Consilium MedicumConsilium MedicumConsilium MedicumConsilium Medicum2075-17532542-2170Consilium Medicum92781ArticlesСтатьиResearch ArticleKhronicheskaya serdechnaya nedostatochnost' i porazhenie pochek: perspektivy lecheniyaХроническая сердечная недостаточность и поражение почек: перспективы леченияMukhinN. AМухинН. А

Кафедра терапии и профболезней

FominV. VФоминВ. В

Кафедра терапии и профболезней

MoiseevS. VМоисеевС. В

Кафедра терапии и профболезней

KhamkhoevaM. SХамхоеваМ. С

Кафедра терапии и профболезней

ММА им. И.М.Сеченова15092008109VOL 10, NO9 (2008)ТОМ 10, №9 (2008)697428122021Copyright ©; 2008, Consilium MedicumCopyright ©; 2008, ООО "Консилиум Медикум"2008Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://consilium.orscience.ru/2075-1753/article/view/92781

Общепринятая концепция нейрогормональной активации как основы патогенеза хронической сердечной недостаточности (ХСН) предполагает важную роль почки в метаболизме ключевых медиаторов (ангиотензин II – АТII, альдостерон, натрийуретические пептиды). Кроме того, именно почка занимает центральное место в регуляции обмена натрия и воды и, следовательно, параметры системной гемодинамики зависят от состояния ее функции не в меньшей степени, чем от сократительной способности миокарда левого желудочка [1]. Наряду с хорошо известным феноменом "застойной" почки, появление признаков которого почти всегда отражает тяжесть ХСН, изменение почечной функции у этих пациентов нередко бывает связано с нарушениями водно-электролитного гомеостаза и/или ятрогенным.Риск ухудшения функции почек при ХСН велик и определяется не только закономерностями ее прогрессирования, но и воздействием многих ятрогенных факторов. Даже умеренное снижение почечной функции при ХСН всегда сопряжено со значительным увеличением риска смерти. В связи с этим максимально осторожное назначение лекарственных препаратов, в том числе ИАПФ, тщательный учет показания и противопоказаний к их применению, а также регулярный мониторинг величин креатининемии, СКФ и калиемии приобретают приоритетное значение с точки зрения предупреждения нарастающей почечной недостаточности у пациентов, страдающих ХСН.

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