[Calcitriol: role in the regulation of erythropoiesis, use in the treatment of renal anemia]. / Kal'tsitriol: rol' v reguliatsii éritropoéza, primenenie v lechenii pochechnoi anemii.

The efficiency of combined therapy (erythropoietin + calcitriol) used in 8 patients with chronic renal failure on programmed hemodialysis was comparatively evaluated with erythropoietin monotherapy employed in 9 patients with the same disease on hemodialysis which represented a control group. The anti-anemia effect was achieved on the average of 5 weeks earlier in the group of patients given the combined therapy than that in the controls. The differences between the two groups were statistically significant in the rate of anti-anemia effect achievement. Possible mechanisms by which calcitriol enhances the anti-anemia effect of erythropoietin, i.e. the mediated effects and direct action of calcitriol on erythropoiesis, are discussed in the paper.

[The efficacy of an erythropoietin-calcitriol combination in patients with chronic kidney failure on programmed hemodialysis]. / Effektivnost' sochetaniia éritropoétin-kal'tsitriola u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu, nakhodiashchikhsia na programmnom gemodialize.

In 8 patients with chronic renal failure (CRF) on hemodialysis combined therapy (erythropoietin+calcitriol) effect was evaluated versus control group of 9 hemodialysis patients on erythropoietin monotherapy. In patients on the combined regimen the antianemic effect occurred sooner, this effect of calcitriol coming prior to correction of uremic defects in phosphoric-calcium metabolism. Calcitriol mechanisms of action in renal anemia and benefits of potential calcitriol+erythropoietin combination use in CRF patients suffering from uremic osteodystrophy, hypercatabolic conditions, uremic hypogonadism and infection complications are discussed.

[Individual differences in the efficacy of Recormon in patients with terminal kidney failure. The role of iron deficiency]. / Individual'nye razlichiia v éffektivnosti Rekormona u bol'nykh s terminal'noi pochechnoi nedostatochnost'iu. Rol' zhelezodefitsita.

Iron deficiency involvement in the results of long-term replacement therapy of renal anemia with recormon, a preparation of recombinant human erythropoietin, has been studied in chronic renal failure patients on programmed hemodialysis. The effect of recormon subcutaneous administration to 51 patients was found reduced in 9 patients; in 5 of them the decreased sensitivity to recormon was attributed to iron deficiency. During a year of treatment the percentage of iron-deficient patients rose from 9.1% to 45% as a result of intensive uptake of iron in the course of erythropoiesis. Iron preparation as a corrective treatment contributed to hematocrit increment reducing effective doses of erythropoietin. In addition to routine control of ferritin and iron it is recommended to trace the degree of transferrin saturation in the course of recombinant erythropoietin therapy.

[The use of ultrahigh doses of corticosteroids in treating the most severe variants of lupus nephritis]. / Primenenie sverkhvysokikh doz kortikosteroidov pri lechenii naibolee tiazhelykh variantov volchanochnogo nefrita.

The authors analyze the 10-year experience gained with the use of steroid pulse-therapy for the gravest forms of lupus nephritis--rapid-progressing lupus nephritis and active lupus nephritis associated with the nephrotic syndrome. Ultrahigh doses of prednisolone and methylprednisolone (1000 mg i. v. for 3 days) was monotherapy or as a constituent part of multimodality treatment were given to 30 patients including 27 women and 3 men aged 18 to 48 years. Of these, 12 patients had rapid-progressing lupus nephritis and 18 active lupus nephritis. The short-term treatment results were estimated after 1 to 3 months, whereas the long-term ones after 12 months to 9 years. Analysis of the treatment results allows the following conclusions to be drawn: the use of steroid pulse-therapy was monotherapy is only justified in patients suffering from active lupus nephritis with the nephrotic syndrome without renal failure and only at the disease debut. In rapid-progressing lupus nephritis and long active lupus nephritis with the phenomena of renal failure, the positive effect can only be attained after combination of steroid pulse therapy and high doses of prednisolone per os or long intake of cytostatics per os or in the form of cytostatic pulses.

[The renal functional reserve in the nephrotic syndrome]. / Funktsional'nyi rezerv pochek pri nefroticheskom sindrome.

Functional reserves of the kidneys (FRK) were examined in 29 patients with the nephrotic syndrome and in 14 healthy subjects. FRK were determined as the degree of the increase of endogenous creatinine clearance after stimulation with beef protein (0.7 g per kg bw) or dopamine (3 micrograms/min per kg bw). It was revealed that in 2/3 of the patients, FRK were lowered or lacking. The lack of FRK was seen in all the morphological varieties of renal lesions, with the frequency being greater in the severe clinical forms of the nephrotic syndrome, in lasting nephropathy, in association with arterial hypertension or renal failure. It has been noted that FRK may recover after successful treatment of the nephrotic syndrome, attesting to a favourable regimen of organ functioning and suggesting deceleration of the tempo of renal disease progress.

[Use of isolated ultrafiltration in nephrotic edema resistant to diuretics]. / Primenenie izolirovannoi ul'trafil'tratsii pri rezistentom k deistviiu diuretikov nefrotichekom oteke.

