The prevalence of left ventricular hypertrophy (LVH) in chronic kidney disease (CKD) patients is higher than in the general population. In order to study the effect of metabolic disturbances on LVH we have performed a prospective cross-sectional study of 115 non diabetic patients (46 men, 69 women) with average creatinine clearance (Ccr) 24 ± 15 ml/min in the age 18 to 55 years, average 43,3 ± 11,3. LVH was diagnosed when the ventricular mass index (LVMI) was above 134 g/m2 for men and above 110 g/mІ for women. We found that in 31% patients with Ccr of 60-30 ml/min (n = 29) LVH has developed. In this group the LVMI correlated with systolic BP (r = 0,424, p = 0,031 ) and the duration of the arterial hypertension (r = 0,421, p = 0,026). The prevalence of LVH significantly (p < 0,05) increased with decreasing renal function, so it was detected in patients with Ccr 29-15 ml/min (n = 53) twice more often (62%). In this group patients LVMI correlated with age (r = 0,362, p = 0,007), systolic BP (r = 0,433, p = 0,003) and diastolic BP (r = 0,354, p = 0,001). A negative correlation was found between LVMI and serum albumin (r = -0,456, p = 0,001) and serum calcium (r = -0,347, p = 0,013 ) levels. 76% of patients had LVH at the beginning of dialysis treatment (Ccr <15 ml/min) (n = 33). In this case LVMI had the correlated with C-reactive protein level (r = 0,496, p = 0,008). The date of the linear regression analyze demonstrated that age, systolic BP, serum calcium level and CRP were the predictors of LVH (R2 = 0,429).

The aim of the study was to reveal kidney pathology occurence in patients treated with analgetics (A) and non-steroid anti-inflammatory drugs (NSAID) in different departments of a general hospital, excluding the urological and nephrological ones. At the first stage of the screening, urine analysis (UA) and blood test were taken from the case histories of 1446 patients (690 men, average age 50 years; 756 women, average age 45 years). On the second stage, data concerning A and NSAID (doze, frequency, duration of treatment) were analysed. At the third stage the data were analysed statistically. 649 (44,9%) patients were treated with A or/and NSAID, 797 (control group) did not receive these drugs. A UA-pathology was found in 351 (24,3%) cases. A UA-pathology and a renal function (RF) impairment was significantly higher in patients treated with A or NSAID (and especially with both A and NSAID) than in control group. A positive correlation between UA-pathology, RF-impairment and drug doze was found.

The aim of the work was the evaluation of fluid balance in HD-patients and study of influence of its disturbances on cardiovascular system. Segmental bioelectrical impedance (BIS) method was used for evaluation of fluid volume in different parts of body and regional fluid distribution. Changes of fluid balance were also studied. Overhydration was found in 39,5% of patients, the most prominent excess of intercellular fluid was found in PD patients. Arterial blood pressure correlated with intracellular volume (r = 0,8, p < 0,05). Left ventricular hypertrophy (LVH) was found in all patients with overhydration and arterial hypertension. No difference in myocardial mass and the left ventricular mass index (LVMI) was found between the PD- and HD-patients. A correlation between the LVMI and duration of HD-treatment was observed. Among PD-patients, the highest LVMI was found during first 6 months of treatment. During next two years LVMI decreased and then tended to increase again. As it is seen from BIS data, by changing the ultrafiltration volume we succeeded in improved control of arterial pressure in patients with arterial hypertension, and menaged to diminishes the number of hypotension episodes. Thus, usage of BIS for fluid balance control allows one to maintain the «dry weight» that leads to diminishing of cardiovascular complications.

Twenty one children aged 1,5-16 years with steroid-resistant GN and biopsy-proven focal and segmentary glomerulosclerosis (FSGS) were treated with Cyclosporine A (CsA) 4-5 mg/kg as initial dosage and oral prednisolone 1-1,5 mg/kg every other day tapered to the 12-th month. Methylprednisolone pulses (MP) 30 mg/kg every other day for the first 2-4 weeks were used in 14 patients. The duration of the disease before treatment varied from 6 months to 7 years. After 6 months of treatment complete absence of proteinuria was achieved in 8 (38%) children, partial remission was found in 5 (24%) patients, more than 2-fold decrease in proteinuria was observed in 2 (10%) children. In 6 (28%) children including one patient who developed the ESRD the treatment had no effect. After one year of treatment complete remission was observed in 11 (55%) patients, partial remission was observed in 4 (20%) children, a decrease in proteinuria was found in 1 (5%) patient and no effect was achieved in 5 (25%) children. In all non-responders, the CsA-treatment was terminated. The MP-pulses were not used in 7 patients because of less severe disease or contraindications. However, 6 of them demonstrated a good response to treatment. None of responders had any severe side effects of CsA. In 8 patients the CsA-treatment was continued for 18 months. Only in 1 case an additional biopsy showed the tubular interstitial toxicity because the dose of CsA was tapered from 4 to 2 mg/kg. Five children were treated with CsA for 2 years, 4 of them had no any side effects. In one case an increase in serum creatinine level demanded tapering the CsA-dose. We conclude that early and prolonged treatment with CsA can provide complete or partial remission of GN in about 75% of patients with idiopathic FSGS.

