[Vessel-platelet and coagulation components of hemostasis in patients with chronic tubulointerstitial nephritis].

AIM: To study vessel-platelet and coagulation parts of hemostasis system, their correlation with clinical characteristics and activity of chronic tubulointerstitial nephritis (CTIN). MATERIAL AND METHODS: 128 patients 15 to 65 years of age with CTIN were included in the study. The diagnosis was confirmed morphologically in 42 patients. The patients were divided into subgroups by activity of the disease at the moment of examination (active and inactive CTIN), by arterial pressure (normotensive and hypertensive patients), intact and low renal function, by duration of the disease (up to 60 months, 61-120 months, more than 120 months). Complex study of hemostasis system was carried out by a set of standard techniques. RESULTS: CTIN runs with activation of vessel-platelet hemostasis characterised by a decrease in platelets count (p < 0.001), persistent platelet hyperaggregation and activation (p < 0.001). Severity of platelet aggregative activity is related with endothelial affection manifesting with high level and activity of Willebrand factor (p < 0.001). The most typical changes of coagulation in CTIN were acceleration of activated partial thrombin time (p < 0.001) closely related with activation of thrombocytic hemostasis and background thrombinemia the presence of which was confirmed by elevated blood level of soluble fibrin-monomeric complexes (SFMC). THE CONCLUSION: Hypercoagulation, suppression of fibrinolytic plasma activity, increase of SFMC and fibrinogen levels in the blood as well as detected enhancement of platelet aggregation testify to a latent course of renal intravascular blood coagulation in CTIN. Hemostasis system activation in CTIN helps assessment of the disease activity.

[The prognosis and risk factors of cardiovascular complications in patients with chronic glomerulonephritis].

The authors evaluated 10-year prognosis according to SCORE scale and risk factors of fatal cardiovascular diseases in 90 Eropoids aged 53.9+/-0.6 years with a valid diagnosis of chronic glomerulonephritis (CGN) and normal renal function or at the pre-dialysis stage of chronic renal failure. The study found that 34.4% of CGN patients were at high risk of severe complications of atherosclerosis with unfavorable prognosis (myocardial infarctions, cerebral stroke etc.) The leading risk factors of fatal cardiovascular complications in middle-age and elderly CGN patients were male sex, age more than 55 years, smoking, and severe systolic and diastolic arterial hypertension. Patients with IIb phenotype hyperlipidemia and those with selective decrease in high density lipoprotein cholesterol are at significantly higher risk of cardiovascular events.

[Immunogenetic analysis of variants of a clinical course and prognosis of chronic glomerulonephritis in the west Siberia].

AIM: To analyze association of HLA antigens with clinical variants of chronic glomerulonephritis (CGN)in 106 patients. MATERIAL AND METHODS: HLA association with the time of development of terminal chronic renal failure (CRF) from the moment of detection of initial CRF was studied in 80 patients. Determination of HLA of class I was conducted in the lymphocytotoxic test. DRB1 genes specificity was determined with DNA polymerase chain reaction. The control group consisted of 341 healthy citizens of Novosibirsk. Common HLA associations of latent and hypertensive, latent and nephrotic CGN variants were found demonstrating their succession. HLA associations with a mixed CGN variant defining its genetic isolation were established. It is shown that development of terminal CRF at different time since the disease onset is associated with different HLA alleles. The findings allow prognosis of clinical CGN variants, time of development of terminal CRF.

[Immunogenetic analysis of pathomorphological forms and prognosis of chronic glomerulonephritis].

AIM: To ascertain whether HLA antigens are associated with morphological forms of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: A retrospective analysis was made of HLA distribution in 122 patients with proliferative and nonproliferative forms of CGN at different stages of fibroplastic transformation and addition of the tubulointerstitial component. Testing of HLA antigens of class I was conducted by lymphocytotoxicity; specificity of DRBI genes was investigated by DNA polymerase chain reaction. The control group consisted of 341 healthy citizens of Novosibirsk. RESULTS: HLA-associations typical for each morphological CGN form, characteristic differences between them were established. CONCLUSION: The tables were plotted allowing estimation of probability of each of CGN morphological forms.

[Evolutionary trends in symptoms of acute glomerulonephritis in adult population of the Novosibirsk region]. / Evoliutivnye tendentsii v klinike ostrogo glomerulonefrite vzroslogo naseleniia Novosibirskoi oblasti.

Acute glomerulonephritis (AGN) trends in the last 3 decades in the Novosibirsk Region have been analysed basing on the data from 308 AGN case histories. The results of the analysis demonstrate that AGN occurs not often but with stable rate. It is encountered more frequently in young men. The last decade is characterized by higher morbidity after streptococcal infection, high percentage of women at reproductive age, aggravation of the clinical course with marked edemas, severe arterial hypertension, renal dysfunction (acute renal failure in 10.4%), cases of left ventricular failure (5.2%) and eclampsia (1.7%) not registered earlier.

[Role of the hemostatic system in the progression of acute glomerulonephritis]. / Rol' sistemy gemostaza v progressirovanii ostrogo glomerulonefrita.

AIM: To study basic parameters of hemostasis in the course of acute poststreptococcal glomerulonephritis (APSGN). MATERIAL AND METHODS: Platelets number and aggregation 4-platelet factor, Willebrand's factor, activated partial thromboplatelet time, antithrombin III, fibrin-monomeric complexes and products of degradation fibrinogen/fibrin were studied in 127 APSGN patients. Autocoagulation, prothrombin and thrombin tests were made. RESULTS: Progredient thrombinemia, stable elevation of Willebrand's factor, high aggregation activity of platelets and content of their degradation products evidence for intrarenal microthrombogenesis in APSGN, confirms direct involvement of platelet hemostasis in long-term inflammation in this disease. CONCLUSION: Mechanisms of APSGN development operate also through changes in hemostatic system.

