The histohemical barrier of the nephron as the biological system in renal pathology.

Hyperhomocysteinemia and cardiovascular diseases in patients on maintaining dialysis.

Furosemide in chronic renal failure.

Quality of life in patients with chronic renal failure.

Role of nitric oxide in pathogenesis of chronic glomerulonephritis (a review of the literature).

Glomerulonephritiswas diagnosed in 52% of patients with infectious endocarditis (IE). In males lesion both of the heart and of the kidneys has a more severe course and rather often the development of nephritic syndrome and kidney insufficiency is observed. The severity of glomerulonephritis is aggravated by the disease duration, primary character of IE and impaired structures of the heart and extracardial symptoms of the disease as well as the contractile ability of the myocardium. In its turn, the degree of the kidney pathology is responsible for a number of electrophysiological disorders in the heart, hypertension in the pulmonary circulation and total peripheral vascular resistance.

INTRODUCTION. The aim of the work was to assess renal hemodynamics before and after protein loading by the method of duplex-Doppler scanning (DDS) and dupplerography of the renal vessels. PATIENTS AND METHODS. The patients (17 children aged between 9 and 16 years) were divided into 2 groups: 7 patients with hypoplasia of the kidney (first group) and 10 patients with the secondary contraction of the kidney as a result of pyelorenal vesicoureneral reflux (second group). The control group included subjects with healthy kidneys contralateral to the injured ones. Soy protein as a protein load was given to the patients on an empty stomach in a dose1g/kg. Control DDS was carried out in 2 hours after loading. RESULTS. No difference was initially revealed in the rate and resistance parameters of blood flow in healthy and hypoplastic kidneys. The secondary contracted kidney had reduced parameters of velocity and resistance of hemodynamics. After protein loading the healthy kidneys showed a considerable growth of the maximum and minimum velocity of blood flow in the trunkal renal artery with the preserved normal values of the peripheral vascular resistance parameters. No reliable difference was found in the velocity and resistance parameters of blood flow in the hypoplastic kidney before and after loading. The contracted kidney was characterized by higher indices of the peripheral vascular resistance after loading, especially in small vessels, and by a tendency to greater diastolic velocity of circulation in the main vessel. The inability of the hypoplastic kidney to considerably increase the circulation velocity after loading shows the reduced activation of the kidney reserves after stimulation that can be due to the initially less number of nephrons. Low indices of the peripheral vascular resistance in the contracted kidney with infiltrative-sclerotic alterations were due to the mechanism of arterio-venous bypass of blood (AVBB) ₁ The higher indices after loading were due to slower processes of AVBB at the expense of the reestablished blood flow in the microcirculation bed, greater influence of the state of perivascular tissues on the peripheral resistance and vasoconstriction to prevent rapture of deformed and thinned arteries in the area of scarry alterations of the parenchyma. CONCLUSION. The differences in initial parameters of hemodynamics and peculiarity of reactions to loading in cases of hypoplasia and contracted kidney can be used in differential diagnosis of the «small» kidney.

The aim of the work was to assess the state of hemodynamics at different levels of the renal artery in children with different forms of glomerulonephritis. The investigation included 74 children with glomerulonephritis and 15 practically healthy children aged between 3 and 15 years. The children were divided into three groups: 1 - children with nephrotic syndrome of acute glomerulonephritis, 2 - children having nephrotic syndrome with hematuria and 3 - children with the nephrotic forms of chronic glomerulonephritis. Disturbed renal hemodynamics was noted in all the groups. More pronounced impairments of the renal hemodynamics were noted in the nephrotic form of CGN charcterized by considerably lower vascular resistance at the arcuate artery level. The resistance indices in the large vessels were not disturbed in patients with exacerbation of CGN. The data obtained suggest that disturbances of the renal hemodynamics depend not only on activity of GN but also on the course of the disease. In the absence of extrarenal manifestations the blood flow was altered mainly in small (arcuate) arteries of the kidneys and has Iowerindicesof vascular resistance. Thus, in the active period the blood flow was disturbed in all variants under consideration. But it was better preserved in patients with the hematuric form of GN. The state of renal blood flow in GN was disturbed at different levels. The greatest disturbances were noted in small arteries of the kidneys - interlobular and especially arcuate. The blood flow in large arteries can remain normal. In the edematous period in the nephrotic form of chronic glomerulonephritis the disfurbancea of the renal blood flow are characterized by the elevation of the indices of vascular resistance, first of all in the renal artery trunk. Thelatter is combined with parenchymal edema and increased size of the kidneys.

