[Arterial hypertension in chronic glomerulonephritis: detectability and treatment efficacy]. / Arterial'naia gipertoniia pri khronicheskom pri khronicheskom glomerulonefrite: chastota vyiavleniia i éffektivnost' lecheniia.

AIM: To study prevalence of arterial hypertension (AH) in patients with chronic glomerulonephritis (CGN), its relationship with activity of the renal process, renal function; to analyse policy and efficacy of antihypertensive therapy. MATERIAL AND METHODS A total of 250 CGN patients treated in 1993-2001 participated in the trial. They had different morphological variants of CGN. AH was diagnosed in 193 patients. In the course of the trial changes in antihypertensive treatment policy were observed. RESULTS: AH was most prevalent in mesangiocapillary (96.6%) and diffuse fibroplastic nephritis (83.9%). In functional insufficiency of the kidneys AH occurred in 90.1%. AH was associated with clinical and morphological signs of nephritis activity, severity of tubulointerstitial alterations, purin and lipid metabolism. Uric acid level and age were independent prognostic factors of AH development. AH correction was achieved in the initial and subsequent periods in 51.7 and 58.7% cases. Later, ACE inhibitors were prescribed more often, both in monotherapy and in combination with other drugs; calcium antagonists were taken less frequently. CONCLUSION: AH in CGN patients is a frequent finding and depends on a morphological nephritis variant, activity of the renal process and degree of renal failure. Age, gender and metabolic disorders are also involved in AH development in CGN patients. Recently, there is a trend to more frequent prescription of combined treatment. Drugs of choice in the treatment of renal AH are ACE inhibitors.

[Use of angiotensin-converting enzyme inhibitors in chronic kidney insufficiency]. / Primenenie ingibitorov angiotenzinprevrashchaiushchego fermenta pri khronicheskoi pochechnoi nedostatochnosti.

AIM: To study effects of ACE inhibitors in patients with diffuse renal diseases at the stage of chronic renal failure (CRF). MATERIAL AND METHODS: Acute changes in renal filtration and in renal hemodynamics in response to 100-200 mg captopril were studied in 7 patients with CRF and 6 patients with intact renal function. Effects of long-term ACE inhibitors were retrospectively studied in 50 patients with CRF (27 men, 23 women, mean age 46.0 +/- 1.9 years, 7 patients were over 60 years old). Sixteen patients were selected from this group who were followed up for a long time. They were examined for CRF progression rate when given conventional antihypertensive treatment and after treatment with ACE inhibitors. RESULTS: Acute response to ACE inhibitors was the following: SCF fell by 18.4% on the average by the end on therapy week 1; by the end of week 3 renal hemodynamics showed stability, SCF returned to normal, effective renal plasm flow rose by 16.9%, serum potassium rose significantly after 7 days of treatment but did not reach 6 mmol/l. Effects of long-term ACE inhibitor in CRF: the treatment was discontinued after 30-60 days in 12 of 50 patients because of high creatinine (> 20%); in 38 patients ACE inhibitor had a pronounced antihypertensive and antiproteinuric action for 2-3 years, creatinine growth inhibited. Progression of CRF became slow. CONCLUSION: ACE-inhibitors in CRF had a nephroprotective effect but blood creatinine levels should be controlled especially within the first 1-2 months of treatment.

[Prognostic significance of controlled and uncontrolled arterial hypertension in patients with terminal kidney failure on chronic hemodialysis]. / Prognosticheskoe znachenie kontroliruemoi i nekontroliruemoi arterial'noi gipertonii u bol'nykh s terminal'noi pochechnoi nedostatochnost'iu, nakhodiashchikhsia na khronicheskom gemodialize.

