No 2 (2010)

Clinical, prognostic significance and approaches to treatment of prehypertension are discussed

Peculiarities of controlled clinical trials in nephrology are discussed

Purpose. Our study was aimed to determine the frequency of calcification of the abdominal aorta (CAA) and associated factors in patients with 1-5 stages of chronic kidney disease (CKD), not receiving renal replacement therapy. Material and methods. The study included 149 patients (43% men) with 1-5 stages CKD, mean age 55.6 ± 13.9 years. Diabetic nephropathy was diagnosed in 59.1% of patients, chronic glomerulonephritis - in 20.8%, other diseases - in 20.1%. In addition to the routine clinical and laboratory tests, level of "intact" parathyroid hormone (PTH) was measured, 24-hour monitoring ECG and blood pressure (BP), echocardiography were performed. We also determined the thickness of the intima-media complex (IMT) of carotid arteries, forearm bone mineral density, and thickness of cortical layers of 2nd metacarpal bone, cortico-diaphyseal index, and the overall length of calcinates of abdominal aorta by X-ray in all patients. Results. CAA was detected in 38.9% of patients. The most common comorbid conditions were coronary artery disease, heart failure as well as diabetes mellitus. CAA was more significant in elderly patients with greater IMT, higher level of blood pressure and low glomerular filtration rate (GFR), higher levels of PTH, phosphate, calcium-phosphate product, with less thickness of cortical layer of 2nd metacarpal bone and a low cortico-diaphyseal index. Patients with CAA have large atrial size, greater left ventricular hypertrophy, and often have calcification and stenosis of the aortic and mitral valves. According to multivariate statistical methods, severity of CAA was linked to the level of alkaline phosphatase and systolic blood pressure regardless of the patients' age, and the presence of CAA - with pulse BP and cortico-diaphyseal index. Conclusion. Severity of CAA in patients with 1-5 stage CKD is predominantly related with the severity of atherosclerosis and its risk factors, and in less extent - with violations of mineral metabolism. CAA is associated with calcification of the heart valves and violation of intracardiac hemodynamics. We first found an association of CAA with severity of osteoporosis.

Purpose. Evaluation of effectiveness of rituximab in patients with severe vasculitis, associated with antineutrophil cytoplasmic antibodies (ANCA). Material and methods. Retrospective study included 11 patients with ANCA-associated vasculitis (9 - with Wegener's granulomatosis, 1 - with microscopic polyangiitis and Churg-Strauss syndrome), treated with rituximab. ANCA were typing in all patients, and physical examination was performed in relation to specific organ damage. Results. As a result of treatment, complete remission was achieved in 7 (63.6%) patients, partial remission - in 4 (36.4%). The dose of prednisolone was reduced from 38.2 to 10.0 (at 6 months) and 7.5 mg/day (at 12 months). Treatment with nonselective cytotoxic drugs was discontinued in 10 (90.9%) patients. Recurrences developed in 4 (36.4%) patients, in 2 patients at 6 months after the administration of rituximab - fatal, and in 2 patients - at 15 and 45 months (in both cases refresh course of rituximab allowed to re-achieve complete remission). Tolerability of treatment was satisfactory. Conclusion. Rituximab has demonstrated efficacy in regard to steroid dependence at the later stages of disease (in case of ineffectiveness of better-studied cytotoxic drugs). It seems, in some situations, rituximab may also be used for induction of remission of vasculitis in the early stages of the disease

Purpose. Comparison of physicochemical properties of different preparations of recombinant human erythropoietin. Material and methods. Preparations of recombinant human erythropoietin - Eprex ® and Eralfon® - were compared with each other using two-dimensional gel electrophoresis and polyacrylamide gel electrophoresis over sodium dodecyl sulfate (SDS-PAGE electrophoresis) with Western blot. Results. The degree of glycosylation of erythropoietin in the drug Eprex ® is exceed the same in the drug Eralfon ®. More basic isoforms of erythropoietin in the preparation Eralfon ® may indicate a short half-life. Eralfon ® contains a significantly greater number of isoforms of erythropoietin as compared with the drug Eprex ®. Conclusion. Physico-chemical properties of recombinant human erythropoietin are different, that can lead to the change of their efficacy and tolerability.

Diabetic nephropathy (DN) plays one of the leading roles in the modern structure of the causes of chronic renal insufficiency. The article discusses the generally accepted and promising markers of diabetic kidney damage, including its early stages

Long-acting dihydropiridine calcium antagonists in treatment and prevention of chronic kidney disease are discussed

History of development of Addis test for leucocyturia and erythrocyturia is described