[Risk factors for cardiovascular system damage in chronic kidney disease].

AIM: To study the prevalence of and risk factors (RF) associated with cardiovascular system damage in patients with predialysis diabetic and nondiabetic chronic kidney disease (CKD). SUBJECTS AND METHODS: The investigation enrolled 317 patients with CKD of various etiologies. In Group 1 (165 patients with CKD: 54% of men, 46% of women; mean age 46 +/- 15 years), the glomerular filtration rate (GFR) was 37.2 ml/min; the serum creatinine level was 2.9 mg/dl. Group 2 included 152 (41%) patients with type 2 diabetes mellitus (DM) (41% of men and 59% of women; mean age 57.3 +/- 7.1 years). The duration of DM averaged 10.4 +/- 7.1 years. All the patients underwent physical examination; the levels of glycated hemoglobin and adipose tissue hormones, urinary albumin excretion were additionally determined in the diabetic patients. Echocardiography was performed in 172 patients. The influence of populationwide and renal failure-associated RFs on the cardiovascular system was evaluated in CKD. RESULTS: Clinical and instrumental examinations of 165 patients with Stages II-IV nondiabetic CKD revealed atherosclerosis of the aorta and the vessels of the heart, brain, kidney, and lower extremities in 60 (37%), 35 (24%), 30 (18%), 23 (14%), and 8 (5%), respectively. As atherosclerotic vascular lesion progressed, the incidence of cardiovascular events (CVE) increased. Left ventricular hypertrophy (LVH) was diagnosed in 37.3% of the patients with nondiabetic CKD. Along with traditional cardiovascular RFs (age, smoking, gender, arterial hypertension), the renal dysfunction-related factors (anemia, diminished glomerular filtration rate, elevated creatitine levels, and abnormal phosphorus and calcium metabolism) are of importance. An association was found between LVH, atherosclerotic vascular lesion, and heart valve calcification. According to EchoCG data, 36% of the patients with type 2 DM were diagnosed as having LVH. The RFs of the latter were albuminuria, obesity, and abnormal carbohydrate and purine metabolisms. There was an association of diabetic nephropathy with left ventricular remodeling processes and a history of CVE. CONCLUSION: The development of cardiorenal syndrome is observed in early-stage CKD and related to both traditional and renal RFs.

[Test strip evaluation of albuminuria for the early detection of chronic kidney disease in persons with different risks (the experience of the Health Centers of the Moscow Region)].

AIM: To evaluate albuminuria (AU) in the Moscow Region's dwellers visiting the health centers and to clarify its association with the proven and discussed risk factors (RF) of chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 1623 patients (390 (24%) men and 1233 (76%) women; mean age 46 +/- 16 years) were examined. Urinalysis using test strips was performed in all the examinees. AU was estimated by the following scale: normal AU (NAU) (< 10 mg/l), an initial increase (11-30 mg/l), a pronounced increase (31-300 mg/ml), very high AU (> 300 mg/ml). A questionnaire covering gender, age, patients' anthropometric data, comorbidities, healthy lifestyle adherence, and smoking was designed to assess possible RFs for CKD. Body mass index (BMI) was calculated. Medical history examination showed metabolic disturbances and cardiovascular diseases. RESULTS: The detection rate of NAU was 18%; the initial and pronounced increases were found in 40 and 41% of the examinees, respectively; the very high AU was in 1%. The first questionnaire items associated with AU > 30 mg/ml were complaints of edema, sternal pain, poor appetite, meat aversion, and constant thirst. The detection rate of AU > 30 mg/l in hypertensive persons was 51%. If the patients had diabetes mellitus or a history of increased blood glucose episodes, the detection rate of AU > 30 mg/l amounted to as much as 65.5%. Estimation of overweight and obesity indicated that AU of > 30 mg/l was found in 44 and 49% of cases, respectively (p < 0.001). Analgesic abusers, long-term smokers, and sedentary people were statistically significantly more frequently found to have AU of > 30 mg/l. CONCLUSION: The pronounced and very high AU was noted in more than 40% of those who had visited the health centers. A questionnaire survey makes it possible to reveal a variety of AU increase-associated factors that primarily reflect metabolic disturbances and cardiovascular diseases and to identify a risk group in order to study AU first. Particular emphasis should be placed on the examinees' lifestyle. Healthy lifestyle non-adherence is closely correlated with increased AU and may be regarded as a RF for CKD.

[Risk factors for myocardial remodeling at stage II-IV of chronic kidney disease].

