No 5 (2010)

Clinical signs, pathogenesis, prognosis and treatment of scleroderma renal crisis are discussed

Methods of treatment of nephrotic crise are discussed

Therapeutic strategies used in focal segmental glomerulosclerosis with special emphasis on cyclosporine are discussed

Aim. Analysis of efficacy of high dose immunosuppressive therapy combined with transplantation of autologous stem cells in systemic lupus erythematosus and lupus nephritis, refractory to standard treatment regimens. Methods. 10 patients with systemic lupus erythematosus and lupus nephritis, refractory to standard treatment regimens, were included into the study. All patients were women in age 18 - 36 years. 5 patients had lupus nephritis class IV, 5 - lupus nephritis class III. High dose immunosuppressive therapy was performed in 10 of this patients, in 9 of them - in combination with autologous stem cells transplantation. Bone marrow was used as a source of stem cells in 1 patient, in 9 they were mobilized by cyclophosphamide and colony-stimulatinmg factor. Treament efficacy was assessed during 1 and 12 months, 5-year survival was also determined. Results. Early (day 11 and 22) mortality from infectious complications was detected in 2 patients. In 1 month systemic lupus erythematosus activity decreased from III to I in degree in 6 patients, in 1 patient - from III to II, in 1 patient remission developed without stem cell transplantation. SLEDAI index, as well as serum level of anti-DNA antibodies, erythrocyte sedimentation rate, proteinuria also decreased. In 12 months disease was stable. In final analysis (median 39,6 ± 6,9 months after stem cell transplantation) incomplete remissiom was detected in 6 patients, lupus nephritis progression - in 1. 5-year survival was 78%. Renal mortality was not detected. In early period after stem cell transplantation systemic infectious complications, that lead to death, were detected in 2 patients, neutropenia - in 9, thrombocytopenia - in 5, enteropathy - in 1, mucositis - in 1, curable bacterial infection - in 1. In long term follow-up in 1 mild cytopenia was seen, in 1 - recurrent herpes infection, in 3 - hyperuricemia, in 2 - interstitial nephrititis. In 1 patient renal cell carcinoma was diagnosed and successful kidney resection was performed. Conclusion. High dose immunosuppressive therapy combined with transplantation of autologous stem cells can be effective in more than 50% of patients with systemic autologous stem cells lupus erythematosus and lupus nephritis, refractory to standard treatment regimens.

Aim. Determination of peculiarities of IgA-nephropathy clinical course in overweight patients. Methods. Retrospective study in 89 patients with IgA-nephropathy: 35 (21 male, 14 female) overweight (body mass index (BMI) 27,9±2,3 kg/m2) and 54 (30 male, 24 female) - with normal weight (BMI 21,8+2,2 kg/m2). Blood pressure, proteinuria, glomerular filtration rate (GFR), serum creatinine level, as well as ultrasound sighs of liver steatosis prevalence and serum AST, ALT and γ-GT activity were analyzed. Renal survival were calculated according to log-rank test. Results. In overweight patients IgA-nephropathy is associated with higher blood pressure (mean BP 105,3±16,7 vs 98,7±13,7 mm Hg, p<0,05) and GFR (102±32 vs 81±27 ml/min/1,73m2, p<0,05), higher prevalence of ultrasound sighs of liver steatosis prevalence and higher serum AST, ALT and γ-GT activity levels. Conclusion. Peculiarities of clinical course of IgA-nephropathy in overweight patients can be partly associated with deteriorated liver elimination of IgA due to nonalcoholic fatty liver disease.

Aim. Determination of efficacy and safety of enalapril, valsartan and their combination in renal transplant recipients with arterial hypertension. Methods. 96 renal transplant recipients with systolic blood pressure (BP) >159 mm Hg, diastolic BP >89 mm Hg were included into open label study. Patients were randomized into three groups, in which enalapril (20 mg), valsartan (160 mg) and their combination (enalapril 10 mg and valsartan 80 mg) were used. Changes of BP, albuminuria, plasma renin activity and aldosterone concentration were determined. Results. All the treatment regimens provided comparable fall in BP, albuminuria and plasma aldosterone concentration. Plasma renin activity elevated, but not significantly. Serious adverse events were nor registered. Conclusion. In renal transplant recipients enalapril, valsartan and their combination in half doses is effective in lowering blood pressure and albuminuria.

The most frequent pitfalls in antihypertensive therapy and approaches to overcome them are discussed

History of description of Bowman capsule in kidney glomerulus is presented.