Bone turnover markers, parathyroid hormone (PTH), spine and hip bone mineral density (BMD) were determined in 56 women receiving triple immunosuppressive therapy with good graft function at 47 ± 35 months after KT. Estradiol, testosterone, sex hormone-binding globulin (SHBG), osteoprotegerin (OPG) and insulin-like growth factor-1 (IGF-1) were estimated in 24 of them (15 in premenopause and 9 in postmenopause). Bone turnover disturbances (increased resorption and normal or decreased formation), hip BMD-losses, lowered level of total and free testosterone, SHBG and IGF-1 were similar in pre- and postmenopause women. Axial BMD-losses were more pronounced in postmenopause women, and correlated with lower estradiol and higher PTH and OPG levels. Axial bone losses in women after KT correlated with PTH and SHBG (inverse correlations) and with free estradiol (direct correlation). Apart from PTH and SHBG, hip bone losses correlated directly with the total and free testosterone.

A question of present interest in renal replacement therapy (RRT) is the treatment and decrease of progression rate of chronic heart failure (CHF) in HD-patients. In the present study the effect of long-term treatment with Carvedilol® is analysed in 27 HD-patients with CHF. The improvement of key hemodynamic parameters, clinical pattern and quality of life achieved in these patients allows us to conclude the necessity of β-blockers in complex CHF-therapy.

Calcium (Ca) and magnesium (Mg) homeostasis was normal in all 25 recipients of kidney allograft with chronic transplant rejection (CTR) who received cyclosporine A (CyA), prednisolone and azathioprine (group 1). Inorganic phosphorus (Pi) homeostasis was normal in 84% patients of this group. Among 77 patients receiving only prednisolone and azathioprine (group 2) Ca, Mg and Pi homeostasis normal in 79,2, 42,9 and 64,9% cases respectively. Hyperphosphatemia was found only in 16% patients of group 1. Hyper- and hypophosphatemia was found in (25 and 10%), calciemia (13 and 8%), magnesiemia (40 and 17%, respectively) of patiens of group 2. The total Ca reabsorption was normal in patients of group 1 and reduced in group 2. The total and active Mg reabsorption was reduced in patients of group 1. Pi reabsorption in recipients with CTR was reduced and did not differ from that in patients with chronic renal failure. Hyperparathyroidism did not affect Ca, Mg and Pi reabsorption. The reduction of the active Mg reabsorption was specific for patients with CTR.

The purpose of our research was to define distribution of various genotypes of polymorphic marker R229Q (G755A) of the podocin gene (NPHS2) in children with nephrotic syndrome. Genetic polymorphism G755A was investigated in 86 children with minimal changes nephrotic syndrome (MCNS) and 29 patients with focal segmental glomerulosclerosis (FSGS). Control group included 80 persons without kidney disease. We found high association of heterozygotic genotype GA with FSGS. Moreover, in thouse patients, who manifested symptomes of FSGS in age of 1-6 years was established significant increase of a share of heterozygotic genotype GA in comparison to children whith disease manifestation during the school period. No association of polymorphic marker R229Q with MCNS was found. However in children, who demonstrated symptoms of MCNS in age of 7-15 years, frequency of genotype GA was significantly higher in comparison to control group.

The actuality of the present work is backed by the last 100 years of studying of the child urinary tract infections (UTIs). At the beginning of the 20th century Walter Birk, a famous German pediatrician, established the fact that these diseases proceed differently in infants and children, that girls get infected 10 times more often that boys, E. coli being dominant in the etiology. Walter Birk pointed out that anatomical organization of female urino-genital organs was not the principal reason for higher disease rates among girls. However, that time this point of view was neither proved, nor disproved convincingly. Another Walter Birk’s postulate which says that chronic suppuration may be cured with the help of natural health-improving factors also was not developed; the antibiotic therapy still being the dominant way of treatment. Clinical and experimental research work which we carried out has shown that many of the theses advanced at the beginning of the 20th century are still up-to-date, however, a number of considerable changes in etiology took place; the number of boys infected with UTIs grew considerably, which already makes it a tendency. The experimental research work has shown the role of the universal mechanism of the process of urinary tract infection.