AIM: To evaluate frequency and risk factors of development of left ventricular hypertrophy (LVH) of the heart in patients with chronic kidney disease (CKD) of stage II-IV. MATERIAL AND METHODS: The trial enrolled 83 patients (42 - 51% males, 41 - 49% females, mean age 46.7 years) with stage II-IV CKD of non-diabetic origin. Glomerular filtration rate (GFR) estimated according to Cockroft-Goult formula was 37,7 ml/min (95% confidence interval from 33,9 do 41,4). Chronic renal failure duration averaged 2,7 years (95 % CI from 2.0 to 3.3). Arterial hypertension (AH) was diagnosed in 96% patients, hereditary predisposition to cardiovascular diseases - in 54%, obesity - in 60%. lipid disbolism - in 66%, anemia - in 34 % and hyperphosphatemia - in 45%; 40% patients smoked. Echocardiography was performed in all the patients. RESULTS: LVH was detected in 31 (37.3%) of 83 patients. With progression of renal failure, frequency of registration of LVH increased LVH onset was associated with conventional (age, AH, high level of total cholesterol) and renal (lowering of GFR, anemia, hyperphosphatemia) factors. Concentric remodeling, concentric LVH, eccentric LVH were detected in 31.3, 19.3 and 18.1% patients, respectively. Eccentric LVH developed more frequently under the influence of factors associated with renal failure (GFR, anemia, hyperphosphatemia, hypocalcemia). Concentric LVH was characterized with the highest systolic blood pressure. CONCLUSION: Patients with renal dysfunction develop LVH of different geometric model associated with both conventional and renal risk factors even at early stages of CKD.

[Association of gene TP53 polymorphic marker Pro72Arg with clinical characteristics of chronic glomerulonephritis].

AIM: To study association of gene TP53 polymorphic marker Pro72Arg coding synthesis of p53 protein with onset, course and progress of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: We examined 126 patients (63 males and 63 females, mean age 38.8 +/- 13.2 years) with CGN duration 13.0 +/- 9.1 years. When analyzing genetic predisposition to CGN, we compared incidence rate of alleles/genotypes of polymorphic marker Pro72Arg of gene TP53 in CGN patients and 69 controls free of renal disease. CGN clinical features were assessed retrospectively including analysis of nephritis onset, clinical and morphological variants. The course of CGN was analysed by changes in severity of hypertension, persistence of proteinuria > 3 g/day during 6 months and longer, conduction of immunosuppressive therapy and response to it. In analysis of progression rate, doubling of blood creatinine was considered as an end point. We used polymerase chain reaction with analysis of restriction fragment length for identification of alleles of Pro 72Arg polymorphic marker of TP53 gene. RESULTS: Distribution of the genotypes of the above polymorphic marker in CGN patients and in controls did not significantly differ. Depending on Pro allele carriage, CGN patients were divided into two groups: Arg/Arg group (59 carriers of genotype Arg/Arg) and Pro group (63 patients with genotype Arg/Pro and 4 with genotype Pro/Pro). Carriage of Pro allele of gene TP53 was associated with high CGN activity at onset, presence of arteriolosclerosis and IgA deposits in kidney biopsy. Patients with genotype Arg/Arg more frequently developed nephritic syndrome without renal dysfunction syndrome. CONCLUSION: We have discovered association of gene TP53 polymorphic marker Pro72Arg with clinical manifestations of CGN. Carriers of Pro allele more often have signs of active glomerular inflammation and vascular impairment with renal dysfunction while carriers of Arg/Arg genotype more frequently demonstrate isolated nephritic syndrome.

[Molecular factors of angiogenesis in renal tissue of patients with chronic glomerulonephritis: association with nephrosclerosis and anemia].

