Vol 15, No 4 (2013)
REVIEWS AND LECTURES
Mini-invasive methods of pre-transplant nephrectomy in children with end-stage kidney disease Review
258-262 27
Abstract
The laparoscopic nephrectomy in children with the end-stage kidney disease (ESKD) is discussed briefly. The study reveals the main steps of minimal invasive procedures, complications, advantages and disadvantages in this group of patients. It provides a critical review of the feasibility of nephrureterectomy using retroperitoneoscopic approach.
ORIGINAL ARTICLES
263-268 23
Abstract
Background. Recent studies have highlighted that podocyte (Pdc) injury leads to proteinuria (PU) and glomerulosclerosis. Urinary detection of Pdc injury markers is widely discussed as more sensitive indicators of chronic glomerulonephritis (СGN) activity and prognosis than PU. The aim of our study was to define nephrinuria (NU) and vascular endothelial growth factor (VEGF) excretion for an assessment of CGN activity and therapy efficiency. Methods. 74 CGN pts were studied: 18 – inactive CGN (I group), 18 – with PU 1-3 g/d (II), 38 – with nephrotic syndrome (NS) (III). 12 healthy subjects were studied as control. NU and urinary VEGF were measured by ELISA. Results: We revealed significantly increased NU and VEGF in active CGN (II, III group) compared to I group and control. These levels were greatly higher in NS than in pts with lower PU. NU depended on NS duration. Positive correlations were revealed between NU and PU value (r=0,27 p<0,05) and mean blood pressure (r=0,3 p=0,032). Urinary VEGF level was the highest in NS without renal failure. In pts with NS and impaired renal function we revealed significantly decreased urinary VEGF. 9 from 11 (82%) pts with low NU (<17ng/ml) had NS remission during 6 month of immunosuppressive therapy. On the other hand, 8 from 12 (67%) pts with high NU (>17ng/ml) had the immunosuppression resistance (9 month to 2 years). Conclusion: We suggest that estimation of NU and VEGF urinary levels may be useful for glomerular damage monitoring, CGN risk progression assessment and treatment efficiency prognosis.
S. S. Koltunov,
E. V. Luzina,
I. V. Malov,
I. Y. Pirogova,
Y. E. Rogachikov,
A. A. Selyutin,
V. I. Chervinko,
F. K. Kokoeva,
V. M. Ruseikin,
M. L. Zubkin
269-276 36
Abstract
Chronic hepatitis C (CHC) remains a serious problem for patients with the end-stage kidney disease on renal replacement therapy. However there is no uniform concept of approaches to antiviral HCV therapy in these patients. Objective of the study: to investigate the efficacy and safety of peginterferon alfa-2a (Peg-IFN-a2а) monotherapy in HCV patients on hemodialysis (HD). Materials and methods: the study included 26 patients with HCV (M: 10 and F: 16) aged 22 to 58 years treated at 5 dialysis centers in various regions of Russia. The viral load was 4,8 ± 1,5 log10 IU/ml. Genotype 1 was identified in 12 (48%) patients, non-1 genotype was identified in 13 (52%) patients. ALT activity was 29,6 ± 18,5 IU/L. Liver needle biopsy was performed in 10 patients. Knodell HAI score was 5,5 ± 1,4. Fibrosis stage 1 (by METAVIR score) was determined in 6 patients, fibrosis stage 2 was revealed in 4 patients. All patients were assigned to receive peginterferon-a2а at a dose of 135 µg/week for 48 weeks. Results of the study: early virological response (EVR) was reported in 22 out of 26 (84,6%) patients. Sustained virological response (SVR) was achieved in 15 out of 26 patients (57,7%). The correlation between EVR and SVR was confirmed: SVR was reported in 13 out of 21 patients with EVR (61,9%) whereas among 4 patients without EVR, only 1 patient (25%) had SVR (р = 0,039). Conclusions: the efficacy and safety of peginterferon-a2а monotherapy in CHC was confirmed in patients on HD.
E. V. Kalyanova,
E. S. Stolyarevich,
N. A. Tomilina,
L. S. Biryukova,
A. V. Frolov,
N. D. Fedorova,
E. V. Zakarova
277-285 28
Abstract
Idiopathic focal and segmental glomerulosclerosis (FSGS) is known as an unfavorable variant of glomerulonephritis. During last few decades the treatment of FSGS with Cyclosporine A (CyA) became widespread. Its efficacy is referred to inhibiting of calcineurin-dependent dephosphorylating and podocytes protein sinaptopodyn stabilization. We analyzed retrospectively the results of treatment of 49 patients with biopsy-proven FSGS. CyA was applied in 40 cases (36 patients), in 24 cases at first presentation, and in 16 – at relapse (4 patients were treated both at first and subsequent episodes). 18 patients, treated with prednisone or prednisone plus cyclophosphamide (CF) at first presentation, constituted control group, 5 of them were subsequently treated with CyA at relapse. Results of the treatment in both groups were comparable. Taking into account the relapsing course of FSGS that demands the long-term treatment with potentially serious adverse events of steroids, we conclude that relatively safe prolonged usage of CyA for sustainingremission is currently the optimal treatment option.
