Vol 79, No 9 (2004)

Chronic progressive nephropathies and modern lifestyle
Mukhin N.A., Balkarov I.M., Moiseev S.V., Fomin V.V., Lebedeva M.V., Krasnova E.A.
Terapevticheskii arkhiv. 2004;79(9):1-9
Arterial hypertension in chronic glomerulonephritis:detectability and treatment efficacy
Kutyrina I.M., Martynov S.A., Shvetsov M.Y., Livshits N.L., Miroshnichenko N.G., Golitsina E.P., Varshavsky V.A.
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.
Terapevticheskii arkhiv. 2004;79(9):10-15
Association of thecomplex of polymorphic markers of ACE genes, aldosteronsynthetase and endothelial synthetase of nitric oxide withprogression of chronic glomerulonephritis
Kamyshova E.S., Kutyrina I.M., Nosikov V.V., Shvetsov M.Y., Gorashko N.M., Ignatyev I.V., Voronko О.Е., Shilo V.Y., Alyaev Y.G., Shilov E.M.
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 risk factor of renal survival deterioration. Conclusion. No association was detected between polymorphic markers of genes ACE, CYP11B2 and NOS3 and onset of CGN. Carriage ofD+C+4a allele combination is an independent factor of risk for fast progression of chronic renal failure.
Terapevticheskii arkhiv. 2004;79(9):16-20
Chronic glomerulonephritis and pregnancy
Rogov V.A., Shilov E.M., Kozlovskaya N.L., Gordovskaya N.В., Nikiforova O.V., Makarov I.O., Milovanov A.P.
Aim. To clarify factors of risk for unfavourable variants of gestational chronic glomerulonephritis (CGN) and poor pregnancy outcomes in CGN; to determine prognostic implications of changes in some renal and uteroplacental indices. Material and methods. Variants of CGN gestational course and pregnancy outcomes have been analysed for 156 CGN patients. The women were examined before pregnancy, in the course of pregnancy and 3-24 months after the delivery. Measurements were made of 24 h proteinuria, glomerular filtration rate, blood transaminases activity, functional renal reserve (FRR), uricemia, blood level ofalphaphetoprotein. Placentas were studied morphologically, uterine and umbilical artery circulation was assessed by dopplerometry. Results. The following abnormalities were registered: high proteinuria (34.6%), progression of hypertension (29.5%), renal function deterioration (15.4%), fetal and neonatal losses (15.4%), fetal underdevelopment (25%), preterm delivery (17.3%), preeclampsia (7.7%), preterm placental detachment (1.9%). There is morphological, dopplerometric and biochemical evidence for placental insufficiency in CGN pregnant women. Conclusion. Activity of CGN (nephritic or acute nephritic syndromes), hypertension, renal failure, disorders of renal hemodynamics are factors of risk for unfavourable gestational course of CGN and pregnancy complications. Placental insufficiency deteriorates pregnancy outcomes in CGN, but changes in uterine and umbilical circulation as well as blood levels of alpha-fetoprotein are not prognostically significant.
Terapevticheskii arkhiv. 2004;79(9):21-25
Cyclophosphamide efficacy inmaintenance therapy of nephrotic syndrome in patients withchronic glomerulonephritis
Duman V.L., Shkerina L.I.
Mm. To study effects of cyclophosphamide (CP) on duration of remission in chronic glomerulonephritis (CGN) with nephrotic syndrome (NS). Material and methods. Achievement of complete remission of NS was followed by intravenous treatment with CP in 25 of 28patients. 20 patients were in remission for 7-90 months (mean 38.9 ±5.6 months). NS recurred in 8patients after remission duration from 3 to 48 months (mean 25.4 ±6.1 months). Results. Patients in remission and NS recurrence were comparable by morphology of CGN, gender, CGN history, start of CP treatment, accumulated CP dose at remission induction, 24 h protein urine loss, levels of immunoglobulins, C-reactive protein, fibrinogen, seromucoid, complement titer, circulating immune complexes. Significant differences were observed in duration of CP maintenance, accumulated dose within the first three months and maintenance therapy. Conclusion. CP maintenance in CGN with NS should be conducted as an intravenous pulse-therapy once in 3 weeks for 3 months than once in 1-3 months for 1.5-2 years.
