Chronic allograft nephropathy (CAN) is the major cause of the late graft loss. CAN is characterized by progressive arteriopathy, glomerulopathy, tubular atrophy and by interstitial fibrosis. Pharmacological inhibition of the renin-angiotensin system with angiotensin-converting enzyme inhibitors (ACEi) is considered now as the standard care of chronic renal disease. However efficacy of this therapy after kidney transplantation is much less investigated. The aim of the study was to determine the efficacy of ACEi enalapril for the prevention of CAN progression. Non-diabetic cadaveric kidney graft recipients (48 males, 17 females) with CAN were randomized to receive either 5-10 mg/day enalapril (33 patients) or placebo (32 patients) together with basic therapy with Ca-channel blockers, β-blockers and occasionally natriuretics. Average follow-up period was about two years. We found that enalapril is safe and effective in slowing down CAN progression and improving the kidney graft survival rate. Its combination with Сa-channel blockers and β-blockers provides the most effective antihypertensive treatment after kidney transplantation.

Background. C4d staining of peritubular capillaries is useful marker of antibody-mediated rejection in kidney transplant biopsies. However the usefulness of C4d-findings in native kidney biopsies have not been extensively studied. Methods. 81 biopsies from 80 patients with different pathology were stained by indirect IF method, using murine monoclonal anti-human C4d Ab (Quidel, Metro Biosystems). Results. Granular pattern of C4d deposition in glomeruli was detected in 4 of 4 lupus cases (2-class IV and 2-class V) and in 3 of 3 cases of idiopathic membranous nephropathy on periphery of capillary loops, possibly corresponding to deposits location. Linear staining of capillary loops and mesangium in all glomeruli was detected in 13 from 17 biopsies of FSGS cases, in 8 from 9 cases of IgM-nephropathy. Biopsies with minimal change disease were negative in 5 from 7 cases (two positive cases have only focal mild deposition of C4d). Most other cases show no significant C4d deposition in glomeruli - IgA-nephropathy (5 cases), myeloma kidney (2), amyloidosis (1), AIN (3), ATN (3), toxic nephropathies (3), diabetic nephropathy (2), pauciimmune crescentic GN (3), TBMD (3). Conclusion. C4d deposition in glomeruli in MGN was described earlier, but C4d deposition in FSGS cases is intriguing findings, which need further investigation. But preliminary results suggest that C4d glomerular staining could be useful marker for differential diagnosis between FSGS and MCD.

We evaluated a 12-month course of mycophenolate mofetil in 6 children with steroid-dependent and 6 children with steroid-resistant nephrotic syndrome. The treatment was effective in reducing of proteinuria in all patients except one with steroid-resistant nephrotic syndrome and in decreasing of maintenance dose of prednisolone in all patients with steroid-dependent nephrotic syndrome. The increasing of liver enzymes as an adverse effect was observed only in 1 patient.

In order to investigate the role of tumor necrosis factor-α and interferon-γ in pathogenesis of tubulointerstitial damage we examined 21 children with chronic glomerulonephritis. In all of them the blood levels of tumor necrosis factor-α and interferon-γ were measured by immunoenzyme assay and renal biopsy was made. We found dependence between the blood level of tumor necrosis factor-α and interferon-γ in children with chronic glomerulonephritis and the degree of the tubulointerstitial damage, was more important the role of these factors in the pathogenesis of tubulointerstitial changes in early period of diseases (on the stage of the influx of inflammatory cells in the renal interstitium).

Prevalence, clinical and laboratory features of acute glomerulonephritis (AGN) were analysed in 326 children and 177 adult patients observed during last 12 years in the nephrological clinic of Novosibirsk medical Academy. The age structure of surveyed shows that AGN often appears in children and teenagers. The predominant etiological factor of AGN in both children and adults is still streptococcal infection. The development of acute nephritic syndrome with imparement of kidney function was typical for children. Eclampsia was observed in 10,7% cases. Recovery rate from AGN in children was 87,1%. Long-term macrohematuria and moderate proteinuria are the factors that lead to chronic renal diseases.

A retrospective study includes 59 hemodialysis patients receiving EPO for treatment of the anaemia. 16 patients were added venofer (ferric saccharate). IV Iron has been shown to increase Hb levels in hemodialysis patients with both low and adequate ferritin levels and to have economic effect.

