Optimization of Treating Nonalcoholic Steatohepatitis with Obesity and Chronic Kidney Disease of the I-II Stages

The purpose of the study was to improve the treatment of non-alcoholic steatohepatitis with obesity and chronic kidney disease of the I-II stages by studying the effect of S-adenosylmethionine on the course of these pathologies. Material and methods. We examined 140 patients with non-alchoholic steatohepatitis with comorbid obesity of the 1st degree and chronic kidney disease of the 1st and 2nd stages. To determine the efficacy of the treatment, 2 groups of patients were randomized according to age, sex, degree of obesity, activity of the cytolytic syndrome of non-alchoholic steatohepatitis and the stage of the chronic kidney disease (chronic uncomplicated pyelonephritis with latent course in the phase of subsiding acute exacerbation). Control group (1) (72 patients) received a hypocaloric diet, metformin 500 mg twice daily, Essentiale H as a hepatoprotective drug (1 capsule 3 times a day), canephron (50 mg 3 times a day) during 90 days. The second group (2) (68 patients) received a hypocaloric diet, metformin 500 mg twice daily, canephron (50 mg 3 times a day), adenosylmethionine (Ahepta) (SAM) as a hepatoprotective drug (200 mg 3 times on a sublingual day) during 90 days. Results and discussion. In the dynamics of treating Adenosylmethionine (Agepta) (SAM), we noticed a significant increase in the liver protein function (albumen content in group 2 increased 1.3 times (p <0.05) versus 7.7% (p> 0.05) in group 1). The probable increase in the total protein content in blood increased 1.3 times (p <0.05) against 1.2 times in group 1, respectively, 3 months after treatment (p <0.05). Thus, SAM possesses powerful membrane-stabilizing properties, stably eliminates the manifestations of cytolysis, cholestasis, mesenchymal-inflammatory syndrome, increases the albumin-synthesizing function of the liver in patients with Nonalcoholic Steatohepatitis (NASH) and prevents the loss of albumins in the conditions of Chronic Kidney Disease of the I-II Stages. The obtained results showed that complex therapy of patients with non-alcoholic steatohepatitis with obesity and chronic kidney disease of the I-II stages, including S-adenosylmethionine, stably eliminates clinical manifestations of the disease, the intensity of cytolysis, cholestasis, mesenchymal-inflammatory syndrome, inhibits the progression of hepatic and renal dysfunction by optimizing the control of fibrosis of the liver and kidneys. Conclusion. Optimization of curing patients with non-alcoholic steatohepatitis with obesity and chronic kidney disease of the I-II stages, including S-adenosylmethionine, is superior to the correction of clinical syndromes of non-alcoholic steatohepatitis and chronic kidney disease.