THE AIM of the investigation was to study coping strategies characteristic of hemodialysis (HD) patients, their specific features as compared to the strategies used by healthy subjects and the variables associated with coping preferences of these patients. PATIENTS AND METHODS. The investigation included 85 patients treated by chronic HD. Coping strategies were estimated with the help of the questionnaire «The ways of Coping Questionnaire». In all the patients the indices of quality of life, levels of depression and anxiety, type of attitude to illness, clinical indices were determined in order to establish the variables associated with coping preferences of the patients. RESUILTS. In HD patients there are such prevailing coping strategies as «selfcontrol» and «planning of solving problems». They rarely have such a passive and nonconstructive method of overcoming problems as «escapeavoidance». Unlike the healthy, HD patients very rarely use «confrontation», «escape», «positive overestimation of the situation» as a means of coping difficult situations and more often «self control» and «distance». The data obtained show sufficiently successful mental adaptation of patients to chronic disease and HD treatment. The indices of coping strategies were found to be associated with the parameters of quality of life, types of attitude to illness, gender, age, duration of kidney disease and HD treatment, dynamics of change to HD. CONCLUSION. The prevailing strategies of coping problems in HD patients are «selfcontrol», «planning of solving problems», they rarely have a passive and nonconstructive means of stress overcoming behavior «escapeavoidance» that suggests good adaptation potentialities of such patients.

THE AIM of the study was to verify antiphospholipid syndrome in patients with chronic alcoholism accompanied by the liver and kidney lesion, to determine the interrelations between clinical and immunological manifestations of antiphospholipid syndrome and cholesterol metabolism status, lipoproteins. MATERIALS AND METHODS. One hundred and eleven male patients with chronic alcoholism having kidney lesion were examined. Blood serum level of ApoV was determined using the method of hard phasic immunofermental analysis according to L.M.Polyakov. RESULTS. The highest blood serum level of ApoV in combination with marked impairments of the albumin transport function was revealed in patients with chronic alcoholism with kidney lesions. CONCLUSION. Chronic alcoholism patients with kidney lesions in 80,7% of cases develop secondary antiphospholipid syndrome with morphological alterations to kidney tissues by the ischemic and necrotic type.

THE AIM of the work was to study the state of hemodynamics at different levels of renal arterial system and the influence of inhibitors of angiotensin converting enzyme (ACE) on hemodynamic indices in children with glomerulonephrites (GN). PATIENTS AND METHODS. In 74 children with different variants of glomerulonephritis inhibitor of ACE Enap (Enalapril) in daily dose 0.1 0.3 mg/kg was used in addition to traditional medicine. RESULTS. According to data of impulse dopplerometry the state of renal blood flow in GN was impaired at different levels of the renal arterial system (in the trunk of the renal artery, segmentary, interlobular and arcuate arteries). The most pronounced disorders in dynamics were observed in small arteries of the kidneys interlobular and, especially, arcuate. But blood flow in large arteries can remain normal. In the edematic period of the nephrotic form (NF) of GN disorders in the renal blood flow are characterized by higher indices of vascular resistance in the renal artery trunk first of all, and in most patients it was combined with edema of parenchyma and increased sizes of the kidneys. Improvement of renal hemodynamics and substantially decreased proteinuria was obtained by administration of Enap (daily dose 0.1 mg/kg) while in nephrogenic AH effective was the daily dose of Enap not less than 0.3 mg/kg. Administration of inhibitors of ACE for NF of chronic GN was followed by a considerable improvement of indices of impulse dopplerometry at all levels of the renal artery, decrease of high arterial pressure. Using Enap facilitated effective drop of high arterial pressure in most patients examined. CONCLUSION. Thus, most children with GN have marked disorders of renal hemodynamics that can often be corrected by ACE inhibitors.

