There are two points of view on the diagnostic significance of bulbar conjunctiva biomicroscopy. According to most authors, alteration of microcirculation is in general the same in different diseases. Other authors believe that changes in microvessels depend on the character of the disease. The aim of this study was to investigate the changes in bulbar conjunctiva microcirculation in Glomerulonephritis using direct, non-invasive and non-contact biomicroscopy. The study was performed on 25 children. In all these cases, the biomicrophotographs showed non-specific signs such as a red blood cells aggregation, arteriolar narrowing and venular dilatation, and decrease of the arteriolar-venular ratio. At the same time, the method of morphometry revealed increasing of tortuosity of cappilares, which seemed to be a specific feature of glomerulonephritis. We suggest that this sign should be useful in diagnosing Glomerulonephritis.

Acetylation processes play an essential role in metabolism. Their phenotypes are now considered to be the geneti cally determined ability of the organism to metabolize compounds containing amino groups. In this study, acetyli tion was studied in 156 children aged from three to 15 years. 97 of them showed clinical evidences of differeii nephropathies. In 59 children there were only minimal urinary changes, but they were residents of regions with soi contaminated by high levels of heavy metals. A special aim of the study was to investigate whether the acetylation tesi could be used to predict kidney or urinary tract diseases in children living in environments with high contents oi heavy metals salts. Rapid acetylation prevailed both in patients with different nephropathies and in children froi regions with high heavy metals contamination, even if they had only mild urinary abnormality. We suggest that thi acetylatation test can be used to predict kidney or urinary tract diseases in ecologically unfavorable conditions.

Malnutrition in hemodialysis and CAPD patients is widely regarded as a predictor of patients' survival, morbidity. Themain reasons for malnut rition in such patients are decreases in nutritional intake due to uremia, poor appetite related to glucose absorption during CAPD, protein loss through the peritoneal membrane, hormonal disorders and severe hypercatabolism. The purpose of this work was to study the prevalence of malnutrition in 31 hemodialysis and 31 CAPD patients. Malnutrition was assessed by food diaries, antropometric measurements and laboratory parameters. The gradations of malnutrition were standard: marasmus and malignant malnutrition, and combinations thereof. Malnutrition was found in 71% of CAPD and 51.6% of HD patients, occuring particularly in patients with diabetes mellitus. Among CAPD patients, a relationship was discovered between the severity of malnutrition on the one hand, and both anemia and mortality on the other hand. This relationship was absent in HD patients. It is therefore confirmed that malnutrition occurs more frequently in CAPD than in HD patients. Dietary supplementation proved to be of benefit in cases of severe malnutrition.

Tuberculosis in patients with end-stage renal disease is often difficult to diagnose. Due to the absence of sputum or bronchoalveolar aspirate culture, atypical x-ray image and various obscure symptoms, the diagnosis should be confirmed by additional testing. The aim of the study was to evaluate the clinical features of tuberculosis, the diagnostic significance of antibodies ofMycobacterium tuberculosis (MT) and MT DMA in polymerase chain reaction (PCR) in 15 patients with end-stage renal disease (5 hemodialysis patients, 10 kidney graft recipients). Immunosuppression included prednisolone, azatioprin and cyclosporin A combined with ketoconasol. Clinical observations confirmed the atypical course of tuberculosis in most patients. Detection of MT antibodies was highly specific (98,5%), but the method proved not sensitive (50%). The latter can be explained by the impaired formation of antibodies in the presence of immunosuppressive therapy in kidney graft patients, or by immunosuppression due to uremia. MT DNA in PCR appears much more effective for diagnoses of tuberculosis in immunosuppressed patients.

The aim of this study was to compare two regimes of anticoagulatioti during hemodialysis and hemodiafiltration procedur es in patients with acute renal failure and bleeding diathesis. Changes of activated coagulation time (ACT) were investigated to estimate the significance of this test for bleedings and dialyser clotting predictions. 36 patients were divided into two groups. In the first group of 28 patients, anticoagulation for hemodialysis was achieved with heparin given as a bolus of 1000-1500 units at the beginning of the procedure. The regime of maintaining hepariniza-tion depended on hourly changes of ACT. If ACT measured 170 seconds or less, heparin boluses of 900 unit were repeated. In the second group dialysis was performed without heparin. This protocol was the most effective for the bleeding patients. The monitoring of ACT proved to be very useful in predicting dialyser clotting. The risk of dialyser clotting was especially high when cuprophan membranes were used.

