Aim. To study changes in renal function in response to protein loads in patients with chronic glomerulonephritis (CGN) who have normal renal function and initial uremia. Material and methods. 63 CGN patients were divided into two groups: 40 patients of group I (17 males, 23 females, age 16-53 years, plasma creatinine-Per < 0.132 mmol/l); 23 patients of group 2 (10 males, 13 females, age 18-57 years, Pcr > 0.132 mmol/l). Renal functional reserve (RFR) was assessed with oral soa isolate SURRO 760 test (protein Techn.Int., USA), 1.0 g of protein per 1 kg of ideal body mass. By three 2-h clearance periods measurements were made of RFR, absolute and fractional excretion, concentration indices and clearances of creatinine, urea, electrolytes, osmolality. All the parameters were referred to the standard body surface. Results. RFR was intact in 14 patients of group 1 and 10 patients of group 2. In CGN without uremia with intact RFR, maximal Per corresponded to the highest values of minute diuresis and sharp increase of urea excretion, osmotically active substances.,In CGN patients with uremia and intact RFR, development of hyperfiltration was accompanied with a significant rise in Pcr, minute diuresis, absolute excretion of urea and osmotically active substances. The rise in the latter two was much less active in CGN if RFR was absent. Multiple stepwise regression analysis showed that RFR intactness dependes primarily on baseline values of absolute excretion of urea and osmotically active substances. Conclusion. A reverse relationship exists between absolute excretion. of urea, osmotically active substances and the degree of SKF in response to protein. load in CGN patients both in intact nitrogen-excreting function and uremia. It is suggested that urea may be involved in regulation of intraglomerular hemodynamics by means of effect on tubular-glomerular feadback mechanism.

Before starting treatment of chronic glomerulonephritis it is desirable to determine the patient's drug sensitivity in vitro because in the absence of such sensitivity chemotherapy should be preceded by immunomodulation with tactivin or thymalin and 3-5 sessions of plasmapheresis to stimulate drug sensitivity. Further measures include prednisolone or cyclophosphamide intravenously for 3-5 days in a dose 300-500 followed by oral administration. Active treatment lasts for 4-8 weeks. After that the patients receive maintenance for 1-2 years.

Enterosorbents were tried clinically in 90 patients with chronic renal failure and in vitro (immersion into gastric juice, enteral and colon content). Advantages of granulated carbone sorbents over polyphepan, lignin derivative, were evident.

The authors hold that perfection of local therapeutic service in present-day situation when insurance principles are introduced in medical care may be achieved through design of medico-economic standards of guaranteed minimum of medical aid for each citizen of Russian Federation. This approach allows accurate estimation of required personnel and equipment. The standards should not replace the principle of individual approach to each case.

A transient inhibition of glomerular filtration and/or elevation of blood creatinine were detected in 126 of 296 patients with chronic glomerulonephritis. Some of the patients had 2-4 episodes which occurred more frequently in exacerbations (56.3% of cases), less frequently in cytostatic treatment or in sanatorium. The predominance of nephrotic syndrome and frequent recurrences or hypertension, long-term course in different causes of the disease suggests several pathogenetic variants of nephrotic syndrome. Transient deterioration of renal function does not affect survival, but as emergence in the course of cytostatic treatment or sanatorium treatment worsens the prognosis being related with sclerosis of the renal tissue.

Recormon was given to 34 patients on hemodialysis. The drug's effects on quality of life were judged by the results of clinical, laboratory, experimental and psychological dynamic investigations. The highest effect occurred on the therapy month 6-12. Recormon contributed to relief of asthenic and depressive syndromes, to an increase of activity and improvement of well-being, quality of life by Karnofsky scale within the first year of treatment. The dynamics of life quality changes depended on initial psychophysical condition of the patients, the age, blood pressure, hematocrit. Recormon treatment is associated with the risk of euphoria.

As indicated by blood tests, chronic glomerulonephritis (CGN) patients with intact renal function have impaired lipid peroxidation and antioxidant defense. In nephrotic syndrome these plasm changes are more pronounced, but red cells remain relatively intact. Persistent nephrotic syndrome produces a trend to shifts in red blood picture. In CGN patients free of nephrotic syndrome red cells exhibited lipid peroxidation and weak antioxidant defense. The above facts support the validity of antioxidants use in combined treatment of CGN.

The results of sanatorium treatment were compared for different health resorts (in the Middle Asia, Yalta, Sestroretsk) where 374 patients underwent 455 courses for chronic glomerulonephritis. The results of the treatment were similar except for the Middle Asia and Yalta sanatoria where the condition of the patients aggravated. This suggests a conclusion of an unfavorable effect of hot climate on the course of chronic glomerulonephritis.

