In 2015, marked 120 years since the birth of kidneys physiology and pathology outstanding researchers - A.G. Ginetsinsky, G.W. Smith, E. M. Tareev. G. Smith developed basic urine formation processes studying clearance methods principles, described the osmoregulation system structure among several vertebrates classes representatives. A. G. Ginetsinsky substantiated osmoregulation reflex role and made a hypothesis about the hyaluronidase-hyaluronic acid system value in antidiuretic hormone mechanism of action. E. M. Tareev showed the importance of endogenous creatinine clearance in the measurement of glomerular filtration rate and formulated a number of key conceptions in clinical Nephrology.

Loss of cellularity, massive cell death with its contents release and following pathologic immune response development. -acute kidney injury central elements. This review is focused on roles of systemic cell dysfunctions and cell death forms, cellular tissue repair mechanisms, as well as future development of therapeutic approaches based on cell death blocking and kidney tissue regeneration activation.

There is the whole proteins family, localized on cellular surfaces and regulating lymphocyte-endoteliocyte interaction process, called ekto-peptides. VAP-1 (vascular adhesive protein-1) also belongs to it. Human VAP-1 is the dimeric membrane protein with molecular weight of 180 kD consisting of short N-trailer cytoplasmatic tail, transmembrane domain and most extracellular part. VAP-1 stimulates lymphocytes rolling, adhesion and transmigration through endothelial vessels lining, and also polymorphic and nuclear leukocytes. During studying of VAP-1 expression in kidneys, it is found in peritubular capillaries and perithelial cells of the, and also in smooth muscle cells of larger vessels. Almost completely absent is VAP-1 expression in glomerular endothelial cells.Further studying of signal VAP-1-mediated pathway influence on glomerulonephritis course and outcomes will provide to expand ideas of disease pathogenesis and new influence ways on chronic kidney disease progressing.

AIM: to study chronic kidney disease (CKD) risk factors prevalence and reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS. CKD risk factors (RF) retrospective analysis was performed in 300 pulmonary department patients with COPD. Glomerular filtration rate (GFR) was calculated using the formula CKD-EPI. RESULTS. CKD rF were revealed in all COPD patients, the combination of 3 or more RF in 92.6% of patients. The initial degree of GFRCKD-EPI reduction 89 - 60 ml/min /1.73 m² - 37.3%, a moderate decrease GFRCKD-EPI 59 - 45 ml / min / 1.73 m² - 26.7%, a significant reduction GFRCKD-EPI 44 - 30 ml / min / 1.73 m² were 3.3% of patients. Direct moderate strength correlation between CKD RF prevalence and COPD severity was found. Negative correlation between GFRCKD-EPI and COPD severity, as well as between CKD-EPI and BMI was found. CONCLUSIONS. High prevalence of potentially modifiable risk factors among patients with COPD determines the need for CKD screening in these patients, as well as search for alternative markers for renal dysfunction early diagnosis in patients with severe and very severe COPD.

THE AIM: to evaluate the association of microvascular inflammation (MVI) and its components (glomerulitis (G) and peritubular capillaritis (PTC)) with the long-term prognosis of renal allograft (RA). PATIENTS AND METHODS: Among 1270 recipients of RA 127 MVI cases with morphological features of G (±PTC) were enrolled into the study, including following groups: 1) G with positive DSA at the biopsy (n=31); 2) G with negative DSA (G+DSA-; n=62); 3) G with undetermined DSA (n=34). According to the presence of T-cell mediated rejection (TCMR) G+DSA- group was further subdivided into: 1) isolated G (isG, n=28); 2) G with concomitant TCMR types IA/B or IIA/B (G+TCMR, n=34). The control groups matched for age, HLA mismatch, year and type of RA included recipients without any rejection (n=92) and with TCMR types IA/B or IIA/B without G (n=65). All recipients enrolled into the study (n=284) were divided into following groups: 1) PTC+G+ (n=83); 2) PTC+G- (n=23); 3) PTC-G+ (n=44); 4) PTC-G- (n=144). Kaplan-Meier survival curves and multivariate Cox regression analysis were applied to estimate the association of MVI, including G and PTC with the risk of graft loss. The median follow-up was 39 (13; 77) months. RESULTS: The RA survival was significantly lower in the presence of MVI (plog-rank <0,001). There were no differences in survival in PTC+G- group and controls without MVI. The presence of G associated with inferior long-term survival irrespectively of presence or absence of PTC. RA survival in G+TCMR was lower than in TCMR without G (plog-rank=0,021). The presence of G was associated with 4,5-5,4-fold increase of related risks of graft loss in multivariable Cox regression analyses, while PTC was not identified as independent predictor of graft survival. CONCLUSION: The prognostic significance of MVI is mainly determined by the presence of G independently associated with RA survival. The early post-transplant diagnostic of G is important for the assessment of prognosis and modification of therapy.

