THE AIM of the investigation was to study the possibilities of accumulation of the green fluorescent protein (GFP) in the rat kidney under conditions of experimental chronic renal failure (CRF). MATERIALS AND METHODS. The experimental group consisted of 13 Wistar rats subjected to subtotal nephrectomy (SNE). In eight days after operation GFP was introduced to the animals through stomach probe. The control group consisted of 12 rats with intact kidneys. The concentration of creatinine, blood plasma urea, diurnal diuresis, concentration of albumin and urine creatinine with calculation of the albumine/cratinine ratio (ACR), concentration index (Ucr/Pcr) and creatinine clearance (Ccr ) were determined in both groups. In addition, light-optical and electron-microscopic investigations were carried on. Confocal microscopy was used for the assessment of accumulation of GFP in the erythrocytes andcell populations of the nephron. RESULTS. It has been found that GFP is absorbed by erythrocytes and, on coming into the systemic circulation, is accumulated in the cell vesicles of the proximal tubules (PT). Morphological and functional changes in the rats with the developing renal failure after SNE are followed by a considerable decrease of accumulation of GFP in PT as compared with the animals without dysfunction of the kidneys. CONCLUSION. The example of the model with GFP in animals with experimental CRF for the first time has demonstrated the fundamental possibility of enteral transport and accumulation of intact foreign proteins in the cells of the proximal nephron segment. The data obtained open new perspectives for studying the role of the kidneys in metabolism of exogenous proteins.

THE AIM of the investigation was to develop a new test allowing assessment of the bilipid layer of erythrocyte membranes in patients on regular hemodialysis in different environmental conditions and under the influence of different effectors on the membranes against the background of the action of a channel former. PATIENTS AND METHODS. Under examination there were 147 patients (78 men and 69 women, mean age 43.9+1.4 years) treated by substitution therapy with regular hemodialysis. The control group consisted of volunteers. The erythrocytes were separated from plasma by centrifugation. The sediment was washed from plasma and transferred into wells containing either model saline or autologous plasma. Nistatin (3.0-10⁴ М) was used as a promoter of transmembrane currents of Na⁺ and K⁺. Uabain (5.60-10" M), erythropoietin and membrane active components of autologous blood plasma were taken as effectors of the erythrocyte membrane in experiments. Saponin was used as a lysing agent. Extracellular concentration of K* was determined by the method of ion-metry using ion-selective electrodes and ion-selective field transistors with photopolymerisable polyurethane membranes. The resistance of erythrocytes to an external action of the channel former was assessed by a new index - "the integral normalized outcome of K*" which was calculated for different time intervals after administration of nistatin. When determining this index the diagram area under the curve of dependence of the normalized K* concentration in time was calculated. RESULTS. Considerable differences of the integral normalized outcome of K⁺ were detected for the erythrocytes of healthy donors and patients with CRF treated by regular hemodialysis during the incubation of cells in the extracellular medium of different composition and exposed to effectors of different nature. Another mechanism of the interaction of uabain with plasma membrane was shown in addition to classical inhibition of Na⁺, К ⁺ATPase resulting in a paradoxical membrane-stabilizing effect observed in erythrocytes of hemodialysis patients. A destabilizing effect of erythropoietin was established under its direct influence on erythrocytes. A strong membrasne-protecting effect of the components of autologous plasma was found characteristic of both the erythrocytes of healthy doors and the cells of hemodialysis patients. CONCLUSION. The integral normalized outcome of K⁺ is a sufficiently informative clinico-laboratory index and can be successfully used for the assessment of plasma membrane quality in patients treated by substitution therapy with regular hemodialysis.

