Biomedical subjects
Publications and source records attributed to V V Stavskaia.
The effectiveness of different treatment programs was studied in correlation with clinical characteristics of chronic glomerulonephritis (CGN) in 665 patients. It was established that the higher was CGN activity, the poorer were the treatment results. Nephrotic syndrome also had negative implications. The best response was brought by prolonged (1-2.5 years) course of corticosteroids and cytostatics.
Clinical course of chronic glomerulonephritis (CG) with recognition of 4 types by frequency of exacerbations was investigated in 592 patients with morphologically verified diagnosis observed for a long time. The disease ran a stable course. Contrary to patients with mesangioproliferative CG who had rare or moderate-frequency exacerbations, patients with membranoproliferative disease had exacerbations annually. This suggests correlation between the form of anatomical changes and the process activity. Irrespective of CG morphological form, the survival of CG patients is closely related to the disease course. Taken into account, this fact may serve the tool of prognosis, choice of treatment intensity and duration of follow-up.
Before starting treatment of chronic glomerulonephritis it is desirable to determine the patient's drug sensitivity in vitro because in the absence of such sensitivity chemotherapy should be preceded by immunomodulation with tactivin or thymalin and 3-5 sessions of plasmapheresis to stimulate drug sensitivity. Further measures include prednisolone or cyclophosphamide intravenously for 3-5 days in a dose 300-500 followed by oral administration. Active treatment lasts for 4-8 weeks. After that the patients receive maintenance for 1-2 years.
A transient inhibition of glomerular filtration and/or elevation of blood creatinine were detected in 126 of 296 patients with chronic glomerulonephritis. Some of the patients had 2-4 episodes which occurred more frequently in exacerbations (56.3% of cases), less frequently in cytostatic treatment or in sanatorium. The predominance of nephrotic syndrome and frequent recurrences or hypertension, long-term course in different causes of the disease suggests several pathogenetic variants of nephrotic syndrome. Transient deterioration of renal function does not affect survival, but its emergence in the course of cytostatic treatment or sanatorium treatment worsens the prognosis being related with sclerosis of the renal tissue.
The results of sanatorium treatment were compared for different health resorts (in the Middle Asia, Yalta, Sestroretsk) where 374 patients underwent 455 courses for chronic glomerulonephritis. The results of the treatment were similar except for the Middle Asia and Yalta sanatoria where the condition of the patients aggravated. This suggests a conclusion of an unfavorable effect of hot climate on the course of chronic glomerulonephritis.
The implications of the treatment variant and chronic glomerulonephritis (CGN) characteristics in the changes of renal function were evaluated by 220 treatment courses for CGN aggravation. A number of statistical methods were employed. In CGN patients free of renal insufficiency glomerular filtration was either unaffected or recovered after transitory decline. In chronic failure further creatinine clearance diminution was observed, serum creatinine levels went up. Corticosteroid treatment was much safer for the kidneys than cytostatics. With increasing duration of CGN, functional affection of the kidney becomes more frequent irrespective of the treatment kind. The same is true for the number of exacerbation and hypertension which are also involved in renal functional decline.
In 520 patients followed up for 4 to 20 years a study was made of the relationship between the actual survival time and the morphological and clinical characteristics of chronic glomerulonephritis. A well-defined parallelism was established between the rate of disease progress and the rate of exacerbations as was an unfavorable prognostic importance of marked tubulointerstitial lesions and glomerular sclerosis, which was more manifest in frequent relapses. Considerable differences in the survival of patients with hypertension or associated hypertension and the nephrotic syndrome with varying process activity do not provide evidence in favour of their direct influence on the rate of the disease progress. As far as certain morphological patterns of glomerulonephritis are concerned, the prognosis is different because of specific clinical manifestations and anatomic alterations common to each disease pattern.
The results of the treatment of 498 patients with chronic glomerulonephritis (CGN) verified on biopsy were analyzed to reveal that all the types of therapy were less effective in episodes of the nephrotic syndrome and frequent relapses than in rarer exacerbations and the lack of massive proteinuria. Considerable differences in the survival of patients with varying activity of CGN treated in the same way attest to the limited possibilities of the pathogenetic and symptomatic agents as regards their action on the natural disease course. The treatment with glucocorticoids, cytostatics and the combined use of these drugs turned out more successful provided the time of the drugs intake was increased to 1-2 years. Administration of glucocorticoids and the long-term use of cytostatics in cases of the sensitivity to them of mononuclear receptors appeared most effective in all the clinical manifestations of mesangioproliferative, membranous proliferative or membranous glomerulonephritis.
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The duration of glomerulonephritis up to the development of azotemia, death or the beginning of programmed hemodialysis was analysed in 605 patients. In 254 of them the term of observation lasted 4-14 years and in 351 patients with a similar characteristic of the disease less than 4 years. The survival rate among the patients with long-term observation was significantly higher than among those who were under observation less time owing to later onset and longer duration of chronic renal insufficiency. Additional analysis revealed the dependence existing between the slowing down of the disease progress and the prophylactic and therapeutic measures which were conducted for a number of years for control of exacerbations.
As a result of clinical and experimental observations the authors have established that even at the early stages of the nephrotic syndrome there occur myocardial lesions determined by concomitant impairment of microcirculation and metabolism leading to the development of nephrotic cardiomyopathy. The appearance of the nephrotic syndrome may be accompanied by the development of hydrothorax and more seldom, primarily in acute glomerulonephritis, by nephrogenous edema of the lungs. The nephrotic syndrome does not exert any material effect on the changes in external respiratory function, common to glomerulonephritis. Nephrotic gastropathy is of total character with low magnitudes of acid secretion and intragastric proteolysis. This does not create any conditions for acid-peptic damage to the gastroduodenal mucosa attended by ulcer formation.
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A study of the results of therapy of exacerbations of chronic glomerulonephritides in 416 patients during the entire course of the disease has shown their dependence on the clinical and, to a lesser degree, on morphological peculiarities of disease. With the same anatomy of the process, the efficacy of glucocorticoids, cytostatics and their combinations with anticoagulants and antiaggregants was less in the presence of the nephrotic syndrome and got lower twice or thrice in patients with a tendency to continuous recurrence. The results of the use of all types of therapy in groups of patients identical by their clinical characteristics were worse in membranous glomerulonephritis and did not differ significantly in mesangioproliferative and membranoproliferative glomerulonephritides. The treatment of the latter was less effective than that of mesangioproliferative glomerulonephritis because of higher frequency of an active course and development of the nephrotic syndrome.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Forty-two patients with membranous glomerulonephritis were treated. Complete regression of the disease and nephrotic syndrome was attained in 46.3%, partial in 27.3% of all the cases of disease exacerbations. The importance of the individualized choice of the most efficacious drug therapy and promising results of the many-month treatment to raise the time of an ensuing remission are shown.