Investigation of the mechanisms underlying cardiorenal relationship and progression of nephrosclerosis is an important problem of nephrology. Results of recent studies indicate that insulin resistance (IR) develops on the earliest stages of chronic kidney disease (CKD) including non-diabetic and in non-obese associated nephropathies. According to the published data, IR can be considered as a mechanism that determines dramatic increase in cardiovascular morbidity on the early stages of CKD compared to general population. It appears as an independent predictor of vascular death in patients with terminal renal failure. Experimental and prospective clinical studies have demonstrated that IR is important pathophysiological factor of progressive CKD along with proteinuria and hypertension. Рathophysiological aspects of the IR formation on different stages of CKD in non-diabetic, non-obese patients can be important in developing new treatment approaches for CKD patients.

Hemophagocytic syndrome (HFS) is a rare life-threatening syndrome that is characterized by fever, splenomegaly, pancytopenia and the presence of hemophagocytosis in bone marrow and other tissues. The review summarizes recent data on pathogenesis, clinical presentation and treatment of HFS. We also present a case of fatal infection-associated HFS in a renal transplant recipient.

The aim of this study was to determine the incidence of nephrotic syndrome (NS) in children according to data of a regional register. A retrospective study was undertaken to describe demographic of all 90 children (54 boys and 36 girls) under 10 years diagnosed with NS in Voronezh region (Russia) over a 15-year period. The mean age of the onset was 3,25 years. The annual incidence of NS was 2,5 (1,8; 3,1) children per 100 000. The incidence of steroid sensitive NS was 2,0/100 000, of steroid resistant NS – 0,3/100 000, frequently relapsing and steroid dependent NS – 0,6/100 000, infrequently relapsing NS – 0,6/100 000. A negative correlation was found between the time courses of the incidence of steroid sensitive NS and of steroid resistant NS (r = –0,533, p = 0,041). The incidence of children with NS in Voronezh region of Russia is similar to overseas studies. The data of regional registry provide a more accurate picture of the epidemiology of NS.

Cardiovascular complications are a principal cause of death in patients with chronic kidney insufficiency. The augmentation index (Aix) is an independent predictor for cardiovascular mortality. The purpose of our research was to study a level and a daily rhythm of Aix in control (healthy teenagers, 10 persons, mean age 14 ± 2 years) and in patients with a functioning kidney transplant (36 persons, mean age 12,88 ± 3,3 years) with 24-hour ambulatory arteriograph BPLab („Petr Telegin“, Nizhny Novgorod, Russia). Transplantation had been performed 3,3 ± 3,2 years prior to examination. Control patients had a significantly lower mean arterial blood pressure (MBP) and mean Aix (MBP 79,17 ± 4,3 mmHg vs . 86,36 ± 9,5 mmHg CI 0,5/13,8, Aix – –55,22 ± 6,4%, –42 ± 18,4% CI 0,4/25, respectively). The plot of the daily profile of Aix in the control group had two peaks (at 11–12 and at 19–20 hours), the maximum values were in the day time, and the minimal values were at night. The daily profile of Aix in patients had the maximum at night. We found no significant correlations between Aix and serum creatinine level, cyctatin C, glomerular filtration rate, dose of immunosuрpressive medications, antihypertensive therapy or MBP. The study suggests that subclinical arteriopathy is often prеsent in young transplant recipients.

Preservation of the intravascular volume is the first choice measure for the prevention of intradialysis hypotension. At present there are devices that allow a continuous monitoring of relative blood volume (RBV) during haemodialysis (HD). The aims of this research were to check data validity of two devices: BVM (Fresenius MC, Germany) and Crit-Line (In-Line Diagnostics Corporation, USA) and to investigate the influence of different dialysis modes on RBV. The coincidence of reading of two monitors and laboratory values of Hb and Ht were assessed during 30 HD sessions in 15 patients. In patients with hyperhydratation RBV curves were monotone and maximum drops of RBV (DRBV) were minor. In all cases relation DRBV/ultrafiltration volume (UF) did not exceed 2,5%/l. In 32 stable HD patients consecutive uses of 5 different UF and Na⁺ profiles did not decrease DRBV. Intradialysis hypotension was observed in cases of rapid RBV fall during first hour of HD (6,72 ± 0,86% for HD with hypotension vs 3,86 ± 1,02% in general, р < 0,05) and when DRBV/UF was high (>6%/L).

