[Primary focal segmental glomerulosclerosis: clinical and morphological prognostic factors]. / Pervichnyi fokal'no-segmentarnyi glomeruloskleroz: klinicheskie i morfologicheskie faktory prognoza.

AIM: To retrospectively analyze clinical course and results of immunodepressive therapy of patients with primary focal-segmental glomerulosclerosis (FSGS), to reveal prognostic factors of the disease progression and patients' sensitivity to immunosuppressive therapy. MATERIAL AND METHODS: Morphological diagnosis was specified, morphological indices of activity and sclerosis were estimated, renal survival was analysed, mono- and multivariate analysis of prognostic factors was made by the evidence obtained in the study of 135 biopsy specimens from CRF patients meeting the criteria of FSGS. RESULTS: At the moment of the disease onset only age of the patients was related to FSGS: 5- and 10-year survival was 100% if the disease started under 16 years of age, if older--the survival was 80 and 65%, respectively. Nephrotic syndrome, hematuria, high creatinine, racemose alterations in the glomeruli worsened the disease prognosis. When cytostatics and corticosteroids were used in combination they produced better results and were associated with better prognosis than each of them in monotherapy. Patients with marked hematuria and low proteinuria were less sensitive to therapy than those with weak hematuria and high proteinemia. Patients with FSGS having high IA and SI required more aggressive therapy for response. CONCLUSION: Renal biopsy with quantitation of IA and IS increases the prognosis accuracy and is important for choice of the treatment policy in patients with primary FSGS.

[Histomorphological tubulointerstitial changes in progression of chronic glomerulonephritis]. / Gistomorfologicheskie tubulointerstitsial'nye izmeneniia pri progressirovanii khronicheskogo glomerulonefrita

The role of histological changes associated with primary types of glomerulonephritides in progression of chronic glomerulonephritis (CGN) is analysed. It is shown that CGN progression acceleration occurs much more frequently if chronic renal failure arises within 7 years since the disease onset, in the presence of concomitant tubulointerstitial changes (TIC)in unfavorable morphological types--mesangiocapillary glomerulonephritis and focal-segmental hyalinosis/ sclerosis. It was found that more frequent occurrence of CGN accelerated progression in unfavorable morphological types and TIC depends on the presence of unfavorable clinical types--active nephritic and nephrotic-hypertensive types (classification of M. Ya. Ratner et al.). In TIC there were primarily unfavorable clinical types which contribute to accelerated progression of CGN. This relationship is explained by involvement of factors belonging to the above clinical types in the mechanism of the morphological changes. In these clinical types CGN accelerated progression takes place irrespectively of the presence of TIC and unfavorable morphological types.

[Prediction of accelerated progression of chronic glomerulonephritis basing on clinical and histomorphological data]. / Prognozirovanie uskorennogo progressirovaniia khronicheskogo glomerulonefrita na osnovanii klinicheskikh i gistomorfologicheskikh dannykh.

AIM: To find out predictive value of three factors in progression of chronic glomerulonephritis (CGN): unfavorable clinical course, unfavorable morphological type and tubulointerstitial changes. MATERIALS AND METHODS: 150 CGN patients entered the trial. Frequency of onset of chronic renal failure (CRF) within 7 years after the diagnosis was chosen as a criterium of accelerated progression of CGN (AP CGN). Chi-square criterium was used for testing relationships between AP CGN and the parameters under study. RESULTS: The findings support previously published data on statistically more frequent occurrence of AP CGN in unfavorable clinical types (active nephritic and nephrotically-hypertensive), in unfavorable morphological types (mesangiocapillary CGN and focal-segmental hyalinosis/sclerosis and tubulointerstitial lesions). In unfavorable clinical types there was a significantly more frequent occurrence of AP CGN irrespective of unfavorable morphological changes. In contrast, both in unfavorable and favorable clinical types, frequency of AP CGN in unfavorable morphological types of CGN and tubulointerstitial changes was the same. CONCLUSION: Clinical type of CGN is a valuable prognostic criterium for AP CGN.

[Implication of clinical and morphological types of chronic glomerulonephritis, tubulointerstitial changes in prognosis of disease progression]. / Znachenie klinicheskogo i morfologicheskogo tipov khronicheskogo glomerulonefrita i tubulointerstitsial'nykh izmenenii dlia prognoza progressirovaniia zabolevaniia.

A highly significant relationship has been established between rapid progression of chronic glomerulonephritis and belonging to unfavorable category of clinical types according to classification of M. Ya. Ratner et al. (chi-square = 84.3, p < 0.001), to unfavorable category of morphological types (chi-square = 13.2, p < 0.01) and the presence of tubulointerstitial changes (chi-square = 32, p < 0.0001).

