The second part of the report of the Russian Renal Replacement Therapy Registry contains detailed data about demography and etiology of end-stage renal disease, comorbidities, as well as treatment patterns, key quality indicators, mortality and survival in patients have been receiving RRT in Russian Federation from 1998 to 2013. For patients treated by hemodialysis and peritoneal dialysis, we analyzed changes in dialysis dose, blood pressure, body mass index, serum albumin, hemoglobin, total cholesterol, total calcium, serum phosphates and parathyroid hormone over the considered period. Special attention was dedicated to the analysis of inter-relationships between aforementioned parameters, especially the influence of Kt/V on clinical and laboratory values. We also analyzed prescribed antihypertensive medications, formulations of iron medications, erythropoiesis stimulating agents, drugs for treatment of mineral and bone disorders, and dislipoproteinemia. For patients with functioning kidney graft we evaluated the estimated glomerular filtration rate, as well as immunosuppressive and antiviral therapy. Along with detailed data on quantitative and qualitative parameters the current report contains practical recommendations for improving patient care and outcomes.

The body is a single entity, and many interconnected systems are working together, creating and maintaining homeostasis. Normal pH of blood plasma and extracellular fluid are sustained in very narrow limits, providing optimal conditions for normal functioning of the body. There are several buffer systems, maintaining acid-base balance. Depending on the base, buffer systems can be divided into three main groups: bicarbonate, phosphate and protein. The restoration of exhausted buffer systems includes numerous physiological mechanisms: fast-acting - lungs and the hemoglobin; and long-acting - kidneys and liver. Proximal tubule of the renal nephron reabsorbs by isoosmotic transport up to 70% pre-filtered bicarbonate. Acidification of the urine (removal of hydrogen ion from the body) occurs in the distal nephron and collecting tubes mainly due to the work of countercurrent-multiplying system of the kidney. The etiology of acidosis and alkalosis can be renal and extrarenal, but under any condition the kidneys bear most of the work on the restoration of the acid-base balance.

Diagnosis of ischemic renal disease is based on the identification of “hemodynamically significant” renal artery stenosis. Proposed criteria of hemodynamic significance of stenosis vary according to different authors. In order to optimize the criteria for early diagnosis of ischemic nephropathy clinical and laboratory structural and functional parameters of the kidneys in patients with varying degrees of atherosclerotic renal artery stenosis: 50-70% and >70% were studied. In a study of 257 patients with coronary heart disease with disease duration 10.0±1.2 years revealed 57 patients with ischemic nephropathy (22.2%). For ischemic nephropathy that is characterized by latent progressive course, the early decline in the relative density of urine, lack of significant proteinuria and pathological changes in the urinary sediment. The patients were divided into two groups depending on the degree of renal artery stenosis: 50-70% of the lumen and >70%. In both groups there were no clinical manifestations of ischemic nephropathy, except for hypertension; were reduced compared to patients without renal artery stenosis, glomerular filtration rate and the relative density of urine; reduced volume of the kidneys and increased kidney echogenicity without significant differences between the groups. In accordance with the findings, renal artery stenosis from 50% to 70% is hemodynamically significant and can serve as diagnostic criterion of ischemic nephropathy.

Aim of the study: we investigated the influence of the new (adaptive) regime of peritoneal dialysis (ARPD): two short dwell times (3 hours) and two long dwell times (9 hours) on the transport properties of the peritoneum and adequacy treatment. Material and methods: this study was a randomized, open, prospective, comparative and local. Ninety patients were studied: 45 patients had their treatment with ARPD and 45 patients received a standard treatment with SRPD for 6 months. We measured peritoneal KT/V urea, volume ultrafiltration (UF), D/Pcreat, and removal of sodium through the peritoneum. Those parameters were monitored every 3 months. Eighty patients out of 90 randomized completed the study. Results. KT/Vurea in patients on both regimens did not change significantly. UF in the group on ARPD remained unchanged, while UF in patients on SRPD substantially reduced from 1.37±0.5 to 1.21±0.4l (p<0.05). D/Pcreat increased from 0.74±0.04 to 0.78±0.4 (p<0.05) in patients on SRPD after 6 months, but did not change in patients on ARPD. Sodium removal in patients on ARPD was much higher (151.9 ±53.0 mmol/24h) than in the group on SRPD 88.48±42 mmol/24h (p<0.05). After 6 months BP did not change greatly in patients on ARPD, whereas systolic and diastolic BP increased substantially in patients on SRPD (from 129.1±15.5 to 132.14±14.5 mmHg; from 75.57±9.7 to 79.6±8.0 mmHg, respectively). Conclusion: the application of ARPD reduces the negative effects of dialysis solution on peritoneum. The highest removal of sodium in patients on ARPD rather than on SRPD can explain the changes in BP, ARPD allows patients to use daytime (without changes) for their better rehabilitation.

