[Immunogenetic analysis of variants of a clinical course and prognosis of chronic glomerulonephritis in the west Siberia].

AIM: To analyze association of HLA antigens with clinical variants of chronic glomerulonephritis (CGN)in 106 patients. MATERIAL AND METHODS: HLA association with the time of development of terminal chronic renal failure (CRF) from the moment of detection of initial CRF was studied in 80 patients. Determination of HLA of class I was conducted in the lymphocytotoxic test. DRB1 genes specificity was determined with DNA polymerase chain reaction. The control group consisted of 341 healthy citizens of Novosibirsk. Common HLA associations of latent and hypertensive, latent and nephrotic CGN variants were found demonstrating their succession. HLA associations with a mixed CGN variant defining its genetic isolation were established. It is shown that development of terminal CRF at different time since the disease onset is associated with different HLA alleles. The findings allow prognosis of clinical CGN variants, time of development of terminal CRF.

[Immunogenetic analysis of pathomorphological forms and prognosis of chronic glomerulonephritis].

AIM: To ascertain whether HLA antigens are associated with morphological forms of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: A retrospective analysis was made of HLA distribution in 122 patients with proliferative and nonproliferative forms of CGN at different stages of fibroplastic transformation and addition of the tubulointerstitial component. Testing of HLA antigens of class I was conducted by lymphocytotoxicity; specificity of DRBI genes was investigated by DNA polymerase chain reaction. The control group consisted of 341 healthy citizens of Novosibirsk. RESULTS: HLA-associations typical for each morphological CGN form, characteristic differences between them were established. CONCLUSION: The tables were plotted allowing estimation of probability of each of CGN morphological forms.

[Evolutionary trends in symptoms of acute glomerulonephritis in adult population of the Novosibirsk region]. / Evoliutivnye tendentsii v klinike ostrogo glomerulonefrite vzroslogo naseleniia Novosibirskoi oblasti.

Acute glomerulonephritis (AGN) trends in the last 3 decades in the Novosibirsk Region have been analysed basing on the data from 308 AGN case histories. The results of the analysis demonstrate that AGN occurs not often but with stable rate. It is encountered more frequently in young men. The last decade is characterized by higher morbidity after streptococcal infection, high percentage of women at reproductive age, aggravation of the clinical course with marked edemas, severe arterial hypertension, renal dysfunction (acute renal failure in 10.4%), cases of left ventricular failure (5.2%) and eclampsia (1.7%) not registered earlier.

[Prognostic criteria for the clinical course of systemic lupus erythematosus]. / Prognosticheskie kriterii klinicheskogo techeniia sistemnoi krasnoi volchanki.

To develop some individual prognostic criteria of SLE clinical course the Wald's analysis of immunogenetic markers (HLA) was used. The obtained summarized diagnostic coefficients allow predicting a subacute or chronic pattern of the disease, the rate of generalization and the most frequent location of the process in certain organs. The constant character of HLA-typing results and the simplicity of the given prognostic tables made the proposed diagnostic method convenient for medical practice.

[The immediate results of using plasmapheresis in patients with chronic glomerulonephritis]. / Blizhaishie rezul'taty primeneniia plazmafereza u bol'nykh khronicheskim glomerulonefritom.

A study was made of the effect produced by a short-term course of plasmapheresis (PA) combined with cytostatic, glucocorticoid and deaggregation therapy on the clinico-laboratory characteristics in 45 patients suffering from chronic glomerulonephritis (CGN). It has been established that PA rapidly normalizes the characteristics such as the level of circulating immune complexes and fibrinogen in the blood, ESR. Exerting no effect on renal function, PA led to a significant lowering of proteinuria and erythrocyturia, with its beneficial effects being preserved after discontinuation of the sessions. The best results were attained in associated CGN and nephrotic syndrome, in mesangioproliferative and mesangiocapillary CGN. The effectiveness of the short-term course of PA in patients with membranous and diffuse fibroplastic CGN turned out questionable.