THEAIM of the work was to establish causes of the development of recurrent pulmonary edema (RPE) in patients with atherosclerotic occlusive lesions of the renal arteries (AOLRA) on the basis of an analysis of the observations, treatment and literature data. PATIENTS AND METHODS. Among 82 AOLRA patients under examination there were 5 (6%) patients with RPE. All of them had bilateral hemodynamically significant AOLRA, including occlusion of one of the renal arteries, high arterial hypertension, pronounced renal failure (serum Cr from 0.16 to 0.43 mmol/l, GFR by MDRD from 9 to 32 ml/min) and symmetrical hypertrophy of the left ventricle (LV) myocardium with its pronounced diastolic dysfunction, but saved ejection fraction (from 48 to 61%). RESULTS. Three patients after revascularization of the kidneys had steadily decreased AP, improved (stable) renal function and no RPE in the early and long-term periods. The other two patients without surgical intervention died. CONCLUSION. RPE in AOLRA patients was found to be pathogenetically due to chronic renal ischemia, but realized by different mechanisms: higher pressure in the capillaries of the lesser circulation owing to diastolic dysfunction of LV caused by acute raising AP; by sodium and water retention due to activation of the rennin-angiotensin-aldosteron system and/or azotemia, increased permeability of the alveolar-capillary membrane of the lungs. The elimination of renal ischemia by revascularization of the kidneys is the only method of effective treatment of RPE in AOLRA patients.

THE AIM of the investigation was translation into Russian and cultural adaptation of questionnaire "THE KIDNEY DISEASE AND QUALITY OF LIFE SHORT FORM (KDQOL-SF^tm) version 1.3, and an assessment of its reliability and validity. PATIENTS AND METHODS. Chronic hemodialysis patients (n=91) were examined. THE KIDNEY DISEASE AND QUAUTYOF LIFE SHORT FORM (KDQOL-SF"") includes 36 questions from SF-36 (a general questionnaire for measuring quality of life (QL) independent of the kind of disease), 43 questions showing the specificity of dialysis therapy, and one question allowing an assessment of health as a whole. The process of realizing the Russian version of the questionnaire included translation into Russian, reversed translation into English, assessment of quality of the translation made by the authors of the initial English language version, translators, a coordinator of the project in Russia, a nephrologist. The reliability and validity of the Russian version of the questionnaire were estimated. RESULTS. For seven scales specific for dialysis the Kronbach reliability coefficient alpha was within the limits from 0.72 to 0.86 which corresponds to a sufficiently high co-ordination of the questionnaire points included in these scales. Reliable correlations were established between the scales of the questionnaire KDQOL-SF^lm specific for dialysis and scales of the general questionnaire SF-36, that evidences constructive validity of the KDQOL-SF ^lm method. CONCLUSION. The Russian version of the questionnaire KDQOL-SF^tm 1.3 has been developed and its reliability and validity demonstrated. The results obtained allow recommendation of the Russian version of the questionnaire KDQOL-SF^lm 1.3 to be used for an assessment of effectiveness of different kinds of substitution renal therapy and for monitoring QL of dialysis patients. It is the first standardized questionnaire in Russian intended for a thorough assessment of QL of patients with chronic kidney disease.

THE AIM of the investigation was to study risk factors of the development of chronic heart failure (CH F) in patients with different stages of chronic kidney disease (CKD). PATIENTS AND METHODS. The examined 154 patients were divided into three groups depending on the stage of CKD: I. - 52 patients with a moderate stage; II - 52 patients with a medium stage; III - 46 patients with a severe stage. In all patients the determination of the levels of total serum cholecterol, TG, LPHD Cs, LPLD Cs, LPVLD Cs, K-atherogenicity, products of lipid peroxidation and antioxidant system, levels of NO was made, the structural-functional state of the LV myocardium was also studied by the finding of EchoKG. RESULTS. A multifactor regression analysis has revealed in the first group patients an independent effect of SAP and DAP on indices E(p=0.025), A (p=0.032),E/A(p=0.018)(R² = 0.23; 0.33; 0.28 respectively), and NO on E(p=0.001), E/A(p=0.02)(R²=0.23; 0.28). In the II group patients the hemoglobin level was an independent factor of changes of E (p=0.02) and E/A (p=0.001), and the level of the total NO became an independent factor of the influence on E/A (p=0.02) and NO₃ on the output fraction (p=0.002). In the III group patients - the hemoglobin level was an independent factor of the influence on E (p=0.020), A (p=0.002), E/A (p=0.006). The level of albumin on E (p=0.01), and GFR on A (p=0.001). SAP exerted a reliable influence on the output fraction (p=0.001). CONCLUSION. In aggravation of the stage of CKD the "non-traditional" risk factors of CHF become more significant in the development of myocardial dysfunction.

