Vascular Endothelial Growth Factor and Lipocalin-2 as Markers of Early Nephron Damage in Patients with Hypertension and Obesity

The aim of the investigation is to evaluate the levels of vascular endothelial growth factor (VEGF) and lipocalin-2 (NGAL) as markers of early diagnosing glomerular and tubular system damage in patients with arterial hypertension (AH) and obesity.

Materials and Methods. The monitoring group consisted of 38 patients with AH of degrees I–II and stages I–II with no signs of structural, functional and organic kidney lesions who received neither statins nor therapy for hypertension. The patients’ mean age was 42.3±8.3 years. Body mass index was 38.0±10.0. The comparison group included 15 healthy volunteers (comparable in age and sex). General clinical and laboratory examination included assessment of lipid profile, glycemia, creatinine, uric acid, body mass index, glomerular filtration rate (GFR) (formula CKD-EPI, ml/min/1.73 m²). VEGF, NGAL and microalbuminuria levels were determined by enzyme immunoassay using Stat-Fax photometer (Awareness Technology Inc., USA) and the appropriate kits.

Results. GFR proved to depend on the degree of obesity. There was noted a negative correlation between GFR and diastolic BP levels, a significant correlation with creatinine, cholesterol, very low density lipoproteins and uric acid levels.

Even in the presence of normal creatinine level pathological microalbumin level was diagnosed in 31.6% of patients, it was elevated in 44.7%. A correlation between microalbumin value and the levels of diastolic BP, creatinine, total cholesterol was found to be positive and it was negative to GFR value. There was also established a direct correlation between VEGF and the levels of systolic BP, microalbumin and uric acid while it was negative to GFR. There was a significant correlation between microalbuminuria and NGAL level.

Conclusion. In patients with uncomplicated AH combined with obesity microalbuminuria and VEGF are the early markers of glomerular damage while NGAL is a marker of tubular injury and tubular dysfunction is not always associated with glomerular damage. Reduced GFR is associated with diastolic BP, microalbuminuria and VEGF and is independent of NGAL level.

1. Sharipova G.Kh., Chazova I.E. Renal pathology features in arterial hypertension patients with and without metabolic syndrome. Rossiyskiy kardiologicheskiy zhurnal 2008; 6(74): 1–10.
2. Arutiunov G.P., Oganezova L.G., Sokolova A.V. Assessment of renal function, involvement of renal glomeruli and tubulo-interstitium in patients with arterial hypertension. Klinicheskaya nefrologiya 2011; 6: 16–24.
3. Krasnova E., Fedorova E., Kutyrina I., Fomin V. Renal disease in obese: clinical, pathogenic and therapeutic aspects. Vrach 2005; 6: 6–9.
4. Litvin A. Microalbuminuria: clinical value. Vrach 2011; 9: 7–13.
5. Velkov V.V. NGAL — the renal troponin: the early marker of the acute kidney injury: the urgency for nephrology and cardiac surgery. Kliniko-laboratornyy konsilium 2011; 2: 90–100.
6. Smirnov A.V., Schilov E.M., Dobronravov V.A., Kayukov I.G., Bobkova I.N., Shcveczov M.U., Czigin A.N., Schutov A.M.National recommendations. Chronic illness of kidneys: main principles of screening, diagnostics, preventive maintenance and approaches to treatment. Klinicheskaya nefrologiya 2012; 4: 4–26.
7. Smirnov А.V., Sedov V.M., Lhaahuu Od-Erdene, Kayukov I.G., Dobronravov V.A., Panina I. Yu. Reduction of the glomerular filtration rate as an independent risk factor of the cardio-vascular disease. Nefrologiya 2006; 10(4): 7–17.
8. Shemetov V.G. Khronicheskaya bolezn’ pochek u bol’nykh arterial’noy gipertenziey: chastota, faktory riska razvitiya, kliniko-prognosticheskoe znachenie. Avtoref. dis. … kand. med. nauk [Chronic kidney disease in patients with hypertension: the frequency, risk factors, clinical and prognostic value. PhD Thesis]. Irkutsk; 2012.
9. Kryachkova A.A., Savelyeva S.A., Gallyamov M.G., Shestakova M.V., Kutiryna I.M. The role of obesity in renal injury in patients with metabolic syndrome. Nefrologiya i dializ 2010; 12(1): 34–38.
10. Kuzmin O.B., Pugaeva M.O., Chub S.V. Mild renal dysfunction in patients with essential hypertension: clinical signs and drug therapy. Nefrologiya 2004; 8(3): 15–21.
11. Nanchikeeva M.L. Rannyaya stadiya porazheniya pochek u bol'nykh gipertonicheskoy bolezn'yu: klinicheskoe znachenie, printsipy profilaktiki. Avtoref dis. … dokt. med. nauk [The early stage kidney disease in hypertensive patients: clinical implications, prevention principles. DSc Thesis]. Moscow; 2010.

Shulkina S.G., Schekotov V.V., Smirnova E.N., Antipova A.A. Vascular Endothelial Growth Factor and Lipocalin-2 as Markers of Early Nephron Damage in Patients with Hypertension and Obesity. Sovremennye tehnologii v medicine 2016; 8(1): 148, https://doi.org/10.17691/stm2016.8.1.20