Experience gained during the treatment of 298 patients on peritoneal dialysis in Moscow Nephrological centre in the years 1995-2002 is analysed and compared with published reports. Peritoneal dialysis is an important component of renal replacement therapy. For first 5 years of therapy its efficiency is as high as that of hemodialysis. Modern renal replacement therapy involves a combination of different methods. Among them peritoneal dialysis is an optimal primary therapy which can be later followed by kidney transplantation or hemodialysis. Alternatively, hemodialysis patients with failed vascular access or significant cardiac failure could be effectively treated with peritoneal dialysis. Such combined approach enables us to increase significantly life expectation of patient with end stage kidney failure.

It is known that the ionic dialysance is equivalent to the blood water urea clearance. Thus, on-line Kt/V measurement can be a useful tool for verification of dialysis dose adequacy. The aim of this study was to verify the accuracy of the On-line Clearance Monitor device (OCM) with different dialysis membranes and its convenience in routine clinical work. Methods. 8 stable dialysis patients (4 M, 4 F, mean age 38 ± 2,2 years) were evaluated during 64 dialysis sessions with different membranes (Polysulfone Fresenius, Althane, Polysulfone Bellco, regenerated cellulose). OCM was incorporated into Fresenius 4008S dialysis machine. This device periodically varied inlet dialysate conductivity (CD) up and down by up to 17,5% from the setting value. The phase of change of CD lasts for a maximum of 60 sec. The CD variation was then followed by a phase of constant CD, and CD was measured at the dialysate inlet and outlet side. The total duration of the ionic dialysance measurement was approximately 11 min. After the measurement, the value of Kt/V is displayed. Blood urea samples were collected before and after each dialysis session (according to NKF-DOQI recommendation). Kt/V was calculated using the formula: Kt/V = -ln (R - 0,03) + (4 - 3,5 × R) × UF/W (Kt/V [Ur]). Results. Kt/V [Ur] was somewhat higher than Kt/V [OCM] in all cases, except for dialysis sessions with high ultrafiltration volume (9% of dry weight, N = 4). Mean Kt/V [OCM] was 1,195 ± 0,04; mean Kt/V [Ur] was 1,271 ± 0,04. The difference was not significant. There was high and significant correlation between these values (r = 0,96, р < 0,001). Kt/V determination was independent of dialyzer’s type. We can conclude that Fresenius OCM is a reliable, simple and inexpensive non-invasive tool for optimization of the dialysis program in usual clinical practice.

There was four-years multicenter study of the Sandimmun Neoral (Novartis Pharma, Switzerland) efficacy in nephrological departments of Moscow, Ekaterinburg, Samara, Novosibirsk (Russia) and Alma-Ata (Kazakhstan). One hundred and two children with NS were treated by unique protocol of using of Sandimmun Neoral. Fifty three patients had steroid-sensitive nephrotic syndome (SSNS), 49 children was steroid-resistant (SRNS). Kidney biopsy was produced in 20 children with SSNS and 31 with SRNS. Duration of the NS before the start of Sandimmun Neoral treatment was from 1 to 10 years. Maximal dose was 5 mg/kg/24 h. Maximal cyclosporin blood level was 150 ng/ml. High grade of efficacy of Sandimmun Neoral was shown as in children with SSNS as in patients suffered by SRNS. Positive effect was noted in different morphological variants of glomerulonephritis. It was shown the possibility to appear of cyclosporin-dependency in some children with NS.

We observed 38 patients to establish the possible influence of constitutional features (CF) on the course of progressing chronic glomerulonephritis (GN). The protocol of clinical test consisted in detailed anamnesis; physical examination with the account of constitutional features of patients; laboratory and instrumental tests. We compared clinical features of GN, degree of kidney injury, the response to therapy and manifistation of dyscrasic (DD), neuroarthritic (ND) and psoric diathesis (PD). CF involves two components: hereditary on three leading diatheses (DD1, ND1, PD1) and signes of diathesis during patient’s life up to the moment of examination (DD2, AD2, PD2). The analysis of individual variants of GN revealed that disease proceeds more favorably if reaction ability of psoric type was preserved and prevailed. We observed that chronic renal failure in GN patients occurred more lately if the reaction ability of neuroarthritic type was preserved. However, a prevalence of dyscrasic reactions increased the insufficiency of organ function, despite of active therapy.

