No 4 (2015)

Aim of the study. To evaluate the efficacy, safety and tolerability of the domestic drug that inhibits the action of MCP-і in patients with protein-uretic forms of chronic glomerulonephritis. Material & Methods. The study included 7 patients with various morphological variants of CGN. All patients had active forms of CGN: 3 of them had marked nephrotic syndrome with preserved renal function and moderate hypertension, 4 had significant urinary syndrome with persistent proteinuria and hematuria, and 3 - an initially decreased GFR (62-74 ml/min, stage 2 CKD). The treatment course consisted of six weekly injections. Injections were given at different time intervals: 6 hours between injections 1 and 2, 24 hours between injections 3 and 4, and 48 hours between injections 5 and 6. For 6 patients the treatment course was repeated 4 weeks later. Urinary excretion of MCP-1 and TGF-ßl was analyzed using Elisa (MCP-і Bioscience, Austria, TGF-beta1 Invitrogen, usa), IL-8 in serum levels were measured with an Immulite. Results. Decrease in proteinuria was noted in 4 of 7 CGN patients on days 7-14 of treatment, but antiproteinuretic effect lasted for a month. In contrast, 3 other CGN patients over the same period of observation were found to have the rise of proteinuria with the sharp increase of urinary levels of MCP-1 and IL-8 serum levels («cytokine» rebound) and decrease the urinary TGF-ß index. Further study of the medication was discontinued due to its low efficiency and lack of persistent effect. Conclusion. The study medication has a quick antiproteinuric action, but absence of consistent effect limits its use in patients with active forms of CGN. The development of long-acting forms of MCP-і inhibitors and evaluation of their effectiveness in combination with standard immunosuppressive therapy is a promising direction of further research.

This study involving 94 children examines the association of angiotensin converting enzyme gene polymorphism with the formation and progression of reflux nephropathy and urinary levels of profibrogenic cytokines: angiotensin II and transforming growth factor ßl. The study aimed to support early treatment with angiotensinconverting enzyme. The authors found no differences in the distribution of ace genotypes between the group of patients with vesicoureteral reflux (VUR) and the control group. It is shown that the D/D-genotype of the ace gene is an independent risk factor for development and progression of renal scarring in children with vesicoureteral reflux. It is demonstrated by the association of the D/D-genotype with higher grade of VUR, more severe reflux nephropathy, more frequent impairment of renal filtration and concentrating function and greater increase in urinary levels of profibrogenic cytokines.

Ischemia reperfusion injury has been an inevitable event accompanying kidney transplantation. This syndrome is a complex, multicomponent process with the critical role of inflammatory mediators - cytokines -in its pathogenesis. One of the promising treatment modalities able to effectively reduce cytokine concentration is coupled plasma filtration adsorption (CPFA). The first results of the study indicate that the reduction in circulating mediator concentration has a protective effect. We evaluated the long-term outcomes of this method application. The purpose of the study: Evaluate long-term results of coupled plasma filtration adsorption in the early postoperative period to reduce the severity of ischemic reperfusion injury of the renal transplant. Patients and methods: Long-term results of renal transplantation in 33 couples of recipients. The patients were divided into two groups: 33 recipients of the study group were treated with CPFA in the immediate postoperative period. In 33 recipients of the comparison group, who received paired kidney transplants, CPFA was not performed. We investigated blood concentrations of creatinine and blood urea, true GFR and 24-hour urine protein at 3, 6 and 12 months after kidney transplantation. Also, protocol kidney transplant biopsies were performed one year after the ART and in cases of graft dysfunction. Results of the study: Analysis of long-term results showed that one year after transplantation patients, treated with CPFA in the immediate postoperative period, had fewer episodes of acute graft rejection and less severe chronic transplant nephropathy. Graft function in the study group was better: lower levels of azotemia and 24-hour urine protein, higher GFR. Between group differences were greater with increasing length of the postoperative period. Conclusions: Thus, as a result of CPFA in the immediate postoperative period, improvement of function can be expected in the long term, as well as improvement of the prognosis of the graft survival.

Purpose of the study. To explore the features of morphological structure, functional activity and platelet population composition of peripheral blood in patients with BPH and to evaluate the effect of intravenous laser irradiation of blood on the platelet morphofunctional state by real-time visualization. Material & Methods. The study is based on the results of examination of 169 patients with benign prostatic hyperplasia. Patients of the main group underwent intravenous laser irradiation of blood (ILIB). We evaluated the platelets morphofunctional state before and after ILIB by computer cytomorphometry using the hardwaresoftware complex BIONI (BIONI hsc). Results. The morphological structure of platelet population composition in patients with BPH was characterized by increased number of highly activated cells to 15% and degenerative platelets to 28% compared to healthy individuals. Platelet morphometric parameters featured the increase in cell geometric characteristics (diameter, perimeter and area) by 20, 18, and 30%, and decrease in the optical characteristics (height) by 42%, indicating the presence of higher percentage of young platelets in circulation. The ILIB treatment course promotes the increase in the number of resting platelets to 61%, reduction in the number of degenerative platelets to 6%, improvement of the vital dimensional parameters of the phase platelet portraits, leading to suppression of platelet adhesion and aggregation. Conclusion: The study results showed that the use of intravenous laser irradiation of blood leads to an earlier elimination of prothrombotic process and improves hemostasis.