Tobacco smoking is the  main  modifiable risk factor for cardiovascular and  respiratory diseases, cancer, premature disability and  mortality. The article summarizes information about acute and  chronic effects of tobacco smoking on the  state of the kidneys in healthy people, as well as on the development and  progression of chronic kidney  disease. Various mechanisms of influence not only of nicotine, but also fine-dispersed components of tobacco smoke are considered. It discusses the development of nicotine dependence when using the main types of tobacco products, such as cigarettes, hookah tobacco, electronic cigarettes.

Introduction: Twenty years ago, the metabolism of vitamin K was connected with its role in hemostasis. Since that time has been shown that vitamin K exerts multiple  functions mediated by the Gla-proteins, having  as a cofactor vitamin K. Numerous publications affirm that these Gla-proteins are related to physiological processes beyond coagulations such as bone metabolism, vascular health and  energy homeostasis. THE AIM: The aim of this research is to provide new data for vitamin K role in a myriad  of physiological processes  beyond blood clotting. Additionally,  it aims  to assess the  potential new  applications of vitamin K as a supplement for prevention bone and vascular disease.

Materials And Methods: Using the online databases Scopus, PubMed and  Google Scholar a search with the  keywords: «vitamin K2», «bone metabolism», «cardiovascular diseases», «osteocalcin» and  «MGP» was conducted. Information regarding the effects of vitamin K on bone and  vascular health was referred to in this work.

Results:  Vitamin K and vitamin K-dependent-proteins play pivotal roles in the physiology of bone mineralization and  in preventing ectopic calcification. Osteocalcin, a Gla protein located in bone and  dentin, is important for bone mineralization. Following the posttranslational carboxylation of Glu-residues with a cofactor vitamin K2 (menaquinone), rather than  vitamin K1 (phylloquinone), osteocalcin shows increased affinity for calcium. osteocalcin is believed to be involved in osteoblast regulation and hydroxyapatite crystal growth. Matrix GLa-protein (MGP), sharing some sequences with osteocalcin, is a local inhibitor of arterial calcification. Vitamin K deficiency impairs the function of osteocalcin and MGP and, therefore, presumably contributes to bone demineralization and  vascular calcification, the  so-called calcium paradox.

Conclusions: Vitamin K deficiencies, traditionally regarded as a cause for internal hemorrhages and  blood clotting disorders, apparently can  be linked to cardiovascular calcification and  abnormal bone modelling. Appropriate treatment of vitamin K deficiency may improve bone and  arterial health.

In the  majority  of hemodialysis patients there are mineral and  bone disorders, of which  the  most common is secondary hyperparathyroidism. A number of new products such as paricalcitol, cinacalcet and  some phosphate-binding drugs have  been developed and introduced in clinical practice in the past decade in order to correct this life-threatening complication of chronic kidney  disease. A number of pharmacoeconomic studies have  been carried out  to determine the  cost-effectiveness of appointing certain drugs due  to increasing of the  public  expenditure in this therapy in many  countries, including Russia. In this review, we consider a brief analysis of the methods for evaluating the profitability of medicines and the results of recent studies devoted to the evaluation of the cost-effectiveness of CKD-MBD treatment.

Hematopoietic cell transplantation (HCT) is becoming an  increasing common treatment modality for a variety  of diseases. Kidneys  are recognized as a target organ of acute and  chronic graft-versus host disease (GvHD).Glomerulopathy significantly limits patient life-time. Acute kidney injury occurs on average in 100 days after  HCT in 15 – 73% of patients due  to treatmentrelated toxity and radiation. Chronic GvHD is associated with chronic kidney disease. The majority of CKD after  transplantation is idiopathic syndrome, thrombotic microangiopathy and  nephrоtic syndrome.

The prevalence of end stage renal failure in the world tends to increase, creating a significant additional burden on the healthcare system. This is particularly relevant for countries with average and  low gross national income relative  to population. The article considers the basic directions and  costs of nephroprotective therapy. The main components are to intensify antihypertensive treatment, dual  blockade of the  renin-angiotensin system, control of hyperlipidemia with statins, correction of anemia and deficiency of vitamin  D, nutrition support, smoking cessation,  restriction of salt  consumption and  modification of lifestyle. According to the register of Saint Petersburg, the most common causes of end stage renal failure are chronic glomerulonephritis (20%), diabetes (16.7 %), hypertension (11.8 %). In 19,7% cases diagnosis is not established. Renal  protection therapy helps to increase the duration of the predialysis period to 1.5-2.0 years. By considering minimum performance criteria: a decrease in systolic blood pressure by 5 mmHg  and  proteinuria of 0.3 g/day. Per 1 patient costs nephroprotection make 63100 rubles per year, while on dialysis  treatment 933005 rubles per year.

The aim: to investigate the  glomerular filtration  rate compared with the  plasma level of bitter  taste receptors TAS2R38  in asthma.

Patients and methods.  23 practically healthy persons and  52 patients with bronchial asthma were examined. The blood plasma TAS2R38 level was determined by an enzyme immunoassay. Glomerular filtration rate (eGFR) by CKD-EPI was estimated.

Results. There were significant differences in TAS2R38 receptor levels  between men  and  women with allergic asthma, and  in women these levels are the lowest. There was a significant decrease in eGFR in the non-allergic variant  of asthma compared with the  allergic variant  of the  disease, and  only in women this decrease reaches a statistically significant value.  When conducting a factor analysis, it was revealed that the level of bitter  taste receptors TAS2R38 is associated with an estimated glomerular filtration rate with a high negative factor load.

