In the study the results of five year prospective clinical trial in 68 patients with ESRD treated by hemodialysis are summarized. A significant correlation between severity of chronic heart failure symptoms (evaluated by special questionnaire) and negative disease prognosis is found. Although the expression of chronic heart failure symptoms wee also affected by the nutritive status and uremic factors lethal outcomes in the majority of cases were determined by cardiovascular causes. The results emphasize the necessity of precise evaluation of cardiovascular lesions in patients with chronic renal failure as a valid tool of patient-related outcomes. Prognosis in patients treated by maintenance hemodialysis can be improved by complex analysis of objective and subjective symptoms of cardiovascular disorders. This paper is aimed to attract attention of the personal of the dialysis units to the necessity of evaluation symptoms of coronary disease and chronic heart failure that might reduce risk of cardiovascular mortality.

The aim of this study was to investigate the impact of chronic kidney disease (CKD) on prognosis in patients with chronic heart failure (CHF). Methods: 251 patients with chronic heart failure (133 M, 118 F, age 56,4 ± 11,2 years) were studied; 59 (23,5%) patients had arterial hypertension, 29 (11,5%) had Ischaemic Heart Disease (IHD) and 163 (65,0%) had IHD and arterial hypertension. Most patients (227 or 90,4%) had I-II NYHA class of CHF. Glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease (MDRD) Study equation and chronic kidney disease was determined according to NKF K/DOQI, Guidelines, 2002. Follow-up period was 60 months. The death incidence of any cause and the re-hospitalization rate were estimated. Results. In 88 (35,1%) patients GFR was below 60 ml/min/1,73 m². The mortality rate for all causes was 41 (16,3%).The mortality rate in these patients was higher than in those with normal GFR. The patients with decreased GFR were re-hospitalized more frequently than those with preserved renal function. CKD was an independent mortality risk factor in patients with CHF (Hazard ratio: 1,6). Conclusions. It is founded that decreased renal function (GFR < 60 ml/min/1,73 m²) increases the mortality risk in patients with CHF. Renal dysfunction is an independent predictor of re-hospitalization for CHF patients.

Thrombotic microangiopathia (TMA) is a disorder that represents a spectrum of multiorgan microvascular thrombosis including kidneys. The only proved method for TMA diagnosis is the fine-needle biopsy although thrombocytopenia and anticoagulant’s using are contraindications for biopsy. The aim of the study was to investigate the renal perfusion in patients with chronic TMA with ultrasound Doppler. We investigated retrospective and prospective groups of chronic TMA pts (71 patients) and 20 volunteers. A decrease in flow velocity, renal infarctions of arcuate and more distal arteries in all chronic TMA patients seem to be the markers of renal ischaemia. Most patients have the “patchy” decrease of resistance index in distal vessel that is a marker of occlusive lesions and arteriovenous blood flow bypassing. Arteriovenous bypass in interlobar arteries and spleno-renal vascular malformations are rare adaptive phenomena in the case of renal ischaemia. Doppler ultrasonography allows one to detect occlusion of distal kidney vessels in chronic TMA. This non-invasive method may be used instead of biopsy.

The aim of the study to analyze retrospectively the efficiency of renal replacement therapy in treatment of severe acute pancreatitis complicated with systemic inflammation and multiorgan dysfunction. The results of treatment of 55 patients (14 F, 41 M) 22 to 72 years old (average 43,5 ± 16,4) treated in intensive care department of Moscow City Hospital No. 52 from 01.01.2000 to 31.12.2006 were analyzed. All patients had multiorgan dysfunction, with 2 to 5 organs (median 4 (3; 4)) involved and receiving renal replacement therapy. Renal replacement therapy can be successfully used in complex treatment of severe acute pancreatitis provided the dialysis dose of at least 35 ml/kg/h. Independent risk factors of lethality in these patients are - severity estimated according to APACHE II SAPS II scales, and dialysis dose of at least 35 ml/kg/h.

