Mycophenolate mofetil (MMF), a MPA prodrug, has been shown to be an effective immunosuppressant in transplant therapy. Clinical trials in renal transplant recipients have demonstrated that MMF therapy can reduce the incidence of acute rejection episodes and improve graft survival. However MMF optimal therapy may be limited by associated side effects, in particular gastrointestinal (GI) toxicity, which may occur in 1/3 of patients. Dose changes due to GI side effects may lead to sub-therapeutic dosing and impaired clinical outcomes. GI complications were found to have detrimental effects on long-term graft survival: four-year graft survival was reduced to 70,2% in those patients with GI complications who discontinued MMF therapy. A new formulation delivering MPA - enteric-coated mycophenolate sodium (myfortic®) - has been developed to improve MPA-related upper GI adverse events. Myfortic® has demonstrated a comparable efficacy and safety profile to MMF in de novo and maintenance patients as well as the trend to lower incidence of dose changes due to GI adverse events.

Renal tubular reabsorption of phosphate (TmP/GFR) was reduced in 375 recipients with good renal allograft function and in 36 patients with exogenous hypercorticoidism (bronchial asthma). Among them 161 recipients received CyA along with azathioprin and corticosteroids that was received by all allograft recipients. TmP/GFR was decreased in the allograft recipient compared to patients with normal PTH level (p < 0,01) and in recipients with reduced Na reabsorption compared to those with normal Na reabsorption (p < 0,05). The TmP/GFR level was increased in patients with hypercorticoidism comparted to that in kidney allograft recipients. There was no difference in TmP/GFR between recipients treated and not treated with CyA. A negative correlation was found between TmP/FGR and PHT, CNs/FGR and CLi/FGR (p < 0,01). Partial correlation estimation showed that TmP/GFR correlates with CNa/GFR and CLi/GFR at constant PTH and correlates with PTH at constant CNa/GFR and CLi/GFR. In patients with normal PTH and Can/GFR, the TmP/GFR level was reduced in allograft patients rather than in those with hypercorticoidism. Conclusion: hypercorticoidism, hyperparathyroidism, reduced Na reabsorption and possibly phosphatonin reduce phosphate reabsorption after kidney transplantation.

The purpose of this study was to extend current knowledge about ureamic encephalopathy and to develop additional diagnostic criteria for evaluation of its degree. Sixty patients with chronic kidney disease (CKD) were examined during renal replacement therapy as well as in the predialysis stage (CKD-IV). For evaluation of brain function, electroencephalography, auditory event-related potentials P-300 and spectral analysis of variability of heart rate have been used. Preferential and early involvement of some structures in hypothalamic area in pathological process was revealed. The study demonstrates the natural course and changes in electrophysiological parameters in progressive ureamic encephalopathy. New criteria for objective evaluation of the degree of disturbances have been introduced.

The aim of this study was to evaluate the health state and renal functions in children living in the areas with highly mineralized drinking water. The total sickness rate as well as extending medical and physiological examination was performed in 13-15-years-old children in two control (Iskitim and Pavlovsk) and two experimental (Kujbishev and Blagoveschenka) Novosibirsk and Altai regions. Drinking water in experimental areas was highly mineralized, hard, and contained high concentration of sodium and potassium salts. In control areas water met hygiene requirements. It has been found that in experimental areas the total sickness rate was significantly higher than in control. The children using highly mineralized water had inadequate renal response to water load, the hypertonic type of cardio-vascular response on physical load, and retarded physical development.

Aim. The frequency distribution of gene polymorphism of angiotensin-converting enzyme (АCE) and its correlation with ACE activity in kyrgyz population with glomerulonephritis (GN) were studied. Material and methods. 48 GN patients 34,08 ± 1,9 years old and 48 healthy subjects were studied. A polymorphic site of ACE gene was amplified using polymerize chain reaction (PCR). ACE concentration and its activity were defined spectrofluorimetrically. Results. The distribution of genotypes II, ID and DD of ACE gene among the patients with GN and in control group corresponded to the Hardi-Wainberg distribution: II - 20,8% (n = 10), ID - 66,7% (n = 32), DD - 12,5% (n = 6), allele I - 54,1%, allele D - 45,9% in patients with GN, and II - 33,3% (n = 16), ID - 52,1% (n = 25), DD - 14,6% (n = 7), allele I - 59,3%, allele D - 40,7% in control group. However, no significant difference in frequency of genotypes and alleles in the specified groups was revealed (χ2 = 2,3; p > 0,05). The average values of АCE activity (ng/ml) in the patients with GN for each of genotypes II, ID and DD were 25,05 ± 3,38, 31,81 ± 2,28 and 41,25 ± 5,65, respectively. Their average value in control group was 23,68 ± 0,99, 31,4 ± 1,73 and 38,06 ± 4,45, respectively. Thus, АCE activity in patients with GN was much higher at DD-genotype in comparison with II-genotype (р < 0,02). In control group the АCE activity was much higher in the subjects with DD-genotype compared to that in patients with II-genotype and ID-genotype (р < 0,02). The total cholesterol level in patients with GN with DD-genotype (7,74 ± 1,16 mmol/l) was significantly higher than in patients with II- (4,69 ± 0,36 mmol/l) and ID- (5,09 ± 0,36 mmol/l) genotypes (р < 0,05). Conclusion. Development of CGN doesn’t associate with ACE gene polymorphism in kyrgyz population. At the same time activity of ACE is much higher at the patients with CGN and in healthy persons with genotype DD. It’s related with higher concentration of cholesterol in the serum.