The conclusion. A hypothesis is advanced on the possible regulatory (protective) function of plasma (soluble) TAS2R38 receptors in relation to the corresponding membrane receptors expressed on the cells of the kidney structures (glomeruli and tubules) in bronchial asthma in women.

The aim: to determine the  clinical and  diagnostic value  of cystatin C, to evaluate estimated glomerular filtration  rate  (GFR) using creatinine and  cystatin C concentration, to compare its results in patients with gout  depending on the presence of arterial hypertension (AH).

Patients and methods.  The study included 105 patients with gout. All patients underwent 24 hour ambulatory blood pressure monitoring (ABPM) using apparatus «BPLab» (Russia). Cystatin C was  measured by enzyme immunoassay method. The glomerular filtration  rate was  calculated by CKD-EPI formulas based on creatinine, cystatin C, and creatinine with cystatin C concentrations.

Results. According to the obtained ABPM data, the main study group consisted of 75 men (71.4%) with AH, the comparison group included 30 (28.6%) patients showing no increase of blood pressure (BP). The concentration of cystatin C in patients with concomitant hypertension was  1.5  times higher than  that  in patients with normal blood pressure (p <0.05) and  2.1  times higher that  in healthy men  (p <0.001). In patients having  gout  with concomitant AH, the  value  of GFR calculated by the  CKD-EPIcys  and  CKD-EPIcr-cys formulas was  equally  decreased. Patients having  gout with normal blood pressure showed a significant decrease in GFR by the CKD-EPIcys method. The inverse correlation of GFR, calculated by the  CKD-EPIcys  formula with the  serum uric acid  level (r = -0.50, p <0.001), the  content of CRP (r = -0.45, p <0.001), the average daily DBP (r = -0.43, p <0.001) and  serum level of cystatin C (r = -0.51, p <0.001) was noted.

Conclusion. In patients with gout there is a significant increase in cystatin C level, which is more expressed with AH. The calculation of GFR based on cystatin C level concentrations reflects more severe stages of kidney injury. Thus cystatin C can  be considered a new early marker of preclinical kidney injury in patients with gout.

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.  Chronic HF was induced by ligation the left coronary artery. Animals with HF 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 HF (n = 10) the drug is not administered. Concentrations and daily urinary excretion of glucose, protein and albumin were measured. The relative level of microRNA-21 urinary expression was established. Morphological examination of kidney tissue was performed using light microscopy.

Results. The administration of empagliflozin to experimental animals resulted in regularly higher values of diuresis, glucose concentration in urine and its daily excretion. There were no significant differences in levels of albuminuria and proteinuria or miRNA-21 expression in urine in groups with and without empagliflozin. The animals receiving the drug  showed a slightly less pronounced damage to the cells of the tubular epithelium compared to rats with only heart failure.

Conclusion. The data obtained, at least confirm the renal safety of long-term empagliflozin administration even under conditions of high risk.

Orozin (alpha-1 acid  glycoprotein) pharmacological activity was  studied on the  experimental model of Kidney Ischemia-Reperfusion  (K I/R). Actovegin was used as reference product.

The aim: to evaluate Orozin effects in kidney  ischemia-reperfusion (K I/R) experimental model.

Matherial and methods: Male Wistar rats  were carried out right-handed nephrectomy followed  by mechanical clamping of the vascular bundle of the left kidney during 45 minutes and subsequent reperfusion. Drugs administrated intravemous in two steps: 10 minutes before stop mechanical clamping of the  left kidney  vascular bundle and  30 minutes after reperfusion. Blood chemistry value (creatinine and  urea levels) were used as effectiveness criteria. After 2 and  24 hours of reperfusion  the  tissues of kidney  were collected for histological assays.

Results:  Study of experimental model of acute renal  faiure showed cytoprotective effect of Orozin confirmed by biochemical and histological analysis.

The aim: to evaluate diagnostic and prognostic value of determination the concentration of homocysteine in children with congenital malformations (CM) of the urinary system (US) dependent of kidneys functional state.

Patients and methods. The study included 119 patients with US CM aged 3 to 18 years. A control group of 10 clinically healthy children. Patients divided into 3 groups: group I – 55 children with congenital vesicoureteral reflux (VUR), group II – 34 children with hydronephrosis and ureterohydronephrosis of congenital origin,  group III – 30 children with other forms of US dysembryogenesis. Concentration of homocysteine in blood serum was  assessed by ELISA.

Results. Hyperhomocysteinemia diagnosed  in 60,9% of cases. Statistically significant differences with control group were revealed in the obstructive types where more often arterial hypertension (AH) and  reduced glomerular filtration rate (GFR) were diagnosed. Significantly higher concentration of homocysteine are registered in patients with hypertension and  reduced GFR.

Conclusion. The importance of estimating concentration of homocysteine in chronic kidney disease in patients with US CM was demonstrated.

Cyclophosphamide is an alkylating  agent widely used for the  treatment of malignant neoplasia and  which can  be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead  to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized  in three phases: pre-chemotherapy, administration of cyclophosphamide, and  post-chemotherapy, taking  into account the  drugs to be  administered before and  after  cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and  sodium, including cyclophosphamide dose adjustment in the  case of kidney disease. Cyclophosphamide is responsible for other rare – but serious – side  effects, for instance, hepatotoxicity, severe hyponatremia and  heart failure. Other  adverse reactions include hair loss, amenorrhea and  menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the  vehicle  used has  been described, as well as stability  and  infusion  times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and  relapse episodes, factors that may burden the health care system.