Tubulointerstitial changes are important factor of progression of chronic renal diseases. The pathogenesis of the tubulointerstitial injury includes the influx of inflammatory cells in the renal interstitium, interstitial scarring and tubular atrophy. Cytokines and growth factors play an important role in this process, in particular monocyte chemoattractant protein 1, transforming growth factor β. Resent data on the pathogenesis of tubulointerstitial changes provide new understanding of the mechanisms of the chronic kidney damage. New observations regarding maneuvers which downregulate such injurious renal responses may direct further studies to develop new diagnostic and therapeutic modalities.

During the last decade the percentage of living kidney donation has increased in most regions of the world. The potential of this important organ source in Russia is much larger than it has been realized so far. First results of the program of living-related kidney transplantation, established in 1999 in the Research Institute of Transplantology and Artificial Organs, Moscow are presented. We conclude that its short- and long-term outcome is much better than those after cadaveric kidney transplantation.

Chronic allograft nephropathy (CAN) is the major cause of late grafts loss. The aim of this study was to investigate the risk factors for CAN and the impact of some clinical and morphological factors in its progression. Acute rejection episodes and inadequate immunosuppression was a significant immunological risk factors of CAN. The nonspecific risk factors were renal graft disfunction on sixth months after transplantation, hypertension and proteinuria. Hypertension and blood creatinine level at time of biopsy were found out to be significant determinants of progression of CAN. There was a close correlation between hypertension and proteinuria, although the latter turned out to be secondary to hypertension. The degree of tubulo-interstitial sclerosis (TIS) and glomerulosclerosis were significant and independent factors which correlated with the rate of CAN progression. Chronic transplant glomerulopathy influence the progression of CAN only accompagnied by severe TIS.

To evaluate an efficacy of plasmapheresis in prevention of ischemia/reperfusion injury we compared the incidence of delayed graft function, as well as long-term results in 32 patients, received plasmapheresis within first 4 hours after graft reperfusion with historic controls (32 patients transplanted before starting of investigated group and 31 patients transplanted after the investigated group was completed). Graft function was considered as delayed if patient received at least two dialysis during first week after transplantation. To compare long term results, actuarial patient and graft survival were calculated and degree of serum creatinine rising was estimated (as micromol/liter/day). Significant reduction of delayed graft function and improved long-term results in investigated group are demonstrated and discussed.

We studied the influence of cyclosporine A (CyA) and cortticosteroids (CS) upon proximal and distal reabsorption of calcium (Ca) in recipients after kidney transplantation with satisfactory function of kidney allograft (56 recipients) and with sings of CyA nephrotoxicity (5 recipients, group 2). The ultrafiltrable Ca (CaUF) plasma level was normal in all recipients. 49 recipients (group 1) was administrated CyA, Cs and azathioprin, 7 (group 3) - Cs and azathioprin. We examined also 36 patients with bronchial asthma, who was administrated CS for a long time (group 4). Reabsorption of sodium (Na) and Ca was indicated by it’s excretory fraction (CNa/GFr and CCa/GFR), proximal tubular reabsorption of Ca - by it’s distal excretory fraction (CCa/CLi), distal gradient transport of Ca - by it’s distal excretory fraction of Na. Active tubular transport of Ca - by distal excretory fraction of Na. Active tubular transport of Ca we calculated by exponential curve with confidence intervals (p= 0,95) of dependence CCa/GFR upon CNa/GFR. Tubular reabsorption of Ca was increased in groups 1 and 2, but normal in group 3. Proximal tubular reabsorption of Ca was increased in group 1 in comparison with health, and in group 2 - in comparison with group 1, but it was normal in group 3. Distal tubular transport of Ca in groups 1,2 and 3 did not differ from population. Distal gradient Ca transport was equally decreased in comparison with health, but active transport - equally increased and did not differ from group 4. In conclusion: CyA influence upon proximal, but KS - distal tubular transport of CA.

The aim of this study is to determine the effects of the primary kidney disease and others factors including age and sex on the onset and progression rate of chronic renal insufficiency (CRI) as well as on the survival rate of hemodialysis patients. 1559 patients with CRI were observed. The age of 60% of them was 20-50 years. The primary kidney disease in 30,6% of patents was glomerulonephritis (GN), in 14,8% - pyelonephritis. In 15,5% of cases the primary kidney disease was unknown. 629 patients were treated with hemodialysis. The correlation between both the onset and progression rate of CRI and primary disease was found. The highest speed of progression was observed in patients with GN and it was the lowest in patients with policystic kidney disease. The CRI developed earlier in patients with nephritic and mixed type of GN when compared to patients with hypertonic and latent types of GN. The age, sex, urinary infections, surgical interventions and associated diseases were the major factors that affected survival of the patients. The life expectancy correlated directly with glomerular filtration and urinary sodium excretion and inversely to serum urea and creatinin level, as well as blood pressure. 5-year survival rate of hemodialysis patients was 82% in the group with pyelonephritis, 73% - in the group with glomerulonephritis, 63% - in the group with amyloidosis, 61% - in the group with hypertensive nephrosclerosis. 59% of hemodialysis patients with pyelonephritis and 40% with glomerulonephritis survived for 10 years. 5-year survival rate of young hemodialysis patients (below 50 years) was 82%, and 10-year survival rate in this group of patients was 50%. 5-year survival rate in the older group of hemodialysis patients (above 50 years) was 50%, their 10-year survival rate turned to be equal 6%. The ratio of male to female in the beginning of the hemodialysis treatment was 61:39, after 5 and 10 years of hemodialysis it was 63:37 and 66:34 respectevely.

For the last 10 years 189 from 207 chronic renal failure (CRF) patients have been successfully treated and showed considerable improvement due to the program haemodialysis at the Ulyanovsk Dialysis Centre. The dynamics of the heart function basic values and the haemodialysis effect upon the circulatory dynamic indices in 47 subjects aged 55-73 was studied to improve and enlarge the indications for the program haemodialysis treatment and to increase the life span of the CRF elderly patients. The age factor is stated not to contraindicate for CRF treatment. The myocardial diastolic and systolic dysfunction aggravated by the congestive heart failure and systolic dysfunction is developing practically in 100% of elderly patients, it casually being connected with the advancement of the secondary hyperparathyroidism.

Peculiarities of CHF development and its influence on the regional cerebral bloodflow in 47 patients older than 55 (range 55-73) were studied to increase the efficacy of haemodialysis treatment, its quality and prolongation of the life period in elderly ESRD patients. Multiple factors such as age, anemia, diabetes mellitus, IHD, hypoalbuminaemia, transformation of the left ventricular hypertrophy into dilatory cardiomyopathy are stated to effect upon the rise and progression of the congestive heart failure resulting systolic myocardial dysfunction. CHF development is an unfavorable factor to prognose the life span of the dialysis patients. Long-term treated by the program haemodialysis. Sufficient abnormalities of the circulation in cerebral vessels were revealed which cause the dyscirculatory encephalopathy and explain the rise of the orthostatic reaction following the haemodialysis procedure.