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Aim: To evaluate albuminuria (AU) in the Moscow Region's dwellers visiting the health centers and to clarify its association with the proven and discussed risk factors (RF) of chronic kidney disease (CKD)., Subjects and Methods: A total of 1623 patients (390 (24%) men and 1233 (76%) women; mean age 46 +/- 16 years) were examined. Urinalysis using test strips was performed in all the examinees. AU was estimated by the following scale: normal AU (NAU) (< 10 mg/l), an initial increase (11-30 mg/l), a pronounced increase (31-300 mg/ml), very high AU (> 300 mg/ml). A questionnaire covering gender, age, patients' anthropometric data, comorbidities, healthy lifestyle adherence, and smoking was designed to assess possible RFs for CKD. Body mass index (BMI) was calculated. Medical history examination showed metabolic disturbances and cardiovascular diseases., Results: The detection rate of NAU was 18%; the initial and pronounced increases were found in 40 and 41% of the examinees, respectively; the very high AU was in 1%. The first questionnaire items associated with AU > 30 mg/ml were complaints of edema, sternal pain, poor appetite, meat aversion, and constant thirst. The detection rate of AU > 30 mg/l in hypertensive persons was 51%. If the patients had diabetes mellitus or a history of increased blood glucose episodes, the detection rate of AU > 30 mg/l amounted to as much as 65.5%. Estimation of overweight and obesity indicated that AU of > 30 mg/l was found in 44 and 49% of cases, respectively (p < 0.001). Analgesic abusers, long-term smokers, and sedentary people were statistically significantly more frequently found to have AU of > 30 mg/l., Conclusion: The pronounced and very high AU was noted in more than 40% of those who had visited the health centers. A questionnaire survey makes it possible to reveal a variety of AU increase-associated factors that primarily reflect metabolic disturbances and cardiovascular diseases and to identify a risk group in order to study AU first. Particular emphasis should be placed on the examinees' lifestyle. Healthy lifestyle non-adherence is closely correlated with increased AU and may be regarded as a RF for CKD.

Aim: To study the prevalence of and risk factors (RF) associated with cardiovascular system damage in patients with predialysis diabetic and nondiabetic chronic kidney disease (CKD)., Subjects and Methods: The investigation enrolled 317 patients with CKD of various etiologies. In Group 1 (165 patients with CKD: 54% of men, 46% of women; mean age 46 +/- 15 years), the glomerular filtration rate (GFR) was 37.2 ml/min; the serum creatinine level was 2.9 mg/dl. Group 2 included 152 (41%) patients with type 2 diabetes mellitus (DM) (41% of men and 59% of women; mean age 57.3 +/- 7.1 years). The duration of DM averaged 10.4 +/- 7.1 years. All the patients underwent physical examination; the levels of glycated hemoglobin and adipose tissue hormones, urinary albumin excretion were additionally determined in the diabetic patients. Echocardiography was performed in 172 patients. The influence of populationwide and renal failure-associated RFs on the cardiovascular system was evaluated in CKD., Results: Clinical and instrumental examinations of 165 patients with Stages II-IV nondiabetic CKD revealed atherosclerosis of the aorta and the vessels of the heart, brain, kidney, and lower extremities in 60 (37%), 35 (24%), 30 (18%), 23 (14%), and 8 (5%), respectively. As atherosclerotic vascular lesion progressed, the incidence of cardiovascular events (CVE) increased. Left ventricular hypertrophy (LVH) was diagnosed in 37.3% of the patients with nondiabetic CKD. Along with traditional cardiovascular RFs (age, smoking, gender, arterial hypertension), the renal dysfunction-related factors (anemia, diminished glomerular filtration rate, elevated creatitine levels, and abnormal phosphorus and calcium metabolism) are of importance. An association was found between LVH, atherosclerotic vascular lesion, and heart valve calcification. According to EchoCG data, 36% of the patients with type 2 DM were diagnosed as having LVH. The RFs of the latter were albuminuria, obesity, and abnormal carbohydrate and purine metabolisms. There was an association of diabetic nephropathy with left ventricular remodeling processes and a history of CVE., Conclusion: The development of cardiorenal syndrome is observed in early-stage CKD and related to both traditional and renal RFs.

