THE AIM of the work was to estimate the significance of Doppler echocardiography for the assessment of dry weight in hemodialysis patients. METHODS. Forty two dialysis patients (19M, 23 F, mean age 49±11 years) received 4 hour bicarbonate hemodialysis (HD) 3 times a week, 32 patients had arterial hypertension, 26 had chronic heart failure. Mmode echocardiography was made and left ventricular mass index (LVMI) and ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time and early deceleration time (DT) were detected. RESULTS. Left ventricular hypertrophy was diagnosed in 36 (85.7%) patients. EF was lower than 45% in 3 patients. There was a significant positive correlation between the ultrafiltration value and ΔE (r=0.59; p=0.001), no correlation being detected between the ultrafiltration value and ΔA. Patients with intradialytic hypotension had considerably higher DT than those without intradialytic hypotension (232.8±64.8 vs 168.1±50.8 ms respectively, p <0.001). CONCLUSION. «Dry weight» is associated with the significantly increased early deceleration time in patients with left ventricular hypertrophy. Patients with the increased early deceleration time have high risk of the development of intradialytic hypotension.

THE AIM of the investigation was to study the state of the systems of hemostasis, kallikrein and complement in patients with different diseases of the kidneys. PATIENTS AND METHODS. The hemostasis system was studied in 244 patients (men and women) with different diseases of the kidneys acute nephrotic syndrome, chronic diffuse glomerulonephritis (nephrotic, hypertonic, hematuric, mixed form with the saved function of the kidneys and mixed form of CRF), urolithiasis, chronic pyelonephritis, hemorrhagic fever with renal syndrome. The standardized indices of coagulogram determining the blood coagulation phases as well as the content of ATIII, C3 component of complement and kallikrein were used. RESULTS. The accelerated prothrombin formation (phase I) in diseases of the kidneys is associated with the inhibition of the following phases (II and III) of hemostasis which is due to binding these thrombogenic proteins in complexes with heparin whose level sharply increases in pathology of the kidneys rather than to the expenditure of fibrinogen and other procoagulants for the formation of blood clots. CONCLUSION. The formation of prothrombinase in diseases of the kidneys is accelerated due to the effect of C3 complement on cell membranes, which is associated with increased tissue procoagulants, kallikrein in blood and lower content of ATIII. The increased activity of the anticoagulant system is associated with the increased amount in blood of renal patients of heparin, its complex bindings with fibrinohen, adrenalin, plasminogen, plasmin and products of fibrinogen and fibrin degradation. Correction of impaired hemostasis in kidney diseases is possible when acting on the following pathogenetic links: C3 component of complement, kallikrein and activation of endogenous heparin with antithrombin III.

THE AIM of the investigation was to study activity of the kidneys in healthy subjects under conditions of different value concentrations of sodium chloride of watersalt loads in order to elucidate the character and mechanisms of their effects and to analyze how suitable this method is for clinical and experimental medicine. PATIENTS AND METHODS. The method of investigation of the renal functional reserve (RFR) was tested in healthy subjects using the sodium chloride solution in concentrations from 0.05 to 0.5%, volume 0.5% of the body mass. RESULTS. It was found that loading with 0.5% sodium chloride solution as compared with the water load is followed by a reliably increased excretion of creatinine, nitrites and osmotically active substances, as well as increased osmolality of urine. CONCLUSION. The results obtained allow a conclusion that when loaded with 0.5% sodium chloride solution the excretion of osmotic load is due to increased filtration charge, the watersalt load with the concentration of sodium chloride equal to 0.5% with the volume of 0.5% of the body mass inducing the involvement of RFR as compared with the reaction to water load.

