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Biomedical subjects

I M Kutyrina

Publications and source records attributed to I M Kutyrina.

At least 19 recordsLinked to original sources
PubMed2006

[Disorders of 24-h rhythm of blood pressure in patients with chronic glomerulonephritis].

AIM: To characterize 24-h profile of blood pressure (BP) and to clarify prognostic significance of 24-h BP variability in patients with chronic glomerulonephritis (CGN) with intact renal function and hypofunction of the kidneys. MATERIAL AND METHODS: A total of 38 hypertensive CGN patients (29 males and 9 females, mean age 37.9 +/- 12.4 years) entered the trial. All the patients had systolic BP (SBP) > 140 mm Hg and/or diastolic BP (DBP > 90 mm Hg. RESULTS: Twenty patients with renal hypofunction (creatinine > 1.4 mg/dl) had significantly higher (p < 0.05) SBP, day and 24-h SBP duration, high variability of day-time and 24-h SBP. Significantly higher mean day-time, night-time and 24-h SBP, SBP day-time and 24-h duration SBP duration, variability of SBP and DBP for a day and 24-h, respectively, were observed in 15 patients with left ventricular hypertrophy. Of prognostic significance in relation to renal survival estimated by Cox in 21 patients in multifactorial analysis were blood creatinine level, glomerular filtration rate, the patient's age, SBP duration for day, night and 24 hours. In multifactorial analysis, the final model included only age of the patient and blood creatinine. CONCLUSION: CGN patients with renal hypofunction had higher SBP and its variability associated with left ventricular variability.

Adult↗
PubMed2006

[Development of renal affection in obese patients].

AIM: To characterize mechanisms, early markers and clinical signs of renal damage in obesity. MATERIAL AND METHODS: The trial covered 29 males aged under 50 years (mean age 37.7+/-9.3 years) with abdominal obesity having neither carbohydrate metabolism disturbances nor chronic renal disease. All the patients were examined for microalbuminuria (MAU), serum level of leptin. Radionuclide scintigraphy of the kidneys with an acute captopril test, tests for serum concentrations of endothelin-1, homocistein, uric acid, ultrasound dopplerography of the brachial artery for assessment of endothelium-related vasodilation (ERVD) were made in 24 patients. In 9 patients MAU and ERVD were estimated after 3 months of valsartan treatment (80 mg/day). RESULTS: MAU was detected in 62% patients, its rate increasing with elevation of serum leptin and endothelin concentration. Under normal values of creatininemia and GFR, obese patients showed deletion of renal functional reserve (RFR). Patients with low RFR had maximal uricemia and homocysteinemia, serum endothelin-1. Such patients demonstrated also abnormal ERVD. 3-month valsartan intake led to elevation of ERVD and disappearance of MAU. CONCLUSION: Excessive leptin registered in obese patients provoked dysfunction of the endothelium of the intrarenal vessels manifesting with MAU, growth of endothelin-1 serum concentration and disorder of ERVD. This leads to unfavourable changes in filtrating function of the kidneys as seen from gradual deletion of RFR in the absence of hypercreatininemia. Elimination of MAU and ERVD disorders in obesity can be achieved by administration of angiotensin II receptor blockers.

Adult↗
PubMed2006

[Risk factors of vascular complications in patients at a predialysis stage of chronic renal failure].