AIM: To study correlations between accumulation of angiogenesis molecular factors (hypoxia-inducible factor-1alpha - HIF-1alpha, vascular endothelial growth factor - VEGF, thrombospondin - TSP-1) in kidney biopsy tissue from chronic glomerulonephritis (CGN) patients and severity of nephrosclerosis, obliteration of renal capillary bed, filtration dysfunction and anemia. MATERIAL AND METHODS: We examined 22 patients with marked proteinuria (2.77; 5.7, mean 4.2 g/ day). Half of the patients had nephrotic syndrome. Glomerular filtration rate (GFR) by Cochroft-Golt formula was 68 (53;84) ml/min/1.73 m2. According to renal biopsy findings, CGN was detected in 19 patients, 2 patients had lupus nephritis (LN), 1 patient had renal amyloidosis. Nineteen CGN patients were divided into two groups by nephrosclerosis severity: group 1-7 patients with moderate nephrosclerosis, group 2-12 patients with severe nephrosclerosis. Cryostate sections of renal biopsy tissue samples were studied immunohistochemically using monoclonal antibodies to HIF-1alpha, VEGF, TSP-1, CD34. The reaction intensity was assessed by 6-point scale semiquantitative method. RESULTS: Response to HIF-1alpha was stronger in the tubular epithelium than in glomeruli. No correlation was observed between accumulation of HIF-1alpha in the glomeruli and tubular epithelium. Intensity of glomerular staining correlated with severity of proteinuria (Rs = 0.63, p < 0.05), intensity of HIF-1alpha accumulation in tubular epithelium correlated with duration of the kidney disease (Rs = 0.74, p < 0.001), duration of persistent arterial hypertension (Rs = 0.68, p < 0.05) and severity of nephrosclerosis. VEGF and TSP-1 were found in equal quantity both in the glomeruli and renal interstitium. CGN patients with marked nephrosclerosis had lower accumulation of VEGF and higher TSP-1 in the interstitium. No correlation was found between intensity of tubular epithelium response to HIF-1alpha and accumulation of VEGF in the interstitium. Patients with severe nephrosclerosis demonstrated weaker staining of tubulointerstitium to CD34, reflecting the degree of its vascularisation. Significant correlation between CD34 and expression of HIF-1alpha, VEGF, TSP-1 was not registered. In patients with low intensity of tubular epithelial staining to HIF-1alpha (less than 2 points) anemia was detected in 63% versus 18% in patients with more intensive accumulation. CONCLUSION: CGN progression is associated with development of renal tubulointerstitial ischemia. High tubular production of HIF-1alpha was not accompanied with activation of VEGF accumulation in renal interstitium but was associated with reduced risk of anemia in CGN patients with manifest nephrosclerosis.

[Cardiorenal syndrome in ischemic renal disease (atherosclerotic renovascular hypertension)].

AIM: To characterize cardiorenal syndrome in ischemic renal disease (IRD). MATERIAL AND METHODS: In examination of 105 IRD patients (63 males and 42 females, mean age 63.8 +/- 5.1 years) we estimated body mass index (BMI), indices of peripheral blood and urine, blood biochemistry, glomerular filtration rate (GFR). Plasmic homocystein concentration was measured in 30 patients. We also studied incidence of some cardiovascular risk factors, clinical variants of atherosclerosis and their correlation with GFR. RESULTS: IRD patients most frequently had hypertriglyceridemia (67.6%), hypercholesterinemia (53.3%), smoking (47.1%), obesity (41.9%), metabolic syndrome (38.1%), type 2 diabetes mellitus, arterial hypertension of the third degree (70.6%), isolated systolic arterial hypertension (46.7%). GFR was significantly lower in smokers (p < 0.001), arterial hypertension of the third degree (p < 0.05), isolated systolic arterial hypertension (p < 0.001) and type 2 diabetes mellitus (p < 0.05). In GFR < 40 ml/min homocysteinemia increased significantly (p < 0.01). Coronary artery disease in IRD occurred in 52.4%, cerebrovascular diseases (brain stroke, transitory ischemic attacks)--in 29.5%, intermittent claudication--in 19.0%, aneurism of the abdominal aorta--in 7.6%, documented atherosclerotic affection of the upper limb arteries--in 2.8%. Patients with intermittent claudication were characterized by significantly less GFR compared to that in patients without clinical symptoms of affected arteries of the lower limbs (38.6 +/- 8.2 and 44.6 +/- 7.3 ml/min, respectively; p < 0.01). CONCLUSION: Basic symptoms of cardiorenal syndrome in IRD are high rate of cardiovascular risk factors, some of them provoke aggravation of glomerular endotheliocyte dysfunction and deterioration of intrarenal hemodynamics leading to GFR reduction underlying appearance of new endothelium-tropic risk factors (hyperhomocysteinemia), and progression of atherosclerotic process with formation of its special clinical forms (intermittent claudication).

[The role of major vessels remodeling in development of left ventricular hypertrophy in patients with a predialysis stage of chronic renal failure].

