No 6 (2010)

Aim. Evaluation of course of hypertensive nephropathy in patients with metabolic syndrome. Methods. 330 patients (303 male, 27 female) with arterial hypertension and no history of chronic kidney disease were included into the study. All patients were divided into 2 groups according to presence or absence of metabolic syndrome. In all patients routine biochemical blood tests, echocardiography and 24-hour blood pressure monitoring were performed. Hypertensive nephropathy was diagnosed, if persistent microalbuminuria (>15 mg/24 hours) was revealed. Results. Metabolic syndrome was diagnosed in 63,6% of patients with arterial hypertension, its prevalence increased wit age. In 31,4% patients wit metabolisc syndrome microalbuminuria was found more often. Prevalence of hypertensive nephropathy was 35,2% in patients with metabolic syndrome, 16,7% - in patients without metabolic syndrome. In patients with metabolic syndrome signs of hypertensive nephropathy appeared in earlier age. Conclusion. Metabolic syndrome predisposes to hypertensive nephropathy development in patients with arterial hypertension

Role of cytokines in diabetic nephropathy in development and progression of diabetic nephropathy is discussed. Perspectives of pharmacological influence on inflammatory cytokines in retardation of progression of diabetic nephropathy are shown

Approaches to phytotherapy of acute and chronic kidney diseases with Canephron are discussed

Aim. Evaluation of the association of obesity and renal affection in diabetes mellitus (DM) type 2. Methods. 106 patients (41 male, 65 female, mean age 60,0± 7,0 years) with DM were included into the study. Exclusion criteria were DM duration <5 years, glomerular filtration rate (GFR) < 60 ml/min/m2, proteinuria >2 g/day. In all patients body mass index (BMI) was determined. Serum creatinine level, uricaemia, total cholesterol, LDL-, VLDL, HDL- cholesterol and triglyceride serum concentrations, as well as adiponectin and leptin plasma concentrations were evaluated. Kidney disease was diagnosed according to GFR and albuminuria parameters. All patients were divided into 2 groups - BMI<30 kg/m2 and BMI≥30 kg/m2). In 65 patients with DM type 2 association of Pro12Аlа allele gene of PPAR-γ-receptor (PPAR-γ) with risk of development of diabetic nephropathy was assessed. 26 patients with diabetic nephropathy had proteinuria or microalbuminuria, 39 patients with DM type 2 duration >10 years had no microalbuminuria/proteinuria and GFR> 60 ml/min/m2. Results. In DM type 2 patients frequency of microalbuminuria and proteinuria increased with increasing of obesity severity (р<0,05). In DM type 2 patients with BMI ≥30 kg/m2 blood pressure levels, uricemia were higher and more oftener HDL-cholesterol levels diminishing was revealed. Leptinemia serum concentration increased in association with BMI. Hyperleptinemia was revealed in all patients with proteinuria. 89% DM type 2 patients had decreased concentrations of adiponcetin. Serum adiponectin level was lower in patients with microalbuminuria and increased in patients with proteinuria. Associations of Pro12Ala polymorphism of PPAR-γ gene with risk of diabetic nephropathy development was not found. Conclusion. In DM type 2 patients obesity is on of the cofactors of kidney disease progression.

Aim. Study of influence of chronic kidney disease (CKD) on prognosis, hospitalization rate and healthcare costs in patients with chronic heart failure (CHF). Methods. 308 patients (167 male and 141 female, mean age 57,8±10,8 years) were included into the study, duration of observation was 60 months. The main (193 patients) etiology of CHF was association of coronary heart disease and arterial hypertension. CHF I (NYHA) was diagnosed in 86, CHF II (NYHA) - in 180, CHF III (NYHAP - in 37, CHF IV (NYHA) - in 5. 47 patients had diabetes mellitus type 2. Glomerular filtration rate (GFR) was estimated according to MDRD formula. Results. CKD with eCGF <60 ml/min/1,73m2 was found in 108 (35,1%) CHF patients. CKD was associated with increase of total mortality (relative risk 1,7), number of hospitalizations per 1 patients (0,9 [CI 95% 0,2-4,2] versus 0,7 [CI 95% 0,09-2,5], p<0,02) due to all causes and due to cardiovascular causes (0,9 [CI 95% 0,6-5,2] vesrus 0,6 [CI 95% 0,1-3,0], p<0,02). CKD with eCGF <60 ml/min/1,73m2 costs for hospital care increased for 21%. Conclusion. CKD in CHF patients was associated with increasing of total mortality, number of hospitalizations and healthcare costs

Aim. To assess the reasonability of immunosuppressive therapy with cyclophposphamide of mesangioproliferative glomerulonephritis with proteinuria/haematuria. Methods. 112 patients with mesangioproliferative glomerulonephritis with proteinuria/haematuria (mean age 25,0±8,2 years, mean duration of kidney disease - 11,3±5,3 years) were included into the study. 23 patients received immunosuppressive therapy: 2 - monotherapy with corticosteroids, 6 - monotherapy with cyclophosphamide, 15 - combination of corticosteroids and cyclophosphamide. Results. In 21 patients immunosuppressive therapy with corticosteroids and cyclophosphamide improved renal survival in presence of glomerulonephritis activity: proteinuria ≥0,5 g/l, haematuria ≥50 erythrocytes in vision view, elevation of seromucoid level ≥0,210 units, hyperfibrinogenemis ≥4,0 g/l, histological activity index ≥21 and/or total sclerosis index ≥8. Conclusion. Immunosupressive therapy can be indicated in patients with mesangioproliferative glomerulonephritis in presence of signs of glomerulonephritis activity.

Aim. Assessment of blood haemorrheology disturbances in patients with lupus nephritis. Methods. 41 patients (8 male, mean age 40±14 years, and 33 female, mean age 37±12 years) with systemic lupus erythematosus were included into the study, 30 of the had lupus nephritis. Patients were divided into 3 groups - with non-active lupus nephritis, with lupus nephritis with proteinuria/haematuria, and with active lupus nephritis and nephritic syndrome. Patients with active lupus nephritis were subdivided into subgroup with less prominent (<1000 erythrocytes/ml) haematuria and with high-grade (>1000 erythrocytes/ml) haematuria. 26 healthy subjects in comparable age served as controls. In venous blood kinetics of spontaneous erythrocyte aggregation and desegregation, as well as erythrocyte deformity were determined. Results. Increase in blood viscosity, decrease of erythrocyte deformity, acceleration of erythrocyte aggregation and increase in erythrocyte aggregates size were detected. In patients with active lupus nephritis time of erythrocyte aggregation, size and durability of erythrocyte aggregates, erythrocyte deformity were minimal. In active lupus nephritis with high-grade haematuria size of erythrocyte aggregates was maximal. Conclusion. Haemorheology disturbances in lupus nephritis increase simultaneously with the disease activity.

History of Bence Jones protein description is discussed.