NATRIURETIC PEPTIDE IS AN EARLY MARKER OF KIDNEY DAMAGE IN PATIENTS WITH ULCERATIVE COLITIS AND IRRITABLE BOWEL SYNDROME COMBINED WITH NON-ALCOHOLIC FATTY LIVER DISEASE
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i4.15017Keywords:
inflammatory bowel disease (ulcerative colitis), irritable bowel syndrome, non-alcoholic fatty liver disease, kidney disease, body mass index, obesity, diagnostics (natriuretic peptide, ghrelin)Abstract
SUMMARY. The study of the level of natriuretic peptide (NT-proBNP) in patients with non-alcoholic fatty liver disease (NAFLD) in combination with inflammatory bowel disease (IBD) may be one of the early markers and indicate the formation of kidney damage in these patients.
The aim – to determine the peculiarities of changes in the level of NT-proBNP in the blood serum in renal damage in patients with ulcerative colitis (UC) in combination with NAFLD.
Material and Methods. We examined 140 patients with UC and NAFLD. The examined patients were divided into two groups: group I (n=64) included patients with UC and NAFLD with diagnosed renal damage, and group II (n=76) included patients with UC and NAFLD without renal damage. The comparison group (group III) consisted of 32 patients with irritable bowel syndrome (IBS) and NAFLD. Cystatin C (Cys C) levels, as well as serum ghrelin and NT-proBNP levels were determined in the examined patients.
Results. Among patients of group I, patients with UC of moderate activity according to the Mayo scale were significantly more frequently detected (53.1 % of patients – p<0.05), while among patients of group II, patients with mild Mayo activity were more frequently detected (50.0 % of patients – p<0.01). Severe UC was diagnosed 10.9 % more often among patients in group I (p<0.01). In the group of patients with kidney damage in the setting of UC and NAFLD, an increase in ghrelin levels and NT-proBNP was found (up to 154.9±2.1 ng/ml and 171.3±3.5 pg/ml, respectively – p<0.001). In group II, on the contrary, there was a decrease in both ghrelin and NT-proBNP levels in the blood serum. A strong correlation was found between the level of NT-proBNP in the blood serum mainly in patients of group I and the glomerular filtration rate according to Cys C (r= 0.96; p<0.01). Assessment of NT-proBNP dynamics in the blood serum can be used for early screening of renal damage in patients with UC and NAFLD.
Conclusions. An increase in the level of NT-proBNP in the blood serum of patients with UC and NAFLD is associated with renal damage (r=0.96; p<0.01) and can be used as an early marker for its determination.
The level of NT-proBNP in the blood serum of patients with UC and NAFLD with kidney damage depends on body mass index and correlates with the degree of disease activity according to the Mayo Clinic score (r=0.92; p<0.01 for patients with severe UC).
A decrease in the level of NT-proBNP in the blood serum was found in patients with IBS and NAFLD in combination with obesity.
References
Cusi, K., Isaacs, S., Barb, D., Basu, R., Caprio, S., Garvey, W.T., Kashyap, S., Mechanick, J.I., Mouzaki, M., Nadolsky, K., Rinella, M.E., Vos, M.B., & Younossi, Z. (2022). American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract., 28 (5), 528-562. DOI: 10.1016/j.eprac.2022.03.010. PMID: 35569886. DOI: https://doi.org/10.1016/j.eprac.2022.03.010
Le, M.H., Le, D.M., Baez, T.C., Wu, Y., Ito, T., Lee, E.Y., Lee, K., Stave, C.D., Henry, L., Barnett, S.D., & et al. (2023). Global incidence of non-alcoholic fatty liver disease: A systematic review and meta-analysis of 63 studies and 1,201,807 persons. J. Hepatol., 79, 287-295. DOI: 10.1016/j.jhep.2023.03.040. DOI: https://doi.org/10.1016/j.jhep.2023.03.040
