It is well known that Helicobacter pylori (Hp) plays a significant role in etiology and pathogenesis of upper gastrointestinal disorders. Patients with terminal Renal Failure treated with haemodialysis (HD) and renal transplant recipients often suffer from gastrointestinal disorders. However the role of Hp in pathogenesis of gastrointestinal complaints remains quite contradictory. The goal of this study is to define correlation between the Hp infection and gastrointestinal complaints in renal transplant recipients. 30 renal transplant recipients were included in this study. Upper gastrointestinal endoscopies were performed in all patients. 23 patients underwent gastric antral biopsies for morphological Hp detection. Serum antibodies to Hp were studied in 29 patients. From these 29 patients 9 (31%) were Hp positive. As a result of morphological test 20 (87%) of 23 patients were found to be Hp positive. Based on the results we conclude that persistence of Hp is one of the most important mechanisms of gastrointestinal disorders in renal transplant recipients. Therefore antibacterial agents with anti-Hp activity should be a routine part of the treatment protocol of early posttransplantation period in these patients.

The aim of the study was to reveal the effect of some clinical and biochemical parameters, patient age and comorbide status on the late result of peritoneal dialysis (PD). 277 patients with ESRD were followed-up. The patients were divided into two groups: 148 patients with successful outcome (continued PD by the end of the follow-up period or those who had kidney transplantation) and unsuccessfully treated patients (died or those who was switched to HD). The late outcome was estimated by survival rate of patients and PD technique. Regression model of Cox was used for calculation of relative death risk. We show that the comorbidity index (M.E. Charlson) is a reliable predictor of the late outcome of PD. Unfavourable risk factors were high permeability of peritoneum and hypoalbuminemia in the beginning of the PD treatment. A decrease in albumin level by 1 g/l below 36 g/l increased the risk of death by a factor of 1,1. It was also shown that the survival rate for diabetics was much lower in comparison with non-diabetic patients.

The results of vaccine prophylaxis of hepatitis B in 175 patients (96 males and 79 females, aged 46,1 ± 14,8 years) treated with haemodialysis were analysed. In 3 month after beginning of vaccination 75% of patients had anti-HBs level between 10 and 100 mME/ml and 51% of patients had anti-HBs level above 100 mME/ml. 7 month after the immunization these levels were detected in 84% and 67% patients, respectively. To reveal predictors of low efficiency of immunization, log-transformed titres of antibodies after 3 months (intermediate response) and 7 months (final response) were correlated with clinical, biochemical and immunological parameters before vaccination. A strong correlation of the intermediate response was found with the number of lymphocytes (p < 0,000005), IgM concentration (p < 0,019), inhibition of leucocyte migration (p < 0,019), interleukine concentration (p < 0,014) and transferrine blood level (р < 0,019). Average value of Кt/V, the numbers of B- and T-lymphocytes in blood (including T-helpers), concentrations of IgM, IL-1 and IL-2 in blood was significantly lower in patients with negative or weak intermediate response. Alternatively, all these parameters were increased in patients with a good response to vaccination. In the group of patients with negative or weak final response to immunization, the IgM and IL-2 concentrations were significantly lower than in the group with good response. Blood level of IgM below 0,95 g/l and concentration of B-lymphocytes below 0,37 × 109/l are the predictors of low efficiency of immunization after 3 month. IgM level below <0,85 g/l and IL-2 concentration under 12,1 pM predict low final efficiency of immunization. Any of these two predictors can be used. Coexistence of both predictors makes the unfavourable prognosis more specific.

The possibility to use rapamycin in immunosuppressive protocol, allowing early cyclosporine withdrawal in kidney transplant recipients, was investigated. Rapamycin was administered in 10 patients. There were no patient’s deaths and graft lost during follow-up period (179 ± 61 days). In one case rapamycin was stopped on day 19 because of gastrointestinal side effects. In the rest 9 cases before start of cyclosporine withdrawal graft biopsy was performed. In 5 patients morphological signs of acute rejection were found and demanded change of immunosuppressive drug combination. Rapamycin is effective immunosuppressive drug that can be used in kidney transplant recipients instead of cyclosporine in 30% of patients. Another 30% patients demand combination of rapamycin, MMF and steroids.

In the present study 169 patients with acute renal failure (ARF) on hemodialysis, were examined. The groups of survived (n = 82) and non-survived (n = 87) patients were analysed. Factors which could influence on the outcome in each grouр were examined. The prognostic unfavourable factors were: shock, sepsis in the etiology of ARF, ARF in multiple organ failure. Age, gender, premorbid condition and level of azotemia did not influence the outcome of ARF. Predictors of the favourable outcome werе: isolated ARF, ARF without oliguria, ARF resulting from renal toxicity and obstruction of the urinary tract.

Pathologic changes in cardiovascular system in patients with the end stage renal disease are one of the causes of mortality and inadequacy of renal replacement therapy [LRT]. Effeсt of standard HD procedure on central circulation was studied in 35 patients using a PC EKG heart circulation analyzer «BIANKOR» for the purpose of maximal survival rate, increase in quality of haemodialysis [HD] treatment. Some extent of structural and functional myocardial changes was found in a majority of patients. Principal haemodynamic data was analyzed. Most of the patients showed auspicious effect of haemodialysis. A group of patients with severe myocardial dysfunction that demand individual SRT regimen to treat HD complications was revealed.

In order to investigate the role of unfavourable clinical and morphological types and tubulointerstitial changes in progression of chronic glomerulonephritis we examined renal functions in moderate and tubulointerstitial changes in 4 groups of children with chronic glomerulonephritis (with favourable clinical and morphological types, with unfavourable clinical type, with unfavourable morphological type, with two unfavourable types). We determined the definite role of unfavourable clinic and morphological types in decrease of renal function in early period of desease and chief significance of tubulointerstitial changes in progression of renal dysfunction.