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Background: Present concepts of the novel coronavirus infection prognosis in haemodialysis (HD) patients are rather controversial. There is little information on therapy efficiency and safety in such patients. We studied COVID-19 course specifics, prognostic factors associated with fatal outcomes, therapy efficiency and its transformation at different stages of the pandemic first year., Materials and Methods: Single-centre retrospective uncontrolled study included 653 COVID-19 HD-patients treated at Moscow City Nephrology Centre from April 1 to December 31, 2020., Results: This period mortality rate was 21.0%. Independent predictors of COVID-19 unfavourable outcome in HD patients were pulmonary lesion extension (CT grades 34), high comorbidity index, and mechanical ventilation. Approaches to COVID-19 treatment modified significantly at different periods. Immunomodulatory drugs (monoclonal antibodies to IL-6, corticosteroids) were used largely at later stages. With tocilizumab administration, mortality was 15.1%, tocilizumab together with dexamethasone 13.3%; without them 37.8% (р0,001). Tocilizumab administration in the first 3 days after hospitalization of patients with CT grades 12 was associated with more favourable outcomes: 1 out of 29 died vs 6 out of 20 (tocilizumab administered at later periods); p0.04. There was no significant difference in death frequency in patients with CT grades 34 depending on tocilizumab administration time., Conclusion: COVID-19 in HD patients can manifest in a severe course with unfavourable outcome. It is urgent to identify reliable disease outcome predictors and develop efficient treatment in this population.

Rationale & Objective: Missed hemodialysis (HD) treatments not due to hospitalization have been associated with poor clinical outcomes and related in part to treatment nonadherence. Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012-2015), we report findings from an international investigation of missed treatments among patients prescribed thrice-weekly HD., Study Design: Prospective observational study., Setting & Participants: 8,501 patients participating in DOPPS, on HD therapy for more than 120 days, from 20 countries. Longitudinal and cross-sectional analyses were performed based on the 4,493 patients from countries in which 4-month missed treatment risk was > 5%., Predictors: The main predictor of patient outcomes was 1 or more missed treatments in the 4 months before DOPPS phase 5 enrollment; predictors of missed treatments included country, patient characteristics, and clinical factors., Outcomes: Mortality, hospitalization, laboratory measures, patient-reported outcomes, and 4-month missed treatment risk., Analytical Approach: Outcomes were assessed using Cox proportional hazards, logistic, and linear regression, adjusting for case-mix and country., Results: The 4-month missed treatment risk varied more than 50-fold across all 20 DOPPS countries, ranging from < 1% in Italy and Japan to 24% in the United States. Missed treatments were more likely with younger age, less time on dialysis therapy, shorter HD treatment time, lower Kt/V, longer travel time to HD centers, and more symptoms of depression. Missed treatments were positively associated with all-cause mortality (HR, 1.68; 95% CI, 1.37-2.05), cardiovascular mortality, sudden death/cardiac arrest, hospitalization, serum phosphorus level > 5.5mg/dL, parathyroid hormone level > 300pg/mL, hemoglobin level < 10g/dL, higher kidney disease burden, and worse general and mental health., Limitations: Possible residual confounding; temporal ambiguity in the cross-sectional analyses., Conclusions: In the countries with a 4-month missed treatment risk > 5%, HD patients were more likely to die, be hospitalized, and have poorer patient-reported outcomes and laboratory measures when 1 or more missed treatments occurred in a 4-month period. The large variation in missed treatments across 20 nations suggests that their occurrence is potentially modifiable, especially in the United States and other countries in which missed treatment risk is high., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate the impact of smoking on kidney transplantation outcomes., Subjects and Methods: The materials of 350 patients (including 229 (65.4%) men aged 37.1±0.6 years) who had undergone kidney allotransplantation (KAT) for end-stage renal disease were analyzed. The main outcomes of KAT (patient status (alive or dead); renal allograft (RAG) function or dysfunction; development of chronic transplant nephropathy (CTN)), were studied., Results: There were 52 (14.8%) smoking patients (50 (96.2%) men and 2 (3.8%) women). The survival rate of smokers after KAT was significantly lower (p=0.043), as was the duration of graft function in the smoking patients (p=0.038). There were statistically significant associations of smoking with age, sex, time to normalize post-KAT serum creatinine concentrations, the development of CTN and graft rejection crises, postoperative hypertension, post-KAT serum creatinine, hemoglobin, and albumin levels, pretransplantation alanine aminotransferase concentrations, pre-KAT left ventricular hypertrophy, patient compliance with the prescribed treatment regimen, the presence or absence of a job in the patient after KAT (p<0.05). The investigators built models for predicting the outcome of KAT for a patient's life and the development of CTN from preoperative patient risk factors, as well as a model of a RAG outcome from the factors of the pre-transplantation period and those seen one year after KAT. The impact of smoking on outcomes of KAT was revealed in all models along with other predictors., Conclusion: Smoking is an important predictor of kidney transplantation outcome for both patients' lives and RAG function.

