No 6 (2014)

Role of Franz Volhard in development of renal arterial hypertension theory is discussed. Results of Volhard clinical and pathological investigations, that lead him to definition of variants of arterial hypertension, which differ according to risk and severity of target organ damage, are analyzed. Main Volhard publications are reviewed.

Aim. Identification of relationship between serum concentration of acyl-ghrelin and main indicators of nutritional deficiency in patients on chronic HD. Materials and methods. a total of 102 patients with end-stage renal failure treated by chronic hemodialysis, including 52 men and 50 women aged 49±7.7 years, were evaluated. All patients underwent fibrogastroduodenoscopy with biopsy of antrum and body of the stomach and the definition of Helicobacter pylori infection. Nutritional status and component composition of the patient’s body were assessed by a comprehensive nutritional assessment, kaliperometry, and bioimpedancemetry. Evaluation of serum acyl-ghrelin was carried out by the method of enzyme-linked immunosorbent assay (Elisa) using commercially available kits (Spi-bio, Montignyle Bretonneux, France). Results. The study has demonstrated a significant decrease in the serum acyl-ghrelin level with an increase in the severity of atrophic changes in the mucous membranes of different parts of the stomach, as well as the dissemination of gastric mucosa by Helicobacter pylori. There was a significant positive relationship between the serum acyl-ghrelin level and main indicators of nutritional status of patients. Conclusion. Reduction of serum acyl-ghrelin level may be considered as one of the factors contributing to the development of nutritional deficiency in patients treated by chronic hemodialysis.

Purpose. The evaluation of the prevalence of renal disease in patients with CD in the Russian population according to the two registers, ORACLE-RF and Pavlovsk register. Material and methods. Pavlovsk register was formed in 2ОО9. The register includes 1ОО1 patients with decompensated heart failure. The follow-up period for the included patients was 30, 90, 180, and З60 days after discharge. ORACLE-RF register was formed in 41 centers of the 20 cities of the Russian Federation (2010-2011). Data for 2404 patients were available for final analysis. 94 patients were lost to follow-up in the post-hospital period . Statistical analysis was performed using Statistica 6.1 and 10 software. Results. Analysis of ORACLE-RF register showed that only 16% of patients had a GFR> 90 mL/min/1.73 m 2, and 28 and 33% could be classified as 1st and 2nd stage CKD, respectively. In the group of stage 1 CKD, albuminuria A1 level was 9%, albuminuria A2 level - 2. In the group of stage 2 CKD, albuminuria A1 level was 11%, A2 - 6%, A3 - 4%. Analysis of Pavlovsk register showed that 47% of the included patients had GFR> 60 mL/min/1.73 m 2, of which only 6% had albuminuria levels A1 and 14% - albuminuria A2 level; contracted kidney confirmed by ultrasound was revealed in 12%. 52% of patients had GFR <60 ml/ min/ 1.73 m 2, with GFR <30 ml/ min /1.73 m 2 in 14% of patients included in the register, and only 1% of patients had GFR <15 ml / min / 1.73 m 2. Arteriosclerotic contracted kidney was diagnosed in patients with GFR> 60 ml / min / 1.73 m 2 in 20% of cases, and in patients with GFR <30 ml / min / 1.73 m 2 - in 13% of cases. When comparing the registers, one of the most significant differences was mortality rate among patients with GFR <60 ml / min / 1.73 m 2. In the Pavlovsk register, GFR has a significant impact on the mortality of patients, whereas in the ORACLE-RF register GFR has no effect on mortality. In ORACLE-RF register, increased creatinine or urea levels had no direct significant effect on mortality, despite the fact that the presence of CKD significantly increased mortality, OR was 3.82 (95% Cl, 3.37-4.33). Conclusions. As a result of the comparative analysis of the two Russian registers on decompensation of heart failure, it was found that the prevalence of CKD is large enough, and Pavlovsk register contains the largest number of patients with CHF and CKD.

A clinical and economic evaluation of the effectiveness of drugs stimulating erythropoiesis in patients with anemia and chronic kidney disease was performed. Pharmacoeconomic benefits of III generation drug stimulating erythropoiesis, С.E.R.A., the use of which allows to reduce the financial costs of the health system associated with pharmacotherapy of nephrogenic anemia, are explained.

Discusses the change in the functional activity of the peripheral nerves, as well as the characteristic features of uremic polyneuropathy in patients with end - stage renal disease. Studied 60 patients with end-stage chronic renal failure. Patients underwent clinical neurological and neuropsychological testing in the form of stimulus EMG. The regularities of the neurophysiological patterns of uremic polyneuropathy are the most frequent complications of the nervous system in patients on dialysis therapy, significantly impairing the quality of life of this group of patients. Revealed that the nature of demyelinating lesions of peripheral nerves of the lower extremities does not coincide with axonal and does not depend on it. Also shown are the characteristic features of the flow of uremic polyneuropathy. Despite the pronounced changes in innervations, significant decrease in the amplitude of M-response motor fibers, motor defect in the patients examined clinically was expressed moderately. At the same time, with a moderate reduction in sensory nerves of lower extremities in the patients examined widely represented sensitivity disorder, which is a typical feature of uremic polyneuropathy.

The article presents the observation of successful treatment of segmental necrosis of the small bowel due to mesenteric thrombosis in patient with nephrotic syndrome after renal transplantation.