AIM: To specify risk factors of vascular complications at a predialysis stage of renal failure. MATERIAL AND METHODS: The trial enrolled 165 patients with chronic renal failure (CRF) aged 46 +/- 15 years, glomerular filtration rate (GFR) - 37.2 (35.02-40.83) and arterial hypertension (96%). The examination included ultrasound dopplerography of the common carotid arteries (CCA) and common femoral arteries (CFA) for detection of atherosclerotic plaques (AP), estimation of the thickness of arterial intima-media, elasticity and rigidity of the vascular wall. Factors of risk for atherosclerosis and cardiovascular complications were assessed. RESULTS: Aortic atherosclerosis was detected in 60 patients, that of cardiac vessels, brain, kidneys and lower limbs - in 35, 30, 23 and 8 patients, respectively. Acute cardiovascular complications occurred in 13 patients. Main atherosclerosis risk factors were age, body mass index, systolic and pulse arterial pressure, disturbances of phosphorus-calcium metabolism. Structure and function of CCA and CFA were studied with dopplerography in 37 CRF patients. Increased intima-media thickness was associated with age, male sex, overweight, hypercholesterinemia, systolic and pulse arterial pressure. Body mass index, GFR, creatinin level were independent factors of intima-media thickness. Abnormal elasticity of CCA was related to hypertension, CFA - to hypercholesterolemia.

Adolescent↗
PubMed2005

[The role of polymorphic markers of vasoactive hormones genes in clinical characteristics of chronic glomerulonephritis].

AIM: To examine association of polymorphic markers of I/D gene of angiotensin-converting enzyme (ACE), C(-344)T gene of aldosterone synthetase (CYP11B2) and 4a/4b gene of endothelial synthetase of nitric oxide (NOS3) with clinical picture of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: The trial covered 167 CGN patients. Clinical characteristics of CGN (nephritis, debute, its clinical and morphological variants, analysis of the clinical course as regards arterial hypertension severity, rate of persistence of proteinuria (PU) of the nephrotic level for 6 months and longer, frequency of AH combination with persistent PU was made retrospectively in the groups of patients by genotypes of the genes ACE, CYP11B2 and NOS3. RESULTS: In CGN patients, carriage of the combination of allele D of ACE gene, allele C of CYP11B2 gene, and allele 4a of NOS3 gene was associated with more frequently occurring nephrotic syndrome and AH in the disease onset. A CGN course in patients with genotype DD (ACE gene) often complicates with AH, in patients with genotype CC (gene CYP11B2) and in carriers of allele 4a (gene NOS3)--with severe AH. Carriers of allele D (gene ACE) HA often combines with persistent PU the nephrotic level. A morphological variant of CGN is not associated with carriage of genotypes of polymorphic markers of genes ACE, CYP11B2 and NOS3. CONCLUSION: There is association of polymorphic markers I/D of ACE gene, C(-344)T of gene CYP11B2 and 4a/4b of gene NOS3 with clinical features of CGN. Carriers of alleles associated with high activity of PAAC--allele D of gene ACE, allele C of gene CYP11B2 and allele 4a of gene NOS3--had more severe clinical picture at all stages of the disease.

Chronic Disease↗
PubMed2005

[Endothelial dysfunction in severe forms of acute renal failure. New approaches to pathogenetic therapy].

AIM: To study endothelial function in different variants of acute renal failure (ARF) at various stages of the disease. MATERIAL AND METHODS: The study of 36 patients with severe ARF at the stages of oliguria and recovery of diuresis included a clinico-laboratory analysis of characteristics of ARF of various etiology and follow-up of plasmic concentrations of endothelin-1, thromboxan A2 and prostacyclin in different ARF variants at different ARF stages. RESULTS: The oliguric phase of severe ARF ran with significant elevation of the level of vasoconstrictive endothelial hormones (endothelin-1 and thromboxan A2 and a fall of a vasodilator prostacyclin. Recovery of diuresis normalized the above parameters. CONCLUSION: Mechanisms of ARF development involve endothelial dysfunction manifesting with alteration of vasoactive hormones synthesis with a dominant rise of a vasoconstrictive hormones concentration.

Acute Kidney Injury↗
PubMed2005

[Factors influencing the condition of the intima-media complex of carotid and femoral arteries at initial stages of chronic renal failure].

