THE AIM of the work was to study the dynamics of clinical manifestations of chronic heart failure (CHF) and structural-functional alterations in the myocardium in patients with chronic kidney disease (CKD) at the predialysis stage and during the first year of program hemodialysis. PATIENTS AND METHODS. The work included 65 patients (29 men and 36 women, mean age 43.1±11.1 years) with the IV-V stage CKD (NKF, 2002): the estimation of the findings of clinical and echocardiographic investigations was made at the predialysis stage and during the first year of hemodialysis according to the national recommendations on diagnostics and treatment of CHF (2003). RESULTS. At the predialysis stage of CKD CHF was diagnosed in 56 patients (86.2%): I stage in 19 (33.9%), IIA – in 28 (50.0%), IIB – in 9 (16.1%) patients. During the first year of program hemodialysis the diagnosis of CHF was abolished in 14 patients (25%), in 42 patients (75%) it was confirmed: I stage – in 22 (52.4%), IIA stage – in 17 (40.5%), IIB stage – in 3 (7.1%) patients. In all cases CHF became apparent as a diastolic dysfunction of the myocardium, in some cases – in combination with systolic (16.1% and 7.1% at the predialysis stage and in the first year of hemodialysis respectively). During the first year of renal-substitutive therapy the incidence of CHF was 21.6% less and made up 64.6% of cases. In the structure of CHF the Ist stage was prevailing, the shares of the IIA and IIB became 1.2 and 2.3 times less. CONCLUSION. The reversibility of main manifestations of CHF in patients with renal cardiopathy stresses the necessity of timely detection and adequate correction of risk factors of cardiac complications. It is expedient to use the criteria of severity of renal cardiopathy in the assessment of adequacy of treatment of CKD for solving the question of timely administration of program hemodialysis.

THE AIM of the investigation was to detect the factors substantially influencing the quality of life of patients with chronic renal failure using the method of main components. PATIENTS AND METHODS. The investigation included observation of 100 patients with chronic renal failure aged from 16 through 60 years: 70 patients with terminal stage of the disease treated by chronic program hemodialysis and 30 patients with conservatively curable stage of chronic renal failure. In addition to a complete clinical and instrumental examination used in the specialized nephrological clinic, the quality of life was investigated using questionnaire EORTC QLQ CORE 30, the state of the emotional-personal sphere was assessed by an abbreviated multifactorial inquirer test, by the scale of reactive and personal anxiety by Spilberger. RESULTS.The factor analysis of the variables obtained after a thorough examination of the patients (total number - 73) allowed establishment of 3 general factors: asthenic, remodeling of the heart and anxious. CONCLUSION.The quality of life of patients with chronic renal failure deteriorated under the influence of the above factors.

THE AIM of the investigation was to study possible involvement of hemopoietic stem cells in regeneration of the kidney in chronic glomerulonephritis (CGN) with different degrees of morphological activity of CGN. MATERIALS AND METHODS. The investigations were performed with the material of 64 nephrobiopcies of CGN patients. Pathomorphological assessment of CGN activity and degree of sclerosis was fulfilled by a semiquantitative method. The immunohistochemical investigation of nephrobioptates was carried on using monoclonal antibodies against α-smooth muscle actin (α-SMA), CD31, CD34 streptovidinbiotin method (LSAB-kit company, DAKO), α-SMC-actin marker of myofibroblasts synthesizing components of the connective tissue, CD31-marker of endothelium, CD34 – of the endothelium and hemopoietic stem cells. RESULTS.The number of cells expressing CD34 in 18.75% of cases under condition of minimal degree of CGN activity exceeded the number of cells expressing CD31. Expression of α-SMA by myofibroblasts was detected in 28%. In cases of mild degree of activity the higher expression of CD34 took place in 46.15% of cases. Myofibroblasts of α-SMA+ were found in all nephrobiopcies. In average activity of CGN the cell expression of CD34 was 50% higher than CD31. In high degree of activity the level of CD34 expression was equal to that of CD31. Possible participation in the regenerative response of hemopoietic stem cells was determined by difference of expression of CD31 and CD34. CONCLUSION. Hemopoietic stem cells with phenotype CD34+ can be involved in regeneration of the kidney in CGN.