Background: This study provides a summary of the 2010 European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report (available at www.era-edta-reg.org)., Methods: This report includes data on renal replacement therapy (RRT) using data from the national and regional renal registries in 29 countries in Europe and bordering the Mediterranean Sea. Individual patient data were received from 27 registries, whereas 18 registries contributed data in aggregated form. We present incidence and prevalence of RRT, transplant rates, survival probabilities and expected remaining lifetimes. The latter two are solely based on individual patient records., Results: In 2010, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA-EDTA Registry was 123 per million population (pmp) ( n = 91 798). The highest incidence rate was reported by Turkey (252pmp) and the lowest reported by Montenegro (21 pmp). The overall prevalence of RRT for ESRD at 31 December 2010 among all registries reporting to the ERA-EDTA Registry was 741 pmp ( n = 551 005). The prevalence varied from 124 pmp in Ukraine to 1580 pmp in Portugal. The overall number of renal transplantations performed in 2010 among all registries was 29.2 pmp ( n = 21 740). The highest overall transplant rate was reported from Spain, Cantabria (73 pmp), whereas the highest transplant rate for living donor kidneys was reported from the Netherlands (28 pmp). For patients who started RRT between 2001 and 2005, the unadjusted 5-year patient survival on RRT was 46.2% [95% confidence interval (CI) 46.0-46.3], and on dialysis 38.6% (95% CI 38.5-38.8). The unadjusted 5-year patient survival after the first renal transplantation performed between 2001 and 2005 was 86.6% (95% CI 86.1-87.1) for deceased donor kidneys and 94.1% (95% CI 93.4-94.8) for living donor kidneys.

Aim: To evaluate the clinical and morphological variants of kidney abnormalities in HIV-infected patients., Subjects and Methods: Thirty HIV-infected patients (60% men and 40% women) aged 26 to 54 years (mean age 31.6 +/- 4.7 years) who had undergone diagnostic needle renal biopsy were examined. The indication for the biopsy was nephrotic syndrome (NS) (isolated or concurrent acute nephritic syndrome) and/or decreased renal function. The morphological study of biopsy specimens included light microscopy and immunofluorescence assay., Results: In the examined HIV-infected patients, the histological variants of kidney abnormalities presented with immune complex glomerulonephritis (ICGN) in 26 cases and with focal segmental glomerulosclerosis (FSGS) in 4 cases. The clinical manifestations of ICGN were as follows: NS (61.5%), acute nephritic syndrome (in more than one third of the patients) concurrent with hematuria, as well as mainly grades 2-3 arterial hypertension (AH) (12/14) and renal dysfunction. Immune complex glomerulopathies were marked by polymorphism in the renal morphological pattern with fluorescence during immunofluorescence microscopy in most cases of virtually all classes of immunoglobulins (IgA, IgM, IgG) and complement system fragments (C3, C1q). FSGS was clinically characterized by NS concurrent with AH, hematuria. The morphological subtypes of FSGS were exhibited by apical, perihilar, and nonspecific variants in 1, 1, and 2 cases, respectively. By the time the signs of renal dysfunction appeared, the HIV-infected patients with glomerulopathy were found to have a high viral load (HIV RNA >100 000 copies/ml) and low CD4 lymphocyte levels (< or = 200 in 1 microl)., Conclusion: In our study, the morphological pattern of chronic glomerulonephritis showed a preponderance of immune complex nephropathies with the clinical manifestations of acute nephritic syndrome and/or NS concurrent with hematuria. High viremia and depressed immune system may be risk factors for nephropathy.

