3, C1q) in SLE participate endothelin-1 and E-selectin, in RA - P-selectin, VSH - homocysteine. Conclusions. All patients with SLE, RA, HSP and MPA peculiar changes of the capillaries and arterioles endothelium of the kidneys glomeruli, in which genesis the disorders of systemic endothelial dysfunction of vessels participate. Author Biography Yelizaveta Iegudina, SE "Dnipropetrovsk Medical Academy" of Health Ministry of Ukraine V. Vernads'kogo str., 9, Dnipro, Ukraine, 49044 PhD, Associate professor Department of the propedeutic of the internal medicine

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