[Annexin-5 as a biochemical marker of early vascular disorders under chronic disease of kidneys].

The study evaluated the significance of annexin-5 as a biochemical marker of atherosclerosis in patients with chronic disease of kidneys. The sample consisted of 46 patients with chronic disease of kidneys without clinical symptoms of atherosclerosis. The indicators of lipidogram, intima-media complex of carotid artery reactivity of vessels of microcirculatory channel and concentration of annexin-5 are determined. The decrease of velocity of glomerular filtration is accompanied by the increase of concentration of annexin-5 related to indicators of lipidogram. The increase of concentration level of annexin-5 is accompanied by the most expressed dysfunction of endothelium. The increase 3a level of annexin-5 in blood of patients with chronic disease of kidneys is especially informative in case of lacking of clinical symptomatic of atherosclerosis and it testifies the presence of vasomotor endothelial dysfunction. The dynamic detection of concentration of annexin-5 can ameliorate the prognosis of possibility of development of cardio-vascular complications under diseases of kidneys.

[Combined therapy of membranoproliferative glomerulonephritis in older patients].

The aim of the study was to investigate the effectiveness of combined long-term therapy by cytostatics and steroid hormones in older patients with membranoproliferative glomerulonephritis to halt renal failure progression. 27 patients older than 60 years with morphologically proved membranoproliferative glomerulonephritis have been treated. Nephrosclerosis was detected in 40% of studied patients according to results of kidney biopsies. The mean age of the patients was 65.8 +/- 1.5 years. The activity of the disease depended on presence and severity of nephrotic syndrome. 17 (62.9%) patients had coronary heart disease, 7 (25.9%) patients had chronic bronchitis, 7 (25.9%) patients had peptic ulcer disease in a remission phase. Patients received therapy by cyclophosphamide in a dose of 2 mg/kg daily and prednisolone in a dose of 1 mg/kg daily during 2 years. Tolerability of assigned treatment was satisfactory. The main clinical and laboratory signs of nephrotic syndrome were significantly reduced and the proof remission was reached after 8-12 months of combined therapy. During the observation (24 month) the glomerular filtration rate in studied patients didn't decreased over 30-59 mL/min/1.73 m2 and corresponded to stage 3 of chronic kidney disease.

[Age features of treatment of idiopathic membranoproliferative glomerulonephritis].

The aim of the study was to investigate the effectiveness of long application of the combined therapy by cytostatics and steroid hormones for patients with morphologically proved membranoproliferative glomerulonephritis depending on age. 51 patients younger 60 years and 27 patients older 60 years were investigated. Patients received therapy by steroid hormones and cytostatics within one year. Shipping of therapy was satisfactory. Despite presence of signs of nephrosclerosis, efficiency of treatment was good. Signs of a nephrotic syndrome were proof remission in all patients of 1st and 2nd groups in 12 months after beginning of treatment.

[Endothelial dysfunction and apoptosis at early stage of chronic kidney disease].

AIM: To study changes in apoptosis and endothelial function in patients with chronic kidney disease (CKD) stage I-IIIb (CKDsI-IIIb). MATERIAL AND METHODS: A complex of biochemical, enzyme immunoassay and device investigations was used to examine 128 patients with CKDsI-IIIb. RESULTS: In CKD stage I reduction of endothelium-dependent vasodilation (EDV) was detected in 34% patients, in stage II -- in 52 %, in stage IIIa -- y 52 %, in stage IIIb - in 70%. An EDV decrease was associated with glomerular filtration rate (GFR), a homocysteine level and hemodynamic factors. Elevation of endothelin-1 (ET-1) level was seen in CKDsI in 41 %, in CKDsII - in 54 %, in CKDsIIIa - in 70 %, in stage IIIb - in 83% patients. A negative correlation was observed between the level of ET-1 and GFR and positive - with diurnal proteinuria. A significant rise of annexin A5 concentration versus normal was detected as early as in CKDsI (1,14 +/- 0,68 ng/ml). In CKDsII annexin A5 was 2,61 +/- 0,75 ng/ml, in CKDsIIIa - 3,75 +/- 0,93 ng/ml and in CKDsIIIb - 5,16 +/- 1.01 ng/ml. Negative correlations were found between annexin A5 level and GFR, a maximal growth of volumetric blood flow rate in skin vessels in the acetylcholine test, positive correlations with systolic blood pressure, body mass index. CONCLUSION: The levels of ET-1 and annexin A5 are factors having an independent impact on EDV in patients with CKDsI-II.

[The level of endothelin-1 and reactivity of skin microvessels in patients with early stages of chronic kidney disease].

