No 3 (2013)

Results of clinical trials, assessing the efficacy and safety of bardoxolone as a nephroprotective agent are discussed.

Aim. Assessment of risk factors of premature atherosclerosis in patients with systemic lupus erythematosus (SLE). Methods. 70 patients with SLE (34 - with lupus nephritis) were included into the study. Atherosclerosis signs were detected by Duplex scanning of carotid arteries and multispiral computed tomography with coronary calcinosis assessment. Patients with chronic renal failure were excluded from the study. Results. atherosclerosis signs were detected in 36 (51%) patients in age 35 - 55 years (mean age 47,5±5,3 years). Monofactor analysis revealed age (<0,001), dyslipidemia (р=0,050), arterial hypertension (р=0,049), menopause (p=0,008), smoking (p=0,014), hyperfibrinogenemia (р=0,008), antiphospholipid syndrome (p=0,05) as risk factors for atherosclerosis. Atherosclerosis frequency increased in patients older than 40 years (61,1% vs 18,8%, р=0,004). Multifactor analysis demonstrated role of age, diastolic blood pressure in the period of disease manifestation, serum fibrinogen level as risk factors for atherosclerosis. SLE activity, measured by SLEDAI index, correlated with dyslipidemia (р=0,049), presence of antiphospholipid sundrome (р<0,001), lupus nephritis (р<0,001), steroid therapy (р<0,05). Conclusion. Premature development of atherosclerosis in systemic lupus erythematosis is associated with traditional and non-traditional risk factors: in high-risk patients screening for subclinical atherosclerosis signs is useful.

Aim. Assessment of influence of direct renin inhibitor on blood pressure (Bp), parameters of central hemodynamics and structure and functional status of thrombocytes in patients with arterial hypertension and chronic kidney disease (CKD). Methods. 50 patients (23 male and 27 female, mean age 43,5 + 3,2 years) with arterial hypertension and CKD were included into the study. Glomerular filtration rate was estimated according to MDRD formula. All patients recieved direct renin inhibitor aliskiren (Rasilez, Novartis AG). Office bp, echocardiography, thrombocyte aggregation and mebrane lipid phase determination were performed. Results. after 8 weeks of aliskiren therapy systolic and diastolic bp decreased significantly, target bp level reached 32 (64%) of patients. Left ventricular myocardial mass index decreased; degree and velocity of thrombocytes aggregation, lipid peroxidation diminished, alpha-tocopherol and phospholipid content in thombocyte membrane increased. Conclusion. Use of aliskiren in patients with chronic kidney disease and arterial hypertension in associated with achievement of target bp in the majority of patients, regression of left ventricular hypertrophy and normalisation of structure and functional status of thrombocytes.

Aim. Estimation of efficacy of diet modification in cardiovascular risk modification in renal transplant recipients. Methods. 60 renal transplant recipients (age 37,5 [36,9; 41,6] years) were included into the study. Mean duration of period after renal transplantation was 6,5 [6,2; 9,4] years. Nutritional status of patients was analysed; diet was modified according to American Dietetic Association recommendations. Results. All renal transplant recipients demonstrated severe disturbances in nutritional status. Dier modification lead to correction of nutritional status disturbances without adverse events. Conclusion. Renal transplant recipients shoul udnergo diet modification for correction of nutritional status disturbances.

Role of low molecular weight heparins in anticoagulation in patients on chronic hemodyalisis is discussed. Results of clinical trials, demonstrating their advantages beyond unfractioned heparin, are reviewed.

Aim. Characteristics of urodynamics of upper and lower urinary tract in children with secondary chronic pyelonephritis. Methods. Urodynamics was assessed by urofloumetry, registration of rthytm of spontaneous mictions, uretheral effux was also quantified. Results. Deterioration of urodynamic parameters in various levels of urinary passage was detected in children with chronic pyelonephritis. Conclusion. Urodynamics deterioration is typical for children with chronic pyelonephritis.

The results of endovideosurgery during nephroectomy are presented. Conducting comparative analysis with conventional nephroectomy has shown significant advantages of using the methods of endovideosurgery during nephroectomy among children: a less traumatic surgery, postoperative period is softer.

Role of Marcello Malpighi (1628-1694) in development of microanatomy is described.