THE AIM of the investigation was to determine the relations between mitral regurgitation (MR) and glomerular filtration rate (GFR) in patients with chronic heart failure (CHF). PATIENTS AND METHODS. Under examination there were 340 patients with CHF (200 men and 140 women, mean age - 58±13 years). Arterial hypertension was the cause of CHF in 44 (13%) patients, IHD - in 112 (33%), their combination - in 184 (54%) patients. The first class of CHF was found in 112 (33%) patients, the second class - in 177 (52%), the third class - in 34 (10%), the fourth - in 17 (5%) patients. GFR was calculated by the Md RD formula. RESULTS. Ejection fraction (EF) of the left ventricle was 56.9±10.5%. Systolic dysfunction was diagnosed in 90 (26%) patients.  Mitral regurgitation was observed in 221 (65%) patients. GFR was 68.8±20.9 ml/min/1.73 m² (from 19.2 to 149.7 ml/min/1.73 m²). In 114 (34%) patients GFR was lower than 60 ml/min/1.73 m². There was a direct relation between CHF FC and MR (r=0.35; p<0.001). Changes to the valve echostructure, cusp induration included, were noted in 228 (67%) patients. GFR had an inverse correlation with the MR degree (r=0.43; p<0.001). Multivariate regression analysis has shown that the degree of MR is associated with the declined functional state of the kidneys irrespective of the patients’ age. CONCLUSION. Changes to the mitral valve echostructure in patients with chronic heart failure due to IHD and/or arterial hypertension was more often observed in patients with GFR less than 60 ml/min/1.73 m². The degree of mitral regurgitation is directly associated with the decreased functional state of the kidneys.

THE AIM of the investigation was an analysis of the influence of erythropoietin preparations on the state of state of the lipid phase of erythrocyte membranes in patients with the terminal chronic renal failure (tCRF) on hemodialysis. PATIENTS AND METHODS. Under examination there were 31 subjects aged 35-40 years treated by program bicarbonate hemodialysis, 12-15 hours a week. All the patients had anemia of heavy degree: the hemoglobin level was not higher than 70 g/l.  In all the patients the lipid profile of erythrocyte membranes was determined: the level of phospholipids, cholesterol as well as primary and intermediate products of lipid peroxidation and alpha-tocopherol.  During a year all patients were given Epocrin in dose 2000 IU subcutaneously three times a week in combination with peroral preparations of iron, folic acid. Control analyses of blood were made in dynamics within 1,3,6  and  12  months.  RESULTS. It was  found  that  in  all  patients with  tCRF  and  anemia  processes  of  lipid  peroxidation  in erythrocytes were  intensified and the antioxidate  defense  mechanisms were weakened. After a year of treatment with rhEPO Epocrin the level of lipid peroxidation products became lower in the erythrocyte membranes along with a decreased degree of anemia.  Stabilization of the  lipid  phase  of the erythrocyte  membranes was noted and an  increased  level of alpha-tocopherol. CONCLUSION. Administration of Epocrin in dialysis patients was found to reduce manifestations of anemia not only owing to the impact on the mechanisms of hematosis, but also due to stabilization of the lipid phase of the erythrocyte membranes.