Kidney transplantation (KT) is the best method of renal replacement therapy. The aim of the study was to identify factors associated with the condition of patients before transplantation to predict outcomes of kidney transplantation. Materials and methods: retrospective analysis was undertaken in cohort of 350 renal transplant recipients: 229 men (65.4%) and 121 women (34.6%). Average patient age was 37.07±0.57 years. The period after operation ranged from 1 day up to 30 years. The following KT outcomes were studied: status of patient (alive or not), the status of renal allograft (functioning or not), the development of chronic transplant nephropathy (CTN). The main methods of statistics were descriptive statistics, correlation analysis methods (Pearson, Kendall, Spearman criteria), survival (Wilcoxon-Gehan, Kaplan-Meier). SPSS 16 software was used. Results: methods of univariate analysis revealed the following significant predictors of ATP results associated with the condition of the patient before the surgery (р<0,05). For patient survival: age, comorbidity index, hemoglobin level, albumin, ALT, duration of dialysis, smoking, employment during dialysis. For renal transplant survival: comorbidity index, hemoglobin level, albumin, ALT, left ventricular hypertrophy, smoking, and employment during dialysis. For CTN: age, hemoglobin level, ALT, smoking.

The aim of the study, materials and methods are described in the first part of the article. Results: Methods of multivariate analysis revealed the following significant predictors of ATP results associated with the condition of the patient before the surgery (р<0,05): for the life of the patient: hemoglobin level, albumin, ALT, cholesterol, smoking; for renal transplant: hemoglobin level, albumin, smoking; for chronic transplant nephropathy: smoking, hemoglobin level, ALT, comorbidity index.

The article describes a case of acute renal failure (ARF) in a 16 years old adolescent. Renal failure arose on the background of severe systemic inflammatory syndrome with pronounced hemorrhagic rash, multiorgan failure in combination with signs of thrombotic microangiopathia, disseminated intravascular coagulation (DIC), cryoglobulinemia. Persistent null complement hemolytic activity was further revealed in the patient. The differential diagnosis concerned meningococcemia, sepsis, systemic vasculitis, including cryoglobulinemic vasculitis, thrombotic microangiopathies (TMAs). Along with diagnostic search intensive complex therapy was carried out, including application of wide spectrum antibiotics, plasma exchanges, methylprednisolone pulses, infusions of human immunoglobulin. The therapy resulted in the improvement of the patient’s general condition, subsiding of inflammation, stable disappearance of TMA/DIC symptoms. Nephrosclerosis and chronic kidney disease (CKD) stage 4 has developed in the outcome of the acute disease. After careful analysis of the disease manifestation and course during acute period, laboratory examination, follow-up observation we came to a conclusion that the teenager has hereditary terminal complement deficiency predisposing him to recurrent meningococcemia. The last acute episode was complicated by multiorgan failure, ARF, DIC and resulted in nephrosclerosis. Further therapy in our patient must be targeted to the slowing of CKD progression and to the prevention of invasive meningococcal infection by vaccination with a tetravalent meningococcal vaccine.

Non-Hodgkin’s lymphomas are the group of diseases with different clinical and morphological manifestations related to malignant neoplasms of lymphoid and hematopoietic tissues. Manifestations of non-Hodgkin’s lymphomas depend on the localization of the tumor focus and the tumor cell’s proliferation speed. Initial development of tumor foci in the lymphoid tissue of non-lymphoid organs (gastrointestinal tract, respiratory system, skin, kidney, etc.) is defined as extranodal embodiment of non-Hodgkin’s lymphoma. The clinic manifestations can be caused by dysfunction, compression of the affected organ and neurovascular bundles, as well as by a number of non-specific symptoms associated with tumor progression. Such a wide range of clinical manifestations often makes the diagnosis rather difficult. The kidneys’ defeat in non-Hodgkin’s lymphoma is extremely rare, as the lymphoid tissue in the kidneys is virtually nonexistent. In case of non-Hodgkin’s lymphoma some forms of glomerulonephritis and acute renal failure due to renal parenchymal infiltration of tumor cells or tumor obstruction of the urinary tract and kidneys’ blood vessels can develop. This non-Hodgkin’s lymphoma with primary extranodal localization in the kidneys could make his debut with acute renal failure, and specific symptoms may appear later. In this situation, the difficulties of the hematological diagnosis are entrusted to nephrologists. In this article, we describe a clinical case of non-Hodgkin’s lymphoma, manifested by renal failure due to bilateral renal lymphomatous infiltration.