THE AIM of the investigation was to study the clinic-functional state of the kidneys, prevalence and severity of anemia among patients with chronic heart failure (CHF). PATIENTS AND METHODS. In 77 patients (mean age 60.4±1.2 years) with CHF I-IV FC (NYHA, 1994) an assessment of the filtration function of the kidneys by the glomerular filtration rate (GFR) was made using the Cockroft-Gault formula, activity of N – acetyl – β – D - hexoaminidase in (NAH) the morning portion of urine – as an index of functional activity of tubules. The presence of microalbuminuria (MAU) was determined that reflected the function of the endothelium and the glomerular apparatus as a whole. The presence of anemia was established by the conventional criteria. RESULTS. A reliably elevated hexoaminidase is characteristic of low FC CHF (FC I-II). At the initial stages of CHF the patients demonstrate the inconsiderably decreased GFR, during progressing of CHF the filtration is considerably decreased and simultaneously MAU is growing. The concentration of blood hemoglobin and hematocrit index is also decreasing with progression of CHF. Anemia is of iron-redistributing character. No association of the concentration of hemoglobin and indices of the functional state of the kidneys was found. CONCLUSION. Hexoaminidase is a marker of early lesion of the tubular apparatus of the kidneys. The tubular lesion in CHF patients precedes the glomerular injury of the kidneys. The presence of anemia in patients is associated with the degree of CHF.

THE AIM of the investigation was to determine factors associated with the development of osteopenia and osteoporosis of different parts of the skeleton in chronic hemodialysis patients besides the indices of phosphoro-calcium metabolism. PATIENTS AND METHODS. Dual X-ray absorptiometry of 3 parts of the skeleton with the estimation of the bone mineral density (BMD) by Z-criterion was fulfilled in 58 patients (m/w - 29/29, mean age 49.8 ± 13.3 years (X±SD) treated by chronic bicarbonate hemodialysis (HD) on average for 74.3±70.1 months. Genetic polymorphism of the vitamin D3 receptor was studied in 30 patients. Under estimation there were the duration of menopause in women, the presence of viral hepatitis В and C, intensity of smoking, alcohol abuse, physical activity, therapy with glucocorticosteroids (GCS) and cytostatics (CS), history of transplantation of the kidneys. RESULTS. BMD of the lumbar vertebra is influenced by genetic polymorphism of the vitamin D3 receptor TAQI: in tt genotype BMD was higher as compared with Tt and TT (F=3.39, _Panova =0.049). In addition, a direct correlation between BMD and the number of blood leukocytes (Rs=0.33; p= 0.015) was also determined. BMD of the proximal part of the femur was higher in patients with greater body mass (Rs=0.57; p<0.001), greater number of leukocytes (Rs=0.35; p=0.012). BMD of the forearm wasdependent on many factors. The negative feedback was found with the duration of HD(Rs=-0.49; p<0.001), duration of GCS therapy (Rs=-034; p=0.028), and CS therapy (Rs=-0.54; p<0.001), allotransplantations of the kidneys in anamnesis (Rs=0.41; p=0.002), the presence of viral hepatitis В and С or their combination (Rs=-0,35; p=0.009), high level of blood ALT (Rs=-0.39; p=0.004) and positive: with the cholesterol level (Rs+0.45; p<0.001) and blood albumin (Rs=0.37; p<0.012). The number of blood leukocytes and the presence of viral hepatitis (Rs=0.54; p<0.001) were associated with the duration of HD. CONCLUSION. A relationship was revealed between BMD of the vertebra and the genetic polymorphism of the vitamin D3 receptor. BMD oftheforearm correlated with a great number of factors: duration of hemodialysis treatment, GCS and CS therapy, the presence of allotransplantations of the kidneys in anamnesis, certain laboratory indices of the nutritional status.

THE AIM of the investigation was to assess the influence of spironolactone therapy on the level of blood aldosterone and state of the epithelium functioning in program hemodialysis patients with V stage chronic kidney disease (CKD). PATIENTS AND METHODS. In examination of 83 program hemodialysis patients with V stage CKD the following parameters were studied: the level of blood plasma aldosterone, the functional state of the epithelium assessed using biochemical markers - 1 type plasminogen activator inhibitor (PAI-1), tissue plasminogen activator (t-PA), endothelin-1 before and after a 6-month course of spironolactone therapy. RESULTS. All the patients initially had a considerably elevated level of blood aldosterone - 478±99.96 pg/ml (norm – up to 160pg/ml). Against the background of spironolactone therapy a considerably decreased level of aldosterone to 346.45±58.1 pg/ml (p=0.009) was noted and a considerably decreased activity of the endothelium dysfunction markers: endothelin-1 from 0.63±0.09 fmol/ml to 0.23±0.03 (p=0.002), PAI-1 from 5.69±0.24 to 3.06±0.25 U/ml (p<0.001); elevated level of t-PA from 5.03±0.3 to 5.64±0.3 ng/ml. CONCLUSION.The spironolactone therapy in program hemodialysis patients results in lower level of aldosterone in blood and better state of the endothelial function.

