Blood serum endotoxins were studied in patients with acute and chronic renal failure in order to correlate this spectrum with the treatment efficacy. Gel [correction of Liquid] chromatography tests of the serum samples were made in 106 patients on hemodialysis, hemodiafiltration and hemosorption. Hemodialysis was found to significantly reduce concentration of middle-mass molecular fraction (C, D, F with molecular mass from 300 to 2000 D). Hemodiafiltration produced the same effect, but more rapidly. A single procedure of hemosorption was able to improve the patients condition in the course of 2 postprocedure weeks. The authors attribute this effect to removal of the molecular fraction A which is highly toxic.
Acute Kidney Injury/blood , Hemodiafiltration , Hemoperfusion , Kidney Failure, Chronic/blood , Peptides/blood , Renal Dialysis , Toxins, Biological/blood , Acute Kidney Injury/therapy , Chromatography, Gel/instrumentation , Chromatography, Gel/methods , Humans , Kidney Failure, Chronic/therapy , Molecular Weight , Time Factors
The authors studied the features of urolithiasis in three different geographical regions: Moscow, the Kirghiz SSR, and Berlin from the findings of examination of the composition and structure of uroliths removed by operation or passed spontaneously, (602 concrements from Moscow, 10,000 from Berlin, and 127 from Kirghizia). X-ray diffraction measurement, infrared spectrophotometry, and polarizing microscopy were conducted to analyze the composition and structure of the stones. Complex biochemical examination was carried out in patients from Moscow and Kirghizia. According to the results of the study, the following features of urolithiasis are common in the studied regions: (1) prevalence of oxalate lithiasis on the whole, which points to the principal role of metabolic factors in lithogenesis; (2) approximately similar amounts of apatite carbonate crystals in the uroliths; (3) certain similarity in composition of concrements from Berlin and Kirghizia. The most essential differences are: (1) the frequency of renal oxalate stones is highest in Berlin and lowest in Moscow. The prevalent types of calcium oxalate stones are: whewellite of concentric structure (linked with hyperuricemia) in Kirghizia; whewellite of small randomly orientated crystals (linked with hypercalciuria) and stones with signs of transformation of weddellite to whewellite in Moscow; (2) lesser distribution of phosphate lithiasis in Berlin than in Kirghizia and particularly in Moscow. Prevalence of struvite crystals in stones from Moscow, the formation of which is linked with the vital activity of Proteus and E. coli; (3) higher distribution of urate lithiasis in Moscow and particularly in Kirghizia where significant metabolic risk factors of lithogenesis were revealed.
Urban Population/statistics & numerical data , Urinary Calculi/chemistry , Urinary Calculi/epidemiology , Berlin/epidemiology , Humans , Kyrgyzstan/epidemiology , Microscopy, Polarization , Moscow/epidemiology , Prevalence , Spectrophotometry, Infrared , Urinary Calculi/metabolism , X-Ray Diffraction
This is an account of experience with extracorporeal detoxication techniques in 238 patients with urologic conditions who underwent 305 hemosorption (HS), 30 plasma sorption (PS) and 171 plasmapheresis (PA) sessions. Clinical and laboratory criteria are presented for employing an extracorporeal detoxication technique depending on predominance of suppurative septic or azotemic intoxication, and contraindications for HS, PS and PA. Absolute indications for these techniques were suppurative septic intoxication secondary to acute and chronic urologic inflammatory diseases, including septic shock, and acute renal failure. An emphasis is placed on the need for utilization of this therapy after urine flow recovery and drainage of all suppurative foci. An overview of mechanisms of different extracorporeal detoxication techniques showed them to share detoxifying and immunostimulating effects and improvement of blood rheology, renal and hepatic function. Application of the extracorporeal techniques reversed 84.4% of acute pyelonephritis, 61% of acute renal failure (without resorting to hemodialysis) and 65.4% of septic shock. This therapy was less efficient in patients with multiple organ failure. Good efficacy of xenogenic-spleen or splenocyte-suspension hemoperfusion was shown in patients with urosepsis.
Sorption Detoxification/methods , Urinary Tract Infections/therapy , Acute Disease , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Humans , Pyelonephritis/complications , Pyelonephritis/therapy , Remission Induction , Shock, Septic/complications , Shock, Septic/therapy , Urinary Tract Infections/complications
Gel chromatography was used for measuring medium-molecular levels in the blood sera of urologic patients: (1) low-pressure chromatography in Sephadex G-15 packed columns with fractionation range less than 1500 dalton or in Toyopearl HW-40 packed columns with fractionation range from 100 to 100,000 dalton; (2) high-pressure chromatography in LKB (Sweden) blue columns. Liquid exclusion chromatography was employed to assess the efficacy of blood extracorporeal detoxication of urologic patients by means of hemoperfusion, hemodiafiltration, hemodialysis, plasma perfusion, plasmapheresis. The highest correlation between patients' state of health and blood levels of medium molecules was observed in hemodiafiltration.
Sorption Detoxification/methods , Toxins, Biological/blood , Urologic Diseases/therapy , Chromatography, Gel , Chromatography, Liquid , Evaluation Studies as Topic , Humans
The authors considered an important problem of in vivo verification of urolith composition as specifying the choice of drug treatment and prevention of urolithiasis. 84 nephrolithiasis patients were allocated to 4 groups according to their concrement compositions (after spontaneous or surgical removal): 23 patients with urate calculus, 19 with oxalate, 20 with phosphate and 22 with oxalate-phosphate concrements. Polarizing microscopy, x-ray structural analysis and infrared spectrophotometry were employed for verification of calculi composition. Biochemical assay was used for the assessment of serum and circadian excretion of calcium, phosphates, sodium, potassium, uric acid, oxalates and uroacidimetric values. The findings were subjected to discriminant computed analysis which resulted in 6 linear computable functions defining 4 selective groups with regard to biochemical blood and urine data. The aforementioned functions were used in diagnostic routine for the in vivo assessment of calculous composition in 26 controls. In 61.5 per cent of the patients the diagnosis was confirmed, in 34.6 per cent it was verified, and only in 3.9 per cent the diagnosis turned to be erroneous.
Kidney Calculi/analysis , Diagnosis, Computer-Assisted , Female , Humans , Kidney Calculi/diagnosis , Kidney Calculi/metabolism , Male , Microscopy, Polarization , Middle Aged , Oxalates/analysis , Oxalates/metabolism , Phosphates/analysis , Phosphates/metabolism , Spectrophotometry, Infrared , Uric Acid/analysis , Uric Acid/metabolism , X-Ray Diffraction
Kidney Failure, Chronic/diagnosis , Plasmapheresis , Pyelonephritis/diagnosis , Toxins, Biological/analysis , Uremia/metabolism , Evaluation Studies as Topic , Hemoperfusion , Humans , Kidney Failure, Chronic/metabolism , Kidney Failure, Chronic/therapy , Male , Pyelonephritis/metabolism , Pyelonephritis/therapy , Time Factors