[Prognostic factors of chronic glomerulonephritis and chronic non-inflammatory glomerulopathies rapid progression]. / Prognosticheskie faktory uskorennogo progressirovaniia khronicheskogo glomerulonefrita i khronicheskikh nevospalitel'nykh glomerulopatii.

AIM: To determine relationships between prognosis of rapid progression of chronic glomerulonephritis (CGN), chronic non-inflammatory glomerulopathies (CNG) with development of chronic renal failure and clinical, morphological types of the disease and tubulointerstitial component (TIC). MATERIALS AND METHODS: 137 CGN and CNG patients were followed up for 7 years. Favorable clinical types were found in 89, unfavorable ones in 48 patients. Favorable and unfavorable morphological types occurred in 87 and 50 patients, respectively. TIC was identified in 56 patients. RESULTS: Rapid progression of CGN and CNG appeared to associate with the unfavorable clinical type (active nephritic types of CGN and nephrotic-hypertensive type of CNG), the unfavorable morphological type (mesangiocapillary glomerulonephritis and focal segmentary sclerosis/hyalinosis) and TIC. CONCLUSION: Prognosis of rapid progression of CGN and CNG is most reliable in combination of the above three predictors or of the unfavorable clinical type with TIC.

[The dependence of the progression of chronic glomerulonephritis on the clinical and morphological types of glomerulonephritis and on the tubulointerstitial changes]. / Zavisimost' progressirovaniia khronicheskogo glomerulonefrita ot klinicheskogo i morfologicheskogo tipov glomerulonefrita i tubulointerstitsial'nykh izmenenii.

Progression of chronic glomerulonephritis (CGN) is strongly associated with morphologic type of the disease, tubulointerstitial changes, some clinical syndromes. The aim of the study was to trace relations between the onset of chronic renal failure within 7 years since the diagnosis (fast progression of CGN--FP CGN), CGN clinical variant according to M. Ia. Ratner et al. classification (1987) and histomorphological changes in the renal biopsy. Unfavorable clinical types (active nephritic types and nephrotic-hypertensive type) proved dominating predictor of FP CGN not only because of close relationship between these type and FP CGN but also due to FP CGN occurrence in morphologically unfavorable morphological types and tubulointerstitial changes in line with concomitant unfavorable clinical types.

[The importance of a new classification of chronic glomerulonephritis for determining the prognosis of the disease]. / Znachenie novoi klassifikatsii khronicheskogo glomerulonefrita dlia opredeleniia prognoza zabolevaniia.

Dependence of chronic glomerulonephritis upon its clinical type was studied on the basis of observation in 165 patients of chronic renal failure incidence during 7 years after the beginning of the disease.

[The tubulointerstitial changes in different clinical and morphological types of chronic glomerulonephritis]. / Tubulointerstitsial'nye izmeneniia pri razlichnykh klinicheskikh i morfologicheskikh tipakh khronicheskogo glomerulonefrita.

As shown by the data available on 228 patients with chronic glomerulonephritis, tubulointerstitial alterations (TIA) occur primarily in mesangiocapillary glomerulonephritis, focal-segmental glomerular hyalinosis/sclerosis, diffuse fibroplastic glomerulonephritis as well as in active nephritic and nephrotic-hypertensive types. In 186 patients with chronic glomerulonephritis chronic renal insufficiency evidencing enhanced progression (EP) if arose within 7 years since the disease onset in the presence of TIA was registered significantly more frequently. TIA patients demonstrated EP as a rule in prognostically unfavorable active nephritic and nephrotic-hypertensive types. The relationship between TIA and EP may be explained by their association with unfavourable clinical types suggesting poor prognosis.

[The prognostic significance of the morphological type of chronic glomerulonephritis and of the tubulointerstitial changes depending on the clinical type of the disease]. / Prognosticheskoe znachenie morfologicheskogo tipa khronicheskogo glomerulonefrita i tubulointerstitsial'nykh izmenenii v zavisimosti ot klinicheskogo tipa zabolevaniia.

The review of 200 cases of chronic glomerulonephritis (CG) led the authors to the conclusion that there is a statistically significant relationship between rapid progression (RP) of the disease (onset of chronic renal failure within 7 years since the diagnosis) and its morphological type (chi 2 = 37), tubulointerstitial changes (chi 2 = 34; p < 0.0000), clinical disease types according to M. Ia. Ratner, V. V. Serov et al. (chi 2 = 115; p < 0.0000). In both prognostically favourable and unfavorable morphological types RP occurred more frequently in concurrent unfavorable clinical types (chi 2 = 19; p < 0.0001). In prognostically unfavorable morphological types there were, as a rule, unfavorable clinical types, whereas in favorable ones-favorable clinical types. In the presence of tubulointerstitial changes RP occurred primarily in unfavorable clinical types which are encountered in these morphological changes significantly more frequently than in their absence (chi 2 = 48; p < 0.01). RP of CG in prognostically unfavorable morphological types and tubulointerstitial changes depends mainly on accompanying clinical types of CG.

