THE AIM. The study was aimed to evaluate factors associated with early stages of chronic kidney disease (CKD) determined as albuminuria (AU) and estimated glomerular filtration rate (GFR) >60 ml/min/1,73 m² in patients (pts) with diabetes mellitus type 1 (DMT1). PATIENTS AND METHODS. 192 diabetic pts with AU <60 mg/24h and GFR > 60 ml/min/1,73 m² were included in this retrospective study. A number of clinical variables were studied. The presence of the early CKD stages was defined as AU 15-59 mg/24h. RESULTS. 46 pts (24%) had. The presence of neuropathy and decrease of hemoglobin (or presence of anemia) were independent predictors associated with higher urinary albumin excretion in linear regression model. The relative risk of AU 15-59 mg/24h associated with neuropathy, increase of glycated haemoglobin (HbA1C) and GFR. CONCLUSION. Monitoring of diabetic neurologic complications, metabolic control as well as GFR and hemoglobin in type 1 diabetic pts seems to be useful for early CKD risk evaluation and prevention.

The article discusses acute glomerulonephritis nosology question.

Abnormalities of homocysteine metabolism are associated with renal injury and anemia leading to the development and progression of micro- and macrovascular diabetic complications that are the main cause of disability and mortality in patients with diabetes mellitus (DM). Therefore, not all aspects of interaction between hyperhomocysteinemia (HHC) and cardiorenal anemia syndrome in carbohydrate metabolism disorder are evident, so study of realization role and factors of homocystein impact is very important. The present review summarizes the results of global studies and assesses their contribution towards better understanding molecular mechanisms of effects related to abnormalities of homocysteine metabolism. On the basis of recent experimental and clinical data we review molecular aspects of interaction between hyperhomocysteinemia and immunocompetent cells, as well as components of renin-angiotensin-aldosterone system, and the role of oxidative stress, vitamin deficiencies and anemia in realization of homocystein impacts in diabetic patients with cardiorenal anemia syndrome. Clinical rationale is given for declared direction of further studies. Moreover this pathogenic perspective leads to consideration of new pathogenic pathways becoming important diagnostic and therapeutic targets that can be translated into clinical treatment of hyperhomocysteinemia in diabetic patients with cardiorenal anemia syndrome.

THE AIM. To evaluate dynamics of tubular damage biomarkers (BMs) and to determine frequency of acute kidney injury (AKI) according to routine diagnostics following hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS. The study involved 30 patients after allogeneic hematopoietic stem cell transplantation (HSCT). The urine samples were taken 7 days prior to HSCT (week 0), on the weeks 1, 2, 3 and 4. BMs concentrations (calbindin, clusterin, IL-18, KIM-1, GST-п, MCP-1) were estimated. Serum creatinine was measured at the same time periods. Clinical AKI was diagnosed according to AKIN/ KDIGO (acute kidney injury network/kidney disease improving global outcomes) classification systems. RESULTS. Clinical AKI (AKIN/KDIGO) diagnostics: the proportion of AKI (AKШN/KDIGO) cases on the weeks 1 and 2 after HSCT was 7%, on the week 3 - 17%, on the week 4- 54% (p <0.05). The frequency of cases with increase of 1 and more BMs concentrations on the week 1 following HSCT was 78%, on the week 2 - 85% and thereafter on the week 3 - 90%. The proportion of cases with simultaneous elevation of 4 and more BMs after HSCT had been progressively increasing: from 6% before HSCT to 38% on the week 4 after it. By week 4 only in 6% of cases no increase in BMs concentration was found, while the cumulative proportion of cases without clinical AKI criteria (AKIN/KDIGO) was much more higher and reached 40%. The frequency of AKI (AkIN/KDIGO) development increased in relation to the number of simultaneously increased BMs. Statistically significant direct correlations were found between BMs of proximal and distal tubules, as well as between BMs simultaneously showing the damage of both proximal and distal tubule. ROC analysis showed that BMs number has sufficient sensitivity in terms of prognosis of clinical AKI (AKIN/KDIGO) development (SAUC=0,69; p=0.006). CONCLUSION. The BMs concentration increase, showing the tubular damage following HSCT, was found in majority of patients (90%) and preceded the development of clinical AKI (AKIN/KDIGO). The evaluation of BMs concentration may be used for the assessment of subclinical tubular structural damage and prognosis of AKI.

