Conception of chronic kidney disease in pediatrics.

Modern convection methods of therapy of chronic renal failure patients. Communication II.

Blockade of renal mineralcorticoid receptors: a new approach to nephroprotective therapy of hypertensive patients with chronic kidney disease.

THE AIM of the investigation was to assess the incidence and prevalence of chronic kidney disease (CKD) of the IVV stage in the Republic of Tuva. PATIENTS AND METHODS. A population investigation was performed in the Republic of Tuva from 01.07.2003 through 30.06.2004 in order to determine the incidence and prevalence with the IVV stages of CKD. RESULTS. A prevalence of the IVV stage of CKD among the population of Tuva proved to be rather high and equaled 493 cases/mln. Incidence with the IVV stages of CKD was 206 patients/mln for the whole population and 277 patients/mln for the city of Kyzyl. The incidence and prevalence with the IVV stages of CKD (GFR<30 ml/min or substitution renal therapy) was somewhat greater in the city than in the rural area. The total number of patients given substitution renal therapy (98% hemodialysis) is126 patients/mln. CONCLUSION. The prevalence of marked stages of CKD among the population of the Republic of Tuva is rather high and comparable with the world tendencies. The incidence and prevalence of IVV stages of CKD in the region under study is sufficiently higher than in the European part of Russia. In the Republic of Tuva as well as in other subjects of the Russian Federation, further accumulation of resources of the nephrological service is necessary for the improvement of early detection, prophylactics, quality and volume of the conservative and substitution therapy of CKD.

THE AIM of the investigation was to make a comparative analysis of two approaches to the diagnosis of diastolic chronic heart failure in patients with chronic kidney disease at the predialysis stage by means of exclusion of the systolic dysfunction and by a compulsory confirmation of a diastolic dysfunction by the method of Doppler echocardiography. PATIENTS AND METHODS. Ninety two predialysis patients (48F, 44M, mean age 49.8±13.9 years) having chronic kidney disease of the IIV stage according to NKF Guidelines (2002) were examined. All the patients had clinical symptoms of chronic heart failure (CHF). Echocardiography and Doppler echocardiography were fulfilled by the same investigator. The diastolic dysfunction was diagnosed according to the state of the transmitral flow and the velocity of spreading the early diastolic flow of the left ventricle by color Mmode Doppler echocardiography. RESULTS. Hypertrophy of the left ventricle was diagnosed in 70 (76.1%) patients. Ejection fraction was lower than 45% in 7 (7.6%) patients, 68 (73.9%) patients had the diastolic dysfunction. In 15 (16.3%) patients the diagnosis of CHF was excluded after examination, the clinical symptoms were due to other causes (anemia etc). CONCLUSION. The diagnosis of diastolic CHF in patients with chronic kidney disease by exclusion of the systolic dysfunction only leads to hyperdiagnostics of CHF. So, in patients with the saved systolic function it is necessary to control the diastolic function by the method of Doppler echocardiography including additional measures for normal and pseudonormal types of transmitral blood flow.

THE AIM of the investigation was to assess the effects of the antioxidant drug Triovit on the state of lipid peroxidation processes in platelets, antioxidant protection, plateletvascular hemostasis and clinical course of pyelonephritis. PATIENTS AND METHODS. Observations were performed in 96 patients with chronic pyelonephritis in the phase of exacerbation. The patients aged from 18 to 50 years were divided into 2 groups including 48 patients each (9  the first degree of activity, 25  the second and 14  the third degree). The first group was treated by a common medicinal treatment including antibacterial, uroseptic drugs and means improving microcirculation. The second group was additionally given Triovit (1 capsule twice a day) during the whole period of staying the patients at the hospital. A control group consisted of 15 practically healthy subjects of the same age and gender. Effectiveness of Triovit in the complex treatment of chronic pyelonephritis patients was assessed by clinical parameters and results of laboratory investigations: into consideration were taken duration and intensity of the pain syndrome in the lumbar area, temperature reaction, symptoms of intoxication and dysuric phenomena, degree of leukocyturia, proteinuria, bacteriuria and the intensity of lipid peroxidation processes and the state of the plateletvascular hemostasis system. RESULTS. Inclusion of Triovit in the complex treatment of chronic pyelonephritis patients suppressed excessive freeradical oxidation, corrected activity of antioxidant protection and facilitated normalization of the plateletvascular link of hemostasis. Positive clinical effect of Triovit was established: reduced intensity and duration of the temperature reaction, pain syndrome, dysuric phenomena, symptoms of intoxication, leukocyturia, bacteriuria, proteinuria (p<0.05). During the treatment no side reactions or drug intolerance were noted. CONCLUSION. Positive antioxidant and rheological properties of Triovit as well as its safety are considered to be a sufficient reason for including it in the complex therapy of patients with chronic pyelonephritis.