THE AIM of the investigation was to study the course of chronic glomerulonephritis (CGN) with isolated urinary syndrome (IUS) and to detect the  most substantial  factors  having a  negative  influence  on the  disease  prognosis. PATIENTS AND METHODS. The course of CGN with IUS was retrospectively assessed in 123 women and 174 men aged from 15 to 77 years (32.72±0.82). Duration of the disease of the patients under investigation was from  1  year to 42 years (11.16±0.42 years) and did  not reliably differ in women  (11.92±0.67) from that in  men  (10.61±0.53).  The date when persistant proteinuria and/or hematuria was registered  is taken  for the  beginning  of the  disease.  RESULTS. Two multifactorial models were formed on the basis of the investigations performed. The first model is a clinico-laboratory model for specification of ihe prognostic value of such factors as age at the moment of the disease beginning, exacerbations and acute nephritic syndrome ans in anamnesis,  intensity of proteinuria and hematuria. The second is a laboratory model. It dealt with the influence of the level of immunoglobulins IgA, IgM, IgG and complement titer on kidney survival. The final variant of the clinico-laboratory model (p=0.000) included such factors as the age more than 35 years (p=0.010), the presence of exacerbations in anamnesis (p=0.073), the presence of ANS (p=0.074) and the proteinuria level (p=0.000). The final variant of the laboratory model (p=0.000) included such indices as higher level of IgA (p=0.000) and IgM (p=0.069). CONCLUSION. The data obtained suggest that activity of the inflammatory process in CGN patients with IUS is prognostically unfavorable. The data of the unfavorable prognostic influence of mild and even minimal proteinuria show that the strategy of managing CGN patients with IUS may be considered as debatable and requiring further analysis of indications to using immunosuppressive therapy in this category of patients.

THE AIM of the investigation was a 7-years catamnestic observation of patients with I type diabetes with different allele variants of the methylenetetrahydrofolate reductase (MTHFR) gene. PATIENTS AND METHODS. The investigation included 96 patients with different genotypes. RESULTS. The data obtained  have shown the frequency of the development of diabetic nephropathy (DN) in patients with TT genotype (0.30) to be higher than in patients having genotype ОО (0.11) and CT (0.09) (p<0.05). CONCLUSION. The results of the investigation have confirmed that the genotype TT determination in patients with I type diabetes mellitus can be used as one of criteria of prediction of the development of DN in clinical practice.

THE AIN of the work was to study the myocardium state in patients with CKD of the III-IV stages and the influence of spironolactone therapy.  PATIENTS AND METHODS. The  investigation  included 46 patients with CKD of the III-IV stages and 83 patients with V stage CKD treated  by program  hemodialysis (HD).  Spironolactone was given to 38 of them  during 6 months (25 mg/day).The parameters  of  EchoCG  under study  included  determination  of the  left ventzicle  (LV)  sizes,  left ventricle  myocardium  mass (LVMM) by ASE formula, relative thickness of the left ventricle wall (RTW). Indexation of LVMM to the body surface area (ILVMM) was carried on.  Hypertrophy and remodeling of LV was diagnosed at ILVMM  125 g/m² and more in men and 110 g/m² and more in women,  increased RTW was estimated at values 0.45 and more.  The remodeling type was determined according to current notions: normal geometry, concentric hypertrophy, eccentric hypertrophy and concentric remodeling. RESULTS. The dynamics of the  left ventricle  echographic  parameters was  shown  under the  influence  of spironolactone  in  a  group  of  patients  taking spironolactone  (1st group)  and  not taking spironolactone  (2nd  group):  left atrium  (LA) was 4.58±0.11  before spironolactone therapy and 4.4±011 after spironolactone therapy in the 1st group and 4.03±0.11 and 3.9±0.09 respectively in the 2nd group; FDS was 4.15±0.13 before spironolactone therapy and 3.94±0.17 after spironolactone therapy in the  1st group and 4.99±0.13 and 5.01±0.1  respectively in the 2nd group; TDWLV was 1.29±0.03 and 1.23±0.04 in the 1st group and 1.19±0.03 and 1.21±0.03 I the 2nd group; LVMM was 238.46±19.11 and 206.18±21.45 in the 1st group and 293.39±17.13 and 291.52±15.43 in the 2nd group, ILVMM was  132.2±10.81  and  113.32±11.75  in the  1st group and  173.57±10.47 and  176.94±10.06  in the  2nd  group.  CONCLUSION. Spironolactone therapy in dosage 25 mg/day in patients with anuria on hemodialysis results in a reliably decreased thickness of the posterior wall,  mass and volume of the left ventricle myocardium and left atrium size.

