THE AIM of the work was to study the epidemiologgy of chronic kidney disease (CKD) in Vologda oblast of the Russian Federation. PATIENTS AND METHODS. A population retrospective investigation performed in the Vologda oblast during the period from 1.07.98 till 30.06.99 has revealed cases of chronic renal failure (CRF) with blood serum creatinin Cr і 300 mkmol/l that corresponds to the IV and V stages of CKD by the calculated values of the glomerular filtration rate. The incidence and morbidity of the IVV stage CKD were determined including those depending on the gender, age, cumulative survival of patients with different etiology of CKD depending on using the substitution renal therapy (SRT) and the nephrologist’s supervision. RESULTS. The examinations have revealed 370 patients with CKD of the IVV stages. The average incidence and mobidity was 286 patients per million (PPM) and 135 p/m, in some cities it was 372434 PPM and 175260 PPM. The men/women ratio was the same (1.03). The most frequent cause of the development of CKD was chronic glomerulonephritis (CGN) 41%, the share of chronic interstitial nephritis was 16%, of diabetes mellitus (DM) 14%, polycystic kidney 8%, amyloidosis 6%, hypertensive nephrosclerosis 2%, other causes 3%, cases with not quite exact etiology 10%. The structure of primary renal pathology in patients given SRT was a little different: the share of patients with CGN increased to 61%, and the share of patients with DM and amyloidosis sharply decreased to 1.6% and 0,8%. The patients (31.1%) not given SRT had Cr > 500 mkmol/l and GFR < 10 ml/min. The incidence of cases of IVV stage CKD where the patients received SRT was 80 PPM, while the number of patients who first started SRT during 1 year, was 8 PPM. Mortality among the patients with renal failure was 85 PPM/ year. Increasing uremia was the cause of death of 88.4% of all the dead not given SRT. The cumulative survival among the patients receiving SRT was 90%, among those not receiving SRT was 50% for a year. Survival of patients with CKD not receiving SRT and observed by a nephrologist was reliably higher (p=0.003). CONCLUSION. The frequency of new cases of CKD of the IVV stages in the region under study is comparable with similar indices in Europe while the incidence was substantially lower due to a less share of people of older age groups and patients receiving SRT. The solution of this urgent problem of treatment of CKD patients in regions of Russia requires both an improvement of the neurological service as a whole and the development of the program of SRT covering now as little as the tenth part of the current requirements.

THE AIM of the investigation was to assess the possibilities to correct insufficient nutrition of dialysis patients with the food additive Supro760 proceeding from the anthropometrical markers of poorer diet. PATIENTS AND METHODS. The investigation included 50 patients (34 in the main group and 16 in the control group) with chronic renal failure treated by chronic hemodialysis. Consumption of main nutrients proteins, fats, carbohydrates taken according to the patients’ diaries and the anthropometrical parameters such as height, weight, deviation from the recommended weight, % of the fat mass in organism, girth of the arm without a fistula was determined in all the patients. During a year the food allowance was corrected: in the main group with the food additive Supro760, in the control group the usual diet was recommended but in sufficient quantity. RESULTS. The muscle mass was found to grow in the main group of patients, the indices in the control group became worse. CONCLUSION. The data obtained confirm the efficiency of using the food additive for the improvement of nutrition of dialysis patients.

THE AIM of the work was to investigate effects of using succinic acid in the complex sanatoriumresort rehabilitation on the state of renal mechanisms of regulation of watersalt metabolism according to the results of functional probes of the kidneys of children living under conditions of chronic exposure to ionizing radiation. PATIENTS AND METHODS. The investigation included examination of 15 children aged from 8 to 14 years living on the territory of Ukranian Polesie under conditions of unfavorable radiation situation. The group of comparison consisted of practically healthy schoolchildren of the city of Odessa undergoing the planned course of healthimprovement rehabilitation. RESULTS. Within 14 days after taking succinate the tendency to reduction of the induced diuresis volume and increased osmolality of urine retained against the background of inconsiderably less excretion of osmotically active substances. The excretion of protein reliably reduced as compared both with the initial values and with the analogous index obtained in 7 days after taking the succinic acid. CONCLUSION. The children living in ecologically unfavorable regions in 14 days after taking succinate demonstrated considerably better state of the kidney functions under condition of the watersalt load that can be concluded on the basis of the data of the investigation of renal excretion of mineral substances.