THE AIM of the investigation was to assess the significance of annexin5 (An5) at the preclinical stage of atherosclerosis in patients with chronic kidney disease. PATIENTS AND METHODS. Under investigation there were 46 patients with CKD without clinical manifestations of atherosclerosis. The parameters of lipidogram, complex intimamedia thickness, endothelial dysfunction and the An5 level were determined. RESULTS. The decreased GFR was followed by an increased An5 level. Its concentration was interconnected with the lipidogram indices. The increased level of annexin5 is accompanied by the most pronounced dysfunction of the endothelium. CONCLUSION. The elevated level of An5 in CKD patients’ blood is especially informative with the absence of clinical symptoms of atherosclerosis and points to the vasomotor form of endothelial dysfunction. The dynamic detection of An 5 can improve the prognostic value of probable cardiovascular problems in patients with CKD.

THE AIM of the investigation was to compare the hypotensive and renoprotective efficacy of different regimens of taking inhibitors of angiotensin converting enzyme and blockers of angiotensin2 receptors. PATIENTS AND METHODS. 152 patients with chronic glomerulonephritis were examined. The patients were divided into groups depending on the regimen of treatment. Before treatment, at the stage of discharge from hospital and 2.5 years later the assessment of clinicolaboratory manifestations of glomerulonephritis and effects of therapy on the markers of progression of the disease was performed. RESULTS. The maximal antiproteinuric effect was noted after a combined administration of two classes of drugs (especially in combination of perindopril with irbesartan). Hypouricemic ability of losartan and irbesartan was revealed which potentiated when combined with perindopril. The needed figures of pressure were obtained more often by the combined treatment than by using each class separately. Monotherapy and combinations of the drugs failed to influence the degree of hyperlipidemia. The most often causes of discontinuation of taking the inhibitors of the angiotensin converting enzyme were cough, hyperkalemia and hypercreatininemia. Hyperkalemia appeared more often in combined treatment than in monotherapy. The combined therapy facilitated greater frequency of dipper and overdipper, and a reduction of prognostically unfavorable types of hypertension such as nightpeaker and nondipper. CONCLUSION. Combined therapy with inhibitors of angiotensin converting enzyme and angiotensin2 receptor blockers gives a better hypotensive and renoprotective effect in treatment of patients with chronic glomerulonephritis than administration of each class of the drugs separately.

THE AIM of the investigation was to assess the effects of βadrenoblockers on certain clinical and laboratory markers of progressing chronic glomerulonephritis. PATIENTS AND METHODS. Under observation there were 125 hypertensive patients with chronic glomerulonephritis. The patients were divided into 2 groups: 62 (49.6%) of them were included in the first group with the saved function of the kidney and 63 (50.4%) patients with the reduced function made up the second group. The groups were divided into subgroups depending on the given βadrenoblocker. The distribution of the patients in the subgroups was fulfilled with special reference to specially developed criteria taking into account the maximal similarity of the clinical, morphological and laboratory course of the disease. Diurnal proteinuria, glomerular filtration rate, glomerular permeability index, degree of albuminuria, general peripheral vascular resistance were investigated before treatment, at discharge from hospital and within 86 months after beginning the treatment. Total cholesterol and triglycerides were determined. The diurnal index was calculated, the arterial hypertension type was determined. RESULTS. Carvedilol and Nebivolol increased the glomerular filtration rate in patients with saved function of the kidney and decreased the general peripheral vascular resistance. Carvedilol in both groups had hypolipidemic properties. Pindolol in patients with saved function of the kidneys and Nebivolol and Pindolol in patients with reduced function of the kidneys decreased the glomerular filtration rate. The necessary figures of pressure in the first group were obtained in 50% of patients treated with Metoprolol, in the second group in 25% of patients treated with Nebivolol. Metoprolol and Nebivolol in the first group caused excessively decreased nocturnal pressure. βadrenoblockers increased occurrence of favorable types of hypertension (nightpeaker and dipper) in patients with saved function of the kidney. In patients with renal failure Pindolol increased the frequency of the development of noncontrolled nocturnal hypertension (nightpeaker type). CONCLUSION. Specific properties of pharmacodynamics of the medicine should be taken into account when choosing βadrenoblocker for treatment of patients with chronic glomerulonephritis.

