The understanding of the unique molecular apparatus of the podocyte recent years have allowed to improve diagnostics and сlassification of diseases which have named podocytopathies. Podocyte injury frequently leads to reorganization of the slit diaphragm and reorganizationof the foot process structure. Results of the numerous researches resulted in the review have allowed to allocate four main mechanism of nephrotic syndrom caused by genetic mutations of podocyte components: a) impaired formation of the slit diaphragm complex; b) abnormalities of the glomerular basement membrane or the adhesion of podocytes to the glomerular basement membrane; c) abnormalities of the actin cytoskeleton and associated proteins, and d) alterations in the apical membrane domain of the podocyte.

We studied case history, clinical, laboratory and histological data of 85 patients: 64 with SLE, 12 with ANCA-assosiated vasculitis and 9 with cryoglobulinemic vasculitis. Mean age 36,7 ± 14,2 years, M/F 23/62. The duration of the disease was 0,5-384,0 months; acute fase duration was 0,5-12,0 months. 55 (64,7%) patients were treated with prednisone and cyclophosphamide pulses, 9 (10,6%) patients with prednisone and asathioprine, and 21 (24,7%) patients with prednisone only. Patients were observed for 0,5-150,0 months. 2/3 of patient revealed CNS involvement, a half of them - pulmonary disturbances, 1/3 - antyphospholipid syndrome and carditis at the beginning of treatment. In patients with SLE more often were found cerebrovasculitis, carditis, leucopenia and antyphospholipid syndrome, in patients with ANCA-assosiated vasculitis - pulmonary infiltrates, leucocytosis and anemia, in patienys with cryoglobulinemic vasculitis - skin ulcers ( p < 0,05). Kidney involvement was characterised by proteinuria (nephrotic syndrome in more than 40% of cases), arterial hypertension (SAD mediana 150 mm Hg) and deterioration of renal function (serum creatinine mediana 2/6 mg/dl), in patients with cryoglobulinemic vasculitis more often were found nephrotic syndrome and arterial hypertension, in patients with ANCA-assosiated vasculitis - renal insufficiency ( p < 0,05). Combination of prednisone and cyclophosphamid pulses was more effective than prednisone and asathioprine and prednisone only as for renal (remission rate 83,6% versus 66,7%) and also extrarenal (remission rate 94,5% versus 70%) symptoms ( p < 0,05). 12-year survival was 65,2%, 12-year renal survivial - 64,6%, the disesase progressed to ESRD was more often in patients with systemic vasculitis than in SLE ( p < 0,05). Risk factors of death proved to be age >35 years and pulmonary hemorrhages, remission of extrarenal symtomes is a predictor of favourable outcome. Risk facrors of ESRD are serious deterioration of renal function, which demanded RRT at the begining of the treatment and the character of main disease - systemic vasculitis.

The current study was aimed at investigation of pharmacokinetic parameters and of clinical efficacy of generic cyclosporine in comparison with Sandimmune Neoral. To evaluate the pharmacokinetic parameters of different cyclosporine formulations, 159 comprehensive pharmacokinetic investigations were accomplished in 115 kidney transplant patients. 71 (45%) out of 159 pharmacokinetic studies were performed in patients treated with Neoral, whereas in 88/159 (55%) cases participants received generic cyclosporine. AUC calculations based on dosing interval concentration values were fulfilled using linear trapezoidal rule. Clinical efficacy of generic cyclosporine was evaluated in a retrospective study of 500 recipients that had undertaken cadaver kidney grafting since 2002 year. 304 participants were treated with Neoral and the other 196 - with generics (mainly Consupren) at least for 3 months. The prevalence of late acute rejection and of chronic allograft dysfunction was analyzed during the mean follow-up period of 29 ± 13 months. The 3-years graft survival rate was calculated by Kaplan-Meyer method. At 100-200 ng/ml maintenance concentration (estimated by C₀ concentration) the generic formulation was shown to yield significantly lower Cmax (824 vs 931 ng/ml respectively; p < 0,01) and AUC (3984 vs 4292 ng/ml/h respectively; p < 0,01). Acute rejection (biopsy-proven) rate proved considerably higher in generic Cy-A than in Neoral group (10,6% vs 4,1% respectively; p < 0,05). Chronic allograft dysfunction occurred in 14% of patients subjected to Neoral immunosuppression and in 24% of generic Cy-A recipients (p < 0,05). 3-years graft survival equaled 90 and 96% in generic Cy-A and Neoral groups, respectively (p = 0,05). Conclusion: Pharmacokinetic studies have shown the absorption profile of generic formulations to differ significantly from that of Neoral. Retrospective trial demonstrated higher acute rejection and chronic allograft dysfunction rates as well as lower 3-years graft survival in patients treated with generics and compared to Neoral group participants.