The multivariate analysis of overall clinicomorphological symptoms in 121 patients with chronic glomerulonephritis (CGN) allowed formulation of independent prognostic factors indicative of the time to chronic renal failure. Similar for diverse morphological CGN forms prognostic charactors are those of CGN aggravation frequency, arterial hypertension, serum creatinine concentration, the pattern of tubulointerstitial changes at 'the time of renal biopsy. The speed of CGN morphological variants is approximately the same in similar expression of prognostically significant characters.

The implications of the treatment variant and chronic glomerulonephritis (CGN) characteristics in the changes of renal function were evaluated by 220 treatment courses for CGN aggravation. A number of statistical methods were employed. In CGN patients free of renal insufficiency glomerular filtration was either unaffected or recovered after transitory decline. In chronic failure further creatinine clearance diminution was observed, serum creatinine levels went up. Corticosteroid treatment was much safer for the kidneys than cytostatics. With increasing duration of CGN, functional affection of the kidney becomes more frequent irrespective of the treatment kind. The same is true for the number of exacerbation and hypertension which are also involved in renal functional decline.

The authors analyze pilot experience with clinical introduction of intestinal dialysis in 7 uremic patients. Repeated sessions of the dialysis relieved some symptoms of uremic intoxication. The method may be of value in contraindications to chronic hemodialysis for chronic renal failure. The technique is easily performed and well tolerated by the patients. The investigations should be continued.

Two groups of patients with chronic renal failure (CRF) underwent chronic hemodialysis within 1976-1990. Acute ulcerogenic situation in them arose during month 1-3 of the treatment. Formation of ulcers was closely related to the acid-peptic factor. Hemodialysis procedure was found to contribute to ulcerogenesis, chronic hemodialysis being somewhat an iatrogenic risk factor in such patients. Modern policy of managing duodenal ulcers in hemodialysis patients is discussed.

A study was made of the structural rearrangement of renal tissues in intravital nephrobiopsy specimens and of the functioning of the renin-angiotensin-aldosterone system and kallikrein-synthetic function in patients with mesangioproliferative (MSPGN) and membranous proliferative glomerulonephritis (MPGN). The morphological changes were revealed. The patients with associated MSPGN and secondary hypertension (SH) mostly demonstrated emptying and hyalinosis of arteries, whereas those with associated MPGN and SH manifested for the most part the derangement of the tubulointerstitial structures. In patients with MPGN, the levels of total renin (TR) and inactive renin (IR) were significantly higher than in those suffering from MSPGN. This can be regarded as risk factor of earlier development of SH. In MPGN patients, the content of TR and IR as well as that of active renin (AR) did not depend on the clinical pattern of chronic glomerulonephritis. As compared to MSPGN patients with isolated urinary syndrome, those with associated MSPGN and SH had a higher AR level, which agreed well with systolic and mean arterial pressure. Apparently, the latter one is implicated in the mechanism of SH in MSPGN. In associated MPGN and SH, kallikreinuria was found to be lowest, which may be the consequence of tubulointerstitial lesions. Discoordination of the renin-angiotensin and kallikrein systems is likely to be one of the causes of earlier formation and severe course of SH in the morphological pattern under consideration.

The restructure of renal tissue in intravital nephrobiopsy specimens, renin-angiotensin-aldosterone together with kallikrein synthetic functions were studied and compared in patients with mesangioproliferative and membranoproliferative glomerulonephritis (MsPGN and MPGN). The characteristics of the morphological changes were defined. In MsPGN with secondary hypertension (SH), nephronic wasting and hyalinosis of arteries were mostly detectable whereas MPGN with SH was primarily marked by the derangement of the tubulointerstitial structures. In MPGN, the levels of total and inactive renin (TR and IR) were significantly higher than in MsPGN. This can be regarded as risk factor of early development of SH. The content of TR and IR and in addition that of active renin (AR) in MRGN did not depend on the clinical form of chronic glomerulonephritis. As compared to MsPGN with an isolated urinary syndrome, in MsPGN with SH, AR was prevalent, while its level correlated well with systolic and the mean arterial pressure. AR may be implicated in the mechanism of SH in MsPGN. In MPGN with SH, kallikreinuria was found to be extremely low, which may be consequent to tubulointerstitial injuries. The discoordination of the renin-angiotensin and kallikrein system may be one of the causes of earlier formation and the grave course of SH in the morphological pattern under consideration.

The results of long-term follow-up (from 4 to 25 years) were studied in 1420 patients with chronic glomerulonephritis registered in the city nephrologic service of Leningrad. The relapses ceased in 45.8 % and became less frequent in 16 % of cases. The survival rate of long-term follow-up patients was significantly higher than of those observed for 2-3.5 years. Long remissions and slowing down of the disease progression were obtained mostly in cases with mild or moderate process activity and seldom in patients with frequent and persisting relapses. Long-term results did not significantly depend on hypertension or nephrotic syndrome but worsened in membrano-proliferative, sclerotic glomerulonephritis and focal glomerulosclerosis due to their inclination to relapse.