The aim of this study was to estimate the parathyroid cells proliferation rate according to the expression of Ki-67 antigen. We retrieved embedded tissue blocks of parathyroids removed at surgery from 14 dialysis patients. New sections were cut and examined for expression of Ki-67, a cell-cycle marker, using MIB-1 antibody with antigen retrieval, and tonsil or thymus as positive control. Using an eyepiece graticule with unbiased square-counting frame, positively labeled chief cells were counted and the prevalence of Ki-67 positive cells per 104 cells (label index or LI) was calculated. Label index converted to cell birth rate assuming that the duration of Ki-67 expression was 24 hours. With this assumption mean cell birth rate [%/year] and corresponding cell life span [years] were calculated (mean cell birth rate [%/year] = LI(10000) × 365/100000 × 100 = LI × 3,65; and cell life span [years] = 100/LI × 3,65). Our calculations confirmed the point that parathyroid cell growth is very slow. We suggest that it is reasonable to start the preventive treatment with phosphate- binders and calcitriol (1-alfa-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol) minimum for 8,3 years before the start of dialysis treatment.

Cytokines are considered to be the key factors in the mechanisms resposible for the different pathological processes. We investigated the blood level of two cytocines (TNF-β and IGF-1) in 45 children with chronic pyelonephritis. All the children were divided into four groups. The first group consisted of 13 children with acute pyelonephritis. The second group consisted of 7 children with an exacerbation of chronic pyelonephritis. The third group consisted of 13 patients with vesicoureteric reflux without any symptoms of active urinary tract infection. The patients of the fourth group (14 children) had the chronic non-obstructive pyelonephritis. The blood level of TNF-β and IGF-1 was estimated by means of DRG IGF-1 ELSA KIT and R&D TNF-β KIT. The blood level of both cytokines was the highest in the third group. It reached 131, 6 ± 4,7 pg/ml in this group and was significantly higher than in three others groups (p < 0,05). The IGF-1 blood level was the lowest in the first group. We suppose that the increase in TNF-β and IGF-1 blood level in children with vesicoureteric reflux may be connected mechanisms responsible for reflux nephropathy.

Pericarditis is one of severe complications in patients with advanced uraemia. The aim of this study was to investigate the haemostasis abnormality related with uraemic pericarditis. We observed 117 patients with endstage renal disease. In 67 of them uraemia was complicated with pericarditis. The increase in disseminated intravascular coagulation was found to be accomponied with pericarditis. In these cases the decrease of hypocoagulation, the severe fibrinolysis depression, the raise of trombin level and the decrease of plasma anticoagulation ability were observed. The investigation of effusion showed the low fibrinogen level in combination with low anticoagulation and fibrinolytic activity. We suppose that the haemostasis disorders may be one of the mechanisms responsible for the uraemic pericarditis.

We have compared the results of the treatment of uremic pericarditis in two groups of patients. The patients of the first group (n = 36) were treated with NSAID and corticosteroids. The patients of the second group (n = 31) received additionaly cryoplasma infusions and proteases inhibitors. The treatment in the second group proved to be more effective (p < 0,05). The patients whose treatment failed were operated.

Antihypertensive effect of felodipine (plendil) was studied in 14 kidney graft recipients (10 men, 4 woman) aged from 20 to 55 years. The mean time after kidney transplantation was 22±4 months. The creatinine plasma level was normal only in 4 recipients, while in 10 of them it ranged between 0,14-0,38 mmol/l. The blood pressure (BP) was not higher than 170/100 mm Hg only in four patients , but in ten others it reached 240-210/120 mm Hg. Before starting plendil the patients has been treated with the combination of nifedipine and β- blocker (propranolol). The indication for the plendil treatment was caused by the absence of its antihypertensive effect. Plendil caused the decrease of BP almost to normal level in 10 from 14 patients. So we have found felodipin as to be a very effective antihypertensive agent after kidney transplantation.

