Use of partusisten in prevention of hyperkalemia in patients with chronic glomerulonephritis with initial forms of renal failure]

The studies performed proved the ability of the drug partusisten (in a dose of 10 mg/day) to effectively reduce an elevated potassium level in the serum of chronic sufferers with glomerulonephritis and initial renal insufficiency. Normal concentrations of Ca, K and Na in relevant patients remained unchanged except a slight rise in K urinary excretion this suggesting an extrarenal mechanism of K redistribution consequent to the action of beta 2-adrenergic agents.     

Experience in the use of valsartan with the aim to inhibit progression of kidney failure in patients with chronic glomerulonephritis

AIM: To assess the effect of valsartan, angiotensin-II receptor blocker type 1, on key factors of progression of chronic renal failure (CRF)--arterial hypertension (AH), proteinuria (PU), sodium excretion (SE)--in patients with chronic glomerulonephritis (CGN) and initial affection of renal function. MATERIAL AND METHODS: 11 patients (mean age 33.7 +/- 13.3 years, mean duration of nephritis 8.6 +/- 6.4 years, male to female ratio 8:3) with AH (AP > 140/90 mm Hg) and marked PU (> 1 g/day) who had not received immunosuppressive drugs for at least 6 months before the trial were given valsartan. It was administered after the period of "washing out" at the initial dose 80 mg/day with further addition of diuretics or raising the dose twice (in hyperuricemia) to decrease AP under 140/90 mm Hg. The duration of the treatment was 3 months. RESULTS: After 3 months of valsartan therapy systolic arterial pressure fell from 162 +/- 18 to 138 +/- 20 mm Hg (p < 0.05), diastolic pressure from 100 +/- 8 to 92 +/- 15 mm Hg (single measurements). 24-h monitoring of AP showed a significant lowering of mean 24-h and night systolic and diastolic AP, day-time diastolic AP, 24-h time index of systolic and diastolic AP. Initial antiproteinuric effect was observed after 1 month of the treatment and after 3 months of therapy PU reduced significantly (from 5.7 +/- 6.0 g/day to 3.3 +/- 3.3 g/day). After 3 months sodium excretion significantly rose, while creatinine level and glomerular filtration rate did not. Potassium rose in one patient. CONCLUSION: In CGN with initial CRF valsartan in a dose 80-160 mg/day produces a pronounced antihypertensive and antiproteinuric actions, stimulates sodium excretion. No serious side effects were noted. It is necessary to continue studies on the ability of valsartan to inhibit progression of CRF.     

Disordered intestinal mechanisms in patients with chronic kidney failure]

The data on impairment of the intestinal mechanisms in 103 patients with chronic renal failure are presented. This impairment is characterized by inhibition of the absorption capacity of the intestine, an increase of the concentration of urea and creatinine in its contents, and by dysbacteriosis.     

早、中期慢性肾功能衰竭的危险因素分析

目的:调查和分析早、中期慢性肾脏疾病(CKD)住院患者高危因素,为早期干预、延缓慢性肾功能衰竭(CRF)进程提供依据。方法:采用流行病学问卷调查方法,对我院各临床科室的肾小球滤过率(GFR)≥30ml/(min·1.73m2)住院患者进行调查,并将患者分成早、中期CRF组和非CRF组。结果:资料完整的病例共661例,其中非CRF组有330例;CRF组331例。相关的分析结果显示:高血糖、高血压、高血脂、心血管疾病、脑血管意外、高尿酸血症、蛋白尿、贫血和年龄与早、中期CRF有关联(P<0.05)。对所有因素进行Logistic回归分析、四格表的比值比(oddsratio,OR)和相对危险度分析,结果显示蛋白尿、高尿酸、贫血、年龄、高血压、高血脂的OR值分别为7.648、4.589、3.118、1.939、1.889和1.450;高尿酸血症和蛋白尿的OR值为7.578。原发性肾小球疾病发生CRF的可能危险因素依次为贫血、高尿酸血症、高血压、高血脂、高血糖、蛋白尿。结论:早、中期CRF高危因素中,主要为高尿酸血症,其次为蛋白尿、贫血、高血压、高血脂等;高尿酸合并蛋白尿者发生CRF的危险性最大。     

电动辅助康复训练对慢性心力衰竭患者心功能的影响

目的观察电动辅助康复训练对慢性心力衰竭(CHF)患者心功能的影响。 方法将60例CHF患者随机分为治疗组及对照组,2组患者均给予常规药物治疗,治疗组在此基础上采用电动辅助训练装置进行心脏功能康复训练。于治疗前、治疗3个月后对2组患者心功能进行评定,评定指标包括：美国纽约心脏病协会（NYHA）心脏功能分级、左心室射血分数（LVEF）、左室舒张末期内径（LVEDD）、血浆B型脑利钠肽（BNP）水平、6 min步行距离等。 结果2组患者分别经3个月治疗后,发现其各项心功能指标均较治疗前明显好转;且以治疗组患者的改善幅度相对较显著,与对照组间差异均具有统计学意义（P<0.01或0.05）。 结论在常规药物干预基础上采用电动辅助训练装置对CHF患者进行心脏功能康复训练,能进一步提高CHF患者心功能,改善其运动耐力,且治疗过程中患者依从性较好,安全性较高。     

