The short review discusses the target blood pressure (BP) in patients with chronic kidney disease (CKD). Analysis of a few randomized controlled trials indicates that the target BP of <130/80 mm Hg that is declared in international and Russian national recommendations are optimal for slowing down the progression of nephropathy and cardiovascular complications. On the other hand moderate deviations from the target BP values for some categories of patients do not affect the prognosis while an extreme antihypertensive therapy could be associated with the development of serious complications.

Deep impairment of kidney function, inadequate intake and/or gastrointestine absorption, dialysis losses, especially during high-flux, high-effective dialysis, require administration of water-soluble vitamins in maintenance haemodialysis (MHD) patients in order to prevent hypovitaminosis. Another reason of vitamin use in MHD patients is based on physiological effects of some vitamins useful for correction of some pathological conditions typical for these patients. In this review we consider physiological effects of vitamins, causes of vitamin insufficiency in MHD patients, dialysis losses, and last recommendation for vitamin supplementation for MHD patients. The review includes information on thiamin, riboflavin, nicotinamid, pantothenic acid, pyridoxin, biotin, folic acid, cobalamin, ascorbic acid, retinol, tocopherol and vitamin K. Although there is a lack of well-design randomized placebo-controlled trials on vitamin usage in MHD patients, the results of some randomized controlled studies of vitamin use in correction of hyperhomocysteinemia, oxidative stress, genomic damage level, muscle cramps, functional iron deficiency, polyneuropathy, hyperphosphatemia, dyslipidemia in MHD patients and European recommendations on vitamins administration in MHD patients reviewed may be interesting and helpful for nephrologists.

It is well recognized that haemodialysis patients display highly elevated rates of cardiac mortality. One of the main causes of mortality is heart failure (HF). Myocardial ischemia due to repeated hypotension events during rapid ultrafiltration and depletion of intravascular volume (IV) play important role in the HF genesis. Monitoring of the relative blood volume (RBV) allows one to control IV changes and to evaluate effectiveness of measures of IV maintenance. Automatic feedback systems that control certain haemodyalisis parameters in response to changes in RBV are promising. However further investigations are needed for their adaptation.

The aim of the study was to estimate relationship between atrial fibrillation (AF) and renal function, microalbuminuria, renal blood flow (RBF) in CHF patients I–IV NYHA functional class. Patients: n = 118, median (interquartile range): age 62,0 (54,0–67,0) years; left ventricular ejection fraction (LVEF, Simpson) 28,0% (23,0–34,0)%, 89,0% males) without primary diseases of kidney, urinoexcretory ways, endocrine system or oncological diseases. AF was found in 38% (95%CI 28,4–47,6) of patients. Frequency of appearance of shortness of breath, fatigue, palpitation were similar in the AF and sinus rhythm (SR) patients, but oedema was more severe in AF patient. There was no difference in the NYHA class, gender, age, LVEF between the AF and SR patients. Glomerular filtration rate (GFR, MDRD) was lower [98,5 (95,2–103,9) vs. 102,7 (97,8–108,2) ml/min/1,73 m²] and urine albumin-creatinine ratio (ACR, immunoenzymatic assay-Jaffe method) was higher [32,7 (9,7–46,3) vs 9,3 (1,8–33,3) mg/g] in the AF compared to the SR patients. Basal and general renal blood flow (RBF) was decreased in the AF patients. The follow-up period was 22 (6–105) months. The total mortality rate was 53,5%. AF did not affect the mortality. GFR decreased during 61 months. Its decline was more severe in the AF vs SR patients – 29,2 (17,1–39,4) vs 9,8 (3,5–13,8) ml/min/1,73 m². So, atrial fibrillation in CHF patients is associated with decrease in renal blood flow and glomerular filtration rate as well as with elevation of urinary albumin excretion compared to patients with sinus rhythm.

