Kidney International supplements Volume 3/issue 3/November 2013; doi:10.1038/kisup.2013.29 http://www.kidney-international.org ©2013 KDIGO Work Group Membership Work Group Co-Chairs Marcello A Tonelli, MD, SM, FRCPC University of Alberta Edmonton, Canada Christoph Wanner, MD University of Wu¨rzburg, Germany Work Group Alan Cass, MBBS, FRACP, PhD Menzies School of Health Research Darwin, Australia Amit X Garg, MD, FRCPC, FACP, PhD London Health Sciences Centre London, Canada Hallvard Holdaas, MD, PhD Hospital Rikshospitalet Oslo, Norway Alan G Jardine, MBChB, MD, FRCP BHF Cardiovascular Research Centre Glasgow, United Kingdom Lixin Jiang, MD, PhD Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China Florian Kronenberg, MD Innsbruck Medical University Innsbruck, Austria Rulan S Parekh, MD, MS, FRCPC, FASN Hospital for Sick Children Toronto, Canada Tetsuo Shoji, MD, PhD Osaka City University Osaka, Japan Robert J Walker, MBChB, MD (Otago), FRACP, FASN, FAHA University of Otago Dunedin, New Zealand Evidence Review Team Tufts Center for Kidney Disease Guideline Development and Implementation, Tufts Medical Center, Boston, MA, USA: Ashish Upadhyay, MD, Project Director Ethan M Balk, MD, MPH, Program Director, Evidence Based Medicine Amy Earley, BS, Project Coordinator Shana Haynes, MS, DHSc, Research Assistant Jenny Lamont, MS, Project Manager Abstract The 2013 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease (CKD) provides guidance on lipid management and treatment for all patients with CKD (non-dialysis-dependent, dialysis-dependent, kidney transplant recipients and children). This guideline contains chapters on the assessment of lipid status and treatment for dyslipidemia in adults and children. Development of the guideline followed an explicit process of evidence review and appraisal. Treatment approaches are addressed in each chapter and guideline recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the GRADE approach. Ongoing areas of controversies and limitations of the evidence are discussed and additional suggestions are also provided for future research. Citation In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 259-305.

Analysis of published data shows that biological feasibility of the disappearance of the enzyme uricase in course of evolution of primates was apparently aimed to increasing the levels of uric acid in the blood for antinatriuretic and vascular effects, which, in turn, helped to maintain a relatively high blood pressure on low-salt diet and to establish conditions for upright walking hominids. The dramatic changes in the food and lifestyle during the last centuries transformed essentially adaptive features of hyperuricemia in the background of a number of diseases and conditions, including gout, urolithiasis and uric acid nephropathy, metabolic syndrome, hypertension and other cardiovascular diseases. At the same time, strong antioxidant properties of uric acid exhibited against brain tissue suggest a beneficial effect on the progression of a number of hyperuricemia neurodegenerative diseases and multiple sclerosis, the development of intelligence and cognitive functions. It is emphasized that the determination of uric acid in the blood seems to be important, and in some cases - a necessary procedure, because on one hand, the leveling of hyperuricemia can facilitate the outcome of a number of diseases, and on the other hand, the hyperuricemia itself can be an important predictor of the occurrence of various pathologies states.

Aim: to analyze the correlations between class-I and class-II anti-HLA antibodies with microvascular inflammation and C4d-staining in cases of late acute and chronic graft rejection. Materials and methods: The study included 108 patients with indicative graft biopsies (with C4d-staining) and detection of anti-HLA antibodies (ELISA). Patients were divided into 3 groups based on pathology pattern: group 1 (n=50) consisted of patients with chronic graft rejection, group 2 included 24 patients with acute graft rejection with microvascular inflammation, group 3 (n=34) was presented by patients with other graft pathology (control group). Results: Anti-HLA antibodies (predominantly class-II anti-HLA) were identified in 70% of patients of group 1, in 62% of patients of group 2 and 29% patients of group 3 (control). The level of class-II anti-HLA antibodies was significantly higher in C4d-positive cases with no difference between its focal or diffuse expression. In 48% and 57% of patients of 1 and 2 groups, respectively both C4d and anti-HLA antibodies were positive and we considered these cases as AMR without subsequent DSA detection. In cases of isolated C4d staining (12% and 35% of cases in 1 and 2 group, respectively) more sensitive methods (LUMINEX) were needed. In C4d-negative cases (22% in group 1 and 29% in control group) single antigen detection of DSA should be performed. Conclusion: Screening of anti-HLA antibody is a first step of DSA detection, but it can be used as an independent method of diagnosis in the presence of biopsy data in some cases.