THE AIM of the investigation was to study the state of serum, membrane lipids, processes of lipid peroxidation in patients with chronic pyelonephritis in the stage of remission. PATIENTS AND METHODS. In 267 patients with chronic pyelonephriis in the stage of remission lipid metabolism was assessed according to the amount of blood serum cholesterol, triglycerides, cholesterol of high density lipoproteins followed by a calculation of cholesterol of low and very low density lipoproteins, the level of the erythrocyte phospholipids and their fatty acid composition with a calculation of the indices of their metabolic transformationsas well as by the state of LPO-AOD with determination of malonic dialdehyde, general antioxidant activity of blood plasma. RESULTS. Patients with chronic pyelonephritis in the remission stage were found to have mild hypercholesterolemia, higher peroxidation processes, redistribution of membrane phospholipids were accompanied by reduced portion of phosphatidylcholine and sphingomyelin, increased phosphatidyl ethanolamine and phosphatidyl serine. In the composition of the fatty acids there was increased amount of palmitic, stearic acids, ω6 polyunsaturated fatty acids against the background of ω3 polyunsaturated fatty acids and general unsaturation of the membrane. Methods of clustered and factor analysis were used for the variants of lipid impairments being found. In each of them specific and most valuable indices of lipid metabolism and the degree of their weight load were determined that allowed assessment of the level of metabolic breakages in patients with chronic pyelonephritis in the remission stage. CONCLUSION. An investigation of indices of lipid metabolism in blood serum, lipid peroxidation processes, detection of the defects of the erythrocyte phospholipids spectrum and its fatty acid composition allows an assessment of the degree of lipid disorders in patients with chronic pyelonephritis in the stage of remission.

THE AIM of the work was to study the influence of lowprotein diet (LPD) with added ketosteril on biochemical indices of blood serum, arterial pressure, hypertrophy of the left ventricle myocardium of rats with experimental uremia. MATERIAL AND METHODS. The investigation was fulfilled in male Wistar rats subjected to 5/6 nephrectomy (NE). In two weeks after NE one group of the animals was given a standard diet (20.16% of animal protein), the other group was given a diet containing 10% ketosteril and 90% vegetable food. The control group contained sham-operated rats receiving a standard diet. RESULTS. The diet containing ketosteril was found to reduce the degree of uremia, phosphatemia, and prevents the development of hypocalcemia in rats with NE. In the animals given ketosteril the average arterial pressure and heart rate in 2 months after NE were not higher than those of control animals. Hypertrophy of the heart left ventricle was less pronounced than in the rats with NE given a standard diet. CONCLUSION. The results obtained confirm the fact of renoprotective effects of LPD with ketosteril. The data on cardioprotective influence of the diet including ketosteril are thought to be an additional ground in favor of expedience to use the substance in nephrological practice.

THE AIM of the investigation was to ascertain structural bases of dysfunction of the kidneys under conditions of hampered outflow of venous blood from these organs. MATERIALS AND METHODS.Modeling the congested plethora of the kidneys was fulfilled by creation of stenosis of the pulmonary trunk in 22 puppies. The animals were observed in the terms from 6 months through 2 years of age. Their kidneys were investigated histologically, stereometrically and morphologically. Material from 10 dogs of the corresponding age was used as controls. RESULTS. It was shown that constriction of the pulmonary trunk because of venous hyperemia of the kidneys with time leads to the appearance of a complex of adaptative and pathological alterations in their vascular system. The first ones manifest themselves as higher tone of the arteries, changes in some of them by a closing type, the second ones – in the development of sclerosis and hyalinosis of the renal vessels. The latter is followed by disturbed hemocirculation in the blood basin of the kidneys, and then glomeruli and nonvascular structures of the organs are impaired. Renal glomeruli are liable to sclerosis, while the renal parenchyma presented by a system of channels – to dystrophic and atrophic changes. On its place stroma grows. CONCLUSION. All this complex of morphological alterations is a precondition for disturbance of the kidney functions which is observed in the clinic of patients with severe forms of stenosis of the pulmonary trunk.