THE AIM: to assess interactions between risk factors as well as arterial sclerotic bed lesion features and GFR decrease in patients with CHD in long term period after myocardial revascularization. PATIENTS AND METHODS. The study included 90 patients with CHD and indications for myocardial revascularization. All patients performed coronary angiography with subsequent surgical myocardial revascularization method definition. Traditional cardiovascular and renal risk factors (GFR) were analyzed in view of coronary angiography. 5,8 ± 0,05 years after blood flow recovery 52 patients were observed, some patients with GFR decrease were revealed. RESULTS. Significant effect of effort angina class III, left ventricular hypertrophy, left coronary artery (LCA) arterial sclerotic disease and also number of clinically significant and subtotal coronary artery stenosis on GFR decrease probability in long term after myocardial revascularization was established. Effort angina class III significantly increased the risk of GFR decrease by 38.2%, LVH - by 74.3%, atherosclerosis - by 40%. Table of calculated GFR aggravation risk stratification according to clinically significant and subtotal CA stenosis is presented. CONCLUSION. GFR factor before myocardial revascularization in patients with CHD is important risk factor of kidneys dysfunction progress in long term period.

THE AIM: to establish possible interaction between fibroblast growth factor 23 (FGF-23) increase in blood serum and factors of left ventricular morphofunctional state, aortic and big arteries wall in patients with chronic kidney disease (CKD) different stages. PATIENTS AND METHODS. 105 Patients (50 men and 55women) aged 34 to 62 years ( mean age 48±4,5 years) with Stages 1-5 CKD were examined. CKD stages were determined in accordance with the NKF-K/DOQI guidelines; glomerular filtration rate was calculated using the CKD-EPI formula. Serum FGF-23 was examined in all patients, by applying commercial enzyme immunoassay kits. Doppler echocardiography was performed to evaluate left ventricle (LV), aorta, arteries morphofunctional state. RESULTS. As renal failure progressed from Stage 1 to Stage 5 CKD, the examined patients had higher serum FGF-23 concentration. The level of FGF-23 and the morphofunctional indicators of LV lesion showed a strong direct correlation that preserved its significance in analyzing the factors in question in relation to the function of the kidneys and the pattern of cardiovascular system lesion. CONCLUSION. The morphogenetic protein FGF-23 seem to play a significant role not only in bone remodeling processes, but also in the development of CVEs in CKD.