AIM: To evaluate endothelin-1 (ET-1) levels and to characterize reflex vasomotor reactions of skin vessels in distant exposure to cold in patients with chronic kidney disease (CKD) of stage I and II. MATERIAL AND METHODS: Glomerular filtration rate (GFR) was calculated by MDRD formula for 40 healthy subjects (mean age 39.2 +/- 2.0 years) and 147 CKD patients (mean age 41.4 +/- 1.8 years). All the patients were also exposed to the cold test (a modified variant). RESULTS: Patients with CKD stage I demonstrated a 35.1% fall in blood flow rate (Qas) in response to cold stimulus, patients of stage II--a 42.2% fall, healthy patients--a 19.3%. CKD patients of stage I and II retained a Qas fall for 3 min after exposure to cold, while healthy subjects resumed skin blood circulation immediately after exposure to cold. Blood plasma ET-1 concentration in healthy subjects was 0.239 +/- 0.055 fmol/ml, in stage I CKD patients--0.334 +/- 0.066 fmol/l, in stage II CKD patients--0.422 +/- 0.041 fmol/l. Relationships were found between ET-1 level and GFR (Rs = 0.242; p < 0.05), 24 h proteinuria (Rs = 0.375; p < 0.003) and Qas% in the cold test (Rs = -0.389; p < 0.003) as well as time of recovery of the background Qas (Rs = -0.311; p < 0.003). CONCLUSION: Dysfunction of autonomic nervous system at early stages of CKD may arise by means of activation of ET-1 synthesis in response to enhancement of sympathetic impacts.

[Glomerular filtration rate is an indicator of endothelial function at early stages of chronic kidney disease].

AIM: To study effects of glomerular filtration rate (GFR) reduction on endothelial function in patients at early stages of chronic renal kidney (CKD). MATERIAL AND METHODS: Endothelial function of 101 patients with CKD of stage I-III was examined using reactive hyperemia test, dopplerography of skin vessels with ionophoresis of acetylcholin and nitroglycerin, lipidogram parameters, homocistein and annexin A5 levels, intima-media complex thickness of the common carotid artery, echocardiography findings. RESULTS: Cardiovascular complications risk factors were found in all the patients: increased body mass index, arterial hypertension, dyslipoproteinemia, hyperhomocysteinemia. Reduced GFR (under 90 ml/min) is an independent factor of atherosclerosis risk. CONCLUSION: GFR reduction corresponding to CRD of stage II is accompanied with enhancement of apoptosis and development of vasomotor endothelial dysfunction that in combination with risk factors contribute to development of a preclinical atherosclerosis phase.

[The factors that determine the manifestation of uremic poisoning during the development of chronic kidney failure]. / Faktory, opredeliaiushchie vyrazhennost' uremicheskoi intoksikatsii v protsesse razvitiia khronicheskoi pochechnoi nedostatochnosti.

To specify factors determining the intensity of uremic intoxication, 86 patients with chronic glomerulonephritis were examined without regard for exacerbation at different stages of chronic renal failure. Microcolumn gel chromatography was used to measure the content of medium-size molecules in the blood serum, urine, gastric and intestinal juice of the patients and 22 mongrel dogs before and after bilateral nephrectomy. It has been established that as the mass of acting nephrons decreases, the content of "medium-size" molecules in the blood serum and intestinal juice rises, being unchanged in gastric juice. At the same time the urinary clearance of the given group of substances declines. It is assumed that in stage I chronic renal failure, enhancement of the excretion of "medium-size" molecules in the proximal third of the small intestine is made for by hyperfiltration of intact nephrons. The appearance of the clinical symptomatology in stage II and III chronic renal failure is determined by intensification of absorption of uremic toxins by the intestine, associated with a fall of their urinary clearance. The necessity of early administration of the low-protein diet combined with enterosorbents is stressed.

[The effect of acetate and bicarbonate hemodialysis on protein and lipid metabolism in patients with chronic kidney failure]. / Vliianie atsetatnogo i bikarbonatnogo gemodializa na metabolizm belkov i lipidov u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

In 26 patients with chronic renal failure undergoing hemodialysis, use was made of an acetate solution (40 mmol/l) and in 7 patients, of a bicarbonate solution (35 mmol/l). The control group was made up of 20 healthy volunteers. In addition to better tolerance, the bicarbonate dialysis favoured adequate correction of acid-base balance, normalization of hypercholesterolemia, lowering of the rate of protein degradation. Among patients on the acetate dialysis, subgroups with normal (9 persons) and delayed (17 persons) acetate utilization were distinguished. A close relationship was discovered between blood acetate concentration before procedure and the rate of urea generation (r = +0.79, p less than 0.05). It is assumed that the acetate dialysis intolerance is determined by protein hypercatabolism under the conditions of delayed utilization of acetate by the peripheral tissues.

[The problems in optimizing the delivery of general therapeutic care at the regional level during the transition to compulsory medical insurance]. / Problemy optimizatsii okazaniia obshcheterapevticheskoi pomoshchi na territorial'nom urovne v usloviiakh perekhoda k obiazatel'nomu meditsinskomu strakhovaniiu.

The authors hold that perfection of local therapeutic service in present-day situation when insurance principles are introduced in medical care may be achieved through design of medico-economic standards of guaranteed minimum of medical aid for each citizen of Russian Federation. This approach allows accurate estimation of required personnel and equipment. The standards should not replace the principle of individual approach to each case.