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Sandimmun was given to 11 patients (7 males and 4 females) aged 16-34 years with chronic glomerulonephritis (CGN) and nephrotic syndrome (NS). Various morphological forms were revealed: minimal changes (MC), focal-segmentary glomerulosclerosis (FSGS), mesangiocapillary glomerulonephritis (MCGS), membraneous glomerulonephritis (MGN), mesangioproliferative glomerulonephritis (MPGN). They occurred in 1, 3, 2, 1 and 3 patients respectively. Biopsy was not made in 1 case. The duration of the disease varied from 1 to 4 years. Prior to this therapy 10 patients failed corticosteroids and cytostatics. Hypertension, high creatinine were registered in 3 and 5 patients, respectively. Sandimmun was given for 2-18 months in a daily dose 3-5 mg/kg. Serum concentration 70-180 ng/ml. After 1 to 18 months of treatment nephrotic syndrome relieved in 1 MGN, 3 MPGN, 2 FSGS, 2 MCGS patients. The recurrences were reported in 4 patients after the drug discontinuation. Serious complications were absent.

The authors studied the species-specific and quantitative composition of the large intestinal microbiocenosis on exposures to various factors of endo- and exogenous etiologies: the presence of a pathological process and its specific features, dietary trace element composition, unfavorable environmental (chemical) factors, as well as the impact of coexistence in the same family and the factors of family variability (the individual genotype of the macro-organism). The microenvironment of non spore-forming anaerobes that colonize the large bowel was found to be influenced by a number of various factors, both exo- and endogenous. The magnitude of these changes is associated with the intensity and specificity of an influencing factor.

The state of the microflora of the large intestine in 18 patients with infectious endocarditis (IE) was studied. The study revealed that the existing specific features of the microbial picture of the large intestine were caused by changes in the content of some representatives of the indigenous group of microbes, as well as in the concentration and occurrence of transitory microbial species. Changes in the character of the microbial picture were found to depend on the activity of IE, as well as on the dynamics of the disease. In the course of this study no correlations between changes in the microbial picture of the intestine and the sex of the patients, as well as between the fact of the infection being primary or not and the presence of different clinical symptoms and syndromes of IE, were established. On the basis of the data thus obtained the most informative diagnostic signs reflecting the general character of changes typical of this disease were selected.

Electron microscopic and immunohistochemical methods were employed to study composition of collagens in extracellular matrix and quantify oncoproteins c-sis and c-fos. It was established that interstitial pulmonary diseases of various etiology are characterized at early stages by alveolitis with activation of alveolar macrophages, at late stages by interstitial fibrosis with accumulation of collagens type I, III, IV and V and epithelial dysplasia which is likely to initiate bronchioloalveolar cancer.

Upon analysis of 550 cases of different chronic diffuse pulmonary diseases included in a group of interstitial diseases of the lungs (IDL) the authors came to the conclusion that IDL incorporate such variants as alveolitis, pulmonary vasculitis and pulmonary hemorrhages; granulomatosis covers exogenic allergic alveolitis, alveolitis in chronic active hepatitis; vasculitis group includes such rare diseases as necrotizing sarcoid granulomatosis vasculitis and lymphoid granulomatosis; fibrosing alveolitis--secondary alveolitis in sclerodermia systematica, rheumatoid arthritis, Sjogren's disease, chronic active hepatitis. Knowledge of IDL etiology (environmental, occupational, induced by radionuclides, drugs, viruses, fungi) with focus on drug affection of the lungs is thought of value. Biopsy and bronchial lavage findings are compared clinically and morphologically. Mechanisms of pulmonary fibrosis and approaches to inhibition of pulmonary fibrosis progression are outlined.

The specific features of the components of human large bowel microbiocenosis were studied in healthy persons and patients with various pyo-inflammatory and other diseases in relation to the physiological status. The presence of a pathological process was demonstrated to be a powerful factor of intestinal microbiocenotic variations. No specific changes in the large bowel microflora were found in the abnormalities in question.

Sandimmun (ciclosporin A) treatment of chronic glomerulonephritis with nephrotic syndrome in a dose 2.5-5 mg/kg for 6-10 months relieved nephrotic syndrome in 2 and resulted in clinical improvement in other 2 of 4 patients treated. In 3 cases the patients failed previous therapy with high-dose corticosteroids and cytostatics. The drug reduced proteinuria, elevated serum levels of albumin and total protein, had low nephrotoxicity.

Clinical picture, morphological changes, immunological disorders confirm reality and nosological independence of MPA. A clear nosological differentiation of systemic vasculitis is important for decision on an individual choice of treatment.

