[Renal lesions in elderly patients with diabetes mellitus]. / Porazhenie pochek u bol'nykh sakharnym diabetom pozhilogo vozrasta.

AIM: To elucidate the role of some renal diseases, pyelonephritis in particular, in elderly patients with type 2 diabetes mellitus (DM). MATERIALS AND METHODS: The trial included 150 patients with diabetes mellitus type 2 aged over 60 years with DM duration 16.6 +/- 7.8 years. All the patients underwent general clinical examination, Reberg-Tareev test, urine seeding, renal ultrasonography. RESULTS: The diagnoses associated with renal pathology were made in 75% of patients, the specific renal parenchymal damage (diabetic nephropathy-DN) proper was much less common (73 patients with type 2 DM). 16 of them were found to have chronic renal failure. The concurrent abnormalities included pyelonephritis (21%), urolithiasis (14%), renal cysts (19%), their combination (43%). Concomitant pyelonephritis had the most significant impact on renal function. Essential hypertension occurred in 65% of patients. CONCLUSION: In old age, renal damage specific for DM develops in the presence of pyelonephritis, cystic degeneration of the parenchyma, involutional processes, atherosclerotic and hypertensive arteriolosclerosis.

[The epidemiological indices of multiple myeloma and concomitant nephropathies]. / Epidemiologicheskie pokazateli mielomnoi bolezni i sochetaiushchikhsia s nei nefropatii.

The authors have conducted an epidemiological study for multiple myeloma morbidity and mortality among 80,000 patients of the Medical Center examined in 1988-1995. Myeloma was diagnosed in 65 cases. Standard incidence rate was 4.09, 3.18 and 3.5 per 100,000 for myeloma in males, females and both sexes, respectively. Standard mortality was 2.76 and 1.73 per 100,000 for males and females, respectively. The above rates do not differ much from those of other countries. In terminal myeloma renal insufficiency occurred in 39 of 41 cases. In 8 cases chronic pyelonephritis was an independent course of renal failure thus indicating the importance of its persistent treatment.

[Immunologic aspects of renal involvement in patients with type II diabetes mellitus]. / Immunologicheskie aspekty porazheniia pochek u bol'nykh sakharnym diabetom II tipa.

Besides the known factors contributing to the pathogenesis of diabetic nephropathy, the role of immune mechanisms in types I and II diabetes is discussed of late; the contribution of autoimmune mechanisms to pathogenesis of noninsulin-dependent diabetes (NIDDM) is virtually unknown. Seventy-six patients with NIDDM and 48 with insulin-dependent condition were examined. Under study were levels of antibodies to FxIA and renal glomerular basal membrane antigens in the blood sera of donors and patients with types I and II diabetes, as well as concentrations, size, and pathogenicity of immune complexes. Antibodies to FxIA antigen were detected in patients with both types of diabetes with diabetic nephropathy. Detection of circulating antibodies to FxIA antigen in more than 70% of diabetics in the absence of protein in the urine may be used as a test system for the laboratory diagnosis of diabetic nephropathy prestage and as a criterion for prescription as early as at the initial stages of nephroprotective agents.

[Programmed hemodialysis in middle and old age]. / Programmnyi gemodializ v pozhilom i starcheskom vozraste.

28 patients treated by programmed hemodialysis (PH) were followed up from 1985 to 1991. All the patients were over 60 years old. 16 patients died within month 1-60 since PH initiation. Overall PH duration for the whole group reached 24.6 +/- 3.58 months. Pretreatment urea and creatinine in plasma of senile patients were significantly lower than in young patients not resulting, though, in uremia reduction. The findings show that it is not valid to consider creatinine a determinant for starting hemodialysis in senile patients. Despite multimorbidity, more rapid progression of atherosclerosis and complicated establishment of the vascular approach, senile patients successfully adapt to PH regimen, need less numerous weekly PH hours. By anemia manifestations, incidence of hyperparathyroidism and polyneuropathy, senile patients did not differ much from their younger counterparts.

[The age-related aspects of gouty nephropathy]. / Vozrastnye aspekty podagricheskoi nefropatii.

The incidence of podagric nephropathy in different age groups was studied on a large populational material (41,452 persons over 30 years). The number of patients suffering from podagra was shown to increase with each decade of life. In 122 patients with podagric nephropathy, deviations in urinalyses were recorded in 80 cases (65.5%). Of these, 53 patients (72.6%) were ot 60 years of age and older. In patients over 60, derangement of nitrogen-excretory renal function was seen more frequently (in 64.4%) than in other age groups. The greater incidence of podagra and podagric nephropathy over the recent decade may be related not to the changes in the nutrition pattern and hypodynamia but also, and possibly to a larger measure, with deterioration of the environmental conditions and alterations in radiation background.

[Senile pyelonephritis with the arterial hypertension syndrome: the use of trental]. / Starcheskii pielonefrit s sindromom arterial'noi gipertenzii: primenenie trentala.

Eighteen patients with senile pyelonephritis and nephrogenic arterial hypertension were examined for the effect of trental monotherapy (600 mg/day) on intrarenal hemodynamics, the rate of glomerular filtration (effective renal blood flow, the intensity of blood flow in the medullary layer of the kidney), activity of the renin-angiotensin-aldosterone system (plasma renin activity, plasma and urine aldosterone), prostaglandin synthetic capacity of the kidneys (PGE and PGF2 alpha), water-electrolyte balance (circulating blood volume, sodium content in the serum and its excretion with urine), and on arterial pressure and general vascular peripheral resistance. Prolonged administration of the drug (from 3 weeks to 6 months) led to a significant improvement of the medullary blood flow, increase (p less than or equal to 0.05) of excretion of natriuretic PGE [correction of RGE] and lowering (p less than or equal to 0.05) of diurnal excretion of PGF2 alpha, which was accompanied by a rise of natriuresis (p less than or equal to 0.05) and diuresis.