THE AIM: to study skin microcirculation (MC) characteristics in hypertensive patients with diabetes mellitus (DM) type 2 depending on stage of chronic kidney disease (CKD). PATIENTS AND METHODS. Study included 120 patients with arterial hypertension stage II-III aged from 40 to 65 years. Patients were divided into groups depending on stage of CKD. We evaluated overall state, clinical heart rate measurement and blood pressure (BP) on both hands with the patient sitting in the standard method, anthropometry, analysis of combined risk of CKD progression and cardiovascular complications development. We also studied skin microcirculation (MC) by Laser Doppler flowmetry (LDF) and determined renal function, HbA1c level. RESULTS. Significant increase of patients with a reduction in tissue blood flow with the worsening of CKD from stage S1 to S3b was revealed. Number of patients with severe venous flow (stasis) was significantly greater among 3 groups compared with those 2 groups (31,9 vs 15,6%, p<0,05). Regardless of CKD stage hyperemic hemodynamic type of MC (GTMC) was prevailed among patients with hypertension and type 2 diabetes. During renal function analysis we noted that proteinuria (PU) level was lower in group 1 patients compared with patients 2, 3 and 4 groups (426,4 ± 49,4 vs 623,9 ± 61,4 vs 734,3 ± 60,1 vs 737,3 ± 85,2 mg / g, respectively, p <0.05). Albuminuria (AU) level significantly increased from 1 to 4 patients group with hypertension and type 2 diabetes. During correlation analysis we found statistically significant relationships between renal function and the skin MC parameters. There were significant correlations between AU level and MC indicator (r = -0,15, p<0,05), PU and MC indicator levels (r = -0,35, p<0,05), PU and tissue oxygen consumption (r = -0,34, p<0,05). It was shown that with CKD severity increase tissue blood flow decreased - direct correlation between GFR (CKD-EPI) and tissue oxygen consumption (I) (r = 0,20, p <0.05) was noted. CONCLUSION. Thus, skin MC indicators change reflects prognosis of combined risk of CKD progression and cardiovascular complications in hypertensive patients with type 2 diabetes.

AIM: to analyze pregnancy course and outcomes and to value dynamic monitoring routine methods for women with persistent single kidney pyelonephritis. PATIENTS AND METHODS. Article presents monitoring results of 63 pregnant women with persistent single kidney pyelonephritis and the reference group. RESULTS. Arterial hypertension among pregnant women with persistent pyelonephritis is more often occurred during III pregnancy trimester (in 22,7% cases). Pregnancy course in women with single kidney (if this kidney keeps functioning) did not differ much from physiological pregnancy course in women without extragenital pathology. Cesarean section was reliably more often observed among pregnant women with pyelonephritis (18,2%) in comparison with control group (9,1%) and pregnant women with single kidney (15%) (р>0,05). No reliable differences in glomerular filtration rate of all patients were discovered. Results of research allow allocating risk group where arterial hypertension during the second part of pregnancy can develop and infectious inflammatory process (pregnant women with persistent pyelonephritis) can deteriorate. Also it is necessary to follow-up women with single kiney in coalition with obstetrician gynecologist and nephrologist with daily blood pressure monitoring as well as blood test with determination of urea and creatinine in each trimester of pregnancy.

Currently realization of educational programs for patients has not only medical but also great social and economic importance. One of such educational foundations for patients with nephrological diseases is a School «Healthy Kidney» established in 2002 and operating successfully for 13 years in the Rostov-on-Don city. This format of working with patients has revealed its high effectiveness and allowed to form an educational platform for all comers.

THE AIM: to identify risk factors of cardiovascular calcification and to determine relationship between severity of valvular and vascular calcification in patients with S5d CKD. PATIENTS AND METHODS: The study involved 83 patients of two outpatient hemodialysis centers. In all patients studied medical history, anthropometric and laboratory data. We analyzed results of instrumental methods, including heart echocardiography and abdominal plain film in the lateral projection. RESULTS: Positive correlation between severity of heart valve calcification as assessed by echocardiography, and degree of aortic calcification according to survey abdominal radiography (r = 0,301, p = 0,006). Revealed malnutrition and inflammation importance in extraossal calcification development. At lower total protein (χ²=8,97, р=0,003), lower level of albumin (χ²=13,9, р<0,01) and increasing of pulse blood pressure (χ²=5,9, р=0,01) cardiovascular calcification formation possibility increased. calcification risk increase occurs not only with pulse pressure increase, but also in hypertension development (χ²=10,6, р=0,005). CONCLUSION: Thus, the severity of valvular calcification associated with aorta calcification, role of malnutrition, inflammation and calcium-phosphorus homeostasis disorders in extraossal calcification development is established.

