Vol 87, No 6 (2015)


Acute glomerulonephritis in the 21st century

Mukhin N.A., Glybochko P.V., Svistunov A.A., Fomin V.V., Shilov E.M., Lysenko L.V.


The paper discusses the specific features of the current course of acute glomerulonephritis, the spectrum of its etiological factors, and clinical manifestations. The factors influencing the course and outcomes of acute glomerulonephritis, including the risk of its progression to chronic kidney disease, are specially depicted.
Terapevticheskii arkhiv. 2015;87(6):4-9
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Role of the morphogenetic proteins FGF-23 and Klotho and the glycoprotein sclerostin in the assessment of the risk of cardiovascular diseases and the prognosis of chronic kidney disease

Milovanova L.Y., Milovanov Y.S., Kudryavtseva D.V., Markina M.M., Milovanova S.Y., Kozlovskaya L.V., Lebedeva M.V., Beketov V.D., Moiseev S.V., Mukhin N.A., Fomin V.V., Svistunov A.A.


Aim. To analyze changes in the serum concentrations of the morphogenetic proteins fibroblast growth factor 23 (FGF-23) and Klotho, as well as sclerostin, an osteocyte-secreted glycoprotein, in relation to the degree of hypertension, left ventricular (LV) hypertrophy, and arterial stiffness in patients with chronic kidney disease (CKD) at its different stages. Subjects and methods: Sixty-five patients (33 men and 32 women) aged 20—65 years, including 25 with chronic glomerulonephritis, 15 with tubulointerstitial nephritis, and 25 with hypertensive nephrosclerosis, were examined. A control group consisted of 15 healthy volunteers matched to the study group patients for age and gender. Serum FGF-23 concentrations and blood pressure (BP) were measured in the all subjects. Patients with BPs >140/80 mm Hg underwent echocardiography, followed by determination of LV mass (LVM) and calculation of LVM index. Vascular circulation, pulse wave velocity, cardiac and vascular calcifications, and vascular functional properties were estimated. Results. There was a strong direct correlation between the serum concentration of FGF-23 and the stage of CKD and an inverse correlation between the levels of Klotho and sclerostin and the stage of CKD. As the glomerular filtration rate became lower, the concentration of FGF-23 increased and that of Klotho and sclerostin decreased just in Stage III CKD while hyperphosphatemia and elevated parathyroid hormone levels were noted in Stages IV-V CKD. As CKD progressed, the serum concentrations of Klotho and sclerostin were inversely correlated with the levels of phosphorus and parathyroid hormone. The degree of blood pressure elevation correlated positively with serum FGF-23 concentrations and inversely with Klotho levels. There was no significant correlation of the level of sclerostin with the degree of BP increase. The direct correlation between higher FGF-23 level and higher VLM is most pronounced in hypertensive patients. There was a strong direct relationship between FGF-23 and Klotho levels and a strong inverse relationship between sclerostin levels and pulse wave velocity. Lower Klotho concentrations were associated with the detection rate of calcifications in the heart valves and large arteries (the abdominal aorta). The reduced serum levels of Klotho and sclerostin were also correlated with concentric LV remodeling. Conclusion. It was demonstrated that there was a clear link between increased serum FGF-23 and decreased Klotho concentration as CKD progressed, and that between arterial stiffness and calcification and myocardial remodelling regardless of traditional risk factors. More experimental and clinical studies are required to clarify the role of sclerostin in CKD.
Terapevticheskii arkhiv. 2015;87(6):10-16
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Cystatin C is a new marker for left ventricular hypertrophy in patients with chronic kidney disease

Vasilyeva M.P., Rudenko T.E., Kutyrina I.M., Solomakhina N.I.


