The high burden of kidney disease, global disparities in kidney care, and poor outcomes of kidney failure bring a concomitant growing burden to persons affected, their families, and carers, and the community at large. Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient deficit, improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policy makers, health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons’ and providers’ education; The World Kidney Day declares 2022 as the year of “Kidney Health for All” to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers. By engaging in and supporting kidney health–centered policy making, community health planning, and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

The main principle of immunosuppressive therapy, in the opinion of many authors, is gradually becoming the need to take into account all the advantages and disadvantages of the prescribed drugs in each particular patient. Individualization of lifelong immunosuppression acts as the main factor in long-term graft survival and, accordingly, in the life of the recipient. This review analyzes the literature on changes in the pharmacokinetics and pharmacodynamics of immunosuppressive drugs in elderly patients, and assesses the prospects for the correction of immunosuppressive therapy in kidney transplantation in elderly patients.

The high prevalence of coronary heart disease requires an increase in interventional interventions using X-ray contrast agents. One of the possible consequences is the development of acute kidney injury (AKI). Previously, the formation of AKI after the procedure with the introduction of contrast was always regarded as contrast-induced. Given the complexity of the pathogenesis of AKI, it is currently recommended to use a more comprehensive term "post-contrast AKI" (). The manifestations of PCAKI include an absolute (greater than or equal to 0.3 or more or equal to 0.5 mg / dL) or relative (greater than or equal to 25 %) increases in serum creatinine (sCr) compared with baseline values, occurring 48–72 hours after intravascular administration of RKV. PC-AKI is a common complication following intravascular administration of iodine-containing contrast media and is associated with prolonged hospital stay and poor long-term prognosis, including unwanted cardiovascular events, and complete loss of renal function. PC-AKI occurs in 5-20% of hospitalized patients undergoing percutaneous coronary interventions. Unfortunately, there are currently no analogues of iodine-containing RKV, and therefore the question of finding optimal PC-AKI biomarkers for the purpose of early diagnosis and prevention of this formidable complication remains relevant. The diagnosis of PC-AKI is based on an increase in serum creatinine, which is a late biomarker of kidney damage. New and earlier serum and urinary biomarkers for the diagnosis of kidney damage have now been identified that can be detected before serum creatinine levels rise. This article provides information on the most relevant and modern biomarkers of PC-AKI.

The last few decades have been marked by significant progress in the investigation of the intestinal microbial-tissue complex and its role in the pathogenesis of a wide range of diseases. The presence of intestinal barrier dysfunction has also been confirmed in various nephropathies. Patients with chronic kidney disease (CKD) are characterized by specific alterations of the qualitative and quantitative composition of the gut microbiota. These changes contribute to an increase in the fermentation of food proteins into uremic toxins, such as p-cresyl sulfate, indoxyl sulfate and trimethylaminoxide, disorders of immune tolerance mechanisms of the mucous membrane, disorganization of intestinal epithelium tight junctions, which inevitably leads to an increase of transepithelial permeability. Translocation of bacteria and microbial metabolism products from the intestinal lumen into the systemic circulation is responsible for systemic inflammation, which is currently considered as one of the leading causes of the CKD progression and related complications. However, the exact mechanisms of gut-kidney interaction remain poorly understood. The second part of the review gives a detailed description of the structural and functional disorders of the intestinal muco-epithelial barrier identified in various nephropathies. The mechanisms of uremia-induced intestinal epithelial disruption are discussed, as well as the current therapeutic strategies that may attenuate consequences of intestinal barrier dysfunction in patients with CKD.

