Since a moment of introduction of Kampath in complex of immunosuppression in the department of kidney transplantation we decided to elucidate wether Kampath is capable to potentate the action of simultaneously administered Zenapax. To appreciate this as a test a length of intervals between Zenapax infusions was taken. Kampath was infused to 7 patients twice: first dose of drug was infused 17-21 days before transplantation. A second one - in the day of kidney transplantation, just the plasmapheresis was terminated. As a control group 9 patients to whom inductive immunosuppresion was realized with Zenapax only was used. Both groups were identical by demographic and laboratory-clinical parameters. Data were statistically treated with the use of Studant criterion. Executed analysis has demonstrated, that in patients with Kampath a length of intervals between infusions of Zenapax was greater than in patients without Zenapax (difference was statistically authentic). Therefore, Kampath exponentiate immunosuppressive activity of Zenapax.

Ischemic heart disease (IHD) is the major cause of death in renal transplant recipients. The aim of this study was to assess the prevalence, risk factors of IHD, influence of coronary artery disease on late results of renal transplantation and the efficiency of coronary revascularization. We analyzed 479 renal transplant patients (332 males, 147 females, age 38,69 ± 11,2 years). The follow-up period was 64,56 ± 37,44 months after transplantation. Diabetes mellitus was found in 68 recipients. IHD was present in 14,8% of all patients (71 from 479); in 12,7% recipients it was found de novo during 32,4 ± 18 mo after transplantation. 10-year patient survival rate was 39% in IHD group and in 75% in patient without coronary artery disease (p < 0,0001). Age >45 year, gender, diabetes, hyperlipidemia, infections, left ventricular hypertrophy (LVH) and renal transplant dysfunction were defined as risk factors of de novo IHD. Coronary artery disease was independently associated only with age (p < 0,009), gender (p < 0,00001) and hyperlipidemia (p < 0,0058). 36 renal transplant recipients with IHD were undergoing percutaneous transluminal coronary angioplasty (PTCA) with stenting and 2 - coronary artery bypass grafting (CABG). Seven PTCA-treated patients required subsequent revascularization during 3-6 months. Follow-up after revascularization was 23 months (2 to 74). Long-term effect (>12 months) was defined in 71% patients. Two PTCA - treated patients dead after 28 and 35 months from extracardial causes. One recipient dead in consequence of cardiac failure in 78 months after subsequent revascularization when he returned to dialysis therapy. Conclusion: IHD is found in 14,8% of renal transplant recipients and in 12,7% patients it defined de novo . Coronary heart disease is associated with Age >45 year, gender, diabetes, hyperlipidemia, infections, left ventricular hypertrophy and renal transplant dysfunction. Coronary revascularization may be used as effective method of treatment of renal transplant patients with IHD.

In 54 PD patients with adequately functioning PD catheters its location and residual volume (RV) in peritoneal cavity after drainage (566 ± 224 ml) were related with delivered dialysis dose, ultrafiltration (UF) stability, peritoneal transport parameters and PD solutions osmolarity. RV has reverse correlation with the parameters defining UF instability and borderline relationship with the level of catheter location in peritoneal cavity. The catheter position was directly linked with PD solutions osmolarity. High level of peritoneal dialysis catheter location in the cavity is quite frequent in PD patients without catheter dysfunction and usually does not worsen PD effectiveness. Nevertheless, the high catheter level and significant residual dialyzate volume can contribute to delivered dose reduction and insufficient fluid removal. Correlation between catheter dysfunction and the level of catheter position should be confirmed by large RV. In cases where conservative measures are insufficient, catheter should be lowered down using laparoscopic technique with fixing its distal part in specially created pleat (fold). Open surgical technique does not allow catheter fixing and is associated with repeated floating up of the catheter tip.

There are structural and functional changes in myocardium of patients with chronic kidney disease (CKD) which cause high cardiovascular morbidity and mortality. The aim of this study was to reveal the correlations between the left ventricular hypertrophy (LVH), duration of hypertension, GFR and renal vascular resistance in patients on early stages of CKD. 102 patients (40 males, 62 females, mean age 44,2 ± 8,3 years) with CKD 1-3 stages (by NKF K/DOQI classification, 2002) were included in the study. The GFR was estimated by the serum creatinine level using the Cockcroft-Gault formula; left ventricular hypertrophy was determined according to echocardiography criteria. We also examined renal vascular resistance by Doppler ultrasonography in segmentar and intralobal arteries of kidneys. We diagnosed LVH and chronic heart failure in patients with higher renal vascular resistance 5 times more frequently and ischemic heart disease 4 times more frequently than in patients with normal renal resistance. There were a significant correlation between LVMI and RI and PI in intralobal arteries (r = 0,7, p < 0,01 and r = 0,57, p < 0,01 respectively) and negative correlation between LVMI and minimum diastolic velocity (MDV, r = -0,53, p < 0,05), LVMI and GFR (r = -0,34, P < 0,05).