Aim. To estimate the diagnostic value of serum cystatin C in the development of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). Subjects and methods. The investigation enrolled 86 patients (53% men, 47% women; mean age, 45±13 years) with nondiabetic CKD. According to the magnitude of glomerular filtration rate (GFR) decrease, the patents were divided into 3 groups: 1) 33 patients with a GFR of 89-45 ml/min; 2) 33 with a GFR of 15 ml/min; 3) 20 hemodialysis patients with a GFR of <15 ml/min. A control group included 20 individuals with a GFR of >90 ml/min. In all the patients, physical examination and transthoracic echocardiography were performed and serum cystatin C levels were measured. Results. In Groups 1, 2, and 3, LVH was detected in 42.4, 63.6, and 80% of cases, respectively. It was not found in the control group. In these groups, serum cystatin C levels were 1489.49±520.76, 2533.13±621.66, 5166.02±1586.61, and 820.08±224.54 ng/ml, respectively. An association was found between cystatin C and LVH (p=0.5; p<0.001). The level of cystatin C was shown to predict the development of LVH with a sensitivity of 78% and a specificity of 62% for predialysis CKD patients. Multivariate analysis of left ventricular mass index (LVMI), E-velocity/A-velocity, (E/A) ratio, and hypertension showed that the cystatin C levels were independently correlated with LVMI only (p<0.05; β=0.3) in all the groups. Conclusion. Serum cystatin C levels may be regarded as an early LVH marker detectable in patients with the earliest stages of CKD.
Terapevticheskii arkhiv. 2015;87(6):17-22
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Endogenous erythropoietin, acute kidney injury, and prognosis in patients with acute coronary syndrome

Menzorov M.V., Shutov A.M., Larionova N.V., Mikhailova E.V., Morozova I.V.


Aim. To investigate the prognostic value of serum endogenous erythropoietin (EPO) in patients with acute coronary syndrome (ACS), including that in the development of acute kidney injury (AKI). Subjects and methods. Eighty-four patients (46 men, 38 women; mean age 63±11 years) with ACS were examined. Twenty-one (25%) patents were diagnosed with ECG ST-segment elevation acute myocardial infarction (STSEAMI), 12 (14%) had ECG non-STSEAMI, and 51 (61%) had unstable angina. Thrombolytic therapy was performed in 10 (48%) patients with STSEAMI. The patients whom had not undergone coronarography were included in the investigation to exclude the nephrotoxic effect of X-ray contrast agents. Results. AKI was observed in 7 of the patients with acute myocardial infarction and in only 1 of those with unstable angina. Four (5%) patients died during hospitalization. The EPO level of >10.5 IU/ml predicted the development of AKI in the ACS patients with a sensitivity of 71% and a specificity of 67%. That of >13.7 IU/ml was associated with hospital death in the ACS patients with a sensitivity of 100% and a specificity of 75% (AUC=0.93%). Conclusion. High serum EPO levels in an ACS patent during his hospital stay may serve as a biomarker for a high risk for AKI and high death rates.
Terapevticheskii arkhiv. 2015;87(6):23-28
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Prognostic value of renal resistance index in estimating the progression of chronic kidney disease

Gazhonova V.E., Zykova A.S., Chistyakov A.A., Roshchupkina S.V., Romanova M.D., Krasnova T.N.


Aim. To study a relationship between main renal and intraparenchymal renal arterial resistance indices (RIs) measured by Doppler ultrasonography and clinical and laboratory parameters and to determine their prognostic value in estimating the progression of chronic kidney disease (CKD). Subjects and methods. The investigation enrolled 53 CKD patients divided into groups: glomerular and interstitial diseases. Glomerular filtration rate (GFR) calculated using the CKD-EPI formula, proteinuria (PU) severity, kidney sizes, renal parenchyma thickness, parenchyma/collecting index, and main and intrarenal vessel RIs were determined at the first hospitalization. The mean follow-up was 14±2.64 months. The rate of GFR decline was estimated at the rehospitalization. Results. Main renal and intrarenal vessel RIs depend on patient age and pulse pressure. The RIs are associated with GFR and PU in the group of glomerular diseases and with kidney sizes and structure in that of interstitial diseases. The interlobar arterial RI is the most sensitive predictor for worsening renal function with a threshold of 0.65, which is comparable to the prognostic value of PU. Conclusion. The main renal and intrarenal vessel RIs may be considered as a predictor for worsening renal function.
Terapevticheskii arkhiv. 2015;87(6):29-33
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Urinary biomarkers for podocyte injury: Significance for evaluating the course and prognosis of chronic glomerulonephritis

Chebotareva N.V., Bobkova I.N., Neprintseva N.V., Kozlovskaya L.V., Malkandueva Z.T.


