Correction reaction of lipid peroxidation in pregnant women with pyelonephritis

Abstract

Introduction: Pyelonephritis in pregnancy predominates in the structure of renal disease in the period of gestation. The significance of this pathology is caused by a high incidence of pregnant women, often relapsing, purulent, and complicated forms of the disease. The gestational pyelonephritis is a factor in perinatal pathology, maternal and perinatal mortality and the formation of the delayed pathology in the women’s urinary tract (I.V. Mikhailov, 2005; M.A. Herraiz et al., 2005; S. Hazhir, 2007). Materials: In our research we have examined 115 pregnant women with gestational pyelonephritis. Among them - 69 pregnant women are with initial acute pyelonephritis in the stage of serous inflammation, 46 - with chronic pyelonephritis in the stage of exacerbation. The control group consisted of 30 women with physiological pregnancy. Pregnant women with acute pyelonephritis had an increase concentration of plasma MDA by 66.2% (p < 0,05), compared with pregnant control group, while the increase of this indicator in pregnant with exacerbation of chronic pyelonephritis was 88.6% (p < 0,05 ) compared with the level indicator in healthy women. In acute pyelonephritis the erythrocyte MDA increased by 97.0% (p < 0,05) more, and in exacerbation of chronic pyelonephritis during pregnancy - by 111.2% (p < 0,05), compared with pregnant control group. In pregnant women with pyelonephritis, which arose only during gestation, blood catalase activity was less, than in healthy ones, by 28.6% (p < 0,01), in pre-existing pyelonephritis - lower, than in the control group, by 28.9% ( p < 0,01). Such modulation is due to a profound imbalance in the «lipid peroxidation - antioxidant protection», manifested a significant reduction in total plasma antioxidant activity, which maintains a certain constant level of non-enzymatic lipid peroxidation processes. Obviously, in patients with chronic pyelonephritis there is the depletion of antioxidant activity of plasma that becomes apparent in a significant increase of TBA-defined products in plasma and erythrocytes. This condition of LPO-AOD suggests the reduced resistance, subacute inflammatory process with the lack of defensiveness, a tendency to exacerbations (Yilmaz M.I. et al, 2006; Costa-Hong V. et al, 2009). By the 3rd day of combined treatment with Essentiale in pregnant women with pyelonephritis there was a tendency to decrease of plasma MDA content by 10,4% (p> 0,05) in relation to the initial index, which in absolute terms was 10,09 ±1,17 mmol /1 against the initial 11,26 ± 1,30 mmol /1. Continuing to decline in the course of the therapy, by the end of the treatment plasma MDA levels in this group was 8,90 ± 0,89 mmol /1, which was by 21.0% (p < 0,05) less than the initial index, but 1.5 times higher than in healthy pregnant women (5,97 ± 0,85 mmol / 1). More significantly is that on the 3rd day of treatment of pregnant women with chronic pyelonephritis, erythrocyte MDA decreased and was 28,51 ± 2,34 mmol /, which was by 12.8% (p> 0.05) less than the initial index (32.67 ± 3,39 mmol /1). At the end of the treatment the level of erythrocyte MDA decreased even more - by 20.5% (p < 0,05) - and reached 25,96 ± 2,25 mmol /1, which was still by 67.8 % (p < 0,05) higher than in healthy pregnant women. Blood catalase activity remained almost the same on the 3rd day of combined treatment with Essentiale of the exacerbation of chronic pyelonephritis and was 2093,78 ± 18,72 nkat / min /1, which was higher than the initial level by only 1.4% (p> 0.05 .) At the end of therapy there was a greater (15.7%, p < 0,05) increase in catalase activity - up to 2391,02 ± 13,42 nkat / min /1, which remained by 17.7% (p < 0,05) lower than normal index (2902,5 ± 19,5 nkat / min /1) After 3 sessions of laser therapy of pregnant women with acute pyelonephritis the level of MDA in plasma was reduced to 9,7 ± 0,99 mmol /1, i.e. by 7.3% (p> 0.05) vs. the initial level, and in red blood cells - by 7.6% (p> 0.05), respectively. At the end of therapy the concentration of malondialdehyde in plasma decreased by 22.0% (p < 0,05), which was 7,89 ± 0,10 mmol /1. In the red blood cells after the treatment the level of MDA reached 20,74 ± 2,87 mmol /1, which was by 28.8% lower than the initial index (p < 0,05). Another positive development was the increase in enzyme antioksidoza activity defense: catalase activity on the 3 day of laser treatment had a tendency to increase by 4.9% (p> 0.05) - up to 2134,28 ± 182,35 nkat / min /1 at initial index 2035,54 ± 191,7 nkat / min /1. At the end of the treatment the marked positive tendency has continued - the content of the enzyme increased by 15.0% (p < 0,05) compared to the initial level, but remained by 19.4% (p < 0,05) lower than in healthy pregnant women. The laser therapy in pregnant women with exacerbation of chronic pyelonephritis led to a significant decrease in plasma MDA levels on the 3rd day of therapy by 14.4% (p < 0,05). Continous treatment resulted in a decrease of this index from the initial by 28.9% (p < 0,05), i.e. up to 8,09 ± 0,89 mmol /1. However, after the treatment plasma MDA level in these women was by 35.5% (p < 0,05) higher than in healthy pregnant women. The dynamics of changes in erythrocyte MDA levels in combination therapy in pregnant women with exacerbation of chronic pyelonephritis was of unidirectional change of plasma MDA. By the 3rd day of the treatment the reduction by 12.4% (p < 0,05) of this secondary lipid peroxidation products in examined pregnant women was reported. However, by the end of the treatment there was a reduction of erythrocyte MDA levels by 31.4% (p < 0,05) with respect to the initial index and its value was 22,22 ± 3,89 mmol /1, which was higher than in the control group by 43, 6% (p < 0,05). However, there were no changes in catalase activity of blood on the 3rd day of the treatment with IKLI patients with chronic pyelonephritis. By the end of the therapy, the activity of this enzyme in the blood increased by 10.7% (p < 0,05) in comparison with its initial activity, but the level of catalase - 2273,73 ± 181,23 nkat / min /1 - remained by 21,4% (p < 0,05) lower than normal index. Thus, the addition of basic therapy with Essentiale and infrared laser light helps to eliminate endotoxemia by reducing lipid peroxidation and improving antioxidant protection.