The aim of the study was to determine the prognostic role of brain natriuretic peptide (BNP) in development of adverse cardiovascular events in patients on program hemodialysis. We studied BNP level and performed ultrasonography in 51 patients with CRF on hemodialysis. Adverse cardiovascular events developed in 14 (27,45%) patients for one year of followup. A significant correlation was found between BNP concentration and systolic and diastolic myocardial function. BNP level was significantly above (p < 0,01) in patients with adverse cardiovascular events compared to patients without them. An increase in quartile BNP was accompanied by an increase in frequency of the end final point (р < 0,05). The relative risk of development of a final point in 4th quartile in comparison with 1st quartile, has made 3,23 (95% ДИ [1,59; 11,8]; р < 0,05). Conclusions: the BNP level is significantly increased in patients on hemodialysis compared to practically healthy people. There is a statistically significant correlation between the BNP concentration and structure and functional myocardial indexes. BNP level was increased in those hemodialysis patients who had adverse cardiovascular events. The raised level BNP is prognostic a marker of adverse cardiovascular outcomes at patients, being on treatment by a program hemodialysis.

The results of a prospective single-center study of efficacy and safety of tacrolimus therapy of steroid-resistant nephrotic syndrome (SRNS) in 8 children are presented. Initial tacrolimus dose of 0,1 mg/kg/24 h was combined with 0,5–1,0 mg/kg/48 h prednisolone. Tacrolimus dose was adjusted to achieve the target blood level of 5,0–10,0 ng/ml. Complete remission was achieved in 3 (38%) children, partial remission in 2 (25%) of them, 3 (38%) patients did not respond to tacrolimus. In 3 children the complete remission remained for 15 months after withdrawal of tacrolimus. The side effects observed were: hyperkalemia in 4 (50%) children, worsening of hypertension in 3 (38%), nephrotoxicity in 2 (25%), glycosuria in 1 (13%) case. Tacrolimus can be considered as effective immunosuppressive agent in children with SRNS.

In modern nephrology GFR is usually estimated by serum creatinine level or calcualed with e-formulas. In pediatric nephrology the Schwartz formula is frequently used. Recently cystatin C (CsC) was suggested as an alternative marker for GFR estimation. The aim of our study was to determine the level of cystatin C and to evaluate this marker for the assessment of renal function in children with different stages of chronic kidney diseases (CKD). 105 children with CKD 1–3 st. were examined. In children with CKD 1 st. the average serum CsC levels was 1144,3 ± 170 ng/ml with no significantly different from the comparison group (870 ± 200 ng/ml) and from the reference figure of 940 ± 270 ng/ml reported by G. Filler (1999). In children with steroid-resistant nephrotic syndrome (GFR >90 ml/min) the CsC level was significantly higher than in the control and reference groups 1647 ± 263 ng/ml (p < 0,05). In children in remission stage of steroid-sensitive/steroid-dependent nephrotic syndrome (GFR >90 ml/min) the CsC level did not differ significantly from its values in the comparison groups 988 ± 230 ng/ml. In children with non-glomerular pathology (GFR >90 ml/min) the level of CsC was higher, 1185,7 ± 191 ng/ml. Children with CKD 2 and 3 st. had significantly higher CsC serum level than in the CKD-1 patients, and in control and reference groups (1754 ± 325 и 3171 ± 918 ng/ml, correspondingly). Thus, we found a significant increase in the serum CsC level in children with GFR <90 ml/min. In functionally compensated stages of CKD a significantly higher CsC level was found in patients with poor prognostic variants of CKD. This confirms that cystatin C to be an early marker for GFR estimation.

The aim of the study was to estimate renal function, urinary albumin excretion (UAE), renal hemodynamics and their relationship with cardiac function, severity of clinical status and prognosis in chronic heart failure (CHF) patients with reduced left ventricular ejection fraction (less than 40%) without extracardiac pathology (n = 70). We found a reduction of glomerular filtration rate (GFR, MDRD) to 60–89 ml/min/1,73 m² in 47,1% (95% CI 34,0–60,2%) patients. It was reduced to 30–59 ml/min/1,73 m² in 30,0% (95% CI 17,9–42,1%) of them, while microalbuminuria was found in 58,6% (95% CI 45,7–71,5%) patients. Linear and volume rate of renal blood flow were decreased, renal vascular resistance was elevated in comparison with healthy subjects (р < 0,001). A significant correlation was found between clinical severity of CHF and renal hemodinamics, GFR, albuminuria, left ventricular ejection fraction, stroke volume and cardiac output. Patients with microalbuminuria, decreased renal blood flow and GFR had increased al-cause mortality in comparison with other patients (р < 0,05). So, decreased GFR, microalbuminuria, abnormalities of renal hemodynamics are widespread in isolated CHF, associated with severity of clinical symptomatics and poor prognosis.

