Youth, which is forgiven everything, forgives itself nothing: age, which forgives itself everything, is forgiven nothing. George Bernard Shaw The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low- and middle-income countries [1]. This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society - in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics [2]. A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke - all of which are key causes of death and disability in older people [3]. Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policymakers and the general public about the importance of kidney disease. The topic for WKD 2014 is «CKD in older people». This article reviews the key links between kidney function, age, health and illness - and discusses the implications of the aging population for the care of people with CKD.

The report of Russian Renal Replacement Therapy Registry represents data on the national, regional and individual patient levels, and cover period from 1998 to 2011. Current volume describes epidemiology of treated end-stage renal disease in Russia, incidence and prevalence for all modalities of renal replacement therapy, its regional features, as well as quality treatment indicators, mortality and survival patterns in hemodialysis patients.

In the review the data supporting the efficiency of on-line hemodiafiltration regarding hard outcomes are briefly described as well as detailed data from recently published three big randomized trials (CONTRAST, Turkish on-line HDF and ESHOL). Being different in primary outcomes, all RCT demonstrated in the post hoc analysis that benefits in hard outcomes received patients with convection volumes greater than 20-24 l/session. The obtaining of such volumes requires resolving issues with hemoconcentration along the dialyzer. The role of HDF in RRT will be defined more exactly in evaluation of its efficiency and cost-efficiency in comparison with other methods of dialysis safety, tolerability and efficacy improvement.

We enrolled 25 patients at the end-stage of chronic renal failure of various origins, who were treated with program hemodialysis (PHD) in the Center of Dialysis and Transplantation at the M.F. Vladimirsky Moscow regional clinical and research institute. The main group consisted of 12 patients who were administered Fraxiparine («GlaxoSmithKline», United Kingdom), a low-molecular weight heparin for hypocoagulation during the procedure of hemodialysis. The drug was administered in a bolus dose prescribed individually into the arterial line after connecting it to a fistula needle. The control group (13 patients) received unfractionated heparin in conventional way (a bolus 2000 to 2500 IU before the beginning of the procedure, followed by 1200 to 1500 IU/h in a continuous infusion, stopped 1 hour prior to the end of dialysis). At the beginning and the end of the procedure the concentration of platelets was measured. Morphofunctional state of living platelets in situ we evaluated by the method of computer morphometry using computer phase-interference microscope (CPM) «Cytoscan» (Moscow, Russia). We analyzed the optical - geometrical parameters and the morphological features of living platelets which reflected the degree of their activation at the beginning of PHD (before administration of heparin), in 15 minutes after it and at the end of the procedure. After the hemodialysis we registered the certain changes of the morphological content and optical (geometrical) parameters of circulating platelets which changed in the different degree depending on prescribed anticoagulant therapy. The results allow us to conclude that the use of Fraxiparine provides better ratio of efficacy/safety and causes a reduction of the platelet activation during the hemodialysis procedure.

Aim: to determine short- and long-term postoperative prognosis in patients with chronic kidney disease (CKD) undergoing correction of valve heart disease depend on evolvement of acute kidney injury (AKI). Patients and methods. 647 patients (298 men and 349 women) aged from 34 till 67 years (average 52,7 ± 7,3 years) were examined whom the correction of valvular heart disease with cardiopulmonary bypass was performed. In 306 patients GFR decreased from 89 to 45 mL/min/1,73 m2 (1st group), but in 341 patients GFR was greater than 90 mL/min/1,73 m2 (2nd group). AKI was diagnosed and classified according to RIFLE-criteria by the change in serum creatinine (sCr). Results. The incidence of early postoperative complications (myocardial infarction, stroke, acute heart failure, paroxysmal tachiarrhythmias, sepsis, respiratory distress) was significantly higher in the 1st group than in the 2nd group. In the first days after operations AKI has developed in 157 patients (51,3%) in the 1st group and in 103 patients (30,2%) in the 2nd group (p < 0,001). Renal replacement therapy (hemodialysis) was performed more frequently in the 1st group (p = 0,003), and in-hospital mortality was also higher in the 1st group (p < 0,001) than in the 2nd group. Conclusion. It was shown that the presence of CKD in patients undergoing correction of valve heart disease and complicated with AKI has adverse influence on short-term postoperative prognosis and long-term prognosis is even better in 46,5% of them.

Purpose. Our aim was to evaluate the endoscopic approach and the efficiency of pretransplant nephrectomy and nephro-ureterectomy in children with end stage kidney disease (ESKD). Materials and methods. We performed pre-transplant nephrectomies and nephro-ureterectomies in 12 children with ESKD and an average age of 8,3 years (11 months to 17 years old) using 3 - port prone-position, lateral retroperitoneal and transperitoneal laparoscopic approaches. The indications were vesico-ureteral reflux with persistent or recurrent urinary tract infection in 11 patients, uncontrolled hypertension in 1. Unilateral trans-peritoneoscopic nephro-ureterectomy was performed in 1 child and bilateral one in 3 patients with uretero-hydronephrosis. Bilateral nephrectomy was performed in 5 children with renal hypodysplasia and hydronephrosis; unilateral nephrectomy in 2, nephro-ureterectomy in 1. Results. 11 procedures were successfully performed. Conversion to open surgery was necessary in 1 case due to considerable sclerosis in paranephric body. One child developed a bleeding at postoperative period, which necessitated blood transfusion. Mean operative time was 72 min (35-95 min) for retroperitoneoscopic nephrectomy and 53 min (40-65 min) for transperitoneoscopic one. Peritoneal dialysis was initiated at a median of 8 hours after retroperitoneoscopic procedure and at a medium of 8 days after transperitoneoscopic one. Hemodialysis began in 1 day after both operations. Conclusions. Both laparoscopic approaches were safe, feasible and effective. Peritoneal dialysis may be initiated immediately after retroperitoneoscopic procedure that is vitally important in children with end stage kidney disease.

