The sarcopenia is an important cause of reduced physical performance in patients receiving renal replacement therapy. Discusses diagnostic criteria, mechanisms of development and methods of correction.

Cardio-vascular diseases are the main cause of death in patietns with chronic kidney disease. Prognostic predictor of these complications if ectopic/vascular calcification. Calcification of soft tissues and vessels in uremia is the result of mineral and bone disorders; therapy for its correction; transdifferentiation of vascular smooth muscle cells. This article presents the literature review which summarizes data of mechanisms and pathogenesis of ectopic calcification in chronic kidney disease.

The problem of the risk of developing chronic kidney disease (CKD) in patients with bronchial asthma (BA) is considered. Research is just beginning, but in a number of papers the link of asthma, particularly, persistent form of the disease, with increased risk of developing CKD is established. Moreover the risk has been shown to be independent of age, gender, presence of obesity, diabetes, hypertension, smoking and other risk factors. Furthermore indirect evidence of risk of developing CKD in patients with asthma when assessing the likely impact of CKD on the formation of pathogenic factors inherent in BA, as well as studies on the expression of biomarkers of acute and chronic renal injury in BA is obtained. It has been shown that the estimated glomerular filtration rate (eGFR) in nonallergic asthma and aspirin induced asthma is significantly lower than in allergic asthma. BA patients receiving systemic (oral) therapy with corticosteroids have also reduced eGFR, but the differences did not reach statistical significance. The papers on the possible impact of key pathogenetic pro- and antiinflammatory cytokines, as well as key adipokines on the glomerular filtration rate in BA are analyzed. We consider the possible impact of programmed cell death, particularly of lymphocytes, on the formation of CKD in BA. The analysis of several papers that have been published to date, suggests a non-random nature of the relationship of BA and CKD that based on common pathogenesis including the cellular and molecular mechanisms of general biological processes such as inflammation, oxidative stress, apoptosis, fibrosis.

The review describes the pathophysiological factors that contribute to the development of uric acid nephrolithiasis. Different approaches to its modeling are presented. Noted the most favorable methods from the standpoint of modern concepts of the disease pathogenesis.

THE AIM. To assess quality of life (QOL) of hemodialysis (HD) pts using the Kidney Disease Quality of Life Short Form (KDQOLSFTM) questionnaire. PATIENTS AND METHODS. The KDQOL-SF questionnaire was administered to one hundred and ninety two HD pts. RESULTS. It was shown that HD pts experienced low satisfaction with the employment – 0,0 [0,0–50,0] (Me[IQR]) on the scale of «work status». A low score on the scale of “burden of kidney disease” was registered – 31,3 [18,8–50,0]. The highest scores were obtained on the scales of «cognitive functioning» 86,9 [66,7–93,3], «quality of social interaction» – 80,0 [66,7–93,3], «social functioning» – 62,5 [50,0–87,5], mental health – 60,8±18,1 (M±SD). Among the most significant stress factors – limited ability to travel and fluid restriction (74% and 66% of pts, respectively). The most bothersome problems were muscle soreness (50% больных), fatigue (45%), dizziness (44%), itchy skin (41%), shortness of breath (40%), dry skin (34%). CONCLUSION. The KDQOL-SF questionnaire which takes about 20 minutes to complete provides important information about the limited opportunities and major concerns of dialysis patients.

The remote consequences of a multiple-factor stress (including small doses of radiation) in liquidators of the Chernobyl disaster are studied. It was observed 41 liquidators aged from 50 up to 70 years. The control group was made by 30 patients (men) who were never affected by ionizing radiation. It is shown that in «liquidators» the functional condition of kidneys is significantly lower, and stages of a chronic kidney disease are higher than in control groups. «Liquidators» in age group of 50-59 years have similar lines of a lipid profile as patients of 60-74 years which never affected by ionizing radiation. That demonstrates early development of an aterogenezis and, as a result, the accelerated aging of an organism. Liquidators of consequences of the Chernobyl accident are at risk group of early formation of a chronic kidney disease, and participation in recovery from the accident on the Chernobyl Atomic plant is nonmodified risk factor of development of a chronic kidney disease.