THE AIM of the work was to study effects of substances of low and middle molecular mass (SLMMM), considered as uremic toxins, upon the indicators showing inflammation. PATIENTS AND METHODS. The investigated group included 30 patients with normal function of the kidneys, 77 patients with predialysis stage of chronic renal failure (CRF) and 54 patients with terminal CRF receiving substitution therapy with hemodialysis (HD). At the moment of examination the patients did not have symptoms of exacerbation of the main disease of the kidneys or coexisting diseases. The concentration of SLMMM was determined in patients with different stages of CGN and then a correlation analysis of interrelations between SLMMM and indices of inflammation (ESR, fibrinogen, CRP, IL6, TNFalpha, albumin, albumin binding power) was made. RESULTS. Positive correlative interrelations of SLMMM with ESR, fibrinogen, IL6 and negative with albumin and albumin binding power were obtained. When the SLMMM indices were elevated the indices of general inflammatory syndrome became worse: ESR, level of IL6 and fibrinogen became higher, while albumin and albumin binding power decreased. CONCLUSION. An analysis of the data obtained allows a supposition that uremia is a cause maintaining inflammation in patients with CGN and in future can result in the development of atherosclerosis, ischemic heart disease, complications to the cardiovascular system.

THE AIM of the work was to assess effectiveness of Cobavit in decreasing immonopathological and inflammatory processes in children with nephrotic syndrome in acute glomerulonephritis (AGN) depending on the degree of involvement of the pancreas in the pathological process. PATIENTS AND METHODS. Under observation there were 65 children with AGN and nephrotic syndrome aged from 4 to 14 years. Patients of the control group (n=42) received basic therapy, 23 patients of the main group were given Cobavit in additipon to basic therapy. RESULTS. AGN with nephrotic syndrome in most children was characterized by the involvement of the thyroid gland in the pathological process which was manifested as its increased size, density and decreased functional activity (73.7%). Increased titer of antibody to the thyroid gland , level of circulating immune complexes (CIC) and middle mass molecules (MMM) was noted depending on the thyroid status. Basic therapy of AGN somewhat decreased antibody titer to the thyroid gland, content of CIC and MMM in blood serum that made for certain elevation of production of thyroid hormones. Patients treated with Cobavit included in the complex therapy had less duration of intoxication, edematic syndrome and hepatomegalia were arrested in shorter terms, the indicators of protein metabolism and partial functions of the kidneys became normalized quicker. Moreover, Cobavit facilitated more pronounced restoration of the hormonal status of the thyroid gland. CONCLUSION. The addition of Cobavit to basic therapy of AGN with nephrotic syndrome in treatment of children facilitated earlier reduction of renal and extrarenal symptoms of the disease and has a tendency to normalization of the functional state of the thyroid gland.

THE AIM of the work was to study the influence of thyroxine on renal functions and renal excretion of nitrites and nitrates under conditions of osmotic load with solution of sodium chloride. MATERIALS AND METHODS. The investigation was carried out in white male rats, thyroxine was injected i/p 50 mkg/100 g body mass. Functions of the kidney were studied under conditions of induced diuresis after intragastric administration of water or 0.3%, 0.8%, 2% and 3% solutions of sodium chloride in volume 5% of body mass. RESULTS. It was found that thyroxin induced a decrease of creatinine clearance and elevated excreation of endogenous nitrites and nitrates. CONCLUSION. 1. Administration of thyroxin results in a stable decrease of glomerular filtration rate in all series of the experiments except load with 3% solution of sodium chloride. 2. Thyroxine exerts stimulating influence on renal excretion of nitrites and nitrates.

