In the review authors discusses cardiorenal interactions in patients on renal replacement therapy (RRT), which are considered as a separate type of cardiorenal syndrome (CRS). Frequency and severity of CRS in patients on dialysis correlate with the number of years of the dialysis treatment; they depend on the quality of dialysis and the level of residual renal function. The RRT-associated cardiac pathology include left ventricular hypertrophy, ischemic cardiomyopathy, congestive heart failure, coronary atherosclerosis and calcinosis, severe arrhythmias. The article analyzes the role of such components as malnutrition and dialysis-induced cachexia, membrane biocompatibility, oxidative stress and inflammation, arterio-venous hemodialysis fistula, and a decrease in residual renal function in the development of dialysis-induced CRS. The review examines the mechanisms of progressive myocardial ischemia induced by dialysis: myocardial stunning, hemodialysis-induced hypotension, uremic disease of small blood vessel. Prevention of dialysis-induced CRS includes a choice of the optimal RRT method (peritoneal dialysis or hemodialysis), control of dialysis regime, residual renal function, biocompatibility of membrane, inflammatory markers, body mass index, serum level albumin, phosphate, calcium, parathyroid hormone, fibroblast growth factor-23. Electrocardiogram, ultrasonic monitoring and coronary angiography reveals indications for conservative cardio-protective therapy and angioplasty interventions, including coronary artery bypass surgery and cardiac pacemaker implantation, in patients with dialysis-induced CRS.

Aim: to study the function of endothelium in patients at the late period after kidney transplantation. Materials and methods: 79 kidney transplant recipients were included into the study. The levels of endothelin-I, C-reactive protein, inhibitor of activator of plasminogen-I, von Willebrand factor and capillary flow reserve estimated by laser Doppler flowmetry method were measured the in the group of patients with the glomerular filtration rate (GFR) below 60 ml/min and equal or higher than 60 ml/min. The GFR level was calculated by CKD-EPI method. Results: a statistically significant increase in the levels of endothelin-I (U (10;14)=35, р=0.04), C-reactive protein (U (52;27)=445, р=0.03), plasminogen activator inhibitor-1 (U (52;27)=56, р=0.004), the von Willebrand factor (U (17;9)=39.5, р=0.05) and decreased level of capillary flow reserve (U (22;24)= 111, р=0.001) were detected in the group of patients with the GRF below 60 ml/min compared to the second group. We found a significant correlation between the level of plasminogen activator inhibitor-1, von Willebrand factor, capillary flow reserve and glomerular filtration rate. Conclusion: at long-term after kidney transplantation, patients with GFR below 60 ml/min more often have endothelial dysfunction that those with higher GFR.

Aim of the study: to describe the features of perioperative management in patients with the end-stage renal disease who require surgical correction of cardiovascular pathology. Materials and methods: 20 patients with the ESRD at the age of 23 to 69 who received heart surgery assistance in the A.N. Bakulev Cardio-surgery center (NMRCCS) in years 2014 to 2017. The duration of program hemodialysis was from 2 months to 12 years. Three thirds 75 % of the patients had ischemic heart disease (IHD); other had heart valve pathology due to the progression of infective endocarditis (IE). Results: stenting of coronary arteries (CA) was performed in 14 of ischemic hard disease (IHD) patients; bypass grafting of CA was performed in 4 cases, transluminal balloon angioplasty (TBA) was performed in one case. Five patients underwent heart surgery interventions involving cardiopulmonary bypass (CB) in regard to the isolated valve pathology. Preoperative preparation procedures included correction of anemia, hypoalbuminemia, water balance, fluid and electrolyte balance disorders, normalization of arterial pressure and procedures of renal replacement therapy (RRT). "Open" heart surgery interventions were performed with combined anesthesia. Anesthesia tactics was aimed to maintaining of heart ejection, central hemodynamic parameters and volume status; ultrafiltration was applied to the patients with anuria. In the post-operative period patients underwent RRT after "open" heart surgery interventions, beginning from the second post-operative day, while patients after endovascular interventions - within the first hours after the operation. Nobody died during the observation. Conclusion: treatment of patients with the ESRD on program hemodialysis who need cardiac surgical interventions is a complex and difficult problem. However, the ESRD should not be considered as a contraindication for surgical intervention.

