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Nephrology (Saint-Petersburg)

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Vol 9, No 1 (2005)
View or download the full issue PDF (Russian)
https://doi.org/10.24884/1561-6274-2005-9-1

LEADING ARTICLE

REVIEWS AND LECTURES

20-28 1323
Abstract
Leptospirosis and acute renal failure.

ORIGINAL ARTICLES. CLINICAL INVESTIGATIONS

34-38 438
Abstract

THE AIM of the investigation was to assess the effects of age on the parameters of systemic arterial pressure (AP) in a group of patients treated by hemodialysis (HD). PATIENTS AND METHODS. Under examination there were 252 patients on chronic HD. The average duration of HD was 62±53 months. Primary renal pathology was presented by chronic glomerulonephritis (68%), polycystosis of the kidneys (9%), malformations of the urinary tracts (7%), interstitial diseases (16%). Mean values of the age in the group under examination were 42.9±12.7 years (1974 years, 95% confidence interval 41.444.5 years). RESULTS. A comparative analysis of mean values of systolic (SAP), diastolic (DAP), average (APaver) and pulse AP (PAP) has revealed that AD (PAP excluded) has lower values in the group of elderly patients of 6074 years of age, and the highest values  among the patients of 1944 years of age. The AP values in 4559 year old patients were intermediate (all Panova <0.005). A clear negative dependence was found between the current age of the HD patients and the values of SAP, DAP and APaver(all p<0.001). PAP did not depend on the age (r=0.107, p=0.09). By the data of multiple regressive analysis the age was included in the group of independent and reliable predictors of the APaver level (β=0.269, p=0.0003) along with the duration of the dialysis therapy (β=0.311, p=0.000021), duration of the HD procedure (β=0.241, p=0.0007), the aorta diameter (β=0.176, p=0.0189) and the calciumphosphate product (Ca* P) (β=0.154, p=0.0274). The same analysis used for SAP and DAP gave similar results with the retained high reliability of the final regression model (R2 =0.324, p=0.0001 and R2 =0.313, p=0.0001, respectively). PAP was determined by the duration of HD treatment (β=0.3, p=0.00002), average duration of the HD procedure (β=0.19, p=0.008) and Ca* P (β=0.2, p=0.005). CONCLUSION. The data obtained need additional investigations in order to specify the mechanisms of agedependent change of AP and show a more careful approach to be necessary to its control in patients of the middle and elderly age including pharmacotherapy and choice of the HD regimen.

39-46 1090
Abstract

THE AIM of the investigation was to analyze effects of nonimmune methods of treatment for chronic glomerulonephritis on parameters of activity of renal immuneinflammatory process, evaluation of efficacy and safety of such therapy. PATIENTS AND METHODS. The examined 1310 patients with chronic glomerulonephritis with normal function of the kidneys were divided into 9 groups: 1 375 patients receiving treatment with inhibitors of angiotensin converting enzyme; 2 27 patients receiving blockers of receptors of angiotensin2; 3 193 patients receiving blockers of calcium channels of verapamil or diltiazem group (retard verapamil 180240 mg/day or diltiazem 90240 mg/day); 4 536 patients treated with dipiridamol 150400 mg/day; 5 51 patients receiving nonsteroid antiinflammatory drugs nimesulid 100 mg 2 times a day or celecocsib 100 mg 12 times a day; 6 17 patients treated with statins (lovastatin 1040 mg/day or simvastatin 2040 mg/day or athorvastatin 2080 mg/day); 7 25 patients treated with cod liver oil 1500 mg/day; 8 12 patients given ticlopidin 500 mg/day; 9 47 patients given vitamin E. Investigation of diurnal proteinuria, fibronectinuria, creatininemia, cholesterinemia, triglyceridemia, kaliemia, finrinogenemia and glomerular filtration rates was carried out in all patients prior to the beginning of treatment and within 7.5 month after the beginning of therapy. RESULTS. Inhibitors of angiotensin converting enzyme, blockers of angiotensin2 receptors, blockers of calcium channels, dipiridamol, ticlopidin and nonsteroid antiinflammatory drugs have an ability to decrease the degree of proteinuria. All antihypertensive drugs under study can lower the fibronectin level in urine that is evidence of processes of inhibition of sclerosing renal interstitium. Blockers of angiotensin2 receptors, blockers of calcium channels of the verapamil or diltiazem group, statins and fish oil decreased the parameters of lipidemia in different degrees. Blockers of angiotensin 2 receptors and ticlopidin accelerated the glomerular filtration rate and decreased fibrinogenemia. When inhibitors of angiotensin converting enzyme were used the augmentation of creatinine concentration in blood serum was noted. Inhibitors of angiotensin converting enzyme and nonsteroid antiinflammatory drugs caused the development of hyperkalemia. The most frequent side effects of treatment were: tussis, transitional hyperazotemia and hyperkalemia when inhibitors of angiotensin converting enzyme were used; headache was caused by dipiridamol; nonsteroid antiinflammatory drugs caused interstitial nephritis, gastropathy and liquid retention; statins caused myopathy; ticlopidin neutropenia and hemorrhagic diathesis. CONCLUSION. Groups of medicines used in the work had favorable effects upon different pathogenetic nonimmune mechanisms of progression of glomerulonephritis.