A retrospective analysis of the authors' own findings and foreign authors' data has demonstrated that neutrophilic cytoplasm antibodies (NCAs) play a definite pathogenetic role in the activation of neutrophils, a central link in the pathogenesis of vascular wall damage in necrotizing vasculitides. The clinical value of NCAs varies with their specificity. Proteinase 3 antibodies whose detection allows one to suppose Wegener's granulomatosis are of greater diagnostic value. Myeloperoxidase antibodies are revealed in various necrotizing vasculitides and promptly progressive glomerulonephritis and more infrequently in other diseases. Thus, the detection of antibodies to proteinase-3 and myeloperoxidase in the presence of appropriate clinical signs is most likely to diagnose primary necrotizing vasculitis. The changes in the levels of NCA reflect the activity of a renal processes and the progression of the whole disease.

Boyden camera tests, chemiluminescence of urinary supernatant, passive hemagglutination tests were used in measuring chemotactic properties of the urine, intensity of free-radical processes, fibronectin urine concentrations, respectively, in 31 glomerulonephritis (GN) patients. The above parameters were closely related to nephritis activity. These were much lower in patients with nephritis remission, than in subjects with nephrotic syndrome or exacerbation of latent nephritis. Chemotactic activity and intensity of free-radical processes were unrelated to protein urea which, however, correlated with fibronectin concentrations (r = 0.35, p < 0.05). The authors discuss the role of the mediators' values in evaluation of local renal inflammation and feasibility of their use as criteria of nephritis activity and prognosis.

The acute effects of protein loading (1.5 g kg-1) on glomerular filtration rate (GFR) and urinary albumin excretion (UAE) were investigated in 23 type-I diabetic patients with no clinical nephropathy, and in 7 healthy subjects (controls). The results were compared with renal morphology data. In controls and in 14 diabetic patients (group 1) GFR increased by 27 and 37%, respectively, corresponding to normal renal reserve, but in 9 patients (group 2) GFR decreased by 20%, indicating the absence of a renal reserve. Microalbuminuria was found in none of the patients in group 1 and in 50% of patients in group 2. Two hours after the load UAE increased in all groups, but the increase was most marked in group 2, despite the fall in GFR. The two groups of patients did not differ with regard to the duration and control of diabetes, but differed markedly in terms of baseline GFR (131 vs. 195 ml min-1, P less than 0.01, in groups 1 and 2, respectively). Renal morphology showed minimal non-specific glomerular injury in group 1, and signs of glomerulosclerosis in group 2. We conclude that the impaired renal response to protein load precedes other subclinical manifestations of diabetic renal injury, and may be useful in the diagnosis of latent diabetic nephropathy.

To study humoral antistreptococcal immunity, 29 patients with acute glomerulonephritis (AGN), 211 patients with chronic glomerulonephritis (CGN) and 30 healthy donors were examined. According to EIA, blood sera of the indicated groups demonstrated antibodies (AB) to structural components of Streptococcus--A-polysaccharide (A-ps) and hyaluronic acid (HA) and to its extracellular products--streptokinase (SK) and streptolysin-O (ASLO). It has been shown that in the blood of AGN patients, the levels of AB to A-ps, SK and ASLO were high. The highest level of AB and SK was detected in 55% of the patients with the disease standing of up to half a year. In patients of all the clinical groups of CGN, the levels of AB to A-ps, SK and HA were elevated. The degree of the rise of the levels of all AB depended on the disease activity. Of prognostic importance in the chronicity of AGN and progression of CGN are high titers of AB and SK. The etiological role of streptococcus in glomerulonephritis and its importance in CGN exacerbation and prognosis are under discussion.

Helium-neon laser therapy of patients suffering from mixed and nephrotic glomerulonephritis demonstrated hypotensive, diuretic and fibrinolytic activity boosting clinical effects. The use of the new treatment method seems to be justified, since all the patients given laser therapy manifested pronounced resistance to the pathogenetic therapy carried out previously (glucocorticoids, cytostatics, hypotensive and diuretic drugs). The presence of diverse effects and lack of complications suggest a broader-scale use of laser therapy in nephrology. At present the authors are analyzing the ++patho-chemical bases of the therapeutic efficacy of laser therapy of patients suffering from chronic glomerulonephritis. The results will be reported in the next paper.

