Vol 78, No 6 (2003)

Ischemic disease of the kidneys
Mukhin N.A., Kozlovskaya L.V., Kutyrina I.M., Moiseev S.V., Shvetsov M.Y., Fomin V.V., Kushnir V.V.
Terapevticheskii arkhiv. 2003;78(6):5-11
Clinical implications of DNA-topoisomerases examination in renal biopsies from nephritis patients
Ivanovа L.V., Shilov E.M., Ivanov A.A., Kozlovskaya L.V., Rudolph P., Proppe D.
Aim. To study expression of topoisomerases (TI) I and Ha (DNA-bound enzymes involved in transcription and replication) in renal tissue as markers of activity and prognosis of glomerulonephritis (GN) decisive for choice of immunodepressive therapy. Material and methods. TI expression was studied immunohistochemically in renal biopsies from 177 patients with different morphological variants of GN and in the samples of unaffected kidney tissue removed in 12 patients for local tumors. Results. There are definite differences between proliferative and поп-proliferative GN variants - elevation of TI levels and monocytic infiltration in proliferative GN. Focal-segmental glomerulosclerosis is characterized by a high TI Ila level in mesangial cells and monocytic infiltration of the glomeruli which are typical for inflammation. A statistical relationship between TI levels in mesangial cells and glomerular epithelium suggests a pathogenetic relation between these links of the pathological process. Molecular markers of activation and proliferation of cells and direct inductors of the inflammatory process (cells of monocytic infiltrate) closely correlated with the activity index - an integral indicator of inflammatory activity, as well as with the integral indicator of sclerotic processes in renal tissuesclerosis index. Monocytic infiltration in the interstitium correlated both with morphological manifestations of activity, progression of nephritis and their clinical equivalents. In high TI expression GN resistance to immunodepressive therapy rose. To overcome the resistance, immunodepressive therapy must be more active - large doses and duration of treatment. In patients with lupus nephritis and merenal GN prognosis was worse in the presence of high TI expression in mesangial cells and epithelium of the renal canaliculi. Conclusion. The authors are the first to demonstrate TI expression in renal tissue of GN patients, correlation of its level with activity of renal process as well as its role in prediction of response to treatsangiocapillary ment and the rate of renal failure progression. It is suggested that high TI expression entails a progressive course of GN.
Terapevticheskii arkhiv. 2003;78(6):11-17
Assessment of vasomotor endothelial function inpatients with diabetes mellitus type l at different stages ofdiabetic nephropathy
Shestakova M.V., Yarek-Martynov I.R., Ivanishina N.S., Dedov I.I.
Aim. To study a vasomotor endothelial function in patients with diabetes mellitus (DM) type 1 at different stages of diabetic nephropathy (DN). Material and methods. Twenty six patients with DM type 1(11 males and 15 females, mean age 25.9 ±4.3 years, mean history of DM 12.9 + 3.4 years) entered the study. They were divided into 4 groups: group 1 -without renal affection, group 2 - with microalbuminuria (MAU), group 3 - with proteinuria (PU), group 4 - with chronic renal failure (CRF). The control group consisted of 7 healthy volunteers. Endothelium-dependent vasodilation (EDVD) was studied in the test with reactive hyperemia provoked by 4-5 min occlusion of the brachial artery by pneumocollar and subsequent assessment of arterial diameter changes after decompression using high-resolution ultrasound dopplerography. Results. Reactive hyperemia resulted in dilation of the artery in all the examinees. This dilation was maximal on second 30 after removal of the collar in the controls, group 2, 3 and 4 and reached 9.2 ± 2.9, 9.63 ± 3.62, 7.25 ± 5.23 and 4.42 ± 4.05%, respectively. Resting blood flow velocity was similar in all the groups and rose maximally by 95-150%. To estimate EDVD of the brachial artery more precisely, the coefficient of endothelial sensitivity to shift tension was calculated. It made up 0.084 ± 0.04 (control group), 0.0825 + 0.08 (group 1), 0.138 ± 0.07(group 2), 0.067 ± 0.05 (group 3) and 0.052 ± 0.04 (group 4). Conclusion. At the earliest stage of DN (stage MAU), EDVD is not affected as maximal vasodilation of the brachial artery and endothelial sensitivity to shift tension do not differ from the control values. This means that the stage of MAU is reversible in early treatment, but PU and CRF are not reversible stages associated with depletion of endothelial cells and loss of sensitivity to changing hemodynamic conditions.
