Highly active antiretroviral therapy (HAART) decreases considerably the mortality and the risk of AIDS progression. However HAART increases the risk of kidney damage. The most common variants of the damage are acute kidney injury, tubulointerstitial nephritis, crystalluria, nephrolithiasis, Fanconi syndrome and chronic renal failure. Furthermore, it is expected that improved survival of such patients is anticipated with increased risk of chronic HAART-associated metabolic complications such as diabetes and dyslipidemia, which, in turn, can contribute to vascular kidney diseases of and decreased renal function. This review describes the occurrence and the mechanisms of renal adverse effects of antiretroviral therapies.

Renal transplantation is the treatment of choice for patients with end-stage renal disease. Recipient and allograft survival have improved with better immunosuppressant protocols reducing acute allograft rejection. However post-transplant infections became more important and severe. An emerging problematic virus in the past decade is the polyoma virus BKV and BKV-associated nephropathy (BKVAN). From 30% to 60% of patients with BKVAN develop graft failure. The diagnosis of BKV infection is based on the combination of the presence of urinary decoy cells, virus in the urine/blood, and typical renal histological findings of interstitial nephritis. The treatment of BKVAN includes reduction in immunosuppression and antiviral therapy with cidofovir or leflunomide or a combination of both. The combinations of the early diagnosis with appropriate reduction in immunosuppressive therapy improves outcome.

We present here a review of data concerning rationale, dosage and efficacy of anti-CD20 monoclonal antibodies (Rituximab) in chronic glomerulonephritis with nephrotic syndrome, systemic lupus erythematosus, ANCA-associated vasculitis and HCV-associated cryoglobulinemia.

The influence of renal tubular calcium reabsorption on calcium homeostasis was studied in 28 healthy volunteers with normo- and hypercalcaemia (during v/v calcium gluconate infusion), 36 kidney allograft recipients with fasting hypercalcaemia (10 of them where treated by cyclosporine A, prednisolone and azathyoprine, 26– with prednisolone and azathyoprine) and 17 kidney allograft recipients with fast hypocalcaemia, treated by prednisolone and azathyoprine. Calcium reabsorption was calculated by CaR/GFR (CaUF – CaE/GFR) and T-score CaR/GFR (the difference between CaR/GFR in the recipient and healthy persons at the same CaUF normalized for its standard deviation in healthy people). It was revealed that hypercalcemia in 8 recipients in triple and in 14 recipients in double-component immunosuppression was caused by a combination of increased tubular calcium reabsorption with elevated calcium flow from tissues to blood. In others recipients hypercalcemia resulted from extrarenal reasons.

The aim of the study was evaluation of bone mineral density (BMD) in children and adolescents with nephrotic syndrome (NS). Lumbar spine BMD was measured with dual energy X-ray absorptiometry (DXA) in 30 patients with NS. The data were expressed as medians (Me) and 25th and 75th centiles and were analyzed with non-parametric tests using SPSS-13 for Windows software. The BMD Z-score was –0,5 (–2,3; –1,05; 0,02; 1,3) [Me (min; 25th; 75th; max)] SD. Low BMD compared to normal value for the same age (BMD Z-score less than or equal to –2 SD) was found in 2 adolescents. Non-severe decrease in BMD (Z-score less than or equal to –1 SD, but above –2 SD) was found in 26,7% (8/30) patients. There was a significant correlation between BMD and patients age ( r = 0,868, p = 0,001) and between BMC and age (r = 0,916, p = 0.0001). Patients with decreased BMD had steroid dependence (p = 0,026) more often than patients with the Z-score above –1 SD. We divided our patients into 4 groups according to cluster analysis. The cluster group of patients with maximum Z-score had minimal period after cessation of steroid therapy and regular prophylactic therapy with low-dose vitamin D plus calcium. No correlation was found between BMD Z-score and duration of steroid treatment or cumulative prednisolone exposure. Our results show that BMD is not significantly decreased in children with NS. Steroid dependence is a risk factor for decrease in BMD. Regular prophylactic with low-dose of vitamin D plus calcium can prevent osteoporosis in children with NS.

The main methods of renal replacement therapy (RRT) are hemodialysis (HD) and peritoneal dialysis (PD). Improvement of dialysis technologies has increased life expectancy of ESRD-patients. This brings attention to estimate of not only indicators of clinical and laboratory parameters, but also to quality of life (QOL). In the present study an analysis of QOL in patients on different methods of RRT is performed. The assessment of QOL in patients on HD ( n =97) and PD ( n =88) was performed with the questionnaire Kidney Disease Quality of Life Short Form (KDQOL-SF^TM), a hospital anxiety and depression scale (A.S. Zigmond, R.P. Snaith, 1983), the comorbidity index of M.E. Charlson. The nutritional status was also estimated. It was found that parameters of QOL and depression depend on the mode of RRT, comorbidity index and nutritional status. Estimations of QOL were higher in the PD patients: the role of emotional functioning, social functioning, burden of kidney disease, and effects of kidney disease. Irrespectively of the mode of RRT disorders of nutritional status were associated with decrease in QOL.

A comparative analysis of the efficiency of different approaches to the use of continuous renal replacement therapy (CRRT) in patients with acute pancreatitis was performed on 96 patients. It is found that the early inclusion of CRRT in the complex treatment provides regression of clinical and laboratory symptoms and significantly improves survival rate compared to delayed CRRT after the development of multiple organ failure. The baseline renal function was revealed to be an independent prognosis factor of survival rate in patients with acute pancreatitis. In accordance with the results obtained we suggest to use creatinine plasma level of above 87 µM and the glomerular filtration rate below 80 ml/min at time of admission as the criteria for the early start of CRRT in patients with acute pancreatitis.

Radioisotope ventriculography was performed in 36 stable dialysis patients in the beginning and at the end of haemodialysis sessions for studying remodeling of cardiovascular system and the mechanisms of intradialysis hypotension. It has been shown that adequate ventricle refilling plays a critical role in the maintenance of cardiac outputduring haemodialysis with ultrafiltration. In the left ventricle the active refilling phase was more significant than in the right one. Interestingly, the decrease of the right ventricle output was accompanied by augmentation of the left ventricle output ( r =−0,91). It can be a mechanisms providing blood return to the right heart. Based on data obtained a theoretical model of adaptation of cardiovascular system in haemodialysis patients was suggested.

A review of literature on catastrophic antiphospholipid syndrome (CAS) including the basic concepts of pathogenesis, clinical displays, morphological features, diagnostics and treatment is presented. The difference between classical variants of CAS – primary and secondary, at systemic lupus erythematosus, is emphasized. The review is illustrated by a clinical case of a patient with CAS which has developed as the main manifestation of SLE. Some aspects of differential diagnostics of CAS with others microangiopathic syndromes – GUS/TTP and DIC-syndrom – are presented.