[Role of intrarenal product TNF-alpha in the development of glomerular and tubulointerstitial tissues changes in elderly patients with diabetic nephropathy].

The aim of this study was to investigate the expression of TNF-alpha produced in the kidney in patients with diabetic nephropathy (DN) type 2 diabetes and its impact on the development of glomerular and tubulointerstitial tissue changes in these patients. The survey was conducted in 49 elderly patients (mean age 66.53 +/- 3.50 years) with type 2 diabetes complicated by the development of DN. The study included patients with serum creatinine less than 0.13-0.14 mmol/l and in the initial stage of chronic renal failure in the level of serum creatinine less than 0.20 mmol/l. Diabetes duration was 17.89 +/- 0.44 years, and the duration of diabetic nephropathy was 1.60 +/- 0.44 years. Light and immunofluorescence microscopy of the renal biopsy specimens obtained by needle lifetime biopsy was performed for all patients. Morphological changes in the tissue were assessed in accordance with the latest international classification of diabetic nephropathy. In addition to light and immunofluorescence microscopy the expression of TNF-alpha in the glomerulus and interstitial tissue by monoclonal antibodies labeled Fitc ("Dako", Germany) were determined in all patients. The location of TNF-alpha expression in the glomeruli (capillary loops, mesangial matrix, glomerular capsule) and in the interstitial tissue (urinary epithelium convoluted tubule basement membrane of urinary tubules, interstitial cells) were estimated. Correlation analysis of the influence of the expression of TNF-alpha on the expression of morphological changes of tissues revealed that a maximum of cytokine production in the glomeruli at the stage IIa class cytokine affected only the development of segmental glomerular sclerosis. With the decrease in TNF-alpha production in the glomeruli you can observe the progression of histological changes--periglomerulyarny sclerosis development, builds thickening of the glomerular basement membrane; mesangial expansion goes from mild to severe and affects more than 25% of mesangial matrix (IIb stage), nodular lesions of Kimmelstil-Wilson are forming. Interstitial produce of TNF-alpha remains relatively high in the epithelium of the urinary tubules and in the interstitial cells of the kidney regardless of the class of diabetic nephropathy and influence the development of tubulointerstitial fibrosis.

[The role of IL-6 in the development of morphological changes in renal tissue in elderly patients with type 2 diabetes complicated by diabetic nephropathy].

Studies in recent years suggest a role for inflammation, proinflammatory cytokines in particular, the development of microvascular complications of diabetes, including nephropathy. We investigated the expression of IL-6 in the biopsy tissue kidneys (in glomeruli and interstitium) in 24 elderly patients with type 2 diabetes complicated by diabetic nephropathy. The significant influence of intrarenal expression of IL-6 on the development of morphological (glomerular and tubulointerstitial) changes in renal tissue in patients with diabetic nephropathy is shown.

[Age-related features of the mesangial proliferative glomerulonephritis].

This article presents the data of 118 patients (77 men and 41 women) with mesangial proliferative glomerulonephritis, aged 22-70 years. It is concluded that the rate of progression and severity of chronic glomerulonephritis, even within the same morphological form, is determined by age.

[Effect of protein load on kidney functions in patients with chronic glomerulonephritis]. / Vliianie belkovoi nagruzki na funktsional'noe sostoianie pochek u bol'nykh khronicheskim glomerulonefritom.

AIM: To study changes in renal function in response to protein loads in patients with chronic glomerulonephritis (CGN) who have normal renal function and initial uremia. MATERIAL AND METHODS: 63 CGN patients were divided into two groups: 40 patients of group 1 (17 males, 23 females, age 16-53 years, plasma creatinine-Pcr < 0.132 mmol/l); 23 patients of group 2 (10 males, 13 females, age 18-57 years, Pcr > 0.132 mmol/l). Renal functional reserve (RFR) was assessed with oral soa isolate SUPRO 760 test (protein Techn. Int., USA), 1.0 g of protein per 1 kg of ideal body mass. By three 2-h clearance periods measurements were made of RFR, absolute and fractional excretion, concentration indices and clearances of creatinine, urea, electrolytes, osmolality. All the parameters were referred to the standard body surface. RESULTS: RFR was intact in 14 patients of group 1 and 10 patients of group 2. In CGN without uremia with intact RFR, maximal Pcr corresponded to the highest values of minute diuresis and sharp increase of urea excretion, osmotically active substances. In CGN patients with uremia and intact RFR, development of hyperfiltration was accompanied with a significant rise in Pcr, minute diuresis, absolute excretion of urea and osmotically active substances. The rise in the latter two was much less active in CGN if RFR was absent. Multiple stepwise regression analysis showed that RFR intactness depends primarily on baseline values of absolute excretion of urea and osmotically active substances. CONCLUSION: A reverse relationship exists between absolute excretion of urea, osmotically active substances and the degree of SKF in response to protein load in CGN patients both in intact nitrogen-excreting function and uremia. It is suggested that urea may be involved in regulation of intraglomerular hemodynamics by means of effect on tubular-glomerular feedback mechanism.

