DOI: https://doi.org/10.22141/2224-0721.14.5.2018.142683

Clinical and pathogenetic importance of hormonal natriuretic peptides in gout

O.V. Syniachenko, D.M. Fedorov, M.V. Yermolaieva, V.V. Pylypenko

Abstract


Background. In addition to purine metabolism disorders, systems of pro-inflammatory cytokines, matrix metalloproteinases and eicosanoids, various medium molecular weight compounds can participate in the pathogenesis of gout, including natriuretic peptides (atrial — ANP, cerebral — BNP), but their significance needs further exploration. The purpose of the study was to evaluate the clinical and pathogenetic significance of ANP and BNP in cases of joint, kidney and heart disease in patients with gout. Materials and methods. One hundred five patients with primary gout were examined, 92 % of them were men and 8 % — women aged 26 to 76 years (51 years on average), and women were 8 years older. The average duration of the disease was 12 years. The first sign of gout in 91 % of patients was the joint crisis, and in the remaining cases — renal colic. The ratio of the incidence of intermittent and chronic forms of arthritis was 2 : 1, latent nephropathy occurred in 66 % of cases, urolithiasis — in 34 %, and the ratio of stages I, II, III and IV of chronic kidney di-sease was 4 : 2 : 1 : 1. The level of serum natriuretic peptides was studied by the method of enzyme-linked immunosorbent assay (PR2100 analyzer, Sanofi Diagnostic Pasteur, France). Results. Primary gout occurs with impaired metabolism of uric acid, oxypurinol, purine bases, purine metabolism enzymes and purine-associated trace elements (molybdenum, lead), the integral changes of which depend on the type of joint and kidney syndromes, the presence of peripheral and bone tofi, as well as the stage of chronic kidney disease. They determine bone-destructive articular lesions, and are prognostic factors for the severity of arthropathy and nephropathy. In addition to disorders of purine metabolism, patients with gout (compared with healthy people in the control group) have a significant increased blood concentrations of ANP — by 31 % (5.50 ± 0.18 pg/ml) and BNP — by 79 % (12.20 ± 1.16 pg/ml), which were found in 57 and 52 % of examined patients, respectively. It is correlated with the severity of joint syndrome, the presence of peripheral and bone tofi, and there are close relationships of medium molecular weight hormone peptides with bone-destructive articular changes, with parameters of purine metabolism and integral level of medium weight molecules which belong to different fractions, and indicators of ANP are of practical value. The type of nephropathy (latent, urolithiasis) and the stage of chronic kidney disease influence the integral state of ANP and BNP in the body of gout patients. Meanwhile, the parameters of urinary syndrome, the development of urolithiasis, nephrocalcinosis and nephrocystosis depend on the levels of these peptides. The effect of ANP level on the formation of diastolic dysfunction of the left ventricle was established, and BNP influence the development of disorders of cardiac conduction and an increase in the size of heart chambers. The level of ANP > 6 pg/ml in gouty arthritis is recommended for assessing the severity of articular narrowing, and this indicator is also a risk factor for decreased kidney function. Conclusions. The studied hormonal natriuretic peptides do not only participate in the pathogenesis of gouty arthritis, nephropathy and cardiopathy, but also are of prognostic significance.


Keywords


gout; course; pathogenesis; natriuretic pep- tides

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