Kidney disease is a global public health problem that affects more than 750 million persons worldwide [1]. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden [2]. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries [3]. These disparities exist across the spectrum of kidney disease - from preventive efforts to curb development of acute kidney injury (AKI) or chronic kidney disease (CKD), to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy (RRT). World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.

Pulmonary hypertension (PH) is a complex pathophysiological and clinical phenomenon characterized by a progressive rise of the pulmonary artery pressure (PAP). The rise of PAP may lead to irreversible structural alterations in pulmonary vascular bed. The clinical manifestation of these alterations is severe, often irreversible, right ventricular failure. PH is widespread among patients suffering from advanced stages of chronic kidney disease (CKD), including those who receive renal replacement therapy (RRT). PH is an independent predictor of lethal outcomes and cardiovascular complications in the above-mentioned patient's population. Pathogenetic mechanisms of PH formation in patients on RRT are multiple and still are the subject of discussion. In some cases PH formation is directly associated with a variety of diseases, which are comorbid to dialysis-depended CKD or actually cause CKD itself. However, at the present time, the attention of the expert community is focused on the neurohumoral and hemodynamic patterns of PH formation connected both with specific features of CKD pathomorphosis and the impact of working arterio-venous fistula (AVF) on central hemodynamics. Updating hemodynamic aspects of PH formation in the patients with working AVF and elaborating evidence-based treatment and observational strategies are impossible without further identification of AVF influence per se on cardiovascular system of a given patient. The diagnostic approach to the evaluation of possible clinical scenarios includes serial echocardiographic examinations, right heart catheterization and the test of temporary AVF occlusion. All diagnostic manoeuvers must be provided by taking into account regular fluctuations of volume status of patient on long-term hemodialysis. The proper methodological evaluation of AVF's impact on PH formation will allow defining concrete treatment strategies in the range of vascular access reconstruction to change of RRT modality.

Introduction: many dialysis/CKD complications remain unsolved despite standard regimen intensifying. The most of studies of frequent dialysis evaluate the six times a week regimen. Aim: to evaluate the efficacy and safety of the four times a week dialysis regime. Method: transfer of a dialysis unit to the seven days per week schedule opens the possibility to increase the dialysis frequency up to four times a week for 15% of patients. The indications for transfer were: uncontrolled hypertension (HT) and hyperphosphatemia (HP), hemodynamic instability (HI). Results: eighteen patients have been treating four times per week during >6 months due to HT (6 cases), HP (7), HI (3), or its combination (4). The baseline HD/HDF duration was 52 (19÷81) month, age was 54±11 years; spKt/V was 1.49±0.24; 82% of patients had Hb >10 g/dl - similar to that in other patients in the center. In three months, blood pressure normalized in 12/12 (100%) of patients with baseline blood pressure >140/90 mmHg; hyperphosphatemia >1.78 (2.15±0.54) resolved in 11/12 (92%); hypotension - in 8/11 patients. The interdialytic weight gain decreased in 15/16 (94%) patients. No vascular access deterioration occurred despite 33% increase of fistula puncture frequency. No hypokalemia episode was registered (dialysate K+ was 2 mEq/l). No one refused more frequent mode. The Hb, ferritin and albumin levels were stable. In some patients with substantial phosphate decrease, the total calcium level increased (remained in target range). Thus, there were no adverse effects of more frequent dialysis during 6-12 months of follow-up. The increased dialysis frequency does not contradict to the current National Clinical Guidelines on (dialysis regimen no less than three times per week). Conclusion: four times a week regime is efficient and safe modality for patients with resistant hypertension, hyperphosphatemia, hemodynamic instability.