THE AIM of the investigation was to analyze clinical manifestations of carcinoma of the renal pelvis and ureter, its classical morphological signs, to give quantitative assessment of expression of protein Ki67 and cell infiltration of carcinoma stroma, and to reveal indicators allowing to refer the patients to groups of high and low risk of progressing and recurrences of carcinoma. PATIENTS AND METHODS. A retrospective investigation of findings of the original examination and fiveyear dispensary followup was carried out after operative treatment of 37 patients with transitional cell carcinoma of the renal pelvis and ureter. In addition to a standard clinical examination and general morphological analysis the content of cellseffectors of stromas of carcinomas were studied in the ablated tumor tissues and Ki67 proliferation index was calculated. The data obtained were compared with recurrent growths into the urenary bladder and five year survival of the patients. RESULTS. Fiveyear survival without progressing carcinoma was lower in patients with coexisting benign prostate hyperplasia (p=0.038), left side position of the tumor (p=0.043), late consultation with a doctor for symptoms of the disease (p=0.035), B(III) blood group (p=0.005), leukocytosis with formula shift to the left (p=0.001), low level of prothrombin (p=0.022), high creatinin level (p=0.024), low specific weight of urine (p=0.30), great depth of invasion (p=0.003), low degree of differentiation (p=0.002), recurring course (p=0.042), short «light» gap without recurrences (p=0.023), high index of proliferation of Ki67 (r=0.48; p=0.003), and more pronounced infiltration of stroma tumor by macrophages (r=0.28; p=0.015) and eosinophilic leukocytes (t=3.76; p=0.001). The regression analysis more exactly demonstrated the probability of recurrent carcinoma into the bladder by revealing low degree of differentiation (p=0.0001) and high values of Ki67 index (p=0.0005). For prognosis of five year survival without progression according to the results of multifactorial analysis (R2  = 0.81; F=40.93; p<0.0001) the most valuable signs proved to be Gcategory, index Ki67 and degree of stroma infiltration by macrophages. CONCLUSION. The combined assessment of clinical, traditional morphological and additional morphometrical and immunohistochemical indices in patients with carcinomas of the renal pelvis and ureter allows to make more exact prognosis of risk of recurrences and progressing of carcinoma.

THE AIM of the investigation was to detect causes of unsatisfactory results of operative treatment of patients with benign prostate hyperplasia (BPH). PATIENTS AND METHODS. Urodynamic examination was performed in 27 patients with unsatisfactory results of operative treatment. Complaints to day and night pollakiuria, feeling of incomplete emptying of the bladder, imperative urges to urination etc. remained in 18 patients. Postoperative urinary incontinence was also noted in 9 patients. The control group consisted of 17 patients with good results of operative treatment. RESULTS. Findings of urodynamic examination of patients showed that dysuria retained after operation was due to a pathology of detrusor: 16 (50.3%) patients had detrusor instability (DI) and 2 (7.4%) had impaired contractility of detrusor. Patients with urinary incontinence also had marked impairments of the detrusor function. The maximal cystometric capacity of the bladder in these patients proved to be as little as 300.1± 30.7 ml (p< 0.05), and DI was diagnosed in 55.6% of patients. At the same time, patients with urinary incontinence had sharply decreased indicators of profilemetry of the urethra characterizing the blood sphincter function of the bladder  the functional length of the urethra, maximal urethral pressure and maximal pressure of urethra closing (p<0.001). The urodynamic examination diagnosed veritable caused by stress urinary incontinence due to a damage of the urinary bladder sphincter in 4 patients. Five patients had mixed character of incontinence of urine due to both a damage of the sphincter and to dysfunction of detrusor (mixed urinary incontinence). CONCLUSION. The urodynamic examination of patients for unsatisfactory results of operative treatment allowed determining the cause of dysuria, urinary incontinence included. Exact diagnosis of specific features and causes of impaired function of the lower urinary pathways in such patients helps to choose adequate policy of treatment.

THE AIM of the investigation was to find out morphological risk factors and to make a mathematical prognostic model of a local recurrence of tumor in patients with prostate cancer after radical prostatectomy. PATIENTS AND METHODS. An analysis of incidence of local recurrences of tumor in 150 patients with localized forms of prostate cancer after radical retropubic prostatectomy was made with special reference to the results of morphological investigation. RESULTS. A local recurrence of tumor after radical prostatectomy took place in 13 (8.7%) patients. The leading morphological risk factors of its appearance (the greatest coefficient of factor load, F) were: positive surgical edge (F=54,20, growth of tumor into the seminal vesicles (F=31.56%) and metastases in the regional lymph nodes (F=21.14). A mathematical model allowing prognosis of its appearance with 84.6% probability was made on the basis of the analysis of morphological factors of risk of recurrence of prostate cancer. CONCLUSION. The assessment of probability of the appearance of local recurrence of tumor is necessary for planning the treatment of the patients after radical prostatectomy with special reference to morphological risk factors.