THE AIM of the work was to assess the prognostic significance of sympathetic hyperactivity in normotensive patients with mesangial proliferative glomerulonephritis (MP CGN). PATIENTS AND METHODS. The investigation included 23 patients with MP CGN. Puncture biopsy of the kidney was fulfilled in all the patients at inclusion in the investigation. At this stage and laterannually during 5 years the following parameters were studied: clinical analysis of blood and urine, daily proteinuria, GFR was calculated by the Cockroft-Gault formula, Holter monitoring of ECG was fulfilled with an analysis of the heart rate variability. The end points were considered to be: emergence of AH, appearance of CGN symptoms, development of acute cardiovascular and cerebrovascular events. RESULTS. In patients with hyperactivity of the sympathetic nervous system arterial hypertension was developing on average not only one year earlier, but also the frequency of its formation in the fourth year of observations was 3 times as high (27.3% against 8.3%) as the same index in the group of comparison. By the end of the fifth year of observations the summary frequency of hypertension in patients with sympathetic hyperactivity was 72.7%, while in the group of comparison it was as low as 46.7%. In patients with sympathetic hyperactivity the decreased function of the kidneys (18.2% against 8.3%) was observed earlier than in the group of comparison. The summary frequency of chronic renal failure in patients with hypersympathicotonia was 36.4% by the end of the fifth year of observation, while in the group of comparison it was only 8.3%. The incidence of lethal myocardial infarction in patients with sympathetic hyperactivity proved to be higher that without it (9.1% against 0%). CONCLUSION. The presence of HSHS in normatensive patients with MP CGN potentially facilitates the development of cardiovascular disorders and more rapid progression of the development of renal dysfunction.

THE AIM of the work was to assess the potential of using the method of capillary electrophoresis for determining the concentration of phosphates in the used dialyzing solution in the process of a hemodialysis (HD) procedure as an index of Ca-P metabolism. PATIENTS AND METHODS. A group of 7 patients (4 men and 3women, mean age 54.5±3.5 years) was examined. They received substitution renal therapy with regular hemodialysis for chronic renal failure (CRF). Every patient received on average 930±240 sessions of HD at the moment of examination. The patients were divided into two groups according to the content of parathyroid hormone (PTH): I group (3 patients) with low content of PTH, II group (4 patients) with high content of PTH. Phosphates were determined by the method of capillary electrophoresis with the device “Kapel-103 P” granted by company “Lumeks”. RESULTS. The level of excreted phosphate was maintained practically constant during the whole session. The correlation analysis has shown that of greatest significance are the interrelations of summary indices of elimination of phosphate with the concentrations of blood plasma protein components, as well as with activity of alkali phosphatase that characterizes the degree of bone tissue resorption. CONCLUSION. The obtained data of the phosphate elimination rate are of great clinical value. However the application of the method of capillary electrophoresis in this experiment seems to be too laborious and uneconomic for using in mass examinations.

THE AIM of the investigation was to study the state of juxtaglomerular apparatus (JGA) and capillaries of the superficial and juxtamedullary vascular renal glomeruli after acute massive blood loss. MATERIAL AND METHODS. The degree of opening the capillaries (DOCC) of the superficial and juxtamedullary vascular glomeruli, the ultrastructure of JGA were studied morphologically in experiments in 60 outbred white male rats with body mass 120-140g before and after acute massive blood-etting (on average 3.0 cm³ or 2.5% of the body mass) in 1, 2 and 24 hours. RESULTS. Within 1-2 hours after blood loss the lessening of the circulating blood volume causes a spasm of the afferent and dilatation of the efferent arterioles, the capillaries of the superficial and juxtamedullary vascular glomeruli have mainly I and II DOCC (up to 20%); the average value of DOCC in both cortex zones smoothes down. JGA is in the state of functional stress. Within 24 hours after blood loss DOCC and JGA structure become almost normal. CONCLUSION. The data obtained suggest that activity of the superficial and juxtamedullary vascular glomeruli under physiological conditions and after acute massive blood-letting is regulated by activity of JGA.

