[The role of renal anemia and cardiovascular disease in the progression of chronic glomerulonephritis]. / Rol' nefrogennoi anemii i serdechno-sosudistykh zabolevanii v progressirovanii khronicheskogo glomerulonefrita.

AIM: To study the rate of chronic glomerulonephritis progression when added by anemia and cardiovascular disease (CVD). SUBJECTS AND METHODS: 231 patients (133 men and 98 women) with predialysis chronic glomerulonephritis (CGN) were examined. The patients' mean age of was 35.8±11.8 years; the disease duration was 1 to 17 years. The disease onset was the date when urinalysis showed evidence of persistent proteinuria and (or) hematuria. Besides, the time when anemia developed and the clinical and instrumental signs of CVD appeared was taken as the initial reference point; the time when end-stage renal failure was diagnosed was taken to be the endpoint. Red blood cell counts with the inclusion of its indices, hemoglobin concentration, hematocrit values, daily proteinuria values, and glomerular filtration rate were analyzed. The biochemical parameters included the concentrations of electrolytes, creatinine, fibrinogen, iron, cholesterol, total protein and C-reactive protein (CRP). Electrocardiography and echocardiography, bicycle ergometry and 24-hour ECG monitoring were used to detect CVD. RESULTS: The presence of anemia and CVD in patients with predialysis CGN versus those without anemia and CVD was associated with an increase in the concentrations of CRP [36.2 and 12.6%; respectively; (p<0.05)], creatinine [123.0 (83.2-217.0) and 86.5 (72.0-128.5) µmol/L; (p<0.05)] and a decrease in GFR [65.4 (30.8-95.5) and 92.7 (64.5-122.3) ml/min; (p<0.05)]. The 8-year survival of patients with CGN concurrent with CVD was noted to be 58% whereas the renal survival in patients with CGN + CVD + anemia was shorter and the 6-year survival in this case was as high as 52%. CONCLUSION: Anemia and CVD in patients with CGN serve as additional independent factors for the progression of the underlying disease. The concurrence of CGN, anemia, and CVD substantially reduces the predialysis period.

[Chronic Reno-Cardial Continuum in Glomerulonephritis].

OBJECTIVES: To elucidate main risk factors contributing to development of cardiovascular pathology at the predialysis stage of chronic glomerulonephritis. MATERIALS AND METHODS: We examined 173 patients (90 men, 83 women, age 15-70, mean age 36.8+/-12.9 years) at predialysis stage of chronic glomerulonephritis. Cardiovascular pathology (coronary heart disease, disturbances of cardiac rhythm, left ventricular hypertrophy, chronic heart failure) was found in 88 patients. Clinical examination included history taking, physical examination with measurement of blood pressure BP and anthropological parameters, laboratory and instrumental investigation for diagnosis verification. Biochemical parameters studied were blood serum levels of cholesterol (Ch), high-density lipoprotein Ch, low-density lipoprotein Ch, fibrinogen, C-reactive protein, total protein, and creatinine. ECG and echocardiography were also performed. RESULTS: Presence of cardiovascular pathology was associated with higher concentration of calcium in blood serum (1.7+/-0.6 vs. 1.4+/-0.5 mmol/l, p<0.05), anemia with lower hemoglobin content, number and volume of erythrocytes, higher creatinine (150 [76-179]) vs. 100 [70-117] mcmol/l; p<0.05) and lower glomerular filtration rate (GFR) (80 [41-104] vs. 100 [69-122] ml/min; p<0.05). CONCLUSION: Main factors, contributing to development of cardiovascular pathology in patients at the predialysis stage of chronic glomerulonephritis were anemia, hypercalcemia, and lowering of GFR with increased serum creatinine.

[Peculiarities of progression of chronic glomerulonephritis associated with anemia].

