Angelov, A.

Nenov, D.

Nenov, K.

Paskalev, D.

Zorcheva, R.

English

Varna Medical University Press: Journals

USE OF INTENSIVE METHODS FOR T R E A T M E N T OF R E N A L D I S E A S E S D. Nenov, A. Angelov, R. Zorcheva, D. Paskalev, K. Nenov Key-words: hemoperfusion — plasmapheresis — sequential ultradiffusion — hemofiltra-tion — lymphosorption — Varna Hemodialysis Centre Ext ra rena l methods for blood depuration are coming into c l in ica l practice ever more and more. I n the Hemodialysis Centre of the Higher Institute of Medi­cine in Varna , a series of intensive therapeutic methods for renal failure and poi­soning such as hemoperfusion ( H P ) , plasmapheresis ( P P ) , sequential ultradiffu­sion, hemofiltration, and lymphosorption ( L S ) , have been introduced. I n Varna , L S is brought into use for the first time in Bulgar ia . The Hemodialysis Centre started wi th 5 posts. Their number rose up to 10 ones during a 10-year period. More than 50 000 hemodialysis procedures were per­formed on total of 612 patients from the district of Varna and North-Eastern Bulgar ia suffering from chronic renal failure ( C R F ) , acute one ( A R F ) , and exa­cerbated C R F . A t the present time, 59 patients wi th terminal C R F are included in the programme for chroniodialysis treatment. Their distribution according to nosological units is as follows: 30 patients are wi th chronic glomerulonephrit­is, 20 ones — with chronic pyelonephritis, one — wi th collagenous nephropathy, two — wi th accompanying nephropathies, and 6 patients — with congenital malformations. The duration of the chroniodialysis treatment is 6 months (for 7 patients), between 1 and 3 years (for 27 ones), between 3 and 5 years (for 15 ones), between 5 and 10 years (for 8 ones) and more than 10 years (for two patients). Most patients undergo a good rehabili tation and almost a l l of them are out-pa­tients. Some of them work at home, they take care of their individual farm and keep house, but pupils go to school and successfully finish the school year. A lot of patients from Bulgar ia and abroad spend their holidays at the sea­side owing to the possibi l i ty to undergo hemodialysis treatment in the Centre. As already mentioned, one part of the patients treated are wi th A R F which presents a particularly actual problem nowadays. I t is noteworthy that the total mortali ty rate remains h igh — according to literature data (7, 8) it reaches up to 30—40 per cent but in single c l in i ca l i forms even up to 65—70 per cent of the cases. Our lethal i ty rate i s 38 per cent (1). During the period from Ю74 to 1986 a total of 121 A R F patients were hos­pitalized. There was a marked tendency towards increase of their absolute num­ber. The male-female ratio was almost 3 :1 . 45 per cent of the females were wi th obstetric-gynecological pathology, most often an illegal abortion. The etiologic role of mushroom poisoning should be also emphasized — it was found out in 14 per cent of these cases. A total of 62 per cent of our patients were aged between 20 and 50 years (1), i . e. persons at the most efficient period of their life. H P is a re lat ively new and effective method for treatment of acute poisonings (2). The side effects of the application of this method are not numerous (e. g. transitory thrombocytopenia) but the main objection is the high cost. More than 50 H P procedures are carr ied out on paients wi th acute intoxications wi th drugs, chemical , and mnshrooms. I n the Hemodialysis Centre in Varna a total of 163 P P are performed in.56 patients as follows: 53 P P w i t h 19 patients wi th immune nephropathies ( inclu­ding the first case wi th Wegener's granulomatosis successfully treated by our­selves); 29 P P wi th 11 myelomatosis patients; 59 P P wi th 15 C R F patients on "58 1 D. Nenov, A. Angelov, R. Zorcheva, D. Paskalev, K. Nenov periodic hemodialysis providing a good effect of P P concerning polyneuropathy (electromyographically