[Clinical-biochemical and immunological parameters in the diagnosis and treatment of chronic pyelonephritis on the background of intercurrent diseases].

Studies have shown that complicated chronic pyelonephritis in the active phase is characterized by structural and functional instability cytomembranes and decreased immunological resistance of the patient man. Supplement standard antibiotic treatment with ozone therapy antioxidant immunomodulation drug thus received immunobiochemical study.

[Clinicobiochemical and immunological assessment of polyoxidonium efficacy in the treatment of patients with chronic calculous pyelonephritis].

Of 59 patients with chronic calculous pyelonephritis (CCP) taking preparation therapy for extracorporeal lithotripsy, 29 patients received combined basic treatment (antibacterial drugs, phytotherapy, physiotherapy) plus polyoxidonium (a course of 10 intramuscular 6 mg injections each other day). The rest 30 patients (controls) received basic therapy alone. Polyoxidonium efficacy was assessed by the results of clinical, device and immunological investigations, content of the main phospholipid fractions and cholesterol in red cell membranes. The results of the tests show that polyoxidonium has anti-inflammatory and immunomodulating effects, exhibits activity of peroxidation processes, contributes to normalization of a lipid phase of cell membranes and can be recommended as a component of combined treatment of patients with chronic pyelonephritis and urolithiasis.

[Immunological indices in urolithiasis patients with secondary pyelonephritis].

The immunological status was studied in 335 patients with urolithiasis and pyelonephritis. The techniques used for assessment of the immunological status provided a multifactorial control over immune system function in inflammation and urolithiasis: registered a significant rise of the level of proinflammatory and anti-inflammatory mediators of the immune response (IL-1beta, IL-4, IL-6, TNF), of neutrophil metabolic activity with parallel suppression of neutrophil phagocytic and absorbing functions, inhibition of bactericidal activity of the serum, a significant fall in the number of mature T-lymphocytes (CD3+) and T-helpers (CD4+). The immune status indices in urolithiasis patients with secondary pyelonephritis are closely linked with clinico-laboratory manifestations of the inflammatory process and renal function. Thus, the results of the study give grounds for developing indications for use of immunomodulating drugs in patients with secondary pyelonephritis associated with urolithiasis.

[Polyoxidonium in the treatment of calculous pyelonephritis].

Efficacy of polyoxidonium was studied in combined therapy of urolithiasis complicated with secondary pyelonephritis. Of 60 patients with secondary pyelonephritis in urolithiasis, 30 received adjuvant polyoxidonium. Phospholipids and cholesterol in cytomembranes were defined with thin-layer chromatography. Humoral immunity was evaluated by the levels of IgA, IgM, IgG, hemolytic activity of the compliment system, the level of circulating immune complexes, activity of lysozyme. Concentrations of IL-1beta, TNF, IL-4, IL-6 were also estimated. Subpopulations of immunocompetent cells were tested on flow cytofluorimeter by immunofluorescence with monoclonal antibodies. Phagocytic component of the immune system was assessed by phagocytic activity of neutrophils, phagocytic count, NBT test. The trial demonstrates that polyoxidonium has a positive action on the disease course, an antiinflammatory, immunomodulating properties, suppresses peroxidation, promotes recovery of structural-functional characteristics of cellular membranes in patients with urolithiasis and secondary pyelonephritis. Polyoxidonium is recommended in secondary pyelonephritis and urolithiasis as adjuvant to basic therapy for anti-inflammatory, detoxication and immunomodulating effect.

[Lipids content in renal tissue membranes in patients with urolithiasis and secondary pyelonephritis].

We studied cytomembranes of the interstitial tissue of renal medullary layer obtained by lifetime biopsy of renal tissue in the course of pyelolithotomy in 46 patients with urolithiasis and secondary pyelonephritis. Biopsy structure was controlled with histological methods using standard staining. Basic phospholipids and cholesterol fractions in renal tissue cytomembranes were assayed at thin layer chromatography. The findings show significant changes in a nephron cytomembrane lipid phase in patients with urolithiasis and secondary pyelonephritis. There was a structural rearrangement of lipid biolayer of renal tissue cell membranes in response to microbial inflammation. Thus, use of membrane-stabilising drugs are grounded in patients with secondary pyelonephritis and urolithiasis.

[Clinical and biochemical manifestations of chronic pyelonephritis and their correction in population of the northen areas of the Tyumen Territory]. / Klinicheskie i biokhimicheskie proiavlenia khronicheskogo pielonefrita u zhitelei pripoliarnogo severa Tiumenskoi oblasti i metody ikh korrektsii.

