Method for treating diabetic nephropathy

FIELD: medicine, endocrinology.

SUBSTANCE: one should introduce heparin into plasma separated during plasmapheresis at 9000-11000 U/l plasma to incubate it at 4-6 C for 12 h, not less, separate precipitate due to plasma centrifuging at 7-9 C for 15-25 min and introduce the rest plasma into patient's blood. Such procedures should be carried out every other day 5-7 times. The present innovation enables to decrease glomerulosclerosis progressing, avoid excessive heparinization and heparinization-associated complications and, also, those associated with introduction of donor's plasma.

EFFECT: higher efficiency of therapy.

2 ex

 

The invention relates to medicine, namely to methods of treatment of diabetic nephropathy.

There is a method of treatment of diabetic nephropathy method of hemosorption (see “Application of hemosorption in treatment of diabetic nephropathy” Try, Taichenachev journal “Medical business” No. 9, 1985, publishers, Kiev, pp. 94-97), namely, using a perfusion pump blood from one vein of the patient passes through the arterio-venous routes through pre-washed 6-8-fold volume of saline with the addition of heparin hemosorbent and returned in another vein, to prevent thrombosis of the extracorporeal circuit is injected heparin to the patient a total dose rate of 100 IU/kg twice with an interval of 30 minutes the rate of perfusion of 60 minutes, the volume perfoirmance blood per session from 1 to 2 volume of circulating blood.

The disadvantage of this method is that this method does not apply to selective due to the fact that specific sorbents have not yet found wide application in medicine because of their often poor efficiency and high cost; requires careful and long-term preparation of the patient prior to the procedure, that requires a large amount of heparin 5000 IU 2 times a day for 3-5 days before the procedure, during the procedure again, neo is going heparin 100 IU/kg twice with an interval of 30 min, the use of large doses of heparin occurs unbalance of the blood coagulation system; the need for Central venous catheterization with all the dangers of this intervention and the installation of permanent catheters, which require careful maintenance.

Also known is a method of treatment of diabetic nephropathy with plasmapheresis (see “Diabetic nephropathy” Vaselin, Allstudent, the monograph “Efferent therapy” edited by Allstudent publishing house “Folio”, St. Petersburg, 2003, str-286), taken as a prototype, which consists in the fact that start plasmapheresis with small hemodilution with total heparinisation at the rate of 100 U/kg, exposium blood from 200 to 500 ml in a standard package “GAMECON”, then the blood is centrifuged in refrigerated centrifuge at a temperature of 15°-17°With 10-15 minutes at a speed centrifugation 2200-2500 rpm, after separation of the plasma on plasmacytoma autoerythrocyte return to the patient, the volume of the remote plasma for the procedure varies from 1/4 to 1 volume of circulating plasma and replaced with either saline solution in combination with dextrans or protein products (albumin, donor plasma).

The disadvantages of this method are the complete replacement of the plasma proteins and other fluids (crystalloids, donor PLA is mA albumin), which leads to frequent allergic reactions, in addition, increases the risk of transmission of hepatitis, HIV infection; as a result of displacement of the plasma develops hypoalbuminemia, complicated by hypotension; neselektivno method, as with pathological substances are removed is necessary for the body substances (protein, and others), the need for installation of permanent catheters, which required skilled effect.

Objective of the claimed invention is to increase the effectiveness of treatment of diabetic nephropathy, reduced the progression of glomerulosclerosis, creating a more selective, simple, less traumatic method.

This object is achieved in that according to the method of treatment of diabetic nephropathy, including blood sampling, separation of plasma and cellular elements of the blood with the return of the cellular elements in the blood, the plasma is injected heparin based 9000-11000 ED 1 liter of plasma, incubated at a temperature of 4°-6°With not less than 12 hours, separating the precipitate by centrifugation plasma at a temperature of 7°-9°C for 15-25 minutes and enter the remaining patient plasma in the blood, such procedures performed in a day 5-7 times.

The use of this invention will avoid plasmosomata, which eliminates the risk of virus infection is Apatite, HIV infection; you don't need expensive sorbents and plasma filters; operation for atraumatic blood corpuscles; no long-term prepare patients for procedures; does not require large doses of heparin, which cause disorders of hemostasis; there are no absolute contraindications to the procedure; allergic reactions practically does not develop, as it does not need plasma-substituting solutions; the procedure can be performed under conditions of therapeutic hospital, without requiring expensive equipment. Use for plasmaboy specifically processed autoplasma patient obtained during a previous operation, will increase the selectivity in vitro operations, and the majority of the useful components of blood plasma is returned to the patient. Loss of protein is only 20-30%, mainly due to the large globular proteins; return own plasma allows the patient during the course of cryofreeze to increase from operation to operation amounts of exfuze and significantly increases the effectiveness of treatment; vascular access is simple, does not require catheterization of Central veins and installation of permanent catheters; duration 2-3 hours. No “draining” effect, as plasmapheresis, which exacerbates the disease at the first session of the procedure.