THE AIM of the investigation was to elucidate the frequency of the development and to determine the potential causes of the development of the syndrome of prolonged QT interval (SPQTI) in patients with chronic glomerulonephritis (CGN) and to substantiate the possibilities to use betaadrenoblockers of metaprolol (corvitol) and its effectiveness for the correction of QT interval. PATIENTS AND METHODS. The investigation included 70 patients with CGN having the acquired SPQTI (mean age of the patients 38.5±0.9 years, and average duration of the disease 10.4±0.3 years). In 57 of them (81.4%) there were signs of decreased function of the kidneys: 14 patients had I stage CRF, 15 II stage, 28 III stage. The function of the kidney was not impaired in 13 (18.6%) patients. In all the patients ECG in rest was made with the apparatus «Fukuda Densi CardimaxJX 326» (Japan) in 12 standard leads with the registration rate 50 mm/sec. Dispersion of the QT interval (QU) was determined as the disparity between the maximum and minimum intervals Q-T (QU) by the formula: dispersion of the interval QT=QT max Q-T min (ms). RESULTS. It was shown that the average length of the Q-T interval and its dispersion in chronic glomerulonephritis patients increased with progressing renal failure. The potential causes of the development of prolonged QT interval syndrome are: hypertrophy of the left ventricle, clinically significant and asymptomatic dysfunction of the myocardium, dilatation of the left parts of the heart. Metaprolol used in patients with normal function of the kidneys and in the compensated stage of the renal failure promotes a decrease of the average length of the QT interval and its dispersion. CONCLUSION. The average length of the Q-T interval and its dispersion in CGN patients increases with progressing renal failure. Metoprolol (corvitol) decreases the average length and dispersion of the Q-T interval in patents with the saved function of the kidneys and in the initial stage of renal failure.

THE AIM of the work was to characterize membranepathological processes and to estimate the effects of alphatocopherol on clinicallaboratory indices in CRF patients on programmed hemodialysis. PATIENTS AND METHODS. The investigation was performed in 102 patients with the endstage CRF on programmed hemodialysis. The levels of alphatocopherol, lipid peroxidation products, major fractions of phospholipids and cholesterin were investigated in all the patients. In 55 patients effects of different doses of alpha tocopherol on lipid peroxidation processes, lipid spectrum of erythrocyte membranes and clinical manifestations of CRF were investigated. RESULTS. All the patients examined had the membrane destabilizing disorders. Positive effects of alphatocopherol were revealed on the structuralfunctional state of cell membrane and clinicallaboratory indices. CONCLUSION. The data obtained widen our understanding the role of the membranepathological processes in mechanisms of the development and progressing of CRF, in the formation of clinical manifestations of uremia. They also prove expedience of using antioxidant preparations in complex therapy of this category of patients.

THE AIM of the investigation was to determine psychosocial, demographic and clinicalbiochemical factors influencing non compliance of hemodialysis patients. PATIENTS AND METHODS. Under examinations there were 51 patients on chronic hemodialysis (HD). The excessive gaining of weight of the patients in the periods between dialysis procedures, absence from the procedures, and shortening the HD sessions were used as indices of noncompliance. Smoking and alcohol abuse were analyzed along with traditional indices of noncompliance. Psychodiagnostic techniques were used for the assessment of depression, anxiety, personal peculiarities, life quality, life aims and value orientations of the patients. RESULTS. Only stricter criteria of noncompliance (relative gaining weight over 5.7% of the patient’s dry weight, absence from and shortening HD sessions more than once a month) included about one third of the patients into the group of noncompliance patients even if by one index. However if the group of undisciplined patients could include all patients with weight gain more than 3 kg in the period between the HD sessions, the group of non compliance would include more than half patients. It was shown that smoking, alcohol abuse and all other indices of noncompliance are closely interconnected. Younger age of the patients (p=0.004) was found to be reliably connected with noncompliance. The rank correlation and factor analyses have shown that noncompliance is associated with such features as mistrustfulness, nonobservance of social norms, independence, low selfcontrol, emotional instability, external locus of control, dissatisfaction with selfrealization, absence of life perspectives. No reliable relationships of noncompliance indicators with gender, education, job, family, social supporting, mental state of the patient, life quality, clinicalbiochemical and anamnestic indices were revealed. CONCLUSION. It was found that the factors predisposing to noncompliance are young age, «somatic safety» and unfavorable personal features.