registered improvement of conductivi ty, reduction of pruritus); 11 P P wi th 5 patients wi th sk in diseasses (pemphigus, psoriasis); 2 P P in patients wi th blood diseases (polycytemia vera) (4). A method for threefold use of both filters and columns is introduced. L S presents a new therapeutic method wi th which the lymph drained from the thoracic duct undergoes depuration through sorption devices and then rein-fuses into the organism. The method is especially appropriate to the treatment of intoxications because the concentration of toxins is 5—10 times higher in lymph than in blood (3, 6) . A total of 54 L S are carried out (together wi th D . Atanasov, M. D . , Department of Surgery of the Higher Institute of Medicine in Varna) on 16 patients. A c l in ica l improvement has been observed (5). I t has to be em­phasized that combined treatment of one female patient wi th severe Phalloides intoxication by both L S and P P resulted in healing of the patient. I n spite of the fact that these intensive methods for treatment of renal di­seases belong to the most expensive ones in the world thanks to their great effect­iveness they become routine methods in the Hemodialysis Centre in Va rna . Nowadays, the results from their application do not differ from these obtained in the leading centres in the world. R E F E R E N C E S 1. А н г е л о в , А., Д . П а с к а л е в , P, З о p ч е в а, Д . П е н к о в а. В: Науч.-практ. конф. хемодиализа. Варна, 18. I I . 1984 г. Варна, 1984, 55—58. — 2. Л о п у х и н , Ю. М., М. Н. М о л о д е н к о в. Гемосорбция. М., Медицина, 1978, 118—127. - 3. Л о-п у х и н, Ю. М., М. Н. М о л о д е н к о в . Гемосорбция. Москва, Медицина, 1977, 64— 69. — 4. Н е н о в , Д . , К. Н е н о в, И. С т а н ч е в, П. Ч а н к о в а. В: Науч.-практ. конф. хемодиализа. Варна, 18. I I . 1984 г. Варна, 1984, 7 9 — 8 1 . - 5. Н е н о в , К., Д . А т а н а с о в , Д . Н е н о в . Съвр. мед., 1983, № 12, 729—732. — 6. П а н ч е н к о в, Р . Т. Хирургия (Москва), 1978, № 10, 98—104. — 7. П а т е в, Е. Остра бъбречна недо­статъчност. С., Мед. и физк., 1981. — 8. П е р м я к о в, Н. К., Л. Н. З и м и н а . Острая почечная недостаточность. М., Медицина, 1983. ПРИМЕНЕНИЕ ИНТЕНСИВНЫХ МЕТОДОВ ЛЕЧЕНИЯ ПОЧЕЧНЫХ. ЗАБОЛЕВАНИЙ Д. Ненов, Л. Ангелов, Р. Зорчева, Д. Паскалев, К- Ненов Р Е З Ю М Е Внепочечные методы очищения крови все шире находят место в клинической практике. В центре гемодиализа при Высшем мгдицин:ком институте в Варне применяется ряд интен­сивных методов лечения почечной недостаточности и различных отравлений как гемопер-фузия, плазмафэрез, секвенциальная ультрафильтрация; гемофильтрация, лимфосорбция. За весь период работы цзнгра гемодиализа проведено сыше 50 ООО гемодиализационных процедур 491 больного с хронической почечной недостаточностью и 121 больного с острой почечной недостаточностью. Общая смертность больных с острой почечной недостаточностью, лечившихся в центре, составляет 38 %. Проведено более 5Э гемоперфузий больных с острыми отравлениями медикаментами, химикалиями и ядовитыми грибами. Методом плазмафереза (163 процедур) лечились 56 больных с различными заболеваниями как иммунные нефропатии, миеломная болезнь, экзо­генные интоксикации, кожные и гематологические заболевания. Впервые в Болгарии в центре гемодиализа в Варне введен метод лимфосорбции. Про­ведено 54 лимфосорбции 19 больных. Было установлено, что метод приводит к улучшиншю клинического состояния пациентов. Высокая эффективность указанных методов обусловила необходимость в том, чтобы они стали рутинными методами лечения в центре гемодиализа. В настоящее время резуль­таты их применения не отличаются от соответствующих результатов ведущих центров в мире. 

USE OF INTENSIVE METHODS FOR TREATMENT OF RENAL DISEASES

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USE OF INTENSIVE METHODS FOR TREATMENT OF RENAL DISEASES

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Varna Medical University Press: Journals