The epidemiology study up to date has shown the increase in the urinary system pathology. Nephropathies are often in ecologicaly damaged regions and as a rule they start in the first months of life. Modern diagnostic approaches allow identification of the early stages of reflux-nephropathies in children. Steroid-resistant nephrotic syndrome in children has been observed more often than in previous 20 years. Mutation in genes encoding porocin and other proteins of podocites as well as mutation in the WT1 gene are the main reasons for steroid resistance in children with nephrotic syndrome. Alport syndrome is know and is often observed among hereditary nephropathies in children. Hereditary and congenital nephropathies account for the vast majority of cases of chronic renal failure in childhood now as it was 25 years ago.

Apoptopsis (programmed cell death) occurs normally for maintenance of a tissue homeostasis and plays an important role in morphogenesis, embryogenesis and tissue growth. On the other hand apoptosis may be involved in different pathological processes such as malignancy, infectious diseases and autoimmune disorders. Apoptosis is regulated by various mediators. Caspases, death receptors, mitochondria, Bcl-2 protooncogenes and tumor suppressor genes are considered to be the most important of them. Advances in apoptosis regulation research suggest new options for therapy of wide range of human pathologies.

Oxidative stress is a disbalance between oxidant and antioxidant systems in body. Many kidney diseases are accompanied by oxidative stress. In the present review (part II) we discuss relationship between oxidative stress, endothelial dysfunction, anemia and atherosclerosis. The impact of ACE-inhibitors, statins and vitamin E on oxidant and antioxidant status of patients with chronic kidney disease are consireted. An intensification of oxidative stress during replacement therapy is discussed.

The Cyclosporine-based therapy is the most used immunosupression in kidney transplantation. The efficacy of cyclosporine therapy has been improved by monitoring drug concentration. But routine trough level which is still widely used to guide dose adjustment correlates poorly with the total drug exposure and with clinical events in patients after kidney transplantation. The aim of the study was to compare two different schemes of CyA-monitoring (С0, С2 and C0 + C1 + C3), to correlate cyclosporine pharmacokinetics and both kidney graft function and pathology in long-term kidney transplant recipients. 123 CsA pharmacokinetic studies were performed in 83 recipients. The patients were divided into 4 groups: 1 - stable graft function (n = 28); 2 - chronic allograft nephropathy or glomerulonephritis (n = 25); 3 - late acute rejection (n = 12); 4 - chronic CsA nephrotoxicity (n = 18). The patients of all groups had approximately the same C0 level, but CsA exposure estimated from AUC and C2 single-point sample proved to be significantly different in the groups with late acute rejection and chronic CsA nephrotoxicity compared to patients with stable graft function. AUC measurement using a limited sample strategy (LSS) (0, 1 and 3 hours postdose) has been shown to be an accurate method of estimating AUC. From the single time point measurement the best correlation with AUC was found for C3 (r2 = 0,68) and C2 (r2 = 0,65).

Revealing the predictors of mortality allows one to choose the optimal treatment strategy of hemodialysis (HD) and to make a successful preventive interventions in patients before starting renal replacement therapy. The purpose of this study was to examine the influence of some clinical and laboratory parameters on survival in a group of incident HD patients. To search for risk predictors, a retrospective cohort study was performed with 213 hemodialysis nondiabetic patients. Duration of HD treatment varied from 3,5 to 60 month (median 27,4; interquartile range 15,6-38,1). During follow-up period of 479,2 person-years 43 patients died, 5-year survival was 68,6% and mortality rate was 9,0/100 patient-years. Kaplan-Meier analysis showed that age >55 years, serum albumin <35 g/l, Charlson Comorbidity Index ≥5, prevalent coronary heart disease and increased left ventricular mass index (LVMI) at the start of HD treatment are significant predictors of mortality. Analysis with the Cox model revealed that increasing of LVMI over normal value by more than 50% (RR 3,54, 95% CI 1,08-11,64) and the Charlson Comorbidity Index ≥5 (RR 3,59, 95% CI 1,19-10,84) are independent predictors of mortality.

