Bone remodeling is a complex regulated process consisting of intercellular action of two cell lines: osteoblasts providing bone formation and osteoclasts critical cells for bone resorption. Cytokines and growth factors particularly interleukin-1, members of TNF-superfamily and TNF-receptor superfamily play an important role in this process. Emerging date on the genesis of bone remodeling are redefining our understanding of the mechanisms of bone damage. New observations regarding maneuvers that downregulate such injurious bone responses may direct further studies that develop new diagnostic and therapeutic modalities.

Oxidative stress is a disturbance of the balance between oxidants and anti-oxidant system. Oxidative stress accompanies many renal diseases. Here we review recent data about toxic oxygen radicals and related compounds. Oxygen radicals can modify macromolecules such as lipids, proteins and nucleic acids inducing damage of cells and tissues. Cell anti-oxidant system is reviewed. Pathological mechanisms of oxidative stress as well as clinical aspects of the problem are discussed.

The aim of the work was to assess prognostic importance of early correction of anaemia in patients with chronic renal failure (CRF) on haemodialysis (HD). 117 patients participated in the trial. Patients of group I had Hb level ≤80 g/l just before the dialysis. Patients of group II (control) had Hb level ≥100 g/l. Patients of group I did not receive epoetin in pre-dialysis stage of CRF. Forty (90%) of 44 patients of group II received epoetin in pre-dialysis stage of CRF (during 6-8 months). Most (94,5%) patients of group I received epoetin from the day of beginning of haemodyalisis and 88,6% patients of group II continued epoetin-therapy after it, respectively. Echocardiography was performed to all patients. Cardiovascular death rate in group I was twice higher than that in group II, inspite of a stable target Ht level by the end of 6th month. The main causes of mortality in group I were acute coronary syndrome, heart failure and arrhythmias. A longterm persistent anaemia in pre-dialysis patients doubles the risk of cardiac death during haemodyalisis treatment.

Fifteen children with steroid-dependent (SD) and frequently relapsing (FR) nephrotie syndrom (NS) were treated with levamisole (1,7-2,5 mg/kg/48 h) for 3 to 19 months. The duration of remission from the beginning of levamisole treatment, duration of remission after cancellation of levamisole and prednisolone, frequency of relapse before and after treatment, and cumulative dose of prednisolone during 6 months before and during immunomodulate therapy were estimated. Sighificant decrease in frequency of relapse and duration of remission was shown in children with FR NS levamisole compared to patients with SD NS. Our preliminary data suggest that levamisole is very efficient in children with FR NS.

Decreasing elasticity of arterial wall is common among the ERSD patients, that results in disturbance of damping arterial function, affects the hemodynamics and contributes in left ventricular (LV) hypertrophy, diastolic dysfunction, morbidity and mortality. Pulse wave velocity (PWV) is the integral parameter that reflects the elasticity of arteries. The aim of the study was to investigate the influence of eventual risk factors on the aortic compliance, as well as the impact of PWV on the patients survival. In prospective observation study we examine 157 pts. on maintenance hemodialysis, 77 fem. and 88 males, age 48,5 ± 0,97, dialysis vintage 45,0 ± 3,6 months. PWV was determined by original method on standard ultrasound device with 1 Doppler sensor, placed in aorta projection close to celiac trunk. PWV M ± Sd was 5,73 (med. 5,4) ± 1,7 (from 3,2 до 17 m/s). Calcium score (CS), DAP, Hb level, max Ca × PO4, EF и Ca max (м), Ca max, PO4, PTH (f). We found correlation between CS and PWW (r = 0,44, p < 0,05). In conclusion, PWV and Ve/Va (reflect the diastolic function of LV) were independent predictors of mortality in patients on maintenance hemodialysis.

Mycophenolate mofetil (MMF) is a potent immunosuppressant which can reduce an incidence of acute rejection in renal allograft recipients and slow progression of chronic allograft nephropathy (CAN). The aim of our study was to evaluate the effectiveness of MMF in acute transplant rejection and in treatment of CAN and to estimate the adverse effects. A group of renal transplant recipients (n = 47) receiving MMF (1,0-2,0 g/day) with cyclosporine A (CsA) and steroids during 6 months after transplantation was compared with a group (n = 47) taking triple immunosuppression protocol including azathioprine (Aza). Separate group of patients (n = 9) received MMF for treatment of CAN. Acute rejection rate was statistically lower in MMF group comparing with Aza group - 32,6% versus 57,45%, respectively, p = 0,022. In patients receiving MMF mean arterial pressure 12 months after transplantation was lower comparing with patients taking Aza - systolic pressure was 135,00 ± 2,57 mm Hg in MMF group versus 145,90 ± 2,00 mm Hg in Aza group, p = 0,001; diastolic pressure - 84,81 ± 1,95 mm Hg versus 91,03 ± 1,63 mm Hg, respectively, p = 0,017. Incidence of adverse effects was similar in both groups. Total rate of infection episodes (including urinary tract infections) was lower in MMF group than in Aza group - 72,3% versus 93,6%, respectively, p = 0,012. Using of MMF in renal transplant recipients with CAN decreased serum creatinine level and proteinuria. In 7 of 9 patients MMF improved or stabilized allograft function. To our mind, MMF is effective and safe drug to prevent of renal allograft acute rejection and to treat CAN.

Taking into consideration anatomical and physiological particularities of puerile organism, marked severity and rapid progress of multiorgan failure after cardiac and vascular surgery, the problem of indication and well-timed beginning of RRT becomes a key one and determines the results of treatment in children after cardiac and vascular surgery. The aim of this presentation was the determination of indications and the analysis of the effectiveness of postoperative RRT use in children after heart surgery. The PD method was of used in 139 children, among them - in 53 infants under 1 year of age. Extracorporal methods were used in 23 children, including 5 neonates. The patients’ age varied from 9 days to 16 years, the weight - from 2,9 to 48 kg. The course of early postoperative period in all patients was complicated by the development of MOF syndrome. The main indications for the beginning of PD were, above all, in the development of oligoanuria, hypervolemia, and edema syndrome with progressing cardiac and respiratory failure. After 4-5 days of complex intensive care, which included PD, we have noticed significant positive dynamics in clinical state of 66% of the children. The survival rate in the studied group was 37%, renal function was restored in all those patients. Negative daily fluid balance was achieved in 100% of cases with HDF use. Already during the first hours of the procedure we noticed a reliable decrease of the level of central venous pressure and PLA pressure within the limits of 10-15% with parallel increase of mean arterial pressure and LVEF; it allowed to decrease significantly the dosage of cardiotonics by the end of the procedure. In this study RRT allowed to stabilize the increase of azotemia and then - to decrease its level in all the patients. Mortality rate in the studied group of patients was 63%, with no lethal outcome being directly related to the complication of RRT and the progressing of renal failure and was most likely caused by the increase of other system dysfunction.