THE AIM: to study clinical and laboratory manifestations of hypercalciuria in children of Barnaul, living in the zone of sharply continental climate of the South of Western Siberia. PATIENTS AND METHODS. The study included 239 children aged from 1 month to 16 years (mean age of 6.6±2,72 years) with idiopathic hypercalciuria (IH), diagnosed according to the level of calcium/creatininemia coefficient (CCC), more than 0.6 mmol/mmol and normal plasma calcium and parathyroid hormone. Conducted physical examination and biochemical blood and urine determination of calcium, phosphorus, creatinine, urea and uric acid, ultrasound of the kidneys and bladder, radiopaque research methods indicated. RESULTS. Family history of urolithiasis have been reported in 56.1% children with hypercalciuria. Analysis of comorbidity showed a combination of IH with urolithiasis in 15.1% patients with urinary system infections(USI) – in 38.5%, with anomalies of the urinary system – 27,2% children with neurogenic disorders of urination – at 9.2 percent. The clinical picture of the disease prevailed dysuric disorders (48,5%) and moderately pronounced edema syndrome (45,6%). In the urinary sediment of children with hypercalciuria, the most frequently recorded crystalluria (31,8%), microhematuria (19,2%) and leukocyturia (13.8%). CONCLUSION. Idiopathic hypercalciuria in children is often combined with such pathological conditions as USI, neurogenic disorders of urination, abnormalities of the urinary system and it is the cause of the development of the urolithiasis already in childhood.

This article presents the modern data of the new markers for diagnostics and monitoring the activity of lupus nephritis at Henoch-Schoenlein purpura and ANCA vasculitis in children, which can be used in practice of nephrologists to optimize the treatment and determine its duration.

Thromboembolic complications in patients on hemodialysis have a significant impact on the duration and quality of life of patients. THE AIM: to study the functional status of platelets at the CKD 5d. PATIENTS AND METHODS. We examined 61 patients with CKD 5d. The duration of renal replacement therapy 133 [74-177] months. The functional activity of platelets was evaluated in the samples with adenosine diphosphate and adrenaline. RESULTS. The average value of platelet aggregation in the sample with adenosine diphosphate was 59.5 [of 32.5 and 87.5]%. The functional activity of platelets was decreased in 35 of patients and not changed in 26 patients. The average value of platelet aggregation in the sample with epinephrine accounted for 68.5 [57,5-73,5]%. The functional activity of platelets was reduced in 38, normal in 8 and increased in 15 patients. CONCLUSION. Test with adrenaline is preferred in the study of the functional activity of platelets in CKD 5d.

AIM: to determine the significance of [-2]proPSA and prostate health index for the diagnostics of prostate diseases in patients with PSA level in blood plasma less than 4 ng/ml. PATIENTS AND METHODS: 148 men were examined in the urology clinic of Pavlov First Saint Petersburg State Medical University for the exclusion of prostate cancer (PCa). The inclusion criteria were: the level of total PSA in blood plasma less than 4 ng/ml, the presence of changes in the prostate during digital rectal examination, the detection of hypoechoic sites according to transabdominal ultrasound examination of the prostate or a decrease in the ratio of free and total PSA in blood plasma less than 15%. For all the patients the level of [-2]proPSA was assessed, its percentage to total PSA and the prostate health index were calculated. Based on the results of the biopsy, all patients were divided into 3 groups. Patients with histopathomorphologically verified benign prostatic hyperplasia (BPH) were included in the first group (83 patients), in the second group (14 patients) - with prostatic intraepithelial neoplasia (PIN), in the third (51 patients) - patients who had focal atypia and/or adenocarcinoma of the prostate. Clinical and laboratory parameters were compared between the abovementioned groups. RESULTS: Prostate health index was found to be the most significant factor of difference comparing patients with BPH and PCa, as well as in the presence of PIN and PCa (p<0.001 for both), while a statistically significant difference in this indicator was not obtained comparing BPH and PIN patients. CONCLUSION: Prostate health index showed the greatest prognostic value in the diagnostics of prostate diseases in patients with PSA level in blood plasma less than 4 ng/ml.

THE AIM: to determine the optimal time and temperature conditions for storage and transportation of urine samples for lipocalin 2 (uNGAL) level measuring. PATIENTS AND METHODS. Levels of uNGAL analyzed by chemiluminescent microparticle immunoassay (Abbott Laboratories, USA) in first morning void urine of 20 patients hospitalized in the Pavlov First Saint Petersburg State Medical University. Urine was transported to the laboratory in ice (+4 °C) within 15 minutes after collection and stored according to different protocols at the temperature -22 °C, +4 °C and +22 °C from four hours to seven days. RESULTS. Concentration of uNGAL is stable for four hours at room temperature (+22 °C), for two days at +4 °C, and at least one week at -22 °C. UNGAL concentration changes significantly when stored for two days at room temperature and for seven days at +4 °C. CONCLUSION. The stability of urinary NGAL concentration allows long distance transport of biological samples to specialized laboratories whereby the study may become available to a wide range of medical institutions.

Almost all chronic kidney disease in varying degrees, are associated with disorders of the internal environment, mainly autoimmune nature. Drug therapy is not always effective and can lead to additional disorders. Pathogenetically justified is the use of plasmapheresis.

Presented the case of a combination of acute ischemic injury of the liver and kidneys in patients of senile age with multimorbidity pathology.