Aim. To estimate the degree of podocyte injury in patients with different types of chronic glomerulonephritis (CGN) from the urinary level of podocyte markers and to determine the significance of these indicators as criteria for disease activity and prognosis. Subjects and methods. Seventy-three patients with CGN, including 20 with inactive nephritis (Group 1), 23 with obvious urological syndrome (Group 2), 30 with nephrotic syndrome (NS) (Group 3), among them there were 7 patients with severe NS and 7 with NS concurrent with acute nephritic syndrome, were examined. A control group consisted of 8 healthy individuals. In the examined groups, the degree of podocyturia (PCU) was investigated by flow cytometry using podocalyxin-labeled antibodies and the levels of nephrinuria (NU), heat shock protein 27 (HSP27) in urine, interleukin 6 (IL-6), caspase 9, and vascular endothelial growth factor (VEGF) were estimated by ELISA. Results. The patients with active CGN were found to have a high level of markers for podocyte injury: PCU and NU, which correlate with the magnitude of proteinuria, severity of NS, and degree of podocytopenia. Those with the severest NS, that concurrent with renal dysfunction in particular, were observed to have a progressive imbalance of inflammatory (IL-6), apoptotic (caspase-9), and defensive (HSP27 and VEGF) factors, which displays the incompetence of self-defense mechanisms in podocytes and contributes to the torpid course of CGN. Progressive PCU and NU are a poor prognostic sign indicating the risk of glomerulonephritis. Conclusion. The indicators considered are universal for all patients with CGN running with proteinuria and may be used to monitor the course of the disease; moreover, the damaging factors should be considered in conjunction with the defensive factors.
Terapevticheskii arkhiv. 2015;87(6):34-39
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Impact of interleukin-10 and interleukin-28 gene polymorphisms on the development and course of lupus nephritis

Krasnova T.N., Samokhodskaya L.M., Ivanitsky L.V., Korogodina A.D., Borisov E.N., Nikiforova N.V., Novikov P.I., Kamalov A.A., Mukhin N.A.


Aim. To assess the relationship of the carriage of IL-10 -1080 G/A and IL-28 rs8099917 C/T polymorphisms to the course of lupus nephritis (LN). Subjects and methods. Ninety-nine patients with systemic lupus erythematosus (SLE), including 68 with LN, were examined. Gene polymorphisms were analyzed using standard molecular genetic techniques. The frequency of the clinical manifestations of LN was analyzed; renal survival (RS) was estimated by the Kaplan-Meier method. Results. Ten-year RS rates were 80 and 86% of the patients with and without the mutant IL-10 allele, respectively (p=0.78). The 10-year RS was lower (75%) in carriers of the mutant IL-28 rs12979860 allele than in patients without this mutant allele (83%; p=0.049) and in those of the mutant IL28 rs8099917 allele than in patients without the above mutant allele (67 and 88%, respectively; p=0.047). LN patients, carriers of the mutant IL-10 -1028 G/A allele, were observed to have higher-grade proteinuria in the presence of nephritic syndrome (mean 6.1 g/l) than those without the mutant allele of this gene (mean 2.9 g/l; p=0.034). However, the mutant allele carriers responded to treatment better (p=0.050). The mutant IL-10 and IL-28 alleles were unassociated with the development of rapidly progressive nephritis, the activity of a renal lupus process, and the rate of onset of SLE and LN. Conclusion. In the LN patients, the carriage of the mutant IL-10 allele A is associated with a better response to treatment and that of the mutant IL-28 allele is linked to the severe course of the disease.
Terapevticheskii arkhiv. 2015;87(6):40-44
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Increased serum concentrations of inflammatory cytokines in type 2 diabetic patients with chronic kidney disease

Konenkov V.I., Klimontov V.V., Myakina N.E., Tyan N.V., Fazullina O.N., Romanov V.V.