Membranous glomerulonephritis (MGN) is the most common glomerular disease leading to nephrotic syndrome in adults. MGN can be primary (idiopathic) or secondary to other diseases. The treatment of MGN can be pathogenic or symptomatic. Pathogenetic treatment is indicated to patients with iMGN or class 5 lupus nephritis and includes a wide range of drugs: corticosteroids, alkylating agents, cyclosporine, tacrolimus, mycophenolate mofetil, ACTH and newer substances, products of gene engineering, such as rituximab and eculizumab. The aim of this study was to evaluate the gender-specific differences in the disease course and to evaluate the effect of the therapeutic schemes in patients with biopsy-proven MGN. We studied 72 subjects with biopsy-proven MGN. The levels of proteinuria, total plasma protein, albumin and renal function were examined at the time of the diagnosis, in its course and at the end of the follow-up. These markers were compared to gender, age, comorbidities and different treatment regimens. We found statistically significant gender-related differences in the levels of proteinuria, total plasma protein and albumin. There was a difference in the full remission rates between genders, but no significant gender difference in the patients that reaching any remission and in the relapse rates. No difference was observed between patients receiving lower doses and high doses of Cyclophosphamide. The results of our study reveal that females have a more favorable disease course with lower proteinuria and a higher chance of reaching complete remission than males. Our data show that treatment with lower doses of Cyclophosphamide leads to equally good results in reducing proteinuria and achieving remission compared to high doses and pulse treatment is a valid option in the treatment algorithm of iMGN.

Introduction: the mixed cryoglobulinemia (MC) can develop at a number of infectious diseases, most often in patients with the persistent infection caused by the hepatitis C virus (HCV). Cryoglobulin proteins precipitate in microvascular bed and induce inflammatory and proliferative responses. Glomerular injury is the most serious complication of MC. The frequency of kidney involvement in patients co-infected with HIV and HCV remains to be studied. The aim of the research was to determine the incidence of MC associated chronic kidney disease (CKD) in patients co-infected with HIV and HCV. Methods: 76 HIV infected adult patients suffering from CKD with HIV/HCV coinfection (56 patients) and without signs of chronic viral hepatitis (20 patients) participated in the study. Results: the frequency of laboratory diagnosed MC was 39.5%. Among patients infected only with HIV, MC was found statistically less frequent than in HIV/HCV co-infected ones: 5.0% (1/20) vs. 51.8% (29/56), р<0.001. Logistic regression analysis has shown that the HCV co-infection was the only significant and independent factor for the development of MC - Exp(B)=0.046, 95% DI: 0.006-0.379, р=0.004. In patients with MC, glomerular damage was significantly more frequent manifested. Nephrotic and/or nephritic syndrome was found in 70% (21/30) of HIV infected patients vs. 22% (10/46) patients without MC (р<0.001). During follow up (1 to 25 months), 11 of HIV-infected (14%) died. There was no statistically significant association between MC and mortality in our cohort. Conclusions: frequency of mixed cryoglobulinemia is high in population of HIV-positive people. It is associated with symptoms of kidneys damage and co-infection with HCV.

Objective: to determine the incidence of AKI among survivors of the Department of surgery and intensive care of newborns and to determine the effect of asphyxia, the presence of heart disease, circulatory failure on the incidence of AKI in a group of children. Methods: a retrospective study of 314 patients who were treated in the neonatal surgery department in the period from 2006 to 2018 was performed. Patients were divided into groups according to the main diagnosis: gastroschisis, diaphragmatic hernia, omphalocele, pulmonary adenomatosis, esophageal, duodenal, small intestine atresia, VACTERL association. Criteria of exclusion: less than 2 biochemical blood tests for 48 hours or 7 days, lethal outcome. The gender of the child, birth weight, gestational age, the degree of asphyxia at birth, the presence of congenital heart disease, the degree of circulatory disorders, the degree of AKI, the day of life when AKI was detected, the day of life when surgery was performed. KDIGO neonatal classification criteria were used to determine the degree of AKI. Results: AKI was found in 93 (29.6%) newborns: AKI 1 in 66 newborns (21% of the total number of children in the study), AKI 2 in 23 (7.3%), AKI 3 in 4 (1.3%) cases. In most cases, AKI in patients with surgical pathology was detected on 2-3 day of life. We have found that low body weight and premature birth are AKI predictors in children with esophageal atresia. It has also been demonstrated that low body weight is a predictor of AKI in children with omphalocele.

