Uric acid plays an important role in the development of kidney disease and cerebrovascular diseases. The kidneys play a crucial role in regulating serum uric acid levels, accounting for 60-70 % of uric acid excretion. Normally, the kidneys reabsorb about 90 % of the uric acid filtered by the glomeruli in the proximal tubules. Uric acid is a product of the breakdown of purines and can perform many physiological functions, including antioxidant and neuroprotective, maintaining blood pressure when taken with a low salt content and modulating immunity. However, excessive production of uric acid and/or an imbalance of renal secretion and reabsorption of uric acid and/or insufficient excretion of extrarenal uric acid, for example, in the intestine, will contribute to hyperuricemia, which is a common metabolic disease. Hyperuricemia and gout are associated with numerous cardiovascular and renal disorders, such as hypertension, myocardial infarction, stroke, obesity, hyperlipidemia, type 2 diabetes mellitus and chronic kidney disease. The article discusses the nephrocerebral continuum in hyperuricemia.

The article provides an overview of current understanding of the risk factors for chronic kidney disease (CKD) and cardiovascular diseases in the pediatric population. The groups of the main structural and functional markers in children with arterial hypertension and CKD in children are considered. The results of studies confirming their value in terms of screening, diagnosis, and assessment of cardiovascular prognosis are presented. Differences in approaches to the use of biomarkers in adults and children are discussed.

THE AIM of the study was to study the relationship between circulating cytokines and blood lipid profiles and their role in the development of kidney dysfunction in individuals with different categories of cardiovascular risk. We examined 249 people with different categories of cardiovascular risk (CVR) according to the SCORE scale: low-moderate cardiovascular risk (n = 92); high CV risk (n = 100); very high (n = 57). Along with general clinical data, the following biochemical parameters were assessed: concentrations of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and IL-10, the ratio of inflammatory and anti-inflammatory cytokines, as well as the levels of total cholesterol (CHC), lipoprotein cholesterol low density (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), atherogenic index (AI), serum cystatin C and creatinine with calculation of glomerular filtration rate (GFR).

PATIENTS AND METHODS. Show that in individuals with very high cardiovascular risk, the level of systolic blood pressure, the median concentrations of IL-6 and IL-10 were significantly higher. Estimated GFR based on serum cystatin C levels in all studied subgroups was significantly lower than GFR calculated based on blood creatinine. RESULTS. A close correlation was demonstrated between the concentration of TNF-α with the level of LDL-C (r = 0.138, p<0.05), HDL-C (r = – 0.193, p<0.05), AI (r = 0.140, p<0.05) on the one hand and between IL-6 with LDL-C (r = 0.253, p<0.05), HDL-C (r = -0.174, p<0.05) on the other. There was a negative relationship between the level of TNF-α and GFR calculated from both creatinine (r= -0.270, p<0.05) and cystatin C (r= -0.308, p<0.05).

CONCLUSION. The most pronounced violations of cytokine metabolism with an increase in TNF-α, IL-6 and a decrease in IL-10 are observed as the CVR increases, especially in people with very high CVR. In individuals with different categories of CV risk, elevated levels of TNF-α and IL-6 are actively involved in lipid metabolism disorders, contributing to the progression of atherosclerosis and the development of kidney dysfunction.

BACKGROUND. Mechanisms of ureteral muscularis layer regulation during trafficking of stones in different compartments remain a poorly understood problem in nephrology. AIM of the study was to analyze the activity of the main receptors modulating contraction (α2-adrenoreceptor, purine P2X1and P2Y-receptors, angiotensin AT1-receptor, TR-receptor to TxA2) and smooth myocyte relaxation (adenosine A2-receptor) in the presence of medium and small stones in the urinary tract (UT).

