[The agreed experts' position of the Eurasian Association of Therapists on tactics of management of patients with comorbid pathology infected with SARS-Cov-2].

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

[Combined therapy of membranoproliferative glomerulonephritis in older patients].

The aim of the study was to investigate the effectiveness of combined long-term therapy by cytostatics and steroid hormones in older patients with membranoproliferative glomerulonephritis to halt renal failure progression. 27 patients older than 60 years with morphologically proved membranoproliferative glomerulonephritis have been treated. Nephrosclerosis was detected in 40% of studied patients according to results of kidney biopsies. The mean age of the patients was 65.8 +/- 1.5 years. The activity of the disease depended on presence and severity of nephrotic syndrome. 17 (62.9%) patients had coronary heart disease, 7 (25.9%) patients had chronic bronchitis, 7 (25.9%) patients had peptic ulcer disease in a remission phase. Patients received therapy by cyclophosphamide in a dose of 2 mg/kg daily and prednisolone in a dose of 1 mg/kg daily during 2 years. Tolerability of assigned treatment was satisfactory. The main clinical and laboratory signs of nephrotic syndrome were significantly reduced and the proof remission was reached after 8-12 months of combined therapy. During the observation (24 month) the glomerular filtration rate in studied patients didn't decreased over 30-59 mL/min/1.73 m2 and corresponded to stage 3 of chronic kidney disease.

[Age features of treatment of idiopathic membranoproliferative glomerulonephritis].

The aim of the study was to investigate the effectiveness of long application of the combined therapy by cytostatics and steroid hormones for patients with morphologically proved membranoproliferative glomerulonephritis depending on age. 51 patients younger 60 years and 27 patients older 60 years were investigated. Patients received therapy by steroid hormones and cytostatics within one year. Shipping of therapy was satisfactory. Despite presence of signs of nephrosclerosis, efficiency of treatment was good. Signs of a nephrotic syndrome were proof remission in all patients of 1st and 2nd groups in 12 months after beginning of treatment.

[The characteristics of left ventricular myocardial remodeling in patients with chronic renal disease, and the effects of spironolactone therapy].

The work reflects modern concepts of the pathogenesis of myocardial and vascular remodelling in a chronic renal disease. Types of changes in left ventricular geometry and the condition of the diastolic function in patients at pre-dialysis stage of a chronic renal disease and patients on program hemodialysis. Dynamic changes in left ventricular parameters under the influence of therapy with spironolactone, an aldosterone receptor blocker, are described. The use of spironolactone in a dose of 25 mg per day is shown to regress myocardial hypertrophy in anuric patients on hemodialysis.

[The role of disorders in the tubular transport of water and osmotically active substances in the progression of chronic kidney failure]. / Rol' narushenii kanal'tsevogo transporta vody i osmoticheski aktivnykh veshchestv v progressirovanii khronicheskoi pochechnoi nedostatochnosti.

Lithium clearance served the criterion for measuring proximal and distal tubular transport of water, sodium and osmotically active substances (OAS) in 41 patients with chronic renal failure (CRF) of various degree. Distal reabsorption of water and sodium occurs early in CRF. In moderate disease the authors observed a drastic rise in distal excreted fraction of OAS which surpassed that of sodium threefold. Proximal fractional excretion of water acquired defects in advanced CRF only. In the range of creatinine clearance 30-65 ml/min an inverse relationship appeared between the clearance and the ratio of urea of OAS concentrations to chlorine concentrations. Distal fractional OAS excretion correlated with relevant parameters directly. It is suggested that a decline in relative chlorine ions content in the tubular fluid at the site of the thick spot entails hypoactivity of the tubular-glomerular feedback mechanisms resultant in hypertension and hyperfiltration in the intact nephrons which start to perish because of overloading.

[The effect of the angiotensin-converting enzyme inhibitor enalapril on the rates of progression of chronic kidney failure in patients with different degrees of functional kidney disorders]. / Vliianie ingibitora angiotenzinprevrashchaiushchego fermenta énalaprila na tempy progressirovaniia khronicheskoi pochechnoi nedostatochnosti u bol'nykh narusheniiami funktsional'nogo sostoianiia pochek razlichnoi stepeni.

By a reciprocal of creatininemia the rate of chronic renal failure progression (CRF) was assessed in 14 patients with nephropathy on enalapril treatment. The day dose ranged from 2.5 to 15 mg. In patients with serum creatinin levels from 0.24 to 0.41 mmol/l (group 1) enalapril significantly inhibited CRF progression, as it did in group 2 (serum creatinin levels from 0.47 to 0.68 mmol/l) but 1 patient. In patients with creatinin levels over 0.71 mmol/l, the influence of enalapril on CRF progression rate was insignificant. All the patients exhibited stabilization of arterial hypertension. Proteinuria diminished in groups 1 and 2, while creatinin clearance decreased in groups 1 and 3. It is inferred that enalapril control of renal function in nephropathy patients is efficient only in early CRF.

