Volume 03 Issue 04-2023
13
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
13-18
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
Cirrhosis of the liver is manifested by necrosis of hepatocytes, disruption of its normal architecture due to diffuse
growth of connective tissue and the formation of regeneration nodules, as well as developing fibrosis. The article
presents a modern approach to the treatment of hepatorenal syndrome, one of the severe complications of the
disease. The effect of eplerenone, L-ornithine L-aspartate and glutathione drugs on the functional reserve of kidneys
was evaluated on the basis of complex treatment.
KEYWORDS
Hepatitis B, hepatitis C, liver cirrhosis, hepatorenal syndrome, renal functional reserve, L-ornithine L-aspartate,
glutathione, eplerenone.
INTRODUCTION
Cirrhosis of the liver is a diffuse disease of chronic
exacerbation, manifested by necrosis of hepatocytes,
disruption of its normal architecture due to the growth
of connective tissue and the formation of regeneration
Research Article
ASSESSMENT OF THE INFLUENCE OF COMPLEX TREATMENTS ON
KIDNEY FUNCTIONAL RESERVE IN PATIENTS WITH LIVER CIRRHOSIS
DEVELOPED DUE TO HEPATITIS V AND C.
Submission Date:
April 01, 2023,
Accepted Date:
April 05, 2023,
Published Date:
April 10, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue04-02
Abdulazizkhojiev B.R.
Andijan State Medical Institute, Uzbekistan
Jo'raeva M.A.
Andijan State Medical Institute, Uzbekistan
Ravzatov J.B.
Andijan State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 04-2023
14
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
13-18
SJIF
I
MPACT
FACTOR
(2021:
5.
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)
(2022:
5.
893
)
(2023:
6.
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)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
nodules, as well as progressive fibrosis. As a result,
developing chronic liver failure, signs of portal
hypertension, severe complications leading to death
are observed.
The disease is one of the six leading causes of death for
patients aged 35 to 60 years in economically developed
countries. It is recorded in 14-30 people out of every
100,000 inhabitants. Every year, about 1.4 million
people in the world die from cirrhosis of the liver and
its complications. Scientific observations confirm that
liver cirrhosis is more common in men [1, 6, 7, 9].
Cirrhosis of the liver is a polyetiological disease, in most
cases it is caused by hepatitis B, C, D viruses (the most
common type C), alcohol abuse. Also, alimentary -
allergic, toxic and other factors cause the disease [1].
Among the numerous complications of liver cirrhosis,
one of the least studied is hepatorenal syndrome.
Approximately 15% of affected patients develop
hepatorenal syndrome within 6 months of first
hospitalization for ascites, and 40% within 5 years [11, 8,
5]. Full-fledged scientific observations dedicated to it
have not been conducted in Uzbekistan.
30 years ago, creatinine levels of 150 mmol/l and higher
were accepted as criteria for kidney failure in
hepatorenal
syndrome.
This
corresponds
to
glomerular filtration rate (FFT) of 40 ml per minute and
below [4, 10]. It is known that GFR can be determined
using special formulas based on endogenous
creatinine levels in blood serum.
Currently, renal functional reserve (RBF) concentration
and tests for its assessment have been created based
on GFR. FSK is understood as its ability to increase GFR
from the basal, i.e., primary state to the maximum
level. To achieve it, all nephrons, not only deep, but
also superficial, participate in the process [2].
In most of the literature, in the data presented, FSK
was studied in patients with diabetes in most cases.
However, there is almost no information on the use of
this test in a number of other diseases, including
hepatorenal syndrome. However, the study of FSK in
hepatorenal syndrome developed on the basis of liver
cirrhosis makes it possible to diagnose nephropathy
early.
The purpose of the study: to evaluate the functional
reserve of the kidneys before and after the complex
treatment with the addition of eplerenone, L-ornithine
L-aspartate and glutathione in patients with advanced
liver cirrhosis due to chronic hepatitis B and C.
