[Use of angiotensin-converting enzyme inhibitors in chronic kidney insufficiency]. / Primenenie ingibitorov angiotenzinprevrashchaiushchego fermenta pri khronicheskoi pochechnoi nedostatochnosti.

AIM: To study effects of ACE inhibitors in patients with diffuse renal diseases at the stage of chronic renal failure (CRF). MATERIAL AND METHODS: Acute changes in renal filtration and in renal hemodynamics in response to 100-200 mg captopril were studied in 7 patients with CRF and 6 patients with intact renal function. Effects of long-term ACE inhibitors were retrospectively studied in 50 patients with CRF (27 men, 23 women, mean age 46.0 +/- 1.9 years, 7 patients were over 60 years old). Sixteen patients were selected from this group who were followed up for a long time. They were examined for CRF progression rate when given conventional antihypertensive treatment and after treatment with ACE inhibitors. RESULTS: Acute response to ACE inhibitors was the following: SCF fell by 18.4% on the average by the end on therapy week 1; by the end of week 3 renal hemodynamics showed stability, SCF returned to normal, effective renal plasm flow rose by 16.9%, serum potassium rose significantly after 7 days of treatment but did not reach 6 mmol/l. Effects of long-term ACE inhibitor in CRF: the treatment was discontinued after 30-60 days in 12 of 50 patients because of high creatinine (> 20%); in 38 patients ACE inhibitor had a pronounced antihypertensive and antiproteinuric action for 2-3 years, creatinine growth inhibited. Progression of CRF became slow. CONCLUSION: ACE-inhibitors in CRF had a nephroprotective effect but blood creatinine levels should be controlled especially within the first 1-2 months of treatment.

[10 years' experience of the operation of a nephrological day hospital]. / Desiatiletnii opyt raboty dnevnogo nefrologicheskogo statsionara.

For a decade 324 patients with nephropathy have been admitted to a day hospital for obtaining more accurate data on nephropathy activity, on the role of hemodynamic and metabolic factor in the disease progression. The treatment group patients received repeated courses of high-dose cytostatics and corticosteroids. Pregnant women at risk of nephropathy were given small doses of aspirin and curantil.

[Hemorrhagic vasculitis and the hepatitis B virus]. / Gemorragicheskii vaskulit i virus gepatita B.

Twenty-one patients with hemorrhagic vasculitis (HV) were examined for HBsAg, nine for HBeAg, anti-HBe, anti-HBc, anti-HBs. HBV markers were identified in 6 out of 21 patients (29.6%): HBsAg in 5 cases (one of them also anti-HBc and anti-HBe), anti-HBs in 1 case. The history of HV ranged from 4 months to 8 years. Normal serum transaminase was seen in 5 out of 6 patients with HBV markers. It was somewhat elevated in 1 of the examinees due to cytostatic treatment in parallel growing of HBsAg titer. Cryoglobulins occurred in 3 out of 6 cases. Renal biopsy from 3 HBV markers carriers identified mesangioproliferative glomerulonephritis in all of them.

[Acetylsalicylic acid and kurantil in the prevention of pregnancy complications in glomerulonephritis and hypertension]. / Atsetilsalitsilovaia kislota i kurantil v profilaktike oslozhnenii beremennosti pri glomerulonefrite i gipertonicheskoi bolezni.

A controlled clinical trial included 64 pregnant females suffering from chronic glomerulonephritis (CGN) and hypertension: 31 patients received acetylsalicylic acid (ASA) in a dose 125 mg/day and curantyl (150-225 mg/day) from gestation week 12-19 till delivery, 33 control females were not given the drugs. Prenatal care and labour management were similar. Total number of the complications (fetal and natal deaths, preterm labour, intrauterine fetal retardation, late toxicosis, premature detachment of normally located placenta) as well as the number of pregnancies with complications were less in the test group. The same was true for the second pregnancies versus the first ones when ASA and curantyl were not given. It is suggested that low-dose ASA plus curantyl improve placental circulation eventually resulting in less frequent occurrence of pregnancy complications and in better pregnancy outcomes in CGN and hypertensive women.

[Laser treatment of patients with chronic glomerulonephritis]. / Lazernaia terapiia bol'nykh khronicheskim glomerulonephritis.

Helium-neon laser therapy of patients suffering from mixed and nephrotic glomerulonephritis demonstrated hypotensive, diuretic and fibrinolytic activity boosting clinical effects. The use of the new treatment method seems to be justified, since all the patients given laser therapy manifested pronounced resistance to the pathogenetic therapy carried out previously (glucocorticoids, cytostatics, hypotensive and diuretic drugs). The presence of diverse effects and lack of complications suggest a broader-scale use of laser therapy in nephrology. At present the authors are analyzing the ++patho-chemical bases of the therapeutic efficacy of laser therapy of patients suffering from chronic glomerulonephritis. The results will be reported in the next paper.

Effects of indomethacin on the renal function and renin-aldosterone system in chronic glomerulonephritis.

The effects of indomethacin on plasma renin activity (PRA), plasma and urine aldosterone levels and on renal function were studied in 37 patients with chronic glomerulonephritis (GN). Indomethacin produced a significant decrease in PRA, in plasma and urinary aldosterone levels and an increase in serum potassium levels. In 4 patients indomethacin induced the clinical syndrome of hyporeninemic hypoaldosteronism with hyperkalemia, which developed during the first weeks of treatment, persisted during treatment and disappeared without any additional drugs when indomethacin was stopped. In 14 patients with chronic GN, indomethacin caused a decrease in glomerular filtration rate (GRF). Their pretreatment PRA was significantly higher than that of patients with unchanged or increased GFR and most of them had prominent sclerotic changes on biopsy. Indomethacin considerably depressed diuresis and urinary sodium excretion. The antidiuretic and antinatriuretic effects of indomethacin were more pronounced in patients with the nephrotic syndrome. The results suggest that indomethacin exerts an effect on the renin-aldosterone axis, may be a cause of drug-induced hyporeninemic hypoaldosteronism and may cause a decrease in GFR in patients with high PRA.