Aim: improvement of the quality of early diagnosis of chronic kidney disease (CKD) among the working population of Krasnodar city. Materials and methods: the study included 1084 office employees that took place prophylactic medical examination. Patients were divided into 4 groups by age with 10 year increment. The study of renal function in all patients was performed by calculating glomerular filtration rate (GFR) using formula CKD-EPI formula. Results: indicators GFRCKD-EPI ≥ 90 ml/min/1.73 m2 - 53.9% of the surveyed, GFRCKD-EPI < 90 ml/min/1.73 m2 > 60 ml/min/1.73 m2 - 38.7%, GFRCKD-EPI < 60 ml/min/1.73 m2 - 7.5%. The peak reduction in GFR falls to 4th age group (66,6%). In all age groups the reduction of GFRCKD-EPI dominated among men. The risk factors of CKD were found in 63,4% of patients. The most often among them were hypercholesterolemia and overweight (51.3% and 37.5% of patients, respectively), the next ones were smoking - 30.5%; AG (28.5%), hyperglycemia (12,7%), chronic kidney disease and the UT (5.0% each), and the most rear hyperuricemia (4.8%). Conclusions: a high proportion of persons with reduced GFRCKD-EPI among the working population demonstrates that at the stage of routine inspection it is necessary to carry out the GFR calculation to determine existing risk factors of CKD.

Objective of the study. The high prevalence of vesico-ureteral reflux (VUR) in kidney graft is one of the weaknesses in the kidney transplantation. This condition is associated with the risk of urinary tract infections and renal allograft dysfunction. The objective of this study was the development of new method of VUR medical prophylaxis and evaluation of it clinical efficacy. Methods. We conducted retrospective study to find the risks factors of VUR in kidney transplant. 68 patients were included to the study. Based on the found risks factors, we proposed a new method of medical prophylaxis of VUR. To evaluate its efficacy we run the randomized prospective controlled clinical study to compare with Lich-Gregoir method in 36 patients. Results. We found that the main risk factor of VUR is the low residual volume of urine output. We created the new method of ureteroneocystostomy with delayed antireflux defence by endovesical injection of periureteral bulking substances. We conducted randomized prospective clinical study of the efficacy of new method compared with routine Lich-Gregour technique. We found that it helps to reduce the frequency of VUR in the risk patients from 72% to 28% (p=0.0184). Besides, we found that our method was associated with reduces risks of UTI, shortness of surgery time and provides the reasonable degree of safety.

Kidney transplantation is the optimal treatment for patients with terminal chronic renal failure. However renal transplant recipients have an increased risk of various malignancies due to long immunosuppression, and persistent viral infections. Malignant tumors can develop in native non-functioning kidney, and in the transplanted kidney - functioning or non-functioning. Tumors of the renal transplant (RT) is a rare disease, but the incidence of its development may be underestimated. According to different authors, tumors of RT develop in 0.19-0.78% of patients. Most of these tumors are papillary carcinoma and have a low degree of malignancy. Sources of tumor growth are different: carcinoma may have donor nature and may develop de novo from cells of the recipient. Most of the recipients at the time of detection of the RT tumor have no clinical symptoms, and the neoplasm is detected by chance, during a routine ultrasound examination of the transplanted kidney. Here we describe a case of successful surgical treatment of kidney transplant carcinoma in 22 years after transplantation and correction of immunosuppression after the tumor removal. Incidence, time of arising, clinical and hystological features, treatment options of kidney transplant tumors are discussed. The need for regular cancer screening in RT recipients is justified.

New normative documents of Government, Health care Ministry and Federal Fund for compulsory health insurance issued in December 2015 substantially change the conditions for the medical aid administering - particularly - in the field of renal replacement therapy. The potential consequences and necessary actions are discussed. New lists of Diagnosis-Related Groups were set up separately for in-patient and day hospital condition of medical care render. New section of established recommendation describes the payment for outpatient medical care. Dialysis sessions can be reimbursed as the unit of healthcare in condition of hospital (day hospital) admittance or in outpatient condition. The necessary medicinal therapy of CKD G5D syndromes can be reimbursed within the framework of DRG 40 (DRG 41) which provides one month patient management or be provided by budgetary funded system of Supplementary Drug Providing, accordingly. The different recommended tariffs for hemodiafiltration, automated peritoneal dialysis, prolonged renal replacement therapy and others were established; the prices sould not depend on condition of healthcare render. The DRG 112 (for inpatient condition) and DRG 42 were established for dialysis access placement. The coefficients of relative expenditure capacity were changed substantially for all DRG.

Calcific uremic arteriolopathy (CUA), previously also called calciphylaxis, is one of the several types of extra-osseous calcification and a rare and devastating disorder which most often occurs in patients with severe renal disease. CUA is a serious disorder characterized by systemic medial calcification of the arterioles that leads to ischemia and subcutaneous necrosis. The pathogenesis of CUA is poorly understood, and the optimal treatment is not known. A multi-interventional strategy (adequate dialysis, surgical debridement and wound care, hypophosphatic diet, drug treatment) is likely to be more effective than any single therapy and allows one to reduce mortality. Here we present a case of a 64-year-old female with the end-stage renal disease on chronic hemodialysis and with several secondary hyperparathyroidism (extensive two ulcers on the left leg with necrotic eschars). Our case study shows that multi-interventional strategy is likely to be more effective in treatment of CUA in patients with the end-stage renal disease on hemodialysis with several secondary hyperparathyroidism.