[Effect of protein load on kidney functions in patients with chronic glomerulonephritis]. / Vliianie belkovoi nagruzki na funktsional'noe sostoianie pochek u bol'nykh khronicheskim glomerulonefritom.

AIM: To study changes in renal function in response to protein loads in patients with chronic glomerulonephritis (CGN) who have normal renal function and initial uremia. MATERIAL AND METHODS: 63 CGN patients were divided into two groups: 40 patients of group 1 (17 males, 23 females, age 16-53 years, plasma creatinine-Pcr < 0.132 mmol/l); 23 patients of group 2 (10 males, 13 females, age 18-57 years, Pcr > 0.132 mmol/l). Renal functional reserve (RFR) was assessed with oral soa isolate SUPRO 760 test (protein Techn. Int., USA), 1.0 g of protein per 1 kg of ideal body mass. By three 2-h clearance periods measurements were made of RFR, absolute and fractional excretion, concentration indices and clearances of creatinine, urea, electrolytes, osmolality. All the parameters were referred to the standard body surface. RESULTS: RFR was intact in 14 patients of group 1 and 10 patients of group 2. In CGN without uremia with intact RFR, maximal Pcr corresponded to the highest values of minute diuresis and sharp increase of urea excretion, osmotically active substances. In CGN patients with uremia and intact RFR, development of hyperfiltration was accompanied with a significant rise in Pcr, minute diuresis, absolute excretion of urea and osmotically active substances. The rise in the latter two was much less active in CGN if RFR was absent. Multiple stepwise regression analysis showed that RFR intactness depends primarily on baseline values of absolute excretion of urea and osmotically active substances. CONCLUSION: A reverse relationship exists between absolute excretion of urea, osmotically active substances and the degree of SKF in response to protein load in CGN patients both in intact nitrogen-excreting function and uremia. It is suggested that urea may be involved in regulation of intraglomerular hemodynamics by means of effect on tubular-glomerular feedback mechanism.

[The effect of urea on the course of experimental uremia in rats with a subtotal nephrectomy]. / Vliianie mocheviny na techenie éksperimental'noi uremii u krys s subtotal'noi nefréktomiei.

The important role of increasing plasma urea levels in renal failure progression was shown in Wistar rats with experimental uremia induced by subtotal nephrectomy. Renal structural lesions and dysfunction were the same as in rats fed a high-protein diet and in those on a low-protein diet supplemented with urea. The changes were much less in the control group of rats fed a low-protein diet alone. The findings suggest that high blood urea concentrations appear to be a cause of intraglomerular hemodynamic disturbances following renal failure progression.

Effect of spironolactone on hypertrophy of left ventricular myocardium in wistar rats with experimental uremia.

Chronic renal failure was modeled in rats by partial nephrectomy. Blood pressure, heart rate, concentrations of aldosterone, urea, creatinine, electrolytes, and protein, index of hypertrophy of visceral organs, and 24-h diuresis were evaluated. In rats treated with spironolactone, the index of myocardial hypertrophy did not considerably differ from that in sham-operated animals, whereas in untreated rats the test parameters considerably differ from the control. We concluded that the blockade of aldosterone receptors with spironolactone produced a cardioprotective effect in Wistar rats with subtotal nephrectomy.

[The reaction of the kidneys and acid-base and osmotic homeostasis to moderate physical exertion in patients with chronic pyelonephritis in the pre-azotemia period]. / Reaktsiia pochek, kislotno-osnovnogo i osmoticheskogo gomeostaza na umerennoe fizicheskoe napriazhenie u bol'nykh khronicheskim pielonefritom v doazotemicheskom periode.

Bicycle ergometry (BE) up to submaximal heart rate provoked moderate metabolic acidosis in 52 patients with chronic pyelonephritis (CP) in preuremic stage. Similar changes in acid-base balance following BE were noted in 14 patients with chronic glomerulonephritis (CGN). BE in CP promoted the reduction in diuresis and fraction water excretion, elevation of creatinine concentration in the urine and its concentration index in the absence of alterations in sodium and osmotic homeostasis. In CGN BE induced similar changes but an insignificant decrease in diuresis and a significant rise in serum sodium concentrations, osmolality of the urine, osmotic concentration index, absolute reabsorption of osmotically free water, fall in excreted sodium fraction. It is suggested that the above differences in the response to exercise test in CP and CGN may relate to tubulointerstitial nature of CP.