Younossi, Z.M., Golabi, P., Paik, J.M., Henry, A., Van Dongen, C., & Henry, L. (2023). The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): A systematic review. Hepatology, 77, 1335-1347. DOI: 10.1097/HEP.0000000000000004. DOI: https://doi.org/10.1097/HEP.0000000000000004
Targher, G., Byrne, C.D., & Tilg, H. (2020). NAFLD and increased risk of cardiovascular disease: Clinical associations, pathophysiological mechanisms and pharmacological implications. Gut, 69, 1691-1705. DOI: 10.1136/gutjnl-2020-320622. DOI: https://doi.org/10.1136/gutjnl-2020-320622
Huang S., Bao Y., Zhang N., Niu R., & Tian, L. (2023). Long-term outcomes in lean and non-lean NAFLD patients: A systematic review and meta-analysis. Endocrine, 1-8. DOI: 10.1007/s12020-023-03351-5. DOI: https://doi.org/10.1007/s12020-023-03351-5
Yandian, F., Caravaca-Fontán, F., Herrera Hernandez, L.P., Soler, M.J., Sethi, S., & Fervenza, F.C. (2023). Kidney Diseases Associated With Inflammatory Bowel Disease: Impact of Chronic Histologic Damage, Treatments, and Outcomes. Kidney Int Rep., 9 (2), 383-394. DOI: 10.1016/j.ekir. 2023.11.011. PMID: 38344742; PMCID: PMC10851004. DOI: https://doi.org/10.1016/j.ekir.2023.11.011
Annese, V. (2019). A Review of Extraintestinal Manifestations and Complications of Inflammatory Bowel Disease. Saudi J Med Med Sci., 7 (2), 66-73. DOI: 10.4103/sjmms.sjmms_81_18. Epub 2019 Apr 12. PMID: 31080385; PMCID: PMC6503692. DOI: https://doi.org/10.4103/sjmms.sjmms_81_18
Santos-Araújo, C., Leite-Moreira, A., & Pestana, M. (2015). Clinical value of natriuretic peptides in chronic kidney disease. Nefrologia, 35 (3), 227-233. DOI: 10.1016/j.nefro.2015.03.002. Epub 2015 Jun 22. PMID: 26299165. DOI: https://doi.org/10.1016/j.nefro.2015.03.002
Gromadziński, L., Januszko-Giergielewicz, B., Czanacka, K., & Pruszczyk, P. (2019). NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3-5 Chronic Kidney Disease. Cardiorenal Med., 9 (2), 125-134. DOI: 10.1159/000496238. Epub 2019 Feb 6. PMID: 30726840. DOI: https://doi.org/10.1159/000496238
Rusu, C.C., Anton, F., Valea, A., & Bondor, C.I. (2024). N-Terminal Pro-Brain Natriuretic Peptide Correlates with Ghrelin and Acyl-Ghrelin in Pre-Dialysis Chronic Kidney Disease. International Journal of Molecular Sciences, 25 (11), 5696. DOI: 10.3390/ijms25115696 DOI: https://doi.org/10.3390/ijms25115696
Nakagawa, Y., Nishikimi, T., & Kuwahara, K. (2019). Atrial and brain natriuretic peptides: Hormones secreted from the heart. Peptides, 111, 18-25. DOI: 10.1016/j.peptides.2018.05.012. Epub 2018 May 31. PMID: 29859763. DOI: https://doi.org/10.1016/j.peptides.2018.05.012
Koratala, A., & Kazory, A. (2017). Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal Divergence. Dis Markers., 1454986. DOI: 10.1155/2017/ 1454986. Epub 2017 Jun 18. PMID: 28701807; PMCID: PMC5494089. DOI: https://doi.org/10.1155/2017/1454986
Madamanchi, C., Alhosaini, H., Sumida, A., & Runge, M.S. (2014). Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure. Int J Cardiol., 176 (3), 611-617. DOI: 10.1016/j.ijcard.2014.08.007. Epub 2014 Aug 9. PMID: 25156856; PMCID: PMC4201035. DOI: https://doi.org/10.1016/j.ijcard.2014.08.007
Buckley, L.F., Canada, J.M., Del Buono, M.G., Carbone, S., Trankle, C.R., Billingsley, H., Kadariya, D., Arena, R., Van Tassell, B.W., & Abbate, A. (2018). Low NT-proBNP levels in overweight and obese patients do not rule out a diagnosis of heart failure with preserved ejection fraction. ESC Heart Fail., 5 (2), 372-378. DOI: 10.1002/ehf2.12235. Epub 2018 Jan 18. PMID: 29345112; PMCID: PMC5880665. DOI: https://doi.org/10.1002/ehf2.12235
P090. (2015). Evaluation of NT-proBNP in Inflammatory Bowel Disease, Journal of Crohn’s and Colitis, 9(suppl 1), S123. DOI: 10.1093/ecco-jcc/jju027.208 DOI: https://doi.org/10.1093/ecco-jcc/jju027.208