THE AIM: to determine the diagnostic value of specific indicators for screening protein-energy wasting (PEW) in patients with chronic kidney disease (CKD) S5d, depending on comorbidity. PATIENTS AND METHODS. PEW screening was performed in 504 patients (46% women) aged 56,0±14,0 years in St. Petersburg dialysis centers. To reveal PEW we determined body mass index, creatinine serum concentration before hemodialysis, albumin and cholesterol serum content, calculated normalized protein catabolism rate. Index Charlson was used to assess the comorbidity. RESULTS. PEW signs met with varying frequency: serum creatinine concentration before HD less than 880 mcmol/l - 62%, albumin less than 38 g/l in 41%, total cholesterol less than 2.6 mmol/l in 2% patients. In accordance with normalized protein catabolism rate value less than 0.8 g/kg/day in 53% patients poor dietary protein intake was supposed. BMI less than 23 kg/m2 was registered in 26% patients. Regardless of which indicator was used, the presence of PEW was associated with more than 6 points Charlson index value. CONCLUSION. For PEW screening in patients with CKD S5d when serum creatinine before hemodialysis less than 880 mcmol/l or when Charlson index is more than 6 points we suggest to perform an instrumental examination to clarify the nature of PEW.

THE AIM: to study levels of NGAL in the blood serum (s-NGAL) and in the urine (u-NGAL) and their clinical relevance to the complicated clinical course of acute coronary syndrome (ACS) during hospital stay. PATIENTS AND METHODS. 113 patients were examined (81 males и 32 females, average age 59,5±9,6 years) and 59 were diagnosed ACS with ST segment rise (ACS-STR), 54 - without ST segment rise (ACSwSTR). During the first three days of hospital stay the following parameters were measured: s-NGAL and u-NGAL content and serum creatinine (sCr). Throughout the hospital stay, frequency of complications was observed and analysed. RESULTS. s-NGAL and u-NGAL levels at ACS-STR [209,2 (146,79; 489,48) and 6,8 (1,8; 30,78) respectively] were higher than at ACSwSTR [192,3 (124,7; 276) and 3,2, (1,8; 5,73), р=0,136 and р=0,009 respectively]. Acute kidney injury (AKI) was diagnosed upon the recommendations of KDIGO by sCR index for 11 ACS patients. Higher s-NGAL and u-NGAL levels were diagnosed for ACS patients with AKI [422,04 (166,82; 768,92) and 21,8 (2,31; 64,74)] in contrast to patients not having AKI [194,61 (133,15; 338,35) and 3,9 (1,8; 8,6), р=0,06 and р=0,09 respectively), however differences didn’t reach a statistical significance. 53 patients had a complicated course of ACS. For these patients median s-NGAL indexes [266,0 (144,39; 508,2)] were accurately half as large again than for the patients who did not develop complications [172,61 (132,3; 262,68)] (р=0,02). Nevertheless, u-NGAL content for both patients with complicated course [3,81 (1,81; 10,09)] and patients with non-complicated ACS course [4,35 (1,79; 10,43)] was comparable (р=0,9). CONCLUSION. ACS patients, who developed complications, got a higher s-NGAL level, as compared to the patients with non-complicated course.

