Modern problems of nephrology in childhood are discussed on the basis of our own experience and literature data. The dysembriogenesis of the kidney, epidemiology of renal pathology, hereditary nephropathy, CRD and AKI, treatment of different kidney nephropathy including renoprotection are reviewed.

We studied hormonal status of 10 male patients from 41 to 69 years old with the end stage chronic kidney disease for 3–18 years and were treated with a program hemodialysis for 0,5–11 years before and just after a hemodialysis session. Using of immunoenzyme analysis the plasma concentration of the following hormones was assesed: aldosterone, cortisol, dehydroepiandrosterone-sulphate, insulin, C-peptide, parathormone, calcitonine, thyroxine, testosterone and estradiol. As the control 21 practically healthy volunteersof the same gender and age are used. In the interdialysis period a significant increase in plasma concentration of aldosterone, cortisol, parathormone, calcitonine, and C-peptide compared to control values has been found. After the 4-hour session of hemodialysis the concentration of aldosterone, insulin, C-peptide, parathormone, and testosterone significantly decreased, while the level of thyroxine increased. A correlation between concentrations of some hormones was revealed. It was essentially different in before dialysis compared to control; after the dialysis the quantity and an orientation of correlative ties came close to control. A dependence of concentration of separate hormones with on age, the duration of illness and hemodialysis, the presence of an arterial hypertension, anaemia, heart insufficiency, and renal osteodystrophy was established.

Aim: the assessment of the systemic inflammation as a typical pathological process associated with chronic renal allograft dysfunction using a new integral criterion – scale of the chronic systemic inflammation. Patients and methods. Three groups of patients were studied: group 1 of patients with the end-stage renal disease who receive renal replacement therapy in the form of programmed hemodialysis; group 2 of patients with chronic renal allograft dysfunction; group 3 of patients with normal function of allograft. Control group was a cohort of 5 healthy persons. The systemic inflammation markers were in blood plasma interleukins (IL-6, IL-8, IL-10), tumor necrosis factor (TNF)a, C-reactivity protein (CRP), cortisol, myoglobin, troponin I, D-dimer using analyzer IMMULITE («SIEMENS», USA). On the basis of these markers we calculated integrated criterion – scale of chronic systemic inflammation, ranging 0 to 8. Point 0 meant the absence of systemic inflammatory response, 1–2 point meant availability of systemic inflammatory response, but the absence of chronic systemic inflammation, points ³3 proved chronic systemic inflammation. Results. Chronic systemic inflammation was detected in 82% patients of group 1, in 43,5% patients of group 2. Patients of group 3 had not chronic systemic inflammation. However, signs of systemic inflammatory response were registered in 90,9% patients of group 1, in 91,3% patients of group 2, in 41,7% patients of group 3. Conclusion: renal transplantation arrests systemic inflammation partially, but there is a strong possibility of chronic renal allograft dysfunction in recipients who have some criteria of chronic systemic inflammation.

The prevalence and structure of the valvular calcification and its relationship to arterial hypertension, calcium-phosphate disorders, anemia, malnutrition–inflammation syndrome, achieving of volume balance were studied in 96 patients on predialysis care, hemodialysis and peritoneal dialysis with echocardiography. A high prevalence of the combined mitral-aortic calcification was revealed. The age and duration of predialysis arterial hypertension were the predictive factors for cardiac valve calcification in CAPD patients, but not for predialysis patients. Heart calcification was not linked with hyperparathyroidism, hyperphosphatemia and hypercalciemia for this group. We found association of left ventricular hypertrophy with the intensity of valve calcinosis in predialysis patients. Both concentric and eccentric types of myocardial remodeling were observed.

