[Bilateral impact of cardiorenal relationships in the nephrotic syndrome.]

To study and analyze the cardiorenal relationships in nephrotic syndrome, taking into account sex differences. A total of 272 patients with nephrotic syndrome (NS) aged 16 to 65 years were examined. All patients underwent general clinical examination, electro-and echocardiography, assessment of peripheral and biochemical blood counts. NS was determined with daily proteinuria of more than 3.5 g/1.73 m2 per day, hypoalbuminemia (albumin less than 30 g/l) and hyperlipidemia (total cholesterol more than 5.1 mmol/l). The duration of the National Assembly ranged from 3 months or more. Depending on the gender, the total sample (n=272) was divided into two subgroups: the 1st subgroup - patients with female NS (n=88), the 2nd subgroup - males with NS (n=184). The mean systolic, diastolic, pulse and mean arterial pressure (BP) were significantly higher in male NS patients (p<0.05). Supraventricular and ventricular ectopic activity was significantly more common in males. In the subgroup of women with NA, sinus tachycardia was significantly more frequently detected, a slowing down of the impulse conduction along the bundle of His, a violation of the processes of repolarization of the LV (p<0.05). The final systolic and diastolic sizes of the left ventricle (LV), the thickness of the interventricular septum and the posterior wall of the left ventricle, the diameter of the aorta, the longitudinal size of the left atrium and the right ventricle were significantly larger in the group of males with NA. Significantly lower concentrations of hemoglobin, hematocrit, erythrocyte counts were observed in the subgroup of females with NS compared with men (p<0.05). In the cohort of men with HC, there was a significant decrease in the content of total serum protein (44.8±11.0 g/l versus 49.2±11.2 g/l; p=0.003) as compared with females. In the male subgroup of HC, serum creatinine concentration [97 (81;143) mmol/l versus 86 (68;123) mmol/l; p=0.005] and the degree of daily protein excretion [6,490 (4,865;9,661) g versus 5,585 (4,168;7,625) g; p=0.034] with urine were significantly higher compared with the female subgroup (Table 2). At the same time, in the cohort of men with HC, there was a significant decrease in the calculated GFR [62.3 (46.2; 114.9) ml/min versus 87.0 (67.7;127.5) ml/min; p=0.002]. In case of NS in females, factors of deterioration of cardiorenal interrelations are anemia, sinus tachycardia, slowing down of impulse conduction along the bundle of His. Whereas in the NA subgroup of men, negative factors of cardiorenal interrelations are hypoproteinemia, increased systolic, diastolic, pulse and mean blood pressure, creatinine concentration and daily proteinuria, which was accompanied by a decrease in glomerular filtration rate and an increase in the linear dimensions of the heart.

[Renal dysfunction and indicators of arterial hormity in persons of elderly and senile age.]

In the presented paper had been examined parameters of arterial stiffness (stiffness index, SI m/s; reflection index, RI%; augmentation index, Alp; biological age of the vascular system, VA years; age index, AGI; alternative stiffness index, aSI; index of increase in HP=75, Aiр 75%), central arterial pressure and cystatin C content in serum. A totally were examined 98 persons (women, n=45 and men, n=53) elderly and older. A comparative analysis of arterial stiffness and its relationship with blood cystatin C in the examined groups with gender differences taken into account. In the elderly and older women, the augmentation index and its increase at a pulse rate of 75, atherogenic lipids (total cholesterol, low-density lipoprotein cholesterol and serum triglycerides) were significantly higher, and the indicators of the alternative stiffness index were significantly lower compared to men elderly and older. The greatest number of correlation interrelations was found between the indices of arterial stiffness and the level of cystatin C in the group of women of elderly and senile age.

Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis.

PURPOSE: to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. MATERIALS AND METHODS: We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. RESULTS: Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. CONCLUSION: We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis].

PURPOSE: to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. MATERIALS AND METHODS: We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. RESULTS: Atherosclerotic changes of CA were found in 79 patients (29.3 %). Four patients (1.4 %) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75 %; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25 % vs. 62.16 %; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. CONCLUSION: We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[The gender features of disorders of composition of lipids of blood serum in patients with chronic pathology of kidneys.]