The authors describe the use of isolated ultrafiltration (IUF) in 16 patients with massive refractory edema associated with the nephrotic syndrome of varying etiology. IUF appeared efficacious in 11 patients and permitted the reduction of the patients' body weight by 9.8 +/- 2.6 kg on the average (maximally by 23 kg) at the expense of the removal of protein-free ultrafiltrate. The removal of the protein-free liquid was not accompanied by any material changes in the electrolyte content in serum. It did not produce alterations in the circulating blood volume or subsequent reduction of diuresis, making IUF more physiological procedure as compared to massive treatment with diuretics. IUF turned out more effective in patients with the hypervolemic pattern of the nephrotic syndrome.

Steroid-induced hypertension in patients with nephrotic syndrome.

In 35 initially normotensive patients with chronic glomerulonephritis and lupus nephritis (including 27 patients with nephrotic syndrome; NS), blood pressure (BP), urinary sodium excretion, plasma renin activity (PRA), plasma aldosterone level (PA), urinary aldosterone excretion (Au and blood volume were measured before and during prednisolone treatment. In 7 patients (all with NS) steroid-induced hypertension has developed. The patients prone to develop hypertension were hypervolemic nephrotics with initial depression of PRA, PA, Au, and severe sodium retention. In these patients prednisolone did not produce diuresis of natriuresis nor did it decrease proteinuria. In normo- and hypovolemic patients prednisolone produced significant diuresis and natriuresis and failed to induce hypertension. Thus, two types of response to prednisolone could be observed in patients with NS.

[The role of the renin-angiotensin system in the pathogenesis of nephrotic syndrome]. / O roli renin-angiotenzinovoi sistemy v patogeneze nefroticheskogo sindroma.

The state of the renin-angiotensin system (RAS) was studied in 102 patients with chronic glomerulonephritis with the nephrotic syndrome (NS) with relation to a phase of the edematous syndrome and sodium balance. Heterogeneity of patients with NS was shown with regard to RAS activity and the circulating blood volume in the whole group as well as in accumulation and stabilization phases of the edematous syndrome. A plasma renin activity value did not correlate with a degree of sodium retention permitting a review of the earlier concept of the role of RAS in sodium retention genesis during NS formation. In the phase of increment of the edematous syndrome there was definite relationship between a degree of sodium retention and glomerular filtration rate, its decrease in the initial period of NS formation being regarded as a possible factor of sodium retention.

[Captopril in the treatment of arterial hypertension in chronic nephritis]. / Kaptopril v lechenii arterial'noi gipertonii pri khronicheskom nefrite.

The effect of captopril on arterial pressure, indices of renal function and renal function regulating factors was studied in 13 patients suffering from chronic glomerulonephritis with arterial hypertension. Captopril considerably decreased the expression of hypertension irrespective of the initial status of the renin-angiotensin-aldosterone system. A prolonged use of captopril resulted in an increase in the renal blood flow, a considerable decrease in the resistance of the renal vessels. A transient decrease in a glomerular filtration value was noted on the first days of treatment. The use of captopril did not cause significant changes in sodium balance; potassium excretion with urine decreased, its concentration in the blood increased. Captopril caused a sharp increase in the blood renin activity, a decrease in aldosterone production and excretion and an increase in the synthesis of renal prostaglandins. Captopril was well tolerated by the patients, noticeable side effects were undetectable. Mechanisms of the hypotensive effect of the drug and mechanisms of its action on renal function were discussed.

[Inactive renin in patients with chronic and terminal renal insufficiency]. / Neaktivnyi renin u bol'nykh s khronicheskoi i terminal'noi pochechnoi nedostatochnost'iu.

Active renin (AR) and trypsin-activated inactive renin (IR) were examined in 32 patients with chronic renal failure (CRF). (of these, 25 patients were kept on the programmed hemodialysis) and in 11 normal subjects. As compared with normal subjects, CRF patients manifested a decrease in both AR and IR. A direct correlation was discovered between AR and IR: R = 0.64, P less than 0.01. The simultaneous decrease in IR and AR attests to the impairment of renin synthesis during CRF.

[Pulse therapy of patients with nephritis: effect on arterial pressure, electrolyte metabolism and the renin-aldosterone system]. / Pul's-terapiia u bol'nykh nefritom: vliianie na arterial'noe davlenie,obmen élektrolitov i renin-al'dosteronovuiu sistemy.

A study was made of the effects of ultra-high doses of prednisolone on arterial blood pressure, electrolyte metabolism and renin-aldosterone system in 18 patients with chronic glomerulonephritis and lupus nephritis, with normal renal function and renal failure. Administration of 1,000 mg prednisolone produced a noticeable but a short-term elevation of the arterial blood pressure. After administration of 1,000 mg prednisolone the patients without renal failure noted marked increase of diuresis and natriuresis accompanied by activation of the renin-aldosterone system. In patients with renal failure, diuresis also increased, however sodium excretion with urine dramatically reduced which was accompanied by inhibition of plasma renin activity. Marked retention of sodium during institution of pulse-therapy in patients with renal failure may cause some grave complications including brain edema.