In order to reveal the role of cytokines and growth factors in renal scar formation in children with chronic pyelonephritis (CP) and vesico-ureteral reflux (VUR) 360 patients with impaired urodynamics aged from 5 to 15 years were examined. In all of them the 24 hours urine excretion of tumor necrosis factor (TNF-α), interleukins-1, -6, -8, -10 (IL-1, -6, -8, -10) and serum concentration of fibroblast growth factor (FGF), transforming growth factor-β (TGF-β), insulin-like growth factor-1 (IGF-1) have been measured by immunoenzime method. All the children underwent color Doppler ultrasound (CDUS) and nuclear examination of kidneys. Three groups of patients were determined: 1) with VUR and normal X-ray and ultrasound pictures of kidneys (n = 190); 2) with CDUS detected reflux nephropathy (RN) (n = 65); 3) with IVU confirmed reflux nephropathy (n = 85). Patients with CP without VUR (n = 20) were used as controls. As a result, all the patients demonstrated significantly elevated daily urine excretion of cytokines and serum concentration of growth factors in comparison with control (p < 0,05), that may reflect the protraction of covered inflammation in renal parenchyma in remission of CP. The similar dynamics of cytokines and growth factors profile in patients with X-ray confirmed RN and CDUS sings of renal scar formation suggestsing they can be used as early markers of renal tissue damage.

Patient survival, estimated with Kaplan-Meier techniques, in 103 type 1 diabetic recipients comparing with 450 non-diabetics, at 1, 5 and 9 year were 95 and 94%, 77 and 82%, 68 and 69%, the difference didn’t reach statistical significance. The most common cause of death was cardio-vascular disease. Graft survival rates in type 1 diabetic patients comparing with non-diabetics were 91 and 90%, 70 and 65%, 57 and 49%, the difference didn’t reach statistical significance. Among the 38 failed grafts in diabetic patients, 23 (61%) were due to patient death rather then primary graft failure, comparing with 176 and 98 (56%) non-diabetics. If the patients, who died with a functioning graft were censored, graft survival rates of type 1 diabetic patients comparing with non-diabetics at 1, 5 and 9 year were 94 and 95%, 88 and 78%, 78 and 69% (p = 0,5).

In order to investigate the role of monocyte chemoattractant protein-1 (МСР-1, chemoattractant cytokine for main cells in the composition of renal interstitial infiltrations) in pathogenesis of tubulointerstitial changes we examined 16 children with chronic glomerulonephritis and 5 children with chronic interstitial nephriris. In all of them the urine levels of МСР-1 was measured. In children with chronic glomerulonephritis the blood levels of this cytokine was also measured by immunoenzyme assay. Urine concentration of МСР-1 was estimated by calculation the correlation of the urine levels of МСР-1 and creatinine (protein-creatinine coefficient). We revealed the definite role of МСР-1 in pathogenesis of tubulointerstitial changes as local messengers, formed directly in renal tissue, and found that the urine protein-creatinine coefficient is useful for definition of the degree of tubulointerstitial damage.

Erythron system was analyzed in 90 patients with chronic renal failure (CRF) who underwent renal replacement therapy (hemodialysis, HD - 39 patients and peritoneal dialysis, PD - 51) without administration of recombinant erythropoietin (EP). Analysis included studying erythrohistograms, conventional hematological indices (erythrocyte number, hemoglobin, and hematocrit), erythrocyte indices (average erythrocyte volume), and morphofunctional status of living erythrocytes. The incidence and degree of anemia expression in CRF patients undergoing HD and PD (but non-treated with EP) practically coincided. The majority of examined patients demonstrated decrease in traditional hematological indices and multiple alterations of erythrocyte morphofunctional state - anisocytosis and poikilocytosis; the latter exceeded 50%. The number of pathologically changed (pre-hemolytic) erythrocyte forms (spherocytes) was greater (by 10%) in HD-patients than in PD ones which is likely to depend on the additional effect of both HD membrane and the components of the extracorporeal circulation on erythrocyte morphogenesis. Erythrohistogram curve in a half of cases had an anomalous character and didn’t depend on hemoglobin level. The data obtained are indicative of disturbances in the central and peripheric links of erythron system due to the bone marrow hemopoiesis defect.