The aim of the study: to assess the prevalence of protein-energy wasting (PEW) in haemodialysis patients (HD). Patients and methods: 645 patients receiving treatment with program bicarbonate HD for 8.4±5.3 years, including 345 women and 300 men, the average age was 56.8±12.8 years were examined. Nutritional status was assessed using the method recommended by the Ministry of Health of the Russian Federation (MHRF) (accounting form № 003/U), and the method proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). The nature of the change in appetite was determined by the Appetite and diet assessment tool (ADAT) and KDQOL-SF (version 1.3). Evaluation of the adequacy of the diet was performed using food diaries filled in by patients for 3 days. Results: a decrease in appetite was recorded in no more than 5% of patients, while these changes were of a persistent, lasting nature. Inadequate intake of essential nutrients, taking into account the recommendations of the ERBP, was found in 9.7% of patients, while inadequate intake of protein was noted. The prevalence of PEW estimated by the MHRF method was 75.3%, and 51.2% for the ISRNM method. No significant difference was found between the patient divided by groups depending on the patient age and the presence of PEW according to the MHRF method (χ2=7.072, p=0.069). Similar data were obtained for the ISRNM method of PEW diagnostics. Statistically significant differences were found between groups of patients with different duration of HD and the presence of PEW accessed by the MHRF method (χ2=22.580, p=0.0001). The prevalence of PEW accessed by the MHRF method increased with the HD duration (Rs=0.184, p=0.0001). Similar data were obtained for the ISRNM method. Conclusion: the prevalence of PEW in haemodialysis patients varies from 51.2 to 75.3%, depending on the method of diagnosis of PEW.

Aim: to describe clinical manifestations and outcomes in patients with Fabry disease (FD) and end-stage renal failure (ESRD) and to compare mortality in dialysis patients with FD and other kidney diseases. Methods: We recruited adult (over 18 years) patients with FD that was confirmed by enzymatic and genetic studies. ESRD was defined according to KDIGO guidelines (2012). Results: We studied 100 patients with FD. Thirty-three (32 males, 1 female) of them had ESRD. The median age of the ESRD patients was 44 (35.5; 51) years. ESRD occurred before other severe organ manifestations (e.g. stroke, clinically significant arrhythmia and cardioverter/pacemaker implantation) in 30 (90.9%) patients. The median age of initiation of renal replacement therapy (RRT) was 39 (32.5; 44.5) years. Eleven (33.3%) males died at the median age of 43 (37; 46) years. The most frequent cause of death was sudden cardiac death (n=9). Five patients received enzyme replacement therapy during 36 months (range 11-59 months). The duration of follow-up for dialysis FD patients was 149.1 person-years. Mortality rate was 7.38 (confidence interval 95% [CI] 7.33-7.42) per 100 person-years for FD patients. According to the Russian RRT Registry, mortality was 13.1 (CI 95% 11.9-14.3) per 100 person-years in diabetes patients, 5.4 (CI 95% 5.0-5.7) per 100 person-years in patients with chronic glomerulonephritis, and 4.8 (CI 95% 4.2-5.4) per 100 person-years in patients with polycystic kidney disease. Conclusion: ESRD occurred in 33% of patients with FD. High prevalence of ESRD could be explained by effect of the screening program for FD in Russian dialysis centers. Mortality in FD patients was lower than in patients with diabetic and hypertensive nephropathy, although higher than in patients with other causes of ESRD.

Fungal infections occur in 2.1% of cases of infectious complications after kidney transplantation. Invasive aspergillosis is second in frequency among fungal infections and the most often reason of mortality caused by complications of fungal etiology after kidney transplantation. More than 80% of cases of invasive aspergillosis were diagnosed during the first year after surgery. Due to the use of voriconazole, the mortality of patients in this group decreased from 40-70% to 19%. A clinical case of invasive aspergillosis in a child after kidney transplantation is presented. The time course of the patient's clinical condition is described: the development of severe leukopenia, the addition of obstructive pneumonia, the long-term persistence of tracheitis with outcome in stenosis. The immunosuppressive therapy was corrected depending on hematological disorders; tacrolimus dose was reduced significantly (in 10 times) while the patient was treated with voriconazole. The early differential diagnosis between inflammatory processes of viral, bacterial and fungal etiology in developing the systemic inflammatory response syndrome in the postoperative period allowed us to diagnose and treat this desease. A significant increase in the level of C-reactive protein with normal or slightly elevated values of procalcitonin may indicate the accession of an infection of fungal etiology.