[Changes of extracellular space volume of the cerebral cortex during peripheral stimulation in rats]. / Izmenenie ob''ema mezhkletochnogo prostranstva kory golovnogo mozga krys pri perifericheskoi stimuliatsii.

Changes of extracellular space (ECS) volume evoked by peripheral repetitive stimulation were studied in the cerebral cortex. Extracellular volume and its changes were measured by electrical impedance method with the fourth electrode scheme. Measurements indicate that the dynamic changes of ECS volume accompany electrical activity of cortex and have value 3-5%.

[Effects of different variants of low-protein diet on progression of chronic renal failure and indices of nutritional status in predialysis stage]. / Vliianie razlichnykh rezhimov malobelkovoi diety na progressirovanie khronicheskoi pochechnoi nedostatochnosti u pokazateli sostoianiia pitaniia na dodializnom étape.

AIM: To investigate effects of different variants of low-protein diet (LPD) (standard and with soy bean protein isolates) on inhibition of chronic renal failure (CRF) progression and prevention of protein-energy insufficiency in predialysis patients. MATERIALS AND METHODS: 150 patients with CRF were divided into three groups 50 patients each. Group 1 patients were given combined LPD with addition of soy bean isolate (0.4 g of protein per 1 kg of recommended body mass a day with standard diet and 0.2 g/kg with protein isolate SUPRO 760). Group 2 patients were given standard LPD without additives (0.6 g/kg a day). Patients of group 3 received free diet. All the patients were normally supplied with energy (at least 30-35 kcal/day). In the course of 26 months, clinical, laboratory, anthropometric, expected and functional parameters were measured each 4 months. RESULTS: Progression of CRF inhibited in patients with restricted protein provision. LPD had no negative effect on laboratory indices. Soy bean isolate LPD was more effective in inhibition of the disease progression than the standard one. CONCLUSION: LPD can be used for a long time for inhibition of the progression of CRF provided energy requirements are met. LPD with food additives (soya bean protein isolates) hold perspective for correction of metabolic disorders.

[Course of heart failure in patients with terminal chronic kidney failure on chronic hemodialysis]. / Osobennosti techeniia serdechnoi nedostatochnosti u patsientov s terminal'noi khronicheskoi pochechnoi nedostatochnost'iu, poluchaiushchikh lechenie khronicheskim gemodializom.

AIM: To evaluate peculiarities of the course of cardiac failure (CF) in initiation of hemodialysis therapy (HT) in patients with terminal chronic renal failure (CRF) and 24 months after HT; to elucidate CF causes late in HT. MATERIAL AND METHODS: Cardiohemodynamics was studied in 152 patients with terminal CRF during 2 years of HT. RESULTS: At initiation of HT, cardiohemodynamics was characterized by hyperkinetic syndrome, high total peripheral resistance, weak left ventricular systolic function, diastolic dysfunction. Chronic HT for 2 years led to attenuation of hyperkinetic syndrome, improvement of left ventricular systolic function, highly increased bypass blood flow along the arteriovenous fistula. The correction of the blood flow along the arteriovenous fistula arrested manifestations of CF in all the patients. CONCLUSION: Drugs with positive inotropic action are contraindicated in patients with terminal CRF on chronic hemodialysis having CF. Regular measurements of blood flow along the arteriovenous fistula are recommended for early detection and correction of increased bypass blood flow.

[Factors influencing the results of chronic glomerulonephritis treatment]. / Faktory, vliiaiushchie na rezul'taty lecheniia khronicheskogo glomerulonefrita.

The effectiveness of different treatment programs was studied in correlation with clinical characteristics of chronic glomerulonephritis (CGN) in 665 patients. It was established that the higher was CGN activity, the poorer were the treatment results. Nephrotic syndrome also had negative implications. The best response was brought by prolonged (1-2.5 years) course of corticosteroids and cytostatics.

[New approaches to therapy in glomerulonephritis patients]. / Novye podkhody k terapii bol'nykh glomerulonefritom.

