THE AIM of the study was to investigate incidence of uremic pruritus and factors influencing the intensity of pruritus in hemodialysis patients. PATIENTS AND METHODS. 230 patients on chronic bicarbonate hemodialysis (Males/Females = 128/102) were investigated. Mean age of the patients was 50.8 ±11.9 (M±SD) (20-80 years), mean dialysis duration – 82 ± 66.8 months. The intensity of pruritus was assessed by a questionnaire scoring method (sum of scores of the pruritus intensity, distribution and frequency) and by a visual analog scale. Standard clinical and biochemical parameters were investigated in all patients. Echocardiography and bone densitometry (dual energy X-ray absorptiometry) were made in part of the patients. Medical and dialysis therapy were assessed. RESULTS. Uremic pruritus was frequently noted in hemodialysis patients: 63% of the patients complained of pruritus in the time of investigation and 13% - in the past. Pruritus was mild in the majority of the patients. The most frequent localization was the back. The factors negatively influencing the intensity of pruritus were revealed: older age (t=2.21; p= 0.028), higher serum calcium (t=2.08; p= 0.039) and creatinine before dialysis (t=2.38; p=0,018), low bone mineral density of forearm (t=2.91; p= 0.0058), X-ray changes of the thoracic aorta (sclerosis and calcification, t=3.04; p=0.03), in patients with stenocardia, especially in a severe form (t=2.72; p= 0.007), the presence of dyspnoe (t=2.68; p=0.008), use of the dialysers sterilized with ethylene oxide (t=2.62; p=0.001). CONCLUSION. Uremic pruritus frequently occurs in patients on hemodialysis. The factors responsible for severity of pruritus are older age, impaired calcium-phosphorus balance (higher serum calcium before diaslysis, low bone mineral density), higher azotemia, cardiovascular pathology (stenocardia, dyspnoe, X-ray changes of the aorta), use of dialysers sterilized chemically.

THE AIM of the investigation was to evaluate the influence of thiol-containing substance DMPS on the reduction of plasma total homocysteine (Hcy) concentration in hemodialysis (HD) patients. PATIENTS AND METHODS. A four-week long open controlled prospective investigation was carried on to compare the effectiveness of monotherapy with group B vitamins and combined therapy with sodium 2,3-dimercapto-1-propanesulfonate (DMPS) in combination with group B vitamins in relation to a decrease of the concentration of total Hcy in blood plasma of chronic HD patients. In the main group patients (n=20) a HD session with a subcutaneous (n=10) or intravenous (n=10) injection of DMPS was followed by an intravenous injection of calcium folinate and vitamins B 12and B 6 . In the control group consisting of 20 patients only a course of group B vitamins was performed. RESULTS. A session of standard HD resulted in a 32± 8% less level of plasma Hcy. A more pronounced decrease of Hcy after HD was observed following a subcutaneous (by 56±17%) and intravenous (by 57±10%) injection of DMPS. The calculated Hcy excretion was 62.3±29.2 мmol for a standard HD session and 224.0±57.0 мmol for the HD session preceded by a subcutaneous injection of DMPS. The 4 week-long course of group B vitamins resulted in a decreased level of Hcy at an average by 43±19% (30.5±12.3 мmol/l before the course of treatment and 16.0±4.3 мmol /l after the course at an average).The same scheme of treatment after a single subcutaneous injection of DMPS resulted in a substantially more considerable reduction (normalization) of plasma Hcy: at an average by 65± 9%, from 27.4±5.3 мmol /l to 9.7±1.8 мmol/l . CONCLUSION. DMPS considerably increases excretion of Hcy during the HD session, results in a rapid and substantially decreased level of plasma Hcy and allows improvement of the effect of correction of hyperhomocysteinemia using group B vitamins.