Research material and methods: As a source of
research, 124 patients with clinical signs of type II
hepatorenal syndrome treated at the clinic of Andijan
State Medical Institute were observed. Patients with
hepatorenal syndrome and included in the study were
divided into two groups. The first group consisted of
60 patients with liver cirrhosis caused by viral hepatitis
Volume 03 Issue 04-2023
15
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
04
P
AGES
:
13-18
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
V, 28 men (46.7%) and 32 women (53.3%), their average
age was 46.44±1.38. The second group had liver
cirrhosis caused by chronic hepatitis C. It consisted of
64 patients. 3 patients died of esophageal variceal
bleeding and 1 of hepatocarcinoma and were not
included in the follow-up group. Of the remaining 60
patients, 25 were men (41.6%) and 35 were women
(58.4%), the average age was 48.82±1.6.
Both groups of patients were divided into two
subgroups of 30 patients in order to evaluate the
effectiveness of complex treatment procedures with
different contents. The first subgroups were
prescribed spironolactone (veroshpiron) + L-ornithine
L-aspartate on the basis of the complex treatment of
liver cirrhosis, and eplerenone + L-ornithine L-aspartate
+ glutathione drugs were prescribed to the second
subgroups on the basis of the complex treatment of
liver cirrhosis. Also, taking into account indications and
contraindications for the second group of patients and
their
1 -table
Changes in renal functional reserve (%) before and after complex treatment of patients with advanced liver
cirrhosis due to chronic hepatitis B.
In this figure, we can see that the FSK values in the
patients were significantly reduced regardless of the
treatment procedures performed. In the first group of
patients, FSK decreased from 4.34 ± 0.13 % to 3.7 ± 0.2
% before and after treatments, respectively. In the
second group, it was 4.23±0.3% and 4.0±0.2% (p<0.05).
The fact that FSK did not appear in patients can be
explained by the fact that the hepatitis B virus has an
Volume 03 Issue 04-2023
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International Journal of Medical Sciences And Clinical Research
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VOLUME
03
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SJIF
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(2023:
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
aggressive effect on the liver and kidneys, causing
irreversible changes in them.
Positive changes were noted in both groups after
treatment with various components in patients with
cirrhosis of the liver due to chronic hepatitis C (Fig. 2).
In the first group of patients, the indicators before and
after treatments increased from 4.09 ± 0.15% to 4.54 ±
0.13%, but they did not develop FSK. In the second
group of patients, this indicator was 4.1 ± 0.2% and 5.09
± 0.14%, respectively, before and after treatment, and
high reliable changes were noted (p<0.001).2-table
Changes in renal functional reserve before and after
complex treatment of patients with advanced liver
cirrhosis due to chronic hepatitis C.
Note: *-r<0.05 - the difference between the indicators before and after treatment.
CONCLUSION
Based on our investigations, we can come to the
following conclusion: before the treatments, the
indicators of the functional reserve of the kidneys,
which were determined with the help of creatinine in
the blood by giving a load of 0.45% sodium chloride
solution, were low in both groups of patients,
indicating the absence of reserve. The positive changes
observed in the FSK after the treatment in the second
group of patients after the treatment procedures can
be attributed to the effective effect of glutathione and
Volume 03 Issue 04-2023
17
International Journal of Medical Sciences And Clinical Research
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VOLUME
03
ISSUE
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P
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SJIF
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OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
eplerenone against fibrosis. Also, in liver cirrhosis
developed on the basis of chronic hepatitis C,
compared to those developed on the basis of hepatitis
B, the reliable reduction of fibrosis processes is related
to the prescription of antiviral drugs in the complex
treatment. Determination of BFZ indicators in the
studied groups makes it possible to detect
nephropathy in cirrhosis of the liver at an early stage.
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Volume 03 Issue 04-2023
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International Journal of Medical Sciences And Clinical Research
(ISSN
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03
ISSUE
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)
(2023:
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184
)
OCLC
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1121105677
Publisher:
Oscar Publishing Services
Servi
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