Damage of the vessels is associated with inflammation. The erythrocyte sedimentation rate (ESR) is a simple method of assessment of the clinical status. The aim of this study was to estimate the relationship between the ESR and total arterial compliance assessed by stroke volume/pulse pressure ratio (SV/PP ratio) in non-diabetic pre-dialysis patients. Sixty seven non-diabetic pre-dialysis patients (36 males and 31 females, mean age 51 ±11 years) were studied. 51 patients (76.1 %) had arterial hypertension. Serum creatinine was 215.8±139.5 mmol/l, hemoglobin concentration -124.1 ±17.3 (range 75-163) g/l, 34 patients had normal ESR (J20 mm/h) and 33 patients had high ESR (>20 mm/h). Total arterial compliance was estimated by the ratio of echocardiographic (Teichholz) stroke volume to pulse pressure (SV/PP ratio). Patients with high ESR had lower SV/PP ratio than those with normal ESR (0.92±0.31 vs 1.2+0.48 ml/mmHg, respectively, p=0.006). The multiple regression analysis showed that ESR independent of the age, gender, body mass index, serum creatinine, serum albumin, hemoglobin was negatively related to SV/PP ratio (Multiple R ² = 0.70; b=-40; p=0.02). These results suggest that low total compliance is associated with the inflammation with high ESR in pre-dialysis patients.

Preliminary investigations of the antiarrhythmic effect of stepwise profiling potassium in dialysate were analyzed and an effort was made to establish a category of patients who had to change the standard dialysis program. Eight stable patients on programmed out-patient clinic hemodialysis were examined. Two series, 16 investigations each, were carried on in two stages. The content of potassium was different at different stages of the investigation. The dialysate with the standard content of potassium - 2.0 mmol/l - was used during the first stage. In the second stage three variants of dialysate were used during hemodialysis: the potassium content 3.0 mmol/l, 2.5 mmol/l and 2.0 mmol/l. Heartarrhythmiaswere noted in 43.8% during the dialysis procedure on a standard dialysate without profiling. The dialysis with potassium profiling in the dialysate was followed by heart arrhythmias in 12.5%. Certain regularities in the blood serum potassium concentration before dialysis and the potassium gradient during the first two hours of dialysis were detected in cases of the development of arrhythmias during dialysis or without them.

Hemostatic disturbances were studied in 61 patients receiving chronic bicarbonate hemodialysis treatment. Hypercoagulability was revealed in 74%. Itwas established that the main hemostatic causes of thrombotic complications were Iow antithrombin III (r=-0.28, p<0.05) and the inhibition of the fibrinolysis process (t=0.21, p=0.02). Nonhemostatic thrombogenic factors were determined: blood hyperviscosity syndrome after hemodialysis, immune inflammation, arterial hypotension, acidosis/alkalosis and primary arteriovenous fistula «vein-artery» (p<0.05).

The aim of the work was to determine the relationship of glycated hemoglobin (GH) and diabetic nephropathy (DN). We investigated 20 patients with diabetes mellitus (DM) and used the method of thiobarbituric colorimetry with preliminary isoelectrofocusing of HbA1 с for the determination of GN. AU the patients with DM had an inadequate level or high vascular risk of glucose control. In 14 patients there was microalbuminuria (0.03-0.39 g/l), 4 patients had DH with proteinuria (>0.3 g/l) and 2 patients had chronic renal insufficiency. AU the patients did not have linear correlation but had a parabolic dependence between GH level and proteinuria (y=-0.5667+0.1621 x-0.0065 X ²). The regression error D=3.4303.