Renal damage in HIV infection may result from direct action of HIV and from other causes including nephrotoxic action of medicines. HIV-infected patients receive a wide spectrum of medicines and can be placed in a risk group of drug-induced damage to the kidneys. Risk of nephrotoxicity should be considered in administration of antiretrovirus drugs in HIV patients. Strategy of preventive measures in relation to pharmacological harm to the kidneys consists in early detection of patients with high risk and correction of modifiable risk factors.

Aim: To study structural-functional changes in left ventricular (LV) myocardium in recipients of renal allograft (RA) after different postoperative period and to specify factors promoting persistence, progression or regression of LV hypertrophy (LVH)., Material and Methods: The study included 240 recipients of primary RA (38% females and 62% males, age 16-69 years, mean age 42 +/- 11 years). A prospective study covered 143 patients., Results: LVH was diagnosed in 52% patients. LVH incidence after renal transplantation (RT) had a wave-like dynamics: during 9 months after RT LVH presents in more than 50% patients; after 9-24 months after the operation it fell to 30% and after 3-7 years after the operation it affected at least 2/3 patients. After RT LVH risk factors were age, duration of chronic renal failure (CRF) and pretransplantation dialysis, reduced mass of the operating nephrons, arterial hypertension, anemia, functioning of arterio-venous fistula (AVF) and chronic inflammation syndrome. LVH was also associated with factors specific for RT: RA rejection crises, infections complicating massive immunosuppressive therapy. LVH is also associated with proteinuria which may indicate RA damage and can be considered as a marker of generalized endothelial dysfunction. 2-year and longer follow-up after RT confirmed complete LVH regression in 1/3 of the recipients. LVH regression was observed in normal RA function, normal blood pressure, the absence of proteinuria, hypoalbuminemia, anemia, AVF, infectious complications., Conclusion: LVH after RT is multifactorial and can completely regress in a favourable posttransplantation course.

The purpose of this study was to retrospectively analyze the efficiency of replacement renal therapy (RRT) in multimodality treatment for severe acute pancreatitis (SAP) concurrent with a systemic inflammatory response and multiple organ failure/dysfunction. The authors analyzed the results of treating 55 patients (14 women and 41 men) aged 22 to 72 years (mean 43.5 +/- 16.4 years) treated at the intensive care units of Moscow City Clinical Hospital Fifty-Two in January 1, 2000, to December 31, 2006. All the patients had multiple organ dysfunctions with the involvement of 2 to 5 organs (median 4 (3; 4) and were on RRT. RRT may be successfully used in multimodality treatment for SAP provided that the dose of dialysis is at least 35 ml/kg/hour. The severe condition rated by the APACHE HII and SAPS II scales and the dialysis dose of less than 35 ml/kg/hour are independent risk factors of death in SAP patients.

Aim: To study efficacy of ANCA-RPGN treatment with corticosteroids and cyclophosphamide or mycophenolic acid drugs., Material and Methods: We treated 28 patients (17 males and 11 females aged 19-71 years) with morphologically verified ANCA-associated crescentic RPGN (crescentic median 79 (63:88)%. The patients received corticosteroids and cytostatics., Results: The response to the treatment was registered in 22 (78%) patients in 8-16 weeks: a complete remission was achieved in 8 patients, a partial one--in 14 patients. In partial remission renal functions recovered incompletely (median Pcr 200 (180;255) mcmol/l) in persistence of moderate proteinuria (median 0.7 (0.6;1.3)g/day) and absence of microhematuria. Probability of the treatment success depended on severity of glomerulosclerosis and weakly depended on activity of extracapillary reaction. Severe renal failure was not an absolute predictor of treatment failure., Conclusion: In the absence of advanced nephrosclerosis early treatment with corticosteroid in combination with cytostatics can produce a positive effect in 70-80% patients with ANCA associated RPGN.

