Kidney diseases belong to a common category of pathology in the elderly and senile age, in which diet therapy occupies one of the central places in complex treatment. Assessment of metabolic disorders in the body of older people with diseases of the urinary system is the most important condition for diet therapy. It should be based on an integrated approach, including anthropometric data on the patient, biochemical information on the state of water-electrolyte, protein-energy, fat, carbohydrate, vitamin-mineral metabolism. The task of implementing nutritional support for the elderly with various nephrological pathologies includes a nosologically appropriate and personalized definition of dietary strategy in choosing patient nutrition, dietary rhythms, dietary programs and diets. The lecture presents methods recommended in Russian and international consensus for the quantitative formulation of diets that take into account the nature and severity of metabolic disorders and pathogenetic features of existing kidney pathology and the severity of involution processes in the body of the elderly and elderly. Algorithms for choosing individually justified diets for various kidney diseases, their severity, and the formation of complications are presented, taking into account the implementation of various therapy programs, including pharmacotherapy options and reasonable types of dialysis. The possibilities of the influence of certain foods and their combinations on reducing the intensity of the mechanisms of development and progression of renal pathology are described. Gerontodietology in clinical nephrology should be considered as the most important component of a comprehensive treatment program, the individualization of which should be based on a thorough study of the patient's metabolic features, understanding the pathogenetic features of the occurrence and chronization of kidney pathology, understanding the essence of involutional processes in the supervised patient and using the extensive knowledge of a creative and erudite doctor to block these identified somatic features. an individualized diet.

Since 2010, studies have been published that have found expression of bitter taste receptors Tas2R (the so-called extralingual or ectopic) on bronchial smooth muscle cells, and then on many other cells outside their canonical localization, in particular, on inflammatory cells. It was found that activation of Tas2R receptors, contrary to the bronchoconstrictor effect initially expected by the authors, led to more pronounced (3 times) bronchodilation than activation by β2-agonists. Over the past 15 years since the discovery of ectopic expression of Tas2R receptors in the respiratory system, a number of research areas have emerged and are developing in this new field of bronchial asthma research. These areas include: I – study of the expression of Tas2R receptor subtypes on bronchial smooth muscle; II – studies of the molecular mechanisms of Tas2R-signaling; III – studies of Tas2R receptor expression on respiratory system cells (ciliated epithelium) and on cells involved in allergic inflammation (lymphocytes, mast cells, macrophages, etc.); IV – studies of Tas2R gene polymorphisms and their association with predisposition to bronchial asthma; V – studies of the role of soluble Tas2R receptors in bronchial asthma; VI – search for opportunities to use Tas2R receptor activation for targeted therapy of bronchial asthma. The review examines the main positions of research areas in the field of Tas2R-signaling in bronchial asthma and provides the main literature in this area. Despite the achievements in the treatment of bronchial asthma, it is known that control over the disease cannot always be achieved completely. It is concluded that, given the versatility of the effects of tas2r receptors in bronchial asthma (bronchodilation, decreased activity of allergic inflammation and bronchial hyperreactivity, effects on remodeling), these receptors are a promising candidate for the development of comprehensive therapy for bronchial asthma.

THE AIM: to assess the relationship between clinical and laboratory parameters of diabetic nephropathy (DN), considering patients’sex and age. PATIENTS AND METHODS. A retrospective cohort study included patients with DN. Clinical-demographic and laboratory parameters were analyzed based on sex and age group. RESULTS. The mean duration of type 2 diabetes mellitus was 12.5 years (11.7 years in men; 13.1 years in women). A decrease in estimated glomerular filtration rate (eGFR <60 mL/min) was found in 43.6 % of patients. The most common comorbid conditions in DN were hyperglycemia (92.6 %), arterial hypertension (62.9 %), proteinuria (50.7 %), overweight (42.2 %), obesity (31.8 %), anemia (40.9 %), and hypercholesterolemia (44.4 %). Women with DN had significantly higher age, body mass index (BMI), venous blood glucose, and total cholesterol levels, while hemoglobin (Hb), hematocrit (Ht), and red blood cell counts were lower compared to men. The prevalence of anemia in DN patients was 40.9 % (42.9 % in men; 57.1 % in women), with women showing more pronounced reductions in eGFR and erythrocyte morphology alterations. A negative correlation was observed between eGFR and age, BMI, systolic, pulse, and mean arterial pressure (MAP), as well as Hb, Ht, red blood cell counts, and venous blood glucose concentration. In men, eGFR significantly correlated with age, BMI, heart rate, systolic, pulse, and mean arterial pressure, Hb, Ht, red blood cells, mean corpuscular hemoglobin concentration (MCHC), and blood glucose levels. In women, eGFR was associated with age, disease duration, BMI, systolic, diastolic, pulse, and mean arterial pressure, double product (DP), Hb, Ht, red blood cells, and blood glucose levels. Young patients with DN had lower erythrocyte morphology parameters and higher venous blood glucose levels. In younger patients, eGFR significantly correlated with BMI and DP; in middle-aged patients —with hemodynamic parameters, Hb, Ht, red blood cells, and blood glucose levels; and in elderly patients – with disease duration, BMI, systolic, diastolic, and mean arterial pressure, Hb, Ht, red blood cells, and blood glucose levels. CONCLUSION. The obtained data con- firm the presence of diverse associations between clinical and laboratory parameters of DN, depending on sex and age, which may be an important factor in the progression of renal insufficiency.

