[Acute renal insufficiency during pregnancy with acute pancreatitis]. / Ostra bubrechna nedostatuchnost pri bremenna s ostur pankreatit.

According to current data the incidence of acute pancreatitis is from 1:1000 to 1:5000. Symptoms vary a lot, one of rare but most severe complications being acute renal failure. The case is a 24-year-old pregnant patients--30-th gestational week with symptoms of acute pancreatitis based most probably on hereditary hypertriglyceridemia and hypercholesterolemia. Parallel to acute inflammation of pancrease a hypercoagulation syndrome developed. It is possible that acute renal failure was caused by active thrombus formation. Because of danger for the life of mother and baby, an urgency preterm Cesarean Section was performed. Resussitation post-surgery care and drug therapy (lowmolecular anticoagulants, antibiotics, spasmolytics and analgetics, protease--inhibitors, inhibitors of protome pump, regulators and inhibitors of pancreas secretion normalize renal and pancreatic function if based on special dietary regimr. Coagulation status also normalizes.

[Lipid metabolism and its changes in pregnancy]. / Lipidniiat metabolizum i promenite prez bremennostta.

A survey is made on physiology of lipid metabolism and its variations during pregnancy. The mechanisms leading to an increase in triglycerides and cholesterol during pregnancy are explained. These changes induce increased aterogenic risk, higher risk for developing pathologic 1 changes in blood vessels on microcirculation level on the basis of endothelial disfunction. A multiorgan pathology may possibly be provoked--kidneys, pancreas or occurrence of praeeclampsia.

[Secondary systemic amyloidosis A combined with primary glomerulonephritis and systemic diseases]. / Vtorichna sistemna amiloidoza A v suchetanie s purvichni glomerulonefriti i sistemni zaboliavaniia.

Amyloidosis is characterized by organic dysfunction as a result of deposition of amyloid substance in the walls of the small blood vessels and extracellularly in different organs. The involvement of the kidneys in systemic amyloidoses AL and AA has irreversible evolution to renal failure. The object of the study was to determine the prevalence of the secondary (reactive) systemic amyloidosis AA in combination with primary glomerulonephritis (PGN) and lupus nephropathy (SLE) and to create diagnostic approach for its early detection. The prevalence of amyloidosis among the renal biopsies in the Department of Nephrology by the Chair of Internal Diseases for the period 1981-1988, retrospectively, is 4% (in 11 out of 268 biopsies). For the period 1989-1996, prospectively, by directed quest, amyloid was found in 35 out of 269 renal biopsies (11%). For differentiation of AA preliminary treatment of the histologic material with KMnO4 was used. In 20 cases amyloidosis appeared as independent finding in the renal tissue, while in 15 it was combined with histologic picture of immune nephropathies: in 11 with primary glomerulonephritis (7% out of 155 PGN) and in 4 with systemic lupus erythematodes (11% out of 31 SLE). The combination of PGN with AA was almost always associated with chronic infections. It was most often observed in diffuse membranous GN or FSGSH. Our studies demonstrate increased prevalence of amyloidosis among the renal biopsies during the last years, which could be due to directed quest, but it could be a real fact, too. We suggest staining for amyloid in all renal biopsies, as well as its directed quest in mucosae of the gastro-intestinal tract and by aspiration of the abdominal subcutaneous fatty tissue in the patients with primary GN or systemic diseases.

[Comparative echographic and computed tomographic studies of acute focal bacterial nephritis]. / Sravnitelni ekhografski i kompiuturnotomografsli prouchvaniia na ostriia ognishten bakterialen nefrit.

The diagnostic potentialities of ultrasound and computed tomography for the early diagnosis of acute focal bacterial nephritis were studied in 12 patients. The echographic findings in all patients are similar: insular tumor-like zone, unclearly defined from the neighbouring parenchyma, hypo-, hyper- or isoechogenic, without liquefaction and lack of distant amplification. The computed tomographic image of 4 from 5 patients studied is as follows: perihilar defect with wedge-shaped form, hypodense structure, radially striated areas from the cavity system toward the parenchyma after applying of a contrast medium. The conclusion is that an early diagnosis of the acute focal bacterial nephritis could be achieved by ultrasound examination which is of high informativeness, harmless, with no radiation and should be basic diagnostic method for this kind of nephritis. The early diagnosis allows a more precise treatment.