BACKGROUND. In CKD lipid metabolism disorders are associated with a high incidence of adverse outcomes. Dyslipidemia in patients with CKD is characterized by a decrease in HDL cholesterol, high triglyceride levels, and normal total cholesterol and LDL cholesterol levels. In CKD, a decrease in the functional activity of the thyroid gland (subclinical hypothyroidism) is often detected. THE AIM: to study the parameters of the lipid spectrum of blood in patients with different stages of chronic kidney disease and thyroid dysfunction. PATIENTS AND METHODS. A one-stage cross-sectional study of 457 patients with glomerulopathies without clinically significant diseases of the cardiovascular system with preserved ejection fraction (> 55% according to Simpson method) according to echocardiography was carried out. To identify thyroid dysfunction, a screening determination of the level of TSH, free T4 was assessed. The parameters of the blood lipid spectrum and GFR were assessed in all patients. Parametric and nonparametric methods of statistical analysis were used. RESULTS. Advanced stages of CKD are characterized by the formation of atherogenic dyslipidemias. 13.1% of patients received statin therapy, the target values of the blood lipid spectrum on statin therapy were not achieved. In the group of patients with nephrotic syndrome, the parameters of the blood lipid spectrum were significantly worse. Most of the patients with CKD were outside the target values of the blood lipid spectrum. In patients with TSH> 7.0 mIU / L, the content of TC, LDL, non-HDL was significantly higher than in the group of patients with normal thyroid function. CONCLUSION. Subclinical hypothyroidism contributes to the formation of atherogenic dyslipidemias in patients with CKD.

BACKGROUND. In recent years, there has been an increase in the number of patients with chronic kidney disease (CKD), including due to the prevalence of arterial hypertension (AH). In chronic pyelonephritis, the accelerated development of changes in the cardiovascular system at the background of a decrease in glomerular filtration rate may be due to arterial hypertension (AH). THE AIM: to assess the state of central hemodynamics, indicators of secretory and excretory kidney function, in patients with a combination of secondary chronic pyelonephritis and AH. PATIENTS AND METHODS. 81 patients with secondary chronic pyelonephritis caused by nephrolithiasis in combination with hypertension in the phase of incomplete clinical and laboratory remission were examined. The age of patients is from 25 to 60 years. A comprehensive assessment of the functional state of the kidneys and hemodynamics was carried out, taking into account the data of anamnesis, clinical and paraclinical examination methods. RESULTS. According to the data of dynamic nephroscintigraphy, an elongation of the excretory phase was revealed with the preservation of the secretory phase in both kidneys. A decrease in the estimated glomerular filtration rate was noted already at AG1 degree. According to echocardiography, violations of LV diastolic function were noted with preserved systolic function of the left ventricle. CONCLUSION. We found that in stage 1 CKD, the preservation of secretory function is combined with a slowdown in the excretory function of both kidneys, which may be associated with the processes of sclerosis of the tubulo-interstitial zone of the kidneys at the background of a chronic inflammatory process. The data obtained allow us to express the idea of the expediency of complex cardiorenal dynamic control already in the debut of CKD, which will contribute to improving the effectiveness of nephro- and cardioprotective measures in this cohort of patients.

BACKGROUND. The term "sarcopenic obesity" has been used not so long ago. The epidemiology of this phenomenon during renal replacement therapy in the Russian Federation has not been studied. THE AIM: to assess the prevalence of sarcopenic obesity in patients on hemodialysis (HD). PATIENTS AND METHODS. 140 patients receiving treatment with programmed bicarbonate HD in 2 dialysis centers of St. Petersburg were examined, among them 68 women and 72 men, the average age was 56.8±12.8 years. The main cause of the development of terminal renal insufficiency was chronic glomerulonephritis – in 43, autosomal dominant polycystic kidney disease – in 14, chronic pyelonephritis – in 9, hypertension – in 15, chronic tubulointerstitial nephritis – in 6 and other diseases – in 53 people. The prevalence of these pathological conditions in men and women did not differ. To assess the component composition of the patient's body, we used: 8–point tactile tetrapolar multi–frequency bioimpedance (BIM) on the InBody device (South Korea) with a frequency range of 1 – 1000 kHz, 10 measurements for each of 6 frequencies for each of 5 body segments (right and left arm, right and left leg, torso), followed by the calculation of the index of appendicular skeletal muscles. The criteria of RN. Baumgartner (2000) were used to diagnose sarcopenic obesity. RESULTS. Sarcopenic obesity was detected in 62 patients (44.3 %). There was no correlation with the underlying pathology. Patients with sarcopenic obesity were distinguished by a longer period of renal replacement therapy, the lowest concentration of serum creatinine and the number of points of the physical component of the SF-36 scale, higher levels of C-reactive protein, parathyroid hormone, HOMA-IR index, Charleson index. Also in this group, the lowest score on the IPAQ scale of motor activity and the worst results in the 6-minute walking test were noted. CONCLUSION. Currently, it is not entirely clear what is the primary link in the development of sarcopenic obesity and whether it is realistic to isolate it in a particular patient. We believe that the main cause of the development of this syndrome is obesity, which causes the expression of pro-inflammatory cytokines and insulin resistance. The most important modifiable risk factor for obesity is considered to be the hypercaloric intake of patients, which is due to the lack of nutritionists with experience in the field of nephrology and indexing the amount of calories indicated in clinical recommendations to the real, and not to the recommended body weight.