Terapevticheskii arkhiv. 2004;79(9):26-28
Early diagnosis of renaldamage in hypertensive patients
Nanchikeeva M.L., Konechnaya E.Y., Bulanov M.N., Gladkaya A.A., Kozlovskaya L.V.
Aim. To determine early criteria of renal affection in hypertensive patients for improvement of diagnosis and treatment of hypertensive nephropathy. Material and methods. 148 patients with essential hypertension (EH) were examined (82 males, 66 females, mean age 43.64 ± 11.35 years). Of them, 46 patients (24 young males among them) had EH of new onset (NOH) and 102 patients had EH of long duration (LDEH). The examination included investigation of lipid, carbohydrate, uric acid metabolism, renal function, microalbuminuria, intrarenal hemodynamics (color dopplerography on ALOKA SSD-2000 MultiView. Results. 50% of NOH and 90% of LDEH patients had metabolic disorders: excessive body weight, hypercholesterolemia, hypertriglyceridemia, uric acid disbolism, impaired glucose tolerance. These disorders, except uric acid metabolism, correlated in severity with duration and severity of EH. Intensity of microalbuminuria depends on EH duration, severity of concomitant metabolic defects. Markers of early renal damage in EH patients are increased intrarenal peripheral vascular resistance and microalbuminuria. These alterations are detectable in 30% NOH patients (at the disease onset). Treatment with ACE inhibitors eliminates microalbuminuria, diminished hype/filtration and improved intrarenal circulation. This justifies use of ACE inhibitors for nephroprotection in EH patients. Conclusion. Monitoring of the above early markers of renal damage and metabolic shifts is essential for assessing progression of hypertensive nephropathy and control over efficacy of antihypertensive treatment including ACE inhibitors.
Terapevticheskii arkhiv. 2004;79(9):29-34
Lowmolecular heparins in the treatment of APS-nephropathy in primary and secondary antiphospholipid syndrome
Kozlovskaya N.L., Shakhnova E.A., Kushnir V.V., Shilov E.M.
Aim. To evaluate efficacy of lowmolecular heparin enoxaparin in the treatment of nephropathy in patients with primary and secondary antiphospholipid syndrome (APS). Material and methods. A total of 11 APS-nephropathy patients participated in the study. Of them 8 patients had primary APS and 3 patients had secondary APS. Biopsy of the kidney was made in 5 patients, ultrasonic dopplerography of renal vessels was performed in all 11 patients. Enoxaparin was given as monotherapy to primary APS and combined treatment to secondary APS patients. Results. Enoxaparin decreased proteinuria, arterial pressure, glomerular filtration rate in all the patients. It also promoted normalization of creatinin. Before the anticoagulant treatment a reduction of maximal systolic and diastolic velocities of blood flow have been registered in segmental and interlobar arteries in all APS nephropathy patients compared to healthy subjects. The depletion of renal cortex blood flow beginning with the level of arcuate arteries was also observed in all the patients. Enoxaparin enhanced blood flow in segmental and interlobar arteries. The recovery of blood flow in the arcuate arteries was registered in 6 of 9 patients. Conclusion. Low molecular heparin may be used in the treatment of nephropathy in patients with primary and secondary APS.
Terapevticheskii arkhiv. 2004;79(9):35-39
Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure
Nikolaev A.Y., Ermolenko V.M., Milovanova L.Y., Milovanov Y.S.
Aim. To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). Material and methods. Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (п = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months ofpreanalysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. Results. Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric L VH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. Conclusion. Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.
Terapevticheskii arkhiv. 2004;79(9):40-42
Impact of ahemodialysis session on cardiac function in patients withchronic renal failure
Shutov A.M., Edigarova О.M., Mastykov V.E.