Before starting treatment of chronic glomerulonephritis it is desirable to determine the patient's drug sensitivity in vitro because in the absence of such sensitivity chemotherapy should be preceded by immunomodulation with tactivin or thymalin and 3-5 sessions of plasmapheresis to stimulate drug sensitivity. Further measures include prednisolone or cyclophosphamide intravenously for 3-5 days in a dose 300-500 followed by oral administration. Active treatment lasts for 4-8 weeks. After that the patients receive maintenance for 1-2 years.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

[Structural-metabolic features of uremic gastroenteropathy]. / Structurno-metabolicheskoe osobennosti uremicheskoi gastroénteropatii.

Concentrations of uremic toxins in the blood and jejunal juice of 72 patients with chronic renal failure (CRF) were studied as well as morphologic changes in biopsies from jejunal mucosa and submucosa, activity and location of acid and alkaline phosphatase as markers of intracellular and transmembrane transport. It was found that maximal excretion of uremic toxins in the jejunum occurs in CRF stage IIA and IIB. In terminal CRF excretion of uremic toxins delays from their concentration in the blood. This process is related with changes in enzymic processes. Histologically, all the examinees exhibited signs of chronic enteritis.

[Assessment of the clinical course of chronic glomerulonephritis]. / Otsenka techeniia khronicheskogo glomerulonefrita.

Clinical course of chronic glomerulonephritis (CG) with recognition of 4 types by frequency of exacerbations was investigated in 592 patients with morphologically verified diagnosis observed for a long time. The disease ran a stable course. Contrary to patients with mesangioproliferative CG who had rare or moderate-frequency exacerbations, patients with membranoproliferative disease had exacerbations annually. This suggests correlation between the form of anatomical changes and the process activity. Irrespective of CG morphological form, the survival of CG patients is closely related to the disease course. Taken into account, this fact may serve the tool of prognosis, choice of treatment intensity and duration of follow-up.

[The problems in optimizing the delivery of general therapeutic care at the regional level during the transition to compulsory medical insurance]. / Problemy optimizatsii okazaniia obshcheterapevticheskoi pomoshchi na territorial'nom urovne v usloviiakh perekhoda k obiazatel'nomu meditsinskomu strakhovaniiu.

The authors hold that perfection of local therapeutic service in present-day situation when insurance principles are introduced in medical care may be achieved through design of medico-economic standards of guaranteed minimum of medical aid for each citizen of Russian Federation. This approach allows accurate estimation of required personnel and equipment. The standards should not replace the principle of individual approach to each case.

[Variants in the transient deterioration of kidney function in chronic glomerulonephritis]. / Varianty tranzitornogo ukhudsheniia funktsii pochek pri khronicheskom glomerulonefrite.

A transient inhibition of glomerular filtration and/or elevation of blood creatinine were detected in 126 of 296 patients with chronic glomerulonephritis. Some of the patients had 2-4 episodes which occurred more frequently in exacerbations (56.3% of cases), less frequently in cytostatic treatment or in sanatorium. The predominance of nephrotic syndrome and frequent recurrences or hypertension, long-term course in different causes of the disease suggests several pathogenetic variants of nephrotic syndrome. Transient deterioration of renal function does not affect survival, but its emergence in the course of cytostatic treatment or sanatorium treatment worsens the prognosis being related with sclerosis of the renal tissue.

[A comparative evaluation of the efficacy of the clinical use of SKN-4M-, SKT-6A- and polifepan-type sorbents in treating patients with chronic kidney failure (clinical and experimental studies)]. / Sravnitel'naia otsenka éffektivnosti klinicheskogo ispol'zovaniia sorbentov tipa SKN-4M, SKT-6A i polifepana pri lechenii bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu (kliniko-éksperimental'noe issledovanie).

Enterosorbents were tried clinically in 90 patients with chronic renal failure and in vitro (immersion into gastric juice, enteral and colon content). Advantages of granulated carbone sorbents over polyphepan, lignin derivative, were evident.

[The effect of Recormon therapy on the quality of life of patients on hemodialysis treatment]. / Vliianie terapii rekormonom na kachestvo zhizni bol'nykh, nakhodiashchikhsia na lechenii gemodializom.

Recormon was given to 34 patients on hemodialysis. The drug's effects on quality of life were judged by the results of clinical, laboratory, experimental and psychological dynamic investigations. The highest effect occurred on the therapy month 6-12. Recormon contributed to relief of asthenic and depressive syndromes, to an increase of activity and improvement of well-being, quality of life by Karnofsky scale within the first year of treatment. The dynamics of life quality changes depended on initial psycho-physical condition of the patients, the age, blood pressure, hematocrit. Recormon treatment is associated with the risk of euphoria.