The article presents results of complex examination of homeostasis parameters in 54 pregnant women at the third trimester with low renin, normal renin and high renin variations of arterial hypertension (AH) caused by intensive enterosorption therapy. The usage of the enterosorption method was substantiated by the data that in patients with the impaired renal function the gastrointestinal tract is considered to be a vicarious organ for elimination of toxins. The medical complex includes the administration of siliceous enterosorbents (Aerosil, enterosgel, polysorb) against the background of provocative diarrhea. Such treatment resulted in hypotensive effects, reverse dynamics of the development of intoxication, reduced edema, stabilization of weight in pregnant women with AH. The method had a normalizing effects on partial renal functions (diuresis, natriuresis) and positive effects on different compartments of the nephron. In pregnant AH women the stimulation of antiradical activity was noted against the background of inhibition and staling of peroxidation. The reduced quantity of average mass molecules has confirmed the effect of detoxication. The method has no negative effects on the fetus. The clinical efficiency of the method is confirmed by the possibility to prolong pregnancy. The program of intensive therapy with the application of the sorption method is mostly indicated to pregnant women with the normal renin variant of AH.

The influence of metachlorobenzhydrylurea on the renal secretion of omnipaque was investigated in rats. It was shown that the mixed type inductor significantly decreased the maximal secretion of X-ray contrast substance. The observed renal effect appeared to be connected with the activated opaque metabolism in the liver. Formed hydrophilic metabolites of this substance were worse secreted by the renal tubules.

The myocardium of rats with experimental chronic renal failure (CRF) (surgical model, UR -14.9±1.2 mmol/l) is characterized by a reduced intensity of isometric contraction and relaxation rate. The low-intensity Iaserirradiation of the myocardium (wave length 632.8 nm, powerflow density 15 mBt/cm ²) causes an increase of the maximum force of isometric contraction of the myocardium in animals with experimental CRF during the period of irradiation and in the postirradiation period. The total effect and of the action and aftereffect of He-Ne laser radiation on the myocardium of rats with uremia results in the reestablishment of the contraction amplitude up to the values characteristic of the control (sham-operated) animals. The isometric contraction rate also increases. During the physiological regimen of mechanical load the contractability was found to increase under the influence of red Iaserwith all end-systolic lengths, and the relative relaxation rate increased with any fixed length. Irradiation of the uremic rats myocardium with laser light results in the reestablishment of smoothed rhythm-inotropic phenomena.

The aim of the work was to follow the effectiveness of arginine for correction of acute renal insufficiency (ARI) at sublimate nephropathy and to determine the optimum combinations with other medicines. Experiments were carried out in 51 white male Wistar rats. The animals were kept on a low sodium diet (sodium content up to 50 mkmol/day). The function of the kidneys was investigated in rats of a control group and four groups of animals with AR) caused by subcutaneous injection of corrosive sublimate (5 mg/kg of body mass in isotonic solution) in 24 hours after injection (oliguria period) under conditions of water diuresis. Corrosive sublimate, arginine chloride, arginine and preductal were injected to the 4 groups of rats intraperitoneally (5 mg/kg); arginine chloride and hyperosmolar infusion solution sorbilact. It was shown that the proposed approach is perspective for treatment of kidneys affected by sublimate and most likely of all other toxic nephropathies since it is pathogenetically substantiated. Choice of the medicine possessing a vasodilatation effect - arginine or sorbilact - mainly depends on the character of disorders of the water-salt metabolism and hemodynamics.

Problems of vaccination of chronic renal patients on hemodialysis.

A case of interstitial nephritis in a child in a late stage of Kawasaki disease.

Immunological diagnosis of lesions to the kidneys with vasculites.

Experience of Balint groups with practical treatment of patients with chronic renal failure and chronic hemodialysis.

Renal dysfunction in chronic renal failure patients at administration of inhibitors of angiotensin I-converting enzyme.

Contemplation of a clinician on the essence of the disease and its components: problem of secondary nephropathies.