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Biomedical subjects

E Kumchev

Publications and source records attributed to E Kumchev.

12 recordsLinked to original sources
PubMed1998

On the disturbances in carbohydrate metabolism in pre-dialysis patients with chronic renal failure.

UNLABELLED: We describe some of the aspects of impaired carbohydrate metabolism in predialysis uremic patients. METHODS: A total of seventy-five nondiabetic patients with chronic renal failure (CRF) were enrolled in the present study. The level of glycosylated hemoglobin was measured in 51 patients using kits from Merck and an oral glucose challenge test was performed in 20 according to a standard protocol. The levels of immunoreactive insulin and growth hormone (GH) were measured in all predialysis patients using original kits and an automatic minigamma counter (Abbott, USA). The results were compared with those from 30 healthy controls. RESULTS: In patients with first degree CRF the level of glycosylated hemoglobin was 5.9 +/- 05%. In patients with second and third degree CRF there was a trend towards higher glycosylated hemoglobin levels--6.3 +/- 0.6% (P > 0.05; u = 1.1) as compared with the controls--5.5 +/- 0.4%. The analysis of the results from the oral glucose challenge test revealed impaired glucose tolerance in 12 predialysis patients with CRF with blood glucose levels of 9.1 +/- 1.6 mmol/l at the second hour following the ingestion of glucose. Nine of those had second or third degree CRF. The baseline levels of plasma immunoreactive insulin showed a tendency towards increase in the patients with uremia as compared with the controls (7.2 +/- 1.1 IU/ml versus 6.4 +/- 0.7 IU/ml) whereas no significant difference was found at the 1st, 2nd or 3rd hour following the ingestion of glucose as compared with the healthy controls. Five of our patients had significantly elevated basal insulin levels. With regard to GH levels, we found similar baseline values in our study patients and the controls. At the 1st hour following the glucose challenge the GH values showed a tendency towards increase in the uremic patients--6.1 +/- 1.1 ng/ml. In 4 of our study patients we found significantly elevated GH levels at the 1st hour following the ingestion of glucose (6.6 +/- 0.7 ng/ml). CONCLUSIONS: 1. No significant disturbances in carbohydrate metabolism were found in patients with mild (initial) CRF. 2. In patients with moderate and advanced CRF we found changes consistent with impaired carbohydrate metabolism and a tendency towards an increase in the basal immunoreactive insulin levels. 3. Growth hormone levels showed a different pattern of change in predialysis patients and those changes cannot be explained by the changes in carbohydrate metabolism.

Carbohydrate Metabolism↗
PubMed1998

Our experience in the combined pathogenetic treatment of chronic glomerulonephritis.

UNLABELLED: The most common combined pathogenetic treatment regimens for the treatment of chronic glomerulonephritis are the object of the present study. It is not quite uncommon in everyday clinical practice for the physician to encounter patients with similar pathohistologic patterns who respond differently to a standard therapeutic schedule. METHODS: Having in mind the complexity of the problem we analyzed our ten-year experience with the combined pathogenetic treatment of 150 patients, aged 17 to 52, with histologically proven chronic glomerulonephritis. The diagnosis was made on the basis of light microscopy, immunofluorescent and, where available, electron microscopy studies of kidney biopsies using clinical and laboratory criteria. In most cases the combined pathogenetic treatment included standard dosage regimens consisting of corticosteroids--Prednisolone in a dose of 1.0-1.5 mg/kg, cytotoxic agents--Cyclophosphamide 1.0-1.5 mg/kg, anticoagulants--heparin (Calciparin) given for one month and antiplatelet drugs--Dipyridamole 300 mg/day. When the preceding regimen was unsuccessful the patients were given pulse therapy with Methylprednisolone 10-15 mg/kg on three successive days or Cyclophosphamide 10 mg/kg in a single dose. Those who failed to respond to the standard pathogenetic and pulse therapy were treated with Cyclosporin (Sandimmun-Sandoz) in a daily dose of 2-5 mg/kg. Complete remission occurred in forty-two patients (63.6%) with mesangial proliferative glomerulonephritis and 18 patients (60%) with membranous glomerulonephritis. The remaining patients were non-responders. RESULTS: The highest percentage of patients with complete remission was observed among those with minimal-change glomerulonephritis--20 patients (95.2%) and the lowest--among those with mesangiocapillary glomerulonephritis--5 patients (27.7%), focal segmental glomerular sclerosis and hyalinosis and sclerosing glomerulonephritis--11.1% and 16.7%, respectively. CONCLUSIONS: The authors think that at present the combined pathogenetic treatment of chronic glomerulonephritis has no alternative and can slow the progression of the renal injury as well as influence favorably the short- and long-term prognosis of the patient with glomerulonephritis.

Adolescent↗
PubMed1997

Cyclic adenosine monophosphate (cAMP) levels in predialysis patients with chronic renal failure.

