Data from the registry for children with chronic renal failure (CRF) in Russia from 2000 to 2002 were analyzed. In 2000 information about 933 children at the age from 0 to 18 years was collected, in 2001 - 900 children, in 2002 - 966. The leading causes of CRF were urinary tract malformations, congenital and hereditary diseases. The prevalence of end-stage renal disease in 2000 was 2,17, in 2001 - 2,56, in 2002 - 2,42 cases per million of total population. The number of children younger than 5 years on the renal replacement therapy (RRT) increased. The proportion of peritoneal dialysis in the whole structure of the RRT increased from 7,5% to 16%.

The pharmacokinetics of recombinant human erythropoietin (Epo) was compared after single dose 100 U/kg intraperitoneal (IP), subcutaneous (SC) and intravenous (IV) administration in 30 noninfected patients on peritoneal dialysis. IP mode was used in 3 regimens: together with 2 liters of dialysate and into dried peritoneum with normal saline 50 ml (dwell time dry was 8 and 14 hours). Blood samples were collected during 48 hours, effluent dialysate from the first postdose exchange was selected to determine Epo recovery. Enzyme immunoassay was used for Epo analysis. Standard pharmacokinetics methods were employed for analysis of the serum Epo concentration. The area under the dosing-requirement curve for IP EPO into a dry peritoneum and bioavailability was larger than for SC administration (p<0,05). IP administration results the higher peak concentration in patients using a 14-hour dry dwell than in patients receiving EPO together with 2 liters and after SC dose, but lower than IV route. After IV administration EPO plasma concentrations half-life was least. The absorption of Epo administered by the IP route improves by extending the time of exposition in peritoneum (% dose recovered in first post-dose dialysate corresponded 76, 25,6 and 11,2 accordingly). In conclusion, the pharmacokinetics of Epo in a dry peritoneum suggests that this route may have potential clinical benefit.

The capability of HCV infection to induce glomerular damage and to compromise host immunity is well known. We’ve investigated the possibility to improve outcome in HCV-infected kidney allograft recipients by immunosupression tailoring, based on HCV features. Forty one cadaver kidney allograft recipients were followed up during 38,8 ± 15 months. Three-year patient and graft survival rates are 95% and 93%. Graft function, evolution of anti-HCV and HCV-RNA and liver function tests, as well as immunosupression change are analyzed and discussed. Evidence-based therapy tailoring leads to save and effective immunosupression management in kidney transplantation.

Aim. Development of the new circuit of treatment hyperlipidemia at nephrotic syndrome (NS) with use separately exogenous hypoxia and mevacor, and also their combined application. Materials and methods. Surveyed 51 patients with НС. The patients have divided into 4 groups depending on a kind of therapy (of hypobaric hypoxia training, mevacor, combination hypoxia with mevacor and control). The rate of treatment was equaled to 28 days. Results. At the end of research cholesterol authentically has decreased on 19% in I groups, on 18% in II groups and on 27% (р < 0,05) in III groups, where the combination of exogenous hypoxia training with mevacor was applied. Conclusion. The combination use of exogenous hypobaric hypoxia training and mevacor allow to achieve more expressed of hypolipidemic effect at NS.

Tuberculosis is a serious infectious complication after kidney transplantation. The aim of this study is to assess the incidence of tuberculosis in renal transplant recipients with the use of different protocols of immunosuppression, clinical features of tuberculosis, character of antituberculosis therapy and complications of treatment, outcomes of tuberculosis. Our retrospective study included 907 patients (1084 transplantations), who were transplanted from January 1987 to December 2003. We used 5 protocols of immunosuppression: in 28 patients - CsA 17 mg/kg + corticosteroids, CS (protocol I), in 366 - CsA 10-12 mg/kg + CS (II), in 210 - CsA 6 mg/kg + CS + Aza (III), in 310 - CsA 2-4 mg/kg + CS + Aza + ketoconazole (IV), in 80 - CsA 4 mg/kg + CS + MMF + ketoconazole (V). Tuberculosis developed in 27 (2,98%) patients. The mean patient age at transplantation was 37,1 ± 2,1 years. Median interval from transplantarion to development of tuberculosis was 869 days (range 14-3140 days). There were no differences in prevalence of tuberculosis in patients received different protocols of immunosuppression: 3,6% (I), 1,4% (II), 3,8% (III), 3,5% (IV), 2,5% (V), p = 0,201. Pulmonary tuberculosis was the most common form of the desease - 70,4%. Extrapulmonary forms developed in 7,4%. The total incidence of disseminated tuberculosis was 37,0%. Mortality rate from tuberculosis was 90,0% in patients with disseminated desease and 12,5% - with local tuberculosis. In 22,2% of patients the lung involvement was revealed only with X-ray CT. Survival rate of recipients with tuberculosis was higher on the treatment of 4-5 antituberculosis drugs. We observed hepatic dysfunction in 20% of patients treated with antituberculosis therapy, decrease of CsA blood level - in 95% of patients received rifampin. To our mind, an aggressive diagnostic approach and adequate treatment can improve outcome of tuberculosis in renal transplant recipients.

The study of pyelonephritis agent structure and their resistance in from children 175 Kazan’s depending on the di-sease form and age allowed us to approach differentially to the choice of antibacterial therapy and to recommend a scheme of children’s treatment taking into account leading position of Enterobacteriaceae on the first stage and peculiarities of age’s structure of agents on the second stage of therapy.

Aim. The aim of this study was to determinate the long-term renal prognosis of hemorrhagic fever with renal syndrome (HFRS) with severe acute renal failure (ARF) necessitating hemodialysis. Methods. Sixty-three patients (55M, 8F, mean age 32,1 ± 4,7 years) had severe acute renal failure due to HFRS, and were treated with intermittent hemodialysis. The diagnosis of hantavirus infection was confirmed by detection of elevated antibody titers to Hantaviruses in serum by indirect immunofluorescence. Duration of long-term observation after illness was 1-7 years. Results. The one (1,6%) patient was dead. 19 patients had arterial hypertension (і140 и 90 mmHg), and 4 (6,3%) had elevated serum creatinine concentration (189-423 µmol/l) at discharge from the hospital. 1-7 years after HFRS all the patients with elevated serum creatinine had decreased renal function (serum creatinine range 165-685 µmol/l) and had arterial hypertension. Conclusion. The long-term renal prognosis after hemorrhagic fever with renal syndrome with severe acute renal failure is not uniformly well. The development of chronic renal failure is possible.