The results of observational studies and clinical trials have formed a contemporary view on the anemia correction targets in patients with chronic kidney disease. However some questions remain unsolved and are the subject of active discussion which are presented in a short review. Expansion of available drugs which stimulate erythropoiesis arise additional concern about their bioequivalence (dosing, clinical effect, adverse events). This study presents the results of transferring of 51 hemodialysis patients from treatment with original epoietin a and b to the treatment with the same doses of Eralfon – a new pharmaceutical dosage formulation of epoietin a in pre-filled syringes produced by ZAO Sotex out of pharmacological substance manufactured by the State Scientific Research Institute of Highly Pure Biopreparations (St.-Petersburg). Eralfon was injected intravenously. After changing the drugs the hemoglobin level in the whole group remained the same (117 ± 6 g/l vs 116 ± 6 g/l); individual changes were also not significantly different from zero: the mean hemoglobin level change was –0,46 g/l (95% CI –1,79÷+0,84), р = 0,46. The mean baseline weekly epoietin dose was 5118 ± 2819 IU/week and did not differ from mean final Eralfon dose 5034 ± 2719 IU/week (р > 0,5). There was neither adverse event related to investigated new drug nor individual intolerability or allergic reactions in a short-term study. The blood pressure level was also stable.

Aim. The aim of the study was to assess the renal functional reserve (RFR), glomerular hemodynamics and tubular function in patients with hypertension and without kidney disease symptoms. Methods. Fifty five patients with hypertension (mean age 44,8 ± 9,9 years) and 32 people in healthy controls have been studied. The RFR was determined by dopamine load; uric acid, Ca, P, ethanolamine levels in serum and in 24-hour urine samples were studied. Ammonium and amino acids levels were also assessed in 24-hours urine samples. Evaluation of all metabolic syndrome parameters was also performed. Results. Patients with hypertension had decreased RFR compared to healthy subjects. According data collected, the patients were subdivided into groups. Patients of group 1 (30 patients) had normal renal functional reserve (58,57 ± 44,5%). Patients of group 2 (25 patients) had decreased renal functional reserve (34,8 ± 21,1%). Decreased RFR was detected more often in patients with 2 and 3 grade hypertension, those long history of the disease, obesity, metabolic syndrome or high GFR level. Regression analysis showed that the RFR level depends on GFR, membrane destabilization and Ca excretion. GFR also depends on the lipids metabolism and metabolic syndrome. Conclusion. Patients with hypertension without clinical symptoms of kidney disease had trends of hyperfiltration, membrane destabilization, and tubular dysfunction. RFR and GFR are affected by components of metabolic syndrome, by Ca excretion and by membrane destabilization.

The aim of the study was to investigate the fractional excretion of sodium and other electrolytes in children with urolithiasis compared to healthy children. The study included 66 children: 40 of them had urolithiasis (28 boys and 12 girls) from 7 months to 16 years old (mean 6,9 ± 4,9 years) and 26 healthy children (16 boys and 12 girls) from 6 months to 16 years old (mean 7,3 ± 5,0 years old). All children got the same diet with a salt content below 3 g/day. Stone samples (30) were examined by X-ray diffraction method using a Shimadzu XRD-6000 diffractometer. Spot urine samples and serum specimens were analyzed for sodium, potassium, calcium, phosphate, magnesium, uric acid, creatinine and urine oxalate levels. Metabolic disorders were revealed in 35% of children, hypercalciuria was found only in 10% of children. The most common stone component was calcium oxalate (61%). We found that the fractional excretion of sodium was significantly increased in children with nephrolithiasis compared to healthy children (0,88 ± 1,05% vs 0,31 ± 0,20%, p < 0,01). The fractional excretion of sodium did not depend on stone composition. A strong correlation between the fractional excretion of sodium and excretion of oxalate was revealed in children with nephrolithiasis only (r = 0,62, p < 0,01). No correlation between the fractional excretion of sodium and excretion of calcium was revealed in any group of children. Due to importance of the sodium excretion in stone formation we recommend to reduce salt intake for preventing stone recurrence in children.