Aim: To evaluate frequency and risk factors of development of left ventricular hypertrophy (LVH) of the heart in patients with chronic kidney disease (CKD) of stage II-IV., Material and Methods: The trial enrolled 83 patients (42 - 51% males, 41 - 49% females, mean age 46.7 years) with stage II-IV CKD of non-diabetic origin. Glomerular filtration rate (GFR) estimated according to Cockroft-Goult formula was 37,7 ml/min (95% confidence interval from 33,9 do 41,4). Chronic renal failure duration averaged 2,7 years (95 % CI from 2.0 to 3.3). Arterial hypertension (AH) was diagnosed in 96% patients, hereditary predisposition to cardiovascular diseases - in 54%, obesity - in 60%. lipid disbolism - in 66%, anemia - in 34 % and hyperphosphatemia - in 45%; 40% patients smoked. Echocardiography was performed in all the patients., Results: LVH was detected in 31 (37.3%) of 83 patients. With progression of renal failure, frequency of registration of LVH increased LVH onset was associated with conventional (age, AH, high level of total cholesterol) and renal (lowering of GFR, anemia, hyperphosphatemia) factors. Concentric remodeling, concentric LVH, eccentric LVH were detected in 31.3, 19.3 and 18.1% patients, respectively. Eccentric LVH developed more frequently under the influence of factors associated with renal failure (GFR, anemia, hyperphosphatemia, hypocalcemia). Concentric LVH was characterized with the highest systolic blood pressure., Conclusion: Patients with renal dysfunction develop LVH of different geometric model associated with both conventional and renal risk factors even at early stages of CKD.

Aim: To study association of gene TP53 polymorphic marker Pro72Arg coding synthesis of p53 protein with onset, course and progress of chronic glomerulonephritis (CGN)., Material and Methods: We examined 126 patients (63 males and 63 females, mean age 38.8 +/- 13.2 years) with CGN duration 13.0 +/- 9.1 years. When analyzing genetic predisposition to CGN, we compared incidence rate of alleles/genotypes of polymorphic marker Pro72Arg of gene TP53 in CGN patients and 69 controls free of renal disease. CGN clinical features were assessed retrospectively including analysis of nephritis onset, clinical and morphological variants. The course of CGN was analysed by changes in severity of hypertension, persistence of proteinuria > 3 g/day during 6 months and longer, conduction of immunosuppressive therapy and response to it. In analysis of progression rate, doubling of blood creatinine was considered as an end point. We used polymerase chain reaction with analysis of restriction fragment length for identification of alleles of Pro 72Arg polymorphic marker of TP53 gene., Results: Distribution of the genotypes of the above polymorphic marker in CGN patients and in controls did not significantly differ. Depending on Pro allele carriage, CGN patients were divided into two groups: Arg/Arg group (59 carriers of genotype Arg/Arg) and Pro group (63 patients with genotype Arg/Pro and 4 with genotype Pro/Pro). Carriage of Pro allele of gene TP53 was associated with high CGN activity at onset, presence of arteriolosclerosis and IgA deposits in kidney biopsy. Patients with genotype Arg/Arg more frequently developed nephritic syndrome without renal dysfunction syndrome., Conclusion: We have discovered association of gene TP53 polymorphic marker Pro72Arg with clinical manifestations of CGN. Carriers of Pro allele more often have signs of active glomerular inflammation and vascular impairment with renal dysfunction while carriers of Arg/Arg genotype more frequently demonstrate isolated nephritic syndrome.

