The review concerns pathogenetic mechanisms and clinical and morphological characteristics of different types of kidney involvement in malignant diseases of lymphoid tissue and plasma cell dyscrasias. We present 11 cases which illustrate kidney damage in multiple myeloma, primary amyloidosis, heavy chain deposition disesase, B-cells chronic lymphocytic leukemia, non-Hodgkin lymphoma, Hodgkin’s disease and a rare case of proliferative glomerulonephritis with monoclonal IgA deposition. We also report clinical and morphological data of 120 patients with renal involvement associated with lymphoplasmacytic disorders treated in our center during the last 14 years.

Along with survival assessment of the quality of life (QOL) in patients on renal replacement therapy is an important measure of its efficiency. Evaluation of changes in QOL during the treatment could help to choose optimal sequence and duration of dialysis and its modality. In stable patients on hemodialysis ( n =84) and on peritoneal dialysis ( n =67) in single dialysis center QOL was assessed by the kidney disease specific questionnaire KDQOL-SF (277 evaluations in total). Many scale’s scores were higher in men than in women and in patients on peritoneal dialysis (PD) than on the hemodialysis (HD) ones. Higher scores, achieved by the end of the first year of HD, comparing with earlier period, may be caused by later beginning of HD. In patients on PD several scales demonstrate a decrease in scores from the 3^rd-4^th year of treatment while they still remain higher than those on HD. Direct relation between hemoglobin level and many QOL scales leaves the question about the target hemoglobin level open (at least in some of patients considering known cardiovascular risks) even within the target range of hemoglobin. The relationship between several QOL scales and two known challenges to modern dialysis - chronic inflammation and hyperphosphatemia - is also worth considering.

In the last decades the frequency of the focal segmental glomerulosclerosis (FSGS) increases. It is established that the dependence of the response on therapy and prognosis of the FSGS depend on morphological type. The aim of our study was to assess the frequency of types of FSGS and the response on therapy in Kazakh children. We have observed 16 Kazakh children with FSGS that was manifested with the nephrotic syndrome (NS) in 11 children, nephritic syndrome (NiS) in 4 children and combination of the NS and NiS in 1 child. The most frequent morphological type of FSGS was tip-lesion - 7 (43,8%). Typical type was observed in 6 (37,5%) children and collapsing glomerulopathy in 1 (6,3%) child. In 2 children FSGS was probably associated with podocytes’ and collagen type IV gene mutations and was not assessed as a primary disease. 9 children with the NS have received cyclosporine A, methylprednisolone pulses and oral prednisolone. Complete remission was achieved in 8 children. All children with NiS have received ACEi and one of them received mofetil mycophenolate with methylprednisolone pulses. A decrease in proteinuria was found in some cases. Thus, the FSGS in Kazakh children more is more often manifested clinically with the nephrotic syndrome, more rarely with the nephritic syndrome, and morphologically - with tip-lesion and typical type. Cyclosporine in combination with pulses of methylprednisolone and oral prednisolone are effective in achievement of complete remission of the nephrotic syndrome, and mofetil myciphenolate with ACEi - in nephritic syndrome (partial remission).

In this work literature data conserning iron compounds used for intravenous administration in patients with CKD treated by dialysis were summarized. Special attention is paid to low molecular weight dextran of iron (Cosmofer) registered in 2008 and being successfully used during a significant period of time in the United States. It is already registered in 50 countries besides Russia. Analysis of published data allows us make an unambiguous conclusion that Cosmofer provides practically equal safety and efficacy as Venofer - already well-known drug in Russian market. On the other hand, due to some structural features a single-step use of large doses of Cosmofer is possible. This saves time of the personnel and makes therapy cheaper.

Renal vascular resistance detected by ultrasound Doppler correlates with the severity of the renal disease and with the renal function. The aim of this study was to estimate the renal resistive index (RI) as a marker of cardiac damages in patients with chronic kidney disease (CKD). 128 patients (mean age 40.1±0.96 years) with CKD 1-3 stages (by NKF K/DOQI classification, 2002) were included in the study. The glomerular filtration rate (GFR) was estimated by the serum creatinine level and age using the MDRD equation; left ventricular hypertrophy (LVH) was determined according to echocardiography criteria. We examined renal vascular resistance by Doppler ultrasonography in main, segmentar, interlobal and arcuate arteries of kidneys. We estimated the prevalence of arterial hypertension, left ventricular hypertrophy (LVH), stable angina pectoris and chronic heart failure (CHF) in 1-3 stages of CKD. Stepwise multiple regression analysis showed that only RI interlobal arteries (RI IA) can be chosen as an independent factor for development of LVH, stable angina and CHF. RI IA>0.64 showed the accuracy of 72.6%, sensitivity of 65.1% and specificity of 80.0% for LVH; the accuracy of 73.3%, sensitivity of 71.5% and specificity of 75.0% for stable angina; and the accuracy of 72.7%, sensitivity of 66.7% and specificity of 78.7% for CHF.

Tha aim of the study was to consider pathogenesis of end-stage renal disease (ESRD) in view of systemic inflammation in patients with diabetes mellitus, chronic pyelonephritis and chronic glomerulonephritis. Material and methods: 42 patients (age 45.4±13.9 years, M±SD) with ESRD caused by chronic glomerulonephritis ( n =22), chronic pyelonephritis ( n =12) and diabetic nephropathy ( n =8) were studied. All patients received haemodialysis for 12 hours per week. A control group consisted of 68 healthy persons (age 18-75 years). Levels of CRP, IL-6, IL-8, IL-10, TNFα in blood plasma were measured before and after haemodialysis with an immunochemiluminescent method (“Immulite”, «SIEMENS», USA). The levels of these markers were used to calculate the integral indices of systemic inflammatory reaction (the reactivity coefficient and level of reactivity). TGFβ1 was measured by immune-enzyme analysis («DRG Instrument GmbH», Germany). Results: Systemic inflammatory reaction (more expressed in diabetic nephropathy) was detected in patients with ESRD. According to ROC-analysis results the reactivity coefficient is the most informative characteristic of systemic inflammatory reaction. We detected compensatory increase in synthesis of anti-inflammatory cytokine TGFβ1 while the level of IL-10 increased ocassionally. Conclusion: The phenomenon of systemic inflammatory reaction plays a significant role in pathogenesis of ESRD. It includes both pro-inflammatory and anti-inflammatory reactions for injury and can be considered as a typical process whose development insignificantly depends on the nosology. The integral indices are the optimal parameters for assessment of the intensity of systemic inflammatory reaction.

A case of diabetic glomerulosclerosis along with APS-associated nephropathy (morphologically nodular glomerulosclerosis and chronic thrombotic microangiopathy) in a patient with type 2 diabetes mellitus and combined thrombophilia (antiphospholipid syndrome and hereditary thrombophilia) is reported. Contribution of smoking and hypercoagulation hemostasis disorders to the early development and progression of nodular glomerulosclerosis is discussed.