No 5-6 (2015)

Aim of the study. To ascertain participation of platelets and the role of agonists (epinephrine and ADP) in the formation of platelet-leukocyte aggregates at maintaining the chronic inflammation and the initiation of acute inflammatory response in patients with chronic obstructive pyelonephritis (COPN). Material & Methods. 43 COPN patients (26 in remission and 17 in relapse) were included in the study. Platelets were isolated following centrifugation of citrated peripheral blood. Evaluation of platelet aggregation was performed by Chrono-Log Platelet Aggregometer (USA) using agonist in EC50 concentration. The formation of platelet-leukocyte aggregates (PLA) was simulated in vitro by incubation of platelets stimulated by epinephrine or ADP and intact leukocytes isolated from peripheral blood of COPN patients. Morphometric analysis of the smears was conducted after staining of the cell suspension by the Romanovsky-Giemsa method. Results. The total number of intact platelet-leukocyte aggregates in the peripheral blood in COPN relapse was 29.8% higher than that in remission (p<0.001). After platelet pre-stimulation, their interaction with the intact (non-stimulated) leukocytes was found to increase. a more pronounced effect on platelet-leukocyte aggregate formation in COPN remission was produced by adrenaline and in relapse by ADP. Agonists simulate a certain ratio between platelets and different leukocytes, which reflects the characteristic features of blood cell interaction in the course of chronic and acute inflammation. Conclusion. Gaining insight into the mechanisms regulating the platelet-leukocyte aggregate formation in the course of inflammation offers new opportunities to substantiate COPN recurrence control.

Aim. To clarify the role of leptin in the development of malnutrition in chronic hemodialysis (HD) patients. Material and methods. The study sample consisted of 78 patients with end-stage renal disease treated with chronic HD, including 38 women and 40 men aged 52,2±і2,9 year. Nutritional status and body composition were assessed by integrated nutritional evaluation, caliper measurements, and bioimpedance analysis. The concentration of plasma leptin was determined by radioimmunoassay (Active Human Leptin Elisa, 10-231001, dsl, usa). The reference ranges were for women - 1,1-27,5 for men - 0,5-13,8 ng/ml. Results. The study results showed a significant reduction of the basic indicators of nutritional status in HD patients with hyperleptinemia. Conclusion. Hyperleptinemia may be an independent factor causing the development of malnutrition in chronic HD patients.

Aim: Identify the clinical and pathogenetic associations in patients with atrial fibrillation and chronic kidney disease stages II-IV. Materials and methods: The study included 46 patients (21 men and 25 women) with atrial fibrillation (AF) and chronic kidney disease (CKD) іі-UV stages, aged 52 to 84 years, mean age 69±9 years. To carry out the main analysis, all patients were divided into 2 groups first according to CKD stages, then depending on AF type. Results: Patients with CKD stage III-IV had significantly higher levels of creatinine and uric acid than patients with CKD stage II. The level of NT-proBNP, as an indicator of myocardial injury, was also higher in the CKD stage III-IV. All patients with a history of ischemic stroke had CKD stage III-IV. The second group patients more often received anticoagulation therapy and had a higher stratification risk of thrombotic complications of AF. Patients with CKD stages III-IV had significantly larger LA moreover, all the patients in this group had left ventricular diastolic dysfunction. Patients with persistent AF had significantly higher levels of creatinine, uric acid and potassium compared with patients with paroxysmal AF. The level of NT-proBNP was also higher in patients with persistent AF. The size of the LA was significantly larger in patients with persistent AF. Conclusion: Hemodynamic and metabolic alterations associated with a reduction in glomerular filtration rate, play an important role in the development and maintenance of AF, and increase the risk of thrombotic complications.

The article presents five clinical cases of cardiac damage in patients with aGUS and review of the literature highlighting the main aspects of cardiovascular disease in these patients. It analyzes the main clinical manifestations and features of thrombotic myocardial microangiopathy. TMM is proposed to consider as a new cause of cardiorenal syndrome type 5.

This review of international and national literature describes immediate and long-term outcomes of parathyroidectomy compared to conservative methods of secondary hyperparathyroidism (SHPT) correction in patients on dialysis. In different health systems optimal approach may vary depending levels of funding. The sensitivity of the parathyroid glands to vitamin D receptor activators and calcimimetic depends largely on the nature hyperplasia - diffuse or nodular. At a certain developmental stage of SHPT, parathyroidectomy may be more clinically effective and cost-effective compared with conservative therapy, providing a full correction of mineral disturbances and bone disease and better survival of dialysis patient. Some uncertainty in the evidence of better survival after parathyroidectomy is associated with the complexity of the study groups formation with comparable other potential risk factors, however, such comparisons, including those held in Russia. Modern techniques of parathyroidectomy include intraoperative parathyroid hormone monitoring, fluorescent intraoperative imaging and preoperative imaging of the gland using ultrasound, computed tomography, and scintigraphy. In cases of SHPT with initial manifestations of resistance to therapy, as an interim solution between conservative therapy and parathyroidectomy, minimally invasive interventions on the parathyroid glands may be applied: sclerotherapy with ethanol or local injection of the active form of vitamin D in the parathyroid glands. The second option differs from sclerotherapy in that the repeated administration of vitamin D provide an enhanced expression of receptors for vitamin D in the gland tissue with subsequent apoptosis under the influence of a local high dose of vitamin d. This eliminates perifocal inflammation inevitable with ethanol sclerotherapy, making possible unconstrained surgical intervention, if necessary in the future.