[Multiple bilateral parapelvic kidney cysts]. / Dvustranni mnozhestveni parapelvikalni bubrechni kisti.

8 patients, 2 men and 6 women, 42 to 67 years of age, with bilateral multiple cysts of the renal sinus are described. 3/6 patients had macroscopic hematuria, pyelonephritis, 5/8 patients were with arterial hypertension and 4/8 patients were with renal failure. All patients were examine by ultrasound once more after a greater diuresis was achieved in order to differentiate from hydronephrosis. The isotopic nephrographic curves were normal in 2/8 patients and were disturbed in the remaining 6 patients. Hydronephrotic type curves were not found. Urography was performed to 4 of the patients and in 2 of them the diagnosis was polycystosis and in the other 2 patients it was bilateral parapelvic cysts. Possible mistakes in the diagnosis of bilateral parapelvic cysts are discussed. The reported cases with superimposed pyelonephritis and renal failure point to the need of prophylactic medical examinations of such patients.

[Immunochemical studies in glomerulonephritis with mesangial immunoglobulin A precipitation]. / Imunokhimichni prouchvaniia pri glomerulonefriti s mezangialno otlagane na imunoglobulin A.

Serum IgA, C3 and circulating immune complexes were examined in 20 patients with morphologically proved chronic glomerulonephritis with mesangial IgA precipitates and in 39 clinically healthy controls. The immune complexes were analyzed. 10 patients were with Berger's disease, 8 patients--with secondary IgA glomerulonephritis accompanying chronic liver disease and 1 patient was with Henoch-Schönlein's purpura. No significant differences were found between the mean values of IgA, C3 and the circulating immune complexes in the patients and the healthy controls as well as between the actively ill patients and those in remission. IgA and IgM in the immune complexes were significantly higher in the patients than in the healthy controls. IgA level in the immune complexes was significantly higher in the patients with active disease than in the patients in remission. In the patients with liver disease C3 and C4 often were not found in the immune complexes. In these patients it is possible that aggregates of immunoglobulins are found instead of immune complexes. The IgA level in the immune complexes could serve as a criterion for the disease activity.

[Potentials of echography for diagnosing x-ray-negative calculi]. / Vuzhmozhnosti na ekhografiiata za diagnostitsirane na rentgennegativni konkrementi.

The objective of the authors, with the present paper, is to specify the possibilities of echography in patients with "negative" renal lithiasis. A total of 54 patients were studied, grouped in two subgroups: subgroup A--33 patients with native-graphy, urography and echography, subgroup B--21 patients with chronic renal insufficiency and intolerance to X-ray contrast media, to whom only native-graphy and echography were performed. The authors concluded, on the base of the statistical calculations, that echography in the patients studied by them, has a higher percentage probability of differentiating the negative concrements than urography.

[Renal biopsy following ultrasonic localization of the kidney]. / Bubrechna biopsiia sled ultrazvukova lokalizatsiia na bubreka.

Venous urography is the method most frequently applied in the localization of the kidney for percutaneous renal biopsy. It, however, cannot be applied to patients with acute or chronic renal insufficiency as well as to patients, hypersensitive to roentgen contrast media. The ultrasound localization of the kidney solves that problem. The results from 25 renal biopsies are reported, performed after ultrasound localization of left kidney. That mode is less harmful for the patients, avoiding the occasional side effects of venous urography, the examination being cheaper.

[Intravenous "pulsed" methylprednisolone treatment of severe collagenic and rapidly progressing glomerulonephritis]. / Intravenozno "pulsovo" metilprednizolonovo lechenie pri bolni s tezhki kolagenni i burzo progresirashti glomerulonefriti.

