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Biomedical subjects

E M Shilov

Publications and source records attributed to E M Shilov.

At least 37 records · Page 2Linked to original sources
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↗
PubMed2001

[Effects of pathogenetic therapy on blood cholesterol in patients with glomerulonephritis].

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.

Adult↗
PubMed2000

[Primary focal segmental glomerulosclerosis: clinical and morphological prognostic factors].

AIM: To retrospectively analyze clinical course and results of immunodepressive therapy of patients with primary focal-segmental glomerulosclerosis (FSGS), to reveal prognostic factors of the disease progression and patients' sensitivity to immunosuppressive therapy. MATERIAL AND METHODS: Morphological diagnosis was specified, morphological indices of activity and sclerosis were estimated, renal survival was analysed, mono- and multivariate analysis of prognostic factors was made by the evidence obtained in the study of 135 biopsy specimens from CRF patients meeting the criteria of FSGS. RESULTS: At the moment of the disease onset only age of the patients was related to FSGS: 5- and 10-year survival was 100% if the disease started under 16 years of age, if older--the survival was 80 and 65%, respectively. Nephrotic syndrome, hematuria, high creatinine, racemose alterations in the glomeruli worsened the disease prognosis. When cytostatics and corticosteroids were used in combination they produced better results and were associated with better prognosis than each of them in monotherapy. Patients with marked hematuria and low proteinuria were less sensitive to therapy than those with weak hematuria and high proteinemia. Patients with FSGS having high IA and SI required more aggressive therapy for response. CONCLUSION: Renal biopsy with quantitation of IA and IS increases the prognosis accuracy and is important for choice of the treatment policy in patients with primary FSGS.

Adolescent↗
PubMed1998

[Comparison of two cyclophosphamide treatment regimens in nephrotic patients with chronic glomerulonephritis].

AIM: Comparison of two cyclophosphamide (CPA) treatment regimens in chronic glomerulonephritis (CGN) patients: oral daily CPA versus intravenous CPA pulses (IV-CPA) MATERIALS AND METHODS: 31 nephrotic patients entered the trial: 12, 16 and 3 with membraneous, mesangial proliferative and mesangiocapillary CGN, respectively. The patients were randomized into two groups. 13 patients of group 1 received oral CPA (1.5-2.0 mg/kg/day for 6 months, while 18 patients of group 2 received IV-CPA pulses (20 mg/kg/monthly, at least 6 pulses) combined with oral prednisolone (40-6-mg/day during 1.5 mo with subsequent tapering). At entry, no statistical differences (p > 0.05) were found between groups 1 and 2 by age, gender, duration of the renal disease, serum creatinine levels, frequency of arterial hypertension. Mean duration of follow-up was 27.6 and 22.6 mo (p > 0.05) for group 1 and 2, respectively. RESULTS: After 6 months of follow-up there was no difference in the rate of complete and partial remission between the groups (69 and 83% for group 1 and 2, respectively). The rate of renal function deterioration was also similar. Side effects occurred 3 times more frequently in group 1 than group 2. The mean cumulative course dose of CPA per 1 patient in group 1 was 35.6 g, in group 2--5.6 g. CONCLUSION: The effectiveness of methods was similar irrespective of CGN morphological form, but in spite of similar rates of remission of nephrotic syndrome, pulse CPA is preferable being more safe as to possible complications.

Adolescent↗
PubMed1997

[Arterial hypertension in lupus nephritis].

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.

Adult↗
PubMed1997

[Sandimmun in the treatment of chronic glomerulonephritis with the nephrotic syndrome].

Sandimmun was given to 11 patients (7 males and 4 females) aged 16-34 years with chronic glomerulonephritis (CGN) and nephrotic syndrome (NS). Various morphological forms were revealed: minimal changes (MC), focal-segmentary glomerulosclerosis (FSGS), mesangiocapillary glomerulonephritis (MCGS), membraneous glomerulonephritis (MGN), mesangioproliferative glomerulonephritis (MPGN). They occurred in 1, 3, 2, 1 and 3 patients respectively. Biopsy was not made in 1 case. The duration of the disease varied from 1 to 4 years. Prior to this therapy 10 patients failed corticosteroids and cytostatics. Hypertension, high creatinine were registered in 3 and 5 patients, respectively. Sandimmun was given for 2-18 months in a daily dose 3-5 mg/kg. Serum concentration 70-180 ng/ml. After 1 to 18 months of treatment nephrotic syndrome relieved in 1 MGN, 3 MPGN, 2 FSGS, 2 MCGS patients. The recurrences were reported in 4 patients after the drug discontinuation. Serious complications were absent.

Adolescent↗
PubMed1995

[The treatment of nephrotic-type chronic glomerulonephritis with Sandimmun (cyclosporin A)].

Sandimmun (ciclosporin A) treatment of chronic glomerulonephritis with nephrotic syndrome in a dose 2.5-5 mg/kg for 6-10 months relieved nephrotic syndrome in 2 and resulted in clinical improvement in other 2 of 4 patients treated. In 3 cases the patients failed previous therapy with high-dose corticosteroids and cytostatics. The drug reduced proteinuria, elevated serum levels of albumin and total protein, had low nephrotoxicity.

Adult↗
PubMed1995

[Effects of a number of cytokines on the proliferation of mesangial cells and the production of extracellular matrix in anti-GBM nephritis].

The interaction of IL-1 and TNF alpha in the autolous phase of anti-GBM nephritis was studied. The influx of mononuclear leukocytes into the glomerulus and high cytokine levels induced a decrease in mesangial cell proliferation and an increase in extracellular matrix production. The methylprednisolone suppression of mononuclear leukocyte infiltration caused the autocine cytokine secretion of mesangial cells. Cyclophosphamide decreased cytokine production, but did not affect mononuclear leukocyte infiltration. The absence of mononuclear leukocytes in the site of the injury induced by imbalance between the synthesis and degradation of extracellular matrix components. The uncontrolled metabolism of the extracellular matrix may be induced glomerulosclerosis.

Animals↗