[Nosocomial infectious complications after transplantation of allogenic kidneys from the related donor].

The comprehensive evaluation of infectious complications after kidney transplantation from the living related donor was performed. Microbes predominantly encountered in urinary tract infection (P. aeruginosa, K. pneumoniae, E. coli, E. cloacae, S. epidermidis, E. faecalis) were studied. Prevention patterns and dosing regimens for the antibacterial therapy were developed considering data from the retrospective analysis of the isolated flora and its resistance. This resulted in the reduced rate of infectious complications.

[Chronic hepatitis B, hemosiderosis, and hepatic fibrosis in a renal graft recipient].

Chronic hepatitis B is a frequent concomitant disease in recipients of a renal graft that worsens results of kidney transplantation due to renal and extrarenal complications. Much rarer hemochromatosis either has genetic roots (hereditary hemochromatosis) or results from multiple blood transfusions and hemolysis during treatment by hemodialysis (secondary hemochromatosis). Combination of chronic hepatitis B and hemochromatosis increases the risk of chronic liver disease leading to cirrhosis and hepatocellular carcinoma. Success of antiviral therapy combined with massive phlebotomy is illustrated by a case of kidney transplantation to a patient with chronic hepatitis B of large duration and iron overload syndrome.

[Chronic hepatitis B and C in renal graft recipients].

Clinical and morphological features of chronic hepatitis B (CHB), C (CHC), and B+C (CHB+C) were studied in 283 renal graft recipients. High total bilirubin serum levels were detected significantly more often in CHB and CHB+C patients vs. CHC patients. High ALT activity was noted in 65% of CHB patients and only in 45% of CHC patients (p = 0.003). Stable low activity of hepatitis prevailed in renal recipients; it was noted in 56.7% of CHB patients, 66.2% of CHC patients, and 62% of CHB+C patients. The character of pathomorphological liver changes in chronic viral hepatitis was studied in 53 renal graft recipients using puncture biopsy. Histopathological activity index (HAI, Knodell R.G. et al., 1981) witnessed a more severe liver lesion in CHB vs. CHC and CHB+C. Thus, inflammatory activity in CHB was found to be minimal or low in 13 patients, and moderate or high in 11 patients, whilst a minimal or low activity in CHC or CHB+C was found in 16 and 10 patients, respectively, and a moderate activity was detected only in two and one, respectively (p = 0.016 and 0.024 compared with CHB). Advanced hepatic fibrosis or cirrhosis was significantly more frequent (p = 0.006) in CHB patients (eight out of 24) than in CHC ones (none out of 18). The rate of advanced sclerotic changes in CHB+C was lower (one out of 10 patients) than that in CHB, and similar to CHC. Thus, clinico-morphological manifestations were more prominent in renal graft recipients with CHB vs. CHC.

[Prognostic signs of accelerated progression of nephrotic types of chronic glomerulonephritis]. / Predvestniki uskorennogo progressirovaniia nefroticheskikh tipov khronicheskogo glomerulonefrita.

A prognostic value of some clinical and morphological signs was followed up in 43 patients with chronic glomerulonephritis concurrent with the nephrotic syndrome versus 85 with other clinical types of the disease. There was a statistically significant incidence of disease progression in combination with arterial hypertension, resistance of the nephrotic syndrome over 12 months and detection of sclerosing renal glomeruli and interstitium within 2 years after onset of the disease. The protracted course of the nephrotic syndrome is a precursor of occurrence of chronic renal failure. With less prolonged phases of the syndrome there is evidence for a long-term period of functional compensation. Occurrence of arterial hypertension early in the disease, as early renal parenchymal sclerosis, fails to predict the rates of chronic renal failure development. In the absence of these factors, the possibility of prompt disease progression may be rejected in all likelihood.

[Factors affecting survival of patients and graft after transplantation of a cadaver kidney]. / Faktory, vliiaiushchie na vyzhivaemost' bol'nykh i transplantata posle peresadki trupnoi pochki.

The following factors were found to contribute to survival rate of 5 years and longer in the patients with transplanted cadaver kidneys: patients' age of 20 to 40, a non-autoimmune nature of the underlying disease (chronic pyelonephritis and renal polycystosis), hemodialysis treatment for not longer than 6 months, and 4-5 preoperative blood transfusions. A good initial status of the recipients, no presensitization, and HLA histocompatibility of the donor and recipient for 3-4 A and B loci are the necessary conditions for prolonged survival of kidney transplants and patients. Programmed hemodialysis is preferable for the patients with a high sensitization, for no long survivals were recorded among them, high mortality rate being registered within the first two years after kidney allotransplantation.

[Clinical and morphologic predictors of the progress of chronic glomerulonephritis]. / Klinicheskie i morfologicheskie prediktory progressirovaniia khronicheskogo glomerulonefrita.

Observation over 183 patients with a morphologically verified diagnosis of chronic glomerulonephritis (CGN) made it possible to establish on a mathematic basis a highly significant relationship between the disease progress and the clinical and morphological disease patterns. In the active nephritic patterns and in the nephrotic-hypertonic pattern, chronic renal failure (CRF) occurred in the majority of the patients within the first 5 years. Meanwhile in the inactive nephritic pattern and in the nephrotic pattern, a corticoid-sensitive one, characterized by the phasic course, CRF could not almost be seen over up to 20 years after the disease onset. As far as the morphological patterns are concerned, focal-segmental glomerular hyalinosis/sclerosis turned out most unfavourable. In patients with this pattern, CRF was diagnosed during 5 years in almost half of the patients. The mesangio proliferative and membranous patterns appeared most favourable. The incidence of CRF during 5 years after the disease onset, common to the definite clinical patterns, did not depend on the concomitant morphological pattern. Provided there were sclerotic lesions throughout 2 years after the disease onset, CRF occurred in 65% of the cases for 10 years, whereas with their lack in 9% of the cases. The most important predictors of CRF were as follows: the clinical pattern of CGN and the presence of sclerotic lesions in the renal biopsy specimen. Of definite significance might be the morphological pattern of CGN.

Organization of treatment of patients with cardiac insufficiency of different origin.

Assisted circulation is now used in the treatment of severe forms of heart failure which complicate the course of many diseases. Application of one method of assisted circulation--intra-aortic counterpulsation by a balloon pump in cardiogenic shock--was successful: prolonged survival (over 1 year) was obtained in 18% of the patients. A further decrease in the mortality rate is dependent on the rational organization of treatment for these patients. This poses two major problems: the organization of treatment of patients in cardiogenic shock and postoperative heart failure in large cardiologic and heart surgery centers, and treatment of heart failure in patients in whom it has occurred secondarily. We developed a method of organizing the treatment of these patients beginning in the prehospital stage and continuing in a specialized hospital. In addition to methods of assisted circulation, various intensive care methods and hemosorption (in poisoning by liver toxins), hemodialysis (in anuria), etc., are used. Although this type of organization complicates therapy, the results are significantly improved.