Terapevticheskii arkhiv. 2003;78(6):17-22
Clinical manifestations of APS-nephropathy in primary antiphospholipid syndrome
Shilov E.M., Kozlovskaya N.L., Meteleva N.A., Kozlovskaya L.V., Varshavsky V.A., Miroshnichenko N.G., Blokhina G.V., Serova A.G., Nesterova S.G., Smolyanilsky A.Y.
Aim. To elicit clinical features of nephropathy associated with antiphospholipid syndrome (APSN) in patients with primary antiphospholipid syndrome (PAPS). Material and methods. The analysis of clinical characteristics and course of APSN has covered 24 patients with PAPS (16 females and 8 males, mean age 34.3 years). Renal damage was represented by arterial hypertension (AH), urinary syndrome, functional decline. All the patients were tested for anticardiolipin antibodies and/or lupus anticoagulant. Renal biopsy was made in 7patients. Results. PAPS patients developed renal affection in the onset of APS or within the first 5 years of its course. In the majority of patients APSN combined with abnormalities of CNS, heart and skin. Arterial/arteriolar thromboses prevailed. APSN manifested with: AH (n = 23, severe AH in 11), abnormal renal fdtration (n = 17, creatinine rise in 8), urinary syndrome with proteinuria (n = 23, in 14 with hematuria). The following clinical variants of APSN were proposed: urinary syndrome with AH (n = 16; 67%), acute nephritic syndrome (n = 7; 29%), nephrotic syndrome (n = 1). Morphological studies of biopsies from APSN patients have revealed sclerotic changes, thrombotic microangiopathy, nonspecific alterations in the glomeruli. Conclusion. APSN is a variant of microvascular renal affection caused by thrombotic processes in intraorgan microcirculation, ft is an early clinical marker of APS. Clinically, APSN manifests with vascular renal affection, the earliest symptom being inhibition of glomerular filtration. Clinical combinations of the symptoms allow to distinguish variant of APSN suggesting the existence of acute and chronic APSN. Combination of APSN with affection of the CNS, heart and skin points to a special PAPS subtype characterized by generalized ischemic damage to the organs as a result of intraorganic arterial and/or arteriolar thromboses.
Terapevticheskii arkhiv. 2003;78(6):22-28
Arterial hypertension, its metabolic aspects and function of the kidneys inconvalescents after hemorrhagic fever with renal syndrome
Pimenov L.Т., Dudarev M.V., Vasilyev M.Y.
Aim. To characterize late convalescence after hemorrhagic fever with renal syndrome (HFRS), i.e. metabolic disorders and their relation with arterial pressure (AP) and renal function. Material and methods. 202 HFRS convalescents were followed up with measurements of AP, purin, carbohydrate and lipid metabolisms, study of glomerular and tubular dysfunctions. Results. A stable rise of arterial pressure registered in 24% HFRS convalescents was associated with intraglomerular hypertension, affected concentration ability of the kidneys and tubular transport of/32- microglobulin in the presence of metabolic disorders: hyperuricemia, hyperinsulinemia and hyperlipidemia of type I la. A significant correlation was found between arterial hypertension and renal dysfunction and metabolic disorders. Conclusion. Late convalescence after HFRS is characterized by glomerular and tubular dysfunctions, persistent elevation of AP and hormonal-metabolic atherogenic and diabetogenic disturbances.
