Sphingolipids are components of the lipid rafts in plasma membranes, which are important for proper function of podocytes, a key element of the glomerular filtration barrier. Research revealed an essential role of sphingolipids and sphingolipid metabolites in glomerular disorders of genetic and non-genetic origin. The discovery that glucocerebrosides accumulate in Gaucher disease in glomerular cells and are associated with clinical proteinuria initiated intensive research into the function of other sphingolipids in glomerular disorders. The accumulation of sphingolipids in other genetic diseases including Tay-Sachs, Sandhoff, Fabry, hereditary inclusion body myopathy 2, Niemann-Pick, and nephrotic syndrome of the Finnish type and its implications with respect to glomerular pathology will be discussed. Similarly, sphingolipid accumulation occurs in glomerular diseases of non-genetic origin including diabetic kidney disease (DKD), HIV-associated nephropathy, focal segmental glomerulosclerosis (FSGS), and lupus nephritis. Sphingomyelin metabolites, such as ceramide, sphingosine, and sphingosine-1-phosphate have also gained tremendous interest. We recently described that sphingomyelin phosphodiesterase acid-like 3b (SMPDL3b) is expressed in podocytes where it modulates acid sphingomyelinase activity and acts as a master modulator of danger signaling. Decreased SMPDL3b expression in post-reperfusion kidney biopsies from transplant recipients with idiopathic FSGS correlates with the recurrence of proteinuria in patients and in experimental models of xenotransplantation. Increased SMPDL3b expression is associated with DKD. The consequences of differential SMPDL3b expression in podocytes in these diseases with respect to their pathogenesis will be discussed. Finally, the role of sphingolipids in the formation of lipid rafts in podocytes and their contribution to the maintenance of a functional slit diaphragm in the glomerulus will be discussed.

One of the cornerstones of preventive care in pediatric renal disease is delivery of routine childhood immunization. Children with chronic kidney disease should receive immunization according to the recommendation for healthy children. Given the increased risk for vaccine-preventable disease post-transplantation, complete immunization is especially important in children with chronic kidney disease С5 as they approach transplantation. The prevention and monitoring of infection in children with renal disease are complex but are critical to the ultimate success of the transplantation.

THE AIM: to assess the effectiveness of long-term treatment patients with benign prostatic hyperplasia (BPH) with dutasteride - inhibitor first and second type of 5-a-reductase. It was analyzed the results of treatment of 311 patients with BPH who receive dutasteride 0,5 mg 1 time per day. The duration of treatment in 28 patients was 6 months (first group), 93 - 12 months (second group), 109 - 24 months (third group), and 81 - 48 months (fourth group). Prostate volume after 6 months of treatment decreased only by 3.5%, after 12 months - by 15.6%, after 24 months - by 21.2%, and after 48 months - by 29.3%. Long-term treatment of BPH patients with dutasteride prevents the progression of the disease, accompanied by significant reduction of prostate volume, reduces the risk of acute urinary retention and the need for surgical intervention.

Literary data about the importance of anamnesis and physical examinations in functional assessment arteriovenous fistula/ graft for hemodialysis.

AIM: to assess the prevalence of chronic kidney disease mineral and bone disorder (CKD-MBD) markers among dialysis patients in North-West Region of Russia and to evaluate its links with clinical and demographical features of dialysis population. PATIENTS AND METHOD: In 1594 patients from 19 dialysis centers in North-West of Russia and Burjatia Republic we assessed serum total calcium, phosphate, parathyroid hormone and 25(OH)D3 levels in central laboratory; ultrasound neck examination was performed by portable scanner. RESULTS: the prevalence categories of calciemia, phosphatemia, PTH levels according to K/DOQI, KDIGO and Russian national ckd-mbd recommendations is presented; hypercalciemia revealed in 6-20% of patients, hypocalciemia - in 38-42%, hyperphosphatemia - in 67% (KDIGO) and 44% by K/DOQI; PTH above 300 pg/ml was found in 60% of cases, above 600 pg/ml - in 29%; PTH level below 150 pg/ml was seen in 24% of patients. We found PTH level in target range in 16% (K/DOQI) or 47% (KDIGO). The prevalence of categories markedly differed by regions; the share of patients in upper category increased with dialysis vintage and was higher in patients with vitamin D insufficiency/deficit. Ultrasound examination revealed one/two/ three/four enlarged parathyroid glands in 17%, 7%, 3% and 3%, accordingly; in parallel, PTH levels increased. 25(OH)D3 level in normal range was found only in 9% of patients. CONCLUSION: The prevalence of hyperphosphatemia, hyperparathyroidism, hypoparathyroidism as well as hypocalciemia and vitamin D insufficiency/deficit are high but rather different in the regions of one area, that presumes the improvement possibilities using the available resourses.

THE AIM: to assess the associations between serum (SUmo) or urinary (UUmo) uromodulin concentrations and the parameters of urinary excretion of various ions in patients with glomerulopathies. PATIENTS AND METHODS. Eighty four patients with different variants of glomerulopathies (M: F 42:42) were studied. Umo concentrations in serum (SUmo) and urine (UUmo) were measured by ELISA. Serum (S_X) and urinary (U_X) concentrations of creatinine, potassium, sodium, chloride, calcium, inorganic phosphorus, and protein levels in urine were stablished. Glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula. For each ion calculated value of daily excretion (U_X24), clearance (C_X) and fractional excretion (EF_X). RESULTS. SUmo significantly directly correlated (Spearman's rank correlation coefficient) with C_K, U_Ca, U_Ca24, C_Ca, U_Mg24, C_Mg and inverse - with S_K, EF.,, ER. , S_„ EF_., EF_d and EF.. . UUmo was directly related to C, U_ „., C_ , U.. and inverse with S_.. UUmo and SUmo directly K’ Na’ Cl’ Cl’ P Mg³ K’ Ca24’ Ca’ Mg24 Cl³ correlated with each other and with the eGFR. CONCLUSION. These data suggest that uromodulina concentration in urine and especially in serum are associated with parameters of renal excretion of the some ions. It is possible that higher levels of serum uromodulin can contribute to renal retention of electrolytes. However, for the final solution of this question requires further study. Key words: uromodulin, glomerulopathy, ion excretion.

THE AIM: to assess the additive effects of dyslipidemia, hypertension and decreased GFR (<60 ml/min/1.73m2) on the characteristics of carotid atherosclerosis in patients with type 2 diabetes (DT2) and CKD stages 1-3. PATIENTS AND METHODS. We investigated 100 patients with DT2 and CKD stages 1-3 aged 56.54±12.17 years. Control group included 26 healthy subjects of the same age. Total plaque area (TPA) was calculated as the sum of all plaque areas. GFR was estimated by CKI-EPI equation. RESULTS. We divided patients with DT2 and CKD into 3 groups: group 1 (n=26) - without additional risk factors for atherosclerosis, group 2 (n=28) - with 1 additional risk factor and group 3 (n=46) - with 2-3 additional risk factors. The prevalence of carotid atherosclerotic plaques was 8% in group 1, 21% in group 2 and 28% in group 3 (p<0.05). We found a significant difference in IMT between left and right carotid artery (0.70±0.16 mm versus 0.66±0.13 mm, p<0.001, respectively). However, there was no significant difference in carotid IMT between patients with plagues and without them (p=0.171). CONCLUSION. The results of the study suggest that dyslipidemia, hypertension and decreased GFR have additive effects on the development of carotid atherosclerosis in patients with DT2 and CKD stages 1-3.