THE AIM of the investigation was to determine the character of relationship between mitral valve (MV) calcification and aortal valve (AV) calcification and the state of myocardium in patients in the predialysis period of chronic kidney disease (CKD). PATIENTS AND METHODS. The investigation included 317 patients in the predialysis period with CKD of the I-V stages, 46.1% of men and 53.9% of women, mean age 50.7±15.2 years with Doppler-echocardiography performed. Patients with chronic glomerulonephritis made up 30.7%, with diabetic nephropathy - 29.4%, with essential hypertension -17.7%, with other diseases -22.0%. RESULTS. Cardiac valvular calcification was revealed in 22.1% of the examined patients: AV - in 6.3%, MV - 4.1% and of both valves in 11.7%. In calcification of AV and MV their stenosis was noted more often (p<0.001 and p= 0.002 respectively) as well as perivalvular regurgitation of the1 degree and higher (p=0.002 and p=0.053). Patients with calcification of AV and  MV had greater diameter of the aorta (p=0.005), left (p<0.001) and right atriums (p<0.001), right ventricle (p=0.007), thickness of walls of the right (p<0.001) and left (p<0.001) ventricles, greater diameter and pressure in the pulmonary artery (p<0.001), more pronounced diastolic dysfunction by the E/A index (p<0.001), higher pressure gradients on MV (p<0.001) and AV (p<0.001) and flows through MV (p<0.001) and AV (p<0.001). By the data of multifactor analysis the following independent factors are associated with valvular calcification:  diameter of the atriums (p<0.001), maximum gradient of pressure on AV (p<0.001), MV (p<0.001), the E/A index (p<0.001), the aortal regurgitation degree (p=0.004), LA diameter (p=0.041). CONCLUSION. MV and AV calcification, irrespective of other factors, results in insufficiency of the valves, increased maximum gradients and maximum flows on AV and MV, dilatation of the atriums, LA, diastolic dysfunction.

THE AIM of the investigation was a complex morpho-functional study of the action of ethylene glycol on the kidney medullary substance, estimation of reversibility of the resulting changes and specificities of the distribution of calcium deposits under conditions of experimental nephrolithiasis. MATERIAL AND METHODS. The experiment was carried out in 20 male Wistar rats, body mass 200-250 g. The animals were divided into 4 groups, 5 rats in each. Rats of the 1st group were given pure water, 2nd group  -  1%  of ethylene glycol during 21 days that induced the development of experimental nephrolithiasis. The 3rd group animals, previously given ethylene glycol during 21 days, after this period received 2% starch suspension with a preparation from tissue culture of Rubia Cordifolia in dosage 75 mg/kg during 3 weeks. The 4th group animals simultaneously received the preparation from Rubia Cordifolia and a 1% solution of ethylene glycol during 21 days. RESULTS. The work has shown reversibility of the morphological alterations in the kidney caused by subchronic effects of ethylene glycol, and protective action of the preparation from tissue culture of Rubia Cordifolia. CONCLUSION. Administration of the preparation from tissue culture of Rubia Cordifolia results in reversible morphological alterations to the medullary substance of the kidney caused by subchronic intake of ethylene glycol.

THE AIM of the investigation was to study the process of free-radical oxidation in the kidneys and blood of rats with experimental urolithiasis. MATERIAL AND METHODS. Experiments were carried out in male Wistar rats given 1% solution of ethylene glycol in drinking water during 21 days. The presence of calcium oxalate crystals in kidney slices was determined histochemically Biochemical methods were used to assess the oxidant (thiobarbiturate reactive products, total oxidant activity) and antioxidant (catalase, superoxiddismutase, glutathione peroxidase, total antioxidant activity) status of the kidneys and blood. RESULTS. Considerable number of Ca-positive crystals localized mainly on the surface of the renal papilla was determined in kidney slices of all rats receiving ethylene glycol. Progression of nephrolithiasis was accompanied by intense activation of free-radical oxidation both in the kidneys and in blood. Abatement of antioxidant defense was simultaneously observed due to the inhibition of activity of glutathione peroxidase. CONCLUSION. Thus, activation of free-radical oxidation in the kidneys and  blood of animals takes place under conditions of experimental oxalate nephrolithiasis in rats. This process is followed by weakened activity of glutathione peroxidase as one of the main antioxidant enzymes.

