Sodium reabsorption and sodium consumption (daily sodium excretion) were studied in 63 health volunteers and 100 recipients of kidney allografts. We elaborated the nomogramm for de fi nition of sodium reabsorption with con fi dence interval 95% and proposed to use T-score CNa/GFR for a quantitative estimation of sodium reabsorption. There was a direct line dependence between sodium fractional excretion (CNa/GFR) and T-score CNa/GFR in kidney allograft recipients with good function and chronic rejection of kidney allograft (R = 0,86; р < 0,01; Yx = 0,593 + 0,64x; R = 0,97; р < 0,01; Yx = 0,147 + 1,146 х and R = 0,97; р < 0,01; Yx = 0,21 + 0,69 х , respectively). In recipients with good function of kidney allograft the regression coef fi cient was signi fi cantly higher, than in health volunteers ( р < 0,01). In the group of recipients with chronic transplant rejection a free member of regression equation was signi fi cantly higher, than in health volunteers ( р < 0,01). Consequently, exactness of sodium reabsorption estimation after kidney transplantation is not suf fi cient without calculation of sodium consumption.

24 recipients after ortotopic liver transplantation (9 women and 5 men) 18–57 years aged were studied in 1–2 and then through 4–18 months following operation. Bone mineral density (BMD) in repeated estimation in 13 recipients was elevated on 14 ± 10,5% and in 11 recipients was decreased on 2,5 ± 2,56%. BMD elevation was associated with bone remodelling normalization. BMD lowering followed transplant dysfunction, glucocorticoid therapy, bone resorption increasing and bone formation suppression.

The dependence between minute calcium and sodium excretion from 1 L glomerular fi ltrate (CaE/GFR; NaE/GFR) with NaE/GFR from 0,1 to 9,71 mmol/l GFR was studied in 103 health volunteers. There was received asymptotique curve with r 2 = 0,54; Y = 0,06 [1 – exp (–x/2,34)]. The nomogramm with con fi dence intervals of 95% was built. On the basis of renal physiology it was offered differentiate gradual (to electrochemical gradiate created by sodium reabsorbtion) and active calcium reabsorbtion. It was assumed that gradual calcium reabsorbtion is equel to sodium reabsorbtion and may be estimate by NaE/GFR, CNa/GFR. We considered that active calcium reabsorbtion is normal if the correlation between CaE/GFR and NaE/GFR is inside being decreased if the correlation is higher and increased if the correlation is lower probable intervals. We proposed T-score CaE/GFR as the quantative parameter of active calcium reabsorbtion. It varied in health volunteers from –1,74 to +2,15. The method was applied in 236 recipients of allotransplanted kidney.

The analysis of retainment and release kinetics of deposited in tissue structures calcium was made in the hypercalcemic conditions in 28 healthy volunteers (22 males and 6 females) of the age of 33 ± 6.5 years via drip infusion (Groups 1, 2) and in 9 individuals (3 males and 6 females) in 12 trials via stream infusion (Group 3). By the end of each hour after the termination of calcium infusion the amount of calcium retained in tissues was calculated (Mtis./kg); the parameters of its binding (specific buffer volume--β3 sp, association constant--Ka, number of binding centers--n) were established using the Langmuir and Scetchard coordinates. The Group 1 volunteers (n = = 12) showed a section of positive cooperativity (a direct regression on Sketchard coordinates, Hill coefficient 3.36 ± 1.63) and 2 sections of the consecutive calcium separation from one set of noninteracting centers. 5 volunteers of Group 2 and 8 volunteers of Group 3 demonstrated a slight calcium delivery to tissues after 1 hour of observation which then followed for 2 volunteers of Group 2 and for 2 volunteers of Group 3. Other volunteers of Groups 2 and 3 showed a release of tissue-deposited calcium via the mechanism of the consecutive separation from one set of noninteracting centers with βsp 3 times less and Ka 7 times higher than with the calcium infusion. The excretion of calcium in urine was the highest in Group 1 and the lowest in Group 3. The [Ca2+] and Mtis./kg values were normalized in Groups 1 and 2 the next morning and in Group 3 after 2-3 hours of observation. An assumption was made about the relationship between the tissue and kidney [Ca2+] normalizing mechanisms with hypercalcemia.

