Urinarytract infections in the elderly: certain medical aspects.

Problem of non-compliance in patients receiving chronic hemodialysis.

Nephropathy as a vascular pathology.

THE AIM ofthe investigation was to estimate the interrelations of circadian rhythms of arterial pressure (AP) with the character of heart remodelling in patients with chronic renal failure (CRF). PATIENTS AND METHODS. Circadian monitoring of AP was performed in 82 patients. In 36 of them echocardiographic investigation was made. The progression rate of CRF wasestimated by the time of doubling the blood creatinin level. RESULTS. Patients with the achieved target level but impaired circadian rhythm of AP had approximately similar progressing of CRF as well as the patients with not achieved target level independent of the circadian rhythm of AP, the rates of progressing of CRF in these patients being substantially higher than those in the group of dippers with the achieved target level of AP. Leftventricle hypertrophy (LVH) was more often observed in patients with not achieved target level of AP (x ²=8.26, p=0.04). In addition, the impaired circadian profile of AP was associated with the greater degree of LVH (τ= -0.25; Z=-2.19; p=0.03). The most often variant of myocardium remodelling among the examined patients was concentric hypertrophy of the Ieftventricle (CHLV), the CHLV being mainly revealed in the group of patients with impaired circadian profile of AP. CONCLUSION. It is in the combination of a sufficient degree of nocturnal decrease of AP (normalization of circadian rhythms) and achieving the target levels of AP that can slow down the rate of progressing CRF. The LVH is associated with higher rates of progressing CRF. The myocardium remodelling in CRF patients is influenced by the diurnal rhythms and level of AR.

THE AIM of the study was to identify risk factors for osteopaenia and osteoporosis in patients with end-stage chronic renal failure receiving dialysis treatment. PATIENTSAND METHODS. 71 hemodialysis patients were examined. Mineraldensityinfemoral bones and lumbar L ₂-L ₄ bone was measured by dual-energy X-ray absorptiometry «Lunar DPX-NT». Values of bone mineral density, T-score and Z-score and analogous criteria in groups of healthy subjects of the corresponding gender and age were determined. Osteopaenia and osteoporosis were diagnosed according to T-score criteria. Osteopaenia is defined as a T-score: osteoporosis <-2.5 and osteopenia from -2.5 to -1.0. RESULTS. 30 patients (42.2%) had a reduced bone mineral density and in 8 (11.3%) patients osteoporosis was diagnosed. Frequency OfIumbarfractures(L ₂-L ₄) increased with the decreased Iumbarmineral density (r=-0.32, p=0.006). Females, height, higher level of serum parathyroid hormone (PTH), prolonged menopause period, anemia and great weekly heparin dose (R ²=O.48) were shown to be lumbar osteoporosis risk factors by the results of the stepwise multiple linear regression analysis. The risk factors of femoral neck osteoporosis included body mass index, elderly age, high PTH Ieveland high weekly heparin dose, anemia, low albumin level and insufficient «dialysis dose» (R ²=O.67). Additional risk factors were: serum phosphate level for Ward’s regions (R ²=O.61), serum phosphate Ieve landduration of renal disease longer than 15 yearsfor trochanter region (R ²=O. 62). CONCLUSION. Risk factors for osteoporosis were revealed for patients with end-stage chronic renal failure receiving program hemodialysis treatment. Moreimportantof them were: serum PTH level higher than 600 pg/ml, elderly age, female, body mass index, menopause longer than 4 months, hyperphosphatemia more than 2.5 mmol/l, serum level of albumin less than 35 g/l, anemia, adequate dialysis (weekly KT/ V index less than 3.1) and weekly hepar in dose during the dialysis procedure more than 15 000 units. Knowledge and correction of these disturbances allow the osteoporosis rate and risk of fractures in patients on chronic hemodialysis to be reduced.

THE AIM of the investigation was to comparatively study the contents of modified (MALB) and native albumin in blood and urine of patients with renal diseases in order to reveal the role of each form of the development of proteinuria. PATIENTS AND METHODS. We have examined 40 samples of blood serum of healthy subjects and 34 samples of blood and urine of patients with proteinuria of different genesis. The content of albuminę and its forms in blood and urine was determined spectrophotometrically. RESULTS. Two forms of albumin (ALB) were detected in blood and grine of patients with proteinuria: NALB and MALB. In the course of enhancement of proteinuria both the total level of MALB and its relative content increased in urine, the latter being 68% and even more (i=+ 0.34; p<0.003; n=34). So in case of proteinuria the modified ALB is eliminated from blood because it might easily penetrate through the glomerular filter due to its modified physico-chemical properties. There is a reliable negative correlation between the level of proteinuria (and albuminuria) and the native albumin concentration of blood serum (τ=-0.40; p<0.005; n=34 in both cases). This is an additional evidence that proteinuria is associated with the predominance of elimination of MALB. CONCLUSION. The data presented give evidence concerning heterogeneity of the albuminę pool in blood and urine, in case of proteinuria one of the forms of albumin, namely MALB, being excreted in a considerably greater extent.