THE AIM of the research was to study the peculiarities of clinical course and biochemical indices of chronic glomemlonephritis associated with hepatitis В virus in children. PATIENTS AND METHODS. Eighteen children aged from 3 to 14 years with chronic glomerulonephritis associated with hepatitis В virus (main group) have been observed. The comparison group consisted of 25 children of the same age without markers of the hepatitis В virus. Most patients in both groups were boys. All the patients had a nephritic form of chronic glomerulonephritis. The clinical symptoms, total blood and urine tests, biochemical and serologic investigations were made. RESULTS. Duration of the disease up to 2 years was noted in most patients of the main group as compared with the comparison group. Clinical signs of the disease were more pronounced in the main group (hepatosplenomegaly, proteinuria, anasarca, ascitis). The previous viral hepatitis was found in case histories of 16% of patients from the main group. The biochemical tests of blood showed reliably high indices of hypercholesterolemia, dysproteinuria, sufficiently increased AlaATT and AapAT activity. CONCLUSION. The hepatitis В virus facilitates the development of severe forms of chronic glomerulonephritis during comparatively short time. Such symptoms as hepatosplenomegaly, proteinuria, anasarca, ascitis, dysproteinuria, hypercholesterolemia are more characteristic of the main group patients.

THE AIM of the present investigation was to compare the morphological features of the urine leukocytes showing the presence of an inflammatory process with a reliable laboratory indicator of the presence of tubulo-interstitial lesion (β₂ -microglobulinuria). PATIENTS AND METHODS. The investigation was carried out in 2 groups of patients: the main group included 68 patients with the main or concomitant diagnosis of exacerbation of chronic pyelonephritis and a control group consisting of 21 healthy subjects. The investigation included the following: the content of leukocytes in peripheral blood, erythrocyte sedimentation rate, C-reactive protein, detailed analysis and cytological investigation of the urine sediment with the methylene blue staining (personal modification) for the detection of active leukocytes and determination of bacteriuria and β ₂ -microglobulinuria. RESULTS. Two kinds of leukocytes were found in the urea. The leukocytes of the first group were of usual sizes and shape, with a poorly discernible nucleus and rough granulosity in the cytoplasm. The leukocytes of the second group were characterized by larger sizes (two-three times more than normal), round shape and sometimes by vacuolized cytoplasm. P₂ -microglobulinuria was found in 57 patients, and 62 patients had bacteriuria. These two signs were not always simultaneously. In the control group the level of β ₂ -microglobulinuria in the urine varied from 0.02 to 0.09 with the average value 0.061 mg/l. CONCLUSION. In all patients having active leukocytes the level of p₂ -microglobulinuria was higher than in the control group. Permanent detection of young polysegmentonuclear, active leukocytes in acute pyelonephritis and increasing β ₂ -microglobulinuria, as compared with healthy subjects, suggest that these indices can be used as additional laboratory confirmation of the diagnosis of activity of chronic pyelonephritis.

THE AIM of the investigation was to assess the hypotensive effectiveness of discontinuous normobaric hypoxitherapy and to study its influence on variability of arterial pressure and functional condition of the idneys n hypertensive patients with chronic glomerulonephritis. PATIENTS AND METHODS. The investigation included 26 patients (16 men and 10 women) divided into 3 groups. The first group consisted of 11 (42.3%) patients for treatment by discontinuous normobaric hypoxitherapy, the second group included 9 (34.6%) patients treated by hypoxitherapy in combination with the inhibitor of angiotensine converting enzyme, the third group included 6 (23.1%) patients treated with the inhibitor of angiotensine converting enzyme only. RESULTS. It was established that discontinuous normobaric hypoxitherapy possessed an independent hypotensive effect, potentiated when combined with the inhibitor of angiotensine converting enzyme, and also facilitated lowering daily proteinuria, reducing the frequency of unfavorable night-piker type of variability of arterial pressure, but does not influence the glomerular filtration rate. Transient tachycardia, dizziness and arterial hypotension are objectionable reactions of discontinuous normobaric hypoxitherapy. CONCLUSION. The data obtained suggest that discontinuous normobaric hypoxitherapy can occupy its place in therapy of hypertensive syndrome in chronic glomerulonephritis patients.

