[Endothelial dysfunction and apoptosis at early stage of chronic kidney disease].

AIM: To study changes in apoptosis and endothelial function in patients with chronic kidney disease (CKD) stage I-IIIb (CKDsI-IIIb). MATERIAL AND METHODS: A complex of biochemical, enzyme immunoassay and device investigations was used to examine 128 patients with CKDsI-IIIb. RESULTS: In CKD stage I reduction of endothelium-dependent vasodilation (EDV) was detected in 34% patients, in stage II -- in 52 %, in stage IIIa -- y 52 %, in stage IIIb - in 70%. An EDV decrease was associated with glomerular filtration rate (GFR), a homocysteine level and hemodynamic factors. Elevation of endothelin-1 (ET-1) level was seen in CKDsI in 41 %, in CKDsII - in 54 %, in CKDsIIIa - in 70 %, in stage IIIb - in 83% patients. A negative correlation was observed between the level of ET-1 and GFR and positive - with diurnal proteinuria. A significant rise of annexin A5 concentration versus normal was detected as early as in CKDsI (1,14 +/- 0,68 ng/ml). In CKDsII annexin A5 was 2,61 +/- 0,75 ng/ml, in CKDsIIIa - 3,75 +/- 0,93 ng/ml and in CKDsIIIb - 5,16 +/- 1.01 ng/ml. Negative correlations were found between annexin A5 level and GFR, a maximal growth of volumetric blood flow rate in skin vessels in the acetylcholine test, positive correlations with systolic blood pressure, body mass index. CONCLUSION: The levels of ET-1 and annexin A5 are factors having an independent impact on EDV in patients with CKDsI-II.

[The level of endothelin-1 and reactivity of skin microvessels in patients with early stages of chronic kidney disease].

AIM: To evaluate endothelin-1 (ET-1) levels and to characterize reflex vasomotor reactions of skin vessels in distant exposure to cold in patients with chronic kidney disease (CKD) of stage I and II. MATERIAL AND METHODS: Glomerular filtration rate (GFR) was calculated by MDRD formula for 40 healthy subjects (mean age 39.2 +/- 2.0 years) and 147 CKD patients (mean age 41.4 +/- 1.8 years). All the patients were also exposed to the cold test (a modified variant). RESULTS: Patients with CKD stage I demonstrated a 35.1% fall in blood flow rate (Qas) in response to cold stimulus, patients of stage II--a 42.2% fall, healthy patients--a 19.3%. CKD patients of stage I and II retained a Qas fall for 3 min after exposure to cold, while healthy subjects resumed skin blood circulation immediately after exposure to cold. Blood plasma ET-1 concentration in healthy subjects was 0.239 +/- 0.055 fmol/ml, in stage I CKD patients--0.334 +/- 0.066 fmol/l, in stage II CKD patients--0.422 +/- 0.041 fmol/l. Relationships were found between ET-1 level and GFR (Rs = 0.242; p < 0.05), 24 h proteinuria (Rs = 0.375; p < 0.003) and Qas% in the cold test (Rs = -0.389; p < 0.003) as well as time of recovery of the background Qas (Rs = -0.311; p < 0.003). CONCLUSION: Dysfunction of autonomic nervous system at early stages of CKD may arise by means of activation of ET-1 synthesis in response to enhancement of sympathetic impacts.

[Glomerular filtration rate is an indicator of endothelial function at early stages of chronic kidney disease].

AIM: To study effects of glomerular filtration rate (GFR) reduction on endothelial function in patients at early stages of chronic renal kidney (CKD). MATERIAL AND METHODS: Endothelial function of 101 patients with CKD of stage I-III was examined using reactive hyperemia test, dopplerography of skin vessels with ionophoresis of acetylcholin and nitroglycerin, lipidogram parameters, homocistein and annexin A5 levels, intima-media complex thickness of the common carotid artery, echocardiography findings. RESULTS: Cardiovascular complications risk factors were found in all the patients: increased body mass index, arterial hypertension, dyslipoproteinemia, hyperhomocysteinemia. Reduced GFR (under 90 ml/min) is an independent factor of atherosclerosis risk. CONCLUSION: GFR reduction corresponding to CRD of stage II is accompanied with enhancement of apoptosis and development of vasomotor endothelial dysfunction that in combination with risk factors contribute to development of a preclinical atherosclerosis phase.

[Chronoprevention and chronotherapy of bronchial asthma]. / Khronoprofilaktika i khronoterapiia bronkhial'noi astmy.

Chronobiological investigation of external respiratory function parameters was conducted in 93 patients with preasthma and bronchial asthma and in 13 healthy persons. The peculiarities of circadian organization of external respiratory parameters which were used for administration of chronotherapy were revealed in the patients. Some time before the appearance of maximum deterioration of indices under study, mostly indices of bronchial permeability, drugs (broncholytics, inhalation steroids and intal) were administered. Objective and subjective methods of assessment of bronchial permeability using a diary of self-evaluation were compared. The substitution of laboratory investigation for self-evaluation will make it possible to widely use chrono-diagnosis and chronotherapy for patients with bronchial asthma, and chronotherapy was found to be more effective than commonly used therapeutic schemes.