World Kidney Day on March 8^th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.

The lecture concentrates on the analysis of mechanisms of development of oedema in cardiac failure, in renal and hepatic diseases. Additionally, the mechanisms of the development of the drug-induced and idiopathic oedema are reviewed. General approaches to the treatment of oedema are introduced including the management of diuretic-refractory oedema. It is concluded that in the chain of events underlying pathogenesis of oedema of varying genesis, antinatriuretic mechanisms strongly prevail upon diuretic ones. Despite different ways of kidney involvement, enhanced renal sodium reabsorption is a common link in the formation of oedema of various origins, and even in advanced stages of renal disease kidney is capable to actively retain sodium.

The main prognostic factors of chronic kidney disease (CKD) are discussed briefly. An analysis of randomized controlled trials reveals prognostic role of etiology and clinical features of CKD, iatrogenic factors, smoking and drug addiction. Analysis of clinical symptoms together with microalbuminuria, signs of cardiovascular involvement, chronic inflammation and malnutrition could increase the efficiency of early prognosis of CKD.

The aim of our study was to investigate the influence of low molecular weight and unfractionated heparin (UFH) on endothelium and platelets in 26 patients with chronic renal failure on hemodialysis. We evaluated a marker for the von Willebrand factor antigen as endothelium dysfunction using “STA Compact” apparatus (Roche, France). The following platelet parameters were measured: the number of platelets in whole blood with “Pentra 60” (France); spontaneous platelet aggregation; adenosine diphosphate- (1,25; 2,5; 5,0 mkg/ml), collagen-, ristomycin-induced platelet aggregation using “Biola”. We determined the features of influence of low molecular weight heparin and UFH on endothelium and platelets.

Sneddon's syndrome (SS) is a vascular disease, characterized by the association of ischemic cerebrovascular disease and widespread livedo reticularis. SS is considered as a variant of antiphospholipid syndrome (APS) since antiphospholipid antibodies (APA) were detected in most SS patients. The possibility of renal involvement in SS was underestimated. The aim of the study was to assess the clinical manifestations, the time course and methods of diagnostics of kidney injury in SS patients. Comparative analysis of clinical, instrumental and morphological characteristics of kidney disease in SS patients, APS-associated nephropathy and nephropathy in the outcome of hemolytic-uremic syndrome found a thrombotic microangiopathy (TMA) as the basis of SS renal injury. It was shown that nephropathy in SS patients, as in other renal TMA, is characterized by specific renal hemodynamic changes including mosaic depletion of cortical blood flow with decreased velocity as the markers of ischemic nature of this pathology type. The intrarenal and intraocular hemodynamic features show a general microvasculature injury which involves not only skin and brain blood vessels. These findings suggested that SS is a systemic ischemic pathology with polyorganic involvement.

Data concerning the risk factors and consequences of acute kidney injury (AKI) after heart transplantation (HT) are dismissingly few and unclear. To identify the risk factors of AKI and to define indications for renal replacement therapy (RRT) data of 114 HT performed at the V.I. Shumakov Federal Center of Transplantology and Artificial Organs were analyzed using multivariable logistic regression modeling. The main risk factors were renal dysfunction and heart failure before HT, duration of ischemia, duration of CPB, intraoperative haemolysis and blood transfusion as well as postoperative heart transplant dysfunction. The reappraisal and widening of indications for RRT were associated with higher survival rate. The development of AKI was a predictor for short (30 days) and long term (>10 years) mortality rate.

In order to study profibrogenic cytokines – monocyte chemotactic protein-1 (MCP-1), transforming growth factor (TGF-β1) and type IV collagen in urine, the parameters of intrarenal hemodynamics in patients with systemic lupus erythematosus (SLE) in the presence of a secondary antiphospholipid syndrome (APS) 91 patient with SLE have been examined. APS was found in 27 of them. The content of MCP-1 in serum and urine, TGF-β1 and type IV collagen in urine were measured by ELISA using commercial kits. Intrarenal hemodynamic study was performed by an ultrasound scan of the arteries with a Toshiba apparatus. In SLE patients with APS we observed higher levels of fibrosis markers: TGF-β1 and type IV collagen in urine and lower levels of inflammation and cytokine fibrosis (estimated by MCP-1) compared to SLE patients without APS. A statistically significant correlation of collagen type IV in urine with the presence of APS was found. Intrarenal blood flow in segmental and parenchymal vessels in patients with APS was characterized by lower blood speed, its unevenness, increased or decreased vascular resistance. There is significant correlation between blood flow velocity and vascular resistance vs . blood creatinine levels, GFR, and type IV collagen in urine.

Introduction and aims: It is known that ADAMTS13 deficit is a reason of thrombotic thrombocytopenic purpura. A reduction of the ADAMTS13 activity has been recently demonstrated in different glomerular nephropathy (lupus nephritis, chronic glomerulonephritis). The aim of our study was to assess the «ADAMTS13 – von Willebrand factor – platelet» system disturbances in patients with nephropathy and thrombophilia with ТМА in biopsy specimens. We evaluated the ADAMTS13 activity in plasma of 20 patients with nephropathy and thrombophilia (antiphospholipid syndrome and hereditary thrombophilia). The ADAMTS13 activity <93% was founded in 8 (40%) pts. The lowest ADAMTS13 activity (56% and 76%) was noted in 2 patients with acute TMA. ADAMTS13 activity directly correlated with platelet counts (r = 0,5, p = 0,012) and there is indirect correlation between ADAMTS13 activity and vWF (r = –0,3, p < 0,05). Our results suggest that the disturbances in the «ADAMTS13 – von Willebrand factor – platelet» system is an universal pathogenetic mechanisms of thrombosis formation in renal microcirculation.

Worldwide experience in the programs of physical rehabilitation of dialysis patients is improving every year. In many countries including Germany that is one of the leaders in this field, this practice becomes a standard method of treatment. The most modern programs of rehabilitation of patients with renal insufficiency are developed and applied in this country. The experience of German colleagues may be used as a basis for the organization of rehabilitation programs for treatment for these patients in Russia.

We presented clinical cases which demonstrate kidney transplant involvement in infections caused by bacteria, BK-polyomavirus, Mycobacterium tuberculosis. Morphological study of graft is crucially important for correct determination of the cause of transplant dysfunction.