Object of the research: 147 patients with diabetes mellitus (DM) types 1 and 2 with diabetic nephropathy (DN) grades 1, 2 and 3. Purpose of the research: optimization of diagnosis of the early stages of DN on the basis of the determination of the blood spectrum and the content of plasma haemocysteine (Hc), as well as improvement in the results of its treatment with elaboration of the correction therapy. Methods of the research: clinical-laboratory, biochemical and instrumental methods. Theoretical and practical results: the most important is the substantiation of the necessity to determine lipid metabolism indices, as well as the homocysteine level, protein, enzyme, bioelement metabolisms, blood coagulation system indices in patients with DM types 1 and 2 together with DN grades 1, 2 and 3, therewith making it possible to regard them as markers of metabolic process disturbances in patients which contribute to DM development. Results of the determination of the indices of lipid metabolism and plasma Hccan serve as the basis for correcting the pathogenetic therapy of DN. Novelty: on the basis of a combined clinical-laboratory examina-tion of patients with DM types 1 and 2 together with DN grades 1, 2 and 3, new data were obtained about the influence of hyperlipi-daemia and hyperhomocysteinaemia on the development and pro-gress of the disorder in the functional state of the kidneys. It was found out that in the majority of patients, who have DM types 1 and 2 with DN grades 1, 2 and 3, there is a disturbance in carbo-hydrate metabolism with progressing chronic hyperglycaemia, in-sulin resistance, high level of glycosulated haemoglobin, as well as renal dysfunction with changes in the glomerular filtration, an increasing excretion of microalbumins with urine, a moderate in-crease of creatinine and C-reactive protein. It was shown that pa-tients with preclinical, 1st, 2nd and 3 rd stages of DN developed a disturbance in protein metabolism with progressing hypoalbu-minaemia and hypergammaglobulinaemia, therewithdemonstrat-ing a disturbance in the structural-functional state of cell struc-tures with the development of the syndrome of cytolysis. The de-velopment of different levels of hyperhomocysteinaemia increased in compliance with DN progressing, whose course was against a background of the toxic syndrome, which produced its negative effects on the metabolic processes in the organism. It was revealed that lipid metabolic disturbances in patients with DM types 1 and 2 together with DN grades 1, 2 and 3 consisted in a higher con-centration of lipids in the blood; the progressing of DN develop-ment lasted with an increased concentration of atherogenic types of hyperlipidaemia, it producing its negative effect on the haemo-dynamic and trophic factors. A disturbance in lipid metabolism was accompanied by the progressing increase of lipid peroxida-tion and inhibition in the state of the antioxidant protection sys-tem. Parallel to metabolic disturbances, there were changes in the system of blood coagulation and bioelementexchange, which produced their negative effect on the development of DN. Corre-lationes wre revealed between the levels of glycosulated haemo-globin, fibrinonectine, Hc, malone dialdehyde in erythrocytes and the state of lipid metabolism, which increased as each degree of DN developed. It was proved that the progressing increase of the number of atherogenic types of hyperlipidaemia parallel to hyper-glycaemia, hyperenzymaemia, dysproteinaemia, hyperfibrinonec-taemia, hyperhomocysteinaemia produced their negative effect on the development of DN. It was found out that the use of a thera-peutic complex, which included Espa-Lipon in patients with DM types 1 and 2 together with DN grades 1, 2 and 3 produced an ex-pressed therapeutic effect with restoration of the functional state of the kidneys, thereby preventing any further development of DN. Degree of introduction: the materials of the thesis paper were in-troduced into the clinical practice of the Endocrinology Depart-ment of the Kharkiv Regional Clinical Hospital, therapeutic de-partments of the Blizniuki, Krasnograd, Dergachi, Zolochev, Izium, Lozova, Nova Vodolaga, and Kharkiv Central District Hospitals. The main propositions of the thesis are used in the edu-cational process at Department of Propedeutics of Internal Medi-cine No. 2 of Kharkiv State Medical University. Sphere of application: medicine, therapy departments.