THE AIM of the research was to monitor the content of blood cells and bone marrow of rats in 24 hours and 7 days after a single intraperitoneal injection of cyclophosphamide (20 and 40 mg of body weight of the animal) and to attempt correction of the observed alterations using irradiation of the skin with extremely high frequency (EHF) waves. MATERIAL AND METHODS. The experiments were performed in 50 male Wister rats. The quantity of blood leukocytes and bone marrow myelocytes were determined in 24 hours and 7 days after injection of cyclophosphamide (20 and 40 mg), EHF irradiation of the skin (37-53 GHz, 7.1 mm, 20 mWt), and a combination of these factors. RESULTS. A single i.p. injection of cyclophosphamide was shown to result in a decreased quantity of blood neutrophils and lymphocytes, lymphoid cells and total quantity of nondifferentiated cell elements of the bone marrow in 24 hours after injection. Lymphopenia and increased number of nondifferentiated cell elements of the bone marrow were noted in 7 days after injection. EHF irradiation of skin leads to the increased quantity of band neutrophils in blood and decreased band and segmental neutrophils in bone marrow of rats in 24 hours and levels the cyclophosphamide-induced increase of the quantity of nondifferentiated cells in bone marrow in 7 days. CONCLUSION. Injection of cyclophosphamide causes cytopenia in blood and bone marrow of rats in 24 hours. In 7 days after injection of cyclophosphamide the quantity of mature cells remains diminished, but the number of nondifferentiated cell forms is increased. EHF irradiation of skin leads to decreased intensity of the observed alterations.

THE AIM of the investigation was to study karyometric features of the cells of transitional cell carcinomas of the urinary bladder, to compare them with clinical data, invasion depth and the degree of cancer differentiation. PATIENTS AND METHODS. Materials of clinical examinations of 12 patients with transitional cell carcinoma of the urinary bladder were studied retrospectively. The carcinoma invasion depth Tis, Ta, T1, T2, T3 and Tx was detected in 1(7%), 4 (29%), 1(7%), 1(7%), 1(7%) and 6(43%), the differentiation degree G1, G2 and G3 – in 8(57%), 4(29%) and 2(14%) preparations respectively. In the postoperative period recurrences were noted in 6(50%) patients, the average duration of the recurrence-free period was 4±1 month. 3(25%) patients died of cancer progression. Under 250x magnification the picture of 10 fields of vision of the tumor tissue were processed with a computer using the program “Video Test Morpho 4.0”, 162 signs of cell nuclei were calculated. RESULTS. Karyometric indices were associated with the gender (p=0.05) and age of the patients (p=).004), sizes (p=0.009), multiplicity (p=0.013), invasion depth (r=0.73; p=0.04) and differentiation degree (p=0.011) of the neoplasms. Survival of the patients without progressing carcinomas proved to be associated with 92 morphometrical parameters (p<0.05). None of the signs studied pointed to the recurrent course of the disease. CONCLUSION. Karyometric features of the cells of the transitional cell carcinomas of the urinary bladder correspond to the clinical picture of the disease and morphometrical features of the tumors, and also point to the probability of progressing carcinoma after surgical treatment.

THE AIM of the work was an attempt to reveal criteria of differential diagnostics of chronic pyelonephritis and chronic cystitis on the basis of a retrospective study of the main anamnestic data and clinic-laboratory symptoms of the urinary tract infections (UTI). PATIENTS AND METHODS. A retrospective analysis of medical documentation of 450 UTI women was made. The presence of chronic UTI (> 1 year) without impaired functions of the kidneys and symptoms of obstruction was taken as a criterion of inclusion of the patients in the investigation. The women were divided into two groups. The first group consisted of women with chronic pyelonephritis (CPN) (n=370), the second group – with chronic cystitis (CC) (n=80). Scitigraphic investigation was performed in all CC patients with RFP of different mechanism of elimination: 1) renoscitigraphy with ⁹⁹ᵐTc -DMSA – was considered as a “golden standard”. 2) renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate - for the assessment of accuracy of the diagnosis method. RESULTS. A comparative analysis of differences of absolute frequencies associated with signs of PN has shown that only 2 of them differed considerably in the groups under study. However, the distinctions, found between patients with CPN and CC were of quantitative rather than qualitative character. Renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate has shown that in 59 patients (74%) with the diagnosis CC there were classical signs of pyelonephritis – “scars”. CONCLUSION. On the basis of using the data of anamnesis and clinic-laboratory characteristics of UTI which are used by physicians in their every-day clinical practice it is not possible to establish the topic of the process (cystitis or pyelonephritis). Renoscitigraphy with ⁹⁹ᵐTc-pyrophosphate is an objective method of diagnosing UTI: the sensitivity of the method is 98%, the specificity – 62%. The scitigraphic investigation data demonstrate the presence of signs of PN in 100% of patients with frequent relapses of CC; in 95% of the patients who had only 2 episodes of cystitis during a year there was no involvement of the kidneys in the inflammatory process.