Nº 3 (2018)

Purpose. To evaluate the renal function in high-risk patients with coronary artery disease (Cad) on the basis OF AN ANALYSIS OF THE IMMEDIATE RESULTS OF MINI-INVASIVE MYOCARDIAL REVASCULARIZATION (MIMR). THE ACTIVE USE OF MIMR in patients WITH cad from the group of high surgical risk raise the urgent issue of assessing renal function AFTER SURGERY. Material and methods. The results of surgical treatment of 1339 high-risk patients with cad in the period from 2003 to 2015 were studied. Patients were divided into two groups. The dynamics of such indicators as creatinine, CYSTATIN C, AND UREA LEVELS WAS FOLLOWED-UP, AND GLOMERULAR FILTRATION RATE WAS ALSO CALCULATED. Results. Statistically significantly better results were obtained in the MIMR group compared with coronary bypass surgery. Conclusion. MIMR has a much smaller impact on kidney function than surgery with artificial circulation, and can be recommended to high-risk patients.

Objective. Analysis and correlation of blood plasma cystatin С level with augmentation index (AI) and central arterial pressure (Cap) in therapeutic patients. Material and methods. a total of 645 therapeutic patients older than 16 years were examined, including 294 men (45.6%), women 351 (54.4%). The mean age OF THE EXAMINED subjects was 50.5±11.1 years. AI and cap were measured in all patients. In addition, the blood plasma lipid spectrum, cystatin С, calcium, and uric acid levels were examined. Based on the measurement of the blood plasma cystatin С level, the glomerular filtration rate (GFR) was calculated according to the F.J. Hoek et al. (2003) formula. Depending on the plasma of cystatin С content, all subjects were divided into two groups. The first group (n=298) included patients with a cystatin С level <1.0 mg/l, the second group (n=347) - patients with a cystatin С level >і.0 mg/l. Results. The mean age of patients (54.5±і4.8 years vs. 44.і±і3.4 years, p<0.05), the body mass index (27.9±5.5 kg/m2 vs. 26.5±5,2 kg/m2, p<0.05), systolic blood pressure (133±19 mm Hg vs. 124±16 mm Hg, p<0.05) and cap (і30±2і mm Hg vs. і22±і7 mm Hg, p<0.05) were significantly higher in the second group compared to the first group. In the group of patients with elevated blood plasma cystatin С levels, mean values of calculated GFR (52.2±і8.5 ml/min vs. 9і.7±і3.4 ml/min, p<0.05) and high-density lipoprotein cholesterol (HDL cholesterol) levels (і.і2±0.29 mmol/L versus i.18±0.28 mmol/L, p<0.05) were significantly lower than in the first group. In the second group, there was also a tendency to increase the degree of AI [і2.6 (0.60-22.90)% versus 10.8 (-3.і0-20.40)%; p=0.060)]. In the general sample, a positive correlation between systolic blood pressure levels (r=0.222, p= 0.00і) and cap (r=0.198, p=0.004) with blood plasma cystatin С levels was obtained. At the same time, the correlation of HDL cholesterol (r=-0.201, p=0.003), calcium (r=-0.349, p=0.000) levels and calculated GFR (r=-0.837, p=0.000) with blood plasma cystatin С levels was negative. Statistically significant relationship was noted only between the calculated GFR and blood plasma cystatin С levels in all groups.

Purpose. Evaluation of the therapeutic efficacy of the preparation erythropoietin а and the ease of administration of different dosages. Material and methods. The study consisted of two stages. In the beginning, a retrospective study was performed including data of 6О patients who received erythropoietin а in routine practice at the premises of the "Fespharm" Dialysis Center. The purpose of this study was to confirm the hypothesis of small doses of this drug to reach the target Hb level 1ОО-12О g/l. In the subsequent, a prospective study was conducted at the premises of the SBHCI City Clinical Hospital n.a. S.P. Botkin (ЗО patients) in order to evaluate the effectiveness of the use of erythropoietin а for the treatment of renal anemia with doses of the drug, significantly less than the recommended instructions for the drug, and assessing the factors affecting the effectiveness of treatment. Conclusion. With the use of erythropoiesis-stimulating agents (ESA), the authors recommend to take into account the body weight of the patient more strictly, in addition to the absolute total weekly dose of the drug. At the same time, the increase in the ESA dose will be faster than the increase in the patient's body weight. The recommended average doses in the instructions to the drug should be determined taking into account the national characteristics of the population, using preparations with different dosage, be more cautious about the appointment of iron preparations, more focusing on transferrin saturation with iron.

Pulmonary pathology in microscopic polyangiitis (MPa) is diagnosed in 25-70% of cases and is primarily represented by necrotizing hemorrhagic alveolitis, which can be the initial manifestation of an autoimmune disease and is a life-threatening pathology requiring the clinician to immediately diagnose and promptly assign adequate pathogenetic therapy. a case of fatal hemorrhagic pneumonitis with pulmonary hemorrhage and rapidly progressive glomerulonephritis due to MPa is presented. According to the ineffectiveness of the artificial lung ventilation, the patient had required the extracorporeal membrane oxygenation, that had improved the respiratory function of the lungs until the development of clinical effectiveness of pathogenetic therapy of MPa, including high-volume plasma exchange, high doses of corticosteroids, immunoglobulins and cytostatics.

ANCA-associated glomerulonephrites (GNs) is a group of diseases with damage to the kidney glomeruli with underlying necrotizing vasculitis associated with the formation of antibodies to the cytoplasm of neutrophils. The clinical feature of ANCA-GN is the tendency to a rapidly progressive course of GN with a decrease in glomerular filtration rate of more than by 50% over several weeks or months. The article presents a review of the literature on epidemiology, classification, etiology and pathophysiology, clinical manifestation and treatment of ANCA-associated rapidly progressive GN.