[Anemia in diabetic nephropathy: prevalence, clinical and pathophysiological aspects].

AIM: To investigate detectability of anemia, its clinical and pathophysiological features in patients with diabetic nephropathy (DN). MATERIAL AND METHODS: The trial included 1020 patients with type 1 and 2 diabetes mellitus (DM). DN was diagnosed in 50% of them. Incidence of anemia was compared in 92 DN patients in type 1 DM and in 230 patients with chronic glomerulonephritis (CGN). Concentration of erythropoietin (EP) in blood serum was measured in 94 DN patients in type 1 and 2 DM. RESULTS: Anemia develops in type 1 and 2 DM patients free of DN and unaffected renal filtration function (glomerular filtration rate--GFR > 60 ml/min 1.73 m2) was 23.3 and 18.3%, respectively. In DN patients incidence rate of anemia depended on GFR and increased with growing severity of renal failure reaching 85.7% in GFR < 30 ml/min/1.73 m2. Development of anemia in DN depended also on protein urine excretion (20.0% in normoalbuminuria, 25.7% in microalbuminuria and 48.2% in proteinuria). Anemia in DN was detected more frequently and was more severe (by hemoglobin reduction) than anemia in CGN in equal GFR. At all stages of chronic disease of the kidneys EP secretion was low normal and independent of Hb and GFR. CONCLUSION: In DN anemia occurs more often and is more severe than in CGN. Anemia results from inadequate production of EP by the kidneys in response to anemia. Thus, early start of its correction is necessary for improvement of quality of life and inhibition of progression of micro- and macrovascular complications of DM.

[Activities of antioxidant defense enzymes in children with insulin-dependent diabetes mellitus]. / Aktivnost' fermentov antioksidantnoi zashchity pri insulinzavisimom sakharnom diabete u detei.

Activities of superoxide dismutase and glutathione peroxidase were measured in 60 children aged 5 to 15 with insulin-dependent diabetes of various degrees of compensation and duration. Measurements of glutathione peroxidase were found to be the most informative marker of the status of antioxidant defense system.

[Effect of high doses of tocopherol on the processes of lipid peroxidation and insulin secretion in patients with non-insulin-dependent diabetes mellitus]. / Vliianie bol'nykh doz tokoferola na protsessy perekisnogo okisleniia lipidov i sekretsiiu insulina u bol'nykh insulinnezavisimym sakharnym diabetom.

Forty-one patients with type II diabetes mellitus were examined, divided into four groups administered various types of treatment: (1) diets, (2) predian, (3) glibenclamide, and (4) sugar-reducing drugs and insulin. All the patients were prescribed vitamin E in daily doses 600 and 1200 mg. The results indicate that vitamin E in high doses stimulates pancreatic insulin-producing function and is conducive to normalization of lipid peroxidation no matter what kind of therapy is administered.

[Use of the lipolytic drug mevacor in the treatment of patients with diabetes mellitus]. / Primenenie lipoliticheskogo preparata mevakor v terapii bol'nykh sakharnym diabetom.

Stable compensation of diabetes mellitus, including normolipidemia, underlies the therapy of diabetic angiopathies. Mevacor represents a nonactive lactone form of a certain hydroxy acid, a potent inhibitor of endogenous synthesis of cholesterol, conducive to blood cholesterol reduction. The aim of the present study was the assessment of the efficacy of this drug in therapy of patients with diabetes mellitus. Ten patients were administered mevacor in a dose of 20 mg for a month. Such therapy was conducive to a significant reduction of the levels of cholesterol, LNP cholesterol, triglycerides, and cholesterol/LVP ratio. It also promoted a reduction of the content of lipid peroxidation products in the blood, these products being an active factor of vessel destruction. The levels of hydroperoxides, blood serum and red cell malonic dialdehyde, and superoxide dismutase were also reduced. These results necessitate addition of mevacor to a complex of therapy for diabetes to normalize lipid metabolism.

[The nature of the pancreatic hormone secretion and of the metabolic indices during the acute and chronic administration of peroral hypoglycemic preparations]. / Izuchenie kharaktera sekretsii gormonov podzheludochnoi zhelezy i nekotorykh metabolicheskikh pokazatelei pri ostrom i khronicheskom vvedenii peroral'nykh sakharoponizhaiushchikh preparatov.

