[The diagnostic significance of antibodies to lipid A in patients with chronic kidney infections]. / Diagnostichno znchenie na antitelata sreshtu lipid A pri bolni s khronichni infektsii na bubretsite.

The interest in antilipid A antibodies increases in recent years. By means of an immunoenzyme test developed by the authors the frequency, quantity and characteristic of these antibodies were studied in 46 patients with chronic renal infections and in 36 healthy controls. The frequency of antilipid A antibodies class IgM is 5.7% and of class IgG it is 2.8% in the control group (healthy persons) and it is 41.3% and 19% respectively in the renal patients group. Most frequently their presence and quantity correlate with an active infection or with the convalescent period following antibiotic treatment (62.5%). This allows the use of antilipid A antibodies as a confirming marker for the presence of a heavy Gram negative infection and as a possible index for evaluation the efficacy of the 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.

[Immunoglobulin A glomerulonephritis in a patient with ankylosing spondylitis]. / Imunoglobulin A glomerulonefrit u bolen s ankilozirasht spondilit.

A case of a 48 years old man with a combination of immunoglobulin A glomerulonephritis and ankylosing spondylitis is reported. The patient presents with the typical clinical and X-ray data of Bechterew's disease and the kidney biopsy shows diffuse mesangioproliferative glomerulonephritis with IgA precipitates. The rheumatic manifestations precede the hematuria and proteinuria. High serum IgA and arterial hypertension are present. It is suggested that the combination of these two diseases is more frequent since common pathogenetic mechanisms may play a leading role.

[Drug sensitivity of urinary microflora and the effect of treatment in exacerbated chronic pyelonephritis]. / Lekarstvena chuvstvitelnost na urinnata mikroflora i efekt ot lechenieto na izostreniia khronichen pielonefrit.

A total of 226 patients with exacerbated chronic pyelonephritis were studied and the effect of 10-day antibacterial course--followed up. In 178 cases the treatment was consistent with the drug susceptibility of urine microflora and in 48, it was carried out in the absence of such susceptibility. The susceptible strains were affected in a considerably higher percentage (64.60) than the nonsusceptible (41.67). The chronic renal insufficiency (ChRI) has been a factor restricting the effectiveness of the antibacterial agents. Out of III affected patients 24 (21.62%) were with ChRI, whereas they were 38 (46.34%) from not-affected ones. It has been concluded that the treatment of chronic exacerbated pyelonephritis should individually be carried out with a dynamic microbiological control.

[Comparative clinical x-ray, radioisotope nephrographic and ultrasonic studies of chronic pyelonephritis patients]. / Sravnitelno kliniko-rentgenologichno, radioizotopnonefrografsko i ultrazvukovo prouchvane pri bolni s khronichni pielonefriti.

The authors compare the incidence of the changes established by X-ray, radioisotope-nephrographic and ultrasound studies on 115 patients with chronic pyelonephritis. Most frequent and most characteristic are the changes with venous urography. Though not specific, the changes in the isotope-nephrogram and ultrasound contribute to the establishment of functional and structural disturbances in chronic pyelonephritis. They have no contraindications for application, hence they are of high value in the presence of chronic renal insufficiency, where venous urographic is not effective. The ultrasound study has indisputable advantages in establishing the X-ray negative calculi, renal cysts and a functioning kidney.

[Microbial spectrum in chronic pyelonephritis and the drug sensitivity of the microorganisms]. / Mikroben spektur pri khronichni pielonefriti i lekarstvena chuvstvitelnost na mikroorganizmite.

The authors studied the etiological spectrum of 226 patients with chronic pyelonephritis, with 926 microbic strains isolated from the urocultures. The most frequent microbic causative agents were E. coli (40,82%), Proteus (a total of 17,82%), Enterobacter (8,86%), Klebsiella (8,64%), Pseudomonas (6,16%), Enterococcus (5,94%). The drug susceptibility of the majority of the isolated gram-negative microorganisms versus ampicillin and chloramphenicol, widely used in out-patient department practice, is relatively low. An important condition for the effectiveness of the treatment is the consideration given to the susceptibility of the microbic strains, isolated from the uroculture.

