sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университетsechenov-742Research ArticleBISSUES OF CLINICAL MEDICINEВОПРОСЫ КЛИНИЧЕСКОЙ МЕДИЦИНЫThe importance of whey protein levels of Klotho and fibroblast growth of factor-23 (fgf-23) as early diagnostic markers of chronic kidney damageЗначение сывороточных уровней белка Клото (Klotho) и фактора ростафибробластов-23 (fgf-23) как ранних диагностических маркеров хронического почечного поврежденияМиловановаЛ. Ю.MilovanovaL. Yu.

Людмила Юрьевна Милованова, к.м.н., научный сотрудник отдела нефрологии НИЦ

119992, г. Москва, ул. Россолимо, д. 11, стр. 5

8 (499) 248–41–66

Lyudmila Yurievna Milovanova, PhD, researcher of the Department of nephrology of the Research Centre

11–5, Rossolimo str., Moscow, 119992

8 (499) 248–41–66

noo@mmascience.ruМиловановаС. Ю.MilovanovaS. Yu.

д.м.н., член Российской Академии Естествознания, научный сотрудник

MD, member of the Russian Academy of Natural Sciences, researcher

КрюковаД. В.KryukovaD. V.

к.м.н., сотрудник факультета фундаментальной медицины

PhD, fellow of the Faculty of basic medicine

МоисеевС. В.MoiseevS. V.

д.м.н., профессор кафедры внутренних, профессиональных заболеваний и пульмонологии

MD, prof. of the chair of internal, occupational diseases and pulmonology

КозловскаяЛ. В.KozlovskayaL. V.

д.м.н., профессор кафедры терапии и профессиональных заболеваний

MD, prof. of the chair of therapy and occupational diseases

Первый МГМУ им. И.М. СеченоваРоссияI.M. Sechenov First MSMURussian FederationМГУ им. М.В. ЛомоносоваРоссияM.V. Lomonosov MSURussian Federation201430062014027883Copyright © Milovanova L.Y., Milovanova S.Y., Kryukova D.V., Moiseev S.V., Kozlovskaya L.V., 20142014Милованова Л.Ю., Милованова С.Ю., Крюкова Д.В., Моисеев С.В., Козловская Л.В.Milovanova L.Y., Milovanova S.Y., Kryukova D.V., Moiseev S.V., Kozlovskaya L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/742

The purpose of the study is to investigate the clinical significance of determination of serum FGF-23 and Klotho in patients with different stages of chronic kidney disease (CKD). Materials and Methods: The study included 70 patients with CKD stages 1–5D (30 men and 40 women, mean age 41,0–6,7 years), in whom the serum levels of FGF-23 and Klotho, as well as work Ca х P and the content of intact parathyroid hormone (iPTH). Results: the progression of CKD from stage 1 to 5D serum concentration of FGF-23 was increased, and the concentration of Klotho decreased. Glomerular filtration rate (GFR) was directly correlated with the serum concentration of FGF-23 (r=0,693, p <0,01) and back — with a protein concentration of Klotho (r=-0,799, p <0,01). Increased levels of FGF- 23 as GFR decline began in CKD stage 3 and outpaced the increase in serum levels of phosphorus and iPTH, which increased in CKD stage 4–5. In 49 patients with CKD and hypertension increase the degree of BP directly correlated with the serum concentration of FGF-23 (r=0,452; p <0,01) and back — with the serum concentration of Klotho (r=-0,687; p <0,01). In addition, changes in the levels found a link of FGF-23 and Klotho with increasing thickness of the posterior wall of the left ventricle, the frequency of detection of calcifications in the heart and major arteries and anemia. Conclusion: These results suggest the possibility of practical application of Klotho and FGF-23 levels as an early diagnostic marker of kidney damage for prognosis and improve cardio-renoprotective strategies.

Цель исследования — изучить клиническое значение определения сывороточной концентрации FGF-23 и Klotho у больных с разными стадиями хронической болезни почек (ХБП). Материалы и методы: в исследование были включены 70 больных ХБП 1-5D стадий (30 мужчин и 40 женщин; средний возраст 41,0±6,7 лет), у которых определяли сывороточные уровни FGF-23 и Klotho, а также произведение Ca×P и содержание интактного паратиреоидного гормона (иПТГ). Результаты: по мере прогрессирования ХБП от 1 к 5D стадии сывороточная концентрация FGF-23 увеличивалась, а концентрация Klotho снижалась. Скорость клубочковой фильтрации (СКФ) прямо коррелировала с сывороточной концентрацией FGF-23 (r=0,693, p<0,01) и обратно — с концентрацией белка Klotho (r=-0,799, p<0,01). Увеличение уровня FGF-23 по мере снижения СКФ начиналось при ХБП 3 стадии и опережало повышение сывороточных уровней фосфора и иПТГ, которые увеличивались при ХБП 4-5 стадии. У 49 больных ХБП и артериальной гипертонией степень повышения АД прямо коррелировала с сывороточной концентрацией FGF-23 (r=0,452; p<0,01) и обратно — с сывороточной концентрацией Klotho (r=-0,687; p<0,01). Кроме того, выявлена связь изменений уровней FGF-23 и Klotho с увеличением толщины задней стенки левого желудочка, частотой выявления кальцификатов в сердце и магистральных артериях и анемией. Заключение: результаты исследований свидетельствуют о возможности практического применения уровней Klotho и FGF-23 в качестве ранних диагностических маркеров почечного повреждения для оценки прогноза и совершенствования кардио-нефропротективной стратегии.

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The authors declare that there are no conflicts of interest present.