THEAIM of the work was to elucidate the possible role of changes in the levels of IL 6 and 10 and certain indices of water-salt homeostasis in the appearance of post-loading proteinuria (PLP) in miners working in deep coal mines. PATIENTSAND METHODS. The investigation was performed on 72 workers in a deep mine after a preliminary medical examination. The examined were divided into 2 groups: I - subjects without proteinuria after shift, Il - subjects with symptoms of proteinuria (albumin from 0.1 to 0.2 g/l) after shift. Control group consisted of 20 practically healthy subjects not engaged in underground workings. Contentof electrolytes (K ⁺, Cl ^-, Na ⁺) in blood and urine was determined by the method of flame photometry by a conventional technique. The level of creatinine in blood and urine was determined by the Popper method. The glomerular filtration rate (GFR) was calculated by the endogenous creatinine clearance using the Cocroft-Gault formula. Concentration of IL 6 and 10 in blood plasma was investigated by ELISA immunoenzyme analysis. RESULTS. The investigations performed in the group of miners with post-loading proteinuria have revealed appreciably changed indices of water-salt homeostasis and levels of IL 6 and I0 which were aggravated during the shift. CONCLUSION. The intensified interaction between different components of water-salt homeostasis and expression of IL in subjects with PLP testifies to a considerable strain of the body mechanisms responsible for maintaining homeostasis.

THE AIM the investigation was to study the degree of correlation of quantitative and functional indices of neutrophil granulocytes (N _lG) with the functional state of kidneys and biochemical composition of blood in I type membranous-proliferative glomerulonephritis (MPGN) in man. PATIENTS AND METHODS. The investigation was performed in 201 type MPGN patients. The content of cationic protein neutrophils was studied by the lysosomal-cationic test (LCT). Expression of erythrocyte, complement and Fcy-receptors on the neutrophil membrane was studied by the rosette-formation method. RESULTS. The value of the cytochemical LCT index positively correlates with the level of Ieukocyturia and negatively - with the glomerular filtration rate (GFR) and circadian proteinuria. Intensity of the E-receptor expression on NG membranes has a correlative association with the concentration of serum creatinine. C3b-receptor expression activity on the NG membrane is correlatively associated with the changes in GFR. The functional changes in NG correlate with GFR, intensity of Ieukocyturia and concentration of serum creatinine revealed 0.5-2 months after the investigation of NG. The changes of GFR, levels of Ieukocyturia and concentration of serum creatinine appeared to be delayed in time, since the changes of NG activity in peripheral blood were investigated ratherthan renal tissue infiltrate where the pathological reaction developed. CONCLUSION. The data presented allow a suggestion of the participation of NG in the mechanisms of lesions of the renai tissue in patients with I type MPGN. The revealed combined changes of activity of E-receptor expression on NG and the values of the cytochemical LCT index can be considered a prognostic sign in this disease warning about the following aggravation of renal functions.

THE AIM of the investigation was to assess results of the influence of pathogenetic therapy of gouty immune complex glomerulonephritis as well as monotherapy with Iovastatin and their combination on the state of lipid metabolism. PATIENTS AND METHODS. 73 patients with gouty glomerulonephritis were examined, 63 of them were treated by traditional methods, 5 -received monotherapy with lovastatin, 5 - traditional treatment in combination with lovastatin. RESULTS. The pathogenetic therapy failed to have valuable effect on the state of blood serum lipid spectrum. Monotherapy with lovastatin failed to decrease the total cholesterol level, although it effectively reduced the concentration of triglycerides and low and very low density lipoproteins. CONCLUSION. A combination of the pathogenetic treatment with Iovastatin was found to result in optimally valuable hypolipidemic treatment and adequate inhibition of further progress of glomerulonephritis.

THE AIM of the investigation was to comparatively assess effectiveness of antidepressants of different chemical groups used in patients with syndrome of itching receiving chronic hemodialysis (CH). PATIENTS AND METHODS. 100 patients with chronic renal failure (CRF) receiving CH were examined, 57 of them (35 men and 22 women) had syndrome of itching. Fifty seven patients having similar demographic and clinical characteristics were given antidepressants of different pharmacological groups: mianserin (tetracyclic antidepressant, tianeptin (tricycli antidepressant), cytalopram (selective serotonin reuptake inhibitor). The group of patients given mianserin consisted of 17 patients, 20 patients received tianeptin and 20 received cytalopram. The doses used in all the patients were not higher than the average daily doses: mianserin - 30 mg, tianeptin - 37.5 mg, cytalopram - 20 mg. The total duration of treatment was 6 weeks. The control group consisted of 20 patients with chronic renal failure on CH having chronic itching but not receiving antidepressants. RESULTS. In CRF patients receiving CH the antidepressants were found to be effective not only in respect to depression, anxiety and pain, but also to itching. In addition, gender differences were revealed in the effectiveness of antidepressants. So, in men the effectiveness of antidepressants was higher than that in women including the correction of itching syndrome. In men mianserin was more effective, next was tianeptin and of little effectiveness was cytalopram. In women the correction of syndromes of pain and itching was slower and in less degree than in men. In women of greater effects was tianeptin, mianserin and cytalopram being less effective, CONCLUSION. The investigation of effectiveness of antidepressants (mianserin, tianeptin, cytalopram) have established that in CRF patients they are able to correct not only affective disorders, but the syndrome of chronic pain and itching. Gender differences were revealed in effectiveness of antidepressants.

