RESUMEN
The content of medium-sized molecules (MSM) in the blood serum was measured in 52 patients with exacerbation of chronic glomerulonephritis (CGN) given pathogenetic therapy. All the patients manifested an initial rise of the content of MSM. Administration of cytostatics and (or) glucocorticoids led to the regression of the nephrotic syndrome in 32 patients. In 20 patients, it was ineffective. All the patients in whom the treatment appeared effective demonstrated the lowering of the content of MSM 2 weeks after the treatment initiation, which outstripped the dynamics of the other parameters characteristic of CGN exacerbation. At the same time the urinary clearance of MSM remained unchanged. The patients in whom the pathogenetic therapy turned out ineffective manifested an increase of the blood content of MSM and of the urinary clearance of these substances. It is suggested that the test with the detection of the urinary clearance and the content of MSM in the blood serum may be used before the treatment and 2 weeks after its initiation to early estimate the treatment efficacy. The prognostic value of the positive test is 82%, that of the negative 80%. It is assumed that the mechanism that triggers the increase of the rate of MSM generation may lie in lipid peroxidation activation.
Asunto(s)
Glomerulonefritis/tratamiento farmacológico , Toxemia/tratamiento farmacológico , Enfermedad Crónica , Ciclofosfamida/uso terapéutico , Quimioterapia Combinada , Glomerulonefritis/complicaciones , Glomerulonefritis/metabolismo , Heparina/uso terapéutico , Humanos , Peso Molecular , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/etiología , Síndrome Nefrótico/metabolismo , Pentoxifilina/uso terapéutico , Péptidos/análisis , Prednisolona/uso terapéutico , Pronóstico , Factores de Tiempo , Toxemia/etiología , Toxemia/metabolismoRESUMEN
To specify factors determining the intensity of uremic intoxication, 86 patients with chronic glomerulonephritis were examined without regard for exacerbation at different stages of chronic renal failure. Microcolumn gel chromatography was used to measure the content of medium-size molecules in the blood serum, urine, gastric and intestinal juice of the patients and 22 mongrel dogs before and after bilateral nephrectomy. It has been established that as the mass of acting nephrons decreases, the content of "medium-size" molecules in the blood serum and intestinal juice rises, being unchanged in gastric juice. At the same time the urinary clearance of the given group of substances declines. It is assumed that in stage I chronic renal failure, enhancement of the excretion of "medium-size" molecules in the proximal third of the small intestine is made for by hyperfiltration of intact nephrons. The appearance of the clinical symptomatology in stage II and III chronic renal failure is determined by intensification of absorption of uremic toxins by the intestine, associated with a fall of their urinary clearance. The necessity of early administration of the low-protein diet combined with enterosorbents is stressed.