Aim: To study the influence of renal anemia on the clinical course of chronic kidney disease in patients with chronic glomerulonephritis (CGN) at the early stage of the disease. Materials and methods: This prospective 12 month study included evaluation of clinical and laboratory characteristics of 149 patients aged 17-66 (mean 37,6±12,6) years at the pre-dialysis stage of CGN (92 men (37,04±13,4 yr) and 57 women (38,2±11,2 yr). Results: By the end of prospective observation, patients of group 1 (CGN without anemia) showed a decrease of the hemoglobin level accompanied by the impairment of nitrogen releasing function with the glomerular filtration rate of 70,1 (43,1-111) ml/min compared with 87 (61,3-115,3) at the onset of observations (p<0,05). In group 2 (CGN with anemia), dynamics of the nitrogen-releasing function was similar but even more pronounced with the glomerular filtration rate reduced to 47,4 (32,2-91,8) ml/min compared with 80,7 (39,8-107,9) at the onset of observations (p<0,05) and the serum creatinine level increased to157 (92-242) mcmol/l compared with 123 (86-171) (p<0,05). Conclusion: Reduction of hemoglobin level in patients with CGN is apparent at the early stages of the disease in association with impairment of glomerular filtration. The data obtained indicate that anemia can be a laboratory predictor of deteriorated nitrogen-releasing function.

[[Effect of erythropoietin and its combination with hypoxic altitude chamber training on the clinical and functional manifestations of chronic glomerulonephritis].

AIM: To evaluate the efficiency of treatment for renal anemia in patients with chronic glomerulonephritis (CGN), by using erythropoietin and its combination with hypoxic altitude chamber training (HACT). SUBJECTS AND METHODS: Sixty-three patients (41 men and 22 women) (mean age 37.1 ± 3.3 years) with CGN during the predialysis phase of chronic kidney disease (CKD) complicated by anemia. Hemoglobin (Hb), packed cell volume (PCV), and red blood cell indices (mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC)), platelet count, serum iron, fibrinogen, C-reactive protein (CRP) and creatinine levels were determined in all the patients at baseline and during a prospective follow-up. Glomerular filtration rate (GFR) was measured using with the Rehberg-Tareev test. Along with standard renal protective therapy, all the patients received either epoetin beta (n=31; Group 1) or its combination with HACT (n=32; Group 2). In Group 1 patients (n=31), erythropoietin (EPO) was given in an initial dose of 20-50 IU/kg thrice daily, followed by the dose being adjusted until the target Hb level was reached. Group 2 patients (n=32) received HACT cycles by the standard procedure in combination with EPO given in lower doses (20-50 IU/kg once weekly). A prospective .follow-up of the patients was carried out during one year. RESULTS: Following one year, the number of patients who had achieved the target Hb level was 74.1% in Group 1 and 87.5% in Group 2. Over time, there were increases in the concentration of Hb (from 108.6 ± 19.4 to 124.5 ± 14.09 g/l; p<0.05), PCV, and red blood cell indices (MCV, MCHC) in the patients receiving EPO (Group 1). Besides an'anti-anemic effect, there was a significant decrease in the concentrations of fibrinogen from 6655 (4884-7634) to 3776 (3330-4884) mg/dL; (p<0.05), serum creatinine from 159 (89--261) to 138 (79-258) pmol/I (p<0,05), proteinuria from 2.955 (1.024-6.745) to 2.069 (0.539-4.279) (p<0.05), which was accompanied by an increase in GFR from 62.3 (37.0 - 107.4) to 76.9 (46.0-96.0) mi/min (p<0.05). In Group 2, the rise in the concentration of Hb (from 114.1 ± 11.7 to 132.0 ± 16.5 g/I (p<0.05), PCV, MCV, and MCHC proved to be more pronounced than that in Group 1 (p<0.05) and accompanied by an elevation in the counts of platelets (from 222.7 ± 19.8.10(9)/1 to 249.3 ± 21.9.10(9)/1 (p<0:05)) and red blood cells (from 4.0 ± 0.4-10(12)/1 to 4.34 ± 0.3 X 10(12)/I (p<0.05)). There was a more marked reduction in the degree of proteinuria from 3.092 (0.764-7.694) g at baseline to 1.600 (0.677-4.078) g one year later (p<0.05) than that in Group 1 (p<0.05). The increase in GFR from 60.1 (46.0-96.0) to 79.4 (44.0-120.0) ml/min (p<0.05) and the fall in the concentration of fibrinogen from 5555 (4884-7770) to 4107 (3776-5328) mg/dL (p<0.05) and serum creatinine from 166 (92-273) to 147 (92-152) µmol/L (p<0.05), which were observed in Group 2, were comparable to those in Group 1. CONCLUSION: Epoetin beta used in patients with CGN has an anti-anemic effect and leads to improved renal nitrogen-excretory function. Erythropoietin in combination with HACT used in CGN provides a higher anti-anemic efficacy and a more pronounced antiproteinuric effect.

