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Biomedical subjects

E M Shilov

Publications and source records attributed to E M Shilov.

At least 19 recordsLinked to original sources
PubMed2005

[Possibilities of outpatient renoprotective therapy].

AIM: To show feasibility of conducting nephroprotective therapy in conditions of a municipal diagnostic center. MATERIAL AND METHODS: The nephrologist of the city diagnostic center followed up for 2 years 9 patients with different nephropathies comorbid with arterial hypertension, hyperlipidemia and slowly progressive renal failure aged 44-77 years. The course of nephropathy for 1 year before and 1 year after correction with nephroprotective therapy (arterial pressure control and treatment with ACE inhibitors and statins) was analysed. RESULTS: Before the start of nephroprotective measures all the patients experienced a slow progression of renal failure. After administration of ACE inhibitors in doses lowering arterial pressure not higher than 130/80 mm Hg and statins reducing serum cholesterol nitric residues stopped accumulating while serum creatinine went down after 5 months of the combined treatment. CONCLUSION: It is feasible to conduct a renoprotective policy with a control of therapeutic efficacy in outpatients of a municipal diagnostic center.

Adult↗
PubMed2005

[Calcification of peripheral arteries in patients with terminal renal failure on programmed hemodialysis].

AIM: To estimate incidence and clinical significance of carotid and femoral arteries calcification in patients with terminal renal failure (TRF) on programmed hemodialysis (PH). MATERIAL AND METHODS: Thirty four patients (25 males and 9 females) with TRF were divided into two groups by severity of hyperphosphatemia: 15 patients with P < 6 mg/dl (group 1) and 19 patients with P > 6 mg/dl. The groups were matched by age (44.4 +/- 15.05 and 42.7 +/- 14.23 years, respectively) and PH duration (2.4 +/- 1.1 and 2.6 +/- 1.16 years, respectively). Calcification of the arteries and structure of the vascular wall were examined with ultrasonic dopplerography of the common carotid and femoral arteries. Measurements were made of intima-media complex (IMC) thickness, systolic and diastolic diameter of the right and left carotid artery. The arteries were studied for the presence of calcinates and atherosclerotic plaques. RESULTS: Patients of group 2 showed a correlation between a P level, incidence rate of common carotid arteries calcification, atherosclerotic plaques in the femoral arteries, IMC of the carotid and femoral arteries, left ventricular hypertrophy and a decline in a left ventricular diastolic function. A significant correlation was established between the rate of atherosclerotic plaques detection and age, male sex, smoking and history of PH. An increase in IMC and arterial rigidity was revealed in 12 (63.2%) of 19 patients of group 2. They had episodes of intradialysis hypotonia, 6 (31.6%) patients had acute coronary syndrome, 5 (26.3%) patients--cardiac arrhythmia. CONCLUSION: A significant contribution to formation of risk factors of cardiovascular complications in TRF patients on PH is made by disturbed phosphorus-calcium metabolism resulting in higher rigidity and diameter of the arteries. The above changes lead to a rise in systolic pressure and fall in diastolic one. Increased pulse pressure is an independent predictor of the risk to develop acute coronary syndrome.

Adult↗
PubMed2004

[Association of the complex of polymorphic markers of ACE genes, aldosteron synthetase and endothelial synthetase of nitric oxide with progression of chronic glomerulonephritis].

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.

Adult↗
PubMed2004

[Chronic glomerulonephritis and pregnancy].

