Today, conditions such as acute myocardial infarction, ischemic stroke, shock organ injury are the leading causes of death in the world. All these states are accompanied by a syndrome of ischemia-reperfusion injury - paradoxical process when cells damage in the ischemic organ is continued after blood flow recovery. Pathogenesis of ischemia-reperfusion injury is very complex and involves a combination of processes such as inflammation, metabolic imbalance, oxidative stress, etc. The existing treatment of these conditions is insufficient. Therefore, there is a reason to look for alternative approaches for the treatment of ischemia-reperfusion injury. Many studies have demonstrated the effect of mesenchymal stem cells in the ischemia-reperfusion injury of different organs. It seems that their special role in this effect is caused by paracrine factors. In this review, we discuss a number of studies in this field, and try to identify the major pathogenic point of application of mesenchymal stem cells in ischemia- reperfusion injury.

Obstructive complications after kidney transplantation typically occur due to the ureter stricture and more rarely are caused by concrement occlusion and vesikoureteraler reflux. Pollakiuria and nocturia are also common in such patients. As more people over 60 are subjected to kidney transplantation more transplant recipients are susceptible to benign prostate hyperplasia, prostate cancer and female stress urinary incontinence. The increase in transplantation rate inevitably leads to the growth in the number of recipients with nonfunctioning transplant requiring resumption of hemodialysis. Direct endoureterotomy is the most effective method of endoscopic correction of urinary stricture with the efficiency rate of 79%. Although up to 6 month long ureteral stenting allows one to improve the result of the treatment, it increases the risk of infectious complications. Shock-wave lithotripsy, ureterolithotripsy or percutaneous lithotripsy are possible in the case of nephrolitiasis. Shock-wave lithotripsy is carried out when a concrement is smaller than 15 mm. Two or more sessions are usually necessary to dispose a stone, the absence of the ureter stent increases the risk of obstruction. Percutaneous nephrolithotomy is advisable in the case of bigger kidney stones. Endoscopic correction with any injection technique seems to be a plausible alternative to correction of refluxing posttransplant ureters, with the average efficiency rate of 50%. In the case of moderate reflux the results are better. Transurethral operations is advisable in patients with bladder outlet obstruction not earlier than 1-1.5 month after the transplantation. If the transplant is not functioning and the patient undergoes hemodialysis, embolization can be used instead of transplant nephrectomy provided the absence of acute pyelonephritis, rejection episode or transplant tumor. The efficiency rate of the interventional treatment stands at 84%.

Currently, renal transplantation has firmly established as the main method of replacement therapy in patients with the end stage chronic renal disease. Thanks to modern immunosuppressive drugs, short-term graft and patient survival are dramatically increased. However, long-term renal allograft survival has improved in a lesser extent. Chronic allograft nephropathy is the most common cause of graft failure, whereas cardiovascular diseases remain the leading cause of death among patients receiving renal transplantation. To improve the results of transplantation, it is important to continue developing new strategies for the prevention of acute and chronic rejection. Two of such strategies are reducing the need for lifelong immunosuppressive therapy and enhancing donor-specific tolerance. This paper reviews different strategies of using cellular technology in renal transplantation. The use of mesenchymal stem cells (MSCs) is a promising therapeutic strategy for controlling the onset and progression of the «graft versus host disease». Preliminary data indicate that the use of MSCs can provide potential benefits in renal transplantation by reducing the doses of immunosuppressive drugs required for maintaining the long-term survival and graft function after surgery.

The data for the medical care of acute kidney injury (AKI) in Russian Federation from year 2008 to 2012 are summarized. Essential estimates for the AKI incidence and accessibility, as well as for the etiology, outcomes, and treatment modalities usage for the 10,886 patients accounted in the Russian registry of renal replacement therapy were revealed. Epidemiological estimates for AKI and information on current strategies for AKI prevention form the international literature are also presented.

Background and objectives. Monthly injection of a continuous erythropoietin receptor activator (C.E.R.A.) represents a more convenient and manageable schedule of administration than the more frequent dosing of currently available epoetin treatments. The study was undertaken to assess the maintenance of hemoglobin concentrations with once a month intravenous C.E.R.A. therapy in dialysis patients with chronic renal anemia who was previously treated with standard epoetin alfa or beta. Design and methods: ALIСE was a prospective, open-label, multicenter study performed at 19 nephrology centers in Russia. After 4 week Stability Verification Period, hemodialysis patients receiving epoetins were converted to monthly intravenous C.E.R.A., with a 16 weeks Titration Phase followed by a 8-weeks Evaluation Phase and 28 weeks - Long Safety Evaluation Period. Results: of 241 patients screened, 200 started C.E.R.A. therapy; 162 were eligible for inclusion in the intent-to-treat population, 145 patients were selected for Protocol Population Aanalysis. The target hemoglobin level of 10.5-12.5 g/dL with variation of ±1 g/dL during the evaluation phase, was achieved in 79 (54.5%) patients [95% CI 46.0 - 62.8%; PP analysis], respectively. During the screening and evaluation phases, mean hemoglobin were 11.7 ± 0.52 g/dL and 11.4 ± 1.0 g/dL, respectively. In PP population the targeted hemoglobin level was achieved in 127 patients (87.6%). C.E.R.A. was well-tolerated with a safety profile similar to that reported in phase III studies. Conclusions: this open-label, multicenter study confirmed that conversion of hemodialysis patients from standard epoetin alfa or beta to monthly C.E.R.A. administration is practical, convenient, safe and offers good control of hemoglobin levels.

A review of published studies, results of own original research and the most important practical recommendations for creation of autogeneous arteriovenous fistulas (AVF) using veins transposition are presented. The results of 113 AVF using vien transposition are described and evaluated

Pregnancy in a woman with end-stage renal disease (ESRD) on long-term hemodialysis is a difficult and rare clinical situation. Such pregnancy is associated with increased maternal and fetal complications. We report a case of successful management of a pregnancy in a woman with end-stage renal disease and receiving hemodialysis for more than 10 years. We also reviewed planning, pregnancy management, dialysis strategy, problems of anemia, fluid balance, secondary hyperparathyroidism, anticoagulation, and prevention of complications in women with ESRD receiving long-term hemodialysis.

The 2011 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury (AKI) aims to assist practitioners caring for adults and children at risk for or with AKI, including contrast-induced acute kidney injury (CI-AKI). Guideline development followed an explicit process of evidence review and appraisal. The guideline contains chapters on definition, risk assessment, evaluation, prevention, and treatment. Definition and staging of AKI are based on the Risk, Injury, Failure; Loss, End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network (AKIN) criteria and studies on risk relationships. The treatment chapters cover pharmacological approaches to prevent or treat AKI, and management of renal replacement for kidney failure from AKI. 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.