The aim of this study was to estimate the state of the renal functions in patients with urogenital tumors treated with irradiation in order to reveal patients with chronic radiation nephropathy. The retrospective analysis of 18 pts (8 F with diagnosis carcinoma of uterus or uterine cervix, mean age 54 ± 5,7 ys, total irradiation dose 55,6 ± 12,9 Gy and 10 M with diagnosis prostate cancer, mean age 59,3 ± 6,1 ys, total irradiation dose 76,6 ± 22,4 Gy) was undertaken. All patients were successfully treated with surgical intervention and irradiation in complex. Non patient have renal diseases or significant systemic hypertension before surgical and radiation treatment. The statement of renal functions was evaluated 2-4 months after irradiation (initial point) and 18 months after irradiation (late postirradiation period) by serum creatinine level and estimated glomerular filtration rate (Cockcroft-Gault formula). The dynamics of systolic and diastolic blood pressure was also monitored. The renal function impairment was observed in most patients in late postirradiation period: 50% pts had pronounced decline of glomerular filtration rate along with rising of serum creatinine level and development of moderate arterial hypertension in some of them; 22% pts had mild decline of glomerular filtration rate with slightly elevated blood pressure in some pts. In 28% of patients renal functions and blood pressure in late postirradiation period were similar to their initial levels. Chronic radiation nephropathy may be a common late complication after radiotherapy and may be found in half of patients with urogenital tumors. Such patients should be timely tested for the ascertainment of chronic radiation nephropathy. The first appearance of renal impairment symptoms in early postirradiation period may indicate acute radiation nephropathy with the possibility of subsequent chronic radiation nephropathy.

We evaluated our results of kidney transplantation from marginal donors who had dopamine-dependent unstable haemodynamics and died from traumatic or haemorrhagic shock. The control group I of 723 patients (with kidney transplanted from donors who died from craniocerebral injury) was compared to group II of 41 patient with kidneys transplanted from the marginal donors. The followed up period was 52 ± 19 months. In both groups the percent of dilate graft function, primary non function transplants, acute graft rejection, patients and graft survival, biopsy prove ischemic-reperfusion graft injury were evaluated. In group II the percent of dilate graft function, primary non function transplants was higher (67% and 51%, 7 and 4%, respectively). 5-years grafts and patients survival rates in group II were lower than in group I (67 and 73%, 71 and 78%, respectively, р < 0,05). At the end of the follow up period the level of serum creatinine was 151 ± 50 mM in group I and 165 ± 80 mM in group II. We conclude that despite slightly worse results in group II, kidney transplantation from marginal donors can be used to decrease the transplant waiting time.

The aim of the present study is to define the risk factors of development of acute renal failure (ARF) and mortality to estimate the efficiency of the use of criteria of acute kidney injury (AKI) in Rhabdomyolysis patients. The stages of AKI were assessed using the criteria of AKIN. 110 Rhabdomyolysis patients 102 M, 8 F, age 20 to 84 (41,1 ± 16,1) years. On admission, stage I of ARF was found in 9% of patients; 6% of patients had ARF stage 2; stage 3 of ARF was observed in 74% of patients. As many as 72% of the patients needed renal replacement therapy (RRT). The mortality predictors in Rhabdomyolysis patients were as follows: age, patient state severity according to SAPS II and lymphocyte level. A significant correlation of AKI criteria with RRT duration was found.

The goal of the study was to assess pathogenesis of the end stage renal disease (ESRD) from the point of view of systemic inflammation. Material and methods. 42 patients (age 45,4 ± 12,95 years) with ESRD caused by chronic glomerulonephritis (n = 22), chronic pyelonephritis (n = 12) and diabetic nephropathy (n = 8) were examined and compared to control group of 68 healthy subjects (18-84 years). All patients received program haemodialysis for 12 hours per week. Duration of the HD treatment was 63,0 ± 62,13 months (from 1 to 223 months). Before and after haemodialysis the blood plasma levels of IL-1b, IL-6, IL-8, IL-10, TNFa, CRP, ECP, myoglobin, troponin I, cortisol, D-dimers were measured, with immunochemiluminescent method (“Immulite”, SIMIENS, USA). Results. The following significant (p < 0,05) changes were found in the ESRD patients: hypercytokinemia (mainly due to TNFa and IL-8), accumulation of 2R, CRP, CRP, ECP, myoglobin, troponin I, cortisol, D-dimers in blood. The most informative factor was the integrated index for cytokinemia - RC, a scoring of 0 to 16 points calculated from the levels of IL-6, IL-8, TNFa. Conclusion. The systemic inflammation phenomenon plays a significant role in the ESRD pathogenesis. The intensity of the systemic inflammation can be estimated with the integrated index for cytokinemia.

Inherited hyperhomocysteinemia in most cases results from a mutation in gene MTHFR C677T. It is a risk factor of both arterial and venous thromboses. A case is described where thrombosis in vena cava inferior, in both renal and left ileofemoral veins and ischemic cerebral infarction have been developed simultaneously in a young man with inherited hyperhomocysteinemia and chronic nephrotic glomerulonephritis.