THE AIM of the investigation was to study the role of renin-angiotensine system (RAS) and nitrogen oxide cycle in pathogenesis of hyperthyroid kidney at an early time period of modeling experimental hyperthyroidism in albino rats caused by administration of thyroxin. MATERIAL AND METHODS. Thyroxin (T4) in dose 50 mkg/100 g of body mass was administered into the stomach in 1% starch gel once or during 5 and 7 days. In addition, against the background of a single administration of T4 a solution of ascorbic acid (0.2 mg/100 g b.m.) was given 30 min before water load, or during 24 h from the moment of administration of T4 the rats were given to drink a solution of Captopril (50 mg/l). After 5 days of administration of T4 the rats were also given to drink a solution of Lozartan (10 mg/l) during 24 h from the moment of the last administration of T4. The rats given T4 during 7 days were given L-arginine in dose 2 mg/100 g b.m. a day, or given to drink a solution of sodium nitrite (20 mg/l). The control group rats were given gel not containing T4 administered into the stomach during 7 days. The functioning of the kidneys was studied within 24 h after discontinuation of giving T4 under conditions of 5% water load. RESULTS. It was established that RAS blockers increased the value of creatinin clearance after a single and continuous administration of T4 to rats, but decreased excretion by the rats’ kidneys of endogenous nitrates and protein as well as prevention of endogenous nitrites retention was registered only when the animals were given Lozartan in 5 days after administration of T4. Continuous administration of T4 to rats was followed by weaker effects of NO and redirection of the arginine-dependent way of NO synthesis to the nitrite-reductase one, which is shown by increased level of endogenous nitrites in blood plasma of the rats continuously given T4, the absence of a pronounced correcting nephrotropic effect of exogenous arginin in hyperthyroid animals and growth of creatinin clearance under the influence of exogenous sodium nitrite in the group of hyperthyroid animals. CONCLUSION. The results obtained show a substantial role of RAS and nitrogen oxide cycle in pathogenesis of the development of “hyperthyroid kidney”.

THE AIM of the investigation was to study efficiency of non-medicinal treatment of hyperactivity of the urinary bladder in women with mixed urinary incontinence (UI). PATIENTS AND METHODS. The observation included 183 women (mean age 67.5 years) with mixed UI. A complex urodynamic investigation was carried out before and after treatment of all patients which included cystometry of filling and measurement of the urethral pressure profile. The subjective data were recorded in the journal of urination which was filled in by the patients during 3 days before and after the course of treatment. Group A 63 patients were prescribed a combination of training pelvic muscles by the biofeedback method with urination according to timetable. Group B (56 women) during 3 months went to toilet strictly according to the timetable, without other methods of treatment. Group C (54 women) used only training of pelvic muscles – without biofeedback – at home. RESULTS. During treatment all the patients demonstrated less number of urinations in a day from 11± 0.7 to 7±0.4 (p<0.05). The frequency of imperative urges was reliably less in groups A and C, in the same patients symptoms of stress urinary incontinence absolutely disappeared. The maximal cystometric capacity increased from 170±25 ml to 280±32 ml (p<0.05) in group A and from 163± 29 ml to 240±13 ml in group B (p<0.05). CONCLUSION. The complex non-medicinal approach to treatment of hyperactivity of the urinary bladder in women with mixed urinary incontinence is a worthy alternative having no side effects in treatment of the older age group.

THE AIM of the investigation was to evaluate microcirculation in the prostate for improvement of the diagnosis and results of treatment of chronic prostatitis patients. PATIENTS AND METHODS. 239 chronic prostatitis patients were examined in dynamics before and after treatment with different medicines. The evaluation of blood circulation in the prostate was performed by the method of color Doppler mapping during transrectal ultrasonic investigation. RESULTS. Blood circulation in the prostate of chronic prostatitis patients before treatment proved to be considerably disturbed: the blood velocity in the arteries and veinswas considerably slower, the vessel resistance index was higher, the volumetric circulation was less. The bio-regulating peptide Vitaprost and the drug of systemic enzymotherapy Vobenzyme can reestablish the circulation in the prostate more effectively as compared with other medicines used for treatment of chronic prostatitis patients. CONCLUSION. In all chronic prostatitis patients the state of circulation in the prostate should be evaluated by the method of color dopplerography and the pathogenetically substantiated method of treatment should be chosen depending on the state of the circulation.

