[Analysis of the Effectiveness of Renoprotection of Low-Protein Diet and Ketoanalogues of Amino Acids In Patients With Chronic Kidney Disease].

AIM: Analysis of the effectiveness of renoprotection in patients with chronic kidney disease (CKD), who is observed by general practitioners for up to 72.1 months, keeping traditional LPD or LPD with prescription of ketoanalogues of amino acids (KA/AK). METHODS: 63 patients with CKD stages 3-4, mainly with glomerulonephritis (GN), were divided into 3 groups: 1 gr--31 patients (53.3 ± 3.1 years old; M/F--18/13), LPD with prescription of ketoanalogues of amino acids; 2 gr--22 patients (54.9 3.2 years old; M/F--13/9) traditional LPD without ketoanalogues; 3 gr--10 patients (51.7 ± 4.2 years old; M/F--6/4) with natural course of CKD. Group 4 (control)--30 healthy subjects (52.3 ± 2.2 years old; M/F--16/14). The following parameters were studied: dynamics of the glomerular filtration rate (GFR), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin levels (Hb), daily proteinuria, and basic parameters of protein, lipid and phosphate- calcium metabolism. RESULTS: The rate of decline in GFR was significantly lower in patients of the first group (-0.78 mL/min/year) than those of the second group (-4.9 ml/min/year). 9.7% of patients of the first group needed the start of renal replacement therapy at the end of the observation, 18.1%--of the second group and 40%--of the third. All patients who received renoprotective therapy, including low-protein diet with KA/AA reached target levels of blood pressure < 140/90 mm Hg. Patients of this group was able to achieve a significant reduction in proteinuria, improvement of lipid metabolism, prevent of reduction of Hb and the development of metabolic disorders of protein and calcium-phosphate metabolism. The second group of patients, following nephroprotection recommendations and LPD without KA/AA, had fewer reductions in BP without reaching the target level, DBP did not change; reduction of proteinuria was less significant than in group 1. There was no negative dynamics of protein and calcium-phosphate metabolism, though significantly increased levels of total cholesterol and LHD were observed. The third group of patients, who did not follow the renoprotection recommendations demonstrated negative dynamics of the studied parameters. CONCLUSION: Renoprotection based on the use KA/AA in patients with CKD stages 3-4 proved to be more effective than without it in slowing the rate of decline in GFR, hypertension correction, proteinuria reduction, maintaining the level of Hb, prevention of disorders of protein and calcium-phosphate metabolism, as well as correction of the lipid metabolism.

[Informative value of immunomembrane indicator of glomerulonephritis activity and effectiveness of membranostabiliser dimephosphon]. / Ob informativnosti immunomembrannykh pokazatelei aktivnosti glomerulonefrita i éffektivnosti membranostabilizatora dimefosfona.

AIM: Study of effectiveness of dimephosphone with regard of the kind and degree of membrane disorders in various clinicomorphological forms of active glomerulonephritis (GN). MATERIALS AND METHODS: 170 patients with nephrotic, nephritic GN have undergone a complete nephrological examination. Informative value of immunological, morphological and membrane (phospholipids, lipid peroxidation) indicators of GN and lupus nephritis (LN) activity was analysed. RESULTS: Membrane destabilisation and GN activity were correlated. Membrane destabilization was also associated with dislipid- and disproteinemia, disturbances of renal function. This can be used for diagnosis of GN activity and its rapid progression. Dimephosphone monotherapy was found effective in correction of immunomembrane disturbances in minimally active GN and hormone-resistant forms irrespectively of the activity forms. Combination of dimephosphone with prednisolone and/or cytostatics proved more effective than dimephsphone monotherapy or conventional treatment with glucocorticoids and/or cytostatics without dimephosphone in respect of frequency of remission and early remission achievement in various types of activity and clinicomorphological forms of GN. CONCLUSION: Combination of dimephosphone with glucocorticoids and/or cytostatics is more effective than monotherapy or combined treatment with glucocorticoids and cytostatics in the treatment of GN of different clinicomorphological forms, hormone-resistant among them, and types of activity.

[Tests for cell membrane destabilization in assessing activity-progression of chronic glomerulonephritis]. / Testy destabilizatsii kletochnykh membran v otsenke aktivnosti/progressirovaniia khronicheskogo glomerulonefrita.

AIM: To study the role of cell membrane destabilization (MD) in the serum and urine in assessing activity/progression of primary chronic glomerulonephritis (CGN). MATERIAL AND METHODS: The trial entered 163 patients (mean age 38 +/- 7.3 years) with primary CGN in active phase, 64 patients with CGN in remission and 24 controls. The groups were compared by MD (urine phospholipids--PL, blood and urine ethanolamine--EA), indexes of activity and sclerosis (AI and SI), lipid peroxidation (LPO), etc. RESULTS: In active glomerulonephritis (GN) vs inactive one there were high levels of 24-h proteinuria, AI, PL and EA in the urine, malonic dialdehyde (MDA) and hydroperoxides (HP) in the blood. SI was similar in both groups. In active GN significant correlations were found between urinary SI, systolic and diastolic pressure, elevated levels of beta-lipoproteins and triglycerides; between blood EA and 24-h proteinuria, blood platelets, beta-lipoproteins, triglycerides, MDA, urine EA. CONCLUSION: LPO and MD play an essential role in GN pathogenesis. They reflect activity of inflammation in GN irrespective of the activity type and clinicomorphological form of GN, absence or presence of CRF.

[Early signs of renal pathology in small intensity chemical exposure]. / O rannikh priznakakh pochechnoi patologii pri khimicheskikh vozdeistviiakh maloi intensivnosti.

Occupational exposure to vapours, gases and aerosols promotes increase of renal diseases incidence. Wider use of anamnestic data is recommended during preliminary and regular check-ups of this population.