The review concerns current views on pathogenesis of secondary hyperparathyroidism and usage of novel drugs, paricalcitol and cinacalcet, which became a new standard of care for patients with chronic kidney disease.

The review concerns hepatonephroprotective effects and complications of aquaretics (vaptans) – V2R antagonists of vasopressin, selective vasoconstrictors – V1R agonists of vasopressin, transjugular intrahepatic portosystemic shunt in patients with HRS. Albumin dialysis and PFAD show temporary effects and give possibility to perform liver transplantation. The transplantation is characterized by satisfactory 5-year survival and unusually high frequency of dialysis-dependent renal failure.

The developments in hemodialysis techniques have spurred new interest in the field of the permanent vascular access for long-term renal replacement therapies. The program of creating of reliable vascular access in hemodialysis patients is now considered as a multidisciplinary problem that must include a collaboration of nephrologists, surgeons and hemodialysis specialists. Here we report a retrospective review of creating and maintaining of permanent vascular access. We evaluated the outcomes of 3174 surgical operations in 2281 patients from January 2001 to December 2011 in our center. The 1812 lower-arm radiocephalic and 547 upper-arm fistulas were created, the secondary fistula 1-year patency was 83,2% and 81,5%, respectively (no significantly statistically difference). The native arteriovenous fistula at the wrist is generally accepted as the vascular access of choice in hemodialysis patients.

To estimate the variability of heart rate in hemodialysis patients 50 patients (23 males, 27 females, average age 55 (46–61) years old) have been surveyed. An essential gender differences have been detected while the general intensity of neurohumoral regulation was reduced before hemodialysis. Men initially had higher tone of sympathetic nervous system while women had higher tone of parasympathetic nervous system. After the hemodialysis a substantial increase in the power of humoral regulation and inessential increase of sympathetic tone have been detected; while the total heart rate variability increased noticeably in male patients compared to females . The indices of heart rate variability in male patients correlated with the duration of hemodialysis and ultrafiltation volume during a hemodialysis session. In females it correlated with the level of serum potassium.

The usefulness of pre-operative parathyroid scintigraphy and neck ultrasound in patients on chronic hemodialysis with secondary hyperparathyroidism (SHPT) is still controversial. 35 patients with SHPT were enrolled in this study, 22 patients underwent parathyroidectomy. The sensitivity and specificity of ultrasonography and scintigraphy were determined in 22 patients. The sensitivities of ultrasonography and scintigraphy were 94,7 and 41,3%, respectively, and the specificity was 100% for both procedures. The sensitivity of combined techniques was 96%.

Kidney transplantation is one of the most effective methods of renal replacement therapy. The aim of the given research is to prove that an ability to work is an indicator of successful kidney transplantation. Materials and methods: we have analyzed the results of 251 kidney transplantation, were the patients that lived more than six months after operations have been included into research. An average age of patients was 36,52 ± 10,50 among whom there were 63, 7 male patients. In 97% cadaver donors were used. For statistical analysis we used SPSS. Results: during the hemodialysis 29 patient (12%) were working. After kidney transplantations 161 (64%) patients returned to work. Survival rate of patients and transplants appeared to be considerably higher among those patients who were able to work after the operations. We made a comparative analysis of patients and transplants survival among working and non-working patients. The lifetime and transplants survival rate was significantly higher among the working patients. Median time of survival was 21 years and 7 years for working and non-working patients correspondingly (p = 0,0001); median time of transplant survival was 20 years and 4 years for working and non-working patients correspondingly (p = 0,0001). Conclusion: work rehabilitation after kidney transplantation is a factor of improved prognosis of operation outcomes.

Metastatic calcification of the soft tissues is a serious problem in patients with end-stage renal disease. Uremic tumoral calcinosis is a rare form of ectopic or extraskeletal calcification characterized by the presence of calcium phosphate deposits in soft tissues mostly surrounding large joints. This complication is thought to be related to hyperphosphatemia and the high calcium-phosphorus product as well as the development of secondary or tertiary hyperparathyroidism in patients on long-term dialysis. There are only several case reports which describe ultrasound evaluation of the uremic tumoral calcinosis. Here we describe a case of a 34-year-old man on a long-term hemodialysis who developed progressively enlarging multiple tumor-like lesions all over his body. Ultrasound evaluation revealed multilocular cysts in calcified structures with active vascularization. This clinical observation demonstrates the use of the ultrasound examination in diagnosis of the uremic tumoral calcinosis allowing to detect the presence, extension, and activity of the process.

Stenosis of arteria illiaca externa on the graft side in the posttransplant period can result in dysfunction of a transplant and as a consequence – its loss. Surgical correction of this complication is a traumatic operation with the risk of graft loss up to 20%. We report a case of correction of the stenosis in artery illiaca externa using a less traumatic method – percutaneus transluminal angioplasty.