THE AIM of the work was to investigate immunological characteristics of children with chronic glomerulonephritis (CGN) associated with hepatitis viruses and treated with hemodialysis. PATIENTS AND METHODS. Eleven children (main group) with CGN against the background of chronic virus hepatitis (CVH) were examined. All of them were treated with hemodialysis. The age of the children was from 7 to 14 years. In 5 out of these children the hepatitis B virus was revealed, in 3 viruses of hepatitis B + C, in other 3 children the hepatitisdelta virus. A group of comparison consisted of 10 children of the same age with CGN without markers of the hepatitis virus and also treated with hemodialysis. The indices of cellular and humoral immunity were studied in all the patients. Serological investigations were made for the detection of hepatitis viruses. RESULTS. More pronounced impairments of the immunological status were noted in the main group of patients evidenced by a considerably decreased number of mature Tlymphocytes. Average indices of Thelpers were almost the same. The percentage of Tsuppressors was the least in this group of patients. The number of natural cells killers was of little difference in these groups. The percentage of zero lymphocytes was high. Changes in the humoral immunity were also more pronounces in the main group. CONCLUSION. The severity of the patients’ state was due to the decreased immunological reactions of organism that was associated with the virus antigen persistence. In the children with CGN against the background of virus hepatitis, as compared with the CGN patients without the hepatitis viruse markers, the changes in the indices of immunity were of one direction. But in the main group of patients the deficiency of T lymphocytes and Tsuppressors was more pronounced.

THE AIM of the work was to evaluate the incidence of delayed graft function (DGF) and its impact on the function and graft survival rate one year after transplantation of a cadaver kidney. PATIENTS AND METHODS. This communication is a result of 153 consecutive operations of transplantations of cadaver kidneys in the period from January 2000 through December 2003. DGF was observed in 16.9 % (26/153) of kidney transplantations. The frequency of episodes of acute rejection, the survival rate of the patients and their transplants and functions were evaluated in all 153 patients. Group 1 consisted of 26 patients with DGF and group 2 (as a control group)  of 127 patients with the graft function recovered immediately after transplantations. RESULTS. There were no significant differences between the age of the recipients (42.2± 12.9 vs 39.2 ±13.7) as well as in HLA matching (2.04 vs 2.24) between those groups. The groups differed in the number of retransplanted patients (1 vs 14), HLA presensibilization PRA>30% (3.8% vs 10.2%), and the age of the donors (41.9±13.9 vs 32.0±15.9). Significant differences were observed in the donors older than 50 years (8/26 vs 17/127), χ2 =4.7707, p< 0.05, respectively). Mean cold ischemic time was similar in both groups (17.1± 8.0 h and 16.3± 5.7 h, respectively). The mean duration of hemodialysis treatment after transplantations was 20.46 days. The mean number of hemodialysis procedures after transplantations was 7.8 procedures per patient. The occurrence of acute rejection episodes was higher in group 1 than in group 2, 73.0% (19/26) vs 37.8% (48/127), χ2 = 10.9142, p<0.05. The survival rate of the patients and transplants within a year was 93.0%, 89.0% vs 94.0%, 86.4% respectively. The portion of the patients with a good function of the graft (serum creatinin < 130 mkmol/l) was unreliably higher in group 2 (70.2% vs 60.0%; respectively). CONCLUSION. DGF is a risk factor for acute rejection, but it has no impact on the survival of the patients and grafts. The data might be used for a decision for the protocols of immunosuppression.