Aim: To assess long-term results of renal transplantation in patients with diabetes mellitus of type 1 (DM-1) with terminal chronic renal failure (tCRF); to detect risk factors of low survival of the patients and development of dysfunction of renal transplant., Material and Methods: A retrospective comparative analysis of 418 recipients of the kidney with non-diabetic nephropathies (NDN) and 113 recipients with DM-1., Results: Survival of DM-1 patients with tCRF after allotransplantation of the kidney was lower than in patients with NDN. Low survival risk factors for DM-1 patients after transplantation of the kidney are: DM-1 duration up to tCRF 25 years and more, minimum 3-year history of dialysis before transplantation, age at transplantation over 45 years, persistence of anemia (hemoglobin < 110 g/l) after operation. Survival of the transplanted kidney in DM-1 and NDN patients was the same. Risk factors of dysfunction of the transplanted kidney are the following: acute crises of rejection and delayed function of the transplant, arterial hypertension > 130/80 mmHg, proteinuria > 300 mg/day. Survival of the transplanted kidney is higher in transplantation from the relative donor, does not depend on the kind and duration of previous dialysis. Causes of a decline in the function of the transplanted kidney (by the data of puncture biopsy of 34 transplants) are the following: acute rejection crises (38%), chronic transplantation nephropathy (24%), toxic nephropathy (18%), recurrent diabetic nephropathy (6%), chronic pyelonephritis (6%). Lethality in DM-1 patients after renal transplantation is 2 times higher than in patients with NDN. Death was due to cardiovascular diseases, gangrene of the lower limbs, infectious complications (in 31%, 15% and 35% cases, respectively)., Conclusion: Transplantation of the kidney is an optimal treatment in DM-1 patients with tCRF.

Aim: To specify the trend in the incidence of left ventricular hypertrophy (LVH) at a predialysis stage of chronic kidney disease (CKD) in the course of its progression from stage III to stage V and after transplantation of the kidney (TK); to study correlations between homeostatic disorders caused by CKD progression and myocardial remodeling; to define the role of some hemodynamic and nonhemodynamic factors in formation of LVH., Material and Methods: The study enrolled 128 patients (58 males and 70 females, age 18-55 years, mean age 42 +/- 11 years) at a predialysis stage of CKD (group 1) and 225 recipients of renal allotransplant--RRA (group 2, 140 males and 85 females, age 18-69 years, mean age 43 +/- 12 years). General clinical examination, biochemical and immunological blood tests, echocardiography were made., Results: At a predialysis stage of CKD, LVH was diagnosed in 56% patients. Incidence of LVH was directly related with age of the patients (p = 0.001), blood pressure (p < 0.001), duration of arterial hypertension (p = 0.004), severity of anemia (p = 0.017), the level of C-reactive protein (p = 0.003), blood phosphorus concentration and inversely correlated with glomerular filtration rate--GFR (p = < 0.001), albumin level (p = 0.023) and blood Ca (p < 0.001). LVH was followed up for 12 months in 35 patients with predialysis CKD. Factors of LVH progression and factors hindering its regression were systolic blood pressure, Hb and Ca in the blood. In group 2 of RRA incidence of LVH was 53%. Significant factors of LVH risk after transplantation were age (p = 0.002), hypertension (p = 0.005) and anemia (p = 0.04). Moreover, LVH closely correlated with proteinuria (p < 0.03), transplant dysfunction (p = 0.002) and posttransplantation ischemic heart disease (p < 0.037). Changes in LVH were analysed in 30 RRA. Frequency of LVH decreased for 2 years after transplantation (from 56 to 32%) but 36-60 and more months after transplantation it increased (46 and 64%, respectively). Transplant dysfunction was the leading factor hindering LVH regression after transplantation., Conclusion: The same mechanisms are involved in LVH pathogenesis after transplantation and at a predialysis stage of CKD. The significance of initial renal lesion signs--minimal proteinuria and hypercreatininemia--was higher after renal transplantation than in patients with CKD.