Aim. To study the relationship between serum inflammatory cytokine levels in chronic kidney disease patients with type 2 diabetes. Subjects and methods. Sixty-four patients aged 43 to 70 years with a glomerular filtration rate (GFR) of >30 ml/min/1.73 m2 were examined. A control group consisted of 15 healthy individuals. The serum concentration of macrophage colony-stimulating factor (M-CSF), macrophage inflammatory protein 1α (MIP-1α), macrophage migration inhibitory factor (MIF), interleukin 6 (IL-6), as well as the urinary excretion of albumin and type IV collagen was determined by enzyme immunoassay. Results. In patients with a GFR of >60 ml/min/1.73 m2, M-CSF and MIF concentrations proved to be significantly higher than those in the control group (p=0.0003 and p=0.001, respectively). In those with a GFR of 30-59 ml/min/1.73 m2, there was an increase in the levels of M-CSF (p<0.0001), MIP-1α (p=0.002), MIF (p=0.02), and IL-6 (p=0.02). The decline in GFR was associated with the higher levels of M-CSF (p=0.02) and MIP-1α (p=0.02) and with the higher urinary excretion of type IV collagen (p=0.01). M-CSF, MIP-1α, and IL-6 correlated positively with the urinary excretion of albumin (r=0.34, r=0.28, and r=0.28, respectively; all p<0.05) and type IV collagen (r=0.31, r=0.4, and r=0.43, respectively; all p<0.05). Conclusion. The findings confirm the concept that chronic inflammation is involved in the development of diabetic kidney disease.
Terapevticheskii arkhiv. 2015;87(6):45-49
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Contrast-induced acute kidney injury after primary percutaneous coronary interventions: Prevalence, predictive factors, and outcomes

Kobalava Z.D., Villevalde S.V., Gaskina A.A., Mayskov V.V., Moiseev V.S.


Aim. To study the incidence, severity, predictive factors, and prognostic value of contrast-induced acute kidney injury (CIAKI) in patients with ST-segment elevation acute coronary syndrome (STSEACS), who have undergone primary percutaneous coronary intervention (PCI). Subjects and methods. The 2012 KDIGO criteria were used to estimate the incidence of CIAKI in 216 patients (mean age, 64±13 years) admitted to Moscow City Clinical Hospital Sixty-Four and underwent primary PCI for STSEACS (hypertension in 90%, prior myocardial infarction in 27%, chronic kidney disease in 7%, type 2 diabetes mellitus in 21%). Logistic regression analysis was performed to identify predictive factors for CIAKI; following 12 months, its prognosis was assessed by phone. Results. Forty-three (20%) patients were diagnosed with Stages I (81%) and II (19%) CIAKI. The patients with CIAKI were older; they had higher baseline serum creatinine levels, a higher volume of contrast agent, a higher ratio of contrast medium volume to glomerular filtration rate, and lower left ventricular ejection fraction. Independent predictive factors for CIAKI were identified; these were chronic kidney disease, multivascular injury in the coronary bed, hospital therapy with loop diuretics, nephrotoxic antibiotics, or mineralocorticoid receptor antagonists. Conclusion. The development of CIAKI is associated with poor outcomes, such as higher 30-day mortality and more frequent cardiovascular disease readmissions.
Terapevticheskii arkhiv. 2015;87(6):50-55
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Hemodynamic effects of succinate-containing dialyzing solution

Smirnov A.V., Golubev R.V., Vasiliev A.N., Zemchenkov A.Y., Staroselsky K.G.


Aim. To assess the results of using an acetate-free succinate-containing dialyzing solution (SDS) against natremia and blood pressure (BP) in patients on chronic hemodialysis (HD). Subjects and methods. Ninety-two patients were transferred from 3 Saint Petersburg HD centers to 3-month HD treatment using SDS. The investigators measured blood biochemical indicators immediately before and 1 and 3 months after the investigation, BP before and after a successive HD session, and the patients’ weight and its gain in the period between HD sessions. Hypotensive and hypertensive episodes were recorded during HD sessions throughout the investigation. Results. Following 3-month treatment using SDS, there were statistically significant decreases in blood sodium levels and systolic BP (SBP) prior to a HD session. At the same time, patients with a baseline pre-HD SBP of less than 100 mm Hg were observed to have a statistically significant increase in this indicator by the end of the investigation. Pre-dialysis diastolic BP (DBP) and post-dialysis SBP and DBP substantially unchanged. After 3 months of SDS use, there was a statistically significant reduction in weight gain in the period between HD sessions. When SDS was administered, the frequency of hypertensive episodes tended to decline after a HD session. Conclusion. The use of SDS causes a drop in pre-dialysis blood sodium levels, ensuring adequate dehydration in patients and improving hypertension control. In doing so, SDS prevents hypotension during a HD session.
Terapevticheskii arkhiv. 2015;87(6):56-61
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Use of the Charlson comorbidity index and the Barthel disability index in the integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy with hemodialysis

Vishnevsky K.A., Zemchenkov A.Y., Korosteleva N.Y., Smirnov A.V.