PATIENTS AND METHODS. The study was prospective and included 126 patients with imaging signs of stones in the pyeloureteral compartment of UT (group 1, 61 patients) and in the middle third of the ureter (group 2, 65 patients). The average size of the stones in group 1 was 16.1±1.0 mm (min-max 7.0-25.0 mm), in group 2 – 4.4±0.8 mm (min-max 2.0-6.0 mm). Platelets (Pts) of patients were used as a model for in vitro evaluation of the functional activity of α2-adrenoreceptor, P2X1and P2Y-receptors, AT1-receptor, ТР-receptor and A2-receptor. Pts aggregation was assessed by turbidimetric method on ChronoLog analyser (USA).

RESULTS. The main pathogenic factors of NLT (mechanical damage of mucosa, activation of SAS and RAS, tissue ischemia and alteration, presence of pyelonephritis) influence urinary tract motility, which can be confirmed by the activity of receptors participating in the regulation of smooth muscle cells function detected in vitro on Pts. In the presence of medium-sized stones, the patient's protective response to ensure their elimination is manifested by hyperreactivity of α2-adrenoreceptor, TР-receptor, P2X1-receptor, normoreactivity of P2Y-receptor and AT1-receptor, and hyporesponsiveness of A2A-receptor. In cases of small-sized stones, there was hyperreactivity of α2-adrenoreceptor, AT1-receptor, normoreactivity of P2Y-receptor and A2-receptor and desensitization of P2X1-receptor and TР-receptor.

CONCLUSION. The revealed peculiarities of molecular regulation of target cells in nephrolithiasis require further study in the context of development of personalized schemes of lithokinetic therapy in patients with concrements of different sizes in the urinary tract.

THE AIM OF THE STUDY. To clarify the role of acyl-ghrelin in the development of protein-energy wasting of haemodialysis patients (HD).

PATIENTS AND METHODS. A total of 645 patients receiving treatment with programmatic bicarbonate HD for 8.4 ± 5.3 years, including 345 women and 300 men, the average age was 56.8 ± 12.8 years. Nutritional status was assessed using the method proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). For the quantitative determination of acyl-ghrelin, the enzyme-linked immunosorbent assay kit “Active Ghrelin ELISA Kit” (highly sensitive method) from Sceti KK, Japan was used in this work. Reference values: 30 – 62 fmol/ml.

RESULTS. The prevalence of protein-energy wasting (PEM) using the ISRNM method was 24.9% (160 patients). Reduced levels of acyl-ghrelin were detected in 352 patients (54.5%). The average acyl-ghrelin values in patients without signs of PEW were 50.2±10.3 fmol/ml, and in patients with PEW 24.9±9.2 fmol/ml (p<0.0001). Patients with reduced acyl-ghrelin levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, and transferrin than patients with normal acyl-ghrelin levels (p<0.0001, p<0.0001, p< 0.0001, p<0.001 and p<0.0001, respectively). Also, patients with reduced acyl-ghrelin levels were characterized by statistically significantly lower values of BMI, skeletal muscle mass, and percentage of body fat mass (p<0.001, p<0.001, p<0.001, respectively).

CONCLUSION. The prevalence of PEW in haemodialysis patients according to the ISRNM method was 24.9%. A reduced level of acyl-ghrelin in the blood serum may be an important pathogenetic link in the development of PEW in haemodialysis patients.

BACKGROUND. The results of the analysis of the content of markers of endothelial dysfunction in the blood serum and urine of children with chronic nephropathies are presented. The prospects of their use in the complex diagnosis of chronic kidney diseases and assessment of the progression of this pathology are discussed.

THE AIM. To analyze the possibility of using the determination of interleukin-6 and intercellular adhesion molecule-1 (ICAM-1) in serum and urine of pediatric patients in the complex diagnosis of chronic kidney diseases.

PATIENTS AND METHODS. 132 patients with chronic kidney diseases were examined. The comparison group included conditionally healthy children without signs of kidney damage and autoimmune process. Quantitative determination of the level of markers of endothelial dysfunction was performed by enzyme immunoassay.