AIM: To study clinicobiochemical features of chronic pyelonephritis (CPN) in the population of northen areas of the Tyumen Territory; to determine emoxipine effects on CPN treatment efficacy. MATERIAL AND METHODS: Clinicolaboratory manifestations of CPN were studied in 246 CPN patients (126 residents of the Tyumen South and 120 residents of the Tyumen North, age 18-55, 174 females, 72 males). The control group consisted of 60 healthy subjects of the same gender and age. RESULTS: CPN in patients living in the north was characterized by more severe intoxication, dysuric disorders, piuria, arterial hypertension, more intensive restructuring of cellular membranes. Membranopathological changes depend on the phase of the pathological process and clinical form of the disease. Emoxipin addition to combined therapy of CPN promoted faster correction of basic CPN symptoms and stabilization of the lipid phase of erythrocytic membranes. CONCLUSION: Clinical and biochemical features of CPN in patients living in the Tyumen North represent additional diagnostic criteria of the disease activity. Adjuvant use of the antioxidant drug emoxipin produces a noticeable clinicobiochemical effect.

[Homeostatic and antioxidant defense enzymes activity in chronic pyelonephritis]. / Pokazateli gomeostaza i funktsional'noe sostoianie fermentov antioksidantnoi zashchity pri khronicheskom pielonefrite.

As shown by the analysis of chronic pyelonephritis, manifestations in patients with high and low activity of antioxidant system enzymes, patients with high catalase activity have more effective defense of red cells, glomerular epithelium. This was concluded from marked differences in urinary excretion of metabolites, hemoglobin levels compared to those in patients with low activity of catalase. In low activity of glutathione peroxidase, inflammation gains activity, nonspecific resistance weakens, excretion of some metabolites inhibits vs patients with high activity of this enzyme. The data provide criteria for diagnosis of antioxidant system defects and show necessity of antioxidant drugs inclusion into the therapeutic scheme (unitiol, antioxidant complex of vitamins A, E, C, P).

[Endovascular Helium-Neon laser irradiation of the blood in the treatment of chronic pyelonephritis]. / Endovaskuliarnoe obluchenie krovi gelii-neonovym lazerom bol'nykh khronicheskim pielonefritom.

The authors analyze the condition of free-radical oxidation and activity of antioxidant system, clinical effectiveness of He-Ne laser therapy of patients with chronic pyelonephritis. It is shown that clinical manifestation of the disease is accompanied with activation of free radical oxidation and hypoactivity of antioxidant system. Endovascular laser hemotherapy stimulates antioxidant system, activity of superoxide dismutase, in particular. A good response and immunomodulation are achieved.

[Membrane-destabilizing processes as the universal basis of inflammation]. / Membranodestabiliziruiushchie protsessy kak universal'naia osnova vospaleniia.

It is established that active pyelonephritis and operative stress are accompanied with structural and functional changes in erythrocytic membranes: cholesterol and its ethers rose in quantity as well as difficulty oxidized phospholipids, cation adenosine triphosphatase activity changed. Being nonspecific, these changes seemed more pronounced in the active phase of chronic pyelonephritis. Minor structural rearrangement of membrane lipids in surgical patients indicated uneventful postoperative period. It is suggested that bacterial inflammation in the kidneys and urinary tracts may be related to the above shifts. The adjuvant use of dimephosphone produced a clear-cut membrane-stabilizing effect clinically reflected by reduced inflammation and improved renal function.

[Autogenous infections in the development of postoperative complications]. / Znachenie autogennogo infitsirovaniia v razvitii posleoperatsionnykh oslozhnenii.

The authors studied the mechanisms of bacterial dissemination in operative wounds in patients after various surgical interventions. It was demonstrated in experiments that during adaptation of the organism to the operative stress, autobacteria enter the blood from the intestinal reservoir and are eliminated through the urinary tract and wound surfaces, if foci of mechanical or toxic destruction exist the autobacteria precipitate in the affected tissues and participate directly in the reparative processes. On the basis of the obtained data it is suggested that the phenomenon of activation and persistence of endogenous microflora exists as one of the syndromes of adaptation of man to the aggression factor, which is aimed at revealing and removing the foci of tissue destruction developing as the result of exposure to the effect of the stress.

[Asymptomatic bacteriuria as the manifestation of a syndrome of the activation and persistence of endogenous microflora in dynamic human adaptation to stress]. / Bessimptomnaia bakteriuriia kak proiavlenie sindroma aktivatsii i persistentsii éndogennoi mikroflory v dinamike adaptatsii cheloveka k stressu.