THE AIM of the investigation was to estimate the influence of spironolactone therapy on progression of experimental chroic renal failure (CRF) and myocardium hypertrophy in rats. MATERIAL AND METHODS. The investigation was performed in Wistar rats with experimental CRF (model of 5/6 nephrectomy). The first group of animals was given spironolactone (0.2 mg/day) after nephrectomy. The animal of the second group did not receive spironolactone. The third group (control) consisted of sham-operated rats. Mean arterial pressure and heart rate were measured, daily urine was collected. In the blood serum taken during killing the content of aldosterone, urea, creatinine, electrolytes and total protein were determined. RESULTS. The myocardium hypertrophy index in the first group did not reliably differ from the third group (2.52±0.06 and 2.35± 0.09 respectively, p>0.05), while in the second group (2.8±0.11) a reliable difference was obtained relative to control (p<0.05). CONCLUSION. Blockade of aldosterone receptors with spironolactone provides a cardioprotective effect in Wistar rats with 5/6 nephrectomy.

THE AIM of the investigation was to study kidney functions in rats under conditions of experimental oxalate nephrolithiasis. MATERIAL AND METHODS. Male Wistar rats were given drinking water with 1% solution of ethylene glycol during 3 weeks. The concentration of oxalate, calcium and phosphorus was determined in daily urine. Activity of marker enzymes lactate dehydrogenase (LDG), γ-glutamil transferase (GGT) and N-acetyl-β-D-glucosaminidase (NAG) was also determined. The presence of calcium-positive deposits on kidney slices was determined by the Koss histological method. RESULTS. Daily using ethylene glycol by rats was followed by the development of hyperoxaluria, which was due to increased formation of oxalate ions in the liver and appearance of oxalate supersaturation in tubule urine. In the experiments it was shown that enzymatic activation of urine against the background of ethylene glycol was substantially increased. Activity of NAG became 20 times higher, GGT – 3.7 times higher. LDG activity which had become 7.5 times higher by the end of the first week, then gradually returned to the initial level. These changes are evidence of injuries to the tubule cell membranes, followed by cytolysis and of pronounced impairment of the renal tubule function. Morphological investigation of kidney slices has detected numerous calcium-positive deposits localized mainly on the renal papilla surface. CONCLUSION. Experiments with continuous intake by rats of ethylene glycol have given an irrefutable proof of progression of calcium-oxalate nephrolithiasis. It points to the developed hyperoxaluria, fermenturia and the presence of calcium positive inclusions on the renal papilla surface. The above changes are signs of experimental urolithiasis in rats.

THE AIM of the investigation was to substantiate new methods of operative interventions in cases of exstrophy of the urinary bladder. PATIENTS AND METHODS. Results of 45 operations in children with exstrophy of the urinary bladder were analyzed. Modified methods were used for elimination of defects of the urinary bladder, anterior abdominal wall and share bones. The patients were divided into 3 groups: the first group consisted of 16 patients; in them a one-stage operation was performed for bringing near the share bones without osteotomy. In the second group (22 patients) cystosphincterourethroplasty was made for bringing near symphys pubis without osteotomy and with transversal suture of aponeurosis of the external oblique and rectal abdominal muscles. In the third group (7 patients) a one-stage operation was performed for bringing near the share bones without osteotomy in the clinic’s modification. RESULTS. High incidence of different complications was noted in the first group; there were 15 (93.75%) complications in the early postoperative period, in the later period there were 19 (118.75%). In the second group there were no complications in the early postoperative period, and in the late period there were only 12 complications (54.54%). In the patients of the third group operated by the new modified method of bringing share bones nearer there were no complications in the early postoperative period. CONCLUSION. Early one-stage operative correction of the defect is indicated in children with exstrophy of the urinary bladder. Effectiveness of this technique is in direct proportion to the patient’s age and is the main cause of successful reconstructive plastic operations for exstrophy of the urinary bladder. All medical measures for exstrophy of the urinary bladder must be completed by the preschool age. Diversion of urine into intestine should be used but after failed reconstructive-plastic operations.