AIM: To assess prognostic implications of controlled and uncontrolled arterial hypertension (AH) in patients with terminal renal failure (TRF) on chronic hemodialysis (CHD). MATERIAL AND METHODS: 90 patients on CHD treated from 1981 to 2001 participated in the trial. All of them were examined morphologically (biopsy of the kidney or autopsy). According to the trend of arterial pressure during CHD treatment they were divided into 3 groups. 72 patients of group 1 had sodium-dependent AH. 8 patients of group 2 had uncontrollable AH (rise of arterial pressure during hemodialysis in spite of controlled iltrafiltration). Group 3 consisted of control patients. RESULTS: It was found that any hypertension in CHD patients is prognostically unfavourable. Controllable AH occurred in 91.1%, uncontrollable--in 8.9% of examinees. Chronic renal failure in 20% of group 1 patients was associated with rapidly progressive nephritis, in 15%--with systemic vasculitides. In group 2, 38% patients had systemic vasculitis, 50%--rapidly progressive nephritis. The activity of the underlying disease in hemodialysis was registered in 75 and 30% patients of group 2 and 1, respectively. Incomplete dialysis syndrome (IDS) was diagnosed in 69.6% group 1 and 40.0% group 2 patients. CONCLUSION: Sodium dependent arterial hypertension was most frequent. It is attributed to IDS. AH uncontrolled by hemodialysis develops, as a rule, in patients with systemic vasculitis or active primary nephritis. Uncontrollable AH is characterized by elevated plasm renin. Lack of control over arterial pressure in hemodialysis is essential for long-term survival of the patients. The shortest survival was observed in patients with renin-dependent AH. Factors provoking AH and deteriorating the prognosis are the following: hypervolemia in IDS, hyperactivity of plasm renin, exacerbation of basic disease in hemodialysis, protein energy deficiency syndrome, lack of residual renal function.

[Role of renin-angiotensin-aldosterone system in pathogenesis of arterial hypertension in chronic renal failure]. / Rol' renin-angiotenzin-al'dosteronovoi sistemy v patogeneze arterial'noi gipertonii pri khronicheskoi pochechnoi nedostatochnosti.

AIM: To characterize status of renin-angiotensin-aldosterone system (RAAS) in patients with chronic and terminal renal failure (CRF, TRF) and its role in pathogenesis of arterial hypertension (AH). MATERIALS AND METHODS: RAAS was studied in 90 patients with TRF on chronic hemodialysis (CHD) and 17 CRF patients with AH on conservative therapy. Plasma renin activity (PRA) and the level of plasma aldosterone (PA) were measured with radioimmunoassay. RESULTS: PRA with moderate CHD-controlled hypertension (1.16 ng/ml/h) was not higher than in control group (1.33 ng/ml/h), while in severe hypertension PRA was increased 4.6-fold (6.09, p < 0.05). In CRF with severe AH PRA was higher 3.6 times (4.8 ng/ml/h, p < 0.05). PA was in CRF and TRF patients 4-5 times higher than in healthy controls. A positive correlation was found between PRA and mean dynamic AP (r = 0.448, p < 0.01) and PRA with PA (r = 0.31, p < 0.05). CONCLUSION: A leading role of RAAS is shown in pathogenesis of AH in patients with hemodialysis uncontrolled hypertension and, partially, in patients with CRF and severe AH.

[The treatment of severe arterial hypertension in patients with chronic kidney failure with captopril and beta-adrenoblockaders]. / Lechenie tiazheloi arterial'noi gipertenzii u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu kaptoprilom i beta-adrenoblokatorami.

Twenty nine patients with chronic renal failure associated with severe essential hypertension, 10 of whom being on programmed hemodialysis, were treated with captopril, a converting enzyme inhibitor (n = 21) and sectral-400, a cardioselective beta-blocker (n = 11). Blood pressure (BP) changes and renin-angiotensin-aldosterone system parameters were studied by radioimmunoassay. When given in a daily dose of 25 to 100 mg for a long time, captopril provided a good and satisfactory antihypertensive effect in 9 patients; a weak or no effect was achieved in 9 and 5 patients, respectively. BP lowered by an average of 14.7%. There were 72% and 17.9% increases in active and total renin levels, respectively, and a reduction in the proportion of inactive in total renin. With sectral-400, 400-1200 mg/day, good, weak or no effects were observed in 6, 3, and 2 patients, respectively. BP decreased by an average of 13%, there were 59% and 12% reductions in active and total renin levels, respectively, whereas the content of inactive renin showed a 21% increase, suggesting a diminution of renin synthesis and activation. The initially higher plasma aldosterone levels in most patients (by an average of 4.2 times) decreased significantly by 23% with the two drugs. Thus, in severe essential hypertension it is advisable to use blockers of the renin-angiotensin system in patients with chronic renal failure, captopril is particularly indicated in those who have a high renin activity, and the hyperkinetic syndrome is an additional indicator for sectral-400 use.