Terapevticheskii arkhiv. 2003;78(6):28-31
Psychologicalcharacteristics and quality of life of patients with chronicdiseases of the kidneys
Pelrova N.N., Savvina N.N., Vasilyeva I.A.
Aim. To study quality of life of patients with progressive renal pathology at the stage of conservative treatment. Material and methods. Quality of life and psychological features were examined in 40 patients with renal diseases (40% males, mean age 48.6 ±1.3 years). 77.5% examinees suffered from glomerulonephritis, the rest had diabetic nephropathy. Results. Personality, behavioral features of the patients were characterized as well as relationships between psychological and somatic factors in development of the disease. Factors influencing quality of life of the above patients are described. Conclusion. Correction of the variables influencing, primarily, the psychological component of the quality of life and, by this component, satisfaction of the patients with their state as a whole may have a good effect on their rehabilitation.
Terapevticheskii arkhiv. 2003;78(6):31-37
A course ofchronic glomerulonephritis and constitutional characteristics
Kukhtevich A.V., Kulikova E.V., Zilov V.G.
Aim. To evaluate correlations between the course of chronic glomerulonephritis (CG) and the patients constitution. Material and methods. 30 men and 33 women with chronic CG were divided into four groups: group 1 - chronic latent GN, group 2 - chronic nephrotic GN without renal failure, group 3 - chronic mixed GN including rapidly progressive GN, group 4 - chronic GN with renal failure. Constitution fell into 3 standard types of diathesis: dyscrasic (DD), arthritic (AD), psoric (PD). Results. Most of the patients with chronic GN exhibited prevalence of DD symptoms over AD and PD ones, especially in groups 3 and 4. In less favourable course of GN, DD signs appeared the first, became more and more pronounced while AD and PD were minimal. In a favourable course of GN symptoms of AD and PD were as pronounced as of DD or even more apparent. Conclusion. Constitutional characteristics of the patients are essential for the course and prognosis of chronic GN as well as for assessment of GN progression pattern and response to treatment
Terapevticheskii arkhiv. 2003;78(6):37-41
The role of ultrasound dopplerography with an acutecaptopril test in assessing renal hemodynamics in chronicglomerulonephritis
Marlynov S.A., Shvetsov M.Y., Kutyrina I.M., Miroshnichenko N.G., Kushnir V.V., Petrov S.V., Struchkova T.Y., Dzhanaliev B.R., Varshavsky V.A., Proskurneva E.P.
Aim. To examine blood flow in renal and intrarenal arteries and its changes in the acute pharmacological test with captopril in patients with chronic glomerulonephritis (CGN). Material and methods. Renal circulation was studied in 50 patients with CGN using ultrasound dopplerography (USDG) of renal vessels on the unit GE Logiq 400 CL PRO Series. The velocity and indices of peripheral blood resistance in the major renal artery (RA) and in intrarenal arteries were estimated. In 26 patients the blood flow was studied again after intake of 50 mg captopril. Results. Poor renal blood flow was registered in cortical parenchyma in 36% CGN patients (with chronic renal failure in 75%). Multifactorial regression analysis has demonstrated that only blood creatinine was independently related with slowing down of the blood flow at the level of RA and intrarenal arteries. Morphological index of activity correlated with resistance indices while a high sclerosis index correlated with blood flow slowing. Older patients had higher resistance indices. Captopril significantly accelerated Mod flow and insignificantly changed indices of peripheral resistance including those in CRF patients. Conclusion. Poor blood flow in the cortical layer of renal parenchyma in CGN, according to USDG, occurs rather frequently and was associated with CRF and older age of the patients. Blocking of reninangiotensin system at the level of angiotensin II formation improves renal blood flow in most of the patients.
Terapevticheskii arkhiv. 2003;78(6):41-46
Diagnosis ofleft-ventricular diastolic dysfunction in patients with pre-di-alysis chronic renal failure
Shutov A.M., Kulikova E.S., Kondratyeva N.I.
