[Heart valve calcification in patients with chronic kidney disease].

The aim of the study was to identify factors related to heart valve calcification (HVC) and effect of HVC on intracardiac hemodynamics in patients with chronic kidney disease (CKD). 377 CKD patients of the control group and 132 ones treated by hemodialysis (HD) were examined using echocardiography, cardiomonitoring, measurement of the carotid intima-media thickness and mineral bone density, X-ray imaging of calcified abdominal aorta. HVC was diagnosed in 38.9 and 27.3% of the CKD patients on hemodialysis and without it respectively. In both groups, patients with HVC were older than HVC-free ones, more of them had coronary heart disease, cardiac insufficiency, aortic calcinosis, and biochemically identifiable inflammation. In the absence of hemodialysis, patients with HVC had thicker intima-media compex, lower glomerular filtration rate, higher arterial pressure, and increased occurrence of diabetes mellitus. In HVC patients receiving hemodialysis, its duration was longer, blood PTH and calcium levels higher, forearm MOC lower. HVC associated with stenosis of mitral and aortic valves, aortic regurgitation, enlarged left and right atrium, thickened left and right ventricular wall. Multifactor analysis showed that HVC in patients receiving hemodialysis was related to the age, disbalance of phosporus and sodium, and duration of hemodialysis; in its absence, it was related to intima-media thickness and diabetes mellitus. Thus, in patients of the latter group, HVC was in the first place associated with atherosclerosis aggravated by a decrease of glomerular filtration rate and with the presence of diabetes. In patients receiving hemodialysis, HVC correlated with phosporus/sodium disbalance and atherosclerosis. The study revealed negative effect of HVC on intracardiac hemodynamics and for the first time demonstrated decreased MOC in patients with HYC.

[Intracardial transplantation of mononuclear cells of the autologous bone marrow in complex treatment of patients with valvular heart diseases].

The authors present the first clinical experience with intramyocardial transplantation of the mononuclear fraction of cells of the autologous bone marrow in complex surgical treatment of 10 patients with valvular heart disease. The cellular transplantation was fulfilled intraoperatively when making a prosthetic mitral (5 patients) and aortal (5 patients) valves on the open heart under conditions of extracorporeal circulation. Simultaneously direct revascularization of the myocardium (aorto-coronary and mammary-coronary shunts) was performed in 4 patients (1--with a mitral and 3--with aortal heart diseases). An investigation of the results of the examination including ECG, EchoCG and investigation of the myocardium perfusion using one-photon emission computed tomography fulfilled in the early postoperative period and within 6-12 months after operation has shown that the cell cardiomyoplasty with mononuclear fraction of cells of the autologous bone marrow improves the myocardium perfusion, however, in the early postoperative period the appearance of transitory impairments of the heart rate is possible.

[Glomerular filtration rate is an indicator of endothelial function at early stages of chronic kidney disease].

AIM: To study effects of glomerular filtration rate (GFR) reduction on endothelial function in patients at early stages of chronic renal kidney (CKD). MATERIAL AND METHODS: Endothelial function of 101 patients with CKD of stage I-III was examined using reactive hyperemia test, dopplerography of skin vessels with ionophoresis of acetylcholin and nitroglycerin, lipidogram parameters, homocistein and annexin A5 levels, intima-media complex thickness of the common carotid artery, echocardiography findings. RESULTS: Cardiovascular complications risk factors were found in all the patients: increased body mass index, arterial hypertension, dyslipoproteinemia, hyperhomocysteinemia. Reduced GFR (under 90 ml/min) is an independent factor of atherosclerosis risk. CONCLUSION: GFR reduction corresponding to CRD of stage II is accompanied with enhancement of apoptosis and development of vasomotor endothelial dysfunction that in combination with risk factors contribute to development of a preclinical atherosclerosis phase.

[The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis]. / Morfofunktsional'nye paralleli pri arterial'noi gipertonii u bol'nykh khronicheskim glomerulonefritom.