[The outcomes and prognosis of a course of acute glomerulonephritis]. / Iskhody i prognozirovanie techeniia ostrogo glomerulonefrita.

Observation of 131 patients with acute glomerulonephritis (AGN) experiencing the first year of disease made it possible to distinguish, by the 4th month of disease, the lingering disease patterns encountered in 100% of cases with the nephrotic form and typical for pronounced and little symptomatic AGN (96.1-78.8%). As compared to the catamnestic data, 83 patients manifested (after 5.8 +/- 0.7 yr.) an unfavourable influence of the lingering disease course on AGN outcomes (the probability of convalescence dropped to 30.8-33.3% in pronounced and little symptomatic forms and was completely excluded in the nephrotic one) and a high diagnostic significance of the dynamics of the urinary syndrome for prognosis determination. The constancy of proteinuria at a level of over 1 g/day and hematuria at a level over 50.0 x 10(3)/ml within 4 to 6 months significantly deteriorated the prognosis. Virus nature of pronounced AGN can be indicated among other prognostic criteria. The other characteristics of the debut produced no significant effect on the disease outcome. The morphological signs of the chronic disease corresponded to mesangiomembranous glomerulonephritis whereas fibroplastic alterations were only observed in special forms of AGN marked by rapid progress.

[A clinico-pathogenetic approach to choosing the therapeutic procedure in chronic glomerulonephritis]. / Kliniko-patogeneticheskii podkhod k vyboru terapevticheskoi taktiki pri khronicheskom glomerulonefrite.

The results have been compared of the use of two schedules (continuous and cyclic) of multimodality therapy of chronic glomerulonephritis (CGN) including cytostatics, corticosteroids, anticoagulants and deaggregation agents. Continuous therapy was carried out for 12.9 +/- 0.41 months on the average, with the drug dosage being corrected depending on the clinico-laboratory and immunological findings as well as on the parameters of the hemostatic system. Cyclic therapy was conducted for 6 months according to a strictly unified program. It has been shown that continuous individualized treatment compares very favourably with the cyclic schedule, which is particularly marked in mesangiocapillary CGN and CGN with a tubulointerstitial component. It is concluded that continuous multimodality treatment chosen with regard to the clinico-pathogenetic disease characteristics allows CGN prognosis to be improved.

[The mechanisms of intravascular blood coagulation in patients with systemic scleroderma]. / Mekhanizmy vnutrisosudistogo svertyvaniia krovi u bol'nykh sistemnoi sklerodermiei.

Hemostasis was investigated in 2 groups of patients with systemic scleroderma (SSD) with minimal (12 patients) and moderate (9 patients) activity of the process. It has been shown that in SSD, the triggering factor of intravascular blood coagulation is the release of Willebrand's factor, an activator of platelets, from the impaired endothelium. Hyperaggregation and labilization of platelets characterizes the course of SSD irrespective of the disease activity. The main changes in coagulation hemostasis are related to the dramatically accelerated triggered thrombin formation and deficiency of the antithrombin potential. The status of fibrinolysis confirming the thrombogenic situation is marked by a number of features: depression of contact lysis is maximally pronounced in chronic SSD with minimal activity, accumulation of the soluble complexes of fibrin monomer only correlates with the disease activity, and no significant rise of the level of fibrin/fibrinogen degradation products has been discovered.

[Precursor thymus-dependent lymphocytes in variants of chronic glomerulonephritis]. / Prekursornye timuszavisimye limfotsity pri raznykh variantakh khronicheskogo glomerulonefrita.

Altogether 67 patients with chronic glomerulonephritis (CGN) were examined for the content of thymus-dependent precursor lymphocytes (auto-RFC, pre-T-cells). The patients suffering from CGN were characterized by the high content of the young post-thymic T-cells (auto-RFC) and high affinity T lymphocytes carrying a receptor for the Fc fragment of IgM as compared to normal donors. In patients with different clinical patterns of CGN, an analysis was made of the content of precursor thymus-dependent lymphocytes. A relationship was discovered between the content of pre-T-cells and the activity of the nephritic process. The activity of the pathological process was associated with the high content of precursor lymphocytes. The inactive course of nephritis was characterized by a well-defined reduction of the number of precursor cells. This might be regarded as depletion of the amount of precursor lymphocytes.

