[Ischemic heart disease in patients with chronic renal failure].
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Biomedical subjects
Publications and source records attributed to N F Iarovaia.
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This study compared the effects of angiotensin converting enzyme (ACE) inhibitors captopril versus enalapril on left ventricular (LV) muscle mass and LV systolic and diastolic function in 58 patients with primary glomerulonephritis and moderate chronic renal failure. The design was a 6-8 week titration phase and 6-month maintenance phase. Mean myocardial mass calculated by M-mode echocardiography in the captopril group was 153 +/- 26 g/m2 before, and 130 +/- 14 g/m2 after 6 months of treatment, in enalapril group 147 +/- 22 g/m2 before, and 126 +/- 23 g/m2 after 6 months of treatment (p < 0.05). LV ejection fraction, early and late transmitral flow velocities and early to late LV inflow velocities ratio were not significantly affected by both ACE inhibitors.
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Upon the analysis of qualitative and quantitative characteristics of hematuria in renal and urinary tract affections it was established that whatever the red blood cell count in the urine, hematuria is primarily glomerular in contrast to nonglomerular in chronic glomerulonephritis and nonglomerular diseases of the kidneys and urinary tracts, respectively. Morphologic studies of urinary red blood cells using phase-contrast microscopy proved a valuable tool for identification of hematuria origin.
The authors analyze the course and outcomes of 33 pregnancies in 26 women suffering from systemic lupus erythematosus (SLE). In patients with active SLE the incidence of gestoses and abnormalities of the newborns is significantly higher than in those with inactive SLE, whose gestational and neonatal complication rate is almost the same as in healthy women. Pregnancy course and outcomes are particularly unfavorable in cases with lupus glomerulonephritis.
The authors studied the content of beta 2-microglobulin (beta 2-MG) in the blood serum and its excretion with the urine in 85 patients with chronic and 35 with lupoid glomerulonephritis (CGN and LGN) depending on the activity of the disease and state of the renal function. In active CGN and LGN one could observe a distinct increase of the content of beta 2-MG in the blood serum and an increase of its excretion with the urine that may be related to presence of marked dystrophic changes of the canalicular apparatus of the kidneys leading to disorders of reabsorption and beta 2-MG catabolism as well as disorders of the immune homeostasis revealed in these diseases. Results indicate that the beta 2-MG levels in the blood serum and urine may be considered as criteria of CGN and LGN activity.
As many as 96 patients with chronic glomerulonephritis (CGN) and 25 with lupus glomerulonephritis (LGN) were examined for chromosomal aberrations (CA) in peripheral blood lymphocytes in different clinical variants and morphological forms of CGN and LGN as well as for their dynamics under the influence of cytotoxic drugs. In patients with active CGN and LGN, chromosomal instability may develop. The treatment with cyclophosphamide in a dose of 2.0-2.5 mg/kg/day appreciably increases chromosomal instability the level of which rises progressively with the treatment period increase. The treatment with azathioprine in a dose of 1.5-2.0 mg/kg/day is not associated with a noticeable increment of the rate of CA. The studies of the level of CA can be used for estimating CGN and LGN activity. Chronic renal failure did not change the level of CA either in CGN or in LGN. In different morphological forms of glomerulonephritis, the rate of CA was determined by the clinical variant of the disease. In order to reduce potential complications provoked by the treatment with cytotoxic drugs, dynamic studies of the CA rate should be carried out in addition to the conventional tests.
Results are presented of an investigation of birefracting fatty bodies in the urine of patients with primary chronic lupoid and Henoch glomerulonephritis. There was a close correlation between the presence of birefracting fatty bodies and severity of glomerulonephritis independent of the morphological picture of the disease and state of renal function. Reduction of the activity of the disease in the course of pathogenetic treatment characterized by a decrease or disappearance of proteinuria was accompanied by a distinct reduction of the level of birefracting fatty bodies or their disappearance.
Glomerulonephritis with minimal alterations presents one of the most complex problems of nephrology. The authors provide the data on the disease incidence and clinico-laboratory correlations in 33 adult patients, discuss problems of the treatment policy.
The author relates the data on the time-course of changes in diurnal proteinuria, diastolic arterial pressure and blood creatinine in 123 patients with primary chronic glomerulonephritis seen during 159 pregnancies. The dependence of the character of those changes on the respective parameters before conception was analyzed as was such a dependence, in part of the patients, on the morphological disease pattern. The rise of proteinuria and diastolic arterial pressure during gestation was seen more often in women with initial diurnal protein losses exceeding 1g and with arterial hypertension that occurred before pregnancy. The rise of blood creatinine before conception was a prognostically unfavourable sign. Mesangiocapillary glomerulonephritis occurring in the gestation period is viewed as less favourable as compared to mesangioproliferative glomerulonephritis.
The levels of aberration of chromosomes in peripheral blood leucocytes were investigated in patients with chronic and lupoid glomerulonephritis considering the clinical variants and morphological forms of the disease. In chronic glomerulonephritis high levels of chromosome aberration were found in patients with nephrotic type; in lupoid glomerulonephritis the frequency of chromosome aberration was higher in patients with active glomerulonephritis. Chronic renal failure did not essentially change the level of chromosome aberration both in chronic and lupoid glomerulonephritis. In different morphological forms of glomerulonephritis the frequency of chromosome aberration was determined by the clinical variant of the disease.
Clinical progress and outcomes of 151 pregnancies have been evaluated in 123 patients with chronic primary glomerulonephritis (GN). The incidence of gestational and neonatal complications was evaluated for a relationship with preconception findings of proteinuria, hematuria, arterial pressure, blood creatinine and, in 45 women, histological patterns of disease. Major preconception proteinuria (over 3 g/day), hypertension, decreased renal function and especially clustering of these findings were prognostically poor. Gestational progress and outcomes in mesangiocapillary GN were worse as compared with mesangial proliferative GN.