AIM: to identify relationship between epithelial-mesenchymal transition (EMT) and renal parenchyma injury and renal dysfunction. PATIENTS AND METHODS. The study included 62 patients with various forms of chronic glomerulonephritis (GN), 25 males and 37 females. To assess phenotype of epithelial cells used monoclonal antibodies (company DAKO, ready-to-use (RTU) to pancytokeratine (clone AE1 / AE3), E-cadherin (clone NCH-38), CD10 (clone 56C6), as marker for mesenchymal differentiation used monoclonal antibodies to vimentin (clone V9) and alpha-smooth muscle actin (clone 1A4). Evaluation of tubular epithelium proliferative activity was performed using antibodies to Ki67 (clone MIB-1). RESULTS. According to the study EMT was observed in 66% patients, in 34% this phenomenon is not found. Tubulointerstitial fibrosis (TIF) had moderate severity in 84%, in 11% cases was significant, in 5% of patients not found. In patients group with IgA-nephropathy and FSGS, during logistic regression analysis without EMT risk of ESRF was 8%, with moderate EMT end-stage renal failure risk increased to 55% (df = 1 , p = 0,003). CONCLUSIONS. Thus, according to results of the study, in patients with EMT severe CKD stages are significantly more common.

THE AIM: to identify ferrokinetic indicators in patients with chronic kidney disease 5D stage receiving treatment by hemodialysis. PATIENTS AND METHODS. Research included 100 patients with chronic kidney disease 5D stage receiving hemodialysis, among them 51 women and 49 men, mean age was 53,4±15,8 years. All patients were performed complex laboratory tests. RESULTS. There was statistically significant correlation between hemoglobin level and some ferrokinetic indicators. Hemoglobin level was directly correlated with serum iron (r=0,30; p=0,002), transferrin saturation (r=0,30; p=0,020), the effective transport concentration of iron (r=0,29; p=0,002), effectiveness of hemodialysis - Kt/v (r=0,22; p=0,0028), total protein (r=0,34; p=0,0006) and albumin (r=0,23; p=0,02), inverse correlation was established with fluctuation-dose erythropoietin (r=-0,46; p=0,01) and iron (r=-0,51; p=0,004) in last 12 months. In patients receiving hemodialysis for more than 12 months, it was observed a positive correlation between hepcidin level and hemodialysis duration (r=0.41; p=0,004), negative correlation was found between hepcidin and erythropoietin dose fluctuation for 3 (r=-0,52; p=0,003), 6 (r=-0,43; p=0,003), 12 (r=-0,5; p=0,04) months and hemoglobin fluctuation level for 3 (r=-0,4; p=0,01) and 6 (r=-0,5; p=0,0004) months. CONCLUSION. Hemoglobin level in patients with end-stage renal failure depends on quality of hemodialysis, iron transport pool and erythropoietin therapy mode. Thus, improvement of hemodialysis technical capabilities, correction of protein metabolism disorders, modification of erythropoiesis stimulating therapy are therapeutic targets in fight against anemia.

THE AIM: to study renal arteries sclerotic disease features in patients with acute coronary syndrome. PATIENTS AND METHODS. Study involved 194 patients with acute coronary syndrome (ACS) 109 male (56,2 %), 85 female (43,8 %) aged from 39 to 77 years old (average age - 59,9±0,64 years). RESULTS. Renal arteries sclerotic disease according to results of renal arteries selective angiography was confirmes for 82 patients with ACS (42,3 %). Where in unilateral renal arteries disease met in 51 patients (61,2 %>),bilateral disease - in 31 patients (38,8 %). 27 patients with unilateral renal arteries disease (52,9%) had hemodynamic significant disease of renal arteries (stenosis> 50%), among patients with bilateral disease this number was 26 people (83,9%).