The aim. Identification of the criteria for choice of the modality of renal replacement therapy (RRT) after cardiac surgery with cardiopulmonary bypass (CPB). Materials and methods. A single-center retrospective cohort study was performed to evaluate some demographic and clinical parameters as the potential risk factors for poor outcome in patients with AKI requiring RRT (AKI-D) after cardiac surgery with CPB. Original severity score was developed and a criterion was made for choice of renal replacement therapy modality. Results. Developed score had the best discriminatory ability for death predicting in patients with AKI-D after cardiac surgery with CPB. The area under the receiver operating characteristic (ROC) curve for the score was 0,892 (95% CI 0,852 to 0,925). Its predictive accuracy was compared with other scores by area under the ROC curve. After applying the new score to the group of patients on intermittent hemodialysis (IHD) a defined criterion for the choice of RRT modality was developed. The value of the new score of 3,2 and below was found to be safe for the choice of intermittent hemodialysis modality. Conclusions. The new score is valid and accurate in predicting death for AKI-D after open-heart surgery. This score and value for the choice of RRT was made for guidance only, but in difficult situations, this score can facilitate the choice.

The aim of the study was examination of the incidence and severity of the acute kidney injury (AKI) in patients with acute myocardial infarction with ST-elevation (STEMI) after thrombolytic therapy with alteplase or streptokinase. Methods. 292 patients (227 men and 65 women, mean age 58 ± 11 years) with STEMI were studied. All patients received thrombolytic therapy: 170 received streptokinase, and 122 - alteplase. Coronary angiography in acute stage of myocardial infarction was exclusion criteria. AKI was defined according to KDIGO Guidelines. Results. Thrombolysis was effective in 213 (73%) patients. There was no statistically significant difference in effectiveness of thrombolysis in the groups of patients who received streptokinase or alteplase (÷2 = 1,14; p = 0,28). Seventy-two (25%) patients developed AKI: 60 (35%) received streptokinase and 12 (10%) - alteplase (÷2 = 15,75; p = 0,0001). The severity of AKI was higher in patients treated streptokinase than alteplase (÷2 = 14,93; p = 0,0001). The incidence of arterial hypotension as complication of fibrynolythic administration was higher in the group of patients who received streptokinase (÷2 = 9,38; p = 0,002). The in-hospital mortality (6%) was significantly associated with AKI. Conclusions. Our results show that the incidence of AKI in patients with STEMI is 25%. The incidence and severity of AKI was higher in patients treated with streptokinase than those treated with alteplase. AKI was significantly associated with in-hospital mortality.

Ischemic injury of the kidney is the leading cause of acute kidney failure (AKF). Using high frequency Doppler technique we explored the central and renal hemodynamics after 40-min ischemia followed by reperfusion (I/R) of the rat kidney. One minute after I/R an essential drop of a total renal blood flow (70% of pre-ischemic values), lowering of the terminal diastolic blood flow rate (67% of pre-ischemic values) and rise of the renal artery resistance index (0,76 before I/R and 0,92 after I/R) were observed. These changes were retained for at least 30 min. At the same time, the changes of the blood flow indexes in abdominal aorta were not significant. Ischemic preconditioning of the kidney (4 cycles of 5-min ischemia followed by 5-min reperfusion each) totally prevented the changes of hemodynamics caused by 40-min I/R. The study of venous output showed very high sensitivity of a renal blood flow to short-term episodes of ischemia.

Kidney International supplements Volume 2/ issue 2/ June 2012 http://www.kidney-international.org Abstract The 2011 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Glomerulonephritis (GN) aims to assist practitioners caring for adults and children with GN. Guideline development followed an explicit process of evidence review and appraisal. The guideline contains chapters on various glomerular diseases: steroid-sensitive nephrotic syndrome in children; steroid-resistant nephrotic syndrome in children; minimal-change disease; idiopathic focal segmental glomerulosclerosis; idiopathic membranous nephropathy; membranoproliferative glomerulonephritis; infection-related glomerulonephritis; IgA-nephropathy; Henoch-Schonlein purpura nephritis; lupus nephritis; pauci-immune focal and segmental necrotizing glomerulonephritis; and anti-glomerular basement membrane antibody glomerulonephritis. 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. Limitations of the evidence are discussed and specific suggestions are provided for future research. CITATION In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney inter., Suppl. 2012; 2: 139-274.