on behalf of the World Kidney Day Steering Committee. 

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.

The article discusses the problem of choosing an adequate method of assessing glomerular filtration rate in overweight and obesity.

The review summarized data on the diagnostic and prognostic value of biomarkers of kidney injury NGAL (neutrophil gelatinaseassociated lipocalin), KIM-1 (kidney injury molecule-1) and L-FABP (liver type fatty acid-binding protein) in patients with CKD. The most studied of these is NGAL, increase of its level in urine reflects the severity of CKD. Elevated levels of urinary NGAL evaluated also as a prognostic criterion which allows identifying patients with high risk of unfavorable course of disease. Elevated levels of urinary KIM-1 inpatients with CHF can detect individuals with tubulointerstitial kidney injury, having an adverse prognostic value, and to assess their risk of death or rehospitalization about CHF. Data obtained in large populations of patients with diabetes type 1 and 2 with CKD show that high levels of urinary L-FABP is associated with an increased risk of diabetic nephropathy progression. High levels of this biomarker in urine of patients with diabetes type 2 and stage1-2 CKD is also unfavorable prognostic marker of increased risk of coronary heart disease and other cardiovascular complications. In general, diagnostic and prognostic value of urine KIM-1 and L-FABP in CKD patients with varying severity poorly understood and needs further clinical studies. 

THE AIM: to assess excretion value of podocytes injury biomarkers in urine and to clarify their significance for early diabetic nephropathy (DN) diagnostics in diabetes mellitus (DM) patients with different severity of albuminuria (AU)/proteinuria(PU). PATIENTS AND METHODS. 74 DM pts were studied, including 30 with type1 DM (T1DM) and 44 pts with type2 DM (T2DM). They were divided into three groups: 41 pts with AU <30 mg/gCr (A1), 13 pts with AU 30-300 mg/gCr (A2), 20 pts with PU (A3). CKD S1 was revealed in 41pts, CKD S2 – in 25 pts, CKD S3 – in 8 pts. Arterial hypertension was observed in 52 pts of 74(70%), mainly in T2DM. 10 healthy subjects were studied as control. Urinary levels of nephrin and podocin (an important slit diaphragm proteins) were measured by ELISA. RESULTS. Nephrinuria (NU) >5,84ng/ml/g, which not detecting in controls, was revealed in 63% of A1 pts, in 77% – in A2, in 80% – in A3. Podocinuria (PdU)>1,73ng/ml/g was revealed in 78% of A1 pts, in 54% of A2 and in 83% – A3. NU in pts with PU was significantly higher than in AU<30 mg/g. PDU in groups with different AU/PU was equally high and has no differ between DM types. Direct correlation was obtained between NU and AU (R=0,947 p<0,05). NU and PdU in T1DM correlated directly with serum creatinine (R=0,489 p<0,05 and R=0,468 p<0,05) and indirectly with GFR (R=-0,461 p<0,05 and R=-0,36 р<0,05). In DM duration less than 5 years NU directly correlated with НbА1с level, in T2DM – indirectly with systolic blood pressure. CONCLUSON. Nephrin and podocin levels can be useful for early diagnostics and monitoring of DN. 

THE AIM: to investigate presence of renal dysfunction in patients with sarcoidosis with overweight. PATIENTS AND METHODS: 46 patients with sarcoidosis (without signs of primary kidney and severe cardiovascular pathology) were divided into 4 groups: 1st – with obesity and active sarcoidosis, 2nd – without obesity with active sarcoidosis, 3rd – with obesity without active sarcoidosis, 4th –without obesity and active sarcoidosis. RESULTS: Negative impacts of obesity and sarcoidosis activity on GFR were found. The lowest GFR was observed in 1st group (71±10 ml/min), significantly higher – in 2nd and 3rd groups (83±8 and 82±8 ml/min) and the highest – in 4th group (110±13 ml/min). CONCLUSION: Obesity in sarcoidosis is associated with renal dysfunction.