Aim. To determine the impact of hemodialysis (HD) session on cardiac function in patients with chronic renal failure. Material and methods. Thirty patients (17 male, 13 female, mean age 49 ± 11 years) on bicarbonate HD were studied. M-mode echocardiography was performed and ejection fraction (ЕЕ) was estimated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were estimated. All the estimations were made one hour before and immediately after HD by one investigator. Flow propagation velocity of early diastolic flow was assessed by color M-mode Doppler echocardiography. Results. A significant decrease of the ejection fraction (delta EF) was observed only in patients with intradialytic hypotension. Hemodialysis resulted in a decrease of early flow velocity from 99.2 ± 23.8 to 80.6 ± 26.0 cm/s (p = 0.0000) and E/A ratio from 1.23 + 0.57 to 0.98 ± 0.43 (p = 0.006). IVRT and DT showed no significant difference. There was a significant positive correlation between the amount of ultrafiltration and deltaE (r = 0.46; p = 0.01), there was no correlation between the amount of ultrafiltration and delta Vp (r = -0.01;p = 0.9). Conclusion. The results show that a hemodialysis session influences cardiac function in patients with chronic renal failure. Early diastolic filling considerably decreased in correlation with ultrafiltration. A significant decrease in an ejection fraction was detected only in patients with intradialytic hypotension. Ultrafiltration had no impact on flow propagation velocity of early diastolic flow of the left ventricle assessed by color M-mode Doppler echocardiography.
Terapevticheskii arkhiv. 2004;79(9):43-46
A renoprotective effect of enalapril in chronictransplantation nephropathy
Tomilina N.A., Bagdasaryan A.R., Stolyarevich E.S., Sukhanov A.V., Fedorova N.D., Ilyinsky I.M., Tyrin V.V., Frolov A.V.
Aim. To study safety and efficacy of ACE inhibitor enalapril in chronic transplantation nephropathy (CTN) as well as nephroprotective efficacy of this drug in various clinical variants of CTN. Material and methods. A retrospective study covered 220 recipients with CRF. The patients were divided into the study group (n = 103) and the control group (n = 117). The study group was given ACE inhibitor enalapril the efficacy of which was assessed by arterial pressure (systolic, diastolic, mean) dynamics, 24 h proteinuria and the rate of CTN progression. This rate was suggested by probability of plasm creatinin doubling (Kaplan-Meier technique). Results. Enalapril significantly inhibited CTN progression running with minimal or marked proteinuria, had a pronounced hypotensive effect, promoted stabilization of minimal proteinuria (in CTN with minimal proteinuria) or reduction of protein excretion (in a proteinuric variant of CTN). Conclusion. Use of enalapril in CTN in a daily dose 10 mg maximum is safe and can be used for inhibition of CTN progression.
Terapevticheskii arkhiv. 2004;79(9):47-52
Clinical and biochemical manifestations of chronic pyelonephritis and theircorrection in population of the northen areas of the Tyumen Territory
Zhmurov V.A., Oskolkov S.A., Kazeko N.I.
Aim. To study clinicobiochemical features of chronic pyelonephritis (CPN) in the population of northen areas of the Tyumen Territory; to determine emoxipine effects on CPN treatment efficacy. Material and methods. Clinicolaboratory manifestations of CPN were studied in 246 CPN patients (126 residents of the Tyumen South and 120 residents of the Tyumen North, age 18-55, 174 females, 72 males). The control group consisted of 60 healthy subjects of the same gender and age. Results. CPN in patients living in the north was characterized by more severe intoxication, dysuric disorders, piuria, arterial hypertension, more intensive restructuring of cellular membranes. Membranopathological changes depend on the phase of the pathological process and clinical form of the disease. Emoxipin addition to combined therapy of CPN promoted faster correction of basic CPN symptoms and stabilization of the lipid phase of erythrocytic membranes. Conclusion. Clinical and biochemical features of CPN in patients living in the Tyumen North represent additional diagnostic criteria of the disease activity. Adjuvant use of the antioxidant drug emoxipin produces a noticeable clinicobiochemical effect.
Terapevticheskii arkhiv. 2004;79(9):53-56
Epidemiology of chronic renal disease in the Northwest of Russia: setting-up the register
Dobronravov V.A., Smirnov A.V., Dragunov S.V., Zverkov R.V., Evdokimova T.V., Butrimova S.S., Grigorschuk V.I.