AIM: To examine changes in the structure of large (carotid and femoral) arteries at an early stage of chronic renal failure (CRF) and factors significant for their development. MATERIAL AND METHODS: Duplex ultrasonography of the common carotid arteries (CCA) and common femoral arteries (CFA), serum biochemical tests, echocardiography were made in 32 patients (15 males and 17 females) with chronic diffuse renal disease at an initial stage of CRF (creatinine 2.7 mg%, CRF duration 2.7 years). Increased thickness of the intima-media complex (IMC) in both vascular territories was found in 72% of the examinees. There was a close correlation between CCA and CFA IMC (chi-square = 14.05; p = 0.0002). Plaques in the carotid arteries correlated with smoking (chi-square = 4.60; p = 0.0320), in the femoral arteries--with male sex (chi-square = 5.18; p = 0.0228). IMC of both arteries correlated with age (r = 0.49 and r = 50, respectively, p < 0.05), body mass index (r = 0.50, p < 0.05), thickness of the left ventricular posterior wall and interventricular septum (r = 0.65 and r = 0.55, respectively, p < 0.05), CFA IMC correlated also with creatinine level (r = 0.39, p < 0.05), hypertriglyceridemia (chi-square = 10.33; p = 0.0013), systolic, pulse and mean arterial pressure (r = 0.45, r = 0.38, r = 0.36, respectively, p < 0.05), smoking (r = 0.48, r = 0.40, respectively, p < 0.05) and family history of cardiovascular diseases (chi-square = 7.16; p = 0.0075). A linear multifactorial regression analysis has detected that an independent factor of increased CCA and CFA IMC in patients under 50 years of age was creatinine, in patients over 50 years--age. CONCLUSION: Even at early stages of renal failure patients have thicker IMC associated with both standard risk factors (age, hypertension, smoking, lipid disbolism) and development of renal failure itself.

Adult↗
PubMed2004

[Arterial hypertension in chronic glomerulonephritis: detectability and treatment efficacy].

AIM: To study prevalence of arterial hypertension (AH) in patients with chronic glomerulonephritis (CGN), its relationship with activity of the renal process, renal function; to analyse policy and efficacy of antihypertensive therapy. MATERIAL AND METHODS A total of 250 CGN patients treated in 1993-2001 participated in the trial. They had different morphological variants of CGN. AH was diagnosed in 193 patients. In the course of the trial changes in antihypertensive treatment policy were observed. RESULTS: AH was most prevalent in mesangiocapillary (96.6%) and diffuse fibroplastic nephritis (83.9%). In functional insufficiency of the kidneys AH occurred in 90.1%. AH was associated with clinical and morphological signs of nephritis activity, severity of tubulointerstitial alterations, purin and lipid metabolism. Uric acid level and age were independent prognostic factors of AH development. AH correction was achieved in the initial and subsequent periods in 51.7 and 58.7% cases. Later, ACE inhibitors were prescribed more often, both in monotherapy and in combination with other drugs; calcium antagonists were taken less frequently. CONCLUSION: AH in CGN patients is a frequent finding and depends on a morphological nephritis variant, activity of the renal process and degree of renal failure. Age, gender and metabolic disorders are also involved in AH development in CGN patients. Recently, there is a trend to more frequent prescription of combined treatment. Drugs of choice in the treatment of renal AH are ACE inhibitors.

Adolescent↗
PubMed2004

[Association of the complex of polymorphic markers of ACE genes, aldosteron synthetase and endothelial synthetase of nitric oxide with progression of chronic glomerulonephritis].