Coronary artery disease (CAD) is the main cause of death in renal transplant recipients. The aim of the present study was to determine the frequency and risk factors of post-transplantation CAD and its influence on the long-term results of surgery, as well as to evaluate the efficiency of myocardial revascularization in patients with severe CAD. Analysis of the observation of 479 renal recipients (332 men and 147 women) aged 38.69 +/- 11.2 was performed. The mean follow-up period was 64.56 +/- 37.44 months. Sixty-eight patients had diabetes mellitus. CAD was diagnosed in 14.8% (71 out of 479) renal recipients; in 12.7% of patients it developed de novo and was revealed 32.4 +/- 18.6 months after the surgery. Ten-year survival of renal recipients with CAD was only 39%, while in the group of non-CAD patients it was 75% (p < 0.0001). Age more than 45, male gender, diabetes mellitus, hypercholesterolemia, infections, pre-existing left ventricular myocardial hypertrophy, and renal transplant dysfunction were defined as significant risk factors of CAD de novo. Multi-factor Cox model found only age more than 45 (p < 0.009), male gender (p < 0.00001), and hyperlipidemia (p < 0.0058) to be independent risk factors of CAD. Myocardial revascularization was performed in 29 patients with coronary lesions: 27 patients underwent percutaneous transluminal coronary angioplasty with stenting and 2 patients underwent coronary artery bypass grafting (5 and 52 months after renal transplantation). However, angioplasty had to be repeated in 6 out of 27 (22%) patients within 3 to 6 months. The average follow-up duration was 23 months (2 to 74 months) after revascularization. Prolonged effect (more than 12 months) was achieved in 17 out of 29 (58.6%) patients. None of the patients developed myocardial infarction after revascularization. Two patients died 28 and 35 months after angioplasty due to extracardial complications (hepatic cirrhosis and an oncological disease); one patient died 78 months after repeated revascularization from progressive cardiac insufficiency while receiving dialysis due to a relapse of renal transplant insufficiency. Thus, CAD develops in 14.8% of renal transplant recipients; in 12.7 of patients it develops de novo. There are conventional and nonconventional post-transplantation CAD risk factors, which include renal transplant dysfunction and post-transplantation infections. Association with myocardial hypertrophy, observed in a significant number of patients, is a feature of post-transplantation CAD. Coronary revascularization, angioplasty with stenting in particular, may be considered to be an effective method of CAD treatment in renal transplant recipients.

The study found bone exchange disorder manifested by accelerated bone resorption, retarded bone formation, and the loss of the bone mineral density (BMD) of the axial and peripheral skeleton in 19 men (39 observations) 66 +/- 44 months following orthotopic heart transplantation (OTHT) and in 92 men 45 +/- 28 months after cadaveric kidney transplantation. An accelerated bone resorption, more pronounced in cadaveric kidney (CK) recipients, is associated with hyperparathyroidism (HPT) and renal dysfunction, while bone formation retardation is associated with a decrease in insulin-like growth factor-1 level. An increase in osteoprotegerin level is of compensatory character. The prominence of HPT depends on the degree of renal dysfunction; in CK recipients it also depends on the degree of the reduction in the levels of biologically active testosterone and estradiol. Reduction in BMD of the peripheral skeleton after OTHT are associated with the degree of renal dysfunction and a decrease in free testosterone index; after CK transplantation it is associated with HPT, the cumulative dose of glucocorticoids, reduction in the levels of biologically active testosterone and estradiol, as well as sex-hormone binding globulin (SHBG); reduction in spine BMD is only associated with SHBG.

The study was undertaken to study the frequency, causes, and efficiency of treatment for acute renal failure (ARF) at the intensive nephrological care unit. The data on 117 patients with ARF of various etiology were studied. In them, ARF was caused by acute interstitial nephritis in 18.8%, by urosepsis in 18.8%, by non-urological sepsis in 19%, by destructive pancreatitis in 18%, in 13% rapidly progressive glomerulonephritis was present in systemic vasculitis. In 8.5% of the patients, ARF developed as a complication of severe pneumonias along with respiratory failure. Only single cases were presented with ARF of other intoxication etiology, crush syndrome, or acute vascular diseases. Renal replacement therapy was used in all cases. Its mode (intermittent or low-flow continuous) was determined by the severity of renal failure and the general condition of patients. The overall mortality was 38% in the whole group. It was 55% in sepsis, 33% in destructive pancreatis, 8.3% in urosepsis, 8% in acute interstitial nephritis, 64.7% in rapidly progressive glomerulonephritis. According to the type of therapy, there were no significant differences in mortality rates. There was also a correlation of the mortality rates and the APACHE score.

