[Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure]. / Kardioprotektivnyi éffekt preparatov éritropoétina u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

AIM: To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). MATERIAL AND METHODS: Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (n = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months of predialysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. RESULTS: Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric LVH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. CONCLUSION: Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.

[Continuous ambulatory peritoneal dialysis in patients with diabetes mellitus]. / Postoiannyi ambulatornyi peritoneal'nyi dializ u bol'nykh sakharnym diabetom.

AIM: To analyse the results of continuous ambulatory peritoneal dialysis (CAPD) in diabetes mellitus (DM) patients, to specify complications, to evaluate transport characteristics of peritoneal membrane. MATERIAL AND METHODS: The ability of peritoneal membrane to eliminate low-molecular substances (creatinine, urea), electrolytes and to evaluate treatment efficacy by residual renal function (peritoneal equilibration, total urine and creatinine clearance). RESULTS: DM patients on CAPD developed vascular complications typical for DM:gangrene (n = 2), diabetic foot (n = 4), acute disorder of cerebral circulation (n = 3), acute myocardial infarction (n = 3). Diabetics' residual renal function deteriorated faster than in patients with non-diabetic uremia, though transport characteristics of the peritoneum in diabetics and non-diabetics were the same. Peritonitis in diabetics was observed much less frequently than in non-diabetics. CONCLUSION: CAPD is an adequate replacement therapy in patients with uremia of different origin including diabetes. In the course of the treatment DM patients develop complications typical for basic disease but their frequency is unrelated to CAPD.

[Low doses of recombinant erythropoietin in the treatment of renal anemia in patients on chronic hemodialysis and ambulatory peritoneal dialysis]. / Nizkie dozy rekombinantnogo éritropoétina v lechenii pochechnoi anemii u bol'nykh, nakhodiashchikhsia na khronicheskom gemodialize i na ambulatornom peritoneal'nom dialize.

AIM: A comparative study of efficiency and safety of low-dose erythropoietin (EP) in two groups of patients with chronic renal failure (CRF): patients on chronic hemodialysis (CHD) and patients on continuous ambulatory hemodialysis (CAHD). MATERIALS AND METHODS: 51 CRF adult patients with renal anemia on hemodialysis entered the trial: 34 CHD and 17 CAHD patients. EP compounds were injected s.c. in a dose 1000-2000 U 2-3 times a week. RESULTS: EP treatment provided a rapid correction of renal anemia in the majority of patients. After 3-month EP therapy a mean increment of Hct (Hct delta) was much greater (p < 0.05) in CAHD than CHD patients (12.2 +/- 6.0 and 9.0 +/- 5.1%, respectively), though EP dose were the same in both the groups. CONCLUSION: Low doses of recombinant human EP injected subcutaneously were effective and safe for correction of anemia in both CHD and CAHD. In CAHD patients EP effectiveness was much higher than in CHD patients.

[Oncogenic osteomalacia: its pathogenesis, clinical picture and treatment]. / Onkogennaia osteomaliatsiia: patogenez, klinika, lechenie.

A female of 53 and male of 35 complained of myasthenia and pain in the bones. Biochemically, they had severe hypophosphatemia secondary to a sharp decline in tubular reabsorption of phosphates. X-ray showed tumor of bone tissue. The patients were diagnosed to have oncogenic osteomalacia. Literature data on pathogenesis, clinical features and treatment of this rare disease are reviewed.

[The erythrocyte pro-oxidant and antioxidant systems of patients with chronic kidney failure]. / Sostoianie prooksidantnoi i antioksidantnoi sistem éritrotsita u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

Lipid peroxidation as shown by malonic dialdehyde (MDA) levels and enzymic antioxidant defense systems were evaluated in red cells from patients with renal affections free of chronic renal failure (group 1), in conservative curable stage of chronic renal failure (group 2a), in terminal stage nondialysis patients (group 2b) and in healthy donors. MDA was higher in patients, in group 2b in particular. MDA levels correlated with concentrations of endogenic creatinine in the serum. Catalase and glutathione peroxidase were at control levels. SOD was not changed in group 1 but appeared reduced in other groups. Its activity was not related to serum creatinine. An inverse relationship existed between MDA content and SOD activity in red cells. It is believed that progression of chronic renal insufficiency leads to activation of lipid peroxidation and deterioration of antioxidant defense in red cells contributing to more active red cell destruction causing anemia in uremia.

[Disruption of regulatory possibilities of the plasma kallikrein-kinin system in chronic kidney failure and during hemodialysis]. / Narushenie reguliatornykh vozmozhnostei kallikrein-kininovoi sistemy plazmy krovi pri khonicheskoi pochechnoi nedostatochnosti i vo vremia gemodializa.

Activation of the kallikrein-kinin system was detected in chronic renal failure treated by routine therapy. In blood plasma of the patients with chronic renal failure, kallikrein was activated from 34.2 to 63.2 mU/ml, while activity of prekallikrein was decreased from 382.0 to 117.8 mU/ml; BAEE-esterase and elastase-like activities simultaneously increased from 340 +/- 20 to 464 +/- 43 mU/ml and from 150 +/- 20 to 340 +/- 18 mU/ml, respectively. In the patients on hemodialysis during the interdialysis period, there were reductions of BAEE-esterase and kallikrein activities to 265.8 +/- 18.5 and 25.9 mI/ml, respectively; and the content of prekallikrein remained decreased. During hemodialysis the elastase-like activity was markedly increased up to 501 mU/ml due to leukocyte activation. The findings suggest that during hemodialysis, due to leukocytic elastase, there is a possible occurrence of thromboses as a result of a potential depletion of the kallikrein-kinin system and decreased blood antiproteolytic potential, including antithrombin III.