[A clinico-morphological analysis of the efficacy of therapy in chronic glomerulonephritis using prednisone, a cytostatic, an anticoagulant and an antiaggregant]. / Kliniko-morfologicheskii analiz éffektivnosti terapii khronicheskogo glomerulonefrita s ispol'zovaniem prednizona, tsitostaika, antikoagulianta i antiagreganta.

Four-component therapy (chlorbutin 0.2 mg, prednisone [correction of prednisolone] 60 mg, curantyl 400 mg/day per os, i.v. heparin 10,000 U twice a day) was given for 9-36 months to 76 patients with chronic glomerulonephritis (CGN). A statistically significant lowering of proteinuria was achieved irrespective of CGN clinicomorphological variant. As indicated by remission frequency and normalization of urinary osmotic concentration, efficacy of the above treatment is related to a clinical CGN type. Because clinical and morphological CGN types are correlated, the disease morphology and treatment effect are associated. The treatment proved effective in nephrotic mesangioproliferative, mesangiocapillary glomerulonephritis, focal-segmental glomerular sclerosis, active nephritic mesangiocapillary glomerulonephritis and inactive nephritic mesangioproliferative and mesangiocapillary glomerulonephritis. Nephrotic-hypertonic focal-segmental glomerulosclerosis and mesangiocapillary glomerulonephritis were resistant to therapy.

[The importance of the clinical classification of chronic glomerulonephritis for the prognosis of its progression and of the efficacy of therapy]. / Znachenie klinicheskoi klassifikatsii khronicheskogo glomerulonefrita dlia prognoza ego progressirovaniia i éffektivnosti terapii.

A significant correlation exists between clinical types of chronic glomerulonephritis (CGN) in a new clinical classification and morphological CGN types according to classification of WHO experts. Rapid progression is significantly correlated with clinicomorphological variants of CGN represented by unfavorable clinical types and unfavorable morphological types. No rapid progression occurred in combination of clinically favourable types and morphologically favourable and unfavorable types. The above classification is recommended for practice.

[The role of tubular interstitial changes in the genesis of the rapid progression of chronic glomerulonephritis]. / Rol' tubulointerstitsial'nykh izmenenii v geneze bystrogo progressirovaniia khronicheskogo glomerulonefrita.

The observation over 146 cases of compensated chronic glomerulonephritis (CGN) led the authors to the conclusion that there is a relationship between rapidly progressive CGN, onset of chronic renal failure 5 years after CGN diagnosis, the existence of tubulointerstitial changes (TIC) and CGN clinical pattern. Rapidly progressive CGN seems to arise primarily against TIC, in active nephritic and nephrotic-hypertensive types. In these clinical types CGN occurred more often than in TIC, while the disease takes a more favourable course in the alternative clinical types than in TIC absence. Thus, a clinical type appeared more reliable predictor of rapidly progressive CGN than TIC. The relations between clinical types and TIC explain more frequent occurrence of rapidly progressive CGN in the presence of the above morphological changes.

[The therapy of mesangiocapillary glomerulonephritis]. / Terapiia mezangiokapilliarnogo glomerulonefrita.

Follow-up of 7 patients with nephritically active mesangiocapillary chronic glomerulonephritis which received for 22 months combined therapy with prednisone (60 mg), chlorambucil (0.2 mg/kg), curantyl (400 mg), heparin or fenilin has found a significant lowering of proteinuria, hypercreatinemia, a rise in osmotic concentration. A complete remission was achieved in 2 patients, partial in 3 patients, a progression occurred after 8 years in one.

[Glomerular permeability for serum proteins in different morphological types of primary chronic glomerulopathy]. / Klubochkovaia pronitsaemost' dlia syvorotochnykh belkov pri paznykh morfologicheskikh tipakh pervichnoi khronicheckoi glomerulopatii.

Membranous glomerulonephritis (MGN), mesangiocapillary (MCGN), membranoproliferative glomerulonephritis (MPGN) and focal segmental sclerosis or hyalinosis (FSSH) were studied for glomerular filter permeability to serum albumins, IgA and IgG. In MGN the permeability for large-molecular globulins is not dependent on that for albumin, permeabilities for the globulins appeared correlated. In MPGN permeability for IgG depends on albumins permeability, correlations between that for IgA and IgG are similar to relevant findings in MGN. In MCGN glomerular permeability for IgA depends on that for albumins, and IgG depends on IgA permeability. In FSSH better albumin permeability implies increased permeability for both globulins, while enhanced permeability for IgA entails the same trend for albumins and IgG. Variable permeability of the glomerular filter for serum proteins in different morphological forms of chronic glomerulopathy may result from dissimilar defects in diverse layers of the filter and in interaction of basal membrane structures with cells responsible for glomerular impermeability for serum proteins.