[Renal anemia and cardiac remodeling in patients with chronic glomerulonephritis].

AIM: To study the pattern of cardiac remodeling and its association with anemia in patients with chronic glomerulonephritis (CGN). SUBJECTS AND METHODS: Sixty patients aged 21 to 58 years (mean age 38.1+9.8 years) with the hypertensive form of CGN were examined. According to the presence of anemia, the patients were divided into 2 groups with 30 persons in each. All the patients underwent physical examination with verification of the diagnosis, estimation of the volume of red blood cells, and echocardiography. RESULTS: The patients with anemia as compared to those with CGN and without anemia were found to have a statistically significant increase in the left atrial size (3.6 +/- 0.6 cm versus 3.3 +/- 0.3 cm; p < 0.05), left ventricular (LV) end-diastolic size (5.4 +/- 0.6 cm versus 5.1 +/- 0.4 cm; p < 0.05), LV end-systolic size (3.7 +/- 0.7 cm versus 3.3 +/- 0.5 cm; p < 0.05), and LV mass index (141.8 +/- 60.5 g/m2 versus 113.5 +/- 30.8 g/m2; p < 0.05). Correlation analysis revealed statistically significant correlations between red blood cell levels, LV end-systolic and end-diastolic sizes and ejection fraction (EF) in the anemia group while this correlation was absent in the non-anemia group. Group 1 showed a correlation between blood pressure (BP) (mainly diastolic BP), LV sizes and wall thickness. CONCLUSION: The patients with chronic glomerulonephritis complicated with anemia exhibited LV remodeling as LV dilatation.

[I/D relationship between polymorphism of ACE gene and progression of chronic glomerulonephritis].

AIM: To study prevalence of angiotensin-converting enzyme (ACE) gene polymorphism and its correlation with ACE level in Kyrgyz population suffering from chronic glomerulonephritis (CGN); to ascertain CGN progression and survival with reference to the genotype of ACE gene. MATERIAL AND METHODS: The above parameters were investigated in 76 CGN patients (mean age 34.1 +/- 1.9 years) and 48 healthy controls matched by sex and age. Amplification of the polymorphic site of the ACE gene was made with polymerase chain reaction. Spectrofluorimetry measured ACE concentration in the serum. Progression of CGN was assessed by reciprocal creatinine. Survival of the patients was calculated according to the Kaplan-Meyer method. RESULTS: The ACE genotype distribution corresponded to the Hardi-Weinberg equilibrium. However, a significant difference in the frequency of genotypes and alleles between CGN and control patients was not revealed. The activity of serum ACE in CGN and healthy subjects was noticeably higher in DD genotype than that in genotypes II and ID (P < 0.02). The former had a significantly higher level of total cholesterol and much lower glomerular filtration rate in a rapid progression of the disease estimated by reciprocal creatinine and higher 5- and 10-year survival compared to genotypes II and ID (P < 0.05). CONCLUSION: Development of CGN is not associated with any genotype of ACE gene in Kyrgyz population. At the same time, deletion polymorphism of ACE gene may serve as a predictor for CGN progression.

[Clinical morphological characteristics of intravascular coagulation in glomerulonephritis]. / Kliniko-morfologicheskaia kharakteristika vnutrisosudistoi koaguliatsii pri glomerulonefrite.

Clinical and morphologic signs of intravascular coagulation have been studied in 63 patients with primary glomerulonephritis (GN) and in 19 patients with nephritis associated with systemic lupus erythematosus. A relationship between the frequency of fibrin deposition in the kidneys and severity of clinical signs and marked morphologic changes in GN has been revealed. Signs of local hypercoagulation are of prognostic significance. A more favourable prognosis is characteristic for patients who show nor fibrin deposition in the renal tissue and whose fibrinolytic system provides an adequate reaction.