[Current trends in the treatment of chronic glomerulonephritis]. / Süvremenni nasoki pri lechenieto na khronichnite glomerulonefriti.

The results from the long-term combined anticoagulant, immunesuppressive and corticosteroid treatment of 36 patients with various histological forms of idiopathic and lupus glomerulonephritis are reported. Twenty five of them are with preserved or slightly disturbed renal function, and 11 - with chronic renal insufficiency. The treatment was carried out with heparin, acenocoumarol, azathioprin and to the patients with lupus glomerulonephritis - corticosteroids in the course of 4 to 50 months. The results were "very good", "good", with "no change" and "deterioration" according to clinical and laboratory indices. Very good and good effect was obtained in 18 patients (72%) of the group with preserved or slightly disturbed renal function (25 patients). Five patients were with no change (20%) and 2 patients died of complications in connection with corticosteroid treatment. Very good results was obtained in 2 patients with rapid progressive glomerulonephritis from the group with chronic renal insufficiency (11 patients) and the rest were without effect. The adverse effects are not frequent and are mainly due to corticosteroids. The combined anticoagulant and immunosuppressive treatment is concluded to be indicated in patients, with idiopathic and lupus nephritis with preserved or slightly disturbed renal function, in patients with rapidly-progressive glomerulonephritis but not in case of manifested chronic renal insufficiency. The considerable duration and the systematic follow-up control are of essential importance for the treatment success.

[Circulation immune complexes in chronic glomerulonephritis]. / Tsirkulirashti imunni kompleksi pri bolni s khronichni glomerulonefriti.

Thirty six patients with chronic glomerulonephritis, 35 -- with chronic pyelonephritis, 5 -- with diffuse glomerulonephritis with systemic lupus erythematosus and 60 healthy subjects were examined with the method by sedimentation with 3.5 per cent solution of polyethyleneglycol for the determination of circulating immune complexes. The average value for the healthy subjects is X = 0.123 +/- 0.047 mg/ml. The average value plus two standard deviations = 0.217 mg/ml is accepted as normal in healthy subjects. An elevated level of circulating immune complexes is found in 60 per cent of the patients with lupus nephritis and 25 per cent of the patients with chronic glomerulonephritis. The average values for the last two groups are X = 0.475 +/- 0.554 mg/ml and X = 0.184 +/- 0.185 mg/ml respectively. Whereas in the patients with lupus nephritis the values for the single patients are considerably over the adopted norm, in patients with chronic glomerulonephritis, in the majority of the cases, they are about its upper limit.

[Clinical characteristics of the anemic syndrome in chronic renal diseases]. / Klinichna kharakteristika na anemichniia sindrom pri khronichnite bubrechni zaboliavaniia

The results from the study of the anemia syndrome in 1100 patients are reported (881 with chronic pyelonephritis, 147 with chronic glomerulonephritis and 72 with endemic nephropathy). Out of them 663 were with preserved renal function, 160 - with compensated and 274 - with decompensated nitrogen retention. Anemia was found in 98.7 per cent of the patients with endemic nephropathy, in 59.2 per cent of the patients with chronic glomerulonephritis and in 56.8 per cent of the patients with chronic pyelonephritis. Anemia precedes the manifestations of renal insufficiency in endemic nephropathy. In 36 per cent of the patients with endemic nephropathy it is severe or very severe. Light anemia was found in 44,6 per cent of the patients with chronic pyelonephritis and in those with preserved renal function. Only in the patients with chronic pyelonephritis the values of serum iron are under the normal. The administration of iron preparations in those patients is with good results. In the stage of decompensated renal insufficeincy effect was obtained by often blood transfusions.