A renoprotective effect of enalapril in chronic transplantation nephropathy

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.     

Peripheral blood responses in elderly patients with some prevalent diseases

The aim of the research was to study blood responses to inflammatory processes in patients of different ages. The subjects of the study were 31 healthy persons and 198 patients, 116 of whom had pneumonia and 82 had chronic pyelonephritis. The patients were divided into three age groups: 16 to 39 years, 40 to 59 years, and older than 60 years. The following parameters were calculated on the basis of peripheral blood leukocyte composition and ESR: leukocyte intoxication index (LII), lymphocyte index (LymI), leukocyte shift index (LSI), leukocyte index (LI), leukocyte to ESR ratio index (LESRRI), lymphocyte-granulocyte index (LGI), total index (TI), neutrophile to lymphocyte ratio index (NLymRI), neutrophile to monocyte ratio index (NMRI), and lymphocyte to monocyte ratio index (LMRI). The majority of the indexes (LII, LymI, LSI, LI, LESRRI, LGI, and LMRI) in acute inflammation processes and some of them (LESRRI, NLymRI, and LMRI) in chronic inflammation altered significantly in all the age groups, which demonstrated that compensatory and adaptive mechanisms remained preserved in the elderly. The were age-dependent differences in blood responses to inflammation: LymI, LI, and LGI were significantly lower in the elderly with chronic pyelonephritis, whereas in Groups 1 and 2 there were no changes; NMRI was decreased in Groups 1 and 2 in chronic pyelonephritis and did not differ from the elderly controls. In acute inflammation, there were no significant differences from the controls in NlymRI in Group 3, while this parameter in Groups 1 and 2 differ from that in the controls. Thus, hematological indices make it possible to assess the work of effectory mechanisms of the immune system, the degree of their compensation in patients belonging to different age groups.     

Rapidly progressive glomerulonephritis in ANCA-associated vasculitis: a course, treatment efficacy, prognosis

AIM: To study efficacy of ANCA-RPGN treatment with corticosteroids and cyclophosphamide or mycophenolic acid drugs. MATERIAL AND METHODS: We treated 28 patients (17 males and 11 females aged 19-71 years) with morphologically verified ANCA-associated crescentic RPGN (crescentic median 79 (63:88)%. The patients received corticosteroids and cytostatics. RESULTS: The response to the treatment was registered in 22 (78%) patients in 8-16 weeks: a complete remission was achieved in 8 patients, a partial one--in 14 patients. In partial remission renal functions recovered incompletely (median Pcr 200 (180;255) mcmol/l) in persistence of moderate proteinuria (median 0.7 (0.6;1.3)g/day) and absence of microhematuria. Probability of the treatment success depended on severity of glomerulosclerosis and weakly depended on activity of extracapillary reaction. Severe renal failure was not an absolute predictor of treatment failure. CONCLUSION: In the absence of advanced nephrosclerosis early treatment with corticosteroid in combination with cytostatics can produce a positive effect in 70-80% patients with ANCA associated RPGN.     

Laparoscopic operations for simple cysts of kidneys at children

Results of treatment of 62 children aged 1 to 15 years with non-parasitic cysts of kidneys using mini-invasive laparoscopic technologies are analyzed. Laparoscopic operations with original technique have been performed at all the patients with various cysts sizes (from 3 to 13 cm across diameter) and localization (including 12 cases of peripelvic cysts). The time of surgery ranged 25 to 110 min (43 min on average); there were no conversions to open surgery, intraoperative and postoperative complications. The follow-up ranged from 1 to 3 years, there were no cases of cyst recurrence, and the functional and cosmetic results were excellent. It is concluded that laparoscopic method should be regarded as "gold standard" for the treatment of non-parasitic kidneys cysts at children that permits to achieve the stable positive results regardless of patient age, size and localization of cyst.     

Integral assessment of endogenous intoxication in patients with purulent mediastinitis

The parameters of endogenous intoxication (EI) were studied in patients with purulent mediastinitis (PM). The integral index of E1--the coefficient C(EI) that included the relative indices (as to the normal values) of the total and effective concentrations of albumin, medium molecular-weight peptides, leukocytic intoxication index, and malonic dialdehyde, was developed. The values multiplied together are C(EI) and reflect the manifestation of EI. The level of EI in patients with PM was ascertained to be much increased on postoperative days 1 and 3. Extracorporeal hemocorrection (plasmapheresis, prolonged venovenous hemofiltration) used in complex therapy diminishes the degree of EI by several times, on day 10 after surgery in particular. The use of C(EI) is shown to considerably increase the diagnostic sensitivity of the early stage of EI, to prescribe adequate detoxifying therapy in time, and to evaluate its efficiency.     

