The effect of antioxidant therapy on the course of predialysis chronic kidney disease in a patient with comorbidity

Abstract

Chronic kidney disease (CKD) is almost always associated with comorbidities such as diabetes, hyperuricemia/gout, urolithiasis, often with urinary tract infection, hypertension, polycystic kidney disease, and other conditions. Autosomal dominant polycystic kidney disease is an inherited kidney disease (1/1000–1/400 worldwide) affecting mainly adults, caused predominantly by mutations in PKD1 (85–90 % of cases) and PKD2 genes (10–15 % of cases), which encode polycystin-1 and polycystin-2 proteins, respectively. In adults with preserved kidney function, the prevalence of gout increases from 1 to 2 % (hyperuricemia up to 11 %), in patients with CKD stage 4 — up to 32 % (hyperuricemia up to 80 %). 70 % of patients with gout and 50 % of patients with hyperuricemia have stage 2 CKD. CKD contributes to a decrease in the urinary excretion of uric acid. In patients with CKD, hyperuricemia is considered to be a serum uric acid level > 6 mg/dL in women and > 7 mg/dL in men. Hyperuricemia is very often observed in hypertension and type 2 diabetes. In patients with kidney disease, diabetes is a major factor of mortality and morbidity. Diabetic nephropathy can be suspected in a patient with type 2 diabetes in the presence of albuminuria and/or diabetic retinopathy. Signs of diabetic nephropathy: basement membrane thickening, mesangial expansion, and increased vascular permeability to albumin induced by nonenzymatic glycation of collagen and laminin. Comorbidity has a negative impact on patients’ health due to increased morbidity and mortality. Such patients are at risk of rapid progression of CKD into the end stage, which requires renal replacement therapy. Therefore, early diagnosis, treatment and prevention of CKD complications are important for such patients. This article highlights the impact of antioxidant therapy and phytoneering on the course of CKD in patients with comorbidities.