Arterial hypertension as a risk factor of higher mortality in chronic hemodialysis patients and approaches to its correction.

Phosphate kinetics in hemodialysis patients.

THE AIM of the investigation was to develop pathogenetical approaches to correction of the myocardial dysfunction in chronic glomerulonephritis patients with the preserved function of the kidneys. PATIENTSAND METHODS. The examination of 43 patients with chronic glomerulonephritis included 5 women and 38 men. The mean age of the patients was 35.6± 2.35 years, duration of the diseasewas7.8±0.5years. Nephrotic syndrome was observed in 7 (16.3%) patients, urinal syndrome - in 36 (83.7%) patients, 7 (16.3%) patients had mesangial proliferative glomerulopnephritis established by nephrobiopsy, 3 (6.9%) patients had mesangiocapillary glomerulonephritis and 15 (34.8%) patients had arterial hypertension. RESULTS. Symptoms of the left ventricle myocardium dysfunction were revealed in 34 patients (76.1%), systolic in 13.9% out of them, diastolic - in 65.2%. Administration of beta-adrenoblockers is expedient in patients with the development mainly of diastolic dysfunction of the left ventricle myocardium, and with the systolic dysfunction - the angiotensine converting enzyme inhibitors. CONCLUSION. The differentiated approach to the correction of contractile disorders of the myocardium is a pathogenetically substantiated method of treatment of heart failure in patients with chronic glomerulonephritis.

THEAIM of the work was to determine the mechanisms of the kidneys in leptospirosis in order to improve the diagnosis, prognosis of the course and pathogenetical therapy of the patients. PATIENTSAND METHODS. General clinical, instrumental (USI, renoscintigraphy) and biochemical investigations were carried on to characterize the kidney function in 451 leptospirosis patients (leptospiral jaundice in 67.2%, bovine leptospirosis - in 32.8%). Myoglobin in blood and urine was determined in 59 leptospirosis patients and in suspensions of the kidneys (in 5 dead from leptospirosis (control groups - patients with acute viral hepatitis B (AVHB), acute renal failure (ARF) of nonleptospirosis etiology, healthy donors and the dead from cerebro-cranial injuries). Pathomorphological alterations in the kidneys were analyzed in 34 dead from leptospirosis and 10 - from AVHB. RESULTS. One of the links of ARF in leptospirosis is rhabdomyolysis resulting in myoglobinuric nephropathy shown in the oligoanuric stage by high indices of myoglobin in blood and renal tissue in autopsy in combination with a low level of myoglobin in urine. It is expedient to include means promoting early liquidation of endotoxicosis and myoglobinemia in pathogenetic therapy of leptospirosis patients. The indices of urine acidity and the coefficient of the blood and urine myoglobin ratio can be taken as a criterion for choosing detoxication methods (conservative or efferent). CONCLUSION. A new important mechanism of the formation of renal syndrome at the height of leptospirosis is substantiated which is related with the elimination by the kidneys of the unusual for blood myoglobin protein formed in high concentrations at specific leptospiral rhabdomyolysis. The ARF developing in the acute period of leptospirosis is reversible under conditions of the rational treatment of the patients.

THE AIM of the investigation was to reveal specific features of periodization and clinical course of acute renal failure (ARF) of different etiology on the basis of clinico-laboratory analysis of patients with the disease. PATIENTS AND METHODS. 398 patients with ARF were divided into 20 groups by nozological principle. Under study there were the dynamics of general clinical features (diurnal urine excretion, arterial pressure), biochemical indices of blood plasma (concentration of urea, creatinine, bilirubin, sugar, sodium, potassium, calcium and chlorine), indices of the general analysis of urine (urine density and protein concentration in urine) in different periods of ARF. RESULTS. A period of secondary oliguria was detected during ARF which was observed in different groups in 23-29% of the patients and was characterized as absolutely lethal. The development of secondary oliguria was accompanied by progressing aggravation of the general condition of the patients, increased concentration of creatinine in blood plasma and excretion of protein with urine against the background of lessening diuresis and relative weight of urine after a period of polyuria. CONCLUSION. Secondary oliguria is developing due to progressing lesion of renal parenchyma in the period of polyuria, is followed by considerably increased concentration of creatinine in blood plasma, proteinuria and level of intoxication, development of hyposthenuria. The development of secondary oliguria in patients is considered to be a prognostically especially unfavorable factor and requires intensification of medical measures including the methods of extrarenal clearance of blood.