The acute effect of a protein loading test (1.5 g kg-1) on glomerular filtration rate (GFR) was examined in 10 Type 1 diabetic patients without clinical nephropathy to evaluate the renal functional reserve. GFR was measured before (baseline) and after (test) ingestion of the protein load. Two groups of diabetic patients were distinguished: those who exhibited normal renal reserve equal to that in healthy individuals (change in GFR 35 +/- 17 (+/- SD)%) and those who had no renal reserve (change in GFR -20 +/- 20%). These groups did not differ in the duration and control of diabetes nor in the level of urinary albumin excretion. However baseline GFR was 120 +/- 34 and 209 +/- 46 ml min-1 in diabetic patients with and without renal reserve, respectively. Renal morphology revealed hilar glomerular lesions composed of severely expanded mesangium only in diabetic patients without renal reserve. Minimal structural nephropathy was observed in those who exhibited normal renal reserve. We suggest that the impaired response of GFR to protein loading precedes other subclinical manifestations of renal lesions in diabetic patients.

Overall 42 normotensive patients suffering from type I diabetes mellitus without proteinuria were examined for the effect of hyperfiltration on renal glomerular function and for changes in glomerular function seen during medicamentous treatment of hyperfiltration. Glomerular function was evaluated from the basal level of glomerular filtration (GF), the status of filtration reserves (i. e. according to the dynamics of the GF level in response to oral protein administration), and from the magnitude of albuminuria. Three groups of diabetes mellitus patients were distinguished: with filtration reserves, with decreased filtration reserves, and with no reserves. All the three groups did not differ in the age, diabetes standing or the degree of carbohydrate disorders compensation (HBA1c). Still, the patients with no filtration reserves significantly differ from the other groups with a high level of GF and albuminuria. In 9 patients, a study was made of the effect produced by captopril (an inhibitor of the angiotensin-transforming enzyme) on filtration reserves and albuminuria. After 3 to 6 months of the treatment five patients with no filtration reserves manifested a fall of the basal level of GF down to normal, the recovery of filtration reserves, and a decline of albuminuria. It is assumed that elimination of hyperfiltration due to the treatment with the inhibitors of the angiotensin-transforming enzyme may be an effective means of diabetic nephropathy prevention.

Based on studying the data obtained during examination of patients with psoriasis combined with the urinary syndrome possible varieties of psoriatic nephropathy, namely chronic glomerulonephritis (CGN) and amyloidosis were distinguished. CGN combined with psoriasis was mainly represented by latent glomerulonephritis (GN) and morphologically, it was mostly represented by the mesangio-proliferative variant, with IgA and C3 being fixed on the basal membrane of the capillaries and in the mesangium. The clinicomorphological feature of that form of psoriatic GN is combination of the signs of both associated CGN and hyperuricemia and IgA-nephritis. Special emphasis is laid on the diagnosis of rapid-progressing GN which is of paramount importance for institution of early etiopathogenetic therapy. Amyloidosis associated with psoriasis is characterized by the signs of acquired disease (AA-amyloidosis) and does not differ in its course from amyloidosis coupled with other diseases.

Ten patients with insulin-dependent diabetes mellitus not associated with any signs of diabetic nephropathy were examined for the reserves of filtration renal function and early morphological alterations in organ tissues. The reserves of filtration were detected under the conditions of acute oral administration of protein (1.5 g/kg) as difference between the initial and stimulated levels of glomerular filtration (GF). Two groups of patients were distinguished: group I included patients with preserved filtration reserves (increment of GF amounted to 35%), group II included patients with no filtration reserves (reduction of GF was 20%). Both the groups differed significantly only in the initial level of GF (120 and 209 ml/min, respectively) and in the degree of morphological changes in the glomeruli: group I manifested minimum structural changes, group II showed the commencing diabetic glomerulosclerosis characterized by pronounced injury to the manubrium of the glomeruli. Therefore, the lack of filtration reserves in diabetes mellitus patients suggests the presence of the commencing diabetic glomerulonephritis even with the lack of the clinical signs of renal injury, which does not require the resorting to organ biopsy. The primary injury to the manubrium of the glomeruli is likely to be related to a high gradient of intraglomerular hydrostatic pressure, resulting in hyperfiltration.

The authors describe the data of a comparative clinicomorphological analysis made in 40 patients with associated latent nephritis and hyperuricemia and 43 patients suffering from latent nephritis without hyperuricemia. No substantial differences in the disease clinical picture or in the structure of the morphological variants of glomerulonephritis (GN) were found in the above groups of patients. A more detailed morphological study made it possible to reveal a higher incidence of tubulostromal-vascular changes in patients with hyperuricemia. It is assumed that excess uric acid is likely to play an etiological role in the development of latent GN. Emphasis is laid on the necessity of early diagnosis of purine metabolism disorders in patients with latent nephritis whose goal-oriented therapy may improve the characteristics of the uric acid syndrome and renal function.