[Disorders of oxidation-reduction processes in nephrotic syndrome]. / Narusheniia okislitel'no-vosstanovitel'nykh protsessov pri nefroticheskom sindrome.

Reduction capacity of the blood and its fractions was studied by potentiometry in 68 patients with the nephrotic syndrome. The type of renal injury was identified by kidney biopsy in all the patients. Control group consisted of 30 donors. Changes of blood reduction capacity were detected in all the patients with the nephrotic syndrome in comparison with the controls. A correlation could be traced between blood reduction capacity and functional compensation of the nephrotic syndrome. Disordered redox equilibrium was not associated in patients with the nephrotic syndrome with increased levels of lipid peroxidation products. The method used to assess reduction capacity is highly informative, rapid, and simple.

[The clinical importance of histocompatibility antigens and their combinations in the diagnosis of chronic pyelonephritis]. / Klinicheskoe znachenie antigenov gistosovmestimosti i ikh kombinatsii v diagnostike khronicheskogo pielonefrita.

Distribution of histocompatibility antigens and combinations thereof were investigated in citizens of St. Petersburg. All the examinees suffered from chronic pyelonephritis (CPN). The occurrence of antigens A1 and B17 in the patients was significantly high and associated with increased risk and etiological fraction. Combinations of antigens were frequently encountered in one locus: A1, A2, interlocus combinations A1, B5, A1, B7, A1, B17. Combinations of these antigens (especially A1 + B17) were indicative of high CPN risk. Frequent incidence of antigens A1, B7; A1, B5 may be due to the fact that in the above combinations they are responsible for higher CPN-risk. Increased incidence rate of antigens HLA-A1 and HLA-B17 evidences their involvement into CPN pathogenesis. Strong association of the disease with antigens A1, B17 seems to be typical for St. Petersburg citizens.

[Changes of the renin-angiotensin-aldosterone system and immunologic parameters in essential and symptomatic arterial hypertension]. / Izmeneniia renin-angiotenzin-al'dosteronoi sistemy immunologicheskikh pokazatelei pri éssentsial'noi i simptomaticheskoi arterial'noi gipertenzii.

The authors examined 150 patients with pronounced arterial hypertension: 73 with essential hypertension, 42 with chronic glomerulonephritis, 26 with chronic pyelonephritis and 10 with diabetic glomerulosclerosis. In addition to conventional tests, measurements were made of renin activity, levels of plasma aldosterone and hydrocortisone, IgA, IgG, IgM, CIC. A significant rise in concentrations of aldosterone, hydrocortisone against a significant fall in those of plasma renin were registered in all the patients irrespective of the disease. Significant differences between the groups by the renin profile, aldosterone and hydrocortisone levels were absent. It is suggested that changes in the hormonal spectrum and immunological indices are independent of renal affections in hypertension, while involvement of renin-angiotensin-aldosterone system in hypertension stabilization has no nosological specificity. The pattern of the immunity shifts evidences for their important pathogenetic role in maintenance and progression of arterial hypertension.

[The clinical significance of immunological indices in chronic pyelonephritis]. / Klinicheskoe znachenie nekotorykh immunologicheskikh pokazatelei pri khronicheskom pielonefrite.

Humoral and cellular immunity and data on biopsy tissue inoculation were evaluated for 72 patients with morphologically confirmed pyelonephritis. Cellular immunity was judged by lymphocyte rosette-test. T-lymphocyte subpopulation was counted in absolute numbers. No case of the biopsy bacterial contamination was shown bacteriologically. A complement C3 component was obtained in amounts similar to those in the controls. In remission IgA tended to a significant increase which (in IgM fall) continues in the disease aggravation. T-lymphocytes (total, active and suppressors) reduced in number, the changes arising in the remission with further intensification in a pyelonephritis exacerbation. Basing on the evidence obtained it is inferred that a significant suppression of cellular immunity, particularly T-suppressors, agrees with the idea of pyelonephritis as genetically determined, infection-mediated immune inflammation initially involving the medullary layer and urinary mucosa. The disease is characterized by defects in local immunity and changes in the density of receptors to the agent antigens. The predisposition came to action in disorders of urodynamics consequent to obstruction or ureteral hypotonicity of nonobstructive nature.

[Effect of protectors on morphofunctional changes in rat kidneys in tourniquet shock]. / Vliianie protektorov na morfofunktsional'nye izmeneniia pochek u krys pri turniketnom shoke.

The protective effect produced on the kidneys in tourniquet shock by thiol agents possessing antioxidant properties (unithiol, cystamine) was compared with that of a preparation of cell capsules of L. bulgaricus (CCLB). Tourniquet shock was modeled under ether Raush anesthesia by applying 8 turns of a rubber tourniquet to the hind limbs for 6 hours. Thirty minutes before removal of the tourniquet animals of the first group were given an injection of 1 ml of physiological solution, animals of the second group--20 mg/kg of unithol, those of the third group received an injection of 20 mg/kg of cystamine hydrochloride. Animals of the fourth group received 50 mg/kg of CCLB in 1 ml of physiological solution 7 days before the experiment. A marked protective effect of CCLB on the kidneys in tourniquet shock was established. According to the degree of the protective effect on the tissue of kidneys in tourniquet shock, the studied agents come in the following order: CCLB, cystamine, unithiol.