THE AIM. Determining the effect of obesity on renal function in children. PATIENTS AND METHODS. The study included 35 adolescents (30 boys and 5 girls, mean age 14.6±2.2 years) with overweight and differing degrees of obesity. In addition to clinical examination determined the presence and severity of risk factors for kidney disease in obesity, especially insulin resistance, lipid metabolism with the definition of atherogenic index (AI). To assess kidney function determined microalbuminuria (MAU) and glomerular filtration rate. RESULTS. Renal function in adolescents with obesity which manifests with increasing the excretion of albumin and decreasing the glomerular filtration rate (GFR) caused by lipid metabolism disorders: increase of lowdensity lipoprotein (LDL) level and decrease of high-density lipoprotein (HDL) level, which reflected on the atherogenic atherogenic index. The correlation between the level of MAU and GFR and atherogenic index (r= 0,42;p<0,05; r = -0,37;p<0.05) was shown, whereas between blood pressure and MAU, as well as between the degree of IR and impaired renal function in adolescents with obesity was absent. We have not found a relationship between blood pressure and MAU, as well as between the degree of IR and renal disorder in adolescents with obesity. Severity of IR depends on the level of HDL (r= -0,52; p<0,05). Disorder of BP biorhythm as insufficient diastolic night fall significantly affected on the renal function in the form of MAU (r = -0,37; p <0,05). It was found that the degree of overweight is not in direct correlation with the degree of lipid metabolism disorder (r = 0,2; p> 0,05). CONCLUSION. In adolescents with overweight and obesity renal function is inversely proportional correlated with severity of lipid metabolism disorder, intensity of which is not dependent on the degree of overweight.

THE AIM: to study potential associations of obesity with progression of idiopathic steroid-resistant nephrotic syndrome (SRNS) in children. PATIENTS AND METHODS. We performed a retrospective one-center 15-years follow up study of SRNS course in 65 children divided into 2 groups: 1) with obesity (n=48); 2) with normal weight or overweight (n=17). RESULTS. In patients with SRNS and obesity we found no associations with clinical predictors of unfavorable outcome – arterial hypertension and proteinuria and also with glomerular filtration rate at recent hospitalization. Renal survival was comparable between SRNS patients with obesity and normal weight or overweight. CONCLUSION. Obesity does not have any impact on course and prognosis of SRNS in children and can not be considered as risk factor for the disease progression.

THE AIM: to identify the frequency and risk factors of cardiovascular lesions in children with ADPKD. PATIENTS AND METHODS: 54 children (27M/27F) with ADPKD were examined. The median age was 12 (IQR: 8.0;15.0) years. Standard two-dimensional echocardiogram was performed. LV mass (LVM) was calculated, normalized to height2.7 and estimated by centile tables. Relative wall thickness (RWT) was calculated. Patterns of abnormal LV geometry were defined as follows: LV concentric remodelling by normal LVMI and RWT ≥0.42; eccentric LV hypertrophy (LVH) by increased LVMI and RWT <0.42; concentric LVH by increased LVMI and RWT ≥0.42. We checked blood pressure with ABPM. Patients were divided into 3 groups according to three levels of BP: hypertension (HBP; greater than the 95th percentile for sex, age, and height), high normal blood pressure (HNBP; 90–95th percentile), and normotension (NBP; less than the 90th percentile). Total kidney volume (cm3) was assessed by ultrasound, corrected for standard body surface and estimated by centile tables. Renal scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA) with the calculation of the integral index of capture (IIC) was performed. RESULTS: Hypertension was found in 42,5 % of cases, HNBP was in 18,5% of cases. HBP were detected more frequently in children with increased renal volume (cm3/1,73m2) more than 97‰+≥50% compared with children with renal volume less than 97‰: (p=0.03), RR=2.9 (95% CI:1.4-4.9). Changes in the structure and geometry of the LV were identified in 14.8% of cases (concentric LVH – 7,4%; eccentric LVH -3,7%; LV concentric remodeling -3,7%). Children with LVMI >90 percentile were more frequently detected systolic hypertension in the daytime, diastolic hypertension at night compared with children with LVMI <90 percentile: 54% vs. 18% (p=0.04), RR=1.81 (95% CI:0.93-3.5) and 55% vs. 16% (p=0.008), RR=2.2 (95% CI:0.98-4.6). LVMI in children with systolic and diastolic hypertension was significantly higher than in children with isolated diastolic hypertension: 34.15 (30.7; 39) vs. 22.77 (22.04; 23.5) (p = 0.03). Increased renal volume (cm3/1,73m2) more than 97‰ and decreased IIC by DMSA were detected more frequently in children with LVMI>90 percentile compared with children with LVMI <90 percentile: (p=0.04), RR=1.7 (95% CI:1.1-2.6) and (р=0.04), RR=1.8 (95% CI:1.1-3.07). CONCLUSION: Risk factor for hypertension in children with ADPKD is increased renal volume. Risk factors for the development of left ventricular hypertrophy are systolic hypertension in the daytime, diastolic hypertension at night, increased kidney volume, and decreased IIC by DMSA. 