The neurogenic bladder is associated with different kinds of neurological disorders. One of the typical symptoms of the neurogenic bladder isnocturnal enuresis. It has been shown recently that one of enuresis' important mechanisms is an impaired 24-hour rhythm of antidiuretic hormone (arginine vasopressin, AVP) release. The decrease in AVP secretion at nighttime causes an increase in nocturnal diuresis that is associated with enuresis under conditions of bladder neurogenic dysfunction. This hypothesis led to trials of the AVP analogue DDAVP (Desmopressin, Adiuretin CD) upon children with noc turnal diuresis. The aim of this study was to estimate the effect of Adiuretin CD (Desmopressin, production of Ferring Co) on the neurogenic bladder. 12 children aged eight to 14 suffering from nocturnal diuresis were observed. To control the effects of Adiuretin CD, the frequencies of emptying and effective bladder volume were measured. In the majority of children, urofloumetry and retrograde cystometry in supine and up-right positions were tested using the domestic system ""Reljef." The initial dosage of 2-3 intranasal drops of Adiuretin CD was gradually increased to maximal level of 6-7 drops depending on the effectivity of the treatment. Enuresis stopped in 10 out of 12 children. The other symptoms of the neurogenic bladder disappeared in all of the children. In this way, our data confirms the pathogenic role of impaired AVP secretion in nocturnal enuresis, at least in certain cases. We suggest that the investigation of Adiuretin CD effects on symptoms of the neurogenic bladder should be continued."

Long-term results of the first cadaveric kidney transplantation (KTr) and risk factors of chronic rejection (CR) nephropathy were studied in 232 recipients operated at the Research Institute of Transplantology and Artificial Organs from January 1989 to January 1993. The postoperative follow-up lasted for at least 12 months. Kidney graft half-life, graft survival, and functional graft survival (FGrS) were calculated using the Kaplan-Meyer method. FGrS was estimated by the percentage of grafts with normal kidney function. In the whole group of recipients graft survival was 57% after 5 years, and graft half-life - 8.1 years. Renal graft failure (RGF) was caused by CR in 59% of the cases. Multivariate Cox analysis identified both antigen-dependent and nonspecific mechanisms as significant factors of chronic rejection. Severe or repeated rejection episodes and immunosuppression inadequacy affected the likelihood of FGrS. The recipients who had never had rejection episodes exhibited a 5-year FGrS rate of 54%, as compared with 40% for those who had one episode and 18% of cases with two or more acute rejections. Irreversible renal dysfunction after acute rejection predicted chronic rejection. In patients with inadequate immunosuppression, 5-year FGrS diminished by 43% among those with an underdosage of cyclosporin A, and by 27% among those with discontinuation of azatioprine. Reduction of renal mass, represented by blood creatinin levels above 0.13 mmol/l by the 6th month after KTr, proved to be the most significant antigen-independent mechanisms of chronic rejection. Hypertension and pro-teinuria were other important antigen-independent pathogenic factors of CR. In cases with moderate hypertension, 5-year FGrS lowered by 21%. In patients with severe hypertension, FGrS was 35% less than those with normal blood pressure. Hypertension was a nonspecific and independent risk factor of CR, but it was closely related with protein-uria. Both these syndromes are early CR predictors.

Before the introduction of continuous ambulatory peritoneal dialysis (CAPD), cases of chronic renal failure ( and, often , acute renal failure (ART) among children were invariably fatal. For those under 5 years of age, sur procedures including vascular access and kidney transplantation posed particular problems. Today, CAPD en; children with CRF to survive to an age at which cadaveric kidney transplantation (CKTr) becomes possible. The of the study was to compare the results of peritoneal dialysis (PD) and hemodialysis (HD) treatment. Analysis observation of 165 children aged 10 days to 4 years with ARF and 22 patients with CRF revealed that electrolytes acid-base metabolism return to normal on the third day of both types of dialysis. In contrast to HD treatment, levels drop significantly under PD treatment, while creatinine levels remain relatively stable. PD provides a smoo more gradual normalization of homeostasis, whereas HD treatment is cyclic and leads to sudden circuit fluctuations and changes in intracellular and intercellular fluid volume spaces. Such sharp drops in blood osmol put children at risk for disequilibrium syndrome. When performed on CRF patients, PD better maintains w electrolyte and osmotic balances and thereby preserves residual renal function. Problems in biocompatil membrane do not arise. Furthermore, children under PD grow better than do HD patents. Thus, CAPD is cost-effe and physiologically safe in comparison with HD treatment. It ensures CRF children a higher quality of life.

The aim of the study was to investigate the effect of corticosteroids (Cs) on the mitochondrial succinate degydrogenase activity (MSDGA) of peripheral blood lymphocites in patients with glomerulonephritis. MSDGA was evaluated by a quantitative cytochemical method in three groups of patients. The first group was treated with Cs pulses, and the second with oral Cs. Patients in the third group went into remission and were therefore not treated. The results of the study confirmed the effect of Cs on the enzyme status of peripheral blood lymphocytes. The changes of MSDGA evaluated in the beginning of therapy correlated with treatment protocol. They were maximal after Cs pulses (1st group) and significantly lower in patients who received oral Cs (2nd group). In the third group, MSDGA was normal. A relationship was found between the changes in MSDGA after the first Cs pulse and the reduction ofproteinuria by the seventh day of treatment.