14-years expirience of treatment of patients with multiple myeloma (MM) complicated by renal failure is presented. Mean age of 40 patients was 57,6 ± 7,7. The predominant renal disease was myeloma nephropathy. Before diagnosing, MM 9 patients had chronic diffuse kidney lesion. Patients with double pathology (MM and uremia) were treated by both nephrologists and hematologists. The average life expectancy was 24,1 ± 12,1 months. Observed data showed the possibility of prolongation of patient’s survival when hemodialysis is applied. Some patients were given multiple polychemotherapy courses. Clinico-hematological remission was achieved and patients were socialy adapted.

To prevent reperfusion injury, 13 patients received plasmapheresis within first 4 hours after renal allograft reperfusion. Urine output during first 24 hours, percentage of patients with oligoanuria, number of hemodialysis after transplantation, time of blood creatinine level dropping below 3,0 mg% were estimated and compared with control (13 patients transplanted in other clinics with the pared kidneys from the same donors). We have found a significant reduction of the grafts with delayed function and faster function recovery in patients received plasmapheresis.

Based on the dynamic (between 1996 and 2001 years) study of the state statistical reports, the indices of general and primary morbidity as a consequence urinary tract diseases of children and teenagers living in the Orenburg region have been studied. Besides, the age and sexual peculiarities of disability among children and teenagers with urogenital system diseases have been studied. The comparative analysis of the obtained statistical information with the data averaged over whole Russia and the results of some epidemiological observations have been carried out. It should be paid attention that these general Russian data of the prevalence of childrens nephrologic morbidity are proved to be higher than those for the Orenburg region, but lower thats the results of our own observations in the children’s ambulatory where special nephrological service is established.

Aim of investigation: Assessment of the hyperphosphatemia (HP) as a cardiovascular risk factor in cronic renal failure (CRF) patients treated with haemodialysis. Material and Methods: We observed 125 patients treated with chronic HD during 6 months - 12 years. The patients were divided into 2 groups depending on the HP levels on HD treatment. HD was performed by standard procedure. Adequacy of dialysis was comparable in two groups. Survival analysis was performed by Kaplan-Meier method. Results: We found, that remaining HP in patients treated with HD is a fatal risk factor. 65% patients of the I group had an elevated calcium-phosphate product (Ca × Р > 70). Patients of the II group had a normal calcium-phosphate product (CPP) value. Number of the vitamin D recipients were larger in I group (38,3 vs 9,3). Calcification of the aortic valve, coronary vessels and peripheral soft tissues was determined in 35% of I group patients and only in 12,5% of the II group patients. Ischaemic heart disease (IHD) was diagnosed in I group of dialysis patients significantly more often. Same patients had significantly positive correlation between CPP and constriction extent of the common coronary artery. Arhythmias were registered in 26,8% of I group and only in 7% of II group. We found also direct significant correlation between hypertrophy of the left ventricular (LV) and HP levels. Development of the hypertrophic cardiomyopathy was main cause of the heart failure (HF) as well as IHD in observed patients. Conclusion: HP is an independent negative prognostic factor, increases progression of IHD, aggravates systolic hypertension and LV hypertrophy, increases arhythmias and also acute and overload HF risk. It is necessary to use elevated doses of CaCO3, intensification of dialysis regimen (increase Kt/V) for the HP prophylaxis. It is essential to monitor of the Ca × P product, iPTG levels, acid-base characteristics and to use new aluminium- and calcium-free phosphate binding agents and synthetic analogs of vitamin D2 for the metastasis calcification prophylaxis.

During 2 years the effects of continuous ambulatory peritoneal dialysis (CAPD) on serum lipids and lipoproteins in 46 uremic patients were studied. The concentrations of very low density lipoproteins (VLDL) cholesterol (CHOL), LDL CHOL, serum CHOL and serum triglycerides (TG) increased significantly. High density lipoprotein CHOL have been reduced. We examined the effects of simvastatin, an HMG-CoA reductase inhibitor, and lipanor (ciprofibrat) on lipoprotein parameters in 20 uremic patients treated with CAPD. The patients with elevated cholesterol (n = 10) were administrated with 5 mg/day simvastatin for 6 months, the patients with elevated triglycerids obtained lipanor 50 mg/day. Significant decrease in serum total lipid, TG, and CHOL levels were observed when compared to pretreatment values. Our results confirm the adverse effect of CAPD on serum lipids. We conclude that simvastatin and ciprofibrat effective to the management of dyslipidemia in uremic patients treated with CAPD.

Left ventricular hypertrophy (LVH) is an independent predictor of mortality in patients with chronic renal failure. In this paper authors review information about LVH and left ventricular geometry in patients with renal diseases and discuss the significance of electrocardiography and echocardiography in diagnostics of LVH. It’s necessary to perform electrocardiography in all chronic renal patients. However, there are not unified recommendations about echocardiography in patients with renal diseases. There is a personal authors opinion that echocardiography must be performed in all renal patients with clinical manifestations of chronic heart failure, and also pre-dialysis patients (candidates to replacement therapy or renal transplantation). In other renal patients echocardiography may be performed depending on clinical situation.

The development of malignant tumor of the kidney in patients with ACDK may be considered as a combination of urologic and nephrologic problems. We present a review of the literature together with 2 own observations in patients, in whom renal cancer has been developed as a progression of ACDK (0,3% from 681 patients treated in Department of Hemodialysis for 30 years). A man aged 35 with chronic glomerulonephritis at the end stage of renal failure. US examination revealed cystic kidney disease. There was no manifestations of cystic transformation of the other organs as well as no indications on congenital polycystic disease in this patient and his relatives. Cancer of the left kidney up to 3 cm. of inner diameter of the cyst was revealed in autopsy. In other cysts trabecular adenomas were found. This case evidences the difficulties in revealing of this form of renal cancer and its predisposition for multifocal growth. The second case was a man aged 42, with the same diagnosis - cancer of left kidney 7 × 5,5 × 4 cm combined with ACDK was revealed by US examination. Nephrectomy was performed. Macroscopical examination showed multiple small cysts outside the tumor and neoplastic masses in venous lumen. This case demonstrates the possibility of rapid growth and large volumes of tumors and intravenous invasion of renal cancer in patients with ACDK. Peculiarities of the treatment modalities in renal cancer relative to ACDK and hemodialysis are emphasized.

Clinical observations in which the development of herpetic infection, acute respiratory disease of viral nature as well as extrarenal tumour due to immune conflict resulted in acute interstitial nephritis with the development of acute renal insufficiency are described. In one of the cases, the development of clinical features of interstitial nephritis occurred prior to the general disease which led to the immune conflict. Early diagnostic of tubulointerstitial renal impairments and proper therapy determine the prognosis and progress of acute tubulointerstitial nephritis.