A comparative study of the effect of acute and chronic administration of sulfanilureal sugar lowering drugs (glipizide and glibenclamide) on the secretion of the pancreatic hormones, indices of microcirculation, the level of triglycerides and nonesterified fatty acids was conducted. Patients with primary detected diabetes mellitus with normal body mass and obesity of I-III degrees were investigated. The principal differences in insulinotropic action of sugar lowering drugs in various groups of patients and significant differences in the mechanism of their hypoglycemic action at varying time of treatment indicate the necessity of a strictly differentiated approach to subscription of these drugs for patients with primary detected diabetes mellitus.

[Pancreatic hormone secretion in patients with newly detected diabetes mellitus]. / Izuchenie sekretsii gormonov podzheludochnoi zhelezy u bol'nykh s vpervye vyiavlennym sakharnym diabetom.

The level of pancreatic hormones was studied in 10 healthy persons and in 40 patients with diabetes mellitus detected for the first time by GTT, their body mass being normal. For assessment of immunoreactive insulin (IRI), the level of proinsulin and biological activity of serum insulin were determined, and these indices were compared with glucose and C-peptide levels. The examinees' inhomogeneity was shown; on the basis of the findings obtained 2 groups were identified. A decrease in the levels of IRI, C-peptide and biological activity of serum insulin in the 1st group indicated a possibility of type I diabetes mellitus in such patients. Hyperinsulinemia, not correlating with glucose and C-peptide, a high percentage of proinsulin and low biological activity of serum insulin were noted in the 2nd group. The study permitted a differentiated approach to assessment of patients and a choice of therapeutic tactics.

[The role of gastrin in regulating insulin and glucagon secretion in patients with diabetes mellitus]. / Rol' gastrina v reguliatsii sekretsii insulina i gliukagona u bol'nykh sakharnym diabetom.

The paper is concerned with the results of investigation of 26 donors and 85 patients with diabetes mellitus, type II, with normal body mass and obesity during GTT and a test breakfast to reveal correlation of IRI and IRG levels with the level of gastrin. Comparative analysis of indices during OGTT and food intake has shown that an increase in the levels of gastrin in patients with diabetes mellitus, type II, does not correlate with body mass and the total level of insulin, but it may correlate with a metabolically active form of insulin. During food intake the levels of gastrin rise and do not change during GTT. A rise of the level of gastrin in patients with diabetes mellitus, type II, during a test breakfast is accompanied by change in the level of insulin, its peak being lower than that during GTT. Attention was focused on a group of patients with a history of obesity in whom by the time of investigation body mass returned to normal and the level of glucose was decreased. However, gastrin and insulin levels were still high, and metabolic regulation was disturbed. Therefore, body mass normalization did not eliminate causative and pathogenetic factors of diabetes mellitus.

[Involutional osteopathies: the clinical x-ray, biochemical and hormonal aspects of the diagnosis]. / Involiutsionnye osteopatii: kliniko-rentgenologicheskie, biokhimicheskie i gormonal'nye aspekty diagnostiki.

A study of patients with involution osteopathy has shown that the development of this disease is associated with osseous tissue dystrophic changes (osteoporosis) and, to a lesser extent, with osteomalacia. Involution osteopathy is not accompanied by severe changes in indices of phosphoric-calcium metabolism; it is characterized by a tendency to an increase in the levels of total and ionized calcium and a decrease in the level of serum phosphorus. A lowered level of calcitonin with a tendency to a decrease in the level of the somatotropic hormone and the unchanged content of parathormone was revealed in involution osteopathy. The blood level of sex steroids (both estradiol and testosterone) in women was decreased, a degree of a rise of gonadotropins in them was lower than that in healthy postmenopausal women. In men with involution osteopathy the mean level of serum testosterone was within low normal limits, the LH content remained normal, and a FSH level was raised. The level of prolactin in patients of both sexes was unchanged.

[Hormone content of the blood in juvenile osteoporosis]. / Izuchenie soderzhaniia gormonov v krovi pri iuvenil'nom osteoporoze.

Juvenile osteoporosis should be regarded as a polyetiological disease developing against the background of constitutional osteopathy in which endocrine disorders play a certain role. A tendency to a decrease in the levels of calcitonin and parathyroid hormone was found in juvenile osteoporosis; mild signs of hypogonadism (secondary) and a relative decrease in hypophyseal somatotropic activity promoted its detection. Two groups of patients were defined: I--with raised AP activity and a normal or lowered level of serum inorganic phosphorus without hormonal disorders; II--with lowered or normal AP activity and a normal level of phosphorus, mild hormonal disorders. Prolonged multimodality therapy with calcitonin, anabolic steroids, active forms of Vitamin D3, calcium agents, physiotherapy and exercise therapy was found effective in juvenile osteoporosis.