Hypokininemia in chronic bronchitis caused by cotton dust

Examination of 102 patients who developed bronchitis due to exposure to cotton dust running a complicated or noncomplicated course recognized a moderate hyperkininemia in 40% of cases (4.46 +/- 0.43 against the normal 2.90 +/- 0.42) and apparent hypokininemia in 60-63% of cases (0.52 +/- 0.03 against 2.90 +/- 0.42). Hypokininemia appeared in association with pathological shifts in external respiration and central hemodynamics. It is an unfavourable factor contributing to formation of occupation complications of chronic bronchitis: pulmonary emphysema, pulmonary hypertension and cor pulmonale.     

Endogenous intoxication parameters in the assessment of a risk for pneumonias in acute azaleptin intoxications

In cases of acute azaleptin poisoning (AAP), the parameters of endogenous intoxication (EI) were studied in patients both with complicated pneumonias and without them. The integral EI index endogenous intoxication coefficient (Cei) was developed, which simultaneously reflects the coupling capacity of albumin of hydrophilic toxins and lipid peroxidation products: Cei (MMWP x MDA/EAC) x 1000, where MMWP is medium molecular-weight peptides; MDA is malonic dialdehyde; EAC is the effective albumin concentration. The use of Cei significantly enhances the efficiency of diagnosis of early-stage EI and provides a more objective assessment of therapy in AAP patients. EI is more severe when poisoning is concurrent with complicated pneumonias. Cei is of informative value in the assessment of a risk for pneumonias in AAP, which may be used in various emergencies accompanied by EI.     

Cicletanine reverses vasoconstriction induced by the endogenous sodium pump ligand, marinobufagenin, via a protein kinase C dependent mechanism

RATIONALE: Cicletanine (CIC), an anti-hypertensive compound with direct vascular and natriuretic actions, is especially effective in salt-sensitive hypertension, in which dysregulation of the sodium pump plays an important pathogenic role, and digitalis-like cardiotonic steroids contribute to increased vascular tone. The purpose of the present study was to investigate whether, and by what mechanisms, cicletanine antagonizes the vasoconstrictor effects of cardiotonic steroids in isolated human arteries. METHODS: The effects of cicletanine on vascular tone were studied in isolated, endothelium-denuded rings of 2nd-3rd-order branches of human mesenteric arteries pre-contracted with bufodienolide marinobufagenin (MBG), an Na/K-ATPase inhibitor, or endothelin-1 (ET-1). Na/K-ATPase activity was measured in sarcolemmal membranes from the mesenteric artery. Activity of rat brain protein kinase C (PKC) was measured using the PepTag phosphorylation assay. RESULTS: MBG and ET-1 both induced sustained vasoconstriction in human mesenteric artery rings, and cicletanine relaxed rings pre-contracted with either MBG (EC50 = 11 +/- 2 micromol/l) or ET-1 (EC50 = 6.4 +/- 1.1 micromol/l). Although 8-Br-cGMP (100 micromol/l) caused complete vasorelaxation of arterial rings pre-contracted with ET-1, it did not affect the MBG-induced vasoconstriction. An activator of PKC, phorbol diacetate (PDA) (50 nmol/l), attenuated CIC-induced vasorelaxation of mesenteric artery rings pre-contracted with MBG (EC50 > 100 micromol/l), but not rings pre-contracted with ET-1 (EC50 = 6.5 +/- 1.2 micromol/l). In mesenteric artery sarcolemma, 100 nmol/l MBG inhibited the Na/K-ATPase by 68 +/- 5% and cicletanine (100 micromol/l) attenuated this Na/K-ATPase inhibition by 85 +/- 6%. In the PepTag PKC assay, cicletanine produced a concentration-dependent inhibition of rat brain PKC activity (IC50 45 +/- 11 micromol/l). In the presence of 50 nmol/l PDA, 100 micromol/l cicletanine did not antagonize the Na/K-ATPase inhibition by MBG, and did not inhibit the PKC from rat brain. CONCLUSIONS: Cicletanine antagonizes vasoconstriction induced by Na/K-ATPase inhibition via a PKC-dependent mechanism that does not involve inhibition of cyclic GMP phosphodiesterase (cGMP-PDE). This mechanism of action may be relevant to the greater potency of cicletanine in salt-sensitive hypertension in which plasma levels of endogenous digitalis-like cardiotonic steroids are elevated. Our findings also suggest that PKC is an important factor for cardiotonic steroid-Na/K-ATPase interactions on the vascular tone, and is therefore a potential target for therapeutic intervention in hypertension.