AIM: To clarify factors of risk for unfavourable variants of gestational chronic glomerulonephritis (CGN) and poor pregnancy outcomes in CGN; to determine prognostic implications of changes in some renal and uteroplacental indices. MATERIAL AND METHODS: Variants of CGN gestational course and pregnancy outcomes have been analysed for 156 CGN patients. The women were examined before pregnancy, in the course of pregnancy and 3-24 months after the delivery. Measurements were made of 24 h proteinuria, glomerular filtration rate, blood transaminases activity, functional renal reserve (FRR), uricemia, blood level of alpha-phetoprotein. Placentas were studied morphologically, uterine and umbilical artery circulation was assessed by dopplerometry. RESULTS: The following abnormalities were registered: high proteinuria (34.6%), progression of hypertension (29.5%), renal function deterioration (15.4%), fetal and neonatal losses (15.4%), fetal underdevelopment (25%), preterm delivery (17.3%), preeclampsia (7.7%), preterm placental detachment (1.9%). There is morphological, dopplerometric and biochemical evidence for placental insufficiency in CGN pregnant women. CONCLUSION: Activity of CGN (nephritic or acute nephritic syndromes), hypertension, renal failure, disorders of renal hemodynamics are factors of risk for unfavourable gestational course of CGN and pregnancy complications. Placental insufficiency deteriorates pregnancy outcomes in CGN, but changes in uterine and umbilical circulation as well as blood levels of alpha-fetoprotein are not prognostically significant.

Adolescent↗
PubMed2004

[Low-molecular heparins in the treatment of APS-nephropathy in primary and secondary antiphospholipid syndrome].

AIM: To evaluate efficacy of low-molecular heparin enoxaparin in the treatment of nephropathy in patients with primary and secondary antiphospholipid syndrome (APS). MATERIAL AND METHODS: A total of 11 APS-nephropathy patients participated in the study. Of them 8 patients had primary APS and 3 patients had secondary APS. Biopsy of the kidney was made in 5 patients, ultrasonic dopplerography of renal vessels was performed in all 11 patients. Enoxaparin was given as monotherapy to primary APS and combined treatment to secondary APS patients. RESULTS: Enoxaparin decreased proteinuria, arterial pressure, glomerular filtration rate in all the patients. It also promoted normalization of creatinin. Before the anticoagulant treatment a reduction of maximal systolic and diastolic velocities of blood flow have been registered in segmental and interlobar arteries in all APS nephropathy patients compared to healthy subjects. The depletion of renal cortex blood flow beginning with the level of arcuate arteries was also observed in all the patients. Enoxaparin enhanced blood flow in segmental and interlobar arteries. The recovery of blood flow in the arcuate arteries was registered in 6 of 9 patients. CONCLUSION: Low molecular heparin may be used in the treatment of nephropathy in patients with primary and secondary APS.

Adult↗
PubMed2004

[Endothelium and platelets in pregnant women with chronic glomerulonephritis and therapeutic efficacy of acetylsalicylic acid and dipiridamol].

AIM: To estimate platelet and endothelial condition in pregnant women with chronic glomerulonephritis (CGN), prognostic value of these changes and efficacy of acetylsalicylic acid (ASA) and dipiridamol in prevention of unfavourable outcomes of pregnancy in CGN. MATERIAL AND METHODS: The examination covered 74 CGN pregnant patients, 14 non-pregnant CGN patients, 11 pregnant women with preeclampsia, 19 healthy pregnant women. The levels of fibronectin, endothelin-1,2, 6-keto-PGF1a, thromboxane B2 (TxB2) secretory beta-thromboglobulin in the blood, activity of intrathrombocytic lactate dehydrogenase (LHG), platelet aggregation. ASA (125 mg/day) was given to 33 CGN pregnant women in combination with dipiridamol (150-225 mg/day). Control group consisted of 32 CGN pregnant women. RESULTS: Content of fibronectin, endothelin, TxB2 and beta-thromboglobulin in blood plasm, aggregation with ADP in CGN pregnant women were higher than in healthy pregnant women and nonpregnant CGN patients. Plasmic 6-keto-PGF1a was low. Preeclampsia was accompanied with elevated fibronectin, TxB2 and beta-thromboglobulin, hyperactive LDH. Platelet aggregation was suppressed. Blood beta-thromboglobulin directly correlated with systolic and diastolic arterial pressure, 24-h proteinuria and blood creatinine. Reverse Correlation was seen in blood beta-thromboglobulin with albuminemia, glomerular filtration rate, body mass of the newborn and term of labor. A direct correlation was found between the activity of intrathrombocytic LDH and systolic and diastolic arterial pressure, a weak reverse correlation--between platelet count in capillary blood and systolic pressure, platelet aggregation with ADP and terms of labor. Of the highest prognostic value were the level of beta-thromboglobulin and fibronectin, the activity of intrathrombocytic LDH and platelet aggregation in response to ADP. ASA and dipiridamol reduced the risk of fetal retardation and fetal loss. CONCLUSION: Pregnant women with CGN have endothelial-thrombocytic dysfunction because of unidirectional influence of both CGN and pregnancy. We think that endothelial-platelet dysfunction connects renal impairment and placental failure in pregnant women with CGN deteriorating a gestational CGN and pregnancy complications. Correction of endothelial-platelet state with ASA and dipiridamol is effective in prevention of fetal retardation and fetal loss in pregnant women with CGN.