Aim. Comparative evaluation of two biochemical markers of bone resorption and hormonal regulation of bone metabolism in liver recipients. Methods and results. B о ne densitometry of L2–L4 and neck of femur, serum level of some hormones (PTH, vitamin D 3 , estradiol, testosterone) regulating osteoclastogenesis as well as com- parative analyses of two bone resorption markers β -crosslaps and tartrate-resistant acid phosphatase type 5b (TRAP-5b) were ful fi lled in patients after orthotopic liver transplantation (OLT). In 1 month after OLT bone density reduction of L2–L4 and neck of femur; decrease of vitamin D 3 , estradiol in women, testosterone in men and increase levels of bone resorption markers were observed. In 1 and 2 years after OLT the rise of bone density, increased levels of PTH, estradiol, testosterone and decreased β -crosslaps levels were revealed, while vitamin D 3 and TRAP-5b levels remained stable. Conclusion. TRAP-5b was found to be a more specif fi c marker of bone resorption, independent from collagen metabolism in liver. Osteoporosis de fi ned in long-term period after OLT was associated with higher TRAP-5b and revialed in women with low estradiol level.

Biochemical markers of bone formation [osteocalcin (OC), N-terminal propeptid of type 1 procollagen (P1NP), bone isoferment of alkaline phosphatase (BALP)] were estimated in 34 recipients after liver transplantation. Three types of deviation have been demonstrated: combination elevated circulating levels OC and P1NP with normal levels BALP in recipients without clinical postoperative complication; combination lower levels OC and BALP with normal levels P1NP in recipients as a result of corticosteroid therapy prior/ following transplantation; superior levels P1NP with normal levels OC and BALP which results excessive accumulation hepatic collagen formation in recipients with postoperative clinical complication.

The kinetics of calcium binding by tissue structures was analyzed in 19 healthy volunteers (13 men and 6 women) from the age group of 33 ± 6.5 years under the conditions of acute hypercalcemia followed by drip intravenous infusion of calcium gluconate for 2.5 h. At the end of each 30-min period, the calcium amount retained by the tissue structures was recorded and the kinetic parameters of calcium binding were determined according to Langmuir and Scatchard. In all volunteers, there was a region of binding isotherm with positive cooperativity (linear regression in Scatchard’s coordinates) with the same buffer capacity (βtis) for calcium in Langmuir’s coordinates (0.58 ± 0.24 L kg). Half of the volunteers exhibited cooperativity at [Ca2+] = 1.3–1.5 mmol/L, while others, at [Ca2+] = 1.0–1.3 mmol/L, which corresponded to the differences in the association constant (Ka) and the number of interactive sites (n) with [Ca2+] = 1 mmol/L. Additionally, two segments of the binding isotherm were detected with the successive binding of calcium to one set of non-interactive centers with similar kinetic parameters of calcium binding (βtis, Ka, n). Four different types of calcium binding in healthy volunteers were found. The results of this study may serve as the basis for a functional diagnostic test of disorders of the tissue calcium-binding properties in different pathological conditions.

Aim. Comparative evaluation of two biochemical markers of bone resorption and hormonal regulation of bone metabolism in liver recipients. Methods and results. B о ne densitometry of L2–L4 and neck of femur, serum level of some hormones (PTH, vitamin D 3 , estradiol, testosterone) regulating osteoclastogenesis as well as com- parative analyses of two bone resorption markers β -crosslaps and tartrate-resistant acid phosphatase type 5b (TRAP-5b) were ful fi lled in patients after orthotopic liver transplantation (OLT). In 1 month after OLT bone density reduction of L2–L4 and neck of femur; decrease of vitamin D 3 , estradiol in women, testosterone in men and increase levels of bone resorption markers were observed. In 1 and 2 years after OLT the rise of bone density, increased levels of PTH, estradiol, testosterone and decreased β -crosslaps levels were revealed, while vitamin D 3 and TRAP-5b levels remained stable. Conclusion. TRAP-5b was found to be a more specif fi c marker of bone resorption, independent from collagen metabolism in liver. Osteoporosis de fi ned in long-term period after OLT was associated with higher TRAP-5b and revialed in women with low estradiol level.