RESULTS. The concentration of interleukin-6 in the blood serum of patients showed significant differences among all the studied groups (N=162, p<0.001). Urine levels of interleukin-6 also differed significantly in patients of all groups (N=156, p<0.001). According to the Mann-Whitney criterion, significant differences in the content of interleukin-6 in blood serum and urine were noted only in patients of the comparison group with patients of the studied groups. The concentration of ICAM-1 in blood serum did not show significant differences among patients of all groups (N=145, p=0.43). But the differences in the level of ICAM-1 in urine reached statistical significance (N=148, p<0.001). According to the Mann-Whitney criterion, significant differences in ICAM-1 concentrations were noted only in urine among patients of the study groups and the comparison group, among patients with primary and secondary immuno-mediated glomerulopathies. There were no statistically significant correlations between the concentration of markers of endothelial dysfunction in blood serum and urine with the characteristics of renal functions and the activity of the pathological process.

CONCLUSIONS. The determination of markers of endothelial dysfunction can be used in the diagnosis of chronic kidney diseases in children. Further investigation of the concentrations of interleukin-6 and ICAM-1 in blood serum and urine is promising for the differential diagnosis of glomerulopathies among themselves. However, it is not possible to talk about the use of these molecules as a marker of the progression of the pathological process in the renal tissue at this stage of the study.

According to the World Association of Pediatric Nephrologists, the incidence of primary nephrotic syndrome (NS) is 3-12 cases per 100,000 children and tends to increase. The number of patients with a progressive course of the disease is growing every year, and nephrotic syndrome with severe proteinuria, hypoalbuminemia, anasarca occurs in 2-4 per 10,000 children under the age of 16.

BACKGROUND: analysis and modification of approaches to intensive care of critical complications of nephrotic syndrome in children.

PATIENTS AND METHODS: A clinical and laboratory examination of 120 sick children suffering from NS was carried out. In accordance with international standards, the patients were divided into SRNS and SRNS in accordance with the response to the standard course of steroid therapy (prednisone 60 mg/m²/day).

RESULTS: Based on the results of our study and on the basis of a correlation analysis of the indicators of renal sodium retention with parameters reflecting volemic disorders in generalized edema in children with HCNS and SRNS, it was possible to establish clinical and functional criteria for the nature of the causes of edema (Figure 6). At the same time, mainly this group (in 11 cases – 45%) with refractory edema consisted mainly of children with HCV, in whom critical hypoalbuminemia (less than 15 g / l in plasma), critical renal sodium retention (FENa <0.2%) and intravascular reduction in fluid volume (hypovolemia: decrease average indices of the index of the area of the NIP, volumetric blood flow through the inferior vena cava and renal veins against the background of a decrease in the diastolic index of the left ventricle, shock and cardiac indices).

CONCLUSION: in children with nephrotic edema of normovolemic and hypervolemic variants with steroid-resistant NS occurring with arterial hypertension, oliguria and a decrease in the glomerular filtration index of the kidneys, high efficacy of furosemide at a dose of 3-5 mg/ kg of body weight and the absence of a reliable effect of albumin and colloidal solutions were noted when relieving generalized edema, which excludes the use of the latter in our recommendations on the revision of approaches to intensive care of NS in children.

BACKGROUND. Chronic kidney disease (CKD) is an increasingly prevalent global health concern, with Pakistan experiencing a rising burden of this condition. However, little is known about the relationship between CKD and serum amylase levels in this region. This cross-sectional observational study conducted at the Karachi Institute of Kidney Disease aimed to investigate the association between CKD and serum amylase levels in patients undergoing chronic hemodialysis.

PATIENTS AND METHODS. A total of 196 participants, both genders, aged over 25, with CKD diagnosed for at least three months, were included in the study. The study spanned six months, from September 2020 to March 2021. Serum amylase, lipase, and creatinine levels were assessed, and data analysis was performed using “SPSS version 21”.

RESULTS. Results showed that 89.3% of CKD patients had elevated serum amylase levels, irrespective of whether they received hemodialysis, indicating a strong correlation between decreased kidney function and elevated serum amylase. The study also found no significant effect of gender, age, body mass index, diabetes mellitus, hypertension, or obesity on serum amylase levels in CKD patients.

