THE AIM of the work was to determine the relationship between the indices of phosphorus-calcium metabolism and bone mineral density (BMD) of different parts of the skeleton in patients on chronic hemodialysis. PATIENTS AND METHODS. Two-energy X-ray absorptiometry of 3 parts of the skeleton assessed by Z-criterion was used in 58 patients (m/f – 29/29, mean age 49.8 ± 13.3 years) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3 ± 70.1 month. In addition to general clinical and laboratory indices in all the patients, the mean values of the level of intact parathyroid hormone (PTH) for the last year were taken intoaccount, osteocalcin and C-telopeptides of the 1 type collagen (crosslaps) were determined in 38 patients. RESULTS. Mean values of BMD by Z-criterion in the lumbar vertebrae were (-0.35 ± 1.61), proximal part of the femur (-0.70 ± 1.16) and forearm (-1.15 ± 1.78) which is lower as compared with the vertebrae (t=2.51; p=0.013). BMD of the lumbar vertebrae was higher in patients with greater body mass (Rs=0.42; p=0.0012). BMD of the proximal part of the femur has a direct correlation with the patient’s body mass (Rs=0.57; p<0.001), product Ca x P (Rs=0.30; p= 0.031) and inversely – with the blood alkaline phosphatase level (APh; Rs= -0.28; p= 0.038). BMD of the forearm was lower in patients with longer HD (Rs=-0.49; p<0.001), high levels of PTH (Rs=-0.33; p= 0.017); APh (Rs=-0.56; p<0.001), C-telopeptides of the 1 type collagen (Rs=-0.53; p<0.001) and osteocalcin (Rs=-0.36; p=0.033). CONCLUSION. The forearm is the most sensitive area of the skeleton in patients to the influence of hyperparathyroidism. Lower BMD of the forearm is more pronounced in patients with long periods of hemodialysis therapy and the diagnosis of hyperparathyroidism.

THE AIM of the investigation was to make a comparative analysis of central hemodynamics indices in patients with essential arterial hypertension and symptomatic arterial hypertension against the background of chronic glomerulonephritis. PATIENTS AND METHODS. Results of clinical observations and EchoCG investigations were analyzed in 145 patients with arterial hypertension. Essential arterial hypertension (EAH) was diagnosed in 94 patients, 51 patients had chronic glomerulonephriis – renal arterial hypertension (RAH), which made up 64.8% and 35.2% of the total number of patients with arterial hypertension respectively. RESULTS. Patients with EAH and RAH against the background of chronic glomerulonephritis had impairments of central hemodynamics, with the most pronounced changes of the LV diastolic function. At that, more substantial changes of the diastolic function were observed in patients with EAH. The EAH patients against the background of insignificant LV hypertrophy had substantial impairments of the LV diastolic function with the saved systolic LV function. Patients with RAH against the background of CGN had more pronounced hypertrophy of the LV myocardium as compared with EAH patients and reliably less manifestations of the LV diastolic dysfunction. CONCLUSION. So, there are particular features in the state of the central hemodynamics in patients with EAH and RAH.

THE AIM of the investigation was to specify the role of components of the renin–ngiotensin-aldosterone system (RAAS) in progressing chronic kidney disease, its renal and cardiovascular injuries. PATIENTS AND METHODS. The concentration of plasma aldosterone (CPA), plasma renin activity (PRA), blood serum creatinine (SCr), creatinine clearance (CCr), total renin plasma (TR), inactive plasma renin (IR) were determined in 214 patients with different forms of chronic glomerulonephritis and different stages of chronic kidney disease (CKD).RESULTS. Increased CPA was noted in the progress of CKD, clear inverse nonlinear dependence between CCr and CPA was established. The linear correlation analysis has revealed highly reliable direct correlation between SCr and CPA and confirmed the inverse correlation between CCr and CPA. No relationships were found between the investigated components of RAAS and levels of arterial pressure, although there were correlations of PRA with TR and of IR with TR. A statistically significant feedback was found between PRA and SCr. CONCLUSION. Aldosterone, A II and rennin can be substantial independent factors of the development and progress of renal and cardiovascular complications in patients with CKD.

