No 6 (2013)

Aim. Estimation of prevalence and severty of calcinosis of abdominal aorta by lateral roentegnography (Kauppila method) in patients on program hemodialysis. Methods. Lateral roentegnography (Kauppila method) of abdominal aorta in patients on program hemodialysis was performed in 40 (22 male, 18 female, mean age 58,70 + і2,26 years, mean hemodialysis period duration 6,90 + 4,57 years) patients with terminal renal failure on chronic hemodialysis. Results. Signs of abdominal aorta calcification were found in 90 %, mean calcification index was 6,82 ± 5,9 (і-23) points. Abdominal aorta calcification severity increased with age, severity of secondary hyperparathyreoidism, and was also interrelated with bone-mineral metabolism parameters and therapeutic approaches. Conclusion. Lateral roentegnography (Kauppila method) of abdominal aorta can be used for diagnosis of vascular calcification in patients on program hemodialysis.

Aim. Assessment of efficacay of early start of correction of calcium-phosphate metabolism disturbances in patients on program hemodialysis in prevention of secondary hyperparathyreoidism. Methods. 128 patients with chronic kidney disease (CKD) stage З - 5D were included into the study: 89 (69,5 %) with chronic glomerulonephritis, ЗО (23,4 %) - with chronic tubulo-interstitial nephritis, 9 (7,1 %) - with hypertensive nephrosclerosis. 82 (64,і %) of included patients had calcium-phosphate metabolism disturbances. According to the previous therapy patients were divided into З groups: 1st (n = 26) - received alfacalcidol per os in predialysis period and intravenously in program hemodialysis, 2nd (n = 26) - paricalcitol per os in predialysis period and intravenously in program hemodialysis, 3rd (n = ЗО) - did not received active vitamin D metabolits in predialysis period, but received intravenous alfacalcidol or paricalcitol on program hemodialysis. 32 (ii -from the 1st group, ii - from the 2nd group, io - from the 3rd group) patients were followed for 5 years. In ΙΟ patients on program hemodialysis, who did not demonstrate adequate decrease of intact parathyreoid hormone клиническая нефрология 6 - 2013 оригинальные статьи (iPTH), active vitamin d metabolits were combined with cinacalcet. All patients before active vitamin d metabolits started receiving phosphate-binders. In all patients in the beginning and in the end of follow-up ultrasound scanning of common carotid arteries was performed. Results. In 3 months after alfacaclidol or paricalcitol start in patients of 1st and 2nd groups normalization of iPTH level was seen. In 6 months paricalcitol lead to more prominent decrease of bp and proteinuria, than alfacalcidol. In combination with ace inhibitors paricalcitol induced decrease of bp and left ventricular myocardial mass index to a greater extent, than alfacalcidol. In patients of 1st and 2nd group, in whom iPTH level was normalized during pre-dialisys period, chronic kidney disease progression was less rapid. 22 patients of 1st and 2nd groups with normalized iPTH level in pre-dialisys period, during first 3 years of hemodialysis secondary hyperparathyreoidism did not develop. ΙΟ patients of 3rd group developed secondary hyperparathyreoidism with ectopic calcification in 3 patients and calciphylaxy in I patient. Conclusion. Inadequate correction of secondary hyperparathyreoidism in pre-dialysis period leads to inefficacy of treatment of secondary hyperparathyreoidism on program hemodialysis with ectopic calcification and calciphylaxy development.

Clinical trials of efficacy and safety of prolonged tacrolimus in renal transplant patients are reviewed. Standard and prolonged tacrolimus demonstrate equal clinical efficacy and safety, but prolonged tacrolimus is associated with higher treatment adherence.

Frequency, risk factors and pathogenesis of thrombotic events in patients with systemic ANCA-associated necrotizing vasculitides are reviewed. Patient with severe Wegener’s granulomatosis, who developed pulmonary artery thromboembolism in absence of thrombotic risk factors, is presented. Interrelations of thromboembolic events and systemic inflammatory response in systemic vasculitides are discussed.

Approaches to prevention and treatment of ischemia-reperfusion injury of donor's organs are discussed. Pathogenesis of ischemia-reperfusion organ injury and use of modern methods of organ conditioning is reviewed.

Aim. Estimation of efficacy of biologically active supplement «Prolit» in patients with urinary tract infections CUTI). Methods. 50 patients with un (ЗО male with chronic pyelonephritis, 20 female with chronic cystitis) were included into the study: 25 of them received Prolit, 25 - only standard un therapy regimen. Changes in blood biochemical parameters and urinalysis were assessed. Results. Use of prolit lead to decrease of frequency of bacteriuria and leucocyturia. Urinary pH also decreased. Kidney function parameters remained stable. Conclusion. Prolit can be used in combined therapeutic approach in urinary tract infections.