Aim. To make an integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy (RRT) with hemodialysis (HD), by using the Charlson comorbidity index (CCI) and the Barthel disability index (BI) and to analyze the compliance of these indices with the disability severity estimated according to disability group (DG). Subjects and methods. The medical records of 605 HD patients (323 men, 282 women) whose mean age was 56.4±13.9 years and mean RRT duration was 65.6±62.8 months, were analyzed. The patients were grouped according to DG, CCI, BI, employment, and a history of diabetes mellitus. Data on basic laboratory parameters were collected. Results. According to DG, the patients were grouped as follows: 1) 292 (51%); 2) 212 (37%); 3) 15 (3%) and 4) 48 (9%) without DG. The disability severity estimated according to DG was found to be correlated with RRT duration (r=–0.35; p<0.001) and employment (r=0.36; p<0.001). CCI averaged 6.3±3.1 scores (n=486). The mean BI was 86±14 scores (n=224). Among the respondents completing the BI questionnaire, 26 (20%) patients with DG 1 showed an uncomplicated comorbid background (CCI, 2—5 scores), no significant disability (BI, 90—100 scores), while 33 (48%) patients with DG 2 exhibited a high comorbidity index (ICC, more than 5 scores) and obvious disability (BI, less than 90 scores). The indicators relating to restricted self-movement in some BI scales were of the most importance. Conclusion. The disability severity estimated in view of DG does not correspond to the severity of comorbidities (CCI) and the magnitude of functional limitations (BI) in some patients with CKD 5D. While determining DG, it is advisable to take into account CCI as an indicator of the severity of physical disorders to objectify the estimate of the sociomedical status of patients with CKD 5D, as well as BI to determine the degree of disability.
Terapevticheskii arkhiv. 2015;87(6):62-67
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Fibroblast growth factor 23 and a novel high-sensitivity troponin I: Early markers and alternative ways of damaging the heart in chronic kidney disease

Dzgoeva F.U., Sopoev M.Y., Gatagonova T.M., Bestaeva T.L., Khamitsaeva O.V.


Aim. To establish possible pathogenetic relationships between the marker of bone mineral metabolism fibroblast growth factor 23 (FGF-23) and the markers of cardiovascular diseases characterizing the state of cardiomyocytes and that of the vascular wall of the aorta and large vessels in chronic kidney disease (CKD). Subjects and methods. A total of 110 patients (57 men and 53 women) aged 25 to 65 years (mean age 56±2.2 years) with different stages of CKD were examined. FGF-23 and troponin I in the sera from all the patients were investigated using enzyme immunoassay kits. Doppler echocardiography was carried out to evaluate the morphofunctional state of the left ventricle (LV). Peak systolic blood flow velocity in the aortic arch and common carotid intima-media thickness were estimated to assess the wall of the aorta and large arteries. Results. As renal failure progressed, just at the early CKD stages the patients were found to have elevating FGF-23 and troponin I levels forestalling an increase in parathyroid hormone concentrations and changes in other calcium-phosphorus metabolism indicators. The levels of FGF-23 and the morphofunctional indicators of LV lesion showed a strong direct correlation that preserved its significance in analyzing the factors under study in relation to the function of the kidneys. Conclusion. The morphogenetic protein FGF-23 seems to play a significant role not only in bone remodeling processes, but also in the development of cardiovascular events in CKD. However, the mechanisms of its implication in the development of heart disease, like the possibilities of using its level changes as early diagnostic criteria for cardiovascular involvement, call for further investigation.
Terapevticheskii arkhiv. 2015;87(6):68-74
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Urinary excretion of angiogenesis regulatory factors and renal injury markers in chronic glomerulonephritis: Significance in the assessment of progression

Shvetsov M.Y., Zheng A., Kozlovskaya L.V., Serova A.G., Travkina E.V., Mukhin N.A.