47-51 347
Abstract

THE AIM of the research was to determine the role of morphologic and metabolic features of erythrocytes in patients suffering from initial chronic pyelonephritis depending on the severity of disease and to substantiate the methods of correction of the impairments revealed. PATIENTS AND METHODS. Under observation there were 96 patients suffering from chronic pyelonephritis in the phase of exacerbation. Among them there were 29 men and 97 women aged 18 to 52 years. The control group consisted of 30 healthy subjects of the same age and gender. Special research methods included an analysis of functional condition of enzymes of the cationic transmembrane transport in erythrocytes and determination of osmotic and acidic erythrocyte resistance. RESULTS. It was found that in the active phase of chronic pyelonephritis a suppression of adenosine triphosphate activity in erythrocyte membranes was noted which was more pronounced in severe and middle degree of severity disease. Most considerable changes could be seen in NaKATphase. The active phase of chronic pyelonephritis with marked clinical manifestations was accompanied by a decreased erythrocyte osmotic and acidic resistance. The biochemical tests used can be proposed for quantitative verification of prognosis of the severity and possible complications in patients with the severe and middle degree of severity disease. CONCLUSION. The use of preparations having a stabilizing effect on membranes can minimize the severity of the lesions and prevent complications.

52-57 363
Abstract

THE AIM of the investigation was to study the morbidity and etiology of infections of the urinary system (IUS) in children of the industrial center of the West Siberia. PATIENTS AND METHODS. The demographic indices on the total number of children under 14 years inclusive and birth rate are presented according to the following document: «Main indices of the medical maintenance of the population and work of health institutions» of the Health Department of Administration of the city of Omsk for 19922003. The cases of the established morbidity of IUS were analyzed by the results of work of the nephrological department of the city children clinical hospital N3 and the city perinatal clinical center of Omsk. The bacteriological investigation of urine and identification of the isolated microorganisms was fulfilled according to the order N535 of Health Ministry of the USSR of 1985. RESULTS. The demographic indices in Omsk for 19922003 were characterized by a substantially reduced total number of children under 15 years and at the same time an increased pathology of the urinary organs, infections of the urinary system included. In 2002 and 2003 there was a considerably increased birth rate and, at the same time, sharply increased morbidity of the new born children with infections of the urinary system. For the last 5 years the rate of IUS in the structure of the pathologies in the newborns became 5.5 times higher, and in terms of 1000 newborns 6.5 times higher. The results of a bacteriological examination show that a substantially decreased etiological role of E.coli and higher frequency of isolation of other microorganisms from the family of Enterobacteriaceae (Proteus, Klebsiella, Enterobacter) and Grampositive microflora took place. The microplasma infection was found in more than 60% of patients of all age groups. CONCLUSION. The increased growth of diseases of the IUS in children is observed. In the etiological structure of IUS there appeared a phenomenon of supplanting of E.coli by other representatives of the family of Enterobacteriaceae and Grampositive microflora. The role of an intrauterine infection of children is growing as the primary cause of IUS, the mycoplasma infection included.

58-62 701
Abstract

THE AIM of the investigation was to reveal the features of immunopathogenesis of different clinicomorphological variants of chronic glomerulonephritis (CGN) and to assess the indices of cytokines in blood serum depending on the level of proteinuria and the concentration of blood creatinine. PATIENTS AND METHODS. The indices of the cytokine profile were investigated in 65 patients with different clinicomorphological variants of CGN and the dependence of these indices on the level of proteinuria and blood creatinine. RESULTS. The investigations have revealed a cytokine disbalance in CGN patients. The cytokine disbalance was most considerable in patients with membrane proliferative glomerulonephritis. In addition, the CGN patients with creatininemia had a higher level of the tumor necrosis factor in blood serum. CONCLUSION. The data obtained show that there are specific features of immunopathogenesis of different variants of CGN and make a basis for searching new ways for treatment of this disease.