The aim of present work is to study low calcium dialysate influence on parathyroid function, mineral metabolism condition and bone metabolism in hemodialysis (HD) patients with adynamic bone disease. Diagnostics of osteopathy type was performed on the basis of noninvasive investigation methods, such as the definition of intact parathyroid hormone (PTH), phosphorus and calcium blood levels, markers of osteogenesis (bone fraction of alkaline phosphatase, osteocalcin) and resorptions (C-telopeptid of collagen of the 1st type - β-Crosslaps). 437 patients were examined. The decrease of intact PTH (less than 150 pg/ml) was revealed in 159 patients (36%). HD with low calcium dialysate (Ca2+ concentration - 1,25 mmol/l) was used during 12 months in 46 patients who had three or more symptoms and adynamic bone disease (ABD). The normalization of serum calcium was observed in 86% patients, these changes lead to an increase of intact PTH and following markers of bone remodeling. The optimal range of intact PTH was achieved in 61% cases. So, the correction of hypercalcaemia due to the negative balance of calcium during the dialysis session is able to make PTH secretion more active, treating inadequately low bone metabolism.

We aimed to study the type, the intensity and the reversibility of the peripheral nerves impairment in patients with chronic renal failure depending on its stage and the method of RRT. 63 patients with chronic renal failure were examined (21 predialytic patients, 28 patients treated by hemodialysis and 14 patients after kidney transplantation). 30 healthy volunteers made up the control group. Investigation included neurologist examination, electromyographic study of peroneus, tibialis and suralis nerves. We found out that electromyographic signs of neuropathy can be seen in the cases when the clinical manifestation of disease is not yet discovered. Sensor and autonomic nerve fibres where the first to suffer, the axonopathy dominated. The treatment of chronic renal failure reduces the polyneuropathy signs. This can be explained by uremic toxin elimination. The patients with kidney transplantation demonstrated the most significant regress of pathological changes.

The aim of the study was determining the nitric oxide (NO) concentration in blood plasma and urine in patients with chronic glomerulonephritis (CGN) and arterial hypertension (AH) at different stages of inflammatory process and different severity of tubulointerstitial component (TIC). Twenty five patients (18 males and 7 females, average age 39,2 ± 2,04 years) were surveyed. The mesangioproliferative GN was diagnosed in all patients, TIC was found in 20 patients. In all patients and 20 healthy donors plasma and urine NO concentration was determined by the method of Golikov et al. (2000). In CGN patients with AH syndrome NO increased. The highest blood NO level was found in patients with inactive form of disease, especially those with TIC (22,5 ± 1,9 and 31,3 ± 2,5 µM/l, respectively). Activation of CGN was accompanied by a moderate increase of NO level (16,5 ± 1,9 and 15,9 ± 2,1 µM/l). Excretion of NO with urea in inactive stage of disease was increased compared to its acute stage (10,2 ± 1,9 and 13,1 ± 1,9 µM/l, respectively). In CGN patients with TIC it was even higher (15,3 ± 2,8 µM/l). High blood level of NO is characteristic for inactive phase of CGN. TIC is a significant factor determining the NO balance between blood and urea in CGN patients.

Comparative research of effectiveness and standness of Polyoxidonium in complex therapy of chronic pyelonephritis’s aggravation in children showed that preparation possessed good clinical effectiveness, exerted immunopotentiating influence and led to the quicker standardization of urinal syndrome and functional state of kidneys. All this shorten the time of antibacterial therapy and patient’s stay in hospital.

The research has been carried out at the Khabarovsk Railroad hospital. Kidney pathology was studied in 27 children infected by Mycobacterium tuberculosis with light microscopy. Percutaneous kidney biopsies have been performed by an automatic pistol with disposable puncture needles (USA). All biopsies have been done with the help of ultrasound scanner «Aloka SSD-650» and the specially designed linear 3,5 MHz probe (Japan). Specific morphological changes in the kidneys were revealed. It was found that the grade of epithelium dystrophy, glomerular and interstitial sclerosis strongly depend on the duration of the infection.