We studied the dynamics of changes in renal function in hospital and follow-up period in patients who underwent the heart valve replacement with cardiopulmonary bypass (CPB). The predictors of acute kidney injury (AKI) and hemodialysis requirement were revealed. 113 patients were enrolled into investigation. The long-term results were evaluated in 56 of them. We analyzed renal function with glomerular filtration rate (GFR) estimated with MDRD and Cockroft–Gault equation during first post-operative day, before the discharge from the hospital and in 1 year after surgery. There was a significant decrease in GFR from 90,0 ± 32,8 ml/min/1,73 m² to 54,5 ± 22,9 ml/min/1,73 m² in 24 hours after an operation with consequent restitution to 86,1 ± 38,1 ml/min/1,73 m² (p < 0,001). According to “RIFLE” classification taking into consideration changes in the serum creatinine level 108 patients were divided into the following groups: no AKI – 40 (37%) patients, risk – 35 (32,4%) patients, injury – 26 (24,1%) patients, failure – 7 (6,5%) patients. The dialysis requirement occurred in 5 (4,4%) patients. Conclusion. The GFR decreases in 24 hours after heart valve replacement operation and restores at the end of the period of hospitalization. This dynamics was similar in patients with different heart valves diseases. The risk factors of AKI and dialysis requirement are initially low GFR, age of patients and the duration of CPB. In 1 year after heart surgery there were fewer patients with 1^st stage of chronic renal disease, more of those with 2^nd and 3^rd stages, and the same fraction of patients who suffering from 4^th stage of chronic renal disease. The patients who needed the dialysis during early post-operative period survived without this procedure in the follow-up period.

We evaluated the incidence, aetiology, clinical and radiological features, the risk factors and outcome of pulmonary infections (PI) in 204 patients who received renal transplant (RT) from January 2005 to June 2010 in our centre. Pneumonia developed in 31 RT recipients (14,2%). Among all patients with PI, 19,3% had bacterial infection, 19,3% had viral and bacterial infection, 45,2% had polyaetiological infection (3–4 microorganisms) and 16,2% had pulmonary tuberculosis. The most common clinical signs of PI were fever (100%), dyspnoea (61,3%), and general fatigue (54,8%). Chest CT scan most often revealed consolidation (74,4%), ground-glass opacity (72,7%), local pneumofibrosis (45,4%) and mediastinal lymphadenopathy (45,5%). Overall mortality rate was 35,5%. The highest mortality was observed in patients with severe polyaetiological pneumonia. PI had a great negative impact on recipients and RT survival. Significant risk factors for PI were delayed graft function (OR 3,31, p = 0,014), chronic graft dysfunction (OR 3,48, p = 0,002), acute rejection of RT (OR 3,72, p = 0,004), treatment with antilymphocytic antibodies (OR 2,96, p = 0,011), CMV infection (OR 4,39, p = 0,0002), EBV infection (OR 3,49, p = 0,009) and leukopenia (OR 5,76, p = 0,0002). Identifying patients with risk factors and careful clinical monitoring, posttransplant chemoprophylaxis with valganciclovir and trimethoprim-sulphamethoxazole, early diagnosis and early treatment are necessary to decrease the incidence of severe pneumonia and mortality from PI in RT recipients.

The study compares endovascular rechannelization of occluded hemodialysis accesses with open vascular surgery. 16 endovascular interventions were performed in 14 hemodialysis patients and 11 accesses were restored surgically in 10 patients. The AngioJet rheolytic thrombectomy technology is described. The results of endovascular intervention were better after 3 and 6 months as well as after 24 months. Between 12 and 24 months after intervention the open surgery revealed results comparable to those of the endovascular interventions.

Renal transplantation in recipients with own kidney cancer is disputable. In this article the results of kidney transplantation in 7 patients with primary kidney tumor are observed. Clinical case of tumor development is also presented. Questions of the time factor of transplantation of a kidney after removal of a tumor are discussed as well.

Post-transplant TB is a serious problem worldwide. Abdominal tuberculosis is a rare disease presented by non-specific symptoms, laboratory and radiography findings that make it difficult to diagnose. Early diagnosis and prompt initiation of treatment for TB among renal transplant patients is very important and vital. We report here a case of abdominal tuberculosis in renal transplant recipient with a diabetes mellitus.

In an unmasked study 31 hemodialysis patients were transferred from rh-EPO products of other manufacturers to the equal doses of Epostim^®, a new erythropoietin product manufactured by Pharmapark LLC (Russia) from in-house produced pharmacological substance. The study has demonstrated that the alternative antianemic therapy in comparable doses is adequate and maintains stable hemoglobin level. In the course of the study none of the patients had to be switched back to the original therapy. No adverse effects attributable to the product, individual intolerance or local reactions were observed.