63-68 268
Abstract

THE AIM of the study was to perform a comparative investigation of effects of the low power laser irradiation (LPLI) with the wave length 632,2 nm on mechanical activity of cardiomyocytes of rats given definitive feeding. MATERIAL AND METHODS. An analysis of effects of LPLI on contractility of the myocardium of rats given water with normal and low content of calcium and magnesium under conditions of isometric and physiological regimens of mechanical loads. RESULTS. The rats given water with the normal content of calcium (125 mg/l) and magnesium (45 mg/l) demonstrated increased contractility of the myocardium followed by a relaxation at all endsystolic lengths as compared with the parameters registered in the animals with the low content of calcium and magnesium (Petersburg urban water). LPLI caused an increased contractility of the myocardium and growth of the relaxation rate in the rats with a relatively low mechanical activity (animals given the Petersburg urban water) and did not influence the contractility of the myocardium of the rats characterized by a relatively high initial mechanical activity (given water with the normal content of calcium and magnesium). CONCLUSION. The results of the investigation have shown that the continuous consumption by rats of water with normal content of Ca and Mg, in in vivo experiments and a direct irradiation of the myocardium of rats given water with the normal content of Ca and Mg, LPLI experiments in vitro, give the same effect. The myocardium mechanical activity is recovered providing the classical dependence frequency. In addition, LPLI does not appear to change the optimal characteristics of both the myocardium mechanical activity and the rhythm inotropic relations in the rats given water with normal content of Ca and Mg. Evidently, the myocardium of these animals is characterized by activation of the processes of Ca+2 transport responsible for the effect of the action of HeNe laser.

69-74 405
Abstract

THE AIM of the investigation was Doxorubicin (DOX) as a widely used anthracycline antibiotic. Administration of DOX is limited due to cardio and renal toxicity because of oxidative stress. Our aim was to investigate early nephrotoxic effects of a single dose of DOX and impact of pretreatment with melatonin, glycine and unithiol. MATERIAL AND METHODS. The animals (35 rats) were divided into 5 groups. One group (Cgroup, n=7) was a control, one group (DOXgroup, n=7) received DOX (7.5 mg/kg, i.p.), one group (Mgroup, n=7) was pretreated with melatonin (1mg/kg, i.v.), one group (Ggroup, n=7) was pretreated with glycine (50 mg/kg, i.v.), one group (Ugroup, n=7) was pretreated with unithiol (5 mg/kg, i.v.).The rats were decapitated within 24 hours. The content of glutathione (GSH), glutathione reductase, NAD(P)H:quinone oxidoreductase, glutathioneStransferase and protein carbonyl group in the homogenate of renal mass were detected. RESULTS. Less concentration of GSH was detected in the renal tissue in the DOXgroup as compared with the Cgroup of rats. There were lower levels of GSH in DOXgroup as compared with Mgroup. Activity of glutathione reductase was lower in the DOXgroup than in the Cgroup. There was no difference in the content of protein carbonyl groups. Pretreatment with melatonin and glycin resulted in normalization of GSH levels. CONCLUSION. It was shown that pretreatment with melatonin and glycin reduced the DOX induced renal damage in rats by means of restoration of GSH in the renal tissue.

JOURNAL IN THE JOURNAL. ACTUAL PROBLEMS OF UROLOGY

75-78 1002
Abstract

THE AIM of the investigation was to determine the possibilities and place of different minimally invasive methods of treatment of liquid formations in the retroperitoneal space. PATIENTS AND METHODS. A statistical analysis of results of treatment of 241 patients with cysts of the kidneys was carried out. Among them there were 158 patients with sclerotherapy, 64 with endovideosurgical operations. A comparison was made with the results of 19 open operations. RESULTS. Puncture treatment of the cysts was favorably different from the operations by the invasion parameters, but due to their being not radical repeated manipulations are necessary during the first month in 9.5% of cases and during the first year in 29.7%. In addition, relapsing cysts after puncture treatment can appear almost in 14% of cases, the number of recurrent cysts increases if there appear such signs as enlarged capsule, multy chambered, heterogeneity of the contents etc. The duration of endovideosurgical operations (EVS) is close to that of traditional ones, but their advantage is the lack of blood loss, good postoperative period and shortest time for recovery. Practically there are no relapses and repeated manipulations are not necessary. CONCLUSION. Puncture of the cyst with sclerotherapy is good as a method of choice for simple onechamber cysts of the kidney with the diameter not more than 6 cm, with clear smooth contours, thin walls and homogeneous internal structure, if the puncture channel goes extrarenally or extraperitoneally. The endovideosurgical operation can be used for any cystic formation of the kidney if there are indications for operative treatment. Traditional open operation can be used but when puncture and EVS operation are either contraindicated or impossible.