The prevalence of SHPT and disorders of calcium-phosphorus metabolism were studied in 450 hemodialysis patients of Hemodialysis Centre “FESPHARM” (Moscow). SHPT were diagnosed in accordance with K/DOQI Clinical Practice Guidelines in patients with iPTH levels >300 pg/ml. On admission to the Centre, SHPT was found in 180 patients (40%): mild SHPT (iPTH 300-450 pg/ml) in 13% cases, moderate (iPTH 450-800 pg/ml) SHPT in 16% cases, a severe one (iPTH>800 pg/ml) in 11% of the patients. About one third (131) of centre patients had optimal iPTH levels of 150-300 pg/ml; 144 patients had iPTH levels of less than 150 pg/ml and had signs of adynamic bone disease. The prevalence of SHPT and severity of hyperparathyroidism were significantly lower in patients with diabetic nephropathy in comparison with other diseases. A reciprocal correlation was found between the iPTH level and age of (except diabetic patients). The prevalence of hypercalcemia was about 15% lower than in similar studies described in literature, whereas phosphorus level and prevalence of hyperphosphatemia (about 50%) did not differ significantly from data of other studies. In 152 patients treated the fraction of patients with SHPT was found to decrease from 46% to 27% over 4 years of treatment. Among 70 patients with SHPT treated with 1 alpha-hydroxylated derivatives of vitamin D3 a remission was achieved in 60% cases. In 82 patients with normal iPTH levels the SHPT incidence rate was 10% per year. It increased with duration dialysis treatment.

More information is needed to evaluate the role of programmed cell death in pathogenesis of autoimmune disorders such as chronic glomerulonephritis. It is important to reveal how apoptosis is regulated and what can we do suppress the process. The aim of this investigation was: 1) estimation of the activity of lymphocytes programmed death in patients with chronic glomerulonephritis; 2) study of dependence of apoptosis activity on duration and severity of the diseasesand the presence of chronic renal failure; 3) evaluation of side effect of immunosuppressive drugs on this process. The main task of this work is elaboration of chronic glomerulonephritis therapy taking into account drugs influence on lymphocytes apoptosis. Patients with chronic glomerulonephritis have increased programmed lymphocyte death activity in comparison with healthy donors. There is correlation between the duration and activity of the disease, presence of chronic renal failure and lymphocyte apoptosis activity. Therapy of chronic glomerulonephritis with glucocorticosteroids, cyclophosphan does not normalise the programmed lymphocyte death activity.

Clinical and functional features of the arterial hypertension (AH) syndrome were studied in 53 patients with chronic renal failure (CRF) continuously treated with peritoneal dialysis: 18 patients with mild AH form, 19 with moderate AH, and 16 with severe AH. All patients underwent biochemical blood analysis, 24-hour-long AH monitoring, and an echocardiography. Patients with moderate and severe AH had glomerulonephritis without residual renal function with moderate or good peritoneal transport functions and marked anemia. Blood level of renin and aldosterone were similar in all patients. Time index of day and night systolic arterial pressure (AP) exceeding 50% was found in 5,5 and 11,1% of patients with mild AH, in 73,7 and 84,2% of patients with moderate AH, and in all patients with severe AH. The value of both the night fall and the rate of disturbance of 24-hour AP rhythm did not depend on AH severity. The aggravation of AH severity was followed by the progression of left ventricular myocardial hypertrophy and by development of systolic dysfunction.

Schonlein-Henoch purpura nephritis (SHN) is the most frequent and serious complication of Schonlein-Henoch purpura (SHP). SHP and AHNare significantly more often in Buryat ethnic group than in other ethnic groups of Baykal region. The most frequent clinical variant of the desease is latent glomerulonephritis. The independent predictors of renal failure are age of debut of SHP 31-45 years arterial hypertension, hyperasotemia, the absence of anticoagulantis therapy in debut of the disease, daily proteinuria of more than 1 g.

In order to investigate the role of vascular dysfunction in pathogenesis of osteopenia in children with chronic glomerulonephriritis we examined 6 healthy children without osteopenia and 34 children with osteopenia: 9 patients with nephrotic syndrome and arterial hypertension, 9 patients with nephrotic syndrome without arterial hypertension, 11 patients with chronic interstitial kidney diseases (5 - with arterial hypertension, 6 - without it), 5 children without chronic diseases. In all of them the blood level of marker of bone formation osteocalcin , urinary levels of marker of bone resorbtion C-telopeptide and marker of vascular dysfunction molecule of cellular vascular adhesion-1 (VCAM-1) were measured by immunoenzyme assay. We found significant increase of a level VCAM-1 and significant decrease in level of markers of bone remodeling in children with chronic glomerulonephriritis, especially in those with nephrotic syndrome with arterial hypertension. We found that vascular dysfunction suppresses bone metabolism in children with chronic glomerulonephriritis, especially in those with arterial hypertension.