Calcium binding kinetic by tissue structures was analysed in 19 health volunteers (13 men and 6 women) of the age group of 33 +/- 6.5 under conditions of acute hypercalcaemia followed by a drip i.v. infusion of calcium gluconate over 2.5 hours. At the end of each 30-minute period the calcium amount retained by tissue structures was recorded and the kinetic parameters of calcium binding were determined according to Langmuir and Scatchard. In all volunteers there was a segment of binding isotherm with positive cooperativity (direct regression in Scatchard) with analogous buffer capacity (beta) for calcium in Langmuir (0.58 +/- 0.24 L kg). One half of volunteers demonstrated cooperativity at [Ca++] 1.3-1.5, while another--at [Ca++] 1.0-1.3 mmol/L which corresponded to the differences in the association constant (Ka) and the number of interactive sites (n) with [Ca++] 1 mmol/L. Additionally, two segments of binding isotherm were detected with the successive binding of calcium to one set of noninteractive sites with similar kinetic parameters of calcium binding (beta, K(a), n). Four different curves of calcium binding in healthy volunteers were established. This study may serve as the basis for a functional diagnostic test of disorders of the tissue calcium-binding properties in different pathological conditions.

Methods and results: bone densitometry of L2-L4 and neck of femur, the level in serum of blood some hormones (PTH, vitamin D3, estradiol, testosterone) and cytokines (OPG, IL-6, FNO-a) regulating osteoclastogenesis as well as comparative analyses of two bone resorption markers β-crosslaps and tartrate-resistant acid phosphatase type 5b (TRAP-5b) were fulfilled at different periods following orthotopic liver transplantation. At the early date after operation there were the bone density decrease of L2-L4, the lowering of vitamin D3, estradiol in women, testosterone in men and the elevation of cytokines and of resorption markers. In 1 and 2 years following liver transplantation there were revealed the rise of bone density, the level of PTH, estradiol, testosterone, which were associated with the lowering of IL-6, FNO-a and β-crosslaps while the level of vitamin D3 and TRAP-5b remained stable. Conclusion: at the early date TRAP-5b was more specific marker of bone resorption which did not depend on collagen metabolism in liver. In 1 and 2 years following liver transplantation bone resorbtion was association with level of PTH, FNO-a and OPG.

Aim. To elucidate the role of cholestasis and menopausal status in the development of osteoporosis in women with primary biliary cirrhosis (PBC) before and after orthotopic liver transplantation (OLT). Methods and re- sults. There were fulfilled 74 estimations of biochemical markers of bone metabolism, estrogen (E2), parathy- roid hormone (PTH) endogenous secretion so as mineral content of lumbar vertebras in 21 women with PBC (10 women before and 17 in different terms after OLT). Bone turnover disturbances were characterized by delay of bone formation associated with hyperbilirubinaemia before OLT while increased bone turnover following OLT. Bone resorption markers correlated inversely with E2 in postmenopausal women and positively with PTH in premenopausal women. Conclusion. Bone wastes degree depended on hard and duration of disease before OLT so as menopausal status after OLT. In postmenopausal women bone wastes were associated with degree of endogenous E2 decreasing, increased bone turnover, and graft dysfunction.

Purpose. The elucidation of the frequency and general determinants of postmenopausal women osteoporosis at the date >12 months following kidney allotransplantation (KA) and orthotopic liver transplantation (OLT). Materials and methods: There were fulfilled estimations of bone biochemical markers, estradiol, parathyroid hormone (PTH) in blood serum so as bone mineral density of lumbar vertebras (BMD) in 24 women following KA (32 estimations) and in 17 — after OLT (43 estimations). Results: Osteoporosis was revealed in 45% and 35%, hyperparathyroidism — in 90% and 37°% women after KA and OLT accordingly. BMD was positively correlated with free estradiol index in women after KA and OLT and inversely with PTH in women after KA so as with bone biochemical markers, disease duration before operation, level ofhyperbilirubinaemia in women after OLT and was more lower in women with cholestatic diseases. Conclusions: General determinants of osteoporosis in postmenopausal women following KA — estradiol deficit and hyperparathyroidism; after OLT — cholestatic liver diseases, transplant dysfunction and estradiol deficit. Osteoporosis in women with immunosupression without glucocorticoids and normobilirubinaemia so as type 1 postmenopausal osteoporosis associated with increased bone turnover and in women with transplant dysfunction — with increased bone resorption.

