[Results of analysis of the structural and functional state of the kidneys by the method of mathematical processing of contrast-enhancing MD-CT data in patients with urolithiasis].

INTRODUCTION: and Objectives: to date there have been several hypotheses on the causes of kidney stone formation. Compromised intrarenal blood flow might play one of major roles in stone formation. Advances in software and 3D technologies have unveiled the nature of contrast medium flow in the intrarenal structures. Mathematical analysis and 3D rendering of computed tomography (CT) scans was utilized for inrarenal contrast medium flow assessment in patients with stone kidney disease. This study aimed at assessing split glomerular filtration rate (sGFR) in patients at the initial stage of stone kidney disease (SKD). sGFR was measured by means of mathematical analysis of 3D rendering abdominal contrast enhanced CT scans. As well as that, possible correlations between irregular inrarenal contrast medium flow and causes of stone formation were considered. MATERIALS AND METHODS: 23 patients of both sexes with stone kidney disease (SKD) were recruited. They underwent US/Dopler investigation of the kidneys and the bladder, plain X-ray, histopathological evaluation of the tissues (those patients who were operated on), spectroscopic analysis of the stone(s). Mathematical analysis of 3D rendering of CT scans was utilized for sGFR assessment (sGFR reference value: 0,55% of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size less than 1,5-2,0 cm 3) stones that do not block urine flow 4) non-operated young patients; 5) patients free of comorbidities. Inclusion criteria were set to mitigate the effects of other factors that might influence on intrarenal blood flow and conduct the study per se. RESULTS: Mathematical analysis of 3D rendering of CT scans allowed to elucidate changes in sGFR in 22 (95,6%) patients out of 23. HypErfiltration (hyperF) was detected in 10 (43,5%) patients, hypOfiltration (hypoF) was detected in 11(47,8%) patients. sGFR values were statistically significantly different in these groups both on the left (p=0,000142) and on the right (p=0,00068). No significant gender differences were observed (hypoF group aged 25-67 years with the mean age of 43,5 years; hyperF group aged 17-57 years with the mean age of 39 years (p=0,563). Ultrasound Doppler renal resistive index in renal arteries was within the normal range in both groups with no statistically significant difference between the groups. However, 1 patient demonstrated no sGFR changes. Another patient had hyporfiltration on the left (0,48%) and hyperfiltration on the right (0,62%) Conclusions: sGFR alterations (hypo- or hyperfiltration) were detected in the majority of the patients with SKD (95,6%). This in turn might be suggestive of compromised intrarenal blood flow. Further studies are needed to elucidate the optimal management of these patients.

[The role of telomerase activity in non-invasive diagnostics of bladder cancer].

PURPOSE: To evaluate the potentials of determining the telomerase activity (TA) in the cellular material of the urine for noninvasive diagnosis of bladder cancer (BC). MATERIALS AND METHODS: Evaluation of TA was performed in the urine of 48 patients with bladder cancer (study group) before and after transurethral resection of the bladder wall (n=38), an open resection of the bladder (n=4), and cystectomy (n=6). TA was also evaluated in 48 tumor tissue samples obtained from these patients during removal of the bladder tumor. Each sample of the tumor tissue was separated into two parts, one of which was subjected to histological examination, and the latter was used to determine the telomerase activity. In all cases, the diagnosis of bladder cancer was confirmed morphologically. Determination of TA in the samples was performed by the modified TRAP-method (telomerase repeat amplification protocol), RT-PCR, PCR, and electrophoresis. As a control, cell material of the urine and tissue in 12 patients with chronic cystitis was investigated. RESULTS: TA before surgery was found in 45 (93.75%) of 48 samples of cellular material of the urine from patients with suspected bladder cancer. BC was histologically verified in all patients in this group. In the postoperative period, TA was not observed in the 48 samples of cellular material of the urine from patients with BC. In the control group of patients with histologically verified cystitis, weak TA was determined only in one sample of cellular material of the urine. The analysis indicates statistically significant predominance of patients with bladder cancer in case of TA in the urine (P=0.001). TA was detected in all samples of tumor tissue. We also analyzed the dependence of TA levels in urine and tissue on the degree of BC differentiation. In patients with highly differentiated BC, mean AT in the cellular materials of the urine was 0,61% (n=15), in patients with moderately differentiated BC - 0.95% (n=23), in patients with low-grade bladder cancer - 1.33% (n=10); in other words, increase in the TA levels with decreasing the degree of differentiation was observed. This finding can be used in the prognosis of the course of disease based on determining the TA level in these patients. CONCLUSIONS: Preliminary data indicate the possibility of use of determining the TA in cellular material of the urine for the diagnosis and monitoring of bladder cancer recurrence.

[Development of noninvasive bladder cancer diagnosis on basis of telomerase and it's subunits hTERT and hTR detection].

Telomerase activity (TA) and expression of genes coding it's subunits (hTERT and hTR) have been examined in tumor tissue and urine sediment samples taken from patients with bladder cancer (BC) using the modified TRAP assay (in the case of telomerase detection) and RT-PCR (in the case of hTERT and hTR expression). Results obtained in this study demonstrate possibility of noninvasive diagnosis of BC with sensitivity of 96% and specificity of 100% in the case of telomerase detection and with sensitivity of 80% and specificity of 100% in the case of hTERT detection in urine sediment samples.