Aim: To study safety and efficacy of ACE inhibitor enalapril in chronic transplantation nephropathy (CTN) as well as nephroprotective efficacy of this drug in various clinical variants of CTN., Material and Methods: A retrospective study covered 220 recipients with CRF. The patients were divided into the study group (n = 103) and the control group (n = 117). The study group was given ACE inhibitor enalapril the efficacy of which was assessed by arterial pressure (systolic, diastolic, mean) dynamics, 24 h proteinuria and the rate of CTN progression. This rate was suggested by probability of plasm creatinin doubling (Kaplan-Meier technique)., Results: Enalapril significantly inhibited CTN progression running with minimal or marked proteinuria, had a pronounced hypotensive effect, promoted stabilization of minimal proteinuria (in CTN with minimal proteinuria) or reduction of protein excretion (in a proteinuric variant of CTN)., Conclusion: Use of enalapril in CTN in a daily dose 10 mg maximum is safe and can be used for inhibition of CTN progression.

Results are submitted of use of propes during different phases of treatment in 36 patients with malignant lymphomas. The above drug is associated with no complications or side effects, inhibits the development of the tumor process. The employment of propes permits enhancing both natural resistance of the organism and its killer activity. It is an effective aid to cytostatic therapy as a way for prophylaxis of hypoplasia of haemopoiesis which can be successfully used in other malignant tumors.

Half-body irradiation at a single dose of 400-800 cGy was delivered to patients with disseminated fast-growing types of lymphomas and large aggregates of tumors and vital dysfunction of the body (the compression syndrome). Active detoxification therapy including heparinization, hemodilution with enforced diuresis and hemosorption was performed to prevent the syndrome of acute tumor lysis and postradiation complications. This treatment modality resulted in the elimination of clinical manifestations of the compression syndrome, normalization of the body homeostasis, a considerable reduction of the volume of tumor aggregates on a short-term basis, entering the patients into a curable state; the 5-year follow-up results were evaluated.

Ampicillin trihydrate was used for the treatment of 29 patients with purulent inflammatory processes, such as peritonitis, suppurating operative wound, urinary tract infection after the kidney allotransplantation. The antibacterial activity of ampicillin was preliminarily tested on 517 microbial strains, i.e. staphylococci, streptococci, E. coli, Proteus and Ps. aeruginosa isolated from the surgical patients. The strains of penicillin sensitive staphylococci, streptococci and E. coli were most sensitive to the drug effect, the MIC ranging from 0.03 to 16 gamma/ml. It was shown that the blood retention time of the antibiotic was much more prolonged in the patients with a decreased excretion function of the kidneys. The treatment was performed under control of the clinical, bacteriological and biochemical parameters. The drug was used in a dose of 0.5 g 6--8 times a day for 5 to 15 days. A satisfactory therapeutic effect was registered in 73 per cent of the cases.

The main indices of cardiohemodynamics, phase structure of the cardiac cycle and ECG were studied in 34 patients with Hodgkin's disease aged 16 to 43: before the initiation of therapy, after a course of radiotherapy and in long term after therapy. The patients were characterized by tachycardia increasing with a degree of a process, ECG signs of myocardiodystrophy, a tendency to the formation of the phase syndrome of hypodynamia, slight pulmonary hypertension, a decrease in AP and peripheral vascular resistance. After a course of radiotherapy according to a radical program functional indices of the cardiovascular system in most of the patients returned to normal. However signs of radiation pericarditis with a favorable clinical course developed in some patients. Long after therapy positive changes in the cardiovascular system were noted among patients with IIA stage, negative shifts were noted in patients with III-IV stage.

Soluble and membrane-bound forms of neutral alpha-glucosidase, which are immunologically similar to the corresponding forms of kidney enzymes, were found in urine of healthy persons and of patients with kidney impairments. Membrane-bound enzyme was only slightly active in urine of healthy persons and constituted 3-10% of total urine activity although the ratio of membrane-bound enzyme was simultaneously elevated under pathological conditions. The increased rate of soluble enzyme secretion was responsible for distinct activation of neutral alpha-glucosidase in urine of the patients with kidney impairments.