The claimed method realized is as follows: after examining the patient is placed in a horizontal position, then produce puncture the cubital vein of the patient fistulas needle. The blood of the patient exposium in plastic container Gamecon 500” anticoagulant “Gleyzer”, after filling the package with the blood and thoroughly mixed with a stabilizer produce disconnection and labeling of the package. Just one procedure of cryofreeze carry from 1 to 3 “fences” blood. After trim packages is the procedure of centrifugation speed 1500 Rev/min at 22°C for 15 minutes using a spring puller plasma was transferred to another container, and the formed elements after resuspension saline return the patient drip through the same fistulous needle. On average, one procedure in containers collect 600 ml of plasma. After the procedure in a sterile container with patient plasma introducing heparin calculation 9000-11000 ED 1 L. Then the plasma is incubated at 4°-6°With not less than 12 hours. The formed precipitate is separated from the plasma by centrifugation speeds of 3500 rpm/min at 7°-9°C for 20 min, and the supernatant into sterile conditions and transferred to another container and return to the patient after centrifugation, if the procedure is carried out on the same day; in other cases, the plasma is frozen and stored at - 20°to the following procedure, while Kotor is the first of its defrost, and the supernatant returned to the patient. On average, over the course of the process 4000 ml of plasma. The procedure is carried out mainly through the day. Each patient performed from 5 to 7 such procedures cryofreeze.

Example 1. Patient S., 62 years old, admitted to hospital with a diagnosis of diabetes mellitus type 2, compensation. Diabetic nephropathy stage 1, was conducted in the course of cryofreeze. One procedure cryofreeze was carried out 1 “fence” of blood. After trim package was the procedure of centrifugation speed 1500 Rev/min at 22°C for 15 minutes. Using a spring puller plasma was transferred to another container, and the formed elements after resuspension saline solution was returned to the patient drip through the same fistulous needle. In one procedure in the containers was about 400 ml of plasma. After the procedure in a sterile container with patient plasma was injected heparin calculation 10000 IU per 1 liter. Then the plasma was incubated at a temperature of 4°With 24 hours. The formed precipitate was separated from plasma by centrifugation speed 3500 rpm at a temperature of 8°C for 20 minutes and supernatant in a sterile environment were transferred to another container, frozen and stored at a temperature of 20°to the following procedure, during which she was restoratives, and su is inatant returned to the patient. The course was processed 4000 ml of plasma. Procedures were performed every other day. The patient was held on 7 procedures cryofreeze.

During the procedure, the patient felt well, improved overall health, decreased dragging pain in the lumbar region, decreased General weakness. The amplitude of daily fluctuations of blood glucose was significantly decreased. Criatures in complex therapy of diabetic nephropathy has improved the functional status of the kidneys (increased maximum specific gravity, increased the rate between the maximum and minimum specific gravity, increased glomerular filtration, reducing the levels of endogenous creatinine, decreased levels of B2-microglobulin in the blood and urine, according to renascentia increased filtration, excretion and renal plasmatic compared to initial level).

Example 2. Patient M., aged 40, arrived at the clinic with a diagnosis of diabetes mellitus type 1, subcompensated. Diabetic nephropathy stage 2, was conducted in the course of cryofreeze. One procedure cryofreeze was carried out 1 “fence” of blood. After trim package was the procedure of centrifugation speed 1500 Rev/min at 22°C for 15 minutes. Using a spring puller plasma was transferred to another container, and the formed elements after resuspension physical and the logical solution was returned to the patient drip through the same fistulous needle. In one procedure in the containers was about 400 ml of plasma. After the procedure in a sterile container with patient plasma was injected heparin calculation 9000 IU per 1 liter. Then the plasma was incubated at a temperature of 5°26 hours. The formed precipitate was separated from plasma by centrifugation speed 3500 rpm at a temperature of 7°C for 15 minutes and supernatant in a sterile environment were transferred to another container, frozen and stored at a temperature of -19°to the following procedure, during which she was restoratives, and the supernatant was returned to the patient. The course was processed 4000 ml of plasma. Procedures were performed every other day. The patient was held on 6 procedures cryofreeze.

During the procedure, the patient felt well, decreased General weakness, decreased the amplitude of daily fluctuations of blood glucose, which led to dose reduction Humulin on 2 UNITS. Dynamics of biochemical parameters (creatinine, urea, B2-microglobulin) has improved. Decreased level of proteinuria in 1.5 times. Dynamics of renascentia was also positive: compared with the previous study was determined by the improved circulation of both kidneys, increasing the filtration activity. The positive effect of treatment of diabetic nephropathy briefer the zoom.

The method of treatment of diabetic nephropathy, including blood sampling, separation of plasma and cellular elements of the blood with the return of the cellular elements in the blood, characterized in that the plasma is injected heparin based 9000-11000 ED 1 l of plasma, incubated at a temperature of 4°-6°With not less than 12 hours, separate the precipitate by centrifugation plasma at a temperature of 7-9°C for 15-25 min and injected the rest of the patient plasma in the blood, such procedures performed in a day 5-7 times.



 

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