[The specific features of kidney injury due to abuse of saluretics and uncontrollable fasting in anorexia nervosa].

The paper describes a case of severe preranal acute renal failure that was induced by the uncontrolled long-term use of furosemide and that was reversible after infusion therapy. Another case is a female patient with anorexia nervosa and end-stage uremia progressing to chronic tubulointerstitial nephritis. Some problems of the pathogenesis of kidney injury and its diagnostic difficulties in anorexia nervosa and diuretic abuse are discussed.

[Pharmacological nephroprotection in chronic kidney disease: current opportunities and perspectives (review of foreign literature)].

A brief literature review analyses pharmacoprotective strategy in most widespread forms of chronic kidney disease: metabolic syndrome, hypertensive angionephrosclerosis. diabetic and non-diabetic nephropathy Nephroprotective properties of the blockers of rennin-angiotensin-aldosteron system and other antiadrenergic drugs, diuretics, hypolipidemic, antianemic and hypouricemic drugs, active metabolites of vitamin D, metphormine and glytasones are reviewed. The highest efficacy of combined pharmaconephroprotection is demonstrated.

[Erythropoetin and iron preparations in the treatment of anemia in patients with chronic kidney disease of stage III-IV in systemic diseases].

AIM: To study efficacy and safety of long-term administration of epoetin and iron preparations in glomerulonephritis (GN) patients with chronic kidney disease (CKD) of stage III-IV in systemic diseases. MATERIAL AND METHODS: A total of 189 patients at predialysis stage of CKD (glomerular filtration rate between 15 and 60 ml/min) were randomized into 3 groups depending on GN etiology: primary GN (group 1, 123 patients), GN in systemic diseases (group 2, 45 patients), controls (group 3, 21 patients). Anemia was characterized not only by red cells indices but also by the level of serum ferritin, C-reactive protein (CRP), saturation of transferrin with iron. Remodeling of the heart was determined in all the patients at dopplerechocardiography estimating left ventricular myocardial mass, relative thickness of its wall. RESULTS: Correction of anemia was achieved in all the patients with GN and CKD of stage III-IV in systemic diseases despite the activity of systemic disease (high blood level of CRP) and persistent nephritis activity (high proteinuria). In many patients from groups 1 and 2 who were initially diagnosed to have left ventricular hypertrophy (LVH) of excentric type LVH regressed after 6 months of anemia correction. In group 3 with untreated anemia frequency of LVH increased. CONCLUSION: Treatment of anemia in GN patients with CKD of stage III-IV in systemic diseases needed higher doses of epoetin and parenteral iron preparations compared to patients with the above stages of CKD with primary GN.

[Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure]. / Kardioprotektivnyi éffekt preparatov éritropoétina u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

AIM: To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). MATERIAL AND METHODS: Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (n = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months of predialysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. RESULTS: Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric LVH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. CONCLUSION: Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.

[Methodical basis for creation of the military telemedicine system in the Russian Federation Armed Forces]. / Metodicheskie osnovy sozdaniia sistemy voennoi telemeditsiny v Vooruzhennykh Silakh Rossiiskoi Federatsii.

Today the telemedicine (TM) is the perspective and rapidly developing direction in the health service. It also concerns the military medicine. In the RF Armed Forces' interests the work on creation of military telemedicine system within the framework of experimental-and-designers' work "Telemed" is conducted. During the development of software to realize the functions of military telemedicine system and to provide the development of its functional potentials the work was done connected with problem description in order to realize all medical technologies for each direction of its application. To solve this problem there are enough specialists in the field of computer and informative technologies capable of bringing the diagnostic and consultation possibilities of district (naval) and Central Military Hospitals as well as republican and regional centers closer to the solution of medical problems of distant garrisons.

[Intradialysis hypotension: causes and sequelae]. / Intradializnaia gipotoniia: ee prichiny i posledstviia.

AIM: To study causes and sequelae of intradialysis hypotension (IH) in patients with terminal renal failure (TRF). MATERIAL AND METHODS: Forty one patients with TRF on chronic hemodialysis (CH) were divided into two groups. The study group consisted of 24 patients with episodes of IH. Seventeen patients of the control group had no IH. All the patients were examined with assessment of protein-energy deficiency, residual renal function, left-ventricular hypertrophy, diastolic function of the heart. Hemodialysis effectiveness was estimated by Kt/V index. Survival of the patients was calculated according to Kaplan-Meier method. RESULTS: In the study group IH episodes occurred in spite of low ultrafiltration velocity (8-10 ml/min). Those patients of the study group who had IH associated with polyneuropathy and left-ventricular hypertrophy had IH episodes more often and sharper falls of arterial pressure. Long-term IH decreased survival significantly. CONCLUSION: Repeated episodes of IH deteriorate effectiveness of hemodialysis because of acute coronary syndrome, acute disorder of cerebral circulation, complications of deficient dialysis syndrome (pericarditis, hyperkaliemia, pulmonary edema, congestive heart failure).