THE AIM of the investigation was to estimate the early outcomes of surgical treatment of patients with chronic renal ischemia. PATIENTSAND METHODS. Surgical treatment of chronic renal ischemia was carried on in 34 out of 40 patients with occlusive-stenotic Iesionsofthe renal arteries (19 men and 15 women aged from 18 to 78, average 53± 14 years). The causes of the lesions of the renal arteries (RA) were as follows: atherosclerosis (30), fibromuscular dysplasia (1), periprosthetic fibrosis (1), thromboangiitis (1) and diaphragmatic compression (1). Bilateral lesion of RA were foundin 14 patients, 13 out of them had atherosclerosis. Arterial hypertension (AH) was found in 34 patients, azotemia (creatinin from 0.013 to 0.4 mmol/l, average 0.19±0.07) in 15 patients with atherosclerosis. Revascularizationwas performed in 34 kidneys in 29 patients (bilaterally in 5) by means of 24 shuntingsof RA(4extraanatomical), 1 endarterectomy, 1 prosthesis, 1 decompression and 7 endovascular angioplasties. Nephrectomy only was performed in 5 cases. Combined operations were performed in 8 patients (24%). RESULTS. AH was arrested in 11 (39%) patients, its course was better in 15 (54%), remained unchanged in 2 (7%). Functions of the kidneys were improved in 6 (67%), stabilized in 2 (22%) patients and deteriorated in 1 (11%). Lethal outcomes (n=6; 17.6%) took place only in patients with azotemia after combined operations. CONCLUSION. Revascularization of the kidneys was effective in the correction of the renal function and AH, but azotemia worsened the results of surgical treatment in the earliest postoperative period.

THE AIM of the work was to study plasma lipid and protein free-radical oxidation in children with chronic pyelonephritis at the stageof steadfast remission with preserved renal function. PATIENTS AND METHODS. 19 patients of school age and 18 healthy children were examined. Traditional indices of lipid peroxidation as well as spontaneous and Fe-stimulated protein oxidation in blood plasma were investigated. RESULTS. The deficiency of plasma thyol groups and reduced reserves of oxidative modification proteins were revealed. CONCLUSION. It has been shown that there exist antioxidative defense holes even in the steadfast and long-term remission of pyelonephritis in school age children.

THE AIM of the work was to determine the regularities of forming the «effector integral» of the leading functional systems responsible for homeostasis of the child’s organism and their individual-typological features with special reference to such a disease as glomerulonephritis (GN). PATIENTSAND METHODS. The observations were performed in 46 GN children aged 7-14 years. The clinical examination used generally accepted methods estimating the condition of all organs and systems. RESULTS. The interrelations of the regulatory, cardiohemodynamic, immune, hemopoietic, hemocoagulatory systems in GN children of school age manifested themselves by the formation of hierarchical interrelationships of the functional system effectors. The contribution of those or other mechanisms in the structure of the homeostatic interactions is not similar. Each type of the vegetative regulation has specific functional grounds with different forms of the interaction of the parameters of homeostasis. The determined specific features of the interrelations of the functional systems make it possible to establish the parasympathicoton/cand, especially, sympathicotonic types of vegetative regulations as the types with the strained mechanisms of maintenance of the physiological level of homeostasis in GN. The investigation of the mechanisms of interaction of the parameters of the functional state of the kidneys as well as the mechanisms of the interaction of pathogenetically singificant for GN systems of hemopoiesis, immunity and hemostasis in school age children depending on the types of the vegetative regulations and systemic hemodynamics allowed to determine the specificity of the individual-typological reactions forming the course and outcome of the disease. CONCLUSION. The data obtained should be taken into account in treatment and rehabilitation of the patients to prolong the period of dispensary observation

