Biomedical subjects
Publications and source records attributed to B I Shulutko.
The most frequent cause of development of the nephrotic syndrome in the elderly is secondary amyloidosis of the kidneys (71%). Most patients showed an association of the nephrotic syndrome with arterial hypertension (74%) and renal failure (59%). As compared with a control group of patients under 40, the elderly revealed concomitant diseases, greater severity and frequency of vascular and interstitial changes during morphological examination.
Morphological changes of the renal blood vessels were studied in 143 patients with different nephropathies and hypertensive disease. Vessels wall changes proper included: fibroelastosis, hyalinosis as well as antibodies to smooth muscle cells observed exclusively in the development of arterial hypertension. The changes were more pronounced in severe and durable hypertension. Perivascular sclerosis was found almost in all hypertensive patients and in some normotonic patients with aggravated heredity for arterial hypertension. The obtained data allow to frame a hypothesis on the role of formation of perivascular sclerosis as a reflection of repeated vascular spasm, subsequent increase of the peripheral resistance in the pathogenesis of development of arterial hypertension.
The author analyses the cases of the occurrence of arterial hypertension owing to renal pathology, resembling, in accordance with the clinico-morphologic criteria (the data of puncture biopsy of the kidneys), essential hypertension. The hypothesis of the pathogenesis of essential hypertension is advanced, accounting for the possibility of the development of the single-type hypertension syndrome under different conditions. The data presented make it possible to review the diagnostic criteria of essential hypertension and of so-called symptomatic arterial hypertensions.
A hypothesis of the development of drug-induced nephropathy has been reviewed. The authors believe that the body sensitization to different drugs underlies drug-induced nephropathy. The sensitization may develop in the presence of congenital or acquired abnormalities leading to hemodynamic disorders in the kidneys.
Puncture biopsy of the kidneys was carried out in 15 patients with different renal lesions. General clinical, laboratory, light microscopy and electron microscopy of the biopsy specimens were employed. Electron microscopy revealed varying changes in the endotheliocytes of the lymphatic capillaries (increased functional activity, destruction of the lymphatic capillary wall). The diagnostic and prognostic value of the findings is discussed.
Clinicomorphological manifestations of little-known forms of tubulointerstitial nephritis (TIN) are described. TIN development is considered in persons on prolonged antispasmodic therapy for epilepsy, in patients with HBS-antigen against a background of chronic hepatitis or liver cirrhosis, and in persons with chronic glomerulo- or pyelonephritis.
Some features of the nephrotic syndrome (NS) were studied in 38 patients with mesangial proliferative glomerylonephritis (MSPGN). Clinicomorphological correlations were deduced, 10-year survival rates were determined. NS in MSPGN can be observed both in diffuse and focal variants, results in clinicomorphological remissions and is not attended by renal functional disorders in most of the patients. The best therapeutic results were achieved with glucocorticosteroids. The 10-year survival rate was 88%. It is assumed that NS main morphological substrate in MSPGN is, first of all, podocytic small outgrowths destruction.
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A study of the clinical picture of renal amyloidosis in 110 patients has shown a possibility of the existence of different variants of its course making it similar to the other nephropathies. Its diagnostic difficulty is determined by relative significance of "aggravated" anamnesis (in 22% of the patients it was absent at all, and its presence did not exclude the development of other renal diseases). Correct diagnosis can be established using kidney biopsy only as amyloidosis in the rectal mucosa and hepatic tissue is detected much less frequently.
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A clinicomorphological study was conducted over time in 62 patients with different morphological types of glomerulonephritis. An increase in vascular, interstitial and sclerotic changes was noted morphologically in most patients, the worst dynamics was observed in membranoproliferative glomerulonephritis. Disease progression was associated with 2 processes; sclerosis of all elements of the renal tissue or active inflammation.
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Based on the clinico-laboratory and intravital morphological examination of 104 patients and the reported data the authors recognize 6 versions of chronic tubulo-interstitial nephritis (TIN): idiopathic, drug-induced, dysplastic, dysmetabolic, secondary TIN associated with primary glomerulopathies and vasorenal hypertension, secondary TIN in the presence of a long-term ischemia. Discuss the features of each form, diagnostic criteria, a possible importance of TIN for the development of arterial hypertension. Emphasize the importance of recognizing TIN in patients with primary glomerulopathies to early specify the causes of the deterioration of the disease course. Discuss the problems of therapy.
Based on an analysis of the clinicolaboratory findings and morphological examination of 93 patients with renal amyloidosis the proteinuric stage was diagnosed in 24, the nephrotic in 35, and the azotemic in 34 patients. Elevation of the arterial blood pressure was revealed in 40% of the patients. During the first year since proteinuria was diagnosed, the nephrotic syndrome developed in 50% of the patients; renal failure in 75% of cases developed over 9 years. The 5-year survival since proteinuria was diagnosed amounted to 72%, the 10-year survival to 34%. The 5-year survival among patients with the nephrotic syndrome constituted 49%, whereas the 10-year survival was attained only in single cases. One year after blood creatinine became elevated only 30% of the patients were still alive. As the disease progressed, there was a gradual increase in amyloid impregnation of the glomeruli alone, while amyloidosis of the tubules was most pronounced in the nephrotic stage. No complete correlation was found between the gravity of the morphological picture of glomerular involvement and blood creatinine level which is undoubtedly influenced by alterations in the exoglomerular structures.