CONCLUSION. Understanding this relationship is crucial for healthcare providers to establish appropriate reference ranges for amylase and avoid misdiagnosis. Future studies on a larger scale are necessary to refine reference ranges for amylase and lipase in CKD patients. Ultimately, this research has significant implications for clinical practice, helping clinicians differentiate between CKD-related changes and other conditions when interpreting serum amylase levels in patients with kidney disease.

BACKGROUND. Cardiovascular diseases are the main cause of death in patients with chronic kidney disease (CKD). The study of the mechanisms of vascular dysfunction in CKD is relevant. To simulate CKD, a decrease in the mass of functioning nephrons is used in the experiments.

THE AIM. The effect of nephrectomy on the dilator and constrictor properties of the arteries was studied in experiments on segments of the superior mesenteric artery (SMA) and internal carotid artery (ICA) of Wistar rats.

MATERILS AND METHODS. Nephrectomy in rats was performed by resection of 5/6 of the mass of renal tissue. Vascular segment reactivity was assessed under isometric conditions. In isolated segments of vessels precontracted with phenylephrine, dilation was induced using acetylcholine or sodium nitroprusside before and during the action of tetraethylammonium or glibenclamide as potassium channel blockers, or methylene blue as a guanylate cyclase inhibitor.

RESULTS. Nephrectomy was shown to increase the contractile response of the arteries to phenylephrine to the greatest extent in SMA (more than 2 times). The dilatation of the arteries to sodium nitroprusside in nephrectomized and control rats was the same. The reaction of SMA and ICA to acetylcholine in most cases consisted of a dilatation and a much smaller constrictor phase. In nephrectomized rats, the magnitude of both the dilator and constrictor phases of the arterial reaction to acetylcholine was significantly lower than in control animals. Tetraethylammonium significantly decreased acetylcholine-induced dilation of the SMA and ICA, and methylene blue reduced this dilation in nephrectomized rats significantly less than in control animals. This, as well as the significant decrease in the dilatation of SMA to nitroprusside in the presence of methylene blue in control rats and an increase in nephrectomized rats, may indicate a malfunction of guanylate cyclase after nephrectomy.

CONCLUSIONS. CKD causes vascular dysfunction, in which arterial constrictor responses mediated by α1-adrenergic receptors are enhanced and endothelium-dependent dilator responses are weakened, which may cause, in particular, an increase in blood pressure.

The article is devoted to the contribution of the chief specialists of the General Military Medical Department (GMMD) of the Red Army and the Medical Service of the Navy (MSN) to the organization of medical support during the Great Patriotic War of 19411945. The authors tried to highlight lesser-known, but no less important aspects of the activities of the chief specialists and their deputies using photographs that were rarely published before. Thanks to the high professionalism and originality of each chief surgeon, chief therapist, chief epidemiologist and other specialists; the scientific approach applied by specialists to the organization of medical evacuation, medical and preventive, sanitary and hygienic, anti-epidemic measures and the protection of troops (forces) from weapons of mass destruction; prompt study of experience and development of new, most rational forms and methods of activity during defensive and offensive operations of the Army and Navy; In cooperation with civilian healthcare, the medical service of the Red Army and Navy managed to achieve unprecedented results. 72.3 % of the wounded and 90.6 % of the sick from the total number of medical losses were returned to duty, which in total exceeded 17 million people. A high price had to be paid for this success: during the war, 125,808 military doctors were wounded, 84,793 people died. The bulk of the total losses (88.1 %) were medics, stretcher-bearers and medical instructors. What was done during the Great Patriotic War by Soviet military medicine, and by chief medical specialists in particular, can be defined as a feat and should not be forgotten.

the article is dedicated to the director of the 1st LMI during the war, I.D. Strashun. Heading the institute from 1941 to 1943, he made a significant contribution to ensuring the operability of the 1st LMI. It should be noted that the 1st LMI was one of the few institutes that worked in blockaded Leningrad. Throughout the years of the blockade, the institute recruited students and held annual graduations. The article uses materials from the personal file of I.D. Strashun, stored in the archives of the Pavlov First Saint Petersburg State Medical University, as well as materials from the St. Petersburg archives