THE AIM of the investigation was to evaluate a possible impact of homocysteine (HCy) on the glomerular and proximal tubule cell injury in the remnant kidney model (RKM). MATERIAL AND METHODS. An experimental group of adult male albino Wistar rats underwent subtotal nephrectomy followed by daily administration of HCy (i.m., 13.4 mg/kg) for three weeks (n=11). Nephrectomized rats not given HCy were used as a control group (n=11). Routine blood and urine functional tests as well as light and electron microscopic examinations of the kidney samples were used to compare urine albumincreatinine ratio (ACR), creatinine clearance (Ccr) and cell alterations in RKM alone and those with a combination of RKM and superimposed hyperhomocysteinemia. RESULTS. Total plasma HCy was 5.0±0.7 and 7.7±1.5 in control and experimental animals respectively (p< 0.005). In the experimental group an increased logACR per 100 g of body mass (2.12±0.52 vs 1.43±0.32 mg/g, p<0.025) and plasma creatinine concentration (79.0±13.9 vs 56.3±8.0, p< 0.001) and decreased Ccr (0.20±0.7 vs 0.46±0.08 ml/min, p<0.005) and Ucr/Pcr (53.2±25.9 vs 123±25.7, p<0.005) were observed as compared to the control group. Moderate mesangial cell proliferation and local leukocyte adhesion to the endothelial lining in the glomeruli, with a pronounced increase of the amount of endocytosislabeling structures, large apical vacuoles included, in the proximal tubule cells, were registered in the kidney parenchyma of the RKM rats. Administration of HCy apparently aggravated the above mentioned alterations in both nephron compartments and also resulted in fibrin deposition within the glomerular capillaries and extensive disorganization of the basal cytoplasm in the proximal tubule cells. CONCLUSION. Both light and electron microscopic data reinforced by the appropriate biochemical findings are considered as a direct evidence of the additional deleterious effects of HCy on the major cell populations of the nephron under conditions of experimental renal failure.

THE AIM of the investigation was to study kidney functions in white rats, the mechanisms and dynamics of the development, determination of dosedependent toxic effects of gentamicin (G) after a single administration of the drug under conditions of induced water diuresis. MATERIAL AND METHODS. The influence of G on the kidney function was studied in 28 white male rats with body mass 160180 g under conditions of induced water diuresis in 2 hours after a single intraperitoneal injection of the drug in doses 10mg/100g body mass and 20 mg/100 g body mass. The amount of urine, content of protein in it, creatinine concentration and osmolality of urine and blood plasma were determined. RESULTS. It was found that injection of G to rats in dose of both 10 mg and 20 mg/100 g of body mass resulted in a reliable decrease of diuresis as early as within 2 hours both in the absolute and relative values, especially after injection of 20 mg. Excretion of protein was noted to increase proportionally to the dose of the drug injected, the indices of specific proteinuria by the acting nephrons being increased. The decreased glomerular filtration rate by clearance of endogenous creatinine, moderately increased content of blood plasma creatinine were noted. Clearance and fraction of osmotically free water in water diuresis, impairment of maximal osmotic dilution of urine were found to decrease suggesting impaired osmoregulating function of the kidneys. The dysfunction revealed can be considered as an evidence of nephrotoxicity of G at a single injection.The dysfunctions revealed might be a result of impaired renal processes glomerular filtration and tubular reabsorption. CONCLUSION. G injected in dose of 10 mg and 20 mg/100 g of body mass possesses a nephrotoxic action in rats within the first 2 hours after injection, that manifested itself as proteinuria, less diuresis and reduced glomerular filtration rate. Increased dose of G up to 20 mg/100 g of body mass resulted in increased proteinuria, that allows the nephrotoxic effect to be considered as dosedependent. Simultaneously a disturbance of the osmoregulating function of the kidneys is observed with their decreased ability to maximal dilution of urine.