AIM: To study correlation between development of left ventricular hypertrophy (LVH) and remodeling of major arteries at a predialysis stage of chronic renal failure (CRF). MATERIAL AND METHODS: A total of 95 non-diabetic patients (48 males-51% and 47 females-49%) with stage I-III CRF entered the trial. A mean age of the patients was 46.7 years (95% CI 43.7-49.8 years). Glomerular filtration rate calculated by Cockrott-Gault formula was 37.7 ml/min (33.9-41.4 ml/min), blood creatinine level--2.9 mg/dl (2.6-3.2 mg/dl). Arterial hypertension (AH) was registered in 96% patients, smoking--in 40%, cardiovascular hereditary burden--in 54%, hyperlipidemia--in 66%, overweight--in 60%, anemia--in 34%, hyperphosphatemia--in 45%. Echocardiography, ultrasonic dopplerography of the common carotid arteries (CCA) and common femoral artery (CFA) were performed in 83 and 37 patients, respectively. RESULTS: LVH (LV myocardium mass index > 134 g/m2 for males and > 110 g/m2 for females) was detected in 37.3% patients. Concentric remodeling was recorded in 31.3%, concentric myocardial hypertrophy--in 19.1% patients, excentric hypertrophy--in 18.1%. Development of LVH was linked with age, high systolic and pulse blood pressure, marked renal dysfunction, anemia, elevated ESR and hyperphosphatemia. The presence of L VH correlated with increased thickness of intima-media complex (IMC) of CCA and CFA (r = 0.65, p < 0.01 and r = 0.51, p < 0.05, respectively). There was correlation between thickness of LV posterior wall and impairment of CCA elasticity (r = -0.42, p < 0.05). CONCLUSION: Patients with initial and moderate disorders of renal function frequently have LVH related to conventional and "renal" risk factors. A LV mass increase and structural-functional changes of major vessels strongly correlate.

[Ischemic renal disease (atherosclerotic renovascular hypertension), a clinical variant of disseminated atherosclerosis and a cause of chronic renal insufficiency].

The study included 105 patients (63 men and 42 women) aged 34-84 (mean 63.8 +/- 5.1) years with ischemic renal disease (IRD). All of them underwent routine medical examination, blood homocysteine was measured in 30 patients. IRD was always associated with other manifestations of disseminated atherosclerosis and cardiovascular risk factors. Plasma homocysteine increased with decreasing glomerular filtration rate (GFR) that was especially low in patients with isolated systolic arterial hypertension, smoking, and type 2 diabetes. In 34.3% of the patients, IRD associated with other chronic conditions and in 49% with cardiovascular complications and/or the development of terminal renal insufficiency. It is concluded that IRD is characterized by a large number of concomitant manifestations of disseminated atherosclerosis and a high probability of irreversible deterioration of renal functions related to cardiovascular risk factors. IRD may be associated with other chronic renal diseases and a high risk of cardiovascular complications and terminal renal insufficiency.

[Risk factors of vascular complications in patients at a predialysis stage of chronic renal failure].

AIM: To specify risk factors of vascular complications at a predialysis stage of renal failure. MATERIAL AND METHODS: The trial enrolled 165 patients with chronic renal failure (CRF) aged 46 +/- 15 years, glomerular filtration rate (GFR) - 37.2 (35.02-40.83) and arterial hypertension (96%). The examination included ultrasound dopplerography of the common carotid arteries (CCA) and common femoral arteries (CFA) for detection of atherosclerotic plaques (AP), estimation of the thickness of arterial intima-media, elasticity and rigidity of the vascular wall. Factors of risk for atherosclerosis and cardiovascular complications were assessed. RESULTS: Aortic atherosclerosis was detected in 60 patients, that of cardiac vessels, brain, kidneys and lower limbs - in 35, 30, 23 and 8 patients, respectively. Acute cardiovascular complications occurred in 13 patients. Main atherosclerosis risk factors were age, body mass index, systolic and pulse arterial pressure, disturbances of phosphorus-calcium metabolism. Structure and function of CCA and CFA were studied with dopplerography in 37 CRF patients. Increased intima-media thickness was associated with age, male sex, overweight, hypercholesterinemia, systolic and pulse arterial pressure. Body mass index, GFR, creatinin level were independent factors of intima-media thickness. Abnormal elasticity of CCA was related to hypertension, CFA - to hypercholesterolemia.

[Ischemic renal disease: clinical course, prognosis, possibilities of treatment].

The case presented for clinical discussion is a patient suffering from ischemic renal disease underlied by renal arterial artherosclerotic stenosis. The article demonstrates a leading role of diagnostic imaging and radiosurgical therapy (balloon dilatation and stenting), and a low effectiveness of conservative treatment.