The results are reported from the "pulse" methylprednisolone treatment of seven patients with severe collagenic and rapidly progressing glomerulonephritis. Good effect was obtained in six patients, manifested in increased and maintained relatively high diuresis, decreased proteinuria and erythocyturia, slowed down ESR, lower values of plasma creatinine, increased creatinine, normalization of the majority of immunologic deviations. The patients with good effect were in a good condition till the end of the follow up, with no complaints, afebrile, without edemas and no manifestations of hypercorticism. The "pulse" intravenous methylprednisolone treatment is concluded to be an effective therapeutic method in rapidlyprogressing, abruptly deteriorated collagenic glomerulonephritis, as well as those with no effect after a combined anticoagulant, immunosuppressive and oral corticosteroid treatment.

[Results of the use of ultrasonic diagnosis in kidney diseases]. / Rezultati ot prilozhenieto na ultrazvukovata diagnostika na bubrechnite zaboliavaniia.

The results are reported from application of ultrasound diagnostics (echography) of 400 patients with renal diseases. The diagnoses were confirmed by venous urography, isotope nephrography, scintigraphy and punch renal biopsy. One hundred eighty seven of the patients are with pyelonephritis with and without concretions and hydronephrosis, 50--with diffuse diseases, 34--with congenital diseases, 22--with focal alterations, 10--with diseases of the bladder and prostate, other diseases--88 patients. Out of all etiological entities--19 silent kidneys were diagnoses. Hydronephrosis proved to be the most frequent cause of the silent kidney. The results obtained stress upon the significance of echography as a diagnostic method.

[Possibilities of combined treatment of diffuse collagenous glomerulonephritis]. / Vuzmozhnosti na kombiniranoto lechenie pri difuznite kolagenni glomerulonefriti.

Combined corticosteroid, immunosuppressive and anticoagulant treatment was performed to 17 patients with various histological forms of collagenous glomerulonephritis, 14--with disseminated lupus erythematodes, 1--with periartheritis nodosa and 2--with Schönlein-Henoch disease. The immunosuppressive treatment was carried out for an average of 14.62 months, the corticosteroid treatment--an average of 17 months and the anticoagulant--18.12 months. In 6 patients the corticosteroid treatment was initiated with a pulse of 30 mg methylprednisolone in the course of 3-10 days, and in the rest of the patients--with an initial dose of 60 mg prednisolone. The anticoagulant treatment was, at first, carried out with heparin 30,000 U daily, and later with acenocoumarol and the immunosuppressive--with azathioprin--100 mg daily. The term of treatment and observation is from 6 to 63 months, an average of 25-82 months. The treatment was discontinued in eight patients. Very good effect (complete clinical and laboratory remission) was obtained in seven patients--41.18 per cent, good effect (clinical remission but incomplete laboratory) in 7 patients--41.18 per cent, one patient with no change--5.88 per cent. Two patients--11.76 per cent, died of the complications of the treatment. Grave complications resulting from the treatment were obtained in seven patients.

[Results of ultrasonic diagnosis of patients with renal transplants]. / Rezultati ot ultrazukovata diagnostika na bolni s bubrechna transplantatsiia.

The echography of transplanted kidney is a modern noninvasive investigation method with significant information value. It is easily applicable even in cases of the gravest states of the patients, allowing the dynamic observation almost immediately in the post-transplantation period. The early and chronic crisis of transplant rejection is excellently diagnosed by echography as well as of perirenal liquid collections, arterial and venous thrombosis, obstructions of excretory ducts. Results are reported from 37 echographic examinations of II kidney transplanted patients, manifesting the following complications: 8 acute crises of transplant rejection, 6--acute tubular necrosis, 3--vascular thrombosis and renal infarctions, 2--perirenal collections. 3--lightly dilated pyelo-calix system. The majority of the echographic diagnoses were confirmed by clinical-laboratory methods, X-ray examination methods and at operation.