Levels of serum intact parathormone (iPTH), alkaline phosphatase, osteocalcin, calcium and phosphorus were examined in 58 patients on continuous ambulatory peritoneal dialysis (12 male, 46 female, mean age 51,8 ± 11,3 years). Bone biopsy, DEXA and ultrasound densitometry were performed in 20 patients. The prevalence of different types of bone diseases found was as follows: adynamic bone disease (n = 16), mixed types of renal osteodystrophy (ROD, n = 20), hyperparathyroid bone disease (n = 22). Patients with secondary hyperparathyroidism was treated with calcitriol and 1a(OH)D3 in mean dose 3,8 ± 1,5 mkg/week, iPTH level decrease on 39,8%. Successful parathyroidectomy were performed in 2 patients. Literature data about modern treatment of ROD were discussed.

The results of 99 kidney transplant biopsies performed in Moscow research Institute of Transplantation and Artificial Organs and Moscow City Nephrological center (Municipal hospital № 52) are discussed. Indications for biopsy were graft dysfunction and/or proteinuria in all cases. Pathology findings were compared with cyclosporine A (CsA) pharmacokinetic profile (area under the curve, AUC) and sodium tubular transport measured by fractional lithium clearance (Cli/Ccr). Peripheral nodular arteriolohyalinosis was considered as main morphological marker of chronic CsA toxicity. There was statistically significant correlation between degree of peripheral nodular arteriolohyalinosis and AUC or Cli/Ccr. There was no correlation between degree of non-specific arteriolohyalinosis and AUC or Cli/Ccr. These results confirm the significance of peripheral nodular arteriolohyalinosis as marker of chronic CsA toxicity. The diagnosis of chronic CsA-nephropathy was extracted and validated from chronic allograft nephropathy diagnosis. CsA-nephropathy was present in 33,3% of transplant biopsies and was characterized by interstitial fibrosis, tubular atrophy and peripheral nodular arteriolohyalinosis morphologically, and by severe hypertension and moderate proteinuria clinically.

The aim of this study was to estimate mass of left ventricular (LVM) with the Devereux formula before and after hemodialysis and to compare two methods of indexation of LVM: LV mass/body surface area (g/m2) and LV/mass/height (g/m2,7). Thirty dialysis patients (17F, 13M, mean age 49 ± 11 years) who received bicarbonate HD for 4 hours 3 times a week were studied. M-mode echocardiography was performed and LVM was calculated by Devereux formula. Left ventricular mass index (LVMI) was calculated using two methods: LV mass/body surface area (g/m2) and LV mass/height (g/m2,7). All measures were performed an hour before and immediately after HD by one investigator. Criteria of left ventricular hypertrophy (g/m2 vs. g/m2,7) was detected in 27 (90%) and 28 (93%) patients, respectively. After hemodialysis ILVM was different from its initial level by -35,0% to +34,9% (percents from initial level) for g/m2 indexation and by -33,0% to +35,3% for g/m2,7 indexation. There was significant positive correlation (r = 0,97; p < 0,001) between ∆ILVM (g/m2) and ∆ILVM (g/m2,7). ∆ILVM (g/m2) and ∆ILVM (g/m2,7) were associated with dynamics of left ventricular end diastolic diameter (LVEDD). A positive correlation between ∆LVEDD and amount of ultrafiltration was found. The data show that LVM calculated by Devereux formula is different before and after hemodialysis session. There are no significant difference between indexation of LVM on body surface area (g/m2) or on height2,7 (g/m2,7).

We analyzed the results of 30 procedures of renal replacement therapy (RRT) in 17 patients with the syndrome of multiorgan failure and a high risk of bleeding in early postoperative period after heart surgery performed under cardiopulmonary bypass. Thirteen procedures of hemodialysis have been carried out without the use of systemic anticoagulation, 17 procedures were performed with the use of modified extracorporeal circuit. The analysis of laboratory and clinical indices revealed a marked coagulopathy, deficiency of АТ-III, thrombocytopenia and anemia. No complications related to the methods of anticoagulation and finished by premature stopping of performance of extracorporeal circuit or by life-threatening bleeding, were revealed. The analysis of the data allows one to recommend both methods for the conduction of RRT in patients with high risk of hemorrhagic complications.