AIM: To study association of the complex of polymorphic markers of ACE genes (ACE complex), aldosteron synthetase gene (CYP11B2) and endothelial synthetase of nitric oxide (NOS3) with onset, course and progression of chronic glomerulonephritis (CGN). MATERIAL AND METHODS: 117 CGN patients were examined. Genetic predisposition to CGN development was studied by comparison of distributions of alleles and genotypes of polymorphic markers of genes ACE, CYP11B2 and NOS3 in CGN patients and controls (n = 80) free of renal diseases and arterial hypertension (AH). The course of CGN was analysed with consideration of the following factors: AH severity, proteinuria persistence, nephritic level for 6 months and longer, immunosuppressive therapy and response to it, therapy with ACE inhibitors and/or blockers of antiotensin II receptors (ARB). CGN progression rate end point was doubling of initial blood creatinine level. RESULTS: Significant differences in the incidence of the above alleles and genotypes in the patients and controls were not found. The patients were divided into two groups: group 1 consisted of 25 patients carrying the combination of alleles D+C+4a, group 2 consisted of the rest 92 patients. The groups did not differ by CGN course parameters, but renal survival was significantly lower in carriers of the allele combination D+C+4a. Cox's mono- and multifactorial regression analysis has shown that carriage of the allele combination D+C+4a is an independent riskfactor of renal survival deterioration. CONCLUSION: No association was detected between polymorphic markers of genes ACE, CYP11B2 and NOS3 and onset of CGN. Carriage of D+C+4a allele combination is an independent factor of risk for fast progression of chronic renal failure.

Adult↗
PubMed2003

[Role of ultrasound dopplerography with acute captopril test in assessment of renal hemodynamics in chronic glomerulonephritis].

AIM: To examine blood flow in renal and intrarenal arteries and its changes in the acute pharmacological test with captopril in patients with chronic glomerulonephritis (CGN). MATERIAL AND METHODS: Renal circulation was studied in 50 patients with CGN using ultrasound dopplerography (USDG) of renal vessels on the unit GE Logiq 400 CL PRO Series. The velocity and indices of peripheral blood resistance in the major renal artery (RA) and in intrarenal arteries were estimated. In 26 patients the blood flow was studied again after intake of 50 mg captopril. RESULTS: Poor renal blood flow was registered in cortical parenchyma in 36% CGN patients (with chronic renal failure in 75%). Multifactorial regression analysis has demonstrated that only blood creatinine was independently related with slowing down of the blood flow at the level of RA and intrarenal arteries. Morphological index of activity correlated with resistance indices while a high sclerosis index correlated with blood flow slowing. Older patients had higher resistance indices. Captopril significantly accelerated blood flow and insignificantly changed indices of peripheral resistance including those in CRF patients. CONCLUSION: Poor blood flow in the cortical layer of renal parenchyma in CGN, according to USDG, occurs rather frequently and was associated with CRF and older age of the patients. Blocking of renin-angiotensin system at the level of angiotensin II formation improves renal blood flow in most of the patients.

Adolescent↗
PubMed2002

[Use of angiotensin-converting enzyme inhibitors in chronic kidney insufficiency].

AIM: To study effects of ACE inhibitors in patients with diffuse renal diseases at the stage of chronic renal failure (CRF). MATERIAL AND METHODS: Acute changes in renal filtration and in renal hemodynamics in response to 100-200 mg captopril were studied in 7 patients with CRF and 6 patients with intact renal function. Effects of long-term ACE inhibitors were retrospectively studied in 50 patients with CRF (27 men, 23 women, mean age 46.0 +/- 1.9 years, 7 patients were over 60 years old). Sixteen patients were selected from this group who were followed up for a long time. They were examined for CRF progression rate when given conventional antihypertensive treatment and after treatment with ACE inhibitors. RESULTS: Acute response to ACE inhibitors was the following: SCF fell by 18.4% on the average by the end on therapy week 1; by the end of week 3 renal hemodynamics showed stability, SCF returned to normal, effective renal plasm flow rose by 16.9%, serum potassium rose significantly after 7 days of treatment but did not reach 6 mmol/l. Effects of long-term ACE inhibitor in CRF: the treatment was discontinued after 30-60 days in 12 of 50 patients because of high creatinine (> 20%); in 38 patients ACE inhibitor had a pronounced antihypertensive and antiproteinuric action for 2-3 years, creatinine growth inhibited. Progression of CRF became slow. CONCLUSION: ACE-inhibitors in CRF had a nephroprotective effect but blood creatinine levels should be controlled especially within the first 1-2 months of treatment.

Adult↗
PubMed2002

[Angiotensin converting enzyme inhibitors in renal diseases].