We observed a group of 718 kidney graft recipients (461 тen and 257 women, aged of 17-63 years) who had been operated in the Department of Chronic Hemodialysis and Kidney Transplantation of Moscow Region Research Institute since 1983 to 1998. The mean duration of the observation period was 41,3 months. Kaposi’s sarcoma appeared to be the most oftenly found malignant complication. It was seen in 15 cases and occured independently on the time after kidney transplantation and on the dosage of Cyclosporin A. We report here two cases of Kaposi’s sarcoma. In one of them a complicated course of disease with numerous visceral damages was shown. The second case illustrated the regression of Kaposi’s sarcoma after the decrease of immunosuppression.

Renal cystic diseases is a group of different diseases found in children quite often. Renal cysts is the common sign of these diseases, but they can be either of congenital, or genetic or aquired origin. In some cases it is only renal disease, in others - they are a symptom of multisystem pathology. The significant progress has recently been made in the understanding of the origin, mechanisms and diagnotics of renal cystic diseases. During the period 1967-1998 we observed renal cystic diseases in 47 patients aged from 1,7 to 16 years. In ten cases it was dysplastic renal disease, in eleven cases it was autosomal dominant polycystic kidney disease (ADPK) and in 16 patients it was autosomal recessive polycystic kidney disease (ARPK). The other patients had Fanconi nephronophtisis, renal cysts in tuberous sclerosis, a «sponge» kidney and the cystic diseаse which could not be differentiated. Diagnostics was made by means of ultrasound and radioraphy methods. In some cases renal biopsy was used. It was proved to be very important in cases of combination of dysplastic renal disease and glomerulonephritis wich was seen in some children. In this study we describe the typical clinical features of the dysplastic renal cystic disease, ADRK and ARPK. Their characteristic symptoms were mild or moderate proteinuria, renal tubular function’s impairment, physical retardation and osteoporosis. Arterial hypertension, anemia and polyuria were less common.

The residual-blood volume (RBV) of dialyzer is an issue in a lot of dialysis units. In this study the RBV after termination of dialysis treatment was determined by means of a spectrophotometric approach. The RVB obtained was then compared with visual score, which relied on common clinical practices. It was shown that a low visually rating score was not warrant a low blood residual remaining in a dialyzer after the rinseback. Even if the color of the dialyzer indicated a large RBV the true volume in most cases were very low for transparent membrane dialyzers.

Hemodialysis causes acute and long-term complications affecting patient’s morbidity and mortality. Dialysate-derived as well as membrane-derived factors may contribute to the appearance of these abnormalities. In this paper hypersensitivity reactions and long-term complications (malnutrition, dialysis-related amiloidosis) caused by bioincompatibility of dialysis membranes are briefly discussed.

Antineutrophil cytoplasmic antibodies (ANCA) are generally believed to be strongly associated with some primary systemic vasculitis (PSV), such as Wegeener’s granulomatosis (WG), microscopic polyangiitis (MPA), and Churg-Strauss syndrom (CSS), wich have some clinical manifestations in common and are ‘pauci-immune’ by immunohistology. This group of PVS has thus been termed ‘ANCA-associated vasculitis’ (AAV). By contrast, essential mixed cryoglobulinaemic vasculitis (EMC) are clinically heterogeneous and characterized immunologically by complement consumption and by immunocomplex depositions; they are also characteristically ANCA-negative. We report here on two SV-patients in whom the detection of cANCA (proteinase 3-ANCA in one case) in conjunction with glomerulonephritis and various extrarenal vasculitic lesions was suggestive of an AAV. However, demonstration of type II cryoglobulinaemia, and histological proof of immunocomplexes in the glomerulus led to the diagnosis of an EMC, which was associated with hepatitis C virus (HCV) infection in one of the cases. Against the setting of ‘false positive’ cANCA in EMC, we discuss the differential diagnostic steps as well as current differential therapeutic approaches.

We report here the case of Waldenstrom’s Macroglobulinaemia ( MW) complicated with mesangioproliferative glomerulonephritis (MPGN) which appeared in a woman of 76 years old. The main clinical features of the disease were nephrotic syndrom associated with vasculitis. The blood immunochemistry revealed a monoclonal secretion of IgM. The changes typical for MPGN were observed in kidney biopsy. We suppose that MPGN was caused by the deposition on the GBM of immune complexes containing the antibody against monoclonal IgM.