THE AIM: to evaluate diagnostic significance of clinical and laboratory resistance in determining urine cytokines in patients with chronic pyelonephritis (CP). PATIENTS AND METHODS. This prospective study included 110 children with CP aged 6 to 16 years in a state of clinical and laboratory remission. The control group consisted of 20 apparently healthy children. Laboratory tests used to determine EGF, TGF-β1, IGF-1, β2 – MG, IL-4, IL-10, IL-17 and IL-12 by ELISA in the morning urine of patients. RESULTS. Comparison of cytokines values depending on the clinical form of the disease revealed the prevalence of levels of TGF-β1 and IL-17 in the urine of patients with obstructive CP. The highest uTGF-β1 / uCr and uIL-17 / uCr were obtained in patients, which have vesicoureteral reflux in anamnesis. Level uIL-10 / uCr almost 2 times was elevated in children with both clinical forms of CP. In patients with the disease experience up to 6 years, were identified unidirectional changes of urine cytokines – increase in both pro- and anti-inflammatory parameters. As the duration of the microbial-inflammatory processes more than 6 years there was a significant decrease in the levels uIGF-1 / uCr and uEGF-1 / uCr relative to the control group, with no significant changes in the uIL-12 / uCr and uIL-10 / uCr at continuing higher levels uTGF-β1 / uCr, uIL-17 / uCr, uIL-4 / uCr. In patients having one or less exacerbation of CP per year, regardless of the duration of the disease, no pathological changes in cytokine levels have been detected. Most of the studied parameters were dependent on renal function. CONCLUSION. Increased concentration of studied urine cytokines indicates the presence of a latent inflammatory process more than in half of studied patients. 

THE AIM. To evaluate the effect of the sodium-glucose cotransporter SGLT-2 inhibitor - empagliflozin on the kidney in nondiabetic Wistar rats with experimental heart failure (HF). MATERIAL AND METHODS. Cronic heart failure (CHF) was induced by ligation the left coronary artery. Animals with CHF in the first group (n=11) received empagliflozin (Jardiance®, Boehringer Ingelheim) orally (1 mg / kg/day) for 1 month. In the second group of rats with CHF (n = 10) the drug is not administered. Systolic blood pressure, heart rate, concentrations and daily urinary excretion of glucose, albumin, creatinine, urea and essential ions were measured. The relative level of microRNA-21 urinary expression was established. RESULTS. Empagliflozin administration led to an increase in glycosuria, albuminuria, and the expression of microRNA-21 in urine. However in this conditions inorganic phosphorus excretion decreased. Empagliflozin did not influence on blood pressure, heart rate or levels of investigated substances excretion including sodium. CONCLUSION. The findings suggest that the SGLT-2 inhibitors may have some negative direct effects on the kidneys. However, in diabetes, such effects of these drugs can be masked by powerful nephroprotective actions associated with the ability of SGLT-2 inhibitors to counteract hyperglycemia and glomerular hyperfiltration.

THE AIM. Histochrome is a native antioxidant drug isolated from natural sourse. The study of pharmacological activity of histochrome showed a wide spectrum of dose-range action. The aim of this study was to investigate the renal effects changes when administered various doses of histochrome in rats. MATERIALS AND METHODS. The study was conducted on outbred stock Wistar rats. The test group of animals (n = 15) was administered subcutaneously histochrome at a dose of 1 mg/kg for 10 days, and the control group (n = 20) was treatment of 10 mg/kg of the drug. Since 3-d day every two days of experiment were measured daily urine output, excretion of Na+ and K+, creatinine excretion, and excretion of histochrome. RESULTS. The tendency of daily urination increase recorded at histochrome administration at a dose of 1 mg/kg. In the comparison group increased diuresis led to a fivefold magnification of parameter on the 7th day. Dynamic renal creatinine excretion during treatment with 1 mg / kg histochrome had a stable character throughout the experiment, while the ten-fold increase in dose was associated with a significant elevation of the factor. Natriuresis steadily increased, exceeding the initial value 5 times in under-test group of animals. In the comparison group the ion excretion increased by 2 times. Potassium excretion have similar dynamics using both histochrome doses. The native form histochrome was not detected in the urine in any of the animal groups. CONCLUSION. The experimental results showed that the behavior of the excretory renal function is histochrome dosedependent and may be due to its metabolites.

Described two clinical observations of atypical hemolytic-uremic syndrome (AHUS) in patients in the second and third trimesters of pregnancy. Presented cases characterize severe course of AHUS that despite timely diagnostics, early initiation of therapy had an adverse clinical outcome. For the first time in Russian literature described the morphological changes of renal tissue by results of histological studies of autopsy material obtained from patients with AHUS.