Introduction: chronic kidney disease remains a major healthcare challenge, particularly in cases of endstage renal failure, where kidney transplantation is the most effective treatment. However, post-transplant complications – such as transplant pyelonephritis – significantly compromise graft function and potentially result graft loss. This study aimed to identify predictors of transplantectomy in patients hospitalized with allograft pyelonephritis and to develop a predictive model for assessing the risk of adverse outcomes.
Materials and Methods: a retrospective single-center study was conducted, analyzing 501 cases of pyelonephritis in transplanted kidneys in adult patients hospitalized between January 1, 2018, and June 30, 2024. Demographic, medical history, laboratory, and imaging data were collected, and patient outcomes were assessed. Logistic regression was applied to identify predictors of transplantectomy. The predictive performance of developed model was evaluated using receiver operating characteristic (ROC) analysis.
Results: transplantectomy was required in 5.8% of patients. Key predictors of graft removal included nonfunctioning graft (adds ratio, OR=13.647; p< 0.001), presence of urosepsis (OR=4.804; p=0.014), and the need for renal replacement therapy (OR=12.884; p=0.026). COnversely, the use of triple immunosuppressive therapy was identified as a protective factor (OR=0,140; p=0.003). The developed predictive model demonstrated strong associations between clinical factors and the risk transplantectomy, showing a reasonably good fit to the observed data (AUC=0.951; 95% CI: 0.920.98).
Discussion and Conclusion: the most significant predictors of transplantectomy were a nonfunctioning graft and systemic infectious complications such as urosepsis. The use of triple immunosuppressive therapy showed a protective effect, underscoring the importance of optimizing immunosuppressive regimens in transplant recipients. These findings provide a foundation for developing strategies to identify patients at high risk of graft loss early and to improve treatment outcomes. However, further validation through multicenter prospective studies is warranted to strengthen and generalize these results.

Aim: to describe the presentation of membranous nephropathy (MN) in patients with systemic vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA) against myeloperoxidase (MPO).
Methods: in this article we report the retrospective data of two patients with MPO-ANCA-positive microscopic polyangiitis (MPA) and biopsy proven MN. ANCA-associated vasculitis (AAV) was diagnosed in accordance with the 2012 Chapel Hill Consensus Conference definitions and the 2022 classification criteria for MPA. Kidney biopsy specimen processing included light and immunofluorescence microscopy.
Results: in both cases, the patients were male, the age of disease onset was 59 years (Patient 1) and 49 years (Patient 2). In Patient 1, the disease manifested with the interstitial lung lesions and nephritic syndrome, which was controlled by the administration of rituximab and glucocorticoids (GC). However, later the patient developed nephrotic syndrome refractory to therapy with calcineurin inhibitors, followed by nephritic syndrome. Remission was induced by cyclophosphamide and subsequent maintenance therapy with rituximab. A renal biopsy performed before the recurrence of nephritic syndrome revealed a picture of MN without evidence of extracapillary glomerulonephritis (ECGN). Patient 2 developed nephrotic syndrome at the disease onset, followed by the rapidly progressive glomerulonephritis and interstitial lung lesions which developed after unsuccessful therapy with calcineurin inhibitors and GC. Kidney biopsy revealed the co-existence of MN and necrotizing ECGN. Incomplete remission of the disease in the second case was achieved by treatment with cyclophosphamide followed by rituximab. Both patients had antibodies to MPO-ANCA and no antibodies to phospholipase A2 receptor (PLA2R) in circulation. In both cases, immunosuppressive therapy was complicated by the occurrence of infections, which resulted in the lethal outcome in Patient 1.
Conclusion: MPO-ANCA-associated MN is a rare variant of glomerular lesions in AAV, which may precede or develop simultaneously with the typical ECGN and manifest as a combination of nephrotic and nephritic syndrome and/or rapidly progressive glomerulonephritis.

Statin-associated muscle symptoms (SAMS) are among the most common side effects of statin therapy. Depending on the severity of muscle damage and the level of creatine phosphokinase (CPK), SAMS can be classified as myalgia, myopathy, myositis, myonecrosis or rhabdomyolysis. Rhabdomyolysis is a rare but severe adverse effect, characterized by non-traumatic muscle necrosis, clinically manifested by myalgia, myoglobinemia, mioglobinuria and, in some cases, by occurrence of acute kidney injury (AKI). While the mechanisms underlying SAMS are not fully understood, several risk factors have been identified – notably, drug interactions between statins and other medications metabolized by cytochrome P450 isoenzymes. This article presents a clinical case of drug-induced myopathy in a patient with focal segmental glomerulosclerosis (FSGS) and recent myocardial infarction (MI) who was treated with atorvastatin and cyclosporine. In July of 2023, a 67-year-old patient N., presented with full-blown nephrotic syndrome (NS), serum creatinine 100 µmol/L. Renal biopsy confirmed the diagnosis of FSGS. Secondary causes were ruled out, and the patient was started on prednisolone 80 mg/day, simvastatin 40 mg/day, and perindopril 2.5 mg/day. After two months, remission of the nephritis was achieved, and prednisolone was gradually tapered; by June of 2024, the dose was decreased to 12.5 mg/day. At this point a rise of proteinuria was observed, followed by the development of acute MI. Treatment was provided according to the clinical guidelines, including the initiation of atorvastatin 80 mg/day and an increase of prednisone in to 20 mg/day. One month later, the nephrotic syndrome relapsed. Pulse glucocorticoids (GC) therapy was administered, and prednisolone dose was increased to 45 mg/day, but without effect. Cyclosporine 200 mg/day was added. During this period, serum creatinine rose to 300 µmol/L, initially interpreted as a manifestation of cyclosporine toxicity, prompting a 50% was reduction. However, the patient subsequently developed progressive muscle weakness, leading to paresis in all extremities, along with marked elevation in CPK and serum myoglobin. Neurological causes were ruled out, and the was diagnosed as severe myopathy associated with combined use of atorvastatin and cyclosporine. Following discontinuation of these drugs, the patient's muscle strength improved, and serum CPK, myoglobin and creatinine levels normalized. Continued steroid monotherapy resulted in nephritis remission. To overcome steroid dependence and maintain remission, the initiation of rituximab is planned. To address the patient’s lipid metabolism disorders, the used of РCSK9 inhibitors is being considered.

The article reviews the updates introduced in the 2024 edition of the ISO 23500 standards (International Organization for Standardization), proving a historical overview of the evolution of this standard series. Originally published in 2019, the ISO 23500 series of standards was officially translated into Russian and approved as GOST R ISO 23500 15-2021.
The supplementary materials outline the requirements for dialysis water set in other regulatory documents, as well as technical specification for water treatment equipment. The article emphasizes that the storage phase of water for hemodialysis (WHD), alongside its production system, plays a critical role in maintaining WHD quality. It presents a detailed list of essential equipment components for dialysis water treatment systems. Additionally, the article discusses the role of medical purpose as a key criterion in classifying water treatment equipment as medical devices (MD). A two-tiered classification approach is proposed. The first type is compact units with easily replaceable consumables that do not require professional maintenance. These are suitable for home use or emergency dialysis situations, providing individual dialysis (considered medical device). The second type – large-scale engineering systems designed to supply more than two patients, ensuring continuous, high-volume delivery of WFD and requiring professional technical maintenance.