The activity of cationic adenosine triphosphatases in the erythrocyte membranes of patients with chronic glomerulonephritis in the preazotemia stage]

Activity of Mg-; Ca-, Na, K-ATPases of the erythrocytic membrane was studied in 67 adult patients with chronic glomerulonephritis (CGN) in the preazotemic stage and in 34 healthy persons. A significant reduction of Ca-ATPase activity was revealed, most pronounced in patients with the hypertensive and combined variants of CGN. Na, K-ATPase activity tended towards decline in all the patients. The rise of the initially decreased activity of Ca- and Na, K-ATPases was demonstrated in patients with the nephrotic variant of CGN treated with glucocorticosteroids. The decline of ATPase activity is related to the damage of cellular membranes in CGN in the preazotemic stage of the disease, which requires the carrying out of active membrane-stabilizing therapy.     

The hospital stage of the long-term oxygen therapy of chronic lung failure in patients with chronic obstructive bronchitis]

The authors analyze the role of the initial inpatient stage of long-term oxygen therapy (LOT) in combined treatment of chronic pulmonary failure in patients with chronic obstructive bronchitis, lung emphysema, and pneumosclerosis. The treatment lasted 30 days both in the main and in the control groups. In addition to basic therapy, the main group patients received 38% O2 for 15 h a day. To decrease the risk of PaCO2 elevation with a possible respiratory disorder, particularly in patients with initial hypercapnia, it is suggested that a special oxygen test with simultaneous control of acid-base balance and gas composition of the arterial blood may be carried out. In contrast to the control group, the main group patients demonstrated an improvement of gas composition of the arterial blood and of the parameters such as the alveolar-arterial gradient according to O2, the physiological pulmonary shunt. The combined use of oxygen therapy and resistance at expiration made it possible to ameliorate a number of external respiration function parameters, diffusion lung capacity, and enhanced the effect of oxygen therapy. It is shown that patients with PaO2 may be given LOT within the range of 60-69 mm Hg, provided the pulmonary physiological shunt exceeds 20%.     

Surface architectonics and erythrocyte deformability in patients with terminal stage of chronic kidney failure

Red cell deformability was examined in donors and patients with chronic renal insufficiency; the red cell surface architectonics before and after filtration was under study. The red cell ability to deformation was found reduced in the patients, the level of nontransitional prehemolytic forms of red cells increased, and the count of discoid cells reduced. These data permit assessing the red cell ability to deformation.     

The mechanism of Na+--K+ pump dysfunction in the erythrocytes of patients with glomerulonephritis and kidney failure]

The mechanisms of Na, K-ATPase dysfunction in red blood cells of patients suffering from glomerulonephritis and renal failure were studied by means of "functional loads" of an enzyme, enabling not only the activity but also the routine of Na, K-ATPase to be determined. Evidence is provided for the presence of immunotoxic factor on the patients' red blood cells, in the plasma of venous blood and serum of arterial blood. Its excretion from the patients' body and recovery of the routine of Na, K-ATPase have been simulated in vivo and in vitro. The cold immunoglobulin nature of the inhibitor related to the M-chains of IgM was established. It has been shown that the mechanisms of formation of the immunopathogenesis of glomerulonephritis are associated with the appearance of cold autoantibodies and their fragments on blood cell membranes, bringing about a decrease of the activity of Na, K-ATPase and modifying its routine.     

Changes in the oxygen transport function in patients with chronic kidney failure during hemodialysis

Some parameters of oxygen transport blood function have been studied prior to hemodialysis treatment and following 5, 25, 50 and 100 hemodialysis procedures. It has been established that programmed hemodialysis decreases O2 transport and reserve. These changes may be associated with an unfavourable effect of the procedure itself on the body, accompanied by anemia, microthromboembolisms in lung vessels, hypercapnia and arteriovenous blood shunt. Partial compensation of O2 transport decrease is achieved due to cardiac output increase and O2 tissue excretion. These compensatory mechanisms cannot ensure normal values of O2 reserve and transport and are fairly quickly depleted in the course of hemodialysis.     

The immediate results of using plasmapheresis in patients with chronic glomerulonephritis]

A study was made of the effect produced by a short-term course of plasmapheresis (PA) combined with cytostatic, glucocorticoid and deaggregation therapy on the clinico-laboratory characteristics in 45 patients suffering from chronic glomerulonephritis (CGN). It has been established that PA rapidly normalizes the characteristics such as the level of circulating immune complexes and fibrinogen in the blood, ESR. Exerting no effect on renal function, PA led to a significant lowering of proteinuria and erythrocyturia, with its beneficial effects being preserved after discontinuation of the sessions. The best results were attained in associated CGN and nephrotic syndrome, in mesangioproliferative and mesangiocapillary CGN. The effectiveness of the short-term course of PA in patients with membranous and diffuse fibroplastic CGN turned out questionable.     