Administration, Oral↗
PubMed2003

[Clinical implications of DNA-topoisomerases examination in renal biopsies from patients with nephritis].

AIM: To study expression of topoisomerases (TI) I and II alpha (DNA-bound enzymes involved in transcription and replication) in renal tissue as markers of activity and prognosis of glomerulonephritis (GN) decisive for choice of immunodepressive therapy. MATERIAL AND METHODS: TI expression was studied immunohistochemically in renal biopsies from 177 patients with different morphological variants of GN and in the samples of unaffected kidney tissue removed in 12 patients for local tumors. RESULTS: There are definite differences between proliferative and non-proliferative GN variants--elevation of TI levels and monocytic infiltration in proliferative GN. Focal-segmental glomerulosclerosis is characterized by a high TI II alpha level in mesangial cells and monocytic infiltration of the glomeruli which are typical for inflammation. A statistical relationship between TI levels in mesangial cells and glomerular epithelium suggests a pathogenetic relation between these links of the pathological process. Molecular markers of activation and proliferation of cells and direct inductors of the inflammatory process (cells of monocytic infiltrate) closely correlated with the activity index--an integral indicator of inflammatory activity, as well as with the integral indicator of sclerotic processes in renal tissue--sclerosis index. Monocytic infiltration in the interstitium correlated both with morphological manifestations of activity, progression of nephritis and their clinical equivalents. In high TI expression GN resistance to immunodepressive therapy rose. To overcome the resistance, immunodepressive therapy must be more active--large doses and duration of treatment. In patients with lupus nephritis and mesangiocapillary GN renal prognosis was worse in the presence of high TI expression in mesangial cells and epithelium of the renal canaliculi. CONCLUSION: The authors are the first to demonstrate TI expression in renal tissue of GN patients, correlation of its level with activity of renal process as well as its role in prediction of response to treatment and the rate of renal failure progression. It is suggested that high TI expression entails a progressive course of GN.

Biomarkers↗
PubMed2003

[Clinical manifestations of APS-nephropathy in primary antiphospholipid syndrome].

AIM: To elicit clinical features of nephropathy associated with antiphospholipid syndrome (APSN) in patients with primary antiphospholipid syndrome (PAPS). MATERIAL AND METHODS: The analysis of clinical characteristics and course of APSN has covered 24 patients with PAPS (16 females and 8 males, mean age 34.3 years). Renal damage was represented by arterial hypertension (AH), urinary syndrome, functional decline. All the patients were tested for anticardiolipin antibodies and/or lupus anticoagulant. Renal biopsy was made in 7 patients. RESULTS: PAPS patients developed renal affection in the onset of APS or within the first 5 years of its course. In the majority of patients APSN combined with abnormalities of CNS, heart and skin. Arterial/arteriolar thromboses prevailed. APSN manifested with: AH (n = 23, severe AH in 11), abnormal renal filtration (n = 17, creatinine rise in 8), urinary syndrome with proteinuria (n = 23, in 14 with hematuria). The following clinical variants of APSN were proposed: urinary syndrome with AH (n = 16; 67%), acute nephritic syndrome (n = 7; 29%), nephrotic syndrome (n = 1). Morphological studies of biopsies from APSN patients have revealed sclerotic changes, thrombotic microangiopathy, nonspecific alterations in the glomeruli. CONCLUSION: APSN is a variant of microvascular renal affection caused by thrombotic processes in intra-organ microcirculation. It is an early clinical marker of APS. Clinically, APSN manifests with vascular renal affection, the earliest symptom being inhibition of glomerular filtration. Clinical combinations of the symptoms allow to distinguish variant of APSN suggesting the existence of acute and chronic APSN. Combination of APSN with affection of the CNS, heart and skin points to a special PAPS subtype characterized by generalized ischemic damage to the organs as a result of intraorganic arterial and/or arteriolar thromboses.