Urinary tract infection (UTI) is often complication after renal transplantation (RT). The aim of the study was to assess the frequency and clinical features of UTI in patients with renal graft (RG), risk factors and bacterial agents of UTI, influence of urinary infections on a survival rate of the recipients and RG. 1169 recipients of RG were included in retrospective study. More precisely UTI in 134 patients after RT were studied. The frequency of UTI was 53,7%. The majority of the patients (60,5%) had this complication during the first month after operation. The incidence of UTI depends on immunosuppression protocol: UTI were observed more often in patients with high doses of corticosteroids (CS) and azathioprin and high doses of cyclosporine A (CsA) with CS in comparison with triple immunosuppression. The frequency of UTI was significantly higher in the patients with urological diseases of native kidneys and urological complications after RT. UTI did not influence on survival rate of RG, but had essential negative influence on 2- and 3-year’s survival of the recipients. The analysis of sensitivity to antibacterial drugs has revealed the presence of bacterial agent species, resistant to many antibiotics, including cephalosporins of III and IV generation and carbapenems. The prophylactic therapy after a course of antibacterial treatment has allowed to lower frequency of relapses during the first 6 months and average duration of hospital treatment within one year.

The purpose of the work was to study the efficiency of rEPO therapy («Eprex») in haemodialysis patients with chronic renal failure (CRF). Patients were subdivided into three groups: group I included patients with CRF, group II included patients with CRF and oncohaematologic diseases, group III was the control group. The treatment was carried out up to 6 months. Patients of group I achieved and maintained hemoglobin (Hb) level of at least 120 g/dl. As expected, Hb level increased in group II, but did not change in the control group. The «Eprex» therapy was associated with significant increase in Hb and decrease in transfusion requirements. Recent studies have confirmed that anemia correction in patients with CRF may slow down the progression of heart failure and improve quality of life.

Primary bladder stones (PBS), once very frequent in children, almost disappeared in developed countries. Although the same trend is observed in Armenian children, PBS is still an important group. Data from 198 patients with urolithiasis admitted to Arabkir Medical Centre in years 1992-2002 was evaluated. 18 of them with vesical stones were considered to have PBS because of large size and the absence of lithiasis or gross abnormalities of the upper urinary tract. Patients with PBS were considerably younger than those with renal stones. There was a clear male preponderance in both groups of patients. PBS were composed of calcium oxalate (72%), uric acid (22%) and ammonium acid urate (6%) as revealed by infrared spectroscopy. All stones were removed by open surgery. Recurrence of urolithiasis was not seen even in a single case of PBS during 10 year follow-up period.

32 patients with mixed form of chronic glomerulonephritis were examined during periods of high activity of nephritis and periods of remission achieved by active therapy. All patients were divided into 2 groups according to renal function: kidney function of 13 patients wasn’t compromised; 19 patients had I stage of CRF diagnosed. To reveal structure peculiarities of thrombocyte’s receptor thrombocyte aggregation inducted by various types of lectins at different stages of nephritis was determined. At periods of high activity of nephritis irrespective of kidney function, a significant reduction of speed, degree and time of thrombocyte aggregation was determined while adding Con A. This may testify low content of mannospecific carbohydrate residues. When patients without CRF were brought into remission, the increase in speed and degree of thrombocyte aggregation was revealed, which seemingly was caused by the restoration of quantity of mannospecific carbohydrate residues. Determination of speed and degree of thrombocyte aggregation inducted by Con A can serve as activity marker of chronic glomerulonephritis.

The Denys-Drash and Frasier syndrome are primary genetic diseases with an early debut of the nephrotic syndrome in children with male pseudohermaphroditism and a mutation in gene WT1 (a gene of Wilms’tumour). A half of patients with the Denys-Drash syndrome has a Wilms tumour. All patients develop chronic renal failure. The therapy of nephrotic syndrome should eliminate steroid and cytostatic therapy. Polymorphism of clinical features and the genetic characteristic of the Denys-Drash and Frasier syndromes is presented, criteria of diagnostics and optimal tactic of treatment are offered.

We analyzed the results of 80 cases of renal replacement therapy (RRT) in 35 patients with POF syndrome and high risk of bleeding in early postoperative period after open-heart surgery. We studied different methods of coagulation depending on initial degree of coagulopathy, thrombocytopenia and anemia in three groups of patients: with the use of systemic anticoagulation with heparin (3-5 U/kg/hour), low-molecular heparins (0,5 mg/kg) and regional anticoagulation with heparin and protamine sulfate (1:1). We revealed the feasibility and the usefulness of the use of all three methods of anticoagulation during RRT on the condition of differentiated approach and justified choice of methods in patients with high risk of bleeding after cardiac surgery.