Chronic diffuse renal diseases, involvement of the kidney in systemic and metabolic disorders are characterized by steady progression of renal pathology with loss of functional nephrons, lowering of renal functions and gradual development of chronic and eventually terminal renal failure. Basic mechanism of progression of chronic renal failure is activation of local renin-angiotensin system with intrarenal formation of a potent vasoconstrictor and growth factor - angiotensin II. Potentially nephroprotective effect can be achieved by pharmacological block of angiotensin II by angiotensin converting enzyme inhibitors. It has been shown in some prospective studies (AIPRI, REIN, ACEi-1 Trial, MICRO-HOPE) that the use of these drugs is associated with slowing of progression of renal pathology irrespective of its etiology and delayed development of terminal renal failure in patients with preexisting chronic renal insufficiency. Data available indicate that angiotensin converting enzyme inhibitors should be first line agents in the treatment of patients with chronic diffuse renal diseases of various etiology and diabetic nephropathy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

[Effects of acute pharmacological blockade of the renin-angiotensin system on intrarenal hemodynamics in patients with systemic lupus erythematosus and systemic scleroderma].

AIM: To evaluate effects of an ACE inhibitor captopril on intrarenal hemodynamics during acute test in patients with lupus nephritis (LN) and chronic sclerodermic nephropathy (CSN). MATERIAL AND METHODS: Renal hemodynamics was studied using ultrasound duplex scanning of renal vessels (UDS) on Vingmed SD-100 unit in 5 patients with SLE with renal affection, 5 patients with scleroderma systematica (SS) with renal affection. The hemodynamic parameters were measured before and 1 hour after administration of 50 mg captopril. RESULTS: LN were found to have low arterial perfusion. CSN patients exhibited low intrarenal blood flow in high resistance of small vessels. Captopril improved intrarenal hemodynamics (enhancement of linear and volume blood flow) in LN patients; in CSN renal artery dilated and resistance of small vessels reduced while renal arterial perfusion increased. CONCLUSION: Improvement of intrarenal hemodynamics in LN and CSN patients in response to captopril allows to recommend administration of ACE inhibitors in SLE and SS with renal damage. Ultrasonic duplex scanning of renal vessels provides detailed information about the condition of intrarenal vessels without invasion.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

[Thromboxane A2 and prostacyclin in patients with chronic glomerulonephritis and coronary heart disease in contrast media nephrotoxicity. Protective effects of calcium antagonists].

AIM: To study pathological significance of circulating thromboxane A2 and prostacyclin in mechanisms of impairment of intrarenal hemodynamics and renal function due to contrast media (CM) in risk group patients and to study protective effects of calcium antagonists in CM nephrotoxicity. MATERIALS AND METHODS: To study plasmic concentrations of TxA2 and prostacyclin, we used radioimmunoassay to measure plasmic TxB2 and 6-keto-prostaglandin F1a in patients with chronic glomerulonephritis (group 1), systemic atherosclerosis and coronary heart disease (group 2). The control group consisted of 23 healthy subjects. Diatrizoate (verografin), a high-osmolar CM, was used (40-60 and 250-400 cc in groups 1 and 2, respectively). RESULTS: Plasma TxB2 and serum creatinine concentrations were significantly elevated in group 1 after CM infusion compared to the preinfusion period and healthy controls. Plasma 6-keto-prostaglandin F1a in group 1 before CM infusion was lower than in controls after CM infusion. The data in group 2 were similar to those for group 1. Administration of nifedipine before and after introduction of CM prevented a rise in serum creatinine and had beneficial effects on TxA2 and prostacyclin synthesis. CONCLUSION: Ionic CM have a renal vasoconstrictive effects mediated by imbalance between vasoconstrictor TxA2 and vasodilator prostacyclin and may be nephrotoxic in risk group patients. The protective effects of calcium antagonists promote normalization of calcium dependent TxA22 and prostacyclin synthesis.

Adolescent↗