No 6 (2011)

Pathogenesis, approaches to diagnosis and treatment of different variants of cardio-renal syndromes are descibed

Aim. Assessment of activity of ADAMTS13, von Willebrand factor and thrombocytes in patients with thrombophilic states and kidney diseases. Methods. 20 patients with thrombophilia (genetically based and antiphospholipid syndrome) and kidney diseases (lupus nephritis, chronic glomerulonephritis) with morphological signs of renal thrombotic microngiopathy were included into the study. In all patients serum activity of ADAMTS13 and von Willebrand factor was determined. Results. Serum activity of ADAMTS13 below the reference (<93%) values (56-92%) was found in 8 (40%) of patients. Serum activity of ADAMTS13 inversly correlated with level of von Willebrand factor (r= -0,3, р<0,05) and directly correlated with thrombocytes blood count (r= 0,57, р<0,01). The most low levels of serum activity of ADAMTS13 were seen in 2 patients with morphological signs of renal acute thrombotic microangiopathy. Conclusion. Deterioration of ADAMTS13 - von Willebrand factor - thrombocytes cascade can be interpreted as universal mechanism of thombus formation in renal microcirculation.

Aim. Assessment of clinical significance of plasma adiponectin level in development of target organ damage (TOD) in metabolic syndrome, associated with non-alcoholic fatty liver disease. Methods. 86 patients (64 male, 22 female; mean age 44+11 years) with metabolic syndrome, associated with non-alcoholic fatty liver disease (ultrasound features of hepatic stetatosis and/or non-alcoholic steatohepatitis) were included into the study. Risk factors and plasma levels of leptin and adiponectin were determined. Results. Frequency of left ventricular hypertrophy, carotid atherosclerosis and chronic kidney disease increaser significantly according to the elevation of number of signs of target organ damage. Patients with >3 signs of target organ damage had the highest rate of non-alcoholic steatohepatitis (78% vs 39% in patients with 1 sign of TOD, р<0,05). Increase in number of signs of TOD was associated with elevation of leptin/adiponectin ratio. Plasma level of adiponectin significantly decreased in patients with carotid atherosclerosis (14,9±10,8 vs 32,5±22,5 mcg/ml, р=0,005) and inversely correlated with intima-media thickness of common carotid artery. Plasma adiponectin level directle correlated with HDL plasma level, leptinemia and DeRitis ratio. Conslusion. In metabolic syndrome, associated with non-alcoholic fatty liver disease, organoprotective effects of adiponectin gradually diminish, that leads to increase of intensity of TOD.

Renal arteriovenous malformations (AVMs) are abnormal communications between the intrarenal arterial and venous systems. These malformations are either congenital, acquired (often by iatrogenic means) or idiopathic, and are usually diagnosed while revealing the source of macrohematuria (Multislice spiral CT or angiography). Endovascular method - super selective embolization (SSE) was widely implemented (as monotherapy) in diagnostics and treatment of congenital renal arteriovenous malformations that are clinically apparent during the last decade. This method is considered to be an alternative to an open surgery (kidney resection or nephroectomy). We posses an experience of successful use of SSE to treat hematuria caused by congenital AVMs in three patients. In all observations we managed to gain a good clinical effect without performing an open surgery. The complications during the embolization and post-embolization period were not observed. Thus, the SSE is an effective and less invasive method of endovascular diagnostics and liquidation of hemorrhage, caused by congenital renal AVM.

Jaccoud's arthritis in patient with lupus nephritis and terminal renal failure is described

Mechanisms of self-defence of kidney in inflammation in fibrosis are discussed with special emphasis on role of heat shock proteins.