Aim: To study correlations between accumulation of angiogenesis molecular factors (hypoxia-inducible factor-1alpha - HIF-1alpha, vascular endothelial growth factor - VEGF, thrombospondin - TSP-1) in kidney biopsy tissue from chronic glomerulonephritis (CGN) patients and severity of nephrosclerosis, obliteration of renal capillary bed, filtration dysfunction and anemia., Material and Methods: We examined 22 patients with marked proteinuria (2.77; 5.7, mean 4.2 g/ day). Half of the patients had nephrotic syndrome. Glomerular filtration rate (GFR) by Cochroft-Golt formula was 68 (53;84) ml/min/1.73 m2. According to renal biopsy findings, CGN was detected in 19 patients, 2 patients had lupus nephritis (LN), 1 patient had renal amyloidosis. Nineteen CGN patients were divided into two groups by nephrosclerosis severity: group 1-7 patients with moderate nephrosclerosis, group 2-12 patients with severe nephrosclerosis. Cryostate sections of renal biopsy tissue samples were studied immunohistochemically using monoclonal antibodies to HIF-1alpha, VEGF, TSP-1, CD34. The reaction intensity was assessed by 6-point scale semiquantitative method., Results: Response to HIF-1alpha was stronger in the tubular epithelium than in glomeruli. No correlation was observed between accumulation of HIF-1alpha in the glomeruli and tubular epithelium. Intensity of glomerular staining correlated with severity of proteinuria (Rs = 0.63, p < 0.05), intensity of HIF-1alpha accumulation in tubular epithelium correlated with duration of the kidney disease (Rs = 0.74, p < 0.001), duration of persistent arterial hypertension (Rs = 0.68, p < 0.05) and severity of nephrosclerosis. VEGF and TSP-1 were found in equal quantity both in the glomeruli and renal interstitium. CGN patients with marked nephrosclerosis had lower accumulation of VEGF and higher TSP-1 in the interstitium. No correlation was found between intensity of tubular epithelium response to HIF-1alpha and accumulation of VEGF in the interstitium. Patients with severe nephrosclerosis demonstrated weaker staining of tubulointerstitium to CD34, reflecting the degree of its vascularisation. Significant correlation between CD34 and expression of HIF-1alpha, VEGF, TSP-1 was not registered. In patients with low intensity of tubular epithelial staining to HIF-1alpha (less than 2 points) anemia was detected in 63% versus 18% in patients with more intensive accumulation., Conclusion: CGN progression is associated with development of renal tubulointerstitial ischemia. High tubular production of HIF-1alpha was not accompanied with activation of VEGF accumulation in renal interstitium but was associated with reduced risk of anemia in CGN patients with manifest nephrosclerosis.

Aim: To study correlation between development of left ventricular hypertrophy (LVH) and remodeling of major arteries at a predialysis stage of chronic renal failure (CRF)., Material and Methods: A total of 95 non-diabetic patients (48 males-51% and 47 females-49%) with stage I-III CRF entered the trial. A mean age of the patients was 46.7 years (95% CI 43.7-49.8 years). Glomerular filtration rate calculated by Cockrott-Gault formula was 37.7 ml/min (33.9-41.4 ml/min), blood creatinine level--2.9 mg/dl (2.6-3.2 mg/dl). Arterial hypertension (AH) was registered in 96% patients, smoking--in 40%, cardiovascular hereditary burden--in 54%, hyperlipidemia--in 66%, overweight--in 60%, anemia--in 34%, hyperphosphatemia--in 45%. Echocardiography, ultrasonic dopplerography of the common carotid arteries (CCA) and common femoral artery (CFA) were performed in 83 and 37 patients, respectively., Results: LVH (LV myocardium mass index > 134 g/m2 for males and > 110 g/m2 for females) was detected in 37.3% patients. Concentric remodeling was recorded in 31.3%, concentric myocardial hypertrophy--in 19.1% patients, excentric hypertrophy--in 18.1%. Development of LVH was linked with age, high systolic and pulse blood pressure, marked renal dysfunction, anemia, elevated ESR and hyperphosphatemia. The presence of L VH correlated with increased thickness of intima-media complex (IMC) of CCA and CFA (r = 0.65, p < 0.01 and r = 0.51, p < 0.05, respectively). There was correlation between thickness of LV posterior wall and impairment of CCA elasticity (r = -0.42, p < 0.05)., Conclusion: Patients with initial and moderate disorders of renal function frequently have LVH related to conventional and "renal" risk factors. A LV mass increase and structural-functional changes of major vessels strongly correlate.

