Acute kidney injury (AKI) remains an independent risk factor for mortality and morbidity. Inflammation plays a major role in the pathophysiology of AKI. In ischemia, sepsis and nephrotoxic models the initial insult results in morphological and/or functional changes in vascular endothelial cells and/or in tubular epithelium. Then, leucocytes including neutrophils, macrophages, natural killer cells, and lymphocytes infiltrate into the injured kidneys. The injury induces the generation of inflammatory mediators like cytokines and chemokines by tubular and endothelial cells which contribute to the recruiting of leukocytes into the kidney. Thus, inflammation plays an important role in the initiation and extension phases of AKI. This review focuses on the inflammation mediators which contribute to the pathogenesis of AKI.

Streptococcus pneumonia-associated hemolytic uremic syndrome (HUS) is an uncommon condition mainly observed in young children. This review presents the pathophysiology, clinical features, diagnostic difficulties and management of this condition.

The review discusses the correction of anemia in CKD patients with impaired renal function. Special attention is given to iron supplements, especially new drug iron (III) hydroxide olygoisomaltozat which has already been registered in Russia. Linear structure and relatively small molecular weight minimized the impact of the drug on the immune system. Matrix disposition of iron's molecules provides its slow release and very little presence of free iron in the serum, which might cause toxic effects. Iron (III) hydroxide olygoisomaltozat dose of ³1000 mg may be administered intravenously over 15 minutes without pre-infusion test dose.

Pregnancy in patients with chronic renal failure (CRF) is associated with serious clinical problems – high rate of preeclampsia, preterm delivery, possibility of unfavorable perinatal outcomes and persistent deterioration of renal function. The aim of the study was assessment of pregnancy course and outcome, influence of pregnancy on renal function in patients with CRF. Thirteen women with stage III chronic kidney disease (CKD) were included to the study. Before pregnancy median GFR was 51 ml/min (min 34,5; max 59). Patients had CRF from 2 to 14 years. For prophylaxis of fetoplacental insufficiency and preeclampsia all patients received gestagens, heparin and dipyridamole since early stages of pregnancy. We observed favorable pregnancy outcome in 12 cases of 13 (92,3%). One newborn died in neonatal period. The incidence of preeclampsia was 76,9%, severe preeclampsia – 15,4%, preterm delivery before 37 weeks of pregnancy, delivery before 34 weeks – 15,4%. Median term of delivery was 37 weeks (min 25; max 38), birthweight – 2680 г (min 670; max 3610). Respiratory distress syndrome appeared in 23,1% newborns. Favorable «nephrological» outcome was observed in 76,9% patients. Acute kidney injury in perinatal period appeared in 23,1% women, who subsequently had persistent CRF reduction (>25%, but <50% from basic level). None of the patients required dialysis treatment during pregnancy and early post delivery. None of women required a continuous renal replacement therapy during 12 months after delivery. Probability of a favorable outcome of pregnancy in women with stage III CKD is high when planning pregnancy, careful surveillance by obstetrician-gynecologist and nephrologist, prophylaxis of preeclampsia with early gestation.

Apoptosis contributes significantly to the glomerular and interstitial sclerosis, the morphological basis of the CKD progression. It leads to the imbalance between glomerular and tubular epithelial cell proliferation and loss due to hyperactivity of Fas-mediated apoptosis. The serum activity of apoptosis markers: a soluble Fas-ligand (sFas-L), metalloproteinase-9 (MMP-9) and its tissue inhibitor (TIMP-1) were investigated in children with CKD1–4 stage. A significant excess of the marker’s activity compared to their normal values at all stages of CKD; the prevalence of apoptotic activity in nephrotic proteinuria patients with GFR >90, significant influence of poor prognostic factors complex: proteinuria, hypertension and hypercholesterolemia on the activity of sFas-L, MMP-9, TIMP-1 were discovered. These results give an opportunity to indicate the biological significance of programmed cell death in the development and progression of renal diseases.

This work is devoted to the role of systemic chronic inflammation in the development of cardiovascular diseases which are the main cause of death of dialysis patients. We were also interesting in the contribution of bacterial endotoxin to the development of system chronic inflammation, as well as neutralizing effect of the antiendotoxin immunity on it. The purpose of this study was to investigate the dynamics of the antiendotoxin immunity indicators and the level of the C-reactive protein in patients with chronic kidney disease on the program hemodialysis. In 2007, 46 patients with chronic kidney disease on program hemodialysis were inspected. Only 32 of them were inspected again in 2011. Also the antiendotoxin immunity indicators and the C-reactive protein level were analyzed in 7 died patients within the first year just after the start of the study. Levels of serum antiendotoxin antibodies of classes A, M and G and the blood concentration of the C-reactive protein were determined by the method of solid-phase enzyme immunoassay. In patients with the chronic kidney disease on program hemodialysis whose treatment is continued currently, the high level of antiendotoxin IgG in blood was noted. In addition, these patients demonstrated an increase in the concentration of C-reactive protein, its level has increased a factor of 4,6 times (p < 0,001) for four years. We found a decrease in the level of serum antiendotoxin IgG and IgM and an increase in the concentration of the C-reactive protein in the patients who died during the first year of the observation. Such manifestations can be regarded as death predictors.

Serological and biochemical testing of blood serum was performed in 434 patients on program hemodialysis living in Baku for determination of spreading and pathogenic peculiarities of hepatitis B and C viral infections inthese. It was demonstrated that the frequency of serologic markers detection forthese infections'among above mentioned patients was significantly higher than the analogous indexes at healthy inhabitants of Baku. Besides it was shown that at more than 2/3 of patients with both infections coursed in pathogenical variants which were not accompanied with the appearance in the blood biochemical signs of liver dysfunction.

Aim of the study. To evaluate the pathological characteristics and results of treatment of children with isolated hematuria and/or proteinuria. In total 33 children who had isolated hematuria and/or proteinuria were examined. The most frequent pathological pattern was IgA-nephropathy – 16 (48,5%). In 15 (45,7%) of patients isolated hematuria and/or proteinuria were due to glomerular basement membrane abnormalities. In 2 (6%) patients mesangioprofilerative glomerulonephritis with IgM deposits was found. Four (12%) children (with IgA-nephropathy) with significant proteinuria (0,8 ± 0,3 g/day) and decreased glomerular filtration rate at the debut of the disease (less than 83 ± 10,1 ml/min) have received the maintenance immunosuppressive therapy with mycophenolate mofetil 500 mg/m²/day. Children with IgA-nephropathy manifested with isolated hematuria and/or proteinuria are in the group of increased risk of progression, especially proteinuria 0,5 g/day, decreased glomerular filtration rate, and prolonged maintenance immunosuppressive therapy combined with ACE inhibitors is effective. ACEi monotherapy is effective for both proteinuria decreasing and glomerular filtration rate normalization for all patients groups.

A clinical case is described: a Sagliker syndrome patient with a severe secondary hyperparathyroidism and congenital anomalies of the urinary tracts which led to the end stage renal disease and subsequent hemodialysis therapy for 6 year follow-up.