Proliferation of interstitial fibroblasts and excessive deposition of interstitial extracellular matrix leading to fibrosis is typical for progression of all renal diseases. Recent investigations show the crucial role of vasoactive, pro- and antyinflammatory, proapoptotic mediators and growth factors in renal scar formation. The review describes the main pathways of nephrosclerosis development in view of integral interaction of different mediators.

Aim. The aim of this investigation was to study clinical manifestation of chronic heart failure in patients with chronic kidney disease in pre-dialysis stage and the functional condition of the heart. Methods. Seventy-three pre-dialysis patients (40F, 33M, age 51,7 ± 13,4 years) who have chronic kidney disease and chronic heart failure were studied. M-mode echocardiography was performed and left ventricular mass index (LVMI), ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were detected. The flow propagation velocity of early diastolic filling (Vp) was assessed by color M-mode Doppler echocardiography. All measures were performed by one investigator. Results. Left ventricular hypertrophy was detected in 58 (79,5%) patients. EF was lower than 45% in 7 patients. 55 (75,4%) patients had diastolic dysfunction. Abnormal relaxation type of diastolic dysfunction was prevalent. In 11 (15,1%) patients after investigation the chronic heart failure was excluded. Conclusion. Diagnostics of chronic heart failure based on its symptoms is difficult in patients with chronic kidney disease. Systolic dysfunction is quite rare in patients with CKD. Diastolic dysfunction of left ventricular is the main cause of CHF in patients with CKD. In this connection, the investigation of transmitral flow by Doppler-echocardiography must be essential in patients with CKD suffering from CHF.

Seventy-one arterial hypertension (AH) patients on programmed ambulatory hemodialysis were divided into four groups: 16 patients (Group I), receiving perindopril (4-8 mg in hemodialysis day); 16 patients (Group II), receiving amlodipine (5-10 mg/day); 16 patients (Group III), receiving a combination of perindopril and amlodipine and 21 patients, mostly with Stage I AH (Group IV, controls). Echocardiography, performed 6 months later, demonstrated that perindopril alone and in combination with amlodipine decreased left ventricular myocardial mass, left ventricular myocardial mass index, improved diastolic myocardial function and decreased corrected QTc-interval. Amlodipine as monotherapy prevented progression of ventricular hypertrophy. Combination of perindopril and amlodipine decreased QT and QTc by 12,1 and 7,2%, respectively. Progression of negative dynamics in myocardial structure was observed in patients not receiving antihypertensive therapy.

The purpose of work was to study capability of the tests-tablets Micro-Bumintest as diagnostic criterion in children with leukocyturia. 95 children were studied, 59 of them had pyelonephritis, 15 girls had vulvovaginitis without pyelonephritis, 12 children had cystitis without pyelonephritis. The control group consisted of 9 children without diseases of uric system. All patient carried out the microalbuminuria tests-tablets Micro-Bumintest. All children in an active phase of pyelonephritis had positive microalbuminuria test. In remission phase of pyelonephritis the microalbuminuria test was negative in at all children. In children with vulvovaginitis and cystitis in a combination with pyelonephritis in remission stage of the microalbuminuria test was also negative. We conclude that the microalbuminuria test is a useful tool in leukocyturia diagnostics.

The aim of this research was to study hemodynamic changes in patients with terminal stage of chronic renal failure, before and after hemodialysis (HD) by using the data of EchoCG. 22 patients treated with chronic HD for 3,5 years in average have been examined. EchoCG parameters of M-regime, sectoral scanning and doppler-EchoCG were used. It has been revealed that before HD hemodynamic changes similar to restrictive type of cardiavc filling which occurs in congestive heart failure with significant impairment of intracardiac hemodynamics are typical. After HD an improvement of systolic and diastolic function of left ventricle which results from a decrease in preload and afterload were observed. Patients with chronic renal failure mostly have left ventricle concentric hypertrophy.

Level of glycated hemoglobin (HbA1c) as indicator of hyperglycemia have been investigated in patients with diabetes mellitus types I and with EsRD on programmed hemodialysis. In 19 patients with diabetes mellitus type I and in 13 patients with diabetes mellitus type II the following parameters were investigated: glucose, hemoglobin, HbA1c, creatinine and urea. The levels of glucose and HbA1c were higher in patients with diabetes mellitus type I compared to type II. In patients with diabetes mellitus type I with glycemia level above 10 mmol/l, the HbA1c content does not reflect actual hyperglycemia. In patients with diabetes mellitus type II on programmed hemodialysis the blood HbA1c increases proportionally to blood glucose concentration.

Background. Vascular access thrombosis is the most common complication in hemodialysis patients. The role of thrombophilia in access thrombosis is not established. Among the risk factors that have been proposed high blood concentrations of total homocysteine and hereditary gene mutations have been considered, but the findings available are controversial. The aim of the study was to compare serum level of homocysteine and genetic thrombosis risk factors (Leiden mutation, mutation G20210A and in gene MTHFR) in patients underwent one or more vascular access thrombosis in comparison to control group without thrombosis. A case-control study was conducted of 127 hemodialysis patients to determine whether thrombophilia was associated with arteriovenous fistula thrombosis. Patients were tested for factor V Leiden, prothrombin gene mutation, methylenetetrahydrofolate reductase genotype, serum homocysteine. It is shown that the total plasma homocysteine level in patients undergoing dialysis is differed from healthy subjects (27,5 ± 9,34 vs 11,2 ± 3,54 µmol/l, p < 0,05), but similar to those in control and experimental groups (28,3 ± 5,1 vs 25,8 ± 6,3 µmol/l). Frequencies of mutations in research and control groups were as follows: Leiden mutation - 4,7 and 3,5%; mutation MTHFR heterozygotic - 28,6 and 31,7%, MTHFR homozygous 2,4 and 3,5%; mutation MTHFR heterozygotic + Leiden mutation of 2,4 and 3,5%, respectively. The conclusion. System risk factors of a venous thrombosis, such as level of tHcy and mutations of genes, do not affect the frequency of thrombosis of vascular access in patients on maintenance hemodialysis. Large, multicenter, prospective cohort studies are needed to confirm the observations from this case-control retrospective study.

The aim of the work was to assess prognostic importance of blood serum creatinine in patients with multiple myeloma. In 132 multiple myeloma patients the level of blood serum creatinine was measured. In group А (creatinine level <177 mkmol/l) the average survival was 50,3 months. In group В (creatinine level >177 mkmol/l) the average survival was 5,0 months. In group В there were more patients with low Hb level, high level of calcium and low level of blood serum albumin. The results show that the level of blood serum creatinine in one of the most significant factor that determines the survival rate of the patients with multiple myeloma.

Women treated with hemodialysis often have periods of unovulation and barrenness. Only about 40% percent betations of the women who have conceived after the beginning of dialysis therapies resulted in birth of alive babies. A case of successful managed pregnancy and its management in a dialysis patient is described. Pregnancy has been revealed at term of 12-13 weeks. Betation was managed according to a protocol developed in collaboration with accoucheurs and gynecologists. Correction of anemia and treatment of placental insufficiency were performed. At about 32-33 weeks a girl weighted 1670 grams was born by a Ceaser section operation.

To examine kidney pathology and clinical manifestation of morphological forms of primary glomerulopathy 498 patients treated in nephrological department of Minsk city hospital No. 5 since 1996 were analyzed. The great part of kidney biopcies revealed primary glomerulopathy. Mesangioproliferative glomerulonephritis predominate among morphological variants of primary glomerulopathy.