We studied the changes in the urinary cAMP level in fifty-five predialysis patients (30 men and 25 women) with chronic renal failure (CRF). The excretion of cAMP in 20 patients with first-degree CRF (serum creatinine levels below 356.6 mmol/I) and 15 patients with second or third degree CRF (serum creatinine below 800 mmol/I) was compared with that of 20 age-matched controls using the original I-125 RIA (radioimmunoassay) kit of Incstar Corporation, USA. The urinary cAMP was within normal limits in first-degree CRF patients (mean +/- Sx = 2,617 +/- 268.2 nmol/l) whose serum calcium level was slightly decreased. When calculated per 100 ml of glomerular filtration rate, their urinary cAMP level was significantly elevated--101.17 +/- 0.39--as compared with that of the controls--2.5 +/- 0.2. The urinary cAMP excretion was significantly higher in second and third degree CRF patients--mean 3,755 +/- 435.2 nmol/l, p < 0.05. This increase correlated with hypocalcemia whereas the serum alkaline phosphatase levels remained normal. 20% of the patients with second or third degree CRF had normal urinary cAMP excretion. In our opinion, urinary cAMP levels can reliably be employed as a sensitive and specific indicator of the onset of mild secondary hyperparathyroidism in predialysis patients with CRF.

Adult↗
PubMed1996

Clinical electron microscopic correlations in patients with glomerulonephritis.

The purpose of the present study was to perform an electron microscopic investigation of patients with chronic glomerulonephritis and to find correlations between the type of glomerular disorder and the features of the clinical course of the disease. 26 patients--16 female and 10 male aged 17-62 years (mean age, 34.5 years) were investigated. All patients were clinically diagnosed as having chronic glomerulonephritis with a disease duration ranging from 3 months to 2 years. The main clinical and laboratory parameters studied were presence of edemas, hypertension, proteinuria, hyperlipidemia, haematuria and renal failure confirmed by the creatinine clearance. A puncture renal biopsy was performed by classical methods under ultrasound guidance using a Vim-Silverman needle. An electron microscope Philips CM-12 was used in the study. We found in all patients a significant correlation between the degree of proteinuria and the marked deformation and edema of the podocyte pedicles. In making the integral histological diagnosis of chronic glomerulonephritis it is necessary to determine more precisely the mesangial involvement and the changes in the membrane by means of an electron microscopic study. This will be conducive to a reduction in the number of mistakes in diagnosing some primary chronic glomerulonephrites.

Adolescent↗
PubMed1994

Study of the effect of recombinant erythropoietin on renal anaemia in predialysis patients with chronic renal failure.

Recombinant erythropoietin was given to six renal anaemia patients (2 male and 4 female, aged 38-66 years) with chronic renal failure in the predialysis state. Eprex (Cilag, Switzerland) was used in the treatment. The preparation was administered subcutaneously, thrice weekly for 6 months, at a mean dose of 50 U/kg. The aim of the therapy was to keep haemoglobin in the target range of 100 and 120 milligrams. No allergic reactions or other forms of intolerance to the preparation were noticed. The mean baseline haemoglobin level prior to treatment (75.5 +/- 4.06 milligrams) increased to 96.3 +/- 6.9 milligrams at three months and 106.0 +/- 7.1 milligrams at six months (P < 0.01). The baseline MCHC increased from 313.6 +/- 2.7 milligrams to 324.3 +/- 4.29 milligrams (P < 0.05) during the third month of treatment. Hematocrit also increased significantly-from 0.23 +/- 0.01 to 0.31 +/- 0.01 (P < 0.01) during the third and to 0.36 +/- 0.02 (P < 0.001) during the sixth month of treatment. The erythrocyte counts from 2.73 +/- 0.2 x 10(12)/l reached 3.69 +/- 0.24 x 10(12)/l (P < 0.01) at three months and 4.01 +/- 0.27 x 10(12)/l (P < 0.001) at six months. Reticulocyte counts increased from 1.93 +/- 0.37/1000 to 4.06 +/- 0.6/1000 after one month of treatment (P < 0.02) reaching the highest values during the second week of treatment. After the fourth week, reticulocyte number fluctuated slightly but not significantly above the baseline. The serum iron decreased from 12.0 +/- 0.36 mumol/l to 10.5 +/- 1.0 mumol/l (P < 0.05) and 9.93 +/- 0.9 mumol/l (P < 0.02) at three and six months, respectively. The results revealed a non-significant reduction of serum ferritin and transferrin in the course of treatment. We also found a strong positive correlation between the dose of Eprex applied and the haemoglobin, hematocrit and the erythrocyte values in the treated patients.

Adult↗
PubMed1994

External respiration in patients with chronic renal failure in a predialysis state.

