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Biomedical subjects

Iu S Milovanov

Publications and source records attributed to Iu S Milovanov.

At least 19 recordsLinked to original sources
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

[Cardioprotective effect of erythropoietin preparations in patients with chronic renal failure].

AIM: To investigate effects of early correction of anemia on the rate of cardiovascular complications and survival on regular hemodialysis (RHD). MATERIAL AND METHODS: Eighty patients with chronic renal failure (CRF) on regular hemodialysis entered two groups: group 1 with hemoglobin (Hb) < 80 g/l (n = 36) and group 2 with Hb > 100 g/l (n = 44). 90% patients of group 2 were treated for renal anemia for 6-8 months of predialysis CRF. When placed on RHD, group 1 started therapy with epoetin, 39 patients of group 2 continued epoetin treatment. RESULTS: Patients of group 2 had a higher rate of eccentric left ventricular hypertrophy (LVH) with reduced ejection fraction and development of congestive cardiac failure and coronary heart disease. Eccentric LVH in group 1 patients regressed only in 80% when the patients were on hemodialysis and received epoetin for correction of anemia. Overall cardiac death in group 1 was twice that of group 2 patients. CONCLUSION: Early correction of anemia led to a 50% increase in 5-year survival. This fact can be explained with inhibited progression of eccentric LVH.

Adult↗
PubMed2003

[Intradialysis hypotension: causes and sequelae].

AIM: To study causes and sequelae of intradialysis hypotension (IH) in patients with terminal renal failure (TRF). MATERIAL AND METHODS: Forty one patients with TRF on chronic hemodialysis (CH) were divided into two groups. The study group consisted of 24 patients with episodes of IH. Seventeen patients of the control group had no IH. All the patients were examined with assessment of protein-energy deficiency, residual renal function, left-ventricular hypertrophy, diastolic function of the heart. Hemodialysis effectiveness was estimated by Kt/V index. Survival of the patients was calculated according to Kaplan-Meier method. RESULTS: In the study group IH episodes occurred in spite of low ultrafiltration velocity (8-10 ml/min). Those patients of the study group who had IH associated with polyneuropathy and left-ventricular hypertrophy had IH episodes more often and sharper falls of arterial pressure. Long-term IH decreased survival significantly. CONCLUSION: Repeated episodes of IH deteriorate effectiveness of hemodialysis because of acute coronary syndrome, acute disorder of cerebral circulation, complications of deficient dialysis syndrome (pericarditis, hyperkaliemia, pulmonary edema, congestive heart failure).

Adolescent↗
PubMed2002

[Prognostic significance of controlled and uncontrolled arterial hypertension in patients with terminal kidney failure on chronic hemodialysis].

AIM: To assess prognostic implications of controlled and uncontrolled arterial hypertension (AH) in patients with terminal renal failure (TRF) on chronic hemodialysis (CHD). MATERIAL AND METHODS: 90 patients on CHD treated from 1981 to 2001 participated in the trial. All of them were examined morphologically (biopsy of the kidney or autopsy). According to the trend of arterial pressure during CHD treatment they were divided into 3 groups. 72 patients of group 1 had sodium-dependent AH. 8 patients of group 2 had uncontrollable AH (rise of arterial pressure during hemodialysis in spite of controlled iltrafiltration). Group 3 consisted of control patients. RESULTS: It was found that any hypertension in CHD patients is prognostically unfavourable. Controllable AH occurred in 91.1%, uncontrollable--in 8.9% of examinees. Chronic renal failure in 20% of group 1 patients was associated with rapidly progressive nephritis, in 15%--with systemic vasculitides. In group 2, 38% patients had systemic vasculitis, 50%--rapidly progressive nephritis. The activity of the underlying disease in hemodialysis was registered in 75 and 30% patients of group 2 and 1, respectively. Incomplete dialysis syndrome (IDS) was diagnosed in 69.6% group 1 and 40.0% group 2 patients. CONCLUSION: Sodium dependent arterial hypertension was most frequent. It is attributed to IDS. AH uncontrolled by hemodialysis develops, as a rule, in patients with systemic vasculitis or active primary nephritis. Uncontrollable AH is characterized by elevated plasm renin. Lack of control over arterial pressure in hemodialysis is essential for long-term survival of the patients. The shortest survival was observed in patients with renin-dependent AH. Factors provoking AH and deteriorating the prognosis are the following: hypervolemia in IDS, hyperactivity of plasm renin, exacerbation of basic disease in hemodialysis, protein energy deficiency syndrome, lack of residual renal function.