79-82 312
Abstract

THE AIM of the investigation was to improve results of medicamental treatment of patients with benign hyperplasia of the prostate (BHP) with medicines of vegetable origin. PATIENTS AND METHODS. Medicines of vegetable origin containing extracts of palm Serenoa repens were used in treatment of 425 patients with BHP. The preparations were given for 16 weeks to 110 patients, and during 2 years and longer to 235 patients. RESULTS. It was found that in the patients of the first group the effect was of short duration and minimal, while the patients of the second group demonstrated a stable positive effect characterized by a considerably decreased both subjective and objective symptoms of the disease. It was proved that prolonged (during 2 years) treatment of BHP patients with the preparations of the fan palm caused reliable changes to the morphological structure of the prostate characterized by a decrease of proliferative activity of both the epithelium and the interstitial tissue. CONCLUSION. The preparations containing the lipidosterole extract of the fan palm may be recommended for treatment of BHP patients with initial and mild subjective and objective symptoms of the diseases but the duration of the treatment must be long (2 years and longer).

83-88 381
Abstract

THE AIM of the investigation was to study the number and composition of cellseffectors of the urinary bladder carcinoma stroma, to compare them with the depth of invasion, differentiation degree, of cancer and survival of the patients. PATIENTS AND METHODS. The data of a primary examination and a fiveyear dispensary followup after radical surgery of 60 patients with transitional cell carcinomas of the urinary bladder (TaT4, NX, M0) were investigated retrospectively. The ratio of men and women was 3.3:1, mean (±SD) age was 63±1 years. In addition to the standard morphological investigation with magnification 600ґ in 7 fields of vision the stroma effectors were counted. Fiveyear survival without progression was 63%, recurrences was noted in 62% of cases. RESULTS. The number of effectors increased with the increase of cancer invasion (p=0.057); in tumors pTa there was less number of lymphocytes (p=0.020) and macrophages (p=0.024). In G1 carcinomas there were fewer plasmatic cells (p<0.001) and macrophages (p=0.009), while in tumors G3 there were more eosinophilic leukocytes (p=0.026). There were more recurrences of tumors with a great number of stroma lymphocytes (p=0.057), and carcinomas pTapT1 also with a less number of segmentonuclear lymphocytes (p=0.042). Fiveyear survival of the patients was characterized by a less number of effectors (p=0.007) and, in particular, of lymphocytes (p=0.024) and segmentonuclear leukocytes (p=0.037). The multiple regression analysis has shown that the leading signs associated with the survival proved to be the invasion depth (p=0002), SD of the mast cells (p=0.041) and number of the lymphocytes (p=0.070) of the stroma. The differentiation degree did not reach the reliability threshold. In the subgroup pTapT1 the determination of the probability of fiveyear survival by the calculation of the number of the segmentonuclear leukocytes (p=0.009) and lymphocytes (p=0.025) of the stroma was more exact (R2  =0.32; p=0.008) as compared with using traditional characteristics  pT and G (R2=0.29; p=0.022). CONCLUSION. An analysis of the stroma effectors of transitional cell carcinomas allowed additional prognostic information to be obtained that can be a prerequisite for recommendation of the corresponding regimens of measures of treatment and postoperative followup.

PROGRAM ON CONTINUOUS POSTGRADUATE EDUCATION ON NEPHROLOGY

89-94 286
Abstract
Prognosis of the effectiveness of enterosorption in chronic renal failure.

PRACTICAL NOTES

95-97 369
Abstract
A case of ultrasound diagnosis of necrotic papillitis.

QUESTIONS AND ANSWERS

98-100 305
Abstract
Specific features of medical strategy in the treatment of acute renal failure.

DISCUSSION AND INFORMATION

101-105 428
Abstract
Multiples of dialysis. The new or... the forgotten old?
106 208
Abstract

The list of dissertations on nephrology and adjacent fields for 2004.

HISTORY OF MEDICINE

108-110 340
Abstract
A.M.Balabanov – a founder of national hemodialysis technology.
111-112 232
Abstract

Vladimir Nikolaevich Tkachuk (to his 75th birthday).



ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)