BACKGROUND. Attempts to improve the clinical outcomes of hemodialysis (HD) treatment through interventions aimed at improving quantitative indicators of uremia correction are not effective enough. The guidelines of professionals for different treatment outcomes differ from the interests and preferences of patients. THE AIM: to evaluate the possibilities of improving symptoms in HD patients by changing the composition of dialysis solution from standard to succinate-containing (SCDS). PATIENTS AND METHODS. The cohort study included 137 patients from one dialysis center. Symptoms were assessed by the Dialysis Symptom Index (DSI). RESULTS. Initially, the median score on the questionnaire was 21 [13.25–37.75], after a year – 25.0 [14.0–38.7]; the median of individual dynamics did not differ from 0 (0,0 [-4,7–9,0], p=0.407). At the same time, the dynamics of DSI in the group of those transferred to SCDS differed from that in the stable mode group: -1 (-12-5.75) vs. 3.5 (-2.25–16.5): Z=-2.714; p=0.007. In a one-factor logistic analysis, switching to SCDS reduced the risk of worsening the symptoms of whole DSI by 75.9 %: OR 0.241 (0.099-0.587); p=0.002, as well as for the mental and bodily components (OR 0.296 (0.123-0.709, p=0.006) and 0.389 (0.163-0.927, p=0.033), respectively). In the multifactorial logistic analysis model, significant factors were: the fact of conversion to SCDS, higher levels of albumin (-5 % risk per 0.1 mmol/l), hemoglobin (-41 % risk per 10 g/l), as well as a higher ultrafiltration rate (+17 % per 1 ml/hour/kg) and a higher phosphate level (+ 8 % per 0.1 mmol/l). CONCLUSION. The use of a succinate-containing dialysis solution in comparison with the standard one can improve the dynamics of DSI. Additional significant factors related to the dynamics of symptoms are the initial levels of albumin, hemoglobin, phosphates in the blood, and the rate of ultrafiltration.

Protein-energy wasting (PEW) is an independent predictor of morbidity and mortality in hemodialysis (HD) patients. Among the dishormonal disorders associated with its development, adiponectin (ADPN), an adipokine with a positive effect on carbohydrate metabolism and skeletal muscle condition, is of particular interest. However, end-stage renal failure (ESRD) is char- acterized by markedly elevated plasma ADPN levels combined with increased risks of cardiovascular events, activation of chronic low-level inflammation, high incidence of BEN and sarcopenia. BACKGROUND: to evaluate the relationship between serum ADPN levels and BEN levels in patients receiving HD treatment. PATIENTS AND METHODS. 645 patients receiving HD treatment (300 men and 345 women) with an average age of 56.8±12.8 years were examined. All patients were treated with bicarbonate HD according to the standard scheme. The diagnosis of PEW was carried out in accordance with the ISRNM rec- ommendations. The level of ADPN in blood serum was determined using the commercial kit "Adiponectin – ELISA" (“Mediag- nost”, Germany). RESULTS. The prevalence of PEW was 24.9%, and no sex differences were found. There was no relationship with the age of patients, the relationship with the duration of HD is highly reliable, but its degree is low (Rs=0.184 p=0.0001). The average concentration of ADPN in the blood serum in men was 7.8±2.7 ng/ml, in women 10.6±3.3 ng/ml (p=0.0001), while in women, elevated serum ADPN levels were statistically significantly less common than in men (63.19% and 79.33%, respectively, χ2=27.533, p=0.006). In patients with elevated serum ADPN levels, statistically significantly lower values of the main indicators of nutritional status were detected. When conducting multiple stepwise regression, a mathematical model was obtained, according to which ADPN is positively correlated with the volume of adipose tissue and negatively with serum albu- min and skeletal muscle mass, which was associated with a 1.5-fold increase in the probability of developing BEN, determined by the ISRNM method (χ2=164.63, p=0.0001). The null statistical hypothesis of the absence of differences and connections was rejected at p<0.05. CONCLUSION. The increase in ADPN levels in our patients is probably due to a combination of several reasons: an increase in production with the development of obesity, a decrease in clearance with ESRD, and the development of peripheral ADPN receptor resistance. The paradoxical, at first glance, relationship between a high level of ADPN and BEN can be explained by an increase in its effects in the paraventricular, arcuate, and lateral nuclei of the hypothalamus due to activation of AdipoR1, which leads to a decrease in appetite and increased energy expenditure.