A. I. Sushkov,
A. V. Sharshatkin,
O. V. Azarenkova,
A. S. Efimkin,
A. G. Malakhov,
D. A. Saidulaev,
I. S. Chichkin,
M. I. Ilzhanov,
I. E. Kandidova,
N. G. Kvadratova,
Y. G. Moysyuk
286-292 47
Abstract
Aim. Analysis of the results of living-related ABO-incompatible kidney transplantations (iABO) and comparison with results of ABO-compatible kidney transplantations from living-related (LD) and deceased donors (DD). Materials and Methods. 279 patients underwent kidney transplantations at our center between January 2011 and June 2013. The patients were divided into three groups: iABO (n = 15), LD (n = 114) and DD (n = 150). Patients from the iABO group underwent pre-transplant desensitization: Rituximab + Plasmapheresis / Immunoadsorption + High-dose IvIg. Maintenance immunosuppression was the same in all three groups: tacrolimus/cyclosporine A + MMF/ mycophenolic acid + steroids. Results. Medians of follow-up perion in the iABO, LD and DD groups were 13, 15 and 12 months, respectively. No death cases occurred in the iABO and LD groups. In the DD group five patients (3,3%) died on different times after Tx. Biopsy-proven acute rejection rate in iABO group was 13,3% and there were no significant differences in comparison with LD group (6,1%, p = 0,3040) and DD group (9,3%, p = 0,6177). One- and two-year graft survival in groups was 91,7% and 91,7% – iABO; 97,3% and 93,1% – LD; 87,5% and 87,5% – DD. No significant differences in graft survival between iABO vs LD (log-rank test p = 0,6938) and between iABO vs DD (log-rank test p = 0,4868) were found. Conclusion. The overcoming the ABO incompatibility barrier in living donor kidney transplantation is perspective trend in transplantology. It is perspective option for increase, at first, the pool of the living donors, and the access for kidney transplantation. The results of ABO-incompatible are non-inferior than in LD group.
L. V. Yarosh,
T. A. Semenenko,
G. Y. Nikitina,
E. V. Shutov,
D. A. Elgort,
A. A. Feldsherova,
A. P. Suslov,
A. I. Bajenov,
M. A. Godkov,
D. A. Kleimenov,
M. L. Zubkin
293-298 36
Abstract
In totals 145 patients and 63 employees of the hemodialysis department were studied for the estimation of the prevalence of the hepatitis B virus (HBV) and hepatitis C virus (HCV) infection markers (HBsAg, anti-HBs, anti-HBc, anti-HBe, anti-HCV). Serological HBV-markers were detected in 97 (66,9%) patients, anti-HCV – in 13 (9,0%), HBsAg and anti-HCV combination in 1 case (0,7%). Antibodies to hepatitis D virus in HBsAg(+) and HBsAg(–)/HBV DNA(+) patients were absent. Serological markers were defined most often on early terms of program hemodialysis treatment: in the first 0–6 months – in 57,9%, from 6 till 12 months – in 42,9%, more than 1 year – in 30,4% of the cases. HBV-markers have been revealed at employees in the first 5 years of work in 10,0%, and at the experience more than 10 years – already in 31,3% of cases. The «latent» HBV-infection was detected at 3 patients (2,1%): in one case – seronegative hepatitis B (HBV DNA without serological markers), in two – the presence of HBV DNA and «isolated» anti-HBc. Sequence analysis of PCR products amplified from the S region in three isolates (genotype D, subtype ayw3) revealed T118А replacement. Patients and personnel of the hemodialysis department still remain high risk group of the HBV and HCV infection.
CASE REPORTS
299-303 33
Abstract
A case of patients with hypertension developed on the basis of segmental kidneys sclerosis/hypoplasia is described. The application of some modern methods for differential diagnosis of the disease associated with the hypertension syndrome in a patient with suspected renal pathology is demonstrated is illustrated.
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. КЛИНИЧЕСКАЯ НЕФРОЛОГИЯ.
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ПРОБЛЕМЫ ХПН. ОБЩИЕ ВОПРОСЫ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. КАРДИОВАСКУЛЯРНАЯ ПАТОЛОГИЯ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ПОСТОЯННЫЙ АМБУЛАТОРНЫЙ ПЕРИТОНЕАЛЬНЫЙ ДИАЛИЗ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ПРОГРАММНЫЙ ГЕМОДИАЛИЗ
351 29
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ТРАНСПЛАНТАЦИЯ ПОЧКИ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ОСТРАЯ ПОЧЕЧНАЯ НЕДОСТАТОЧНОСТЬ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ПЕДИАТРИЧЕСКАЯ НЕФРОЛОГИЯ
ТЕЗИСЫ К VIII ВСЕРОССИЙСКОЙ НАУЧНО-ПРАКТИЧЕСКАЯ КОНФЕРЕНЦИИ РДО. ЭПИДЕМИОЛОГИЯ ХЗП И ОРГАНИЗАЦИЯ НЕФРОЛОГИЧЕСКОЙ ПОМОЩИ
ISSN 1680-4422 (Print)
ISSN 2618-9801 (Online)
ISSN 2618-9801 (Online)