[Comparative study of the spectra and activities of isoenzymes in haploid and autodiploid strains of Pichia pinus]. / Sravnitel'noe izuchenie spektrov i aktivnosti izozimov fermentov u gaploidnogo i avtodiploidnogo shtammov Pichia pinus.

The spectra and activities of isozymes of hexokinase and alcohol dehydrogenase (enzymes that catalyse glucose and ethanol assimilation), glucose-6-phosphate dehydrogenase (the key enzyme of the pentose phosphate shunt) and malate dehydrogenase (an enzyme of the tricarboxylic acid cycle) were comparatively studied in Pichia pinus haploid (MH4) and autodiploid (D4) strains. Differences in the qualitative composition of the isoenzyme spectra and activities suggest that the intensity and the role of the studied metabolic pathways and cycles differ between the haploid and autodiploid strains of Pichia pinus.

[Chronic action of the fat-mobilizing fragment of human somatotropin on the fat content of fat depots and the plasma glucose level in rabbits]. / Khronicheskoe deistvie zhiromobilizuiushchego fragmenta somatotropina cheloveka na soderzhanie zhira v zhirovykh depo i vroven' gliukozy v plazme krovi u krolikov.

The effect was studied of synthetic tetradecapeptide-the fat-mobilizing human somatotropin fragment 31-34--on the fat content in fat depot and glucode concentration in the rabbit blood plasma and urine. A marked decrease in subcutaneous (the nape region), perirenal, mesenteric and epididimal fat content, accompanied by partial replacement of the fatty tissue by the connective one, was seen 3 to 4 weeks after tetradecapeptide injection to rabbits. Peptide effect manifested itself only under condition of the inadequate diet and was especially pronounced in young animals. Clucosuria and hyperglycemia were not observed after chronic tetradecapeptide injection. Tetradecapeptide did not exert an evident hyperglycemic or insulinogenous effect and did not produce a marked glucose tolerance fall after short administration to rabbits and during the glucose tolerance test in rats.

[Insulin-receptor interaction on liver cell membranes and isolated adipocytes of rats in experimental obesity]. / Insulin-retseptornoe vzaimodeistvie na plazmaticheskikh membranakh kletok pecheni i izolirovannykh adipotsitakh krys pri éksperimental'nom ozhirenii.

It was established that alimentary obesity in rats was accompanied by a considerable elevation of the blood insulin level. Under these conditions the number of receptors to insulin on the rat liver cell plasmatic membranes decreased 1 1/2 to 2 times depending on the obesity degree. The receptor affinity to the hormone remained unchanged. It was shown that the receptor density to insulin on adipocytes isolated from the rat fatty tissue was sharply reduced, the decrease being correlated with the biological effect lowering of insulin in this tissue.

[Insulin-receptor interaction of plasma membranes of liver cells and isolated adipocytes of the rat with different insulin content in the blood]. / Insulin-retseptornoe vzanmodeistvie na plazmaticheskikh membranakh kletok pecheni i izolirovannykh adipotsitov krys crazlichnym soderzhaniem v krovi inculina.

Study on the insulin--receptor interaction of the plasma membranes of liver cells demonstrated a reverse dependence of insulin concentration in the blood and the number of insulin-binding sites on the membranes. Using isolated adipocytes, it was shown that at a constant number of receptors the receptor density is changed. These changes are correlated with the decrease of biological effects in experimental obesity accompanied by hyperinsulinism. In the case of streptosotocin diabetes (simulated hypoinsulinism) no correlation between insulin binding and its biological effects was observed, which can be accounted for by disturbances in transmission of the signal from the insulin--receptor complex to the enzymatic systems of the cells.

[Biological method of blood plasma glucagon determination]. / Biologicheskii metod opredeleniia gliukagona v plazme krovi.

Biological method of glucagon determination in the blood plasma was worked out. The method consists in incubation of the rat liver membranes with glucagon which stimulates adenylcyclase, whose activity was determined by the accretion of cAMP content in the incubation medium. Membranes with increased sensitivity of glucagon were obtained; hormone concentrations in the plasma of healthy persons and of patients suffering from diabetes were determined. In healthy persons glucagon content varied from 54 to 175 pg/ml.