[A trial of the long-term use of a low-protein diet and ketosteril in chronic kidney failure]. / Opyt dlitel'nogo primeneniia malobelkovoi diety i ketosterila pri khronicheskoi pochechnoi nedostatochnosti.

Ten CRF patients (mean glomerular filtration rate 10.1 ml/min) were put on low-protein diet (0.3 g/kg protein daily) supplemented with ketosteryl (10-12 pills daily). During 3 out of 6-34 months of the diet azotemia declined: creatinine, blood urea nitrogen, uric acid, phosphorus concentrations diminished by 5%, 12%, 10% and 17%, respectively. Further accumulation of nitrogen residues slowed down. Monthly increment of serum creatinine and hemoglobin loss rate reduced 2-fold (from 0.23 to 0.117 mg% month and from 0.16 to 0.08 g% month, respectively). Protein deficiency did not occur as serum albumin and body mass remained the same, whereas urea nitrogen/creatinine ratio showed a 35% decrease. It is concluded that rigorous low-protein diet combined with keto-analogues of essential amino acids is able to abate uremia and inhibit CRF augmentation.

[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 effect of recombinant human erythropoietin during hemodialysis on the thrombocyte and erythrocyte functions of patients with chronic kidney failure]. / Vliianie rekombinantnogo chelovecheskogo éritropoétina v usloviiakh gemodializa na funktsiiu trombotsitov i éritrotsitov bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

To elucidate causes of thrombotic complications early in the course of RHE treatment, the authors studied platelet function (by aggregation of washed platelets), cAMP and cGMP as well as TxB2 levels in blood plasma, red cell function (by MDA content) in 16 patients suffering from chronic renal failure (CRF) on hemodialysis. 8 of them had been on RHE for 1.5 months. It appeared that plasma levels of TxB2 and cGMP increased, thrombin-induced platelet aggregation slightly decreased, MDA in red cells on treatment month 1.5 rose. The authors made the conclusion that early in the course of RHE treatment the conditions promoting active thrombogenesis may arise as a result of red cell induced platelet activation due to increased number of red cells with poor resistance to oxidant damage and hemolysis. Application of RHE in CRF patients should be combined with antioxidant therapy, especially in patients at high thrombogenesis risk.

[The effect of human recombinant erythropoietin on the lipid peroxidation processes and antioxidant protection of the erythrocytes in patients with chronic kidney failure on hemodialysis]. / Vliianie rekombinantnogo chelovecheskogo éritropoétina na protsessy perekisnogo okisleniia lipidov i antioksidantnuiu zashchitu éritrotsitov bol'nykh khronicheskoi pochechnoi nedostatochnost'iu v usloviiakh gemodializa.

Twenty patients with terminal-stage chronic renal failure (CRF) underwent long-term hemodialysis. Ten of them (group 1) did not receive human erythropoietin (HEP), four patients (group 2) received HEP for 1 month, six patients (group 3) for 12 months. Group 3 patients exhibited a marked increase in Hb, hematocrit, red cell number, while serum Fe was reduced. MDA rose in group 1 by 34% (p < 0.05), in group 2 by 199% (p < 0.05), was normal in group 3. Red cell catalase and glutathione peroxidase activities were normal. The results evidence that 1-month HEP treatment enhances oxidant degradation of erythrocytic membrane lipids. Lipid peroxidation becomes normal to the end of 1-year HEP treatment despite low SOD activity. Application of HEP in CRF patients is advisable to combine with antioxidant modalities to intensify red cell resistance to hemodialysis.

[Nephropathy-related disorders of physical and sexual development in girls: experience with successful stimulation by zinc, parlodel and norcolut]. / Sviazannoe s nefropatiiami narushenie fizicheskogo i polovogo razvitiia u devushek: opyt uspeshnoi stimuliatsii tsinkom, parlodelom i norkolutom.

The paper reports 3 cases of physical and sexual retardation in girls aged 14-22 with nephropathy: 1 girl had uremia in a conservative stage, 1 patient was put on a chronic hemodialysis for terminal uremia, 1 girl received a renal transplant. In response to combined treatment (zinc sulfate+parlodel) in the former two patients and norcolute therapy in the latter one body mass and growth increased in all the 3. The discussion is concerned with mechanisms of developmental defects in nephropathies, comparative efficacy of the drugs used and social rehabilitation of nephropathy girls with small height and sexual infantilism.

[Lipid peroxidation as a possible mechanism of erythrocyte damage in patients with chronic kidney failure on hemodialysis]. / Perekisnoe okislenie lipidov kak vozmozhnyi mekhanizm povrezhdeniia éritrotsitov u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu v usloviiakh gemodializa.

Ten patients with chronic renal failure (CRF) treated by hemodialysis (HD) were examined. All the patients demonstrated remarkable anemia. The red blood cell count was (2.7 +/- 0.2) x 10(12)/I the concentration of hemoglobin 79.5 +/- 5.6 g/l, on the average, hematocrit 23.2 +/- 1.8%. The content of malonic dialdehyde in the patients' red blood cells was far greater than in controls, amounting to 132% (per 1 ml of hemolysate), 134% (per 1 mg of protein) (p < 0.05). Catalase and glutathione peroxidase activity in the patients' red blood cells did not differ from that in controls. Superoxide dismutase activity reduced by 43% as compared to that in donors (p < 0.001). The authors review possible mechanisms of lipid peroxidation (LPO) and a decrease of antioxidant defense in red blood cells of CRF patients on hemodialysis. It is concluded that activation of LPO processes and the decrease of antioxidant defense produce a noticeable destructive effect on the integrity of the red blood cell membrane. They also influence the development of hemolysis.