The results of long-term observation of 267 patients with the various clinical and morphological types of primary glomerulonephritis debuted in childhood are discussed. The features of the course of the disease, interrelation between clinical types, morphological changes and survival of the patients are shown. The parameters influencing on survival rate in these patients are revealed.

Aim. Intradialytic hypotension remains a frequent complication of dialysis. The aim of this study was to estimate the relationship between diastolic dysfunction and intradialytic hypotension in chronic hemodialysis patients. Methods. Twenty dialysis patients (11 M, 9 F, mean age 49 ± 12 years) who receive 4 hours bicarbonate HD 3 times a week were studied. Causes of chronic renal failure were chronic glomerulonephritis (n = 9), essential hypertension (n = 9) and diabetes mellitus (n = 2). Twelve patients had chronic heart failure. Seventeen patients had arterial hypertension. M-mode echocardiography was performed and left ventricular mass index (LVMI), ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were detected. All measures were performed one hour before and immediately after HD by one investigator. Results. Left ventricular hypertrophy was detected in 18 patients. EF was lower than 45% in 2 patients. Average amount of ultrafiltration was 1,9 ± 1,2 (range 0,2-4,2) l. There was significant positive correlation between weight loss and ∆E (r = 0,58; p = 0,01), and we didn’t detect correlation between ∆E and intradialytic hypotension. Patients with intradialytic hypotension had higher DT than patients without IDH (231,2 ± 65,3 vs 175,0 ± 51,0 ms, respectively, p = 0,04). Conclusion. Intradialytic hypotension is associated with left ventricular hypertrophy with significant increase of early deceleration time.

The study of the effect of prenatal dexamethasone (DM) treatment on water-salt balance and renal function of offsprings of Wistar rats is presented. The newborn rats had decreased body weight during first 60 days of their live. The content of water, K+ and Na+ concentration in all tissue samples were significantly higher in the DM-treated rats than in control group. The same tendency (especially expressed in subcutaneous fat tissue and liver) was observed in pregnant dams. The renal response to water load in 60-70 days old DM-treated rats was characterised by a decrease in hydrouresis (especially in glomerular filtration rate) and by a sodium retention in comparison with control rats. The increase in the number of glomeruli has been revealed in 20-day old rats after prenatal DM-treatment. However dystrophic changes in their proximal and distal tubuli were found morphologically.

We have evaluated the character and peculiarities of urologic diseases in patients with nephrological diagnoses and marked out several groups of combinations: I group: nephrological masks of urologic diseases. Example: tumour of the kidney (haematuria) was primarely diagnosed as chronic glomerulonephritis. II group: combination of urological and nephrological diagnoses. Example: chronic glomerulonephritis combined with nephroptosis. III group: double combined process. Example: simultaneous coexistence of chronic glomerulonephritis with pyelonephritis and nephroptosis or - combination of chronic glomerulonephritis with pyelonephritis and nephrolithiasis. IV group: general diagnoses which cannot be considered as final and demand precise definition - pyeloectasia, hematuria of unclear genesis, purine metabolism disturbances, recurrent urinary pathways infection and others. V group: urologic and andrological complications of cytostatic or steroid therapy of nephrological diseases. Example: development of hemorrhagic cystitis, infertility in young men, pyelonephritis as an additional disorder. Selection of these groups provides us with better evaluation of combination of urological disturbances and peculiarities of simultaneous diseases in patients with nephrological diagnoses.

The diagnosis of pyelonephritis is based on the results of clinical manifestation and laboratory data. Therapy of children with pyelonephritis should be integrated. It should include broad-spectrum antibiotics and antioxidants, immunotherapy and phytotherapy.

An update for a diagnostic and treatment modalities of urinary tract infection in children is reviewed. On this basis, a unified treatment protocol is proposed.