[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.

[Erythropoietin drugs in patients with chronic renal failure at the stage of conservative treatment. Effectiveness and side effects]. / Preparaty értropoétina u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu v stadii konservativnogo lecheniia. Effektivnost' i pobochnye iavleniia.

AIM: To assess activity and safety of erythropoietin (EP) drugs in conservative chronic renal failure (CRF). MATERIAL AND METHODS: The antianemic effect of EP drugs, central and cardiac hemodynamics were studied in 28 CRF patients (mean blood creatinine 5.27 mg%) with renal anemia. In addition, arterial pressure was automatically measured within 24 hours and the CRF progression rate was assessed. RESULTS: Low-dose EP drugs injected subcutaneously rapidly produced antianemic and cardioprotective effects and may improve residual renal function. CONCLUSION: Pathogenetically grounded and safe for patients with conservative CRF is a combination of low-dose subcutaneous EP drugs with hypotensive drugs (calcium antagonists, ACE inhibitors), loop diuretics and low-protein diet.

[Treatment of bone disorders in renal diseases]. / Lechenie patologii kostnoi sistemy pri zabolevaniiakh pochek.

AIM: To study possible correction of bone disorders (osteopenia, Ca/P-imbalance, bone pain, limited volume of indolent movements) which are still a serious complication associated with renal diseases and pathogenic therapy (steroids). MATERIALS AND METHODS: The bone disorders were treated in 10 uremic hemodialyzed patients (8 men, 2 women; group 1) with vitamin D3 (calcitriol made in Russia) + rhEPO (recormon; Boehringer Mannheim), in 15 patients (15 women, 0 men) with lupus-nephritis (group 2) with vitamin D3 (n = 5, group 2a) or miscalcic (Sandoz) (n = 10, group 2b), in 2 patients (2 men, 0 women) with glomerulonephritis (group 3) with vitamin D3 + miacalcic. Additionally all the patients received Ca salts. In groups 2 and 3 renal function was normal. The duration of the treatment was 3-6 months. RESULTS: In all the groups we obtained an analgetic effect (attenuation of bone pain and more indolent movements), improvement of life quality, diminished need in analgetics, elevation of serum Ca level (p > 0.05). CONCLUSION: Treatment of renal patients with bone affection with vitamin D3 and miacalcic has an analgetic effect, improves life quality.

[Low doses of recombinant erythropoietin in the treatment of renal anemia in patients on chronic hemodialysis and ambulatory peritoneal dialysis]. / Nizkie dozy rekombinantnogo éritropoétina v lechenii pochechnoi anemii u bol'nykh, nakhodiashchikhsia na khronicheskom gemodialize i na ambulatornom peritoneal'nom dialize.

AIM: A comparative study of efficiency and safety of low-dose erythropoietin (EP) in two groups of patients with chronic renal failure (CRF): patients on chronic hemodialysis (CHD) and patients on continuous ambulatory hemodialysis (CAHD). MATERIALS AND METHODS: 51 CRF adult patients with renal anemia on hemodialysis entered the trial: 34 CHD and 17 CAHD patients. EP compounds were injected s.c. in a dose 1000-2000 U 2-3 times a week. RESULTS: EP treatment provided a rapid correction of renal anemia in the majority of patients. After 3-month EP therapy a mean increment of Hct (Hct delta) was much greater (p < 0.05) in CAHD than CHD patients (12.2 +/- 6.0 and 9.0 +/- 5.1%, respectively), though EP dose were the same in both the groups. CONCLUSION: Low doses of recombinant human EP injected subcutaneously were effective and safe for correction of anemia in both CHD and CAHD. In CAHD patients EP effectiveness was much higher than in CHD patients.

[Acute renal failure: diagnosis, choice of treatment method, prognosis and outcomes]. / Ostraia pochechnaia nedostatochnost': diagnostika, vybor metoda terapii, prognoz i iskhody.

Main aspects of clinical and laboratory diagnosis of various forms of acute renal failure (ARF) are presented. Special attention is paid to choice of therapy with due consideration for the etiology, form, and stage of ARF. Indications for the use of different methods of hemodialysis and hemofiltration are defined. Complications of extracorporeal methods of treatment are discussed and approaches to preventing them outlined.