THE AIM of the work was to study the indices of waterelectrolyte metabolism and stability of urine in children with dismetabolic nephropathies. PATIENTS AND METHODS. The observations were performed in 118 dismetabolic nephropathy children aged from 5 to 16 years. The biochemical methods of the analysis of urine included the following: diurnal urine excretion, urine pH, excretion of ammonia, titrated acidity, concentration and excretion of basic ions (sodium, potassium, inorganic phosphorus, chlorine). Risk of crystallization of urine in relation to the salts of oxalic and uric acids was detected by determining calcium and magnesium ions by the atomadsorption method. The indices of factors of urine stability and calciphylaxis tests, peroxide and polar lipid tests were studied by standard methods developed by E.Yu.Yurieva (1984). RESULTS. Certain components of the structure of tubular dysfunction were determined in children with dismetabolic nephropathies. CONCLUSION. Changes in indices of the functional state of the kidneys, membrane destruction and urine stability factors were revealed which were better expressed in groups of children with metabolic disorders in combination with inflammatory diseases of the kidneys and non infectious pathology of organs of the gastrointestinal tract.

THE AIM of the work was to analyze morphological alterations in the kidneys in gouty glomerulonephritis using investigations of bioptates of living patients and sectional findings. PATIENTS AND METHODS. There were 28 histological examinations of the renal tissue, nephrobiopsy was performed in 21 of the patients (1st group). In 7 cases the sectional material was studied taken from corpses of people dead from renal failure (2nd group). Morphological alterations in the renal tissue in gouty glomerulonephritis were assessed. RESULTS. It was found that the alterations in the kidneys of the first group patients corresponded to focal mesangial proliferative (62%) and mesangiocapillary glomerulonephritis (28.6%). Both morphological forms of glomerulonephritis are accompanied by a sharply pronounced tubulointerstitial component. Alterations in the kidneys of the second group reflected nephroangiosclerotic processes. The degree of the alterations in the renal tissue depended on the duration of the disease. CONCLUSION. The data obtained suggest the presence of different variants of glomerular lesions of the kidneys with a sharply pronounced tubulointerstitial components in patients with gout.

THE AIM of the investigation was to study the local system of kidney hemostasis in complex treatment of experimental Mazugi nephritis. MATERIAL AND METHODS. Blood tests were taken from the renal artery and renal vein of 50 rabbits narcotized with ethaminal before and after administration of a complex of drugs (plasma with high content of ATIII, phentolamine, prodectine). Effects of plasma and urine of the animals on a number of indices of coagulogram were studied which included 19 tests determining the state of the coagulating and anticoagulating potentials of the local vascular basin of the kidneys. RESULTS. Plasma with high content of ATIII, phentolamin and prodectin have a positive therapeutic effect reducing the formation in the vascular bed of the kidneys of prothrombinase, elevating the content of anticoagulants, enzymatic and nonenzymatic fibrinolytic compounds. CONCLUSION. Treatment of experimental nephritis with plasma with ATIII as the most important cytoprotector inhibiting C3 complement component, with phentolamine as a blocker of alphaadrenoreceptors and prodectine as a kallikrein inhibitor is substantiated pathogenetically.

THE AIМ of the investigation was to study activity of rats’ kidneys under conditions of a single and chronic administration of small doses of nitrites. MATERIALS AND METHODS. The work was performed in white male rats. Effects of a single dose of sodium nitrite (0.2 mg/100g of body mass) against the background of 5% water load were studied in mature rats with body mass 95110 g (n=20). Chronic administration of sodium nitrite was fulfilled by watering the animals (body mass 190260 g) with water solution of sodium nitrite (50 mg/l) during 7 days (n=10). In addition, a series of experiments were carried on with a simultaneous watering with water solution of sodium nitrite (50 mg/l) and capropril (10 mg/l) during 7 days (n=20). The results obtained were compared with the controls of the same age 15 rats in each group. The function of kidneys was investigated under conditions of 5% water load. RESULTS. It was found that small doses of sodium nitrite when given once or chronically caused reliably decreased creatinine clearance and elevation of renal excretion of protein. It was also shown that captopril at chronic administration of nitrites failed to abolish the decrease of creatinine clearance and the increase of proteinuria. CONCLUSION. 1. A single or chronic administration of small doses of sodium nitrite to white rats results in decreased creatinine clearance and elevated excretion of protein. 2. Chronic administration of small doses of sodium nitrite is followed by accumulation of nitrites in the extracellular fluid. 3. The simultaneous chronic administration of ACEinhibitor and small doses of sodium nitrite facilitates further increase of protein excretion by the kidneys against the background of lower value of creatinine clearance. 4. Blockade of ACE with captopril influences the renal transport of exogenous nitrites and nitrates and the state of the nitrogen oxide cycle.