The analysis has been performed of the mechanisms underlying the origin of asymptomatic bacteriuria as an adaptive reaction in response to surgical aggression. The experiments proved penetration of autobacteria from the intestine to blood channel and organic structures of the animals in the course of adaptation to an operative trauma and consequent elimination of the bacteria from the body. It was observed that endogenic microflora participates in regeneration of macroorganism structures which have lost their morphofunctional integrity due to mechanic and toxic aggression. It is suggested that activation and persistence of endogenic microflora may arise to identify and abolish foci of aseptic destruction during the aggression in adaptation to stress.

[The indices of cell membrane destabilization in urolithiasis patients]. / Pokazateli destabilizatsii kletochnykh membran u bol'nykh mochekamennoi bolezn'iu.

The paper gives the results of a clinical and biochemical study of 165 patients with urolithiasis and 46 healthy persons. Their urinary samples and renal biopsy specimens were analysed to assess the structural and functional status of nephron cell membranes. In urolithiasis patients, the urine was found to contain a great quantities of emulsified lipids enriched in toxic phospholipid and cholesterol metabolism products; renal tissue cytomembranes in the patients were depleted of phospholipids, free cholesterol and enriched in phospholipid lysoforms and cholesterol esters. Lipid phase destabilization of nephron epithelial membranes was shown to be pathogenetically associated with concrement formation. The examination of emulsified urinary lipids is an objective tool of renal tissue crystallization activity and may be recommended for the early diagnosis of urolithiasis, as well as an indicator of membrane-stabilizing therapy efficiency.

[The enzyme function of cationic transmembrane transport and its relationship to the homeostatic indices of patients with chronic pyelonephritis]. / Funktsional'noe sostoianie fermentov kationnogo transmembrannogo transporta i ikh vzaimosviaz' s nekotorymi pokazateliami gomeostaza u bol'nykh khronicheskim pielonefritom.

The paper examines the relationship between the clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane erythrocyte transport (Mg(2+)-, N(+)-K(+)-, Ca(2+)-ATPases). An individual analysis ascertained that the patients who showed a low Ca(2+)-ATPase activity had marked signs of inflammation in the body, as evidenced by ESR, seromucoid and fibrinogen concentrations. These patients had more significantly depressed immune defense mechanisms as reflected by the levels of immunoglobulins, T-lymphocytes, complement, the neutrophil phagocytosis, and urinary IgA concentrations). Variations were also found in examining the excretion of a number of metabolites. There was a substantial decrease in urea, creatinine, titrated acid, phosphorus excretions in patients with deficient Ca(2+)-ATPase activity than in those with its high activity. It was concluded that there was a relationship between some clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane transport. To treat metabolic disorders, membrane-protective agents are recommended to include into combined therapy.

[The treatment of coralliform nephrolithiasis]. / Lechenie korallovidnogo nefrolitiaza.

A total of 184 patients with dendritic nephrolithiasis (74.5% females and 25.5% males) were under study. It was established that in more than half of them the disease developed from the infectious inflammation of the urinary tract. Based on the findings, the authors supposed that in these patients the initial instability of cellular membranes was associated with a decrease in nonspecific resistance which was unfavourably complicated by infection of the urinary tracts and the formation of calcium phosphate calculus. As the presence of friable (low-contrast) calculi in the state of growth is accompanied by a severe inflammation, a continuous nonoperative treatment is mandatory. When the growth of the calculus is stopped and confirmed by its high-contrast dense X-ray shadow and the signs of inflammation ceased the authors insisted on the conduction of the 3-4-week inpatient preoperative management. The latter should include the administration of wide-range antibiotics, drugs for potentiation of nonspecific resistance and the complex of vitamins. Subcortical pyelolithotomy with partial nephrotomy is a method of choice in case of a "dry kidney". An average postoperative bedtime comprised 22.3 days.

[Urinary excretion of emulsified lipids in urolithiasis]. / Ekskretsiia s mochoi ému'lgirovannykh lipidov pri moche- kamennoi bolezni.

Examinations of the urine emulsified lipid phospholipid composition carried out by thin-layer chromatography have revealed that phospholipid excretion is the minimal in normal subjects and is represented only by sphingomyelin and phosphatidylcholine fractions. In subjects with a history of cholelithiasis (CL) phospholipid excretion is essentially elevated and the total phospholipid spectrum, including the minor fractions, is present in the urine. In CL patients phospholipiduria+ is still more marked, phosphatidylethanolamine appears in the urine, that is absent in the other groups of examinees. This method is recommended for the early diagnosis of CL.