[The atherosclerotic stenosis of the sole kidney's artery combined with diabetic nephropathy].

The author presents a case of left-sided ischemic renal disease in a patient with diabetes mellitus, who underwent nephrectomy.

[Disorders of 24-h rhythm of blood pressure in patients with chronic glomerulonephritis].

AIM: To characterize 24-h profile of blood pressure (BP) and to clarify prognostic significance of 24-h BP variability in patients with chronic glomerulonephritis (CGN) with intact renal function and hypofunction of the kidneys. MATERIAL AND METHODS: A total of 38 hypertensive CGN patients (29 males and 9 females, mean age 37.9 +/- 12.4 years) entered the trial. All the patients had systolic BP (SBP) > 140 mm Hg and/or diastolic BP (DBP > 90 mm Hg. RESULTS: Twenty patients with renal hypofunction (creatinine > 1.4 mg/dl) had significantly higher (p < 0.05) SBP, day and 24-h SBP duration, high variability of day-time and 24-h SBP. Significantly higher mean day-time, night-time and 24-h SBP, SBP day-time and 24-h duration SBP duration, variability of SBP and DBP for a day and 24-h, respectively, were observed in 15 patients with left ventricular hypertrophy. Of prognostic significance in relation to renal survival estimated by Cox in 21 patients in multifactorial analysis were blood creatinine level, glomerular filtration rate, the patient's age, SBP duration for day, night and 24 hours. In multifactorial analysis, the final model included only age of the patient and blood creatinine. CONCLUSION: CGN patients with renal hypofunction had higher SBP and its variability associated with left ventricular variability.

[The role of polymorphic markers of vasoactive hormones genes in clinical characteristics of chronic glomerulonephritis].

AIM: To examine association of polymorphic markers of I/D gene of angiotensin-converting enzyme (ACE), C(-344)T gene of aldosterone synthetase (CYP11B2) and 4a/4b gene of endothelial synthetase of nitric oxide (NOS3) with clinical picture of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: The trial covered 167 CGN patients. Clinical characteristics of CGN (nephritis, debute, its clinical and morphological variants, analysis of the clinical course as regards arterial hypertension severity, rate of persistence of proteinuria (PU) of the nephrotic level for 6 months and longer, frequency of AH combination with persistent PU was made retrospectively in the groups of patients by genotypes of the genes ACE, CYP11B2 and NOS3. RESULTS: In CGN patients, carriage of the combination of allele D of ACE gene, allele C of CYP11B2 gene, and allele 4a of NOS3 gene was associated with more frequently occurring nephrotic syndrome and AH in the disease onset. A CGN course in patients with genotype DD (ACE gene) often complicates with AH, in patients with genotype CC (gene CYP11B2) and in carriers of allele 4a (gene NOS3)--with severe AH. Carriers of allele D (gene ACE) HA often combines with persistent PU the nephrotic level. A morphological variant of CGN is not associated with carriage of genotypes of polymorphic markers of genes ACE, CYP11B2 and NOS3. CONCLUSION: There is association of polymorphic markers I/D of ACE gene, C(-344)T of gene CYP11B2 and 4a/4b of gene NOS3 with clinical features of CGN. Carriers of alleles associated with high activity of PAAC--allele D of gene ACE, allele C of gene CYP11B2 and allele 4a of gene NOS3--had more severe clinical picture at all stages of the disease.

[Factors influencing the condition of the intima-media complex of carotid and femoral arteries at initial stages of chronic renal failure].