[Lipidemia in the nephrotic syndrome and the atherogenicity of the plasma]. / Lipidemiia pri nefroticheskom sindrome i aterogennost' plazmy.

The nephrotic syndrome is characterized by proteinuria, hypoalbuminemia and hypercholesterolemia. Hypercholesterolemia is in some cases a risk factor for atherosclerosis in this group of patients. The lipid plasma spectrum was studied in 45 patients with the nephrotic syndrome. Most pronounced changes of the lipid composition of the plasma were revealed in patients with systemic lupus erythematosus and a special form of mesangio-proliferative glomerulonephritis which is characterized by a torpid course and rapid development of chronic renal failure. Plasma atherogenicity was calculated according to the index of plasma atherogenicity. A high atherogenicity index was revealed in patients with an association of the nephrotic syndrome and arterial hypertension. Plasma atherogenicity is determined mainly by the level of high-density-lipoprotein cholesterol.

[The correlation of different forms of primary glomerulonephritis today and their diagnostic criteria (the work experience of a nephrology department and a clinico-morphological analysis of 3000 cases)]. / Sootnoshenie razlichnykh form pervichnogo glomerulonefrita v sovremennykh usloviiakh i ikh diagnosticheskie kriterii (opyt raboty nefrologicheskogo otdeleniia, kliniko-morfologicheskii analiz 3000 nabliudenii).

The author reviews the structure of nephropathies on the basis of an analysis of the clinicomorphological data obtained during the follow-up of 3000 patients examined at the nephrological center. In a group of primary glomerulonephritis, the mesangioproliferative form occurred most frequently (68%), the membranoproliferative form was encountered in 27.2% of cases, and the membranous form in 1.8%. Over the recent years not a single case of acute glomerulonephritis has been observed. Analysis of the diagnostic criteria allowed the antibody variety only to be regarded as an independent pattern of rapid-progressing glomerulonephritis. Equally to the manifestations of glomerulonephritis proper, mesangial proliferation should be also viewed as a possible nonspecific response to the other pathological processes. Focal glomerulosclerosis as a disease entity is to be excluded from the nomenclature of glomerulonephritis.

[Use of partusisten in prevention of hyperkalemia in patients with chronic glomerulonephritis with initial forms of renal failure]. / Primenenie partusistena dlia borby s giperkaliemiei u bol'nykh khronicheskim glomerulonefritom s nachal'nymi formami pochechnoi nedostatochnosti.

The studies performed proved the ability of the drug partusisten (in a dose of 10 mg/day) to effectively reduce an elevated potassium level in the serum of chronic sufferers with glomerulonephritis and initial renal insufficiency. Normal concentrations of Ca, K and Na in relevant patients remained unchanged except a slight rise in K urinary excretion this suggesting an extrarenal mechanism of K redistribution consequent to the action of beta 2-adrenergic agents.

[Arterial hypertension in glomerulonephritis]. / Arterial'naia gipertenziia pri glomerulonefrite.

The duration of nephropathy, the onset of arterial hypertension (AH), a family history of AH, uric syndrome, intravenous urographic evidence, glomerular filtration rate (GFR) determined from endogenous creatinine, the cellular membranes studied in erythrocytes by ureal hemolysis, and blood levels of thiol and disulfide groups by back amperometric titration, red blood cell activity of glutathione reductase and glucoso-6-phosphate dehydrogenase were evaluated in 108 patients with essential hypertension (EH), mesangial proliferative glomerulonephritis who had elevated and normal blood pressures and 18 healthy subjects. All the patients underwent closed renal puncture biopsy. There were structural alterations in the red blood cell membranes as evidenced by examinations of glucose-6-phosphate dehydrogenase, thiol and disulfide groups in erythrocyte protein and low-weight molecular fractions in healthy subjects with a family history of AH, patients with EH, with mesangial proliferative glomerulonephritis. The abnormal uric syndrome was detected in patients with EH. Patients with AH displayed glomerular hyperfiltration and higher glomerular dimensions. Renal biopsy revealed adrenal interstitial sclerosis in patients with AH.

[Once more about interstitial nephritis]. / Eshche raz k voprosu ob interstitsial'nom nefrite.

A comparative study was made of 25 patients (Group 2, control) with documented pyelonephritis and 55 patients (Group 1) who had a morphological picture of chronic interstitial inflammation without signs of abnormal urodynamics, bacteriuria, urographic and sonographic evidence of pyelonephritis. All the patients underwent life-time morphological study, their immunological spectrum (IgA, IgG, IgM, IgE) was explored. They had a test for sensitization of a peripheral blood mononuclear fraction to one or several drugs which had been given to the patients. The patients from Group 1 displayed significantly elevated IgE levels and a regularly detected sensitization of mononuclears to one or several drugs. Morphologically, there were signs of congenital renal tissue dysplasia in the presence of diffuse interstitial inflammation. Positive immunofluorescence findings were seen in the tubular wall of 10 (18%) patients. The findings made it possible to define diagnostic criteria for interstitial nephritis, a nosological entity.