The study included 105 patients (63 men and 42 women) aged 34-84 (mean 63.8 +/- 5.1) years with ischemic renal disease (IRD). All of them underwent routine medical examination, blood homocysteine was measured in 30 patients. IRD was always associated with other manifestations of disseminated atherosclerosis and cardiovascular risk factors. Plasma homocysteine increased with decreasing glomerular filtration rate (GFR) that was especially low in patients with isolated systolic arterial hypertension, smoking, and type 2 diabetes. In 34.3% of the patients, IRD associated with other chronic conditions and in 49% with cardiovascular complications and/or the development of terminal renal insufficiency. It is concluded that IRD is characterized by a large number of concomitant manifestations of disseminated atherosclerosis and a high probability of irreversible deterioration of renal functions related to cardiovascular risk factors. IRD may be associated with other chronic renal diseases and a high risk of cardiovascular complications and terminal renal insufficiency.

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.

The author presents a case of left-sided ischemic renal disease in a patient with diabetes mellitus, who underwent nephrectomy.

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.

The case presented for clinical discussion is a patient suffering from ischemic renal disease underlied by renal arterial artherosclerotic stenosis. The article demonstrates a leading role of diagnostic imaging and radiosurgical therapy (balloon dilatation and stenting), and a low effectiveness of conservative treatment.

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.

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.

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.

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.

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.

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.

Aim: To assess the effect of valsartan, angiotensin-II receptor blocker type 1, on key factors of progression of chronic renal failure (CRF)--arterial hypertension (AH), proteinuria (PU), sodium excretion (SE)--in patients with chronic glomerulonephritis (CGN) and initial affection of renal function., Material and Methods: 11 patients (mean age 33.7 +/- 13.3 years, mean duration of nephritis 8.6 +/- 6.4 years, male to female ratio 8:3) with AH (AP > 140/90 mm Hg) and marked PU (> 1 g/day) who had not received immunosuppressive drugs for at least 6 months before the trial were given valsartan. It was administered after the period of "washing out" at the initial dose 80 mg/day with further addition of diuretics or raising the dose twice (in hyperuricemia) to decrease AP under 140/90 mm Hg. The duration of the treatment was 3 months., Results: After 3 months of valsartan therapy systolic arterial pressure fell from 162 +/- 18 to 138 +/- 20 mm Hg (p < 0.05), diastolic pressure from 100 +/- 8 to 92 +/- 15 mm Hg (single measurements). 24-h monitoring of AP showed a significant lowering of mean 24-h and night systolic and diastolic AP, day-time diastolic AP, 24-h time index of systolic and diastolic AP. Initial antiproteinuric effect was observed after 1 month of the treatment and after 3 months of therapy PU reduced significantly (from 5.7 +/- 6.0 g/day to 3.3 +/- 3.3 g/day). After 3 months sodium excretion significantly rose, while creatinine level and glomerular filtration rate did not. Potassium rose in one patient., Conclusion: In CGN with initial CRF valsartan in a dose 80-160 mg/day produces a pronounced antihypertensive and antiproteinuric actions, stimulates sodium excretion. No serious side effects were noted. It is necessary to continue studies on the ability of valsartan to inhibit progression of CRF.