THE AIM of the investigation was to determine the concentration in urine and renal tissue of CGN patients of fibrinogenic mediators - monocyte chemotactic protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1) and to specify their significance for the assessment of processes of inflammation and fibrosis in the kidney and as the prognosis criteria. PATIENTS AND METHODS. Urinary excretion of MCP-1 and TGF-β1 using the immunoenzyme method (ELISA), and expression of TGF-β1 in kidney tissue using the immunohistochenical method were studied in 63 patients with active proteinuric forms of CGN. The interstitium area was measured by the morphometric method. RESULTS. Patients with active proteinuric forms of CGN unlike healthy subjects had higher urinary excretion of MCP-1 and TGF-β1. It was found that the level of urinary excretion of MCP-1 in patients with nephrotic syndrome was reliably higher than that in patients with a mild urinary syndrome. The urinary index MCP-1 was particularly high in patients with a stable renal failure. TGF-β1 excretion depended mainly on the creatininemia value, being the highest in patients with pronounced proteinuria and stable impairment of the kidney function. Intensive urinary excretion of TGF-β1 was observed in patients with CGN in whom expression of this cytokine in the kidney interstitium was revealed which confirmed its local-renal origin. The relationship of the urinary indices of MCP-1 and TGF-β1 was determined with the value of tubule-interstitial fibrosis. For the first time, high informative value (sensitivity and specificity) of urinary indices of MCP-1 and TGF-β1 as markers of the interstitial fibrosis degree was demonstrated and their significance in the prognosis of CGN. CONCLUSION. The investigation has demonstrated an important role of MCP-1 and TGF-β1 in the process of remodeling of tubulointerstitium. The indices under study are markers of TIF, and the determination of the level of MCP-1 and TGF-β1 in urine is an informative noninvasive method allowing activity of the disease and fibrosis stage to be monitored, and to estimate the prognosis of CGN.

THE AIM of the investigation was to determine polymorphism of gene PAI-1 linked with deletion/insertion of guanine in – 675 position from a starting point of the promoter in patients with CGN. PATIENTS AND METHODS. The polymorphic marker 4G/5G of gene PAI was investigated in 170 patients with chronic glomerulonephritis. The patients were divided into three groups by the data of morphological investigation. According to the morphological classification the first group included 86 children with nephrotic syndrome with minimal changes (NSMC), 29 patients of the second group had focal-segmental glomerulosclerosis (FSGS) and 55 patients of the third group had mesangioproliferative nephritis (MPN). RESULTS. A reliable association of the polymorphic marker 5G5G and allel 5G with NSMC and FSGC (χ2=9,85; p=0.002 and χ2=8.5; p= 0.004 respectively) and (χ2=10.53; p=0.001 and χ2=9.18; p= 0.0025 respectively). MPN is reliably associated with genotype 4G4G and allel 4G (χ2=5.1; p=0.024 and χ2=5.34; p= 0.02). The least renal survival was found in genotype 4G4G (p=0.055) carriers. CONCLUSION. The investigation fulfilled has demonstrated a difference between the associations of the polymorphic marker 4G/5G of gene PAI-1 in children with NSMC, FSGS and MPN. The results have shown the influence of allle 4G on the development of proliferative nephrites and progression of the disease.

THE AIM of the work was to determine the character of the relationship between the bone mineral density in different parts of the skeleton and pathology of the valves of the left half of the heart in patients treated by chronic hemodialysis. PATIENTS AND METHODS. Two-energy X-ray absorptiometry of 3 parts of the skeleton assessed by Z-criterion was performed in 58 patients (m/f – 29/29, mean age 49.8 ± 13.3 years) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3 ± 70.1 months. In addition to general clinical and laboratory indices in all the patients USI was performed and in 40 patients - 24 hours’ monitoring of ECG and of arterial pressure. RESULTS. Patients with low bone mineral density (BMD) of the forearm more often had alterations of the mitral valve (infiltration and calcification; F=3.13, p anova = 0.035). CONCLUSION. More pronounced alterations of the mitral valve in patients with low BMD of the forearm appear to be due to general risk factors of the development of these conditions: prolonged hemodialysis therapy and hyperparathyroidism.

