THE ROLE OF ALIMENTARY OBESITY IN THE DEVELOP-MENT OF STRUCTURAL AND FUNCTIONAL CHANGES OF THE KIDNEY, HEART AND VESSELS

Today in the pathogenesis of many diseases there is a hormonal imbalance. Adipose tissue secretes a number of hormones that can adversely affect the cardiovascular system and the kidneys. Violation of the interaction between metabolic and immune processes (im-mune metabolism violation) can be a link between weight gain and other diseases. Today among the main factors of the progression of kidney damage in obesity are insulin resistance, dyslipidemia, changes of systemic and renal hemodynamics, renal tissue ischemia, auto- and paracrine effects of adipose tissue hormones. The accumulation of fat in the body contributes to the increased production of proinflammatory adipokines, in particular, leptin, resistin, adipsine, and also proinflammatory cytokines (TNF-α, IL-6, IL-1), and is accompanied by a decrease in the synthesis of anti-inflammatory cytokines (in particular, adiponectin and visfatin, which may lead to the development of chronic systemic inflammation. The unexplored role of the hunger hormone - Ghrelin in the pathogenesis of obesity remains. There is no consensus on the relationship between it and the hormonal and metabolic factors involved in the formation of obesity, changes in the lipid blood spectrum. There is evidence that low levels of ghrelin in the plasma are associated with insulin resistance and hypertension and may affect blood pressure. Resistin is considered as a prognostic marker for the development of atherosclerosis of the coronary arteries. Currently, resistin is now considered as a link between obesity, inflammation and atherogenesis, and is often a poor marker of metabolic disorders in patients with hypertension and CKD, regardless of the presence of obesity. In recent years, there are some publications where CRP is regarded as a "new" proatherogenic, pro-inflammatory adipokin. The hypothesis that fatty tissue, namely adipocytes, can be considered as a potential source of CRP, and its level in the blood - is correlated with BMI and the amount of visceral adipose tissue. An important pathogenetic role in the development of CKD belongs to interleukin-6, 10% of which is pro-duced by adipose tissue, and which is the main inducer of the synthesis of CRP. The content of IL-6 increases in proportion to the degree of obesity, and its high level in blood plasma reflects increased risk of cardiovascular desease. In recent years, the determination of the level of cystatin C as an alternative marker for assessing damage to renal tissue is common. There is evidence of a close relationship between the level of cystatin C and systolic pressure, the left ventricular myocar-dial mass index, and also the markers of inflammation. To not well-educated biomarkers of cardiac pathology belongs a tissue inhibitor of matrix metalloproteinase (TIMP-1). Recent studies have shown that matrix metalloproteinases and their inhibitors play an important role in the pathogenesis of connective tissue damage and its fibrosis in a variety of cardiovascular pathologies. There is evidence that the state of the TIMP-1 collagen matrix can be considered as a new independent prognostic marker of ischemic dysfunction of the myocardium, left ventricular fibrosis and cardiorenal damage.