[Comparative characteristics of hemostasis system in patients with endstage renal disease admitted for urgent and elective hemodialysis].

AIM: To evaluate parameters of hemostasis system in patients with end-stage renal disease (ESRD) with consideration of elective or urgent start of dialysis treatment. MATERIAL AND METHODS: A total of 47 patients with ESRD entered the study. They were divided into two groups depending on urgent (group 1) or elective (group 2) start of hemodialysis. Group 1 consisted of 31 patients (13 female, 18 male) aged 18-86 years, group 2 - of 16 patients (9 female, 7 male) aged 36-79 years. The patients were comparable by ESRD causes. Clinical and laboratory findings were compared: activated partial thromboplastin time, prothrombin time, levels of fibrinogen, soluble complexes fibrin-monomers (SCFM). RESULTS: Azotemia, hyperkalemia and anemia were close to similar. Group 1 patients had more severe alterations of nutrition status and fat metabolism, marked hyperhydration and hypervolemia, arterial hypertension, more frequent neurological and infectious complications, symptoms of enteritis. Thrombotic complications developed in 51.5%, thromboses of the vascular access in 45% in group 1 vs group 2 which demonstrated only one type of thrombotic complications - thromboses of primary arteriovenous fistula (in 1 patient, 6.25%). Hemorrhagic complications were absent in group 2, in group 1 these developed 5 times less frequently than thromboses. Platelet count was significantly less (p = 0.001) in group 1 than in group 2. Hyperfibrinogenemia occurred in about 65% patients of group 1 and in 46% in group 2. SCFM levels were elevated in both groups, but in group 1 these levels were by 50% higher than in group 2 (p = 0.005). This evidences for stronger activation of intravascular coagulation in patients on urgent hemodialysis. CONCLUSION: ESRD patients admitted for urgent hemodialysis had more severe uremic syndrome with stronger activation of blood coagulation than patients admitted for elective hemodialysis. Frequency of thrombosis in patients admitted for urgent hemodialysis was 8.3 times higher than in patients admitted for elective hemodialysis.

[Cryoapheresis in the treatment of patients with cryoglobulinemic mesangiocapillary glomerulonephritis and acute kidney failure]. / Krioaferez pri lechenii bol'nykh krioglobulinemicheskim mezangiokapilliarnym glomerulonefritom s ostroi pochechnoi nedostatochnost'iu.

AIM: To assess cryoapheresis (CA) efficacy in the treatment of cryoglobulinemic glomerulonephritis (CG) with acute renal failure (ACR). MATERIAL AND METHODS: Ten 34-64-year-old CG patients with associated HCV infection and symptoms of ACR (diuresis under 500 ml/day, serum creatinin 1.6-8.1 ml/dl). All the patients were examined clinically, for serum cryoglobulins, HCV, HBV markers, morphologically (renal and hepatic biopsies in 8 patients). All the patients received therapy with CA, immunodepressants. Three patients with virus replication received, in addition, antiviral drugs (alpha-interferon in a dose 3,000,000-5,000,000 IU 3 times a week intramuscularly for 6 months). RESULTS: CA in combined CG therapy led to fast elimination of cryoglobulins from the body, stabilization of renal function with arrest of rapid progression of renal failure, normalization of diuresis with subsequent lowering of serum creatinin. The course of CA normalized renal function fully in 3 patients, partially in 7 patients. Later, these 7 patients developed chronic renal failure. Complete elimination of the virus and remission of CG were achieved in 2 of 3 patients who had undergone the antiviral treatment for a year. CONCLUSION: CA can be added to combined therapy of CG aggravation as it improves renal function.

[Intermittent hemofiltration in the treatment of acute kidney failure in glomerulonephritis patients]. / Intermittiruiushchaia gemofil'tratsiia v lechenii ostroi pochechnoi nedostatochnosti u bol'nykh glomerulonefritom.

Intermittent hemofiltration (IH) was used in the treatment of acute renal failure (ARF) in 11 glomerulonephritis patients with nephrotic syndrome. IH was found effective in the above patients as it provides fast relief of interstitial edema of the essential for life organs (the kidneys, liver, lungs, etc.), control of plasma urea and potassium. In nephritis patients with ARF IH is superior to isolated ultrafiltration in providing 10 times higher urea clearance.

[The use of extracorporeal blood purification for the treatment of cardiac rhythm disorders]. / Primenenie ékstrakorporal'noi ochistki krovi dlia lecheniia narushenii serdechnogo ritma.

Hemosorption and plasmapheresis were used in 26 patients with episodes of atrial fibrillation and extrasystoles. A response lasting 4 +/- 0.9 months was registered in 80% of cases. Negative effects were absent.

[The use of hemosorption and plasmapheresis for treating cardiac arrhythmias (a preliminary report)]. / Primenenie gemosorbtsii i plazmafereza dlia lecheniia aritmii serdtsa (predvaritel'noe soobshchenie).