THE AIM of the investigation was to establish possible changes of renal effects of a continuous injection of furosemide against the background of permanently preliminarily administered chloramphenicol. MATERIALS AND METHODS. Experiments were performed in rats. The concentration of furosemide collected for 6 and 18 hours after injection was determined using HPLC, sodium and potassium – using the method of flame photometry. RESULTS. A 7 days intraperitoneal injection of furosemide (20) against the background of chloramphenicol (50 mg/kg/day per os) was followed by an increased diuretic effect and less strong weakening of its sodiumuretic effect as compared with experiments without chloramphenicol. The effects obtained were due to an increased renal excretion of the diuretic. The experiments have shown that a continuous injection of the diuretic was not followed by substantial changes of its excretion for the first 6 hours of the day cycle. Excretion of the drug during the following 18 hours was gradually increasing for the whole period of observation. These changes of the diurnal dynamics were responsible for the 1.5 times increased excretion of furosemide with urine which in particular resulted in an increase of its diuretic effect. And more than 85% of the diurnal excretion of sodium took place within the first 6 hours after injection of furosemide and was accompanied by a comparable value of its excretion. Excretion of water and potassium during the day was more even. CONCLUSION. Under conditions of a continuous longterm administration of furosemide against the background of a permanent using of chloramphenicol there occurred 1.5 times greater diurnal excretion of furosemide with urine which gave its substantially increased diuretic effect.

THE AIM of the investigation was to study homeostatic reactions of the kidneys to water and salt loads of healthy and pregnant rats with toxic nephropathy. MATERIAL AND METHODS. The functional state of the kidneys was studied in not pregnant rats on the 20th day after injection of sublimate in dose 0.4 mg/100g of body mass and in pregnant rats on the 17-20th days under conditions of induced water (5% of body mass) and saline solution (3% solution of sodium chloride in the same volume). RESULTS. It was shown that in rats with physiological pregnancy the adaptation of the kidneys to salt load consisted in an increased rate of glomerular filtration with an involvement of nitrous oxide system judging by a 3 times greater excretion of endogenous nitritesand nitrates. In rats with sublimate nephropathy the filtration was not increased and excretion of nitrites decreased. The similar and even greater changes were detected in pregnant rats. CONCLUSION. It is concluded that reaction of the kidneys in non-pregnant and especially in pregnant rats with sublimate nephropathy is disturbed.

THE AIM of the investigation was to develop recommendations fo r choice of the method of treatment of patients with carcinomas of the urothelium. PATIENTS AND METHODS. A retrospective investigation of findings of primary examination and 5 year dispensary follow-up was carried on after radical surgical treatment of 452 patients with superficial and locally-spread carcinoma of the urothelium (urinary bladder - in 344 (76.1%), urinary bladder and urethra - 33 (7.3%), renal pelvis - 37 (8.2%), ureter - 23 (5.1%), renal pelvis and ureter - 15 (3.3%) patients respectively). The ratio of men and women was 3.2:1, mean age - 62.4±13.2 years. All patients underwent radical operative treatment. In addition to standard histological investigation of TNMG categories in tumor tissue the stroma effectors were calculated, an analysis of the parameters of distribution of nucleolus organizers and Ki-67 index was made. Survival of the patients with carcinoma of urothelium of the upper and lower urinary tracts after the first, third and fifth years of postoperative follow-up was 72%, 29%, 19%, and 91.7%, 77.8%, 68.6% respectively. Recurrences were found in the urinary bladder in 69% of the patients, the term of the appearance of recurrences was from 0.5 through 62 months and was at an average 11.9±1.8 months. RESULTS. High proliferative activity, invasive growth, low degree of differentiation, weakly pronounced stromal component and high degree of its infiltration by effectors, squamous cell cancer and adenocarcinoma in combination with the infiltrative character of growth, plurality and big sizes of tumors in patients older than 60 years, with impaired urodynamics and infected urinary tracts point to the highest risk of postoperative progressing and recurrences of carcinomas of the urothelium. Recommendations for choice of the method of treatment of such patients were developed depending on the significance of the risk factors. CONCLUSION. A complex approach in detection of prognostically unfavorable factors determining the risk of aggressive biological behavior of cancer after radical surgical interventions allows possible decision on the correct medical strategy in patients with carcinomas of the urothelium.