THE AIM of the investigation was to analyze the influence of chronic urologic pathology on quality of life of such patients. PATIENTS AND METHODS. Questioning of 408 patients hospitalized to a surgical department for inpatient treatment in St.Eugenia hospital in 2004-2006 was performed using SF-36 questionnaire. RESULTS. It was shown that urologic diseases considerably decrease quality of life of patients: most of the patients have limited physical activity, have problems in work and other every-day activity as well as in contacts with the family, friends, neighbors and colleagues due to the physical and emotional state. Positive emotional background was noted in such patients much more rarely than negative; physical pains during the last four weeks before questioning were noted in more than 90% of responders; as a rule, the patients consider their health to be mediocre or bad as a whole, and are expecting it to be even worse in future. CONCLUSION. The worse quality of life of such patients is due mainly to such components as physical, mental and social problems which must be taken into account by the urologist rendering specialized care. The rehabilitation of patients with urological pathology, especially of elderly ones, should include psycho-therapeutic treatment since they have many negative psycho-emotional problems. The data obtained as a whole are in agreement with literature data.

THE AIM of the investigation was to improve results of surgical treatment of elderly patients with benign hyperplasia of the prostate (BHPP) by means of using complex intraoperative hemostasis during adenomectomy which combined an original removable suture and inhibitors of local fibrinolysis. PATIENTS AND METHODS. The investigations included 885 BHPP patients aged from 74 through 92 years (mean age 79.3±0.5 years) after adenomectomy. The patients were divided into 3 groups. The first group consisted of 214 patients in whom the removable hemostatic suture was put on the bed of the ablated adenomatous nodes by an original method. The second group consisted of 393 patients in whom putting the removable hemostatic suture was combined with temporary tampon of the bed with an inhibitor of fibrinolysis – Gordox and introduction of it into the bed tissueof the ablated nodes. The third group (group of comparison) included 278 patients in whom hemostasis was made by the temporary tampon only. RESULTS. A comparative analysis suggests that the volume of postoperative blood loss was considerably different in the first group patients with the hemostatic suture. It was 2.2 times less than in the group of comparison. In the second group of patients with the hemostatic suture and local application of Gordox it was 4.7 times less. CONCLUSION. The mechanical arrest of bleeding in adenomectomy by putting a removable hemostatic suture with a local application of the fibrinolysis inhibitor Gordox results in a substantially less volume of blood loss and better results of operative treatment in elderly BHPP patients.

THE AIM of the investigation was to study the prognostic value of determination of the prostate-specific antigen (PSA) and its dynamics before performing radical prostatectomy (RPE) in patients with localized forms of cancer of the prostate. PATIENTS AND METHODS. Radical retropubic prostatectomy was made on 150 patients with localized forms of prostate cancer in the period from 1996 through 2003. Mean age of the patients was 61.5±0.4 years (from 49 to 71 years). An analysis of correlation between different clinic-laboratory factors and PSA in blood plasma of patients with prostate cancer was made both 3 months before RPE and just before it. After RPE all the patients were under observation and underwent control outpatient observation in 1, 3, 6, 12 months and later every year. The maximal period of postoperative follow-up was 5 years. RESULTS. Higher level of PSA was noted in patients with a high stage and degree of malignancy of the tumors by the Glison scale. More important prognostic information has not so much the preoperative level of PSA in blood plasma as its dynamics during 3 months before RPE. In particular, rapid growth of the PSA level in blood plasma before RPE (higher than 2.5 ng/ml during 3 months) points to a risk of early appearance of remote metastases. CONCLUSION. The evaluation of PSA level in blood plasma and its dynamics before RPE underlies the prognosis of outcomes of the surgical treatment of patients with prostate cancer and facilitates its optimization.