Aim of the study was to investigate the efficacy, safety and tolerability of sodium mycophenolate after renal transplantation. Material: 183 renal transplant recipients from 16 centers were analysed. The 1st (de novo) group of 83 recipients who received sodium mycophenolate since renal transplantation (RT) in combination with prednisolone and cyclosporine. The 2nd (maintenance) group of 100 patients was switched from mophetyl mycophenolate or azathioprine to myfortic after 57,3 ± 48,6 months after RT. The duration of follow-up was 6 months. The efficacy of immunosuppression was evaluated by the rates of acute rejection, graft survival, serum creatinine level (Pcr) and creatinine clearance. For the analysis of safety and tolerability of sodium mycophenolate sodium, the frequency of adverse effects and dose reduction/drug withdrawal were taken into account. Results: In de novo group acute rejection was detected in 6% of patients. The 6-month patients and grafts survival were 98,7% and 98,7%, respectively. Pcr at 3 and 6 months of observation was 120 ± 32 mM and 124 ± 38 mM, respectively. Infections haved developed in 44,5%, hepatic disorders in 13%, leucopenia in 12% and gastrointestinal complications in 7,2% of patients. The sodium mycophenolate dose was reduced in 7 (8,4%) patients due to development of adverse effects. No acute rejection was observed in maintenance group. Patient and graft survival at 6 months were 100% and 98%, respectively. Two grafts were lost due to chronic rejection. Pcr at 3 and 6 months of observation was 137 ± 43 mM and 134 ± 47 mM, respectively. Infections in this group occurred in 27%, liver dysfunction in 6%, gastrointestinal disorders in 10% and leucopenia in 11% of patients. In 13 (13%) of patients mycophenolate sodium dose was reduced, and in 3 of those the drug was cancelled completely thereafter. Conclusions : Preliminary results of the study confirmed data of other authors about high efficacy and safety of in basic immunosuppressive therapy after renal transplantation. The adverse effects of sodium mycophenolate can restrict its application to a limited number of patients.

To evaluate the prevalence and structure of kidney disease in out-patients clinical records and reports of out-patients followed-up in the city out-patient clinic since year 2005 up to 2009. The number of visits to nephrologist increased in 1,8 times during the past 5 years. The number of kidney diseases diagnosed in the population increase in 5,8 times reaching 6,1% of the total number of patients followed-up. The number of patients of working age (17–60) with registered kidney diseases was 164, that was higher than the number of patients with chronic myocardial ischemia (n = 153), hepatitis (n = 81), liver cirrhosis (n = 12), rheumatism (n = 8). The structure of kidney diseases found was as follows: pyelonephritis (54,3%), chronic renal insufficiency (12,2%), chronic glomerulonephritis (10,4%) and diabetic nephrosclerosis (8,5%). The results obtained suggest the necessity of employing a qualified specialist-nephrologist at the level of the city or district out-patient clinic.

Thrombotic microangiopathy is a rare manifestation of juvenile dermatomyositis. Such patients can develop acute kidney injury. Recognition of this manifestation has important therapeutic implications as the patients may require therapy with plasma exchange and dialysis in addition to the treatment of dermatomyositis. Here, we report a case of a 4-year-old boy with juvenile dermatomyositis with thrombotic microangiopathy. The patient initially received pulses of methylprednisolone and intravenous immunoglobulin which did not induce a significant improvement. He was given infusion of fresh frozen plasma and pulse of cyclophosphamide. The patient responded successfully to this therapy and achieved total remission.

The pneumonia after transplantation is a common complication. This complication is really dangerous and has a high mortality rate due to use of immunosuppressive drugs. This results in poor clinic and laboratory manifestations of pulmonary diseases that develops fulminantly inducing pulmonary failure and is resistant to standard therapy. The diagnostic and treatment of such patients requires special experience of medical staff. We present a case of successful treatment of pneumonia in a kidney transplant recipient.

We present the materials published by an international workshop, which examined how cyclosporine fits into the “therapeutic armamentarium” in idiopathic nephrotic syndrome. A unified and integrated approach for the use of cyclosporine in the most common histologic variants of idiopathic nephrotic syndrome and provided recommendations for monitoring of potential side effects is also described. We also present the data from reviews, devoted to the immunosuppressive regimens and the use of cyclosporine in SLE, treatment of lupus nephritis with cyclosporine and recommendations concerning the use of cyclosporine in proliferative and membranous lupus nephritis.