[The ability of partusisten to improve kidney excretory function in the initial stage of kidney failure in patients with chronic glomerulonephritis]. / Sposobnost' partusistena uluchshat' ékskretornuiu funktsiiu pochek pri nachal'noi pochechnoi nedostatochnosti u bol'nykh khronicheskim glomerulonefritom.

To assess the effect of partusisten (fenoterol) on excretory function of the kidneys, the drug was administered per os in a dose of 10 mg/day for 7-10 days in 17 chronic glomerulonephritis patients with initial forms (stages I-IIA) of renal failure. A dramatic increase of glomerular filtration, a certain rise of tubular reabsorption, a reduction of blood concentration of nitrous residues were revealed, which was accompanied by electrolyte shifts and hemodynamic changes characteristic of partusisten. It is concluded that partusisten can be used as a drug ameliorating excretory function of the kidneys in chronic glomerulonephritis patients with initial forms of chronic renal failure.

[Arterial hypertension in glomerulonephritis]. / Arterial'naia gipertenziia pri glomerulonefrite.

A study is presented of the humoral mechanisms of arterial hypertension, clinical course and morphological changes of the renal tissue as evidenced by kidney biopsy data in 203 patients with mesangial proliferative glomerulonephritis (GN) depending on the presence of arterial hypertension and time of its development. The development of arterial hypertension is caused by genetic factors and is similar to hypertensive disease by its humoral indices. The mechanisms of initiation of arterial hypertension are also similar at the onset and final stage of GN. The morphological reflexion of arterial hypertension is sclerosis of the medullar layer of the kidneys. The hypertensive syndrome in GN should be considered from the viewpoint of its appearance as it determines the course of nephropathy.

[Clinical, immunological and morphological evaluation of nephrotic syndrome]. / Klinicheskaia, immunologicheskaia i morfologicheskaia otsenka nefroticheskogo sindroma.

The results are available of combined examination of the kidneys in 84 patients with manifest nephrotic syndrome varying in etiology: 57 had glomerulonephritis, 18 amyloidosis, 9 diabetic nephropathy. The study covered lipid metabolism, immunological status, lifetime morphological investigation of the kidneys. The latter procedure proved advantageous over biochemical and immunological studies in deciding upon nosological diagnosis of nephrotic syndrome and its prognosis. Destruction of podocytic miner processes revealed in all the syndrome cases can serve a uniform morphological substrate underlying massive proteinuria.

[The malignant hypertension syndrome: incontrovertible and questionable truths]. / Sindrom zlokachestvennoi arterial'noi gipertenzii: istiny besspornye i somnitel'nye.

A total of 42 patients with malignant arterial hypertension (MAH) were examined. Of these, 32 patients had essential hypertension (26 with normal renal function and 6 with renal failure treated by programmed hemodialysis) and 10 suffered from chronic glomerulonephritis. The patients were examined for central hemodynamics, hormonal background (plasma renin activity) (PRA), plasma aldosterone and cortisol concentration. 14 patients underwent closed puncture biopsy of the kidneys. All the patients manifested high PRA associated activation of gluco- and mineralocorticoid adrenal function along with the hyperkinetic syndrome. MAH was characterized by dramatic discrepancy between the stroke and cardiac indices and specific peripheral resistance. Nephrosclerosis whose extent varied, attaining maximum in patients with associated essential hypertension and renal failure and in autopsy material, in addition to severe lesions of the renal vessels appeared to be the common feature of all morphological alterations. Plasmic impregnation and fibrinoid necrosis of the arterioles were not detectable in all the patients, being of focal character. The same alterations were identified in the patients during exacerbation of glomerulonephritis and in the absence of MAH. The data obtained point to the nonuniformity of MAH. Four clinicomorphological variants of MAH are suggested.

[The role of the kidney lymphatic capillaries in the pathogenesis of the nephrotic syndrome]. / Rol' limfaticheskikh kapilliarov pochki v patogeneze nefroticheskogo sindroma.

As many as 16 patients with nephrotic syndrome (NS) of varying etiology and 10 patients without the NS were examined for ultrastructure of lymph capillaries of the kidney. Many-staged changes, from regenerative to destructive ones, associated with proteinuria growth and formation of the NS were revealed in lymph capillaries of the kidney. Patients with the NS of long standing manifested irreversible destructive processes--destruction of the capillary walls, karyopyknosis and cytoplasm coagulation. Microcirculatory disorders may be regarded as one of the mechanisms implicated in nephropathy progress.

[The nephrotic syndrome in elderly patients]. / Nefroticheskii sindrom u bol'nykh pozhilogo vozrasta.

The most frequent cause of development of the nephrotic syndrome in the elderly is secondary amyloidosis of the kidneys (71%). Most patients showed an association of the nephrotic syndrome with arterial hypertension (74%) and renal failure (59%). As compared with a control group of patients under 40, the elderly revealed concomitant diseases, greater severity and frequency of vascular and interstitial changes during morphological examination.