The purpose of the study was to investigate gender features of abnormalities of blood serum lipid composition and their relationship with clinical and functional manifestations in patients with chronic kidney disease (CKD). The study covered patients with CKD at pre-dialysis stage of disease, aged 17 - 71 years (average age 37.3±13.0 years). All patients underwent complex clinical and laboratory examination. Depending on gender, the sample (n = 417) was divided into 2 groups: group I - males (n = 277) and group II - females (n = 140). Blood sampling was implemented using venipuncture of ulnar vein after 12-14 hours of fasting in morning time. The lipid analysis of blood serum was performed using the auto-analyzer "Respons 920" (Germany), including detection of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The atherogenic index (AI) was calculated according formula: AI = (TC - HDL-C)/HDL-C. At analysis of the results of lipidogram, the levels of TC (hypercholesterolemia), LDL-C (hyper-beta-cholesterolemia) and TG (hypertriglyceridemia) were considered as increased when their values were ≥5.0 mmol/L, ≥3.0 mmol/L and > 1.7 mmol/L respectively. The level of HDL cholesterol (hypo-alpha-cholesterolemia) was considered as decreased when its concentration was ≤1.0 mmol/L in males and ≤1.2 mmol/L in females. In the group of male patients, hypo-alpha-cholesterolemia was detected in 135 patients (48.7%), hypertriglyceridemia - in 162 (58.4%), and average value of atherogenic index was significantly higher - 3.49 (2.43-5.08) as compared with 3.12 (2.12-3.74) in female patients (p=0.001). The laboratory signs of anemia were significantly more frequent in group of females - 53 (37.8%) as compared with 63 (22.7%) than in males (p = 0.001). In males, average values of HDL cholesterol and total serum protein were significantly lower (1.07 ± 0.44 mmol/L vs. 1.23 ± 0.42, p = 0.000 and 53.3 ± 14.6 g/L vs. 57.4 ± 11.9 g/L, p = 0.007, respectively. The levels of TG - 1.92 (1.23-2.74) mmol/L vs. 1.85 (1.04-2.37); p = 0.034], sodium (140.3 ± 6.20 mmol/L vs. 138.3 ± 6.01 mmol/L, p = 0.010) and uric acid in blood serum were significantly higher (0.38 ± 0,09 mmol/L vs. 0.34 ± 0.01 mmol/L, p = 0.003) as compared with females. In the group II (females), a noticeable slowing of the glomerular filtration rate (GFR) - 68,4 (43,6-98,1) ml/min vs. 87,6 (55,0 - 117,6) ml/min; (p = 0.001) was detected as compared with group I (males). Among male patients, a reliably significant positive relationship was established between TC and BMI, level of diastolic blood pressure and proteinuria; LDL cholesterol level and proteinuria; concentration of TG - and BMI, level of diastolic blood pressure and level of proteinuria. No correlation was established between the concentration of HDL-cholesterol and aforementioned laboratory markers of CKD. In contrast with males, in females, TC demonstrated an inverse relationship with the concentration of Hb, values of GFR and proteinuria, and level of HDL cholesterol - with indices of BMI, thrombocytes and uric acid of blood serum. In females a positive relationship was established between LDL cholesterol and level of diastolic blood pressure, GFR and daily proteinuria, and also between concentration of serum TG and volume of daily proteinuria and BMI. In general group, a reliable positive relationship was detected between TC and BMI and proteinuria, between LDL-C level and proteinuria, and between TG concentration and BMI, level of diastolic blood pressure, sodium content and proteinuria. The negative relationship was established between concentration of HDL cholesterol and BMI and uric acid in blood plasma, and TG level with Hb concentration. In male patients with CKD at pre-dialysis stage of disease, decreasing of level of HDL cholesterol was established as an increased concentration of TG and increasing atherogenic index. The content of triglyceride of blood serum is closely related to body mass index, level of diastolic blood pressure and proteinuria. In females, slowing of glomerular filtration rate is accompanied by development of anemia and atherogenic dyslipidemia.

[Correlations between parameters of central hemodynamics and cytokine profile in chronic kidney disease in combination with cerebrovascular diseases]. / Vzaimosviaz' parametrov tsentral'noi gemodinamiki i tsitokinovogo profilia pri khronicheskoi bolezni pochek v sochetanii s tserebrovaskuliarnymi zabolevaniiami.

AIM: To study the relationship between central hemodynamics and arterial stiffness indicators with cystatin C, tumor necrosis factor-alpha (TNF-alpha) and interleukin-(IL)-10 in patients with chronic kidney disease (CKD) in combination with cerebrovascular diseases (CEV). MATERIAL AND METHODS: One hundred and twenty patients, aged from 19 to 81 years, with signs of chronic renal dysfunction, including 73 with CKD (1st group) and 47 with CKD in combination with CEH (group 2), were examined. 'AngioScan' (Russia) was used to study indices of arterial rigidity. Blood plasma concentrations of TNF-alpha, IL-10 and cystatin C were determined by the enzyme immunoassay. RESULTS: There is a significant increase (p<0.05) in the systolic, diastolic, central levels of arterial pressure, augmentation index, the index of increase at a pulse rate of 75 per min, the age index, the age of the vascular system and cystatin C content in the patients with CKD in combination with CEV compared to the patients with CKD without accompanying CEH. In the group of patients with CKD in combination with CEV, a correlation was found between the level of TNF-alpha and arterial stiffness index on one side (r=0.318; p<0.05) and the augmentation index on the other (r=0.299; p<0.05). CONCLUSION: The results confirm the fact that there is a significant increase in the level of plasma cystatin C and a decrease in GFR in patients with CKD in combination with CEV. Correlations were found between the level of TNF-alpha, augmentation index and deterioration of parameters of central hemodynamics and arterial stiffness in CKD in combination with CEH.