THEAIM of the work was to investigate effects of ketosteril and SUPRO 760 found in nutritional ration on the development of experimental chronic renal failure (CRF) in Wistar rats. Amodel of CRF was made by means of a standard two-stage operation (5/ 6 nephrectomy). MATERIALS AND METHODS. Under investigation there were 5 groups of rats: 1. rats with 5/6 nephrectomy (NE) given a standard diet; 2. rats which in two weeks after NEwere given the diet having ketosteril (10% ketosteril + 90% carbohydrate) for the following 6 weeks; 3. rats given the diet containing SUPRO 760 (10% soy protein + 90% carbohydrate)after NE; 4. sham operated rats given the standard diet (control group); 5. sham operated rats given SUPRO 760 (10% soy protein + 90% carbohydrate). RESULTS. Within 8 weeks after NEthe uremic rats were compared with the sham operated controls. The uremic rats (group 1)had elevated urea, cholesterol, phosphorus and reduced total calcium in blood serum as compared to the control. The content of urea, cholesterol, phosphorus in blood serum of rats given the diet with SUPRO 760 or ketosteril was Iowerthan that in group 1, though was higher than the indices of the control groups. Calcium level was not reduced. Arterial pressure was considerably higher in group 1 than in groups 2 and 3. Hypertrophy of the left heart ventricle was less in the rats given SUPRO 760 after NE (group 3) than in groups 1 and 2. CONCLUSION. The investigations performed have revealed positive effects of SUPRO 760 on slowing down the development of experimental CRF and confirmed the possibility to use soy proteins in nutritional ration of neurological patients.

THE AIM of the work was to comparatively investigate the mechanical properties of the myocardium of rats receiving difinitive diet. MATERIAL AND METHODS. An analysis of myocardium contractility of rats drinking water with normal low content of Ca ⁺⁺ and Mg ⁺⁺ cations was carried out under conditions of isometric and physiological regimens of mechanical loading. RESULTS. Under conditions of normal content of calcium (120 mg/l) and magnesium (45 mg/l) in drinking water the rats showed increased contractility of the myocardium followed by delayed relaxation in all end-systolic lengths as compared to the parameters registered in the animals given water with low concentrations of calcium and magnesium (St. Petersburg pipe water). CONCLUSION. The myocardium of rats drinking water with normal concentration of calcium and magnesium is characterized by well pronounced Bowditch scale and post-stimulation potentiation unlike the animals given water with low concentration of calcium and magnesium.

THEAIM of the investigation was to study the state of renal functional reserve in rats during pregnancy. MATERIAL AND METHODS. The investigation was performed in 4 groups of white laboratory rats: groups 1 and 2 - non-pregnant rats with body mass 215-250 g, groups 3 and 4 - pregnant rats (second half of pregnancy, mass of the fetuses 3-5 g) with body mass 240-270 g. The value of renal functional reserve was determined by increased creatinine clearance between groups of animals under conditions of water loading (basal CFR values) and acute osmotic loading with 3% solution of sodium chloride (stimulated CFR values). The state of the tubular portion of the nephron was analyzed on the basis of investigating renal excretion of calcium, phosphates, osmotically active substances and protein. RESULTS. Itwas found that in rats with physiological course of pregnancy the value of renal functional reserve was increased which was followed by increased excretion of endogenous nitrates and nitrites. It was also shown that during physiological course of pregnancy the renal regulation of osmotic homeostasis was more exact. CONCLUSION. 1. The value of the renal functional reserve in rats increases during pregnancy. 2. Renal excretion of inorganic nitrogen oxides increases in rats during physiological development of pregnancy. 3. Renal mechanisms of regulation of osmotic homeostasis work more exactly in pregnant rats.

THEAIM of the work was to estimate the role of the development of arterial hypertension with a lack of calcium in diet. MATERIAL AND METHODS. Experiments were performed in narcotized rats in order to compare the influence of a synthetic analogue of parathyroid hypertensive factor on pressor effects of angiotensin Il and adrenaline. RESULTS. It was found that while potentiating and prolonging pressor effects of adrenaline, the parathyroid hypertensive factor blocks pressor effects of angiotensine II. The introduction of the parathyroid hypertensive factor against the background of effects of angiotensin Il results in paradoxically decreased arterial pressure. CONCLUSION. The results obtained confirm the hypothesis that renin-angiotensin-aldosteron system plays not less substantial role in the formation of calcium-dependent forms of arterial hypertension than the sympathoadrenal system.

Estimation of results of urodynamic investigations in diagnosis of infravesical obstruction.

The history of national urology.

Dialysis encephalopathy.

Nephro-urological pathology with outcome to chronic renal failure associated with Recklinghousen disease.

Administration of dophamin in treatment of acute renal failure.