Adult↗
PubMed2001

[Cryoapheresis in the treatment of patients with cryoglobulinemic mesangiocapillary glomerulonephritis and acute kidney failure].

AIM: To assess cryoapheresis (CA) efficacy in the treatment of cryoglobulinemic glomerulonephritis (CG) with acute renal failure (ACR). MATERIAL AND METHODS: Ten 34-64-year-old CG patients with associated HCV infection and symptoms of ACR (diuresis under 500 ml/day, serum creatinin 1.6-8.1 ml/dl). All the patients were examined clinically, for serum cryoglobulins, HCV, HBV markers, morphologically (renal and hepatic biopsies in 8 patients). All the patients received therapy with CA, immunodepressants. Three patients with virus replication received, in addition, antiviral drugs (alpha-interferon in a dose 3,000,000-5,000,000 IU 3 times a week intramuscularly for 6 months). RESULTS: CA in combined CG therapy led to fast elimination of cryoglobulins from the body, stabilization of renal function with arrest of rapid progression of renal failure, normalization of diuresis with subsequent lowering of serum creatinin. The course of CA normalized renal function fully in 3 patients, partially in 7 patients. Later, these 7 patients developed chronic renal failure. Complete elimination of the virus and remission of CG were achieved in 2 of 3 patients who had undergone the antiviral treatment for a year. CONCLUSION: CA can be added to combined therapy of CG aggravation as it improves renal function.

Acute Kidney Injury↗
PubMed1997

[Intermittent hemofiltration in the treatment of acute kidney failure in glomerulonephritis patients].

Intermittent hemofiltration (IH) was used in the treatment of acute renal failure (ARF) in 11 glomerulonephritis patients with nephrotic syndrome. IH was found effective in the above patients as it provides fast relief of interstitial edema of the essential for life organs (the kidneys, liver, lungs, etc.), control of plasma urea and potassium. In nephritis patients with ARF IH is superior to isolated ultrafiltration in providing 10 times higher urea clearance.

Acute Kidney Injury↗
PubMed1995

[Acute kidney failure related to the use of x-ray contrast agents and indomethacin: the risk factors and mechanisms of its development].

7 acute renal failure (ARF) and experiments provided information on ARF induced by radio-opaque substances and indomethacin. The leading mechanism underlying renal failure is supposed to be the spasm of renal afferent arterioles secondary to hypercalcemia, prostaglandin synthesis blockade, activation of renin-angiotensin system and high activity of adenosine.

Acute Kidney Injury↗
PubMed1993

[Plasmapheresis in the treatment of rapidly progressing glomerulonephritis].

Twenty patients with rapidly progressing glomerulonephritis (RPGN) aged 16-50 underwent plasmapheresis (PA) as adjuvant to immunodepressants. Of these, 9 patients had lupus, 4 Bright RPGN, 4 and 3 patients combined glomerulonephritis with hemorrhagic vasculitis and Wegener granulomatosis, respectively. A total of 130 procedures were performed (3-13 per each patient). The results of PA treatment included complete recovery of renal function in 8 and partial in 10 patients (3 of them could stop hemodialysis), death of pulmonary edema (2 cases). The authors think advisable to combine immunodepressants with PA, especially when the drugs are contraindicated, in patients with malignant glomerulonephritis.

Acute Kidney Injury↗
PubMed1992

[Acute kidney failure in patients with chronic glomerulonephritis].

The causes of acute renal failure (ARF) and results of its treatment are analyzed in 34 patients aged 15 to 51 years with exacerbation of chronic glomerulonephritis (CGN). Of these, 20 patients presented with lupoid GN, 11 with Bright's GN, and 3 had GN associated with systemic vasculitis (2 of them also had mixed cryoglobulinemia). All the patients underwent clinical treatment that lasted from January 1, 1986 to December 31, 1990. In 15 patients, ARF was due to the activity of the underlying disease or development of its complications (nephrotic crisis, disseminated intravascular coagulation, cryoglobulinemia); in 15 patients, it was determined by complications induced by drug treatment (diuretics, antibiotics, nonsteroid antiinflammatory drugs), and in 4 patients, by complications related to invasive examinations (radiographic contrast studies) and treatment (isolated ultrafiltration). The authors hold that superaddition of progressive tubular disorders, rapid decrease of the rate of glomerular filtration accompanied by the growth of serum creatinine form the basis for ARF to be diagnosed in such patients. Identification of the cause of ARF and delimitation of whether the pathological process is renal or prerenal in CGN patients is required for rational treatment prescription.

Acute Kidney Injury↗