Renal dysfunction in chronic heart failure: theoretical and clinical aspects.

Investigation of the glomerular filtration rate before and after the dopamin load for determining the renal functional reserve is a sufficiently simple and available method for prognosis of the disease course. It can be an objective means of the assessment of effects of therapy on the glomerular hemodynamics state. Systemic enzymotherapy allows to increase the glomerular filtration rate and to carry out correction of the developed hyperfiltration.

THE AIM of the work was to determine the influence of life quality indices and other clinical data on survival of young patients on chronic hemodialysis (HD). PATIENTS AND METHODS. A prospective observation of 83 patients from 16 to 44 years of age treated by chronic HD was carried out during 30 months. Before the observation in all the patients the indices of life quality (by the SF-36 method) and clinical indices were determined for the assessment of their prognostic significance in relation to survival of the patients. RESULTS. In the group of the dead (n=14) the initial indices of life quality such as the ability to endure physical loads (PF), sensitiveness of pain, and a total index of physical health were lower. CONCLUSION. It was found that the integral index of physical health based on the self-appraisal of the patient is one of important independent predictors of survival of young patients on HD on a level with the average volume of ultrafiltration, calcium-phosphate product, diameter of the left atrium and HD type. The indices of mental health of the patient under study were not associated with survival.

THE AIM of the work was to analyze 315 cases of patients (aged 47±5.7) who died of tuberculosis in the period of 1992-2001. PATIENTS AND METHODS. In the total number of cases there were 40 patients found to have amyloidosis of their internal organs which developed against the background of the tuberculosis process (12.69% of all the analyzed cases). Furthemore, 35 patients (87.5%) suffered from fibrosis-cavernous tuberculosis, 2 patients (5%) had disseminated tuberculosis of the lungs and 3(8.5%) had infiltrative tuberculosis of the lungs. In 38 cases (95%) an elimination of bacilli was observed. RESULTS. A diffuse injury of internal organs (liver, kidney, spleen) was registered in 9 cases (22.5%) and isolated injuries of the kidneys took place in 31 cases (77.5%). Amyloidosis of the kidneys in tuberculosis proceeds, as a rule, with normal or reduced arterial pressure, and in more than half of the patient with isolated proteinuria and «empty» urinary deposit. The development of chronic renal failure took place but rarely. In cases of its appearance the Iiverfailurewas present in early stages. CONCLUSION. Acorrelation between proteinuria at the nephrotic level, the degree of tubular atrophy and interstitial fibrosis were revealed. In all cases the cause of death was a consequence of activity and progression of the basic disease.

THE AIM of the investigation was to study the indices of arterial pressure in chronic glomerulonephritis patients with arterial hypertension. PATIENTS AND METHODS. The indices of diurnal variability of arterial pressure were studied in 20 chronic glomerulonephritis patients with saved and reduced function of the kidneys. RESULTS. The predominance of nocturnal over diurnal pressure was found in patients with chronic renal failure. In patients with the normal renal function the episodes of spontaneous hypotonia were registered more often. CONCLUSION. Specific features of variability of arterial pressure allowed to refer chronic glomerulonephritis patients with normal renal function to «non-dipper» category, and the patients with the reduced function - to «night-piker» category which is the most unfavorable variant of the course of hypertension.

Among 186 examined children there were 74 children with different forms of pyelonephritis (PN) and 112 children with tubulo-interstitial nephritis (TIN). The parameters of the functional condition of the kidneys in children were estimated in the acute period of illness, during the formation of clinico-laboratory remission, in a year and 3 years after the acute period. Mathematical modeling of the kidney function condition was carried out by the method of a systemic multifactorial analysis (SMA). The impairment of the kidney function in all the patients occurred due to its tubular component that manifested itself in the impaired function of the proximal and distal tubule (reduced reabsorption of the tubules and concentration ability, parameters of acido-and ammoniogenesis, increased diurnal proteinuria). The assessment of nephroscintigrams with the tubulotropic preparation MAG-3 has confirmed the data obtained. No impairment of the azoteliminating function and electrolyte structure of blood were revealed. The SMA has confirmed the primary impairment of tubular functions. The designed weight factors and integral parameters reflected a tubular dysfunction. In the acute period of PN the functional condition of the kidney was reduced due to the impaired concentration function and that of the distal tubule. In children with chronic PN and TIN the degree of impairment of the functional condition of the kidneys was higher during the longer process in renal tissues (inflammation in tubulo-interstitial tissue of the kidney, sclerotic processes in the tubules).

THE AIM of the work was to study renal hemodynamics and natriuresis in ischemic heart disease patients with the I and Il functional class (I FC and Il FC) heart failure against the background of treatment with one of inhibitors of angiotensin converting enzyme (IACE) - Perindopril (Prestarium). PATIENTS AND METHODS. The investigation of 60 patients (average age 58.75±1.75) included 20 patients with I FC heartfailure (first group), 20 patients with Il FC heartfailure (second group) and 20 patients without heart failure (control group). Patients of the first and second groups were given Perindopril (4 mg/daily) during 6 months against the background of basis therapy and were examined twice before and after treatment with Perindopril. Patients of the control group were examined once against the background of basis therapy. The indices of renal hemodynamics such as effective renal plasma flow (ERPF), effective renal blood flow (ERBF) and renal vascular resistance (RVR) were estimated by Hippuran 1-131 clearance. Sodium reabsorption in proximal portions of the renal tubules was determined by exogenous lithium clearance (Cl Li). RESULTS. ERPF and ERBF were reliably lower in patients of the 1 sland 2 nd groups before taking Perindopril, and RVR was reliably higher than in the control group. Indices of Cl Li in these patients were reliably lower than in the control group patients, natriuresis being somewhat lower. CONCLUSION. After 6 months of taking Perindopril ERPF and ERBF were higher and RVR lower (reliably at Il FC HF), Cl Li reliably elevated as well as natriuresis and diuresis that suggests improvement of the renal hemodynamics of the eliminating function of the kidneys.