The authors present pilot experience in extracorporeal blood purification (hemosorption, plasmapheresis) aimed at correction of cardiac arrhythmia. Seven responders of 8 patients treated had less frequent episodes of cardiac fibrillation the severity of which decreased, they suffered no more from high-grade extrasystoles, were put on reduced doses of antiarrhythmic drugs. The response is attributed to improvement of blood rheology and elimination of arrhythmogenic substances.

[Plasmapheresis in the treatment of rapidly progressing glomerulonephritis]. / Plazmaferez v lechenii bystroprogressiruiushchego glomerulonefrita.

Twenty patients with rapidly progressing glomerulonephritis (RPGN) aged 16-50 underwent plasmapheresis (PA) as adjuvant to immunodepressants. Of these, 9 patients had lupus, 4 Bright RPGN, 4 and 3 patients combined glomerulonephritis with hemorrhagic vasculitis and Wegener granulomatosis, respectively. A total of 130 procedures were performed (3-13 per each patient). The results of PA treatment included complete recovery of renal function in 8 and partial in 10 patients (3 of them could stop hemodialysis), death of pulmonary edema (2 cases). The authors think advisable to combine immunodepressants with PA, especially when the drugs are contraindicated, in patients with malignant glomerulonephritis.

[Acute kidney failure in patients with chronic glomerulonephritis]. / Ostraia pochechnaia nedostatochnost' u bol'nykh khronicheskim glomerulonefritom.

The causes of acute renal failure (ARF) and results of its treatment are analyzed in 34 patients aged 15 to 51 years with exacerbation of chronic glomerulonephritis (CGN). Of these, 20 patients presented with lupoid GN, 11 with Bright's GN, and 3 had GN associated with systemic vasculitis (2 of them also had mixed cryoglobulinemia). All the patients underwent clinical treatment that lasted from January 1, 1986 to December 31, 1990. In 15 patients, ARF was due to the activity of the underlying disease or development of its complications (nephrotic crisis, disseminated intravascular coagulation, cryoglobulinemia); in 15 patients, it was determined by complications induced by drug treatment (diuretics, antibiotics, nonsteroid antiinflammatory drugs), and in 4 patients, by complications related to invasive examinations (radiographic contrast studies) and treatment (isolated ultrafiltration). The authors hold that superaddition of progressive tubular disorders, rapid decrease of the rate of glomerular filtration accompanied by the growth of serum creatinine form the basis for ARF to be diagnosed in such patients. Identification of the cause of ARF and delimitation of whether the pathological process is renal or prerenal in CGN patients is required for rational treatment prescription.

[The partial recovery of kidney function in chronic uremia patients during hemodialysis treatment]. / Chastichnoe vosstanovlenie funktsii pochek u bol'nykh khronicheskoi uremiei vo vremia lecheniia gemodializom.

Out of 432 patients placed on the treatment with hemodialysis (HD) for terminal renal failure (TRF) at the All-Union Nephrologic Center from January 1, 1978 to December 31, 1987, 17 patients manifested partial recovery of renal function, which enabled dialysis treatment to be discontinued for a time. Among the 17 patients with noticeable improvement of renal function, 8 presented with lupoid rapid-progressing glomerulonephritis (RPGN), 2 with RPGN associated with hemorrhagic vasculitis, 1 with idiopathic RPGN, 4 with chronic glomerulonephritis (CGN), 1 with chronic pyelonephritis, and 1 with polycystic kidneys. In 11 patients with RPGN, the rate of renal failure progression, expressed by the regression coefficient, was much higher among those in whom HD treatment was discontinued that in the group of patients without renal function recovery. In the 4 patients with CGN, renal function was recovered after the correction of marked disorders of purine metabolism, whereas in the 1 patient with chronic pyelonephritis and in the 1 with polycystic kidneys after urinary infection elimination. According to the ultrasonography data, out of the 17 patients with partial recovery of renal function, the size of the kidneys turned out normal in 14 patients.

[Plasmapheresis in the treatment of rapidly progressing glomerulonephritis]. / Plazmaferez v lechenii bystroprogressiruiushchego glomerulonefrita.

The authors are of the opinion that plasmapheresis (PP) combined with immunosuppressant therapy is an effective and a relatively safe method for the treatment of rapidly progressing glomerulonephritis (RPGN). Introduction of PP in multimodality treatment of RPGN made it possible to arrest rapidly progressing renal failure in all 6 treated patients. After PP treatment was over, renal function was recovered completely in 3 patients. One patient manifested the retention of renal failure of medium degree while rare hemodialysis sessions permitted one to control water-electrolyte disorders. In two patients the discontinuation of PP treatment resulted in the progress of renal failure. The data obtained do not make it possible to relate the improvement of renal function exclusively to the action of PP, since all the patients received immunosuppressants. Nevertheless, in 2 cases, the improvement could be attributed to PP, for its discontinuation in these patients (without any changes in the remaining treatment) brought about again the progress of renal failure.