The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis]

The restructure of renal tissue in intravital nephric biopsy specimens, renin-angiotensin-aldosterone together with kallikrein synthetic functions were studied and compared in patients with mesangioproliferative and membranoproliferative glomerulonephritis (MsPGN and MPGN). The characteristics of the morphological changes were defined. In MsPGN with secondary hypertension (SH), nephronic wasting and hyalinosis of arteries were mostly detectable whereas MPGN with SH was primarily marked by the derangement of the tubulointerstitial structures. In MPGN, the levels of total and inactive renin (TR and IR) were significantly higher than in MsPGN. This can be regarded as risk factor of early development of SH. The content of TR and IR and in addition that of active renin (AR) in MRGN did not depend on the clinical form of chronic glomerulonephritis. As compared to MsPGN with an isolated urinary syndrome, in MsPGN with SH, AR was prevalent, while its level correlated well with systolic and the mean arterial pressure. AR may be implicated in the mechanism of SH in MsPGN. In MPGN with SH, kallikreinuria was found to be extremely low, which may be consequent to tubulointerstitial injuries. The discoordination of the renin-angiotensin and kallikrein system may be one of the causes of earlier formation and the grave course of SH in the morphological pattern under consideration.     

The morphofunctional parallels in arterial hypertension in patients with chronic glomerulonephritis]

A study was made of the structural rearrangement of renal tissues in intravital nephrobiopsy specimens and of the functioning of the renin-angiotensin-aldosterone system and kallikrein-synthetic function in patients with mesangioproliferative (MSPGN) and membranous proliferative glomerulonephritis (MPGN). The morphological changes were revealed. The patients with associated MSPGN and secondary hypertension (SH) mostly demonstrated emptying and hyalinosis of arteries, whereas those with associated MPGN and SH manifested for the most part the derangement of the tubulointerstitial structures. In patients with MPGN, the levels of total renin (TR) and inactive renin (IR) were significantly higher than in those suffering from MSPGN. This can be regarded as risk factor of earlier development of SH. In MPGN patients, the content of TR and IR as well as that of active renin (AR) did not depend on the clinical pattern of chronic glomerulonephritis. As compared to MSPGN patients with isolated urinary syndrome, those with associated MSPGN and SH had a higher AR level, which agreed well with systolic and mean arterial pressure. Apparently, the latter one is implicated in the mechanism of SH in MSPGN. In associated MPGN and SH, kallikreinuria was found to be lowest, which may be the consequence of tubulointerstitial lesions. Discoordination of the renin-angiotensin and kallikrein systems is likely to be one of the causes of earlier formation and severe course of SH in the morphological pattern under consideration.     

慢性肾功能衰竭患者肾活检并发症观察及护理

目的对慢性肾功能不全（ＣＲＦ）行肾活检的患者的并发症及不良反应进行观察与分析。方法对２５３例临床诊断为ＣＲＦ,血清肌酐（ＳＣｒ）＞１７８μｍｏｌ／Ｌ并行肾活检患者的临床资料进行分析,对其并发症和不良反应的发生率及相关危险因素进行统计学处理。结果并发症发生率为２８．１％,其中较重并发症如肉眼血尿发生率２．７７％,肾周血肿需输血处理２．３５％。导致并发症出现的危险因素包括术后高血压及心率增快,术中配合欠佳,术后自解小便困难等。５６．５％的并发症出现手术后２４ｈ内,２６．１％出现于术后２４～７２ｈ内,其余１７．４％出现于７２ｈ以后。结论加强患者术前术后心理护理,可在一定程度上减少并发症和不良反应的发生。重视患者术后主诉及生命体征监测有助于及早发现并发症并进行对症处理。     

Cryoapheresis in the treatment of patients with cryoglobulinemic mesangiocapillary glomerulonephritis and acute kidney failure

AIM: To assess cryoapheresis (CA) efficacy in the treatment of cryoglobulinemic glomerulonephritis (CG) with acute renal failure (ACR). MATERIAL AND METHODS: Ten 34-64-year-old CG patients with associated HCV infection and symptoms of ACR (diuresis under 500 ml/day, serum creatinin 1.6-8.1 ml/dl). All the patients were examined clinically, for serum cryoglobulins, HCV, HBV markers, morphologically (renal and hepatic biopsies in 8 patients). All the patients received therapy with CA, immunodepressants. Three patients with virus replication received, in addition, antiviral drugs (alpha-interferon in a dose 3,000,000-5,000,000 IU 3 times a week intramuscularly for 6 months). RESULTS: CA in combined CG therapy led to fast elimination of cryoglobulins from the body, stabilization of renal function with arrest of rapid progression of renal failure, normalization of diuresis with subsequent lowering of serum creatinin. The course of CA normalized renal function fully in 3 patients, partially in 7 patients. Later, these 7 patients developed chronic renal failure. Complete elimination of the virus and remission of CG were achieved in 2 of 3 patients who had undergone the antiviral treatment for a year. CONCLUSION: CA can be added to combined therapy of CG aggravation as it improves renal function.