Aim. To specify effectiveness of different methods for assessment of diastolic function in patients with pre-dialysis chronic renal failure (CRT). Material and methods. Forty non-diabetic pre-dialysis СRFpatients (20 males and 20 females, mean age 51 ± 11 years) were studied. Serum creatinine was 209.3 ± 117.4 mcmol/l. 19 patients had chronic heart failure (CHF) of NYHA class l-lll. M-mode echocardiography and Doppler echocardiography were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography. The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the patients had preserved systolic function (ejection fraction > 45%). Results. Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However, we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18; p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of 16 patients with problems of transmitral flow assessment. A negative correlation was revealed between NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and E/Vp (r = 0.45; p = 0.004). Conclusion. Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of transmitral flow types.
Terapevticheskii arkhiv. 2003;78(6):46-50
Intradialysis hypotension: causes and sequelae
Milovanova L.Y., Nikolaev A.Y., Safonov V.V., Milovanov Y.S.
Aim. To study causes and sequelae of intradialysis hypotension (IH) in patients with terminal renal failure (TRF). Material and methods. Forty one patients with TRF on chronic hemodialysis (CH) were divided into two groups. The study group consisted of 24 patients with episodes of IH. Seventeen patients of the control group had no IH. All the patients were examined with assessment of protein-energy deficiency residual renal function, left-ventricular hypertrophy, diastolic function of the heart. Hemodialysis effectiveness was estimated by Kt/V index. Survival of the patients was calculated according to Kaplan-Meier method. Results. In the study group IH episodes occurred in spite of low ultrafiltration velocity (8-10 ml/min). Those patients of the study group who had IH associated with polyneuropathy and left-ventricular hypertrophy had IH episodes more often and sharper falls of arterial pressure. Long-term IH decreased survival significantly. Conclusion. Repeated episodes of IH deteriorate effectiveness of hemodialysis because of acute coronary syndrome, acute disorder of cerebral circulation, complications of deficient dialysis syndrome (pericarditis, hyperkaliemia, pulmonary edema, congestive heart failure).
Terapevticheskii arkhiv. 2003;78(6):50-53
HELLP-syndrome as a variant of renal thromboticmicroangiopathy
Ermolenko V.М., Nikolaev A.Y., Biryukova L.S., Kuznetsova T.A.
Terapevticheskii arkhiv. 2003;78(6):53-56
Morphologically unfavorable forms of lupus glomerulone-phritis: treatment and prognosis
Zakharova E.V., Mikhailova N.A., Ermolenko V.M., Gabdurakhmanov I.I., Varshavsky V.A., Proskurneva E.P.
Terapevticheskii arkhiv. 2003;78(6):56-60
Nephrolithia-sis as an initial clinical manifestation of Wilson-Konovalovdisease
Rakhimova O.Y., Rozina T.P., Ignatova Т.М.
Terapevticheskii arkhiv. 2003;78(6):60-62
Distal renal tubular acidosis complicated by medullary cysts
Vashurina T.V., Sergeeva T.V., Chumakova O.V., Tsygina E.N.
Terapevticheskii arkhiv. 2003;78(6):62-66
The role of genetic studies in development ofnephrology
Ignatova M.S.
Terapevticheskii arkhiv. 2003;78(6):66-73
Nephrological aspects ofblood diseases
Biryukova L.S., Timokhov V.S.
Terapevticheskii arkhiv. 2003;78(6):73-79
Polymorphicmarkers of vasoactive hormones genes and progression ofrenal diseases
Kamyshеva E.S., Nosikov V.V., Kutyrina I.M.
Terapevticheskii arkhiv. 2003;78(6):79-84
Nephrological aspects of congestivecardiac failure
Moiseev S.V., Fomin V.V.
Terapevticheskii arkhiv. 2003;78(6):84-89
Bobrov Vladimir Alexeevich (the 60th anniversary of birth)
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Terapevticheskii arkhiv. 2003;78(6):95-96

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