To date, there is no universal approach to choosing the optimal management strategy for patients with SHPT, including the choice between calcimimetics or parathyroidectomy (PTX). THE AIM: to compare the survival rate of patients with uncontrolled SHPT on etelcalcetide therapy and after PTX, as well as to identify additional factors influencing treatment outcomes. PATIENTS AND METHODS. A retrospective cohort comparative study included two groups of hemodialysis patients: 55 patients who received etelcalcetide in 2018-2019 at 20 dialysis centers and 84 patients who underwent PTX in 2011-2016. The groups were compared at baseline by key demographic and clinical parameters. The main endpoint was patient survival (Kaplan-Meyer). Secondary endpoints included the risks of death in the Cox multiple regression analysis. RESULTS. In the etelcalcetide group, 12/55 patients died over a three-year period, and 4/84 in the PTX group (p=0.003). Survival by 36 months was 72.0±7.1 % in the etelcalcetide group and 91.8±4.1 % in the PTX group (p=0.014). Multiple Cox regression analysis showed a significant reduction in the risk of death in patients after PTX (HR 0.19; 95 % CI 0.06–0.60, p=0.004). Achieving the target PTH level (300-600 pg/ml) after PTX is associated with better survival (HR 0.12; 95 % CI 0.02–0.95, p=0.045). Perhaps the preferred target level for PTX (but not for drug therapy) is the range of 150-600 pg/ml. CONCLUSIONS. Patients with uncontrolled SHPT (PTH>1000 pg/ml) who have undergone PTX have a better survival rate compared to patients receiving etelcalcetide. Achieving the target level of PTH (150-600 pg/ml) 6 months after PTX can be considered as a prognostically favorable factor. In conditions of limited access to etelcalcetide therapy for severe hyperparathyroidism, PTX is the preferred method of correcting HCG.

THE AIM: To evaluate clinical and genotypic features, renal prognosis in orphan tubulopathies with nephrocalcinosis and cys- tine calculi in 22 pediatric patients. PATIENTS AND METHODS: The study included 22 patients (from 1 year 4 months to 17 years 11 months) with orphan tubulopathies with nephrocalcinosis (22) and cystinuria, cystine stones (2). Of the 22 probands, there were 14 (63.6 %) boys and 8 (36.4 %) girls. Clinical, biochemical, imaging, and molecular genetic diagnostic methods were used. The severity of chronic kidney disease was stratified according to the K/DOQI classification (2002). RESULTS: A genetic study of 22 children with nephrocalcinosis revealed primary hyperoxaluria of types I, II, III (AGXT, GRHPR, HOGA1) in 5; familial hypomagnesemia with hypercalciuria and nephrocalcinosis (CLDN16) in 5; hypophosphatemic rickets with hypercal- ciuria and nephrocalcinosis (SLC34A3) in 3; Bartter type I syndrome (SLC12A1) in 1 and Bartter syndrome type IV (BSND) in 1, Dent1 disease (CLCN5) in 1, Dent disease 2 (OCRL) in 1, idiopathic infantile hypercalcemia type I (SLC34A1) in 1 and type II (CYP24A1) in 2. Based on the detection of mutations in the SLC3A1 and SLC7A9 genes, 2 probands were diagnosed with type I and non type I cystinuria. The features of gene mutation variants in 22 children with orphan tubulopathies with nephrocalci- nosis and cystinuria, and cystine nodules were identified. A study of kidney function in 22 children over the age of 2 years with nephrocalcinosis and cystinuria revealed CKD C1 with normal glomerular filtration rate (17), CKD C2, C3, C4 (5). A girl with familial hypomagnesemia with hypercalciuria and nephrocalcinosis due to a mutation of the CLDN16 gene, progression CKD of С1 to C4, underwent kidney transplantation at the age of 18 before starting dialysis. CONCLUSION: Features of the clinical phenotype and variants of mutations of genes of orphan tubulopathies with nephrocalcinosis and cystinuria, cystine stones in 22 children were established. Progression of CKD from C1 with normal glomerular filtration rate to C2, C3, C4 was ascertained from 22 in 5 children (25) % with primary hyperoxaluria type1 (1), hypomagnesemia with calciuria and nephrocalcinosis (3), Dent-2 Disease (1). Identification of gene mutations in molecular genetic studies in children with nephrocalcinosis and cys- tinuria establishes a clinical and genetic diagnosis, the pathogenesis of an orphan tubulopathy, and determines personalized management based on individual genetic characteristics.