The purpose of this study was to make functional assessment of the external respiration in patients with chronic renal failure (CRF) in a predialysis state and to find some early indicators for uremic lung impairment. Twenty two patients (13 men, 9 women, aged 30 to 65) with different renal diseases were investigated. According to the stage of progression of CRF we allocated the patients to two groups-14 patients with stage I CRF (serum creatinine up to 353.6 mumol/I), and 8 patients with stage II CRF (serum creatinine from 353.6 to 707.2 mumol/I). The comprehensive functional study included slow spirometry, forced expiration, bodyplethysmography, and investigation of the diffusion, blood-gas and acid-base parameters. The respiratory muscle strength was measured by means of a modified device first used by Black LE and Hyatt RE. Ventilatory parameters in stage I CRF patients were found to be either normal or slightly changed while the parameters of the respiratory muscle strength worsened earlier than the ventilatory parameters. In the patients with stage II CRF the pronounced ventilatory and diffusion disorders was found to occur much more frequently.

Adult↗
PubMed1993

Glomerular hyperfiltration and serum beta 2-microglobulin used as early markers in diagnosis of autosomal dominant polycystic kidney disease.

This study was undertaken to investigate the dynamics of glomerular filtration and serum beta 2-microglobulin in patients with confirmed autosomal dominant polycystic kidney disease (ADPKD) without chronic renal failure (CRF). Twenty five patients (11 women and 14 men, age range 15 to 56 years) with echographically and computer-tomographically proven ADPKD were entered into the study. Glomerular filtration was followed using the 24 hour creatinine clearance and beta 2-microglobulin serum level was measured radioimmunologically using an ABBOTT laboratories kit. 12 patients had a significantly reduced glomerular filtration: 1.01 +/- 0.05 ml/s compared with 2.12 +/- 0.15 ml/l in the control group (P < 0.001). This group of patients also had a significantly increased level of the serum beta 2-microglobulin: 3.54 +/- 0.47 micrograms/l versus 1.42 +/- 0.28 micrograms/l in healthy controls (P < 0.001). Seven of the patients showed normal glomerular filtration and significantly increased beta 2-microglobulin: 2.65 +/- 0.46 micrograms/l (P < 0.05). The glomerular filtration in six of the patients was found to be significantly increased (hyperfiltration) 2.65 +/- 0.04 ml/s (P < 0.001) while their serum beta 2-microglobulin level tended to rise (2.25 +/- 0.3 micrograms/l). We believe that glomerular hyperfiltration combined with the increased level of the serum beta 2-microglobulin can be used as an early marker of ADPKD.

Adolescent↗
PubMed1992

Ionized calcium in patients with chronic renal failure.

Parameters of various renal disorders were studied in 31 patients (17 men and 14 women) who all were in the stage of chronic renal failure (CRF). These parameters included total serum creatinine, ionized calcium, serum creatinine, creatinine clearance and acid-base balance. The results were compared with a control group of 30 healthy subjects. In the patients with first stage CRF, the total serum calcium did not significantly decrease (mean = 2.19 +/- 0.12 mmol/l) and ionized calcium was within reference value limits (mean = 1.28 +/- 0.02 mmol/l). The percentage of ionized calcium in total serum calcium was higher for these patients (mean = 58.43%) than for the control group (mean = 52.25%). For patients with first and second stage CRF, the total serum was significantly lower (mean = 1.92 +/- 0.03 mmol/l) than for the healthy controls (p < 0.001) as well as for patients with first stage CRF (p < 0.05). The ionized calcium in these patients was not significantly lower (mean = 1.14 +/- 0.01 mmol/l); however, its percentage was higher than that of serum calcium (mean = 59.38%). There was a slight negative correlation between the levels of ionized calcium and serum creatinine in patients with first stage CRF (r = -0.30) and a significant correlation in patients with second and third stage CRF.

Adult↗
PubMed1990

[The hemolytic-uremic syndrome during contraceptive prevention with Rigevidon].

A case of a 20-year-old woman who developed a hemolytic-uremic syndrome while using the contraceptive drug Rigevidon is reported. Clinically the disease was manifested by acute renal failure, thrombocytopenic purpura and hemolytic anemia. The treatment with antiaggregants, anticoagulants, hemodialysis and plasmapheresis was without effect. The diagnosis was proved by the postmortem examination. The risks of the use of oral contraceptives and the need of new and better methods for contraception are discussed.

Acute Kidney Injury↗
PubMed1988

[Urinary magnesium excretion in nephrolithiasis].

Magnesium urine excretion and its correlation with calcium urine excretion were studied in 152 patients with nephrolithiasis by atomic-absorption spectrophotometry. In 14.5% of the patients with unilateral nephrolithiasis and in the 25.6% of the patients with bilateral nephrolithiasis the magnesium urine excretion was lowered. Following calcium loading the magnesiumuria in healthy persons was reliably and positively influenced while in the patients with nephrolithiasis with initial lowered magnesium excretion there was an insignificant increase. The ration MgU/CaU is of special importance for the evaluation of the lithogenic risk. The determination of the Ca-Mg interrelation is obligatory for every patient with nephrolithiasis because of its great practical importance for the treatment of these patients.

Adolescent↗