Berezovs'kyj O. Using of low molecular weight heparin in patients with diabetic nephropathy.

Object of the research: diabetic nephropathy (DN) with different functional state of the kidneys. Purpose of the research: optimization of the diagnosing and treating DN in patients with diabetes mellitus (DM) of types 1 and 2 on the basis of the study of the influence exerted by low-molecular heparins (LMH) on partial functions of the kidneys. Methods of the research: general clinical, biochemical, instrumental (supersonic, electrocardiographic) methods, spectrophotometric ones, as well as the method of indirect solid-phase enzymoimmunoassay. Theoretical and practical results: the thesis demonstrated that opportune revealing of renal lesions in DM required examination of the partial functions of the kidneys, microalbuminuria (MAU), microglobulin ?2 content in the blood and its excretion with urine. The appearance of MAU, a higher excretion of microglobulin ?2 with urine, its content in the blood are the criteria for supplementing the complex therapy with LMH Fragmine, thereby making it possible to decelerate the rates of development and progression of chronic renal failure (CRF). It was shown that renoprotective effects of Fragmine could be used at all stages of CRF development, including the conditions of treatment with programme haemodialysis. Novelty: it was proved for the first time that LMH Fragmine had renoprotective effects in DN in patients with DM types 1 and 2. It was demonstrated that under the conditions of treating DN with Fragmine there was some lowering in the level of daily proteinuria, microalbuminuria, a reduced blood content of creatinine and urea, a higher rate of glomerular filtration. It was revealed that the effect of Fragmine resulted in a lower blood level of microglobulin ?2 and its excretion with urine, a higher excretion of Nа+ и К+, a decreased level of these electrolytes owing to better functioning of the renal tubular system. It was found out that under the conditions of programme haemodialysis the renoprotective effect of Fragmine on the state of the function of residual nephrons was preserved. For the first time, advantages of the renoprotective action of Fragmine over the effects of nonfractional heparin and angiotensin-converting enzyme inhibitors (ACEI) were shown: nonfractional heparin did not influence the rate of glomerular filtration, blood concentrations of urea, creatinine and microglobulin ?2, excretion of microglobulin ?2 with urine; the renoprotective effects of ACEI did not spread to the electrolyte-releasing function of the kidneys in patients with DN. The positive effects of ACEI versus Fragmine on the partial functions of the kidneys were less expressed. Degree of introduction: the main results of the conducted re-search were introduced into the practical work of the Nephrology Department and Haemodialysis Department of Shapoval Re-gional Centre of Urology and Nephrology (Kharkiv), the Endo-crinology Department of the Kharkiv Regional Hospital, the Ne-phrology Department of Meshchaninov City Hospital of First and Urgent Aid (Kharkiv), the City Nephrology Room of Kharkiv City Hospital No. 2. Sphere of application: medicine, therapy departments.