To optimize the approach to pharmacotherapy of hypertension in patients with end stage renal disease (ESRD) on maintenance hemodialysis and to reveal the influence on the quality of life by administration of modern hypotensive agents. Cardiohemodynamics was studied in 45 patients on maintenance hemodialysis against the background of the hypotensive therapy and the received data were compared with the data of the individual prospective examination of quality of life (QL) according to the SF-36 method. The patients including 20 women and 20 men were randomized into 2 groups. The patients of the I group were on the standard hypotensive therapy (Ca-antagonist and ACE-inhibitor), while patients of the II group also intake imidazoline receptors agonist (Physiotens, «Solvay Pharma», Germany) in addition to the standard therapy. Physiotens (mocsonidin) was administrated in a dose 0,2 mg once a day in the morning. The course of treatment was 24 weeks. Inquiry of the patients and laboratory measurements were repeated after 1, 3 and 6 months. In order to find any connections between QL and level of blood pressure we used in the out-patient hemodialysis center daily monitoring of the blood pressure; the patients were inquired three times according to the SF-36 method and the data of ECHO-CG were analyzed in the mentioned terms. Statistically significant changes were revealed by the sixth month of the treatment. It is noted the reliable improvement in examination of QL at the third month of the treatment, mainly due to psychical summary component (PSC). In conclusion, administration of the imidazoline receptors agonists in combination with other groups of hypotensive agents in patients with ESRD allows implementing individual approach to the pharmacotherapy of the hypertension syndrome, to reach the objective levels in blood pressure, improving correspondingly the quality of life in patients of the hemodialysis unit.

The results of the work of keeping the registry for children with chronic renal failure (CRF) in Russia in 2000 were analysed. CRF was diagnosed in 1238 children at the age from 0 to 18 years or in 2,17 children per million total population. 296 children received renal replacement therapy (RRT): 52% - hemodialysis, 9% - peritoneal dialysis (PD) and 39% - kidney transplantation. We paid attention at a very small group of children at the age before 5 years and a very small proportion of PD in the whole structure of RRT.

The purpose of the this work was to study the electrophoretic mobility (EM) of red blood cells in (RBS) 33 patients with chronic renal failure (CRF) as a parameter allowing to estimate an superficial electrical charge of RBS. All 33 patients with CRF are surveyed. Control group was made of 8 practically healthy donors. The anemia of hemodialysis patients was corrected by EPO resulting in the elimination of haemotransfusions, increasing in reticulocytes, Hb and Ht. The increase in reticulocytes became evident after the second or third dose, and Hb started to rise one week later. In spite of the decline of endogenous EPO, the reticulocyte count remains high, which would indicate improved conditions for stimulation of red cell progenitors, but the decrease of EM of RBC indicates a change in properties of RBC membranes.

Fifty one kidney transplantations performed in 38 children, who started the renal replacement therapy at the age before 10 years, were analyzed. The best outcome was found in patients, received the kidney from the donors of 20 years old and younger, maintained on dialysis not more then 6 months and having 0-1 DR mismatch. Any interference between weight and height of the child and further transplant outcome and graft function was not found.

Ketoconazole (Keto), an inhibitor of the cytochrome P-450 system, can reduce the cyclosporine (CsA) dose and the cost of treatment in renal transplant patients. In this study we evaluated possible metabolic consequences of Keto and CsA coadministration. A group of renal transplant recipients taking 100 mg/day Keto (n = 23) was compared with a control group not receiving Keto (n = 13) during three years aftertransplantation. Evaluation of all patients included graft function, liver function tests, bone status, control of CsA blood concentration, mean arterial pressure (MAP) and body weight (BW) monitoring. The initial CsA dose was 3,478 ± 0,102 mg/kg/day in the Keto group and 5,500 ± 0,196 mg/kg/day in the control, p < 0,001. CsA dose reduction was 70% at 6 months aftertransplantation in patients receiving Keto and only 26% in recipients without Keto. Graft function and frequency of rejection episodes was similar in both group. Serum bilirubin, albumin, ALT, GGTP, cholesterol, calcium, phosphorus, alkaline phosphatase, PTH and bone mineral density were no different between Keto group and No-Keto group. Fracture rate was lower in the Keto group comparing with control (0,0324 versus 0,0379 patient years). Keto did not influence negatively on MAP and BW changes. We conclude that long-term use of low dose Keto in CsA-treated renal transplant recipients is safe and cost-saving.