A study was made of the structural rearrangement of renal tissues in intravital nephrobiopsy specimens and of the functioning of the renin-angiotensin-aldosterone system and kallikrein-synthetic function in patients with mesangioproliferative (MSPGN) and membranous proliferative glomerulonephritis (MPGN). The morphological changes were revealed. The patients with associated MSPGN and secondary hypertension (SH) mostly demonstrated emptying and hyalinosis of arteries, whereas those with associated MPGN and SH manifested for the most part the derangement of the tubulointerstitial structures. In patients with MPGN, the levels of total renin (TR) and inactive renin (IR) were significantly higher than in those suffering from MSPGN. This can be regarded as risk factor of earlier development of SH. In MPGN patients, the content of TR and IR as well as that of active renin (AR) did not depend on the clinical pattern of chronic glomerulonephritis. As compared to MSPGN patients with isolated urinary syndrome, those with associated MSPGN and SH had a higher AR level, which agreed well with systolic and mean arterial pressure. Apparently, the latter one is implicated in the mechanism of SH in MSPGN. In associated MPGN and SH, kallikreinuria was found to be lowest, which may be the consequence of tubulointerstitial lesions. Discoordination of the renin-angiotensin and kallikrein systems is likely to be one of the causes of earlier formation and severe course of SH in the morphological pattern under consideration.

[The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis]. / Morfofunktsional'nye paralleli pri arterial'noi gipertensii u bol'nykh khronicheskim glomerulonefritom.

The restructure of renal tissue in intravital nephric biopsy specimens, renin-angiotensin-aldosterone together with kallikrein synthetic functions were studied and compared in patients with mesangioproliferative and membranoproliferative glomerulonephritis (MsPGN and MPGN). The characteristics of the morphological changes were defined. In MsPGN with secondary hypertension (SH), nephronic wasting and hyalinosis of arteries were mostly detectable whereas MPGN with SH was primarily marked by the derangement of the tubulointerstitial structures. In MPGN, the levels of total and inactive renin (TR and IR) were significantly higher than in MsPGN. This can be regarded as risk factor of early development of SH. The content of TR and IR and in addition that of active renin (AR) in MRGN did not depend on the clinical form of chronic glomerulonephritis. As compared to MsPGN with an isolated urinary syndrome, in MsPGN with SH, AR was prevalent, while its level correlated well with systolic and the mean arterial pressure. AR may be implicated in the mechanism of SH in MsPGN. In MPGN with SH, kallikreinuria was found to be extremely low, which may be consequent to tubulointerstitial injuries. The discoordination of the renin-angiotensin and kallikrein system may be one of the causes of earlier formation and the grave course of SH in the morphological pattern under consideration.

[Use of a kinetic model of radio-hippuran transport in the human body for the quantitative evaluation of total and divided kidney functions]. / Primenenie kineticheskoi modeli transporta radioaktivnogo gippurana v organizme cheloveka dlia kolichestvennoi otsenki summarnoi i razdel'noi funktsii pochka.

The paper is concerned with the results of a method for the interpretation of commonly used methods of the determination of blood clearance and radio-nephrography with 131I-hippuran based on a mathematical model of its transport in the human body. Empirical values of model parameters were obtained in 120 patients with chronic glomerulo- and pyelo-nephritis verified morphologically and roentgenologically. The use of computational-interpretation algorithms made it possible to determine the volume of circulating plasma (blood), values of true summary and isolated effective renal plasma flow (blood flow) by means of a single i. v. hippuran administration. New indicators for assessment of isolated excretory-transport function and renal hemodynamics as well as indicators of the symmetry of renal function were proposed. The results of a statistical analysis made it possible to recommend some of them as criteria of early diagnosis of pre-uremic disorder of renal function. Radionuclide indicators of renal function showed good correlation with biochemical, morphological and roentgenological characteristics of renal damage in renal diseases.