[Comparative evaluation of the clinical course and dynamics of the morphological changes in chronic glomerulonephritis]. / Sravnitel'naia otsenka klinicheskogo techeniia i dinamiki morfologicheskikh izmenenii pri khronicheskom glomerulonefrite.

The results of a simultaneous study of a clinical and morphological course of chronic glomerulonephritis (CGN) in 30 patients after repeated morphological investigation of the renal tissue showed that a prevailing tendency in this disease was the progression of morphological changes which could be noted in a stable clinical picture and even in clinical improvement. The detection of tubulointerstitial changes in the first nephrobiopsy was an unfavorable prognostic factor. Of the greatest importance for indirect assessment of a morphological course of CGN were changes in creatinine clearance, effective renal plasma flow and arterial pressure. A morphological course of different variants of CGN and the effect of pathogenetic therapy on it were analyzed.

[Long-term remission of the nephrotic syndrome in renal amyloidosis]. / Dlitel'naia remissiia nefroticheskogo sindroma pri amiloidoze pochek.

The authors presented the results of a clinical study of an atypical course of secondary renal amyloidosis developing in a patient with pulmonary tuberculosis and progressing against a background of chronic post-tuberculosis bronchitis. The disease manifested itself in the acute development of the nephrotic syndrome which could be arrested as a result of tuberculostatic therapy. Clinico-laboratory signs of the disease were absent for 20 yrs., then arterial hypertension and chronic renal failure accompanied by minimum proteinuria, developed. The diagnosis of renal amyloidosis was confirmed by nephrobiopsy. Considerable difficulties arose in differential diagnosis with glomerulonephritis in such a clinical course.

[Tubulointerstitial component of chronic glomerulonephritis. Clinico-morphological comparisons]. / Tubulo-interstitsial'nyi komponent khronicheskogo glomerulonefrita. Kliniko-morfologicheskie sopostavleniia.

A total of 179 patients with chronic glomerulonephritis were examined for the development of the tubulo-interstitial component (TIC) of the disease. It was established that the rate of the development and intensity of the TIC are linked with different morphological variants of GN and increase successively in mesangiomembranous, membranous, mesangioproliferative, mesangiocapillary (and lobular) GN, reaching a maximum in diffuse fibroplastic GN. In patients with no TIC, the hematuric and latent forms of CGN were mostly encountered. The disease took a stable course, with a frequent occurrence of improvements and remission. The 5-year survival was 100%. In patients with a moderate TIC, the nephrotic form of CGN was encountered more often than in other patients. As regards other characteristics, this form occupied an intermediate position, with the 5-year survival rate amounting to 91%. Patients with a pronounced TIC were marked by progressive CGN, which was largely observed in the hypertonic and mixed patterns of the disease. The three-year survival amounted to 34% in this case. The TIC of CGN is an important prognostic factor and the dissimilar course of different morphological variants of CGN is accounted, to a considerable degree, for by the dissimilar rate of TIC development.

[Kidney lesions in dietary and toxic paroxysmal myoglobinuria (Iuksovsk-Sartlansk disease)]. / Porazhenie pochek pri alimentarno-toksicheskoi paroksizmal'noi mioglobinurii (Iuksovsko-Sartlanskoi bolezni).

The authors described 114 patients who developed alimentary-toxic paroxysmal myoglobinuria after eating white-fish in one of the districts of the Novosibirsk region. Renal lesion of the myorenal syndrome type with the development of acute renal insufficiency (ARI) was detected in 14% of the patients. The outbreak was more severe than those known in the literature. Hemosorption and hemodialysis were applied for the treatment of ARI to reduce the level of myoglobinemia.