THE AIM of the investigation was to analyze the course of morphologically confirmed forms of chronic glomerulonephritis (CGN) from its debut in childhood and adolescence to adult age, to assess the effects of clinical-laboratory symptoms of CGN debut on its further course. MATERIALS AND METHODS. The course of the disease was analyzed in 110 patients with a morphologically verified form of CGN with debut in childhood. The investigation took in consideration the premorbid background of the disease debut, hereditary factor, clinical and laboratory data of the medical documentation of the patients concerned with the course of the disease at its different stages. The maximum period of observations was 42 years. RESULTS. In the morphological structure of CGN prevailing was the mesangial-proliferative form (50.9%) and the lipoid nephrosis considered to be characteristic of the child age was found but in 10.0 % of patients. In 71 patients (65.6%) persistent arterial hypertension developed, in 39 (35.5%) patients CGN was diagnosed, lethal outcome took place in 10 patients (9.1%). No reliable influence of the morphological form on the course and outcome of CGN was revealed. However there was a correlation between the clinical-laboratory indices of the CGN debut and the appearance of persistent arterial hypertension, continuous recurrences of the disease, development of CGN. CONCLUSION. The investigation has shown an interrelation between the clinical-laboratory symptoms of the CGN debut and the character of the further course of the disease. The early predictors of the unfavorable development of CGN were also established.

THE AIM of the investigation was to comparatively assess the frequency of attaining the desired levels of lipids in chronic glomerulonephritis patients with hyperlipidemia known to be one of metabolic potentially modifying factors of progress of chronic glomerulonephritis, against the background of treatment with statins, fibrates and nicotinic acid as well as the influence of such therapy on certain laboratory indices and frequency of attainment of the terminal points. PATIENTS AND METHODS. The investigation included 36 primary chronic glomerulonephritis patients with a noncompromised function of the kidneys. The patients were divided into three groups depending on the hyperlipidemia phenotype. The first group consisted of 12 patients treated with statins, the second group (10 patients) treated with nicotinic acid, and the third group (14 patients) treated with phenofibrate. The total duration of the investigation was 25 months. RESULTS. The frequency of attaining the desired levels of lipids in the blood during 25 months of treatment was as follows: for statins – 66.7%, for fibrates - 57.1%, for nicotinic acid – 50%. The anti-inflammatory effect of statins manifested itself as a decrease of C reactive protein and diurnal proteinuria. Nicotinic acid facilitates the formation of hyperuricemia. Phenofibrate has hypouricemic, anti-inflammatory and fibrinolytic properties. CONCLUSION. The treatment with statins and fibrates, in a greater extent than nicotinic acid, allowed frequency of the development of chronic renal failure and arterial hypertension to be decreased, and the non-fatal myocardial infarction to be prevented.

THE AIM of the investigation was to define polymorphism of genes IL-4 in the promoter areas (C-590T) and IL-13 in the 4th exone (G4257A), NPHS1 in the 3rd exone (G349A), NPHS2 in the 5th exone (G755A) in patients with the nephrotic syndrome. PATIENTS AND METHODS. Studying the polymorphic markers of genes IL-4, IL-13, NPHS1 and NPHS2 was carried out in 74 patients with the nephrotic syndrome in the age from 1 through 18 years. All patients were divided into two big groups: the first group – 53 children with the nephrotic syndrome with minimal changes (NSMC) and the second group – 21 patients with focal-segmental glomerulosclerosis (FSGS). RESULTS. The authentic association of polymorphic marker IL-13 with NSMC (χ 2 = 7.64; p<0.05) and polymorphic markers NPHS1 (χ 2 = 6.25; p<0.05) and NPHS2 with FSGS was established (χ 2 = 9.18; p<0.05). CONCLUSION. The research has allowed revealing an association of various genetic markers with NSMC and FSGS and thus the hypothesis was confirmed about various pathogenetic mechanisms in the structure of the morphological forms in question.