Aim: To evaluate effects of corticosteroids, cytostatics, ACE inhibitors, Ang-II receptor blockers, HMG-CoA-reductase inhibitors on the levels of blood cholesterol in patients with progressive glomerulonephritis (PGN)., Material and Methods: The influence of medications which are used for treatment of chronic glomerulonephritis on the serum levels of total cholesterol (TCh) was investigated in 53 patients with chronic glomerulonephritis and persistent nephrotic syndrome (NS). All the patients with NS or nephrotic range proteinuria were divided into five groups depending on the type of therapy: corticosteroids, cytotoxic agents, ACE inhibitors, Ang-II receptor blocker, HMG-CoA-reductase inhibitors., Results: No negative change of serum TCh was revealed after the courses of treatment with corticosteroids and cytotoxic agents. Moreover, treatment with ACE inhibitors and Ang-II receptor blockers was accompanied with a significant reduction of the TCh level., Conclusion: ACE inhibitors and Ang-II receptor blockers affect some mechanisms of glomerulonephritis progression including hypercholesterolemia.

Aim: To study the role of abnormal intrarenal hemodynamics (IRHD) in progression of lupus nephritis (LN) and its response to therapy with inhibitors of angiotensin-converting enzyme (ACE)., Materials and Methods: The trial included 30 LN patients (27 females, 3 males; age 29.8+(-)10.4 years). 19 had aggravation of active LN. All the patients were free of chronic renal insufficiency. IRHD was studied with estimation of renal functional reserve (RFR) using protein loading, evaluation of clinical activity of LN and renal function, blood pressure. The tests were repeated after 6 months of treatment with ACE inhibitors (captopril and ramiprilol) in 13 patients (11 of them had exacerbation of active LN)., Results: Disturbed IRHD was found in 37% of the patients. Blood hypertension deteriorated this condition. Treatment with ACE inhibitors in 6 months brought about a significant decrease in blood pressure and improvement of IRHD. Before treatment RFR was absent in 46% of patients, after treatment in 1 patient., Conclusion: Defects in IRHD occur in LN frequently. These are related with the presence of blood hypertension and activity of LN. Inhibitors of ACE seem perspective in management of essential hypertension in LN patients but this hypothesis needs confirmation by the results of further studies.

Incidence of arterial hypertension (AH), its relation with activity of lupus nephritis (LN), other factors (antiphospholipid syndrome, old age, disturbances of purin and lipid metabolism), prognostic implication of AH were studied in a trial performed from 1957 to 1996. A total of 398 patients with LN were divided into 3 groups according to immunosuppressive therapy practiced in different time periods. Overall AH incidence and that of severe AH were similar at present and in the past. AH occurred frequently in patients with rapidly progressing LN and active LN with nephrotic syndrome. In remission of nephrotic syndrome AH incidence was on the decrease. This suggests that hypertension may be a criterion of LN activity. AH was also associated with the presence of antiphospholipid syndrome and old age. AH was a separate prognostic indicator in respect to overall and renal survival. Hemodynamic mechanisms may contribute to LN progression.

The paper is concerned with lupus nephritis with marked microhematuria. The presence of severe morphological alterations in the kidneys, hematuria gravity correlation with that of SLE, positive effects of active immunosuppressive treatment allow one to consider hematuria as a separate clinical criterion of lupus nephritis activity. A case is reported of a female who had unusual clinical picture of the disease possibly due to high IgA in the blood and the presence of renal vasculitis.

A case of rapidly progressive nephritis is reported in a female patient having systemic lupus erythematosus (SLE) with antiphospholipid syndrome. Clinical presentation of progressive lupus nephritis with intensifying renal insufficiency, arterial hypertension, hematuria, nephrotic syndrome was associated with unusual morphological manifestations of mesangiocapillary glomerulonephritis with advanced vasculitis. The authors attribute a malignant nephritis course atypical for patients with antiphospholipid syndrome to development of renal vasculitis. The discussion covers lupus genesis of vascular involvement, a probable triggering role of antibodies to phospholipids in impairment of endothelial cells.