The sample of 45 recipients (30 females and 15 males) after orthotopic transplantation of liver was examined thrice in dynamics. Three groups were formed according the resulted values of T-criterion of bone mineral density in the area of lumbar vertebrae. The bone mineral density of group A was considered as osteoporosis, of group B as osteopenia and of group C as physiologic norm. In early period (1-4 months) after orthotopic transplantation of liver gross disorders of bone metabolism were established in all recipients independently of the degree of bone mass loss. In distant period (up to 32 months) after orthotopic transplantation of liver the bone losses decreased entailing full normalization of bone metabolism in 37% of recipients with osteoporosis, 82% with osteopenia and 91% with normal bone mineral density.

The sample of 45 recipients (30 females and 15 males) after orthotopic transplantation of liver was examined thrice in dynamics. Three groups were formed according the resulted values of T-criterion of bone mineral density in the area of lumbar vertebrae. The bone mineral density of group A was considered as osteoporosis, of group B as osteopenia and of group C as physiologic norm. In early period (1-4 months) after orthotopic transplantation of liver gross disorders of bone metabolism were established in all recipients independently of the degree of bone mass loss. In distant period (up to 32 months) after orthotopic transplantation of liver the bone losses decreased entailing full normalization of bone metabolism in 37% of recipients with osteoporosis, 82% with osteopenia and 91% with normal bone mineral density.

Biochemical markers of bone formation [osteocalcin (OC), N-terminal propeptid of type 1 procollagen (P1NP), bone isoferment of alkaline phosphatase (BALP)] were estimated in 34 recipients after liver transplantation. Three types of deviation have been demonstrated: combination elevated circulating levels OC and P1NP with normal levels BALP in recipients without clinical postoperative complication; combination lower levels OC and BALP with normal levels P1NP in recipients as a result of corticosteroid therapy prior/ following transplantation; superior levels P1NP with normal levels OC and BALP which results excessive accumulation hepatic collagen formation in recipients with postoperative clinical complication.

Active calcium and sodium reabsorption (ACR, SR) examination was performed in 125 renal recipients (RR) [ 78 with good renal function (GRF), 26 with chronic rejection(CR), 21 with cyclosporine nephrotoxity(CN)], 18 with bronchial asthma (36 estimation) receiving for a long time glucocorticoid therapy (EG) and 16 - with chronic renal disease in the initial stage of renal insufficiency (CRD). It was revealed elevated level of ACR in all patients being maximal in triple immunosupression therapy (cyclosporine, prednisolone, azathioprine) and minimal in double (prednisolone, azathioprine) therapy both in GRF and CR. There was reliable linear inversely proportional dependence between ACR and SR in all recipients receiving triple immunosupression and EG patients with analogous regression coefficient and free article. The latter was lower in group of health voluntaries. ACR value did not depend on parathyroid hormone level in all groups of patients. In summary elevated ACR in RR is the result of low SR and high glucocorticoid level in blood and did not depend on PTH.

Bone mineral density (BMD) was estimated twice in 18 recipents of ortotopic liver transplantation. There was decreased BMD in axial so as in peripheral skeleton in early time and in vertebral or hip Ward triangle in late time following transplantation being lower in primary biliary cirrosis then in cirrosis following chronic virus hepatitis despite tacrolimus immunosupression without prednisolon. Tacrolimus immunosupression with prednisolon in primary biliary cirrosis patients in late postoperative time was associated with hard BMD lowering which correlated with glucocorticoid therapy duration and prednisolon cumulative dosis.

The dependence between minute calcium and sodium excretion from 1 L glomerular filtrate (CaE/GFR; NaE/GFR) with NaE/GFR from 0,1 to 9,71 mmol/l GFR was studied in 103 health volunteers. There was received asymptotique curve with r(2) = 0,54; Y-x = 0,06 [1 - exp (-x/2,34)]. The nomogramm with confidence intervals of 95% was built. On the basis of renal physiology it was offered differentiate gradual (to electrochemical gradiate created by sodium reabsorbtion) and active calcium reabsorbtion. It was assumed that gradual calcium reabsorbtion is equel to sodium reabsorbtion and may be estimate by NaE/GFR, CNa/GFR. We considered that active calcium reabsorbtion is normal if the correlation between CaE/GFR and NaE/GFR is inside being decreased if the correlation is higher and increased if the correlation is lower probable intervals. We proposed T-score CaE/GFR as the quantative parameter of active calcium reabsorbtion. It varied in health volunteers from -1,74 to + 2,15. The method was applied in 236 recipients of allotransplanted kidney.