THEAIM of the work was to investigate the effects of a hemodialysis (HD) session on transmitral blood flow. PATIENTS AND METHODS. Echocargiographyand doppler echocargiography were carried out in 27 patients (15 women and 12 men, average age 49±12 years) before and after bicarbonate 4 hour long HD. Maximum rates of the early (E) and late (A) diastolic filling and their ratio (E/A), time of isovolumic relaxation of the left ventricle (IVRT), time of slowing down the early diastolic flow (DT) were determined. The concentration of sodium, potassium, calcium, magnesium in blood serum were determined before and after HD. RESULTS. Hemodialysis resulted in the reduction of the maximal rate in E peak from 98.3± 24.8 to 76.5±23.8 cm/c (p<0.001), and the rate in A peak did not substantially change, the E/A ratio decreased (from 1.21 ±0.59 to 0.95±0.43; p=0.009). IVRT and DT did not substantially change. A direct correlation relationship was found between the ultrafiltration value and the dynamics of rate in E peak ( D E, r=0.45; p=0.02). Hemodialysis resulted in a reliable decrease of potassium and sodium and increase of calcium in blood serum, the electrolyte dynamics being not associated with the dynamics of the parameters of transmitral blood flow. CONCLUSION. The data obtained suggest a demonstrable influence of a hemodialysis session on the diastolic filling of the left ventricle. The early diastolic filling considerably decreased which had a direct association with ultrafiltration. Patients with the ultrafiltration value more than 3% of the body mass were found to have considerably more demonstrable changes in transmitral blood flow.

THE AIM of the work was to determine the concentration of copper and ceruloplasmin activity in plasma of patients with chronic renal failure before and after hemodialysis. PATIENTS AND METHODS. Under examination there were 28 hemodialysis patients and 15 healthy subjects. The causes of chronic renal failure were: chronic glomerulonephritis in 14 out of the 28 patients, chronic pyelonephritis - in 10 patients, other disease in 4 patients. Seventeen patients underwent 200 and more hemodialyses, 11 - less than 200 hemodialyses. The concentration of copper and ceruloplasmin activity were examined immediately before and after hemodialysis in patients with an empty stomach. The Ten express method was used for the investigation of ceruloplasmin activity. RESULTS. The ceruloplasmin activity was significantly lower in patients before hemodialysis than in the controls (27.9±1.61 and 37.27±1.03 u/l respectively, p<0.001 ).The concentration of copper in plasma was practically the same in hemodialysis patients and in the control group (16.29±0.68 and 16.34+0.94 u/l respectively). CONCLUSION. The hemodialysis procedure results in higher levels of ceruloplasmin activity and copper. A good correlation between activity of ceruloplasmin and copper was shown.

THE AIM of the work was to investigate the bioamine status of the kidney. MATERIAL AND METHODS. Two series of experiments were carried out. The first series included 10 white rats: 4 - controls, 3 - one day of water deprivation (WD), 3 - two days of WD with free access to dry food. RESULTS. During the first day WD decreased the intensity of fluorescence of catecolamines (CA), serotonin (S) and histamine (H) 2-3 times (p< 0.01) in all parts of the nephron.On the second day of WD there was a tendency to restore the initial level of CA and S, but the fluorescence remained reliably lower than in control, the fluorescence of H was completely restored. Fluorescence of acetylcholine (ACH) during the first days of WD was 7-8 times greater in the glomeruli and Henle’s loops, and 2-3 times in the tubules (p<0.001). In all parts of the nephron there was a strong negative correlation between ACH and other mediators under study (p<0.01) and strong and median positive correlation between other mediators. In the second series having the same scheme the influence of WD on the renal population of mast cells (MC) was investigated. Beginning from the first day WD resulted in 2 times greater number of MC in the subcapsular zone of the kidneys which remained high. In the medullary zone the number of MC was 8 times greater on the second day. CONCLUSION. The extraneuronal pools of renal CA, S, H 1ACH and MC are involved in the regulation of the renal status in WD.

THE AIM of the work was to study the state of the intact rats’ kidneys in response to acute osmotic loading in relation to age. MATERIALS AND METHODS. An analysis of the state of the osmoregulating function of kidneys was performed under conditions of the water and acute osmotic (3% solution of sodium chloride) loading in intact rats of three age groups: animals in the stage of pubescence, young pubescent and old age group animals. RESULTS. It was found that 3% sodium chloride in the volume of 5% of body mass given to rats in the stage of pubescence, to young pubescent and animals of the old age group, as compared to water loading in the volume of 5% of body mass resulted in the increased rate of glomerular filtration. The highest initial values of creatinine clearance and the indices of the induced growth of this parameter were registered in the group of young pubescent animals, and the minimal ones in the group of animals in the stage of pubescence. COMCLUSION. The difference in the dynamics of the glomerular filtration rate and renal excretion of the substances under study points to the presence of adaptive reactions of the renal activity regulation systems which adequately demonstrate age-related features of balance of metabolic processes and functional abilities of the renal homeostatic mechanisms.

The last disease and death of Peter the Great.

Current approaches to diagnosis and treatment of diabetic nephropathy.

Estimation of the functional state of kidneys according to Kt/V index.

Is the use of calcium-D ₃ Nikomed justified for correction of disturbed phosphorus-calcium metabolism in patients with the predialysis stage of chronic renal failure?