THE AIM of the work was to determine the factors influencing the employment of young patients on hemodialysis (HD) and to assess the effects of the indices of clinical, mental and socialdemographic character on the employment of such patients. PATIENTS AND METHODS. The examination of 83 patients from 16 to 44 years of age treated by chronic HD included the determination of the indices of life quality by the SF36 method and of clinicolaboratory indices in order to estimate their influence on the employment of such patients. RESULTS. It was shown that in the group of the employed patients (n=18) reliably higher indices of life quality included the following: the estimation of vital activity (V) and the absence of pain (BP), less pronounced restrictions in every day activities because of the emotional state (RE), higher total indices of mental and physical health. Multivariate regression analysis has shown that the level of education is an independent and most significant predictor of the employment of HD patients. Higher education of the patient makes the probability of employment almost 12 times higher as compared with those having secondary or special secondary education. The employment also depends on the life quality of the patient: the higher the total subjective index of his mental health and the less negative the influence of his emotional state on the every day life, the higher the probability of employment. CONCLUSION. It was established that the education level and mental health are significant and independent predictors of the employment of young HD patients.

THE AIM of the investigation was to study effects of different classes of hypotensive drugs on frequency of the development of types of remodeling of the left ventricle in patients with primary chronic glomerulonephritis with the saved and lowered function of the kidneys. PATIENTS AND METHODS. The examined 138 chronic glomerulonephritis patients were divided into 2 groups depending on the state of the renal function. The first group included 75 patients with the saved renal function. The second one consisted of 63 patients with the level of serum creatinin 140200 mkmol/l. In the first group both the patients with arterial hypertension and normotensive patients but having hypertrophy of the left ventricle were given the inhibitor of angiotensin converting enzyme (ACE) berlipril (n=28) in daily dose 520 mg (Berlinchemie, Germany), betaadrenoblocker corvitol (n=25) 2550 mg (Berlinchemie, Germany), calcium channel blocker amlodipin (n=22) 510 mg. In the second group 12 patients were given corvitol (the daily dose 5075 mg), 17 patients amlodipin (510 mg), 34 patients berlipril (1020 mg). Among the latter 15 patients received a combination of the ACE inhibitor with preparations of the central effect (clofelin, dopegyt or moxonidin). EchoCG with dopplerography on the apparatus Ultramark9 was performed in all the patients. RESULTS. In the patients with the saved function of the kidneys all the used classes of drugs promoted the reduction of frequency of the prognostically most unfavorable concentric variant of hypertrophy, only the inhibitors of the ACE and betaadrenoblockers assisted «normalization» of the left ventricle geometry. In patients with renal failure only inhibitors of ACE reliably lowered the frequency of concentric and excentric hypertrophy. CONCLUSION. The inhibitors of ACE and betablockers are the groups of choice for the treatment of concentric hypertrophy in patients with the saved renal function. The inhibitors of ACE is the group of choice for the medicamental reversion of concentric hypertrophy of the left ventricle in patients at the compensated stage of renal failure.

THE AIM of the investigation was to study the functioning of the white rats’ kidneys in the acute period of damage of the liver with carbon tetrachloride. MATERIALS AND METHODS. White male rats with body mass 95120 g were given subcutaneous injections of carbon tetrachloride in dosage 0.5 ml per 100 g of body mass. The investigation of the renal function was performed in 24 hours after injection of CCl4 under conditions of water load (5% of body mass). RESULTS. It was found that injection of CCl4 resulted in a reliable diminution of the value of creatinin clearance, renal excretion of endogenous nitrites, nitrates and calcium. At the same time an increased excretion of osmotically active substances, protein and phosphates was registered. CONCLUSION. Injection of carbon tetrachloride results in reliable alterations of indices of renal functions. The results obtained allow a suggestion that the revealed declinations in renal functioning were mainly due to the impaired calcium transport at the nephron level which manifested itself as the increased renal excretion of protein, phosphates and osmotically active substances as well as the decreased concentration index of creatinin and are accompanied by a reduced glomerular filtration rate.