[Pathophysiological features of arterial hypertension in chronic nephritis]. / Patofiziologicheskie osobennosti arterial'noi gipertonii pri khronicheskikh nefritakh.

The activity of the renin-angiotensin-aldosterone system (RAAS), excretion of renal prostaglandins, renal hemodynamics, water-electrolyte balance were studied in 110 patients with chronic nephritis with arterial hypertension: 47 with hypertonic nephritis and 63 patients at the stage of renal insufficiency. Some investigations, the results of data processing, an analysis of the results of cross-group comparative studies, and the use of captopril (a drug that inhibits the activity of angiotensin-converting enzymes) confirmed the RAAS involvement in the pathogenesis of arterial hypertension in nephritides. Pathophysiological features of arterial hypertension in nephritides are the following: disturbances of physiological interrelationships between renin plasma activity and the state of water-electrolyte balance; hyperaldosteronism and depression of renal prostaglandin synthesis revealed both in unchanged and lowered renal function. The peculiarity of arterial hypertension at the stage of marked renal insufficiency is invariability of renin production resulting from structural reserves of the renal juxtaglomerular apparatus.

[Current possibilities of correction of hormonal imbalance in uremia]. / Sovremennye vozmozhnosti korrektsii gormonal'nykh narushenii pri uremii.

The authors' and literature data on hormonal imbalance in uremia are analysed. The pathogenesis, clinical and laboratory signs and present-day methods of correction of renal osteodystrophy, anemia, arterial hypertension, derangements of carbohydrate and lipid metabolism, and hypogonadism developing as complications of chronic renal insufficiency (CRI), are considered. Increased potentialities of pharmacological correction of the above endocrine disturbances in CRI have been shown.

[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.

[Conformational isomerization of lactate dehydrogenase complexes formed by pyruvate and coenzyme analogs]. / O konformatsionnykh perestroikakh kompleksov laktatdegidrogena3y, obrazovannykh piruvatom i analogami kofermenta.

The kinetics of LDH-catalyzed reduction of pyruvate involving APADH were studied. It was shown that under conditions of a single turnover reaction the first order rate constant is equal to 37+/-4 sec-1. The reaction rate (vo) did not change when a deutero-coenzyme was used. The relationship between vo and pyruvate concentration is hyperbolic. It is concluded that isomerization of the ternary LDH-APADH-pyruvate complex limits the reaction rate. The spectral properties and the kinetics of formation and dissociation of abortive LDH complexes with pyruvate and NAD analogs (APAD and PAAD) were studied. The participation of the carboxamide group of NAD in conformational isomerization of the LDH-NADH-pyruvate and LDH-NAD-pyruvate complexes was studied.

[Effect of arteriovenous shunt and anastomosis on the central hemodynamics of patients kept on programmed hemodialysis]. / Vliianie arterio-venoznogo shunta i fistuly na tsentral'nuiu gemodinamiku bol'nykh, nakhodiashchiksia na programmnom gemodialize.

Investigations of central hemodynamic indices made by the method of dye dilution in 30 patients kept on a programmed hemodialysis evidenced that the discharge of the blood through an arterio-venous shunt and fistula was one of the causes accounting for the development of the hyperkinetic circulatory syndrome, the fistula exercising a greater influence on the circulation than did the shunt.

[Arterial hypertension and chronic hemodialysis]. / Arterial'naia gipertoniia i khronicheskii gemodializ

Basing on the literature data and their own observations of patients with chronic hemodialysis the authors have analysed the pathogenesis, course, hemodynamic shifts and possibilities of purposeful treatment in terminal uremia. Besides two variants of the hypertension course (controlled and noncontrolled), a third type has been revealed--hypertension difficult to control, in the pathogenesis of which, as well as in the noncontrolled variant, an important role is played by the activization of the renin-angiotensin system. Hemodynamic mechanizms of an abrupt change in the arterial pressure (acute hypotension and hypertensive crisis) in the process of hemodialysis are analysed.