The improvement of haemodialysis quality requires more long functioning of vascular access. We demonstrate, that the surgical method provides high efficiency of formation and supporting of permanent vascular access for haemodialysis. The application of additional methods (fistulography, duplex Doppler sonography) allows to diagnose the developement of complications of vascular access, that promotes their successful prophylaxis and correction.

Clinico-morphological characteristic of idiopathic focal segmental glomerulosclerosis/hyalinosis (FSGH) was investigated by histological, immunohystochemical and electron microscopy methods. Two stage of FSGH were devided. The first stage characterized by the predominantly lesion of juxtamedullar glomeruli with mild fibroplastic transformation (FT). Tubulointerstitial component (TC) was weakly expressed or absent. 53,2% cases were immunonegative, in 21,8% fixation IgM was detected. Activity index (AI) was 1,6 ± 0,6, sclerosis index (IS) - 3,7 ± 0,8. In 71,4% cases nephrotic syndrome was present. Second stage of FSGH was characterized by the lesion of juxtomedullar as well as medullar with high intensity of FT and TC. Immunonegative were only 7,7% of cases, fixation of IgM revealed in 73,1%. AI was 3,3 ± 0,8; IS - 10,6 ± 2,2. The nephrotic syndrome (34,3%), hypertonic (21,8%) and mixed form (34,3%) were detected. Decrease of glomerular filtration rate and concentrative function of kidney was found.

There is no consensus on the optimal therapeutic and prophylactic approach for thrombotic complications in nephrotic syndrome, so the investigation was performed to evaluate the efficacy and safety of low molecular weight heparin-fragmin in nephrotic children. Fragmin was given in prophylactic dose (2500-5000 ME/24 h once a day) for 3 weeks with measurement of anti Хa activity. There was no evidence of bleeding and/or thrombocytopenia at the time of treatment. In all patients fibrinogen level decreased after fragmin treatment. Prothrombin complex was in normal limits even if respiratory infection was developed with increasing of disease activity. This study demonstrates the efficacy and safety of fragmin in therapy of nephrotic syndrom in children in above-mentioned dose.

On the basis of a thoracic rheography is designed a non-invasive method of definition of «dry weight» for the patients on a programme hemodialysis (HD). The 50 patients with terminal renal failure on hemodialysis were studied. The changes of transthoracic impedance, koefficient of thoracic impedance (L2/Z), mass of body of the patients, parameters of a central hemodynamics in intradialysis period, before and after HD were investigated. 25 healthy persons was a control group. All surveyed patients regarding a koefficient of thoracic impedance were divided into 3 groups. The first group (10) included the patients, for whom L2/Z in intradialysis period did not differ from of healthy people and was 21,1 ± 0,5 sm2/om. The second group (30) included the patients, for whom L2/Z was higher 21,1 ± 0,5 sm2/om and on the average it was 31,1 ± 0,6 sm2/om in the group. The third group included the 10 patients, whom L2/Z was less than in control and on the average it was had 16,8 ± 0,7 sm2/om. Besides it turned out, that the faces the 3-rd group had reliably more often (on the average in 6,3 times p < 0,05) than the patients of the 1-st and 2 groups the cramps and sequences of a hypotension when carrying out HD. The analysis of changes of a koefficient of thoracic impedance shoved, that this parameter before and immediately after HD reliably decreased on the average by 19,6% (with 28,1 ± 1,6 up to 22,6 ± 1,3 sm2/om, p < 0,001) within the all surveyed patients. The high correlation (r = 0,81, p < 0,001) between alterations of body mass of the patients and L2/Z in reply to ultrafiltration (UF) was noted. The formula for calculation of optimum of a liquid offered, which one is necessary for removing during UF on a haemodialysis. Thus, the patients having koefficient of thoracic impedance more than 21,1 sm2/om, even in the absence of clinical exhibiting of a hyperhydratation, need to decrease «dry weight». For optimization of a regime of a ultrafiltration during a procedure HD the calculation of removed fluid can be conducted under the formula: ∆Н2О = 0,23 × (L2/Z - 21,1) + 1,9. The patients with a koefficient of thoracic impedance less than 21,1 sm2/om are in a state of dehydratation and need to increase «the dry mass of a body».

The purpose of the study was to examine the problem of non-compliance in 276 hemodialysis patients. We analyzed the reasons of non-compliance in Russian dialysis population. We found significant difference between non-compliant and compliant patients in age, quality of life (relying on SF-36) and blood pressure. Mortality risk of non-compliant patients was significantly higher compared with compliant patients.

To evaluate an efficacy of plasmapheresis in prevention of ischemia/reperfusion injury we compared the results of core needle byopsies in 32 patients, received plasmapheresis within first 4 hours after graft reperfusion with historic controls (32 patients transplanted before our investigation and 31 patients transplanted after the investigated group was completed). Statistically significant reduction in the incidence of chronic allograft nephropathy as well as signs of structural reconstruction of kidney tissue in acute rejection (arteriolar hyalinosis, intersticial fibrosis and tubular atrophy) in investigated group are demonstrated and discussed.