BACKGROUND. Patients receiving treatment with programmed hemodialysis are at high risk for the incidence of COVID-19. THE AIM: to analyze the clinical picture, features of the course, risk factors and treatment options in COVID-19 patients treated with programmed hemodialysis in Makhachkala. PATIENTS AND METHODS. 162 patients (87 men and 75 women) were treated with HD for terminal renal failure were under observation in the GBU RD "RKB" of Makhachkala, repurposed to provide medical care to patients infected with SARS-CoV-2 from April 2019 to April 2020. The study was single-center, retrospective and uncontrolled. The end point of observation was considered to be the patient's discharge from the hospital or death. Patients who continued treatment at the end of the study were excluded from it. RESULTS. Infection with SARS-CoV-2 in 101 (62.3%) patients was confirmed by PCR results, and in the rest – by a characteristic pattern determined by CT of the chest organs. The fatal outcome of COVID-19 in patients with HD was associated with a more severe and widespread lung lesion (CT-3 and CT-4), which was diagnosed significantly more often compared to the surviving patients. In a significant number of patients with endstage CKD treated with HD, it is characterized by a severe course and an unfavorable prognosis. In this regard, there is a need to search for effective and safe methods of prevention and treatment in groups at increased risk of infection and severe COVID-19. CONCLUSION. Patients with CKD have an increased risk of developing severe COVID-19. Concomitant cardiovascular diseases and diabetes mellitus may predispose to this. Given the availability of a vaccine or approved therapy, nephrologists should advise patients with CKD to follow the recommendations of social isolation.

The issues of organ and tissue transplantation are currently one of the urgent tasks of clinical medicine. This also applies to the practice of treating kidney diseases, where one of the effective methods is the transplantation of a donor organ. However, despite extensive practice to date, all the problems of organizing this process have not been solved. The aim of the work was to study the history of development and prospects of interaction between transplant doctors and forensic medical experts during kidney transplants in St. Petersburg. The period of the early 2000s to the present was analyzed. As a result of the study, the main difficulties of such joint work in the implementation of kidney transplants at different stages of the analyzed period were revealed. It is shown that the main condition for successful transplantation activity is adaptation to the requirements of society, detailed awareness of the requirements of laws and other governing documents, as well as strict and strict compliance with them. Only the joint efforts of transplantologists, city health managers, specialists of the city's Forensic Medical Examination Bureau and law enforcement agencies made it possible to create and develop an operating, constantly improving system of post-mortem organ donation. One of the key concepts in such a system was the development of requirements for "forensic medical support of organ transplantation". In cooperation with interested specialists of St. Petersburg, the city Bureau of Forensic Medical Examination organized round-the-clock shifts of forensic medical experts. Clear instructions have been developed for them with legal, medical and forensic contraindications to the collection of organs and tissues from the corpses of donors. This type of activity of the Bureau of Forensic Medical Examination was introduced as a state task.

This article is the continuation of analysis and discussion from the book by Professor AI Nevorotin "Matrix phraseological collection: a manual for writing a scientific article in English". The Matrix phraseological collection is a kind of catalog of text samples. The samples were from articles selected from the leading English-language scientific journals and were systematized in such a way that when writing an article in English, a Russian researchers are able easy to find examples suitable for his/her own work. Furthermore, the selected samples can be transformed accordingly saving the semantic and syntactic relations between the elements and, finally, be inserted into the text. The sixth part of this series of articles is devoted to the most important aspect of scientific work: the discussion of the results obtained. And, in particular, the peculiarities of scientific thinking. Preferred phrases and most relevant terms are presented.