Aim. To study the urinary excretion of the molecular factors regulating angiogenesis, such as vascular endothelial growth factor type A (VEGF-A), thrombospondin 1 (THBS1), and angiopoietin 2 (ANGPT2), versus that of the urinary markers of renal injury and fibrogenesis, such as neutrophil gelatinase-associated lipocalin (NGAL), type IV collagen (COL4), and known clinical risk factors for accelerated disease progression to estimate the prognostic value of urinary excretion in patients with chronic glomerulonephritis (CGN). Subjects and methods. Eighty-two patients (45% men, 55% women; mean age, 36.5 years) with a clinical diagnosis of CGN were examined. 31.7% of the examinees presented with nephrotic syndrome; 31.7% had a glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m2. Morning urine samples were analyzed by Elisa to determine the urinary excretion of biomarkers (VEGF-A, THBS1, ANGPT2, NGAL, and COL4). The results were adjusted to urinary creatinine concentrations. Results. The urinary excretion of the angiogenesis regulators VEGF-A, THBS1, and ANGPT2 correlated between them, with that of the renal injury markers NGAL and COL4, with the level of proteinuria. That was found to be unassociated with blood pressure and GFR. In the presence and absence of nephrotic syndrome, high (>75th percentile) urinary excretion rates were 46.2 and 14.8% for VEGF-A (р<0.01); 50 and 13% for THBS1 (р<0.001); and 46.2 and 14.8% for ANGPT2 (р<0.01), respectively. That for ANGPT2 was also high in the presence of anemia (63.2 versus 11.7%; p<0.001). Conclusion. The finding of the high urinary excretion of the angiogenesis regulators VEGF-A, THBS1, and ANGPT2 and its association with that of kidney injury markers in the patients with the proteinuric forms of CGN suggest that this excretion may be considered as an integral index that displays glomerular injury and indicates tubulointerstitial proteinuric/hypoxic remodeling.
Terapevticheskii arkhiv. 2015;87(6):75-82
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Efficiency of tacrolimus therapy for perianal Crohn’s disease

Nanaeva B.A., Vardanyan A.V., Khalif I.L.


Aim. To determine the efficacy of 0.1% tacrolimus ointment in patients with perianal Crohn’s disease (CD). Subjects and methods. This prospective randomized trial enrolled 20 patients with perianal CD as anal fissures and rectal fistulas. The inclusion criteria were rectovaginal or extrasphincteric fistulas and purulent leakages. A study group comprised 11 patients, including 9 with anal fissures and 2 with fistulas. A control group included 9 patients, including 8 with fissures and 1 with fistulas. The study group received systemic therapy with azathioprine 2 mg/kg/day and tacrolimus ointment 2 mg/day; the control group had systemic therapy with azathioprine 2 mg/kg/day, hormone ointment 1 mg/day, and metronidazole suppositories 250 mg/day. Control examination and perianal CD activity index (PCDAI) determination were done 6 and 12 weeks after therapy initiation. Results. At 6 weeks after beginning the study, local examination revealed the signs of anal fissure epithelialization in 5 (45.5%) of the 11 patients in the study group and in 3 (33.3%) of the 9 patients in the control one. At 12 weeks, fissure epithelialization and fistula obliteration were stated in 6 (54%) patients in the study group and in 3 (33%) of the 9 patients in the control group. At 12 weeks, PCDAI in the study and control groups was 2.00 and 4.44 scores (p=0.01). Conclusion. The findings suggest that topical 0.1% tacrolimus ointment versus antibacterial suppositories and hormone ointments is effective in treating patients with perianal CD. Topical 0.1% tacrolimus ointment therapy caused a reduction in PCDAI.
Terapevticheskii arkhiv. 2015;87(6):83-87
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Meta-analysis of clinical trials of cardiovascular effects of magnesium orotate

Torshin I.Y., Gromova O.A., Kalacheva A.G., Oshchepkova E.V., Martynov A.I.


