[Dynamics of morphometric parameters of peripheral blood platelets as a criterion in assessing thrombogenicity of dialysis membranes].

The study enrolled 45 patients with terminal chronic renal failure (CRF) aged 24-57 years on hemodialysis (a study group) and 30 healthy subjects of matched age (a control group). Morphofunctional condition of circulating platelets in situ was assessed by vital computer morphometry using computer phase-interference microscope, the analysis was made of opticogeometric parameters and morphological features of live platelets reflecting the degree of their activation. CRF patients' proportion of different platelet types in circulating population was 56.5, 34, 8.7 and 0.8% (platelets in situ, platelets with low, high activation, degenerative) versus 59.4, 28.1, 10.5 and 2% in the controls, respectively. Changes in morphological composition and opticogeometric parameters of circulating platelets were found in the dialysis membrane after a hemodialysis procedure. The changes were less or more pronounced depending on the dialysis membrane type. Thus, vital morphometric platelet parameters reflect condition of the platelets allowing quantitative assessment of impairment of the structure and functional activity of the cells in CRF progression. Hemodialysis procedure results in characteristic alterations of morphofunctional status of circulating platelets related, to a certain degree, to the material of extracorporeal outline. This dictates necessity of objective evaluation of such impact and prognosis of thrombogenic complications. Morphometric parameters of platelets can serve objective criteria of dialysis membrane thromboginicity.

[The use of xidifon for the correction of phosphorus-calcium metabolism in patients in the terminal stage of chronic kidney failure who are on programmed hemodialysis]. / Primenenie ksidifona dlia korrektsii fosforno-kal'tsievogo obmena u bol'nykh s terminal'noi stadiei khronicheskoi pochechnoi nedostatochnosti, nakhodiashchikhsia na programmnom gemodialeze.

Correction of impaired phosphoric-calcium metabolism was performed in 15 hemodialysis patients with terminal chronic renal failure (TCRF). For this purpose a synthetic analogue of pyrophosphoric acid xidiphone produced in Russia was used (2% aqueous solution 1 tablespoon 3 times a day 0.5 h before meal for 2-3 months). Prior to and in the course of xidiphone treatment all the patients received calcium gluconate (1 g x 3 daily), polyvitamins, on-demand digoxine. Measurements of serum concentrations of urea, potassium, sodium, total calcium, alkaline phosphatase activity demonstrated xidiphone-related normalization of serum total calcium, serum activity of alkaline phosphatase, a mild rise of sodium. The results say in favor of using xidiphone in the TCRF patients.

[The correlations of the basic indices of central and renal hemodynamics in patients with a single allograft kidney]. / Vzaimootnosheniia osnovnykh pokazatelei tsentral'noi i pochechnoi gemodinamiki u bol'nykh s edinstvennoi allotransplantirovannoi pochkoi.

A simultaneous assessment of relationship of central and renal hemodynamic parameters has been performed in patients with a renal transplant of different functional performance. Radionuclide routine techniques of one-passage radiocardiography and indirect renal angiography in single bolus intravenous introduction of radiopharmaceutical were used. Three groups of patients were identified according to functional capacity of the renal transplant: 15 patients with satisfactory function of the transplant for 85 days on the average (group 1); 8 patients with unstable function of the transplant for 155 days (group 2); 7 patients with poor function of the transplant for 375 days on the average. The transplant's function was judged by the routine clinical data including blood urea, arterial pressure, heart rate, diuresis, the patients' complaints. Basic parameters of central hemodynamics appeared elevated in all the three groups, the differences being statistically insignificant. However, total peripheral vascular resistance was growing with deterioration of the renal function. Renal hemodynamics worsened with the decline of the transplant's function. Investigation of the relationships between total peripheral vascular resistance (TPVR) and renal vascular resistance (RVR) showed that between the groups there was a significant difference by RVR/TPVR (7.0, 9.0 and 14.0 for groups 1, 2 and 3, respectively), the higher value being the indication of increasing uremic intoxication and functional decline. A simultaneous rise of RVR and TPVR in persistent ratio 7-8 was associated with acute failure of the function in 7-14 days (3 cases). The results of the trial support the validity of simultaneous assessment of central and renal hemodynamics for specifying function of the renal transplant and cardiovascular system in patients with terminal renal failure and transplanted kidney as well as to define the risk group of the transplant's functional failure 7-14 days before manifestation of clinical symptoms.

[A comparative evaluation of the central hemodynamic indices in patients with the terminal stage of kidney failure during dialysis therapy and allografting]. / Sravnitel'naia otsenka pokazatelei tsentral'noi gemodinamiki u bol'nykh s terminal'noi stadiei pochechnoi nedostatochnosti v khode dializnoi terapii i allotransplantatsii.

Changes of the functional indices of central and intracardiac hemodynamics during treatment with hemodialysis or peritoneal dialysis, as well as after cadaver kidney transplantation, were studied in 44 patients with the terminal stage of chronic renal failure by means of radiocardiography with 131I-albumin. The signs of cardiac insufficiency were evaluated according to the classes of the cardiologists' New York classification accepted in 1964. Four groups of patients were distinguished during the analysis: group 1-10 patients given intravenous detoxification therapy; group 2-19 patients treated by chronic programmed hemodialysis; group 3-4 patients kept on peritoneal dialysis; group 4-11 patients after allotransplantation of cadaver kidney. It was found that in group 1 patients the indices of central (mean arterial pressure, cardiac and stroke indices, total peripheral vascular resistance, work of the left ventricle) and intracardiac (time of circulation of blood in the heart cavities and lungs) hemodynamics were on the upper normal values and in occasional cases exceeded it. In patients of group 2 the indices of intracardiac hemodynamics grew worse and required an individual approach to the hemodialysis regimens with due account for the volemic disorders. In group 3 some indices of central and intracardiac hemodynamics corresponded to those in group 2, but the circulation volume, and mean arterial pressure were normal, which was reflected by better subjective tolerance to peritoneal dialysis. Analysis of indices in group 4 patients showed improvement of normalization of most parameters of central and intracardiac hemodynamics with gradual increase of diuresis, and abatement of the clinical signs of cardiac insufficiency after successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)