Use of specific anti-HLA antibodies in clinical nephrology.

In order to optimize the regimen of pathogenetic therapy of glomerulonephritis with nephrotic syndrome we used transfusions of plasma containing specific anti-HLA antibodies against the patient's phenotype as a part of the treatment in the acute stages of disease. The method was theoretically based on the conception of autoimmune genesis of glomerular lesion as well as on the assumption that the highest expression of HLA-antigens are on the surface of activated immunocompetent cells. In previous experiments in vitro we demonstrated immunosuppressive activity of cytotoxic serum on lymphocytes in the absence of complement. Stable remission that was associated with the recovery of serum IgG/IgM balance and normalization of cellular immunity indices was achieved in 72% of 50 treated patients after 2-4 transfusions. Immunotherapeutic properties of anti-HLA antibodies were also confirmed with preliminary results of plasma transfusions in 5 kidney graft recipients. Posttransfusion reactions of a non-haemolytic type were slight and transient. The data presented allow us to conclude that our method may be useful in clinical cases associated with undesirable immune activation induced by both auto- and alloantigens.

[The use of laser irradiation in nephrological practice]. / Primenenie lazernogo oblucheniia v nefrologicheskoi praktike.

The authors studied therapeutic potential and mechanism of action of low-intensity low-energy laser irradiating the skin at the site of the projection of the transplanted kidney poles through the development of chronic rejection or chronic pyelonephritis. The trial included 7 kidney recipients and 9 controls with primary chronic pyelonephritis. The treatment course implied 10 daily session of 20 minutes duration of He-Ne laser irradiation which was preceded by clinical-laboratory evaluation of the blood and urine, cellular and humoral immunity, hemostasis, central hemodynamics, local and mediator hormones, factors of nonspecific resistance, spin probe characteristics. The effect appeared contradictory. It is thought valid to combine quantum and drug therapy thus achieving optimal therapeutic effects and preventing side effects.

[Features of correction of phosphate-calcium metabolism disorders in terminal renal failure]. / Osobennosti korrektsii narushenii fosfatno-kal'tsievogo obmena pri terminal'noi pochechnoi nedostatochnosti.

Mineral metabolism was studied in 27 hemodialyzed patients with terminal chronic renal failure (CRF). Because of progressing hyperparathyroidism the initial treatment included calcium drugs, active forms of vitamin D (videchol, oxidevit), almagel, bicarbonate hemodialysis and hemosorption. The condition improved in 8 and stabilized in 12 patients. Conservative treatment was ineffective in 7 patients who consequently underwent total (4 cases) or subtotal (3 cases), parathyroidectomy. The response was achieved in 3, stabilization in 3, the disease advanced in 1 patients.

[A method of preparing an arteriovenous shunt for chronic hemodialysis]. / Metodika nalozheniia arteriovenoznogo shunta dlia khronicheskogo gemodializa.

The authors discuss their experience in forming arteriovenous fistulas for conducting chronic hemodialysis in 361 patients with accentuation placed on the features of performing repeated and multiple operations. The formation of arteriovenous fistulas in the lower third of the upper arm or the cubital fossa with retrograde blood flow into the venous system is the operal vessels, and a history of multiple operations on the forearm vessels. Hemodialysis in such cases should be started no sooner than two weeks after the operation.

[Pathogenetic characteristics of hemostatic disorders in chronic renal failure]. / Patogeneticheskie osobennosti gemostaticheskikh narushenii pri khronicheskoi pochechnoi nedostatochnosti.

As many as 45 patients with terminal chronic renal failure (CRF) admitted to the hospital were examined for hemocoagulation and blood plasma content of medium-sized molecules (MSM). Animal (rabbit) experiments were made in vitro and in vivo to study the effect produced on hemocoagulation of MSM isolated from CFR patients' blood by acidic deproteinization, ultrafiltration and gel chromatography. Integrally, the MSM fraction was shown to exert marked anticoagulant and antiaggregation effects, to increase vascular permeability, promoting the development of hemorrhagic diathesis in CRF patients. Hemodialysis (HD) is an effective method for treating hemorrhagic diathesis of the given genesis. At the same time under the conditions of the presence of the cellular template (red blood cell hemolysis, platelet destruction as a result of HD) MSM may give rise to the development of thrombotic complications after HD completion and heparin neutralization. Therefore accumulation of MSM may play an important part in the onset of hemocoagulation disorders in patients with CRF.

[Correction of disorders of systemic hemodynamics and rheologic indices of the blood in patients with chronic kidney failure during hemodialysis]. / Korrektsiia narushenii sistemnoi gemodinamiki i reologicheskikh pokazatelei krovi u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu v protsesse gemodializa.

During hemodialysis, 44 patients with terminal chronic renal failure were examined for the systemic hemodynamics and blood rheological properties as well as for the possibility of their correction by infusion of the plasma substitutes: polyglucine, rondex or 10% albumin at a volume of 400 ml per administration. It was established that patients on hemodialysis manifested pronounced hemodynamic and rheological disorders. During hemodialysis, the hemodynamic disorders correlated with the changes in the rheological properties of the blood (r = 0.23-0.45, p less than 0.05). It is indicated that to treat the hypotensive states occurring in the course of hemodialysis, infusions of the plasma expanders, rondex, 10% albumin and polyglucine may be used at a limited volume. The plasma substitute rondex ensures a more favorable hemodynamic and rheological effect, comparing very favourably with other preparations investigated.

[Comparative study of hemodialysis methods]. / Sravnitel'noe issledovanie metodik gemodializa.

An analysis of the results of chronic hemodialysis on central systems and individual apparatuses in 20 patients with the terminal stage of renal insufficiency was performed. It was established that the use of chemically pure water, disposable systems and dialyzers for hemodialysis ensured a decrease in the number of complications and improved the patients' rehabilitation. Bicarbonate hemodialysis proved to be a highly effective method for the treatment of patients with sodium acetate intolerance, decompensated metabolic acidosis and low arterial pressure. A single-needle approach to the patient's vascular system provided for a less marked decrease in uremic toxins, however statistically significant differences were undetectable as compared to the common methods.