Aim. To make a meta-analysis of clinical trials of magnerot (magnesium orotate) used in cardiac patients. Subjects and methods. The meta-analysis covered the data of 19 randomized trials including a total of 603 patients treated with magnerot (a case group) and 587 receiving placebo (a control group). The patients’ mean age was 36±19 years. On the average, the patients took magnerot 1878±823 mg/day for 4.2±29 months. Results. Associations between the intake of magnerot and the risk of 50 pathological conditions were analyzed. Significant associations were established between the drug’s administration and the reduced risk of conditions, such as hypomagnesemia (relative risk (RR)=0.06; 95% confidence intervals (CI): 0.04 to 0.09; p=2∙10–46), exercise intolerance (RR=0.41; 95% CI: 0.27 to 0.62; p=0.0004), dysautonomia (RR=0.08; 95% CI: 0.04 to 0.14; p=2∙10–21), morning headache (RR=0.16; 95% CI: 0.09 to 0.29; р=1.5∙10–6), tension headache (RR=0.16; 95% CI: 0.09 to 0.27; р=5∙10–10), dizziness (RR=0.28; 95% CI: 0.15 to 0.50; р=0.0004), first-degree mitral valve prolapse (MVP) (RR=0.05; 95% CI: 0.03 to 0.09; р=1.2∙10–25), grade 1 regurgitation (RR=0.29; 95 CI: 0.14 to 0.60; р=0.0075), supraventricular (RR=0.30; 95% CI: 0.21 to 0.44; р=1∙10–8) and ventricular (RR=0.48; 95% CI: 0.30 to 0.76; р=0.019) premature contraction, paroxysmal supraventricular tachycardia (RR=0.28; 95% CI: 0.15 to 0.50; р=0.0002), and hypertension (RR=0.32; 95% CI: 0.17 to 0.58; р=0.0027). Conclusion. The use of magnesium orotate is promising not only in treating MVP and compensating for hypomagnesemia, but also in preventing and treating cardiac arrhythmias, regulating blood pressure, and improving the function of the autonomic nervous system.
Terapevticheskii arkhiv. 2015;87(6):88-97
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The concurrence of light-chain deposition disease, AL-amyloidosis, and cast nephropathy in a patient with multiple myeloma

Rekhtina I.G., Zakharova E.V., Stolyarevich E.S., Sinitsina M.N., Denisova E.N.


Despite of the fact that their clinical manifestations are similar, AL-amyloidosis (AL-A) and light chain deposition disease (LCDD) are individual nosological entities in view of considerable differences in their pathogenesis and pathomorphology. The paper describes a rare case of the concurrence of LCDD and AL-A in a patient with multiple myeloma. Clinically, there was dialysis-dependent renal failure, flail leg syndrome, myocardiopathy, and rhabdomyolysis. At the disease onset, his nephrobiopsy specimen could diagnose LCDD and myeloma or cast nephropathy. The disease was characterized by an aggressive course. Despite the administration of innovative agents, the patient had a short-term remission and died from disease progression. Autopsy additionally revealed amyloid deposition in the heart and kidney. The development of AL-A in the presence of prior LCDD may reflect the progression of the tumor and the appearance of an additional subclone of plasma cells that produce amyloidogenic light chains. The uncommonness of this case is that renal amyloid was found in the tubular casts and absent in the glomeruli, which may be considered as a special form – tubular AL-amyloidosis.
Terapevticheskii arkhiv. 2015;87(6):98-101
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Algorithm for the diagnosis, treatment, and prevention of stress (for general practitioners)

Akarachkova E.S., Kotova O.V., Vershinina S.V.


By inducing physical and mental disorders, human stresses are known to lead to long-term serious consequences and frequent use of more medical resources. Owing to long-term clinical trials, a management algorithm based on the principles of personalized medicine has been elaborated to minimize the consequences of stress, to activate natural adaptation mechanisms and to enhance stress resistance
Terapevticheskii arkhiv. 2015;87(6):102-107
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Kidney injury associated with monoclonal gammopathies: Perspectives on diagnosis and treatment

Kozlovskaya L.V., Rameev V.V., Mrykhin N.N., Kogarko I.N., Kogarko B.S.


It is currently well justified that monoclonal gammopathies are the most important predictor for kidney diseases, including glomerulonephritis. To determine a correlation of nephropathy with oligosecretory gammopathy is of fundamental importance, as the treatment of these patients necessitates the use of special chemotherapy regimens to eliminate a pathological clone of lymphocytes or plasmocytes. If this clone is not eliminated, injury of the organ may recur to develop its failure. The principles of this therapy have been presently tried out by the example of AL-amyloidosis and showed its efficiency and relatively low toxicity.
Terapevticheskii arkhiv. 2015;87(6):108-111
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Cryoglobulinemic vasculitis with renal involvement: A historic aspect of the problem

Gordovskaya N.B., Kozlovskaya L.V., Milovanova S.Y.


The paper presents the steps for studying cryoglobulinemia from essential to cryoglobulinemic vasculitis associated with hepatitis C virus. It shows advances in the study of the etiology of cryoglobulinemia, diagnosis, specific features of renal injury, and current approaches to treating HCV infection-related cryoglobulinemic vasculitis with renal involvement, by using 3 clinical cases (with a difference of a few decades during a follow-up).
Terapevticheskii arkhiv. 2015;87(6):112-117
pages 112-117 views

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