THE AIM of the investigation was to study the variants of remodeling the heart and types of diastolic dysfunction of the left ventricle in patients with anomalies of the kidneys associated with the «dysplastic heart» and patients with a combination of anomalies of the kidneys, the «dysplastic heart» and chronic pyelonephritis. PATIENTS AND METHODS. The examined 114 patients with signs of non-differentiated dysplasia of the connective tissue (NDCT) were divided into 3 groups: 1. 30 patients with the «dysplastic heart» without renal anomalies and chronic pyelonephritis; 2. 64 patients with the «dysplastic heart» and renal anomalies; 3. 20 patients with the «dysplastic heart» and renal anomalies complicated by chronic pyelonephritis. Clinical-laboratory investigations, Echo-CG, USI were carried out in all the patients. RESULTS. The increasing number of pathological signs (from the «dysplastic heart» to kidney anomalies associated with the «dysplastic heart», and to a combination of kidney anomalies, «dysplastic heart» and chronic pyelonephritis) was accompanied by increasing transversal size of the left auricle, thickness of the myocardial walls, LV myocardium mass and ejection fraction. The probability of remodeling the heart in patients with kidney anomalies associated with the «dysplastic heart» is 18%; in 15% there was remodeling without HLV with prevailing concentric remodeling in every 10th case. When the kidney anomalies were complicated by chronic pyelonephritis the probability of remodeling was 64% and in 34% HLV was determined with the prevailing concentric model (29%). Despite the prevailing normal type of diastolic filling of the LV, in 13% of the patients with anomalies of the kidneys associated with the «dysplastic heart» an abnormal relaxation type is formed. The type of the abnormal relaxation of LV is prevailing in patients with anomalies of the kidney complicated by pyelonephritis and is found in 2/3 of patients. CONCLUSION. The importance of timely diagnosis of NDCT as kidney anomalies and the «dysplastic heart» is due to the presence of structural-geometric deviations which are the anatomical basis for more complex variants of remodeling of the heart formed when chronic pyelonephritis is present.

THE AIM of the investigation was to evaluate accuracy of performing the hemodialysis sessions in patients with different values of arterial pressure. PATIENTS AND METHODS. The effectiveness of hemodialysis performed in 95 patients was assessed by KT/V criterion and by the urea reduction ration. The degree of hydration was estimated by bioimpedansometry. RESULTS. Normal arterial pressure was revealed in half of our patients only. Only 33% of our patients had normal degree of hydration. But the strategy of hemodialysis was the same in patients with different arterial pressure. As a result, the number of hypotonic patients was considerably greater after hemodialysis. CONCLUSION. The strategy of hemodialysis sessions should be chosen individually that can be achieved using bioimpedansometry as a method of determination of the hydration degree.

THE AIM of the investigation was to study pharmacological properties of a renal herbal product made on the basis of an original methodological approach to creation of complex phytomedicines. The access means a combination of herbals with special reference to biologically active substances (BAS) found in them. MATERIALS AND METHODS. The pharmacological properties of the decoction of these herbals were studied in experiments in rats given the decoction for a long time. The effects on the kidney functions were estimated by the diurnal diuresis and excretion with urine of creatinine, sodium and potassium. Antiinflammatory properties were estimated on models of carraginin edema of the rats’ pads and cotton granulomas. Antioxidant activity was estimated by the indices of the antioxidant and prooxidant activity under conditions of the formalin edema of the rats’ hind pads. Antimicrobial activity of the herbal decoction was determined by a modified technique of St.Ph. XIth edition. RESULTS. An analysis of the herbal product has established its ability to increase urination, reduce the intensity of acute and chronic inflammatory reaction, influence the processes of free radical oxidation and suppress the development of gram-positive and gram-negative pathogenic microflora. CONCLUSION. The results of pharmacological and microbiological investigations have shown that the original herbal product can be considered a perspective means for prophylactics and treatment of inflammatory diseases of the kidneys due to its high effectiveness and complex action in experiments. The approach used is shown to be perspective in making herbal mixtures.

THE AIM of the investigation was to study the intensity of activation of the hypothalamic structure cells (VMH and LHA) after administration of cyclophosphamide (CPh) and attainment of possibility of a modulating effect of EHF irradiation of the skin on this process. MATERIAL AND METHODS. The work was carried out in 18 male Wistar rats weighing 250g. The detection of activation of the hypothalamus cells (by c[1]fos gene expression) following injection of CPh in dosage 20 and 40 mg/kg of body mass and EHF irradiation of the skin was made using an indirect immunohistochemical method. RESULTS. Different patterns of activation of VMH and LHA zones were shown after injections of different doses of CPh. Certain zones were established in which the cells reacted by c-Fos expression to the CPh dose of 20 mg/kg, while the dose 40 mg/kg resulted in activation of the cells of all the structures under investigation. The effect of EHF irradiation of the skin was observed as a decreased number of c-Fos positive cells but after 20 mg/kg of CPh. Greater doses had no grading effect of EHF irradiation of the skin. CONCLUSION. Activation of LHA and VMH cells was detected suggesting a possible participation of specific groups of neurons in the processes developing in the brain in response to administration of CPh. The modulating action of EHF irradiation of the skin was first shown on the degree of brain cell activation induced by administration of CPh.