THE AIM of the investigation was to study the prognostic value of using 5aminolevulinic acid (ALA)fluorescent cystoscopy in transurethral resection (TUR) of tumors of the urinary bladder by an analysis of its sensitivity and specificity as well as a comparison of frequency of recurrence in subgroups of patients after TUR performed by a standard method and with the application of ALA fluorescence. PATIENTS AND METHODS. A retrospective study of the data of primary examination and observations after TUR of 53 patients with transitional cell carcinoma of the bladder (mean age 62±9 years) was carried out.. In these patients 1.5 g of 5ALA (MEDAC, Germany) in 50 ml of 8.4% solution of sodium bicarbonate with pH =6.5 was introduced into the bladder three hours before operation. After standard cytoscopy during TUR the bladder mucosa was illuminated with blue light within the range 375450 nm of the xenon lamp DLight Storz and the fluorescing, in red light, parts were visualized and resected. Within 68 weeks a control fluorescent cytoscopy was performed with a repeated transurethral resection in the area of the primary carcinoma and with a histological investigation of the resected tissue, and 12 months later a standard control cytoscopy was made. The results were compared with the indices of the control group (51 patients) who underwent a standard TUR of the bladder tumor. RESULTS. The sensitivity of a standard cytoscopy to detect carcinoma of the urinary bladder was 96%, the sensitivity, specificity and positive prognostic value of the diagnosis of carcinoma of the urinary bladder with ALAfluorescent cystoscopy was 95%, 42% and 67% respectively. In patients after TUR with ALAfluorescent cystoscopy the areas with malignant urotheium were detected more rarely within 68 weeks as compared with the control group (p=0.005), and 12 months later there were rarer recurrences (p=0.030). CONCLUSION. Standard cytoscopy with the added ALAfluorescence used in TUR in patients with urinary bladder carcinoma allowed the transitional cell carcinomas and prognostically dangerous areas with a high risk of malignant transformation of the urothelium to be identified with high sensitivity and radically resected. The application of fluorescent cytoscopy proved to be a factor corresponding to a low risk of recurrence of carcinoma of the urinary bladder in the nearest postoperative period.

THE AIM of the investigation was to assess the effectiveness and safety of using a new domestic drug from the class of cytomedins Vitaprost in patients with chronic abacterial prostatitis. PATIENTS AND METHODS. Suppository Vitaprost was administered to 98 patients with chronic abacterial prostatitis during 2530 days. RESULTS. An examination of the patients has shown that against the background of treatment with Vitaprost the blood flow in the prostate improves, the rheological blood properties and immunity indices become normal, the motility of spermatozoa in the ejaculate increased. CONCLUSION. Vitaprost is an effective and pathogenetically grounded medicine for treatment of patients with chronic abacterial prostatitis.

THE AIM of the investigation was to study the efficiency of complex treatment of women with hyperactivity of the urinary bladder. PATIENTS AND METHODS. Treatment of 67 women with hyperactivity of the urinary bladder included administration of Detruzitol (Tolterodin) 2 mg daily during 3 months. Simultaneously with the medicamentous treatment the urinary bladder was trained. Efficiency of the treatment was assessed according to journals of urination, results of cystometry before and after treatment as by the subjective estimation of the patients. RESULTS. After treatment 15 (22.4%) women noted complete disappearance of symptoms of disturbances of urination, 42 (62.7%) showed an improvement, and 10 (14.9%) women had no changes in the symptoms of the disease. Positive dynamics in the objective parameters was found: less frequency of urination, increased volume of filling the bladder by the moment of the appearance of the first and maximal unstable reduction of Detruzitol, increase of the maximal cytometric capacity of the urinary bladder. The most frequent side effect was xerostomia (20.9% of the patients). CONCLUSION. Complex therapy of hyperactivity of the urinary bladder was shown to be highly effective and resulted in complete or partial healing in 85.1% of the patients.

A case of diagnosis of secondary disease of monoclonal immunoglobulin deposition.

Hereditary forms of nephrogenic diabetes insipidus.

Growth factors of glomerulosclerosis in diabetic nephropathy.

Certain problems of diagnosis of chronic pyelonephritis.

List of books on nephrology and adjacent fields published in 2005.

List of dissertations on nephrology and adjacent fields defended in 2005

Systematized numeral index of articles published in Vol.9 of Journal «Nephrology» in 2005.

Index of names.