THE AIM - to study the effect of metformin on the tubulointerstitial fibrosis development and microRNA 21 expression in urine on the model of unilateral ureteral obstruction (UUO) in rats. MATERIAL AND METHODS. Male Wistar rats weighing 230-250 g were used for modeling tubulointerstitial fibrosis following UUO. The first group (control; n = 5) rats received a standard diet, the animals of the second group (n = 5) immediately after surgery received standard diet and metformin 10 mg per day. Both groups of rats were observed for 14 days after the UUO modeling. One day before the experiment termination, in rats which were placed in a metabolic chamber urine was collected during 24 hours for subsequent miRNA 21 expression determination. After removal the animal from the experiment received samples of urine from the renal pelvis of the kidney with UUO to determine miRNA 21 expression, as well as samples of kidney tissue for subsequent histological examination. Severity of morphological changes were evaluated by quantitative morphometry to determine the relative volume of tubulointerstitium (RVTin) and relative volume of the tubular epithelium (RVTe). RESULTS. In the control group, the experimental UUO led to a logical, a statistically significant increase in RVTin compared with the contralateral kidney. Similar data were obtained by the group of animals treated with metformin. Metformin had no significant effect on the severity of RVTin neither contralateral (intact) kidney, nor kidney with UUO. UUO in animals treated with metformin resulted in a significant decrease in the value RVTe. There were no significant differences in the levels of RVTe in the intact kidneys or kidney with OOM in animals receiving and not receiving metformin. CONCLUSION. The obtained results have not confirmed nephroprotective effect of metformin on the tubulointerstitial fibrosis development in rats with UUO. However for the final resolve of this problem requires additional clinical and experimental studies.

THE AIM: To evaluate the efficacy of combined use of prostate gland and thymus peptides in infectious chronic prostatitis (CP). PATIENTS AND METHODS: 63 patients aged 23 to 48 years were divided into three groups. In the 1st group (18 patients) patients were administered intramuscularly thymogen 100.0 mg/day. Patients in group 2 (21) received 30 mg prostatilen in suppositories with Dimexidum at night, and patients of the 3rd group (24 patients) received the combined treatment (prostatilen + timogen). Before and after treatment, patients were examined with prostate ultrasound, uroflowmetry, bacteriological examination of prostatic secretions. Symptoms of disease were assessed by International scale IPSS, patients quality of life (Ql) was analyzed. RESULTS: In patients from Group 1 inverse dynamics of clinical symptoms and prostate volume were less pronounced in comparison with the 2nd and 3rd groups. Total score of symptoms by IPSS decreased in patients from group 2 with 16,2 ± 2,3 to 12,4 ± 2,4 (p <0.05) and in patients from group 3 with 17,4 ± 3,1 to 12,1 ± 2,2. At the same time quality of life index in patients from 2nd and 3rd groups decreased from 5,0 ± 0,3 to 1,8 ± 0,4 (p <0.01) and 5,3 ± 1,1 to 2,1 ± 0,5 points (p <0.01), respectively. Prostate volume in patients from 2nd and 3rd groups decreased from 51,4 ± 5,5 cm3 to 47,2 ± 5,4 cm3 and 49,2 ± 4,6 cm3 to 45,4 ± 3,4 cm3, respectively, and the maximum urinary flow rate increased from 11,7 ± 2,4 ml/sec to 16,6 ± 2,8 ml/sec (p <0.05) in patients from group 2 with 12,7 ± 3,4 ml/sec to 18,4 ± 2,8 ml/sec (p <0.05) in patients from the 3rd group. CONCLUSION: The use of combined treatment (prostatilen with timogen) showed more pronounced regression of clinical symptoms, which is associated with a more profound impact on the pathogenesis of prostatitis and immune homeostasis.

The features of renal pathology in the oculo-cerebro-renal Lowe syndrome (OCRL) in children. Renal pathology is characterized by tubulopathy with generalized defect of glucose transport systems, amino acids, phosphates, bicarbonates in proximal tubules, manifested syndrome Fanconi, rarely combined with congenital ureterohydronephrosis, proteinuria, incomplete nephrotic syndrome.

Literary data about the basic hemodynamic effects resulting from arteriovenous fistula construction in different times of functioning.