The therapeutic effect of the prednisone therapy, of the short-time (duration of treatment 2-4 months) and of the long-term (duration of treatment 1.5 to 2 years) imuran and prednisone therapy was investigated on 218 patients with chronic, functionally compensated glomerulonephritis. The importance of the urine symptomatology for the control of the therapeutic success and for the prognosis of the disease was elaborated. Corresponding to the clinical picture the experiment of a clinical classification of the chronic glomerulonephritis was performed.

One hundred and twenty-five patients with different morphoclinical variants of chronic glomerulonephritis (CGN) were examined for the efficacy of cytostatic-anticoagulant-antiaggregation (CAA) therapy. The treatment appeared successful in 47 (37%) of patients. The efficacy largely depended on the degree and intensity of the disease clinical manifestations as well as on a dramatic increase in the permeability of the glomerular filter for medium- and high-molecular serum proteins and on superimposition of sclerotic transformation of renal glomeruli. The use of CAA therapy was most successful in GN whatever superimposition of fibroplastic transformation. The treatment was abortive in prolonged (more than 12 months) persistence of pronounced proteinuria combined with hematuria and/or arterial hypertension, in the nephrotic-hypertonic pattern of GN irrespective of the disease stage, in disease patterns manifesting themselves chiefly by hematuria and negligible proteinuria.

Distinct correlation was found between the activity of neutral alpha-glucosidase in urine and the degree of kidney impairment in 76 patients and in 15 healthy persons. In the patients with non-impaired kidney functions the activity of the enzyme in urine varied within the normal limits (from 12 to 39 microM/hr/mmole of creatinine; normal value being 14.6-15.9 microM), in the patients with moderately expressed disfunction of kidney--from 40 to 79 microM/hr/mmole of creatinine. The enzymatic activity, exceeding 80 microM/hr/mmole of creatinine (up to 227 mM), was observed in cases of severe impairment of the kidney functions. High activity of alpha-glucosidase, correlating with the severity of kidney impairment was found in urine of patients with pyelonephritis albeit the content of protein was quite normal. Interrelationship between the activity of alpha-glucosidase in urine and the state of kidney functions enables to conclude that the enzymatic activity depends on the degree of kidney impairment under various pathological conditions and that estimation of the enzyme activity in urine may be important for diagnosis of kidney diseases as well as for the control of treatment efficiency.

In 45 patients with chronic compensated hypertensive glomerulonephritis and in 184 others suffering from different clinical variants of the same disease the state of tubular functions controlling the osmotic and acid-base homeostasis was investigated. The objective was to assess in this connection the scope of renal processes in this connection the scope of renal processes peculiar to the hypertensive from that keep up these function, to reveal (by studying the materials of renal biopsies) the morphological substrate of the dysfunctional under consideration and also to determine its ossible importance in maintaining hypertension. As a criterion for the mass of active nephrons the magnitude of glomerular filtration (from clearance of endogenous creatinine with a minute-long diuresis of 1.5-2.5 ml/min) was used. It was established that, as distinct from the latent forms, in cases of benign hypertensive form of chronic glomerulonephritis, as well as in those of nephritic one, the ammonium excretion is halved and so is also the maximum osmotic concentration. Common to the hypertonic syndrome proved to be a particularly steep, by 70%, fall of CH2O. The disclosed disturbances, except for reduced excretion of "osmotically free" water, may be attributed to the nature of morphological changes inherent in this form of the disease, i.e. in the atrophy of the tubular epithelium and of the tubulo-interstitial component. The major fall of CH2O is largely determined by an increased proximal transport of sodium and inhibition of this process in the distal part of the nephron. A derangement of the studied tubular functions may, though in part, be considered as a factor keeping up the arterial pressure.

As shown in studies of 123 patients with various nephropathies, activities of alpha-glucosidase and N-acetyl-beta-D-hexosaminidase in urine of the patients correlated with severity and stages of these diseases; at the same time, simultaneous estimation of both enzymatic activities in urine was shown to be more informative in diagnostic of kidney impairments. Low values of correlation coefficient (r = 0.35 +/- 0.09) between daily excretion of protein and the activity of neutral alpha-glucosidase in urine showed that the enzyme activity did not depend on proteinuria and was independent test for kidney impairment. Estimation of alpha-glucosidase activity could be used for control of the therapy; the enzymatic activity in urine correlated distinctly with the clinico-laboratory patterns of the patients studied.