[Prognostic criteria for the clinical course of systemic lupus erythematosus]. / Prognosticheskie kriterii klinicheskogo techeniia sistemnoi krasnoi volchanki.

To develop some individual prognostic criteria of SLE clinical course the Wald's analysis of immunogenetic markers (HLA) was used. The obtained summarized diagnostic coefficients allow predicting a subacute or chronic pattern of the disease, the rate of generalization and the most frequent location of the process in certain organs. The constant character of HLA-typing results and the simplicity of the given prognostic tables made the proposed diagnostic method convenient for medical practice.

[The immediate results of using plasmapheresis in patients with chronic glomerulonephritis]. / Blizhaishie rezul'taty primeneniia plazmafereza u bol'nykh khronicheskim glomerulonefritom.

A study was made of the effect produced by a short-term course of plasmapheresis (PA) combined with cytostatic, glucocorticoid and deaggregation therapy on the clinico-laboratory characteristics in 45 patients suffering from chronic glomerulonephritis (CGN). It has been established that PA rapidly normalizes the characteristics such as the level of circulating immune complexes and fibrinogen in the blood, ESR. Exerting no effect on renal function, PA led to a significant lowering of proteinuria and erythrocyturia, with its beneficial effects being preserved after discontinuation of the sessions. The best results were attained in associated CGN and nephrotic syndrome, in mesangioproliferative and mesangiocapillary CGN. The effectiveness of the short-term course of PA in patients with membranous and diffuse fibroplastic CGN turned out questionable.

[The outcomes and prognosis of a course of acute glomerulonephritis]. / Iskhody i prognozirovanie techeniia ostrogo glomerulonefrita.

Observation of 131 patients with acute glomerulonephritis (AGN) experiencing the first year of disease made it possible to distinguish, by the 4th month of disease, the lingering disease patterns encountered in 100% of cases with the nephrotic form and typical for pronounced and little symptomatic AGN (96.1-78.8%). As compared to the catamnestic data, 83 patients manifested (after 5.8 +/- 0.7 yr.) an unfavourable influence of the lingering disease course on AGN outcomes (the probability of convalescence dropped to 30.8-33.3% in pronounced and little symptomatic forms and was completely excluded in the nephrotic one) and a high diagnostic significance of the dynamics of the urinary syndrome for prognosis determination. The constancy of proteinuria at a level of over 1 g/day and hematuria at a level over 50.0 x 10(3)/ml within 4 to 6 months significantly deteriorated the prognosis. Virus nature of pronounced AGN can be indicated among other prognostic criteria. The other characteristics of the debut produced no significant effect on the disease outcome. The morphological signs of the chronic disease corresponded to mesangiomembranous glomerulonephritis whereas fibroplastic alterations were only observed in special forms of AGN marked by rapid progress.

[A clinico-pathogenetic approach to choosing the therapeutic procedure in chronic glomerulonephritis]. / Kliniko-patogeneticheskii podkhod k vyboru terapevticheskoi taktiki pri khronicheskom glomerulonefrite.

The results have been compared of the use of two schedules (continuous and cyclic) of multimodality therapy of chronic glomerulonephritis (CGN) including cytostatics, corticosteroids, anticoagulants and deaggregation agents. Continuous therapy was carried out for 12.9 +/- 0.41 months on the average, with the drug dosage being corrected depending on the clinico-laboratory and immunological findings as well as on the parameters of the hemostatic system. Cyclic therapy was conducted for 6 months according to a strictly unified program. It has been shown that continuous individualized treatment compares very favourably with the cyclic schedule, which is particularly marked in mesangiocapillary CGN and CGN with a tubulointerstitial component. It is concluded that continuous multimodality treatment chosen with regard to the clinico-pathogenetic disease characteristics allows CGN prognosis to be improved.

[The mechanisms of intravascular blood coagulation in patients with systemic scleroderma]. / Mekhanizmy vnutrisosudistogo svertyvaniia krovi u bol'nykh sistemnoi sklerodermiei.

Hemostasis was investigated in 2 groups of patients with systemic scleroderma (SSD) with minimal (12 patients) and moderate (9 patients) activity of the process. It has been shown that in SSD, the triggering factor of intravascular blood coagulation is the release of Willebrand's factor, an activator of platelets, from the impaired endothelium. Hyperaggregation and labilization of platelets characterizes the course of SSD irrespective of the disease activity. The main changes in coagulation hemostasis are related to the dramatically accelerated triggered thrombin formation and deficiency of the antithrombin potential. The status of fibrinolysis confirming the thrombogenic situation is marked by a number of features: depression of contact lysis is maximally pronounced in chronic SSD with minimal activity, accumulation of the soluble complexes of fibrin monomer only correlates with the disease activity, and no significant rise of the level of fibrin/fibrinogen degradation products has been discovered.

[Study of the blood coagulation and fibrinolysis systems in evaluating the activity of glomerulonephritis]. / Koaguliatsionnaia i fibrinoliticheskaia sistema krovi v otsenke aktivnosti glomerulonefrita.

Certain parameters of blood coagulation and fibrinolysis were studied in 84 patients suffering from different variants of chronic glomerulonephritis. The disease is characterized by various conditions of the coagulation system, and acceleration of the initial stages of coagulation; the most typical are disturbances of thrombin inactivation. Simultaneous accumulation in the blood of products of degradation of fibrin and monomeric fibrin complexes is observed. The degree of manifestation of changes in blood coagulation and fibrinolytic systems corresponds to disease activity. The tests used are more sensitive than the traditional clinicolaboratory tests and reveal not only manifested by also latent disease activity.