THE AIM of the investigation was to comparatively describe renal lesions in patients with arterial hypertension (AH) and mild proteinuria who had hypertonic nephroangiosclerosis or mesangial-proliferative glomerulonephritis diagnosed when investigating the kidney bioptates. PATIENTS AND METHODS. Under study there were 81 patients who had AH in combination with mild proteinuria that was considered as an indication to nephrobiopsy. The patients were divided into two groups of comparison: patients with essential hypertension (EH, n=42) in whom the morphological data had undoubtedly shown nephroangiosclerosis and patients with mesangial-proliferative glomerulonephritis (MPGN, n=39). Nephrobioptates were investigated at the level of standard light microscopy. Additional semi-quantitative assessment of some signs of lesions to the kidneys was made. RESULTS. Patients with EH of older age, had longer AH and higher values of arterial pressure (AP). Patients with EH had considerably lower glomerular filtration rate than patients with MPGN with comparable values of proteinuria. The degree of nonspecific glomerular, vascular and tubulointerstitial lesions of the kidneys in patients with EH was also higher than in patients with MPGN. More distinct direct correlation was noted between the levels of AP and morphological signs demonstrating lesions of the microcirculatory bed of the kidneys. CONCLUSION. The data obtained confirm that hypertonic nephroangiosclerosis is not infrequently accompanied by proteinuria and the degree of morphological alterations to the kidneys in patients with AH of different nature is associated with the level of AP.

THE AIM of the investigation was to specify effects of doxorubicin (DOX) on renal cells using eukaryotic model Saccharomyces cerevisiae since the mechanisms of toxic effects of DOX on the kidneys still remain obscure. MATREIALS AND METHODS. The investigation was performed with strain S.cerevisiae YPH499. Incubation of the cells with different concentrations of DOX lasted 24 hours. The degree of injury of DNA was evaluated by activity of the ribonucleotide reductase -3 (RNR3). The concentration of reduced glutathione (G[1]SH), oxidized glutation (G-SSG), contents of malonic dialdehyde (MDA) were determined. RESULTS. DOX caused a decrease of cell proliferation, resulted in growing concentration of G-SH and so a reliable growth of the concentration of G[1]SSG was noted, but in less degree. In control experiments the ratio G-SH/G-SSG was 7.33±0.28 while in experiments with 10, 20, 30, 40, 50 mkM DOX the ratio G-SH/G-SSG was 7.52± 1.08 (p>0.05); 5.51±0.46 (p<0.01); 6.38±2.39 (p>0.05); 5.19±0.63 (p<0.01) and 5.05±0.70 (p<0.01) respectively. DOX induced expression of gene RNR3. The content of malonic dialdehyde did not substantially change. CONCLUSION. During the incubation of S.cerevisiae in the medium containing DOX and glucose an increase of G-SH due to expression of gene RNR3 compensates the redundant formation of free radicals and does not lead to free-radical damage of biomolecules. In the kidneys of animals administration of DOX fails to provide a sufficient concentration of G-SH and under these conditions free radicals induce oxidative stress at the expense of redox of cyclic reactions of DOX.

THE AIM of the investigation was to study specific changes of the main classes of membrane phospholipids and activity of some membrane-bound enzymes (Na/K-, Mg- and Ca- ATPases, 5’-nucleotidase) in radiation pathology. MATERIALS AND METHODS. The investigation was performed in white male rats with body mass 140-160 g. The animals were exposed to a single 3 Gr dose of general irradiation. On the 10th day after irradiation a microsomal fraction of the renal tissue cells was studied. The phospholipids fraction was performed by the method of thin-layer chromatography. Changes to the ATPase and 5’-nucleotidase activity were registered by the growth of non-organic phosphorus. RESULTS. Essential activation of 5’-nucleotidase and enhancement of total ATPase and Mg-ATPase activities in the renal tissue cells was established against the background of statistically reliable inhibition of Na/K-ATPase, as well as Ca-ATPase activities. The changes observed were accompanied by a significant decrease of the content of phosphatidilcholines with a simultaneous increase of the level of phosphatide acids, diphosphoglycerides and phosphatidilserines. CONCLUSION. Ionizing irradiation is characterized by a disturbance of the function of membrane-bound enzymes and redistribution of the qualitative and quantitative contents of phospholipids of the renal tissue cell membranes. The changes observed in the lipid-lipid and lipid-protein interrelations in the membranes of the renal tissue cells can cause a disturbance of the functional state of the kidneys.