Aim. To study epoidemiology of chronic renal disease (CRD) in the North-West region of the Russian Federation. Material and methods. A population retrospective trial was performed from 01.07.98 to 30.06.99 in the Vologda region, towns Veliky Novgorod and Syktyvkar (total population 1840000). 490 cases of chronic renal failure (CRF) with creatinin levels > 300 mcmol/l corresponding to CRD stage IV and V by glomerular filtration rate were detected. CRD stage IV-V prevalence, morbidity including sexand age-specific parameters, cumulative survival in different etiology of CRD regarding replacement therapy (RT) and nephrologist supervision were estimated. Results. Mean prevalence and morbidity were 266 and 108 cases per million. Number of affected males and females was the same. CRD was provoked by chronic glomerulonephritis (CGN) - 41%, chronic interstitional nephritis - 16%, diabetes mellitus - 14%, renal polycystic disease - 8%, amyloidosis - 6%, hypertension nephrosclerosis - 2%, other causes - 3%, cases of unclear etiology 10%. Among patients with primary renal pathology on RT, number of CGN patients was higher 61% while diabetic and amyloidosis shares were much lower 1.6 and 0.8%. 31.1% patients given no RT had Cr > 500 mcmol/l and glomerular filtration rate < 10 ml/min. Incidence of CRD stage IV- V in RT patients was 80 per million, 8 patients per million for I year started RT for the first time. CRF mortality was 85 patients per million a year. 88.4% of deaths in patients given no RT was due to uremia. Cumulative survival for RT patients and RT untreated was 90 and 50% a year, respectively. Survival of the RT untreated observed by the nephrologist was significantly higher (p = 0.003). Conclusion. New cases of CRD stage IV- V were comparable in number to European incidence rate while prevalence was much less because of lower number of old patients and RT treated. The problem of CRD treatment is urgent for RF and requires updating nephrological service and development ofRT programs.
Terapevticheskii arkhiv. 2004;79(9):57-61
Effects of carvedilol, atenolol and their combination with fosinopril on cardiac rhythm variability, clinicofunctional status and quality of life in patients with postinfarction left ventricular dysfunction
Teplyakov А.Т., Popov S.V., Kalyuzhin V.V., Garganeeva A.A., Kurlov I.O., Nilogov V.L., Rybalchenko E.V., Shilov S.N.
Aim. To study effects ofcarvedilol and atenolol and their combination with fosinopril on heart rhythm variability (HRV), clinicofimctional status and quality of life in postmyocardial infarction patients with moderate chronic cardiac failure (CCF). Material and methods. An 8-week randomized open study enrolled 50 male patients (mean age 55.7 ± 1.58 years) with postinfarction CCF. They were divided into two equal groups. Group one received carvedilol (24.4 ±2.0 mg/day) followed by addition of fosinopril (2.5-40 mg/day). Group 2 received atenolol (44.1 ±5.1 mg/day) followed by fosinopril in the same dose as in group 1. Results. A 4-week therapy with carvedilol and atenolol effectively corrected depression of HRV in both the group. Combined therapy with these beta-adrenoblockers and fosinopril improved impaired global left ventricular contractility , exercise tolerance, quality of life, relieved symptoms of CCF. Conclusion. Carvedilol, atenolol and their combination with fosinopril in patients with postinfarction CCF improve clinico-hemodynamic and functional status, raise HRV and quality of life.
Terapevticheskii arkhiv. 2004;79(9):62-65
Progressiveazotemia provoked by ACE inhibitor in renal ischemia
Fomin V.V., Taronishvili О.I., Shvetsov M.Y., Shilov E.M., Moiseev S.V., Kushnir V.V., Sorokin Y.D.
Terapevticheskii arkhiv. 2004;79(9):66-69
Management of patients with diabetes mellitus withterminal renal failure on programmed hemodialysis
Shestakova M.V., Lepetukhin A.E., Kvaratskhelia М.V., Dedov I.I.
Terapevticheskii arkhiv. 2004;79(9):70-74
Dyslipidemiaand chronic progressive diseases of the kidneys
Kolina I.В., Stavrovskaya E.V., Shilov E.M.
Terapevticheskii arkhiv. 2004;79(9):75-77
Risk factors: microalbuminuria
Khirmanov V.N.
Terapevticheskii arkhiv. 2004;79(9):78-83
Role of the studyof urinary molecular mediators of immune inflammationand renal fibrosis in chronic glomerulonephritis
Kozlovskaya L.V., Bobkova I.N., Plieva О.К., Scherbak A.V., Chebotareva N.V., Mukhin N.A.
Terapevticheskii arkhiv. 2004;79(9):84-87
Variants of renal affection in Wilson-Konovalov disease
Rakhimova O.Y.
Terapevticheskii arkhiv. 2004;79(9):88-90
Renal damage in antiphospholipid syndrome
Meteleva N.A., Kozlovskaya N.L.
Terapevticheskii arkhiv. 2004;79(9):91-96

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