The purpose of this study is a comparative analysis of patients' satisfaction with the results of treatment at a regional dialysis center. Materials and methods. Based on the available information on this problem, a questionnaire was developed that characterizes the patients' opinion on the organization of medical care in the dialysis center. In the course of the research, the following methods were used: study and generalization of experience, analytical, statistical, sociological (questionary/interview). Results. Positive dynamics of patients' satisfaction with the work of the center and the conditions of stay and during the dialysis procedures were noted. A high score was awarded for a number of factors reflecting the quality and the level of medical services in the center, also an assessment of the satisfaction of attitudes towards the work of the and medical staff, the work of the registry, cloak room, availability of TV set, quality of toilets, availability of rest rooms after dialysis, information support with printed materials, allocated parking, quality of clothes for patients. Conclusion. The article outlines some directions for increasing the availability and quality of hemodialysis care in the Krasnoyarsk region, affecting the level of medical care in the dialysis center, depending on transport availability and other indicators.

Introduction: АА amyloid precursor is serum amyloid A protein, produced in response to the cytokine stimulation. The broad spectrum of the diseases with quite different etiology and pathogenesis may be eventually compicated by AA amyloidosis, in some cases these are rare diseases, presenting difficulties for diagnostics. Case presentation: we present three cases of systemic AA amyloidosis, illustrating the difficulties in diagnostics of the underlying diseases. AA amyloidosis complicated prolonged chronic inflammation in patients with Castleman’s disease, sclerosing angiomatoid nodular transformation of spleen (SANT), and cystic fibrosis. In all cases the disease had a prolonged course with persistent chronic inflammation, presenting with non-specific clinical features and highly elevated C-reactive protein level. AA amyloidosis diagnostics based on the gradual development of nephrotic syndrome with impaired kidney function was confirmed by histology. End stage of renal disease demanded hemodialysis, however, surgical removal of the source of inflammation and absence of other organs dysfunction gives an opportunity to offer kidney transplantation. Conclusions: nephrotic syndrome and impaired kidney function in patients with signs and symptoms of chronic inflammation, regardless of its known or unknown origin, provide the high suspicion index for AA amyloidosis. Pathology confirmation is crucial; however even in the absence of timely pathology diagnostics clinical judgment in some cases gives a guidance for work-up and treatment. Different etiology of chronic inflammatory conditions, leading to AA amyloidosis, demands multidisciplinary approach. Rarity of the described conditions leads to the substantial difficulties for diagnostics; therefore only collaboration between the representatives of different specialties ensures adequate diagnostics and successful treatment.

Transthyretin amyloidosis (ATTR) is a rare, progressing autosomal-dominant, systemic disease caused by the extracellular deposition of insoluble amyloid fibrils formed by mutated transthyretin (TTR) in various organs and tissues of the body: peripherical and autonomic nerves, heart and other organs. The development of ATTR is associated with at least 100 different transthyretin mutations, the substitution of methionine for valine at position 30 is the most common ATTR-associated mutation. Patients with the same mutation demonstrate a variety of clinical manifestations depending on the differences in environmental and genetic factors. The main clinical features of ATTR are progressive sensor-motor and autonomous polyneuropathy, damage of various organs and systems with a variety of clinical manifestations. Involvement of kidneys is manifested by impaired function and proteinuria. Microalbuminuria may be the first symptom of kidney damage, even before the onset of neuropathy. Since TTP is synthesized mainly in liver, liver transplantation has been considered as the main method of treatment for a long time. However new possibilities of drug therapy are now available. The absence of pathognomonic symptoms, clinical variability and unawareness of doctors about this disease lead to difficulties in diagnostics. Untimely diagnosis significantly worsens the prognosis and life quality. Here we present some literature data and clinical observation of familial TTR amyloidosis with kidney involvement found in three member of the same family.

Membranoproliferative glomerulonephritis is a term that is used for a number of glomerulopathies, which have similar light microscopy pictures, but differ in etiology, pathogenesis, immunohistochemical and ultrastructural changes in the renal parenchyma. Here we present a clinical case of a 16-year-old girl who had proteinuria when she 2.5 years old. She was diagnosed with chronic membranoproliferative glomerulonephritis with light microscopy at the age of 13. However, with later nephrobiopsy performed in our clinic with the use of a three-component morphological study allowed us to establish a rare histological manifestation of the disease, fibronectin glomerulopathy. Glomerulopathy with fibronectin deposits is a rare hereditary kidney disease, characterized by extensive deposition of fibronectin in the glomeruli, especially in mesangial regions and subendothelial zones. Refers to the group of glomerulopathies with the formation of microfibrils. Differential diagnosis between the fibrillary and immunotactoid glomerulopathies is necessary. The combination of electron microscopy and immunohistochemical data makes it possible to clarify the nature of the damage of renal tissue. So far, there are reliable methods for treatment of fibronectin glomerulopathy. The disease was reported as slowly progressing, leading to kidney failure in the most cases.