THE AIM of the investigation was to improve the diagnosing and treatment of copulative disorders in patients with previously treated chronic prostatitis using a photo-vacuum-laser method in combination with medicine Impaza. PATIENTS AND METHODS. The investigations were carried out in 135 out of 432 patients with previously treated chronic prostatitis who had the diagnosis of cumulative dysfunction. The age of the patients was from 21 through 50 years (mean age 33.3±1.2 years). These 135 patients were divided into 2 groups. The first group included 74 patients treated only by the photo-vacuum-laser method with apparatus AMVL-01. The session duration was 20 minutes every other day. The course consisted of 15 procedures. The second group included 61 patients treated by a combination of the photo-vacuum-laser method with a simultaneous taking Impaza (one 0.3g tablet twice a day) every day during 12 weeks. The control group included 20 patients treated by traditional methods: ultrasound, diadynamic currents, electrophoresis etc. RESULTS. All the patients had poorer quality of adequate erections, longer time of sexual stimulation, «dull orgasm», less libido, the symptom of «expected failure», untimely ejaculation and periodical pains in the perineum. Duration of the disease was from 6 months to 3 years. In all groups before treatment the overall number of all components of the copulative cycle, the International index of the erectile function and the scale of symptoms of chronic prostatitis were low. The colored doppler mapping has revealed early symptoms of arterial and venous insufficiency in the vessels of the penis and prostate. In some patients mild androgen deficiency was detected. All the patients had impaired mobility of spermatozoa. An assessment of effects of the 3 methods of treatment in different groups of symptoms has shown that the earlier positive effect was obtained using the combined method as a better quality of erection, components of the copulative cycle, early increase of the linear speed of blood flow in the vessels of the penis, prostate, scrotum organs, higher concentration of the sex hormone and decreased levelsof gonadotropic hormones, normalization of secretion of the prostate, its better echostructure, greater concentration and mobility of spermatozoa and somewhat slower after monotherapy. The application of traditional physical methods did not give substantial improvements of the copulative function. CONCLUSION. A simultaneous combination of the photo-vacuum-laser method with medicine Impaza results in the reestablishment of the copulative function somewhat earlier in patients with previously diagnosed chronic prostatitis, prevents early symptoms of arterial and venous disorders in the vessels of the penis, prostate, scrotum organs, elevates the hormonal status, spermatologic indices acting and has no side effects.

THE AIM of the investigation was to analyze interrelationships between urodynamic indices and the indices showing the kidney function in patients with benign hyperplasia of the prostate (BHP). PATIENTS AND METHODS. In 291 patients (mean age 61.3±0.7 years) with BHP the ultrasonic investigation of the kidneys, determination of the level of blood serum creatinin and urea were made as well as a urodynamic investigation with uroflowmetry and miction cystometry (investigation “pressure-flow”). The level of glomerular filtration (Rehberg test) was determined in 63 BHP patients. The results of miction cystometry for determination of detrusor contractility and intravesical obstruction (IVO) were interpreted using the W.Shafer (1990) method with the determination of the bladder emptying index by the method of P.Abrams (1999). RESULTS. The strength of contraction of detrusor influenced the blood creatinin level after operative treatment of BHP (r=0.54; p=0.48). The interrelationship was found between strength of contraction of detrusor (r=-0.2; p= 0.047) and urea level, i.e. the less bladder contractility is accompanied by higher urea level. The presence and degree of IVO did not influence the concentration of creatinin and urea in the blood (r=-0.16; p=0.22; r=-0.02; p=0.89). The less detrusor contractility is accompanied by lower level of glomerular filtration (r=0.41; p=0.035) and widening of the calycle-pelvic system (CPS) (r=0.41; p=0.035). The widening of the calycle-pelvic system is also influenced by the detrusor pressure with maximal unstable contraction (r=0.52; p=0.01) and the bladder volume with maximal unstable contraction (r=0.44; p=0.035). At the same time no correlation was observed (r=0.06; p=0.74) between hyperactivity of the detrusor and the widening of CPS. CONCLUSION. It was shown that the functional state of the upper urinary pathways in BHP patients was influence by a decrease of the contractile ability and powerful unstable contractions of the detrusor with large volumes of the bladder ratherthan by the IVO degree.