THE AIM of the work was to investigate the content of calcium and magnesium in drinking water on the development of experimental chronic renal failure (CRF) in rats. MATERIALS AND METHODS. Male Wistar rats were subjected to 5/6 nephrectomy (NE). In two weeks after NE the rats were divided into 2 groups. Group 1 received standard Petersburg waterpipe water (8 mg/ l Ca2+ and 3 mg/l Mg2+). Group 2 received water rich in calcium and magnesium (120 mg/l Ca2+ and 45 mg/l Mg2+). Shamoperated rats were taken as control (group 3 received standard Petersburg waterpipe water; group 4 water rich in Ca2+ and Mg 2+). RESULTS. Six weeks later the uremic rats were compared with shamoperated animals. The uremic rats had higher levels of urea and phosphorus in blood serum. However, the content of total calcium was lower in group 1 as compared with group 2. Arterial pressure was considerably higher in group 1 than in groups 2. 3 and 4. Myocardium hypertrophy was noted in less degree in the animals of group 2 than in the rats of group 1. CONCLUSION. We consider that correction of the mineral content of drinking water can slow down the development of arterial hypertension and cardiiovascular disorders in rats with experimental CRF.

THE AIM of the investigation was to find out the advantages and disadvantages of the open, lumboscopic operations and distance shock wave lithotripsy (DSWL) in treatment of large calculi of the kidneys and upper parts of the ureter and to determine the place of these methods in treatment of patients with urolithiasis. PATIENTS AND METHODS. A statistical analysis was made of 97 case histories of patients with large (from 0.9 to 2.5 cm) concrements of the pelvis, upper and middle third of the ureters down to their crossing of the iliac vessels. The patients were subjected to traditional (18) and lumboscopic (48) operations, distance shock wave lithotripsy (31).RESULTS. The hospital period after DSWL was 5.7± 1.1 days, after lumboscopic operations 5.2 ± 0.8 days, and after open interventions it was 10.2±2.1 days. The minimum number of the nearest and distant complications was noted after the lumboscopic operations. About one third of the patients after DSWL needed relithotrisies. CONCLUSION. The lumboscopic interventions are an alternative to open surgery and are in a considerable competition with DSWL in cases of large concrements of the pelvis, upper and middle thirds of the ureters.

THE AIM of the investigation was to elucidate the perspectives and expedience of using endovideosurgical techniques in treatment of diseases of the upper urinary tracts. PATIENTS AND METHODS. Among 200 endovideosurgical operations performed by transperitoneal and retroperitoneal access there were 49 nephropexies, 105 operations for liquid formations in the retroperitoneal space, 17 nephrectomies, 23 operations aimed at the reestablishment of patency of the pyeloureteral anastomosis and 6 ureterolithotomies. A comparative analysis was made of the results of operative treatment of these patients with the results of open operations. RESULTS. The endovideosurgical method can be used in performing nephrectomy, nephropexy, ablation of the renal and ureteral calculi, in operations for impaired patency of the pyeloureteral segment and cystic lesions of the kidneys. A standard equipment and a set of instruments is enough for performing laparoscopic operations. The results of endovideosurgical operations are considerably superior in the parameters of invasion and terms of recovery of the patients to analogous operations made by the open access. CONCLUSION. The endovideosurgical techniques allow the typical urological operations to be performed with better results than when using traditional methods. They are thought to be an alternative to open surgery due to the evident advantages in the parameters of minimally invasive interventions and, hence, more favorable course of the postoperative period.

THE AIM of the investigation was to establish the character and frequency of complications after endovideosurgical treatment of diseases of the upper urinary tracts, to determine the modes of their liquidation and measures of prophylactics. PATIENTS AND METHODS. The complications appearing in patients operated on by the endovideosurgical method were analyzed. There were 224 operations including 51 nephropexies, 111 operations for liquid formations in the retroperitoneal space, 17 nephrectomies, 24 operations for the reestablishment of patency of the pyeloureteral anastomosis, 21 operations in patients with urolithiasis. RESULTS. 7 complications and 9 conversions of the access were registered. In 2 patients (0.9%) reoperations had to be made. The mechanisms of the appearance, frequency and character of the complications, causes of the conversions arising from the endovideosurgical treatment of the upper urinary tracts were found out. The results obtained are as a whole similar to those described in the literature. CONCLUSION. The using of endovideosurgical techniques in operations on the upper urinary tracts decreases the total number of complications and reduces their severity.