Adult↗
PubMed2002

[The course and prognosis of mesangioproliferative glomerulonephritis].

AIM: A retrospective analysis of a clinical course of mesangioproliferative glomerulonephritis (MPGN) in patients with glomerular deposition of IgA (IgA nephropathy--IgA-N), with glomerular deposition of other Ig to determine prognostic factors of MpGN progression including IgA-N and to examine the patients' sensitivity to immunodepressive therapy. MATERIAL AND METHODS: 2000 patients with primary MPGN followed up from 1980 to 1999 from the disease onset to development of chronic renal failure (creatinine > 2.5 mg%). Factors affecting kidney survival were studied using the Cox regression model, factors predicting sensitivity to immunodepressive therapy--using multiple logistic regression. RESULTS: IgA-N differed by the course and prognosis from other forms of MPGN. In IgA-N urinary syndrome and macrohematuria were encountered more frequently, in other forms of MPGN more frequent was nephrotic syndrome. Prognosis of patients with IgA-N was worse than in MPGN patients without IgA deposition: 10-year "renal survival" (creatinine < 2.5 mg%) was 64 and 97% (p < 0.05), respectively. Prognosis-deteriorating factors for MPGN patients were the following: male sex, nephritis onset in 40-year-olds and older subjects, acute nephritic syndrome (creatinine > 1.5 mg%), high proteinuria, hematuria (> 50 in sight), the presence of synechia and TIC in renal biopsy, location of immune deposits both in the mesangium and basal glomerular membranes. The responders to the immunodepressive therapy had 10-year renal survival 100%. Positive results of immunodepressive therapy were observed significantly more frequently in patients with normal level of creatinine, moderate hematuria, absence of synechias and TIC in renal biopsy, given large total course dose of corticosteroids and cytostatics. Efficiency of oral cyclophosphamide and its intravenous pulse-therapy did not differ significantly. In pulse therapy an average cumulative dose was lower 6 times, side effects occurred 3 times less frequently. CONCLUSION: The importance of morphological information for prognosis and predicting sensitivity of MPGN patients to immunosuppressive therapy necessitates renal biopsy before therapy. Intravenous pulse therapy with cyclophosphamide is preferable as an active treatment in patients with sclerosis in renal biopsy.

Administration, Oral↗
PubMed2002

[Renal and uterine hemodynamics in pregnancy with chronic glomerulonephritis of the hypertonic type].

AIM: To study gestational changes in renal and uterine hemodynamics and their relation to systemic and intracardiac hemodynamics in pregnant hypertensive women with chronic glomerulonephritis (CGN). MATERIAL AND METHODS: Echocardiography, ultrasonic dopplerography of renal and uterine arteries were made in 16 pregnant women with CGN and AH syndrome in trimester II-III and 1-3 months after the delivery. Hemodynamic indices in pregnancy were compared to those after the delivery which were considered baseline. RESULTS: In CGN pregnant women with AH syndrome resistance of renal arteries did not change in pregnancy and were similar postpartum. With advancing pregnancy, the resistance of the uterine arteries diminished. The indices of the resistance in the main trunk of the renal artery correlated with volumetric cardiohemodynamic indices, heart rate and total peripheral resistance in segmental interlobular arteries. No significant correlation were found between uterine, systemic and cardiac hemodynamics though it existed between renal and uterine blood flow. CONCLUSION: Pregnancy does not affect vascular resistance of renal arteries in CGN pregnant women with AH syndrome, but contrary to pregnancy with essential hypertension in that with CGN and AH syndrome renal circulation responds to changes in systemic hemodynamics and volumetric indices of cardiohemodynamics. These findigns may reflect disturbances in autoregulation of renal circulation and additional effects on pregnancy outcome in women with CGN and AH syndrome.

Adult↗