THE AIM of the investigation was to improve the effects of treatment of patients with urolithiasis due to inclusion in the treatment complex of a method of electrotreatment: magnesium and thiosulfate electrophoresis. PATIENTS AND METHODS. The work was based on the results of observations of 104 patients with different forms of urolithiasis. The patients were divided into 2 groups. Under study was the dynamics of general clinical indices (content of phosphorus, calcium and magnesium in the blood and urine), the influence of complex therapy on the content of different crystals of salts in urine in different periods of treatment and processes of lithogenesis in the urine. RESULTS. The data obtained have shown high electrophoretic properties of ionized magnesium. The number of patients having crystalluria became less and the contingent of patients in whom crystals of mineral salts were not discharged with urine considerably increased. There appeared a greater number of patients in whom there was no process of active lithogenesis in the urine. CONCLUSION. The inclusion of the methods of electrotreatment in the complex treatment of urolithiasis patients considerably improved the effectiveness of treatment and exerted a prophylactic-antirecurrent action on the course of the disease.

THE AIM of the investigation was to study the distribution of nucleoli and argentophilic nucleolar organizers in the superficial transitional cell tumors of the bladder and to analyze the correlation of the obtained indices with recurrences of cancer and survival of the patients after surgical treatment. PATIENTS AND METHODS. The data of primary examination and dispensary observation were retrospectively studied in 22 patients with superficial transitional cell cancer of the bladder in whom transurethral resections (TUR) of the tumors were fulfilled. In addition to standard examination the sediment of urine taken before TUR was stained with 50% solution of AgNO3 , identified and the tumor cell nuclei were counted. The numbers of nucleoli were determined in the nuclei and the argentophilic granules in them were counted. The indices of the distribution of the signs studied were compared with the results of a histochemical investigation of the ablated tumor tissue as well as with the clinical findings obtained before operations and during the postoperative dispensary follow-up. RESULTS. The number of cell nuclei in the preparation proved to be associated with the number of nucleoli (p<0.001), and the argentophilic granules (p=0.001), the number of nucleoli - with the number of granules (p<0.001). Neither the number of nucleoli, nor the argentophilic granules were associated with the depth of invasion and degree of the cancer differentiation (p>0.1). Higher indices of the 5 year survival were noted in patients with less number of the argentophilic granules in the nucleoli (p=0.007), nuclei (p=0.023) and content of nucleoli in cell nuclei (p=0.062). Recurrence of cancer was observed more often in patients with great number of nuclei (p=0.057) and nucleoli (p=0.081). A short period without recurrences corresponded to a great number of the argentophilic granules (p=0.078) and more saturation with them in nucleoli (p=0.074). CONCLUSION. Investigation of the urine sediment using the method of silver impregnation provides additional information of belonging of patients with superficial transitional cell cancer of the bladder to groups of risk of recurrences and progression.

THE AIM of the investigation was to assess the effectiveness and safety of a new minimally invasive method of treatment of patients with calculi – extracorporeal shock wave lithotripsy. PATIENTS METHODS. Extracorporeal shock wave lithotripsy was used in 233 patients with renal calyx calculi. In 115 (49.3%) patients the calculi were found in the upper calyx of the kidney,in 80 (34.3%) – in the middle calyx, in 32 (13.7%) – in the lower calyx, in 6 (2.6%) patients there were calculi in the upper and middle calices. RESULTS. Complete destruction of the calculus of the renal calices after extracorporeal shock wave lithotripsy was diagnosed in 208 (89.3%) of the patients, partial – in 18 (7.7%) patients, the calculus was not destructed in 7 (3.0%) patients. Outcome of all fragments of the completely destructed calculus during 3 months after lithotripsy was noted in all patients with localization of the calculus in the upper calyx, in 87.3% of the patients with localization of the calculus in the middle calyx, and in 50% of patients with localization in the lower calyx. CONCLUSION. For the successful treatment of patients with nephrolithiasis with calculi localized in renal calices of great significance is the correct decision on the indications and contraindications for extracoreporeal lithotripsy.