BK virus-associated nephropathy caused by reactivation of BK virus is a major reason of allograft loss. In this article we present our findings for complement-fixing antibodies (CFA) to BK virus in kidney transplant recipients, patients on hemodialysis and healthy blood donors. CFA were observed in 63/181 (35%) of kidney transplant recipients, 7/41 (17%) of patients on hemodialysis and in 3/38 (8%) of blood donors. The patients on hemodialysis and blood donors had maximal titers 1:20 whereas the kidney transplant recipients had CFA titers 1:40 or 1:80. We also analyzed the frequency of revealing CFA a function of duration of posttransplant period; it was 45% in group of patients with posttransplant period more than 1 year, and only 16% in group about one year. This work provides the first set of data about BK virus infection in the population of kidney transplant recipients in Russia. The results confirm an existing point of view that there is high frequency of BK virus reactivation in kidney transplant recipients.

The aim of the study was to evaluate the severity of gastrointestinal adverse effects (GAE) and GAE-related quality of life in stable kidney transplant recipients following their conversion from MMF therapy to enteric-coated micophenolate sodium - Myfortic (EC-MPS) administered at an equimolar dose. The prospective study of 30 kidney graft recipients in maintenance immunosuppressive therapy with MMF, cyclosporine and prednisone was performed. All patients completed the Gastrointestinal Symptom Rating Scale (GSRS; higher score indicates increased severity) and Gastrointestinal Quality of Life Index (GIQLI; higher score indicates better GI-specific health-related QoL). Apart from these, long-time changes in gastrointestinal symptoms and in quality of life following the MMF-to-EC-MPS conversion were evaluated with respective questionnaire at Visits 2 and 3. Before conversion, 93% of patients studied had gastrointestinal disturbances. Analyses of gastrointestinal symptoms intensity changes (GSRS) revealed statistically significant improvements on all subscales: abdominal pain (-1,38; p < 0,001), reflux (-1,06; p = 0,00005), diarrhea (-1,8; p = 0,00026), and dyspepsia (-1,0; p < 0,000001). The GAE-related quality of life also improved significantly: from 82,3 ± 17,5 points (at week 1 of observation) to 108,6 ± 15,5 points at 12 weeks (p = 0,00013). By the end of this study, 63% of patients appraised an improvement in their condition as stable and significant. So the conversion of kidney graft recipients from MMF to EC-MPS resulted in a significant reduction of severity of GAE and in better quality of life.

The study presents frequency of occurrence, clinical and morphological features of Thin Basement Membrane Nephropathy (TBMN) in children. TBMN was diagnosed using EM ultrastructural morphometry of the kidney biopsy specimens. TBMN was diagnosed in 10 (19,2%) of 52 children subjected to renal biopsy in years 2004-2005 only in one of 10 patients. Other 9 children had TBMN combined with mesangial-proliferative glomerulonephritis. Four patients had IgA-nephropathy, three had nephrotic syndrome. After renal biopsy children with nephrotic syndrome were treated with steroids and immunosuppressive drugs: two with cyclophosphamide, one - with cyclosporine A. All 10 children also were treated with ACE-inhibitors. After the follow up period all children have had microscopic hematuria and mild proteinuria. There were no signs of either nephrotic syndrome or renal progression (mean GFR 97,2 ± 8,2 ml/min). Our preliminary data suggest that TBMN could be predisposition factor for different glomerular diseases.

Congenital nephrotic syndrome (CNS) comprises a heterogeneous group of conditions having in common the disruption of normal glomerular permselectivity, and carries a poor prognosis, with most patients progressing to end stage renal disease. Recently mutations in the LAMB2 gene encoding b₂ laminin were described as the cause of Pierson syndrome that is characterized by CNS and a complex ocular maldevelopment with microcoria as the most prominent clinical feature. Most affected children exhibit early onset of chronic renal failure, neurodevelopmental deficits, and blindness. We report on a patient with CNS, high grade myopia, and structural eye anomalies including remnants of pupilla membranes, but no microcoria. The patient did not develop renal failure by the age of 11 months and showed no neurodevelopmental deficits. He turned out to be homozygous for a novel LAMB2 missense mutation. This observation together with two recent reports on milder variants of Pierson syndrome corroborates the concept that the clinical expression of Pierson syndrome is more variable, and that milder phenotypes may be related to hypomorphic LAMB2 alleles.