AIM: To examine changes in the structure of large (carotid and femoral) arteries at an early stage of chronic renal failure (CRF) and factors significant for their development. MATERIAL AND METHODS: Duplex ultrasonography of the common carotid arteries (CCA) and common femoral arteries (CFA), serum biochemical tests, echocardiography were made in 32 patients (15 males and 17 females) with chronic diffuse renal disease at an initial stage of CRF (creatinine 2.7 mg%, CRF duration 2.7 years). Increased thickness of the intima-media complex (IMC) in both vascular territories was found in 72% of the examinees. There was a close correlation between CCA and CFA IMC (chi-square = 14.05; p = 0.0002). Plaques in the carotid arteries correlated with smoking (chi-square = 4.60; p = 0.0320), in the femoral arteries--with male sex (chi-square = 5.18; p = 0.0228). IMC of both arteries correlated with age (r = 0.49 and r = 50, respectively, p < 0.05), body mass index (r = 0.50, p < 0.05), thickness of the left ventricular posterior wall and interventricular septum (r = 0.65 and r = 0.55, respectively, p < 0.05), CFA IMC correlated also with creatinine level (r = 0.39, p < 0.05), hypertriglyceridemia (chi-square = 10.33; p = 0.0013), systolic, pulse and mean arterial pressure (r = 0.45, r = 0.38, r = 0.36, respectively, p < 0.05), smoking (r = 0.48, r = 0.40, respectively, p < 0.05) and family history of cardiovascular diseases (chi-square = 7.16; p = 0.0075). A linear multifactorial regression analysis has detected that an independent factor of increased CCA and CFA IMC in patients under 50 years of age was creatinine, in patients over 50 years--age. CONCLUSION: Even at early stages of renal failure patients have thicker IMC associated with both standard risk factors (age, hypertension, smoking, lipid disbolism) and development of renal failure itself.

[Arterial hypertension in chronic glomerulonephritis: detectability and treatment efficacy]. / Arterial'naia gipertoniia pri khronicheskom pri khronicheskom glomerulonefrite: chastota vyiavleniia i éffektivnost' lecheniia.

AIM: To study prevalence of arterial hypertension (AH) in patients with chronic glomerulonephritis (CGN), its relationship with activity of the renal process, renal function; to analyse policy and efficacy of antihypertensive therapy. MATERIAL AND METHODS A total of 250 CGN patients treated in 1993-2001 participated in the trial. They had different morphological variants of CGN. AH was diagnosed in 193 patients. In the course of the trial changes in antihypertensive treatment policy were observed. RESULTS: AH was most prevalent in mesangiocapillary (96.6%) and diffuse fibroplastic nephritis (83.9%). In functional insufficiency of the kidneys AH occurred in 90.1%. AH was associated with clinical and morphological signs of nephritis activity, severity of tubulointerstitial alterations, purin and lipid metabolism. Uric acid level and age were independent prognostic factors of AH development. AH correction was achieved in the initial and subsequent periods in 51.7 and 58.7% cases. Later, ACE inhibitors were prescribed more often, both in monotherapy and in combination with other drugs; calcium antagonists were taken less frequently. CONCLUSION: AH in CGN patients is a frequent finding and depends on a morphological nephritis variant, activity of the renal process and degree of renal failure. Age, gender and metabolic disorders are also involved in AH development in CGN patients. Recently, there is a trend to more frequent prescription of combined treatment. Drugs of choice in the treatment of renal AH are ACE inhibitors.

[Association of the complex of polymorphic markers of ACE genes, aldosteron synthetase and endothelial synthetase of nitric oxide with progression of chronic glomerulonephritis]. / Assotsiatsiia kompleksa polimorfnykh markerov genov angiotenzinprevrashchaiushchego fermanta, sintazy al'dosterona i éndotelial'noi sintetazy okisi azota s progressirovaniem khronicheskogo glomerulonfrita.

AIM: To study association of the complex of polymorphic markers of ACE genes (ACE complex), aldosteron synthetase gene (CYP11B2) and endothelial synthetase of nitric oxide (NOS3) with onset, course and progression of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: 117 CGN patients were examined. Genetic predisposition to CGN development was studied by comparison of distributions of alleles and genotypes of polymorphic markers of genes ACE, CYP11B2 and NOS3 in CGN patients and controls (n = 80) free of renal diseases and arterial hypertension (AH). The course of CGN was analysed with consideration of the following factors: AH severity, proteinuria persistence, nephritic level for 6 months and longer, immunosuppressive therapy and response to it, therapy with ACE inhibitors and/or blockers of antiotensin II receptors (ARB). CGN progression rate end point was doubling of initial blood creatinine level. RESULTS: Significant differences in the incidence of the above alleles and genotypes in the patients and controls were not found. The patients were divided into two groups: group 1 consisted of 25 patients carrying the combination of alleles D+C+4a, group 2 consisted of the rest 92 patients. The groups did not differ by CGN course parameters, but renal survival was significantly lower in carriers of the allele combination D+C+4a. Cox's mono- and multifactorial regression analysis has shown that carriage of the allele combination D+C+4a is an independent riskfactor of renal survival deterioration. CONCLUSION: No association was detected between polymorphic markers of genes ACE, CYP11B2 and NOS3 and onset of CGN. Carriage of D+C+4a allele combination is an independent factor of risk for fast progression of chronic renal failure.