THEAIM of the work was to investigate the effects of alcohol dehydrogenase (ADG) inhibitors, isovalerianic acid amid (IAA) and ethanol on main biochemical indices and histological alterations in acute peroral poisonings with ethylene glycol (EG) and its methyl and ethyl ethers. MATERIAL AND METHODS. Th ewor kwas fulfilled in 240 white male rats (body mass 140-180 g) got from animal nursery Rappolovo. EG and its monomethyl (methyl cellozolv)and monoethyl (ethyl cellozolv) ethers were given as a single intragastric dose equal to 1.0 LD50 (6928±352,11761 ±204,2643±316 mg/mg respectively). A noncompetitive inhibitor of IAA was used as ADG inhibitors, and ethyl alcohol - for the substrate inhibition. RESULTS. It was found that intoxications with these substances result in biochemical changes of a similar character and differ not qualitatively but quantitatively. They were more pronounced in EG intoxications, the leading among them being changes showing lesion of the kidneys (higher concentration of nitrogenous metabolites) and liver (increased activity of aminotransferases, alkaline phosphatase and concentration of bilirubin). The histological alterations caused by poisonings with EG and its ethers were of a similar character and were more pronounced in intoxications with glycol. The administration of ethanol and IAA considerably decreased the degree of both biochemical and histological changes caused by EG and its ethers. CONCLUSION. The data obtained suggest that using specific ADG inhibitors is a perspective direction of the improvement of antidotal therapy of such intoxications.

THEAIM of the investigation was to study the correlations of the quantitative and functional indices of the state of neutrophilic-granulocytic cells at IgA-nephropathy with the functional state of the kidneys and the biochemical composition of blood. PATIENTS AND METHODS. The investigation was performed in 15 IgA-nephropathy patients. The control group consisted of 21 patients with non-lgA mesangial-proliferative glomerulonephritis (Mes-PGN). The number of neutrophil cationic proteins was studied by the lysosomic-cationic test. Expression of erythrocytic, complementary and Fcg-receptors was investigated on the neutrophil membrane. RESULTS. The correlation of intensity of expression of the complementary and Fcy-receptors on the neutrophil membrane with the level of proteinuria was detected. CONCLUSION. The data obtained allow a suggestion that one of the mechanisms of the development of the glomerular filter in IgA-nephropathy might be a mechanism mediated by elevated exocytosis of cationic proteins of NG. C3b- and Fcy-receptors of NG might also be involved in injuring the glomerular filter in IgA-nephropathy. The mechanisms of injury of the renal tissue with NG in IgA-nephropathy differ from the mechanisms in Mes-PGN.

THE AIM of the work was to study histological and histochemical alterations to the kidneys in modeling poisonings with domestic gas in experiment. MATERIAL AND METHODS. Changes in activity of NAD-H2-dehydrogenase, lactate dehydrogenase (LDG), succinic dehydrogenase (SDG) and alkaline phosphatase (APh) were estimated in the proximal and distal channels of the kidneys of white rats in modeling poisoning with domestic gas. Activity of the enzymes was estimated by quantitative cytospectrophotometric method in perinuclear parts of nephrotelium cell cytoplasm. RESULTS. The histochemical investigation of the epithelium of convoluted channels of the kidneys of experimental animals allowed to detect substantial changes of metabolism of cells characterized by impaired energy metabolism of tissue ventilation and transportation processes. A histoenzymological analysis has shown that toxic exposure to the gas resulted in a reliable reduction of LDG activity as compared with the control. Activity of SDG was also changed, but was considerably higher as compared with LDG. Activity of NAD-H2-dehydrogenase was considerably increased as compared with activity of this enzyme in the group of control animals. Poisoning with the gas resulted in higher activity of APh as compared with activity of the enzyme registered in control rats. CONCLUSION. The process of intoxication with domestic gas was followed by morphofunctional alterations of the kidneys which can lead to the development of renal failure.

Congenital nephrogenic diabetes insipidus, vitiligo, neurosensory bradyacuasia in son and his mother: is ita variant of Voght-Koyanagi-Harada or a new syndrome?

Nephroptosis in therapeutic practice (lecture).

Main stages of the development of hemodialysis service in the Northwest region of the Russian Federation.

Sodium in dialysate - on the question of monitoring the composition of the dialyzing solutions: there exists no simple conformity of electric conduction and concentration of sodium ions.

Does the level of protein intake by diabetes mellitus patients influence the course of diabetic nephropathy?