BACKGROUND. Obesity is considered a traditional risk factor for cardiovascular disease and chronic kidney disease (CKD). The cardioprotective and nephroprotective effects of soy diet in CKD are known. The effect of a diet containing soy proteins on the cardiovascular system in obese patients has been virtually unstudied. In this regard, the purpose of the work was to test the hypothesis about the cardioprotective effect of the soy diet in Wistar rats fed a diet high in animal fat. MATERIALS AND METODS. Three groups of Wistar rats were studied. The first (control) received laboratory food containing 20 % animal proteins and 15 % (calorie content) fats; the second is a diet with a high (50 % calorie) content of beef fat (HFD) and 20 % casein; third – HFD and 20 % soy protein SUPRO-760. After 2 months, systolic blood pressure (BP), biochemical blood parameters, albumin in urine were determined, insulin resistance, glucose tolerance tests, and histological examination of the myocardium was performed. RESULTS. HFD in combination with casein led to an increase in BP, myocardial mass index (IMM), visceral obesity, increased glucose levels, lipid metabolism disorders, and albuminuria. In rats of this group, an increase in interstitial and perivascular fibrosis, cardiomyocyte thickness, and intramyocardial vessel walls was noted. In rats on high-fat diet with soy protein, insulin resistance, glucose tolerance, lipid spectrum disorders, albuminuria, increased BP, and myocardial remodeling were less pronounced. CONCLUSION. The introduction of soy proteins into a high-fat diet reduces visceral obesity, improves carbohydrate and lipid metabolism, has a hypotensive and cardioprotective effect.

The article is devoted to some fragments of the history of the formation of nephrology in St. Petersburg. The materials on the organization of laboratory diagnostics of kidney diseases in the framework of scientific research at the First Leningrad Medical Institute are presented. The history of the first scientific research institute of nephrology in the USSR is briefly described.

Nephrogenic diabetes insipidus is an orphan disease characterized by the kidneys' inability to concentrate urine due to insensitivity of the distal nephron to antidiuretic hormone. Primary (hereditary) nephrogenic diabetes insipidus is often diagnosed in childhood and is associated with mutations in the AVPR2 and AQP2 genes. Secondary nephrogenic diabetes insipidus, in most cases, is identified in adult patients against the backdrop of diseases that impair renal concentrating function, therapy with agents that suppress AQP2 expression, and metabolic disorders, such as hypokalemia and hyperkalemia. In congenital abnormalities of the urinary system, secondary nephrogenic diabetes insipidus may also develop in early childhood due to impaired urodynamics. The clinical presentation of the disease is characterized by a polyuria-polydipsia syndrome, which significantly depends on the degree of dehydration and the timely compensation of renal fluid losses through adequate water intake. In severe cases, serious complications may arise, including hypernatremic dehydration and delays in physical and psychomotor development in young children. Given the diversity of potential clinical manifestations, the diagnosis of nephrogenic diabetes insipidus poses a challenging task in medical practice. This article describes two clinical cases of patients with genetically determined and secondary nephrogenic diabetes insipidus. Both men exhibit clinically similar symptoms from birth. However, given the differing etiology of the conditions, the treatment approaches vary. Timely detection of the condition and an appropriate therapeutic strategy can significantly enhance the quality of life for patients and prevent serious complications.

Local amyloidosis of the bladder is a rare disease characterized by the colonization of the bladder wall by an abnormal clone of plasma cells that produce amyloidogenic immunoglobulin light chains. According to modern classification, this condition is classified as AL amyloidosis (A for amyloidosis, L for light chains of immunoglobulins). In cases of local amyloidosis, the amyloidogenic light chains of immunoglobulins are not present in the bloodstream, as the clone functions locally in the tissue and the synthesized immunoglobulins are retained by the interstitial tissue. As a result, plasma cells encased in amyloid are not accessible to chemotherapy. Due to this limitation, chemotherapy is not a viable treatment option for local amyloidosis. Radiation therapy is also not recommended as it could cause significant damage to the regenerative capacity of the bladder wall, leading to a reduction in mechanical strength and functionality. Therefore, the primary treatment method for local amyloidosis of the bladder is transurethral resection. In cases of recurrent forms, patients may be offered open or laparoscopic resection of the bladder wall or cystectomy. This case study presents a clinical observation of a patient with local amyloidosis of the bladder, highlighting the challenges in diagnosis and discussing potential approaches to surgical treatment.