THE AIM of the investigation was to carry on a complex study of the state of the glutathione system and intensity of lipid peroxidation processes in the liver and kidney tissues in white rats after repeated administration of cyclophosphamide (daily during 3-10 days, in doses 20 and 40 mg/kg in each injection). MATERIAL AND METHODS. The concentration of reduced glutathione, sulfhydryl groups of proteins, malondealdehyde, diene conjugates and activity of glucose-6-phosphate dehydrogenase, glutathionereductase, glutathioneperoxidase, glutathione-S-transferase, catalase was determined spectrophotometrically in tissues of 50 animals. RESULTS. It was shown that this form of intoxication was accompanied by pronounced changes in the state of the glutathione system in the liver and kidney tissue of the poisoned animals (lower content of sulfhydryl groups of proteins, impaired activity of glutathionereductase, glucose-6-phosphate dehydrogenase, glutathione-S-transferase, glutathioneperoxidase), activation of lipid peroxidation processes. The causes of the appearance of these biochemical shifts, their tissue distinctions were discussed as well as their role in realization of the cytotoxic effect of cyclophosphamide. CONCLUSION. The pathogenetic role of a depletion of functional possibilities of the glutathione system was established as well as activation of free radical processes in realization of the cytotoxic effect of alkylating drugs.

THE AIM of the investigation was to assess the detrusor contractility in patients with benign prostatic hyperplasia (BPH). PATIENTS AND METHODS. Complex urological examination was performed in 540 BPH patients (mean age 64.1±0.7 years) in order to determine the detrusor contractility. It included urodynamic investigation with uroflowmetry and urination cystometry (investigation «pressure-flow»). Interpretation of the results of urination cystometry was made by the W.Shafer nomogram, the index of the bladder emptying was determined as a percent ratio of the urination volume to maximal cytometric bladder capacity. RESULTS. Decreased detrusor contractility was detected in 61.7% of BPH patients examined. Results of the determination of bladder contractility by W.Shafer nomogram depend on the degree of infravesical obstruction (IVO). The bladder emptying index does not depend on IVO or its degree and characterize both the bladder emptying degree and the duration of contraction. Such coexisting pathologies as ostechondrosis of the lumbar part of the spine and diabetes mellitus make the bladder emptying worse. The contractility can be reliably estimated but on the basis of a urodynamic investigation because the results of the generally used examination of BPH patients for the estimation of detrusor contractility are insufficiently informative. CONCLUSION. In a considerable number of BPH patients the impaired function of the lower urinary tracts is dependent on decreased contractility of the bladder rather than on infravesical obstruction, that must be taken into account in the decision on the treatment strategy.

THE AIM of the investigation was to study the influence of overactive bladder on the quality of life of patients. PATIENTS AND METHODS. Using an analysis of questionnaires of quality of life KNQ in 349 patients with overactive bladder, the investigation concerned the degree of symptoms of the disease and the results of urodynamic examinations on certain components of the quality of life of the patients. RESULTS. Patients with overactive bladder have substantially worse quality of life, influencing the worsening of all its components – social, familial, emotional and professional. The degree of the worsening depends on the intensity of the symptoms of overactive bladder and is different in different age and gender. The greatest influence on the quality of life had more frequent urinations and imperative urges to urinate. No relationship was found between worsening quality of life and results of urodynamic investigation. CONCLUSION. The degree of worsening quality of life of patients with overactive bladder depends on the intensity of the symptoms and age and gender of the patients.