The questions of pediatric nephrology are discussed. The modern views on the achievements and challenges of pediatric nephrology are reviewed.

Hypocomplementemic urticarial vasculitis (HUV) is a variant of immunocomplex autoimmune disease with predominating damage of a small vessels. Currently available data and hypotheses concerning pathogenesis as well as and clinical approaches to the
diagnostics of this, frequently underrecognized disease, are disscussed in the review.

Acute poisoning by exotoxins are characterized by high mortality. Moreover, approximately 20% of cases of acute kidney injury (AKI) is a consequence of chemical exposures. Structural changes in renal tissue of the dead of poisoning by various toxins are often nonspecific. On the other hand the morphological picture exotoxic kidney depends on the properties of specific toxins and their metabolites. In this review special attention is paid to signs of damage of the kidney tissue, specific to each group of the most common nephrotoxins.

Feeding problems, anorexia and upper gastrointestinal lesions are common patients with chronic kidney disease (CKD). However, the gastroenterological and nutritional aspects of CKD have received little attention, therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CKD on regular hemodialysis. Patients with CKD have significant upper gastrointestinal tract abnormalities which mainly occur due to changes in metabolism of gastrointestinal hormones.

THE AIM of the investigation was to determine the role of dysfunction of endothelium in mechanisms of carotid artery (CA) calcification in patients with endstage renal disease undergoing chronic haemodialysis (HD). PATIENTS AND METHODS. 94 HD patients (men/women, 52/42; age 46,4±11,2 years) were included in the study (HD duration, 28,9±32,4 months) with implementation of ultrasound scanning of CA. Research of morphofunctional state of extracranial vessels was carried out using standard approaches. Echogenicity of carotid plaques (14) was estimated according to GrayWeale classification. Depending on ultrasound morphology of carotid plaques, three groups of patients were formed: 1st group – without plaques – (n=31), 2nd – hypoechogenic plaques – (n=21), 3rd – hyperechogenic plaques – (n=42). Vasomotor function of the brachial artery (BA) was distinguished in the test with reactive hyperemia (endotheliumdependent vasodilation (EDVD), and sensitivity of BA to shear stress (K) was also estimated accordingly. Plasma content of nitrite (NO2 –) and nitrateanions (NO3–), and amount of circulating endothelial cells (СECs) were measured. RESULTS. In the groups of patients with the presence of echogenic carotid plaques content of NO2 – was below both in relation to a group without plaques (р=0,003) and with hypoechogenic plaques (р=0,008), and content of NO3
– in the mentioned groups was not significantly different. HDpatients with calcified plaques in CA compared to patients with soft plaques showed lower indexes of EDVD (р=0,001), shear stress (К, р=0,017), higher amount of CECs (p=0,007), and vasoconstriction (EDVD<0) and undilatation (EDVD=0) reactions (p=0,032) appeared more often. CONCLUSION. Calcification of CA in patients on chronic HD was combined with damage of endothelium, disturbance of vasoreativity and deficit of nitric oxide (NO). Defect of NO system can be the factor in the formation of carotid plaques calcification.

THE AIM. To assess the safety and tolerability of management with dualcomponent ((lisinopril, and valsartan) and «triplecomponent» (lisinopril, valsartan, and spironolactone) pharmacological blockade of the reninangiotensinaldosterone system (RAAS) in patients with end stage renal disease treated with maintenance hemodialysis (MHD). PATIENTS AND METHODS. Patients was into the two groups: Group 1 (36 patients) receiving the «triplecomponent» scheme of RAAS blockade, and Group 2 (35 patients) received the «dualcomponent» therapy (lisinopril, valsartan). The duration of treatment period was 6 months. In both groups serum potassium concentration (SK) has been measured after 3 and 6 months of treatment. RESULTS. There were no clinically significant changes of SK in both groups during the entire period of treatment. Tolerability of both schemes was good. Nobody of patients experienced any side effects during the trial. CONCLUSIONS. Management with combined RAAS blockade (lyzinopril, valsartan, and spironolacton or lyzinopril, and valsartan) in MHD patients doesn’t induce hyperkalemia. It allows to continuing the investigation of cardioprotective efficacy of dual or triple blockade of RAAS in MHD patients.

THE AIM. To assess changes in coronary blood flow and the structural and functional features of heart disease in diabetic patients with different stages of diabetic nephropathy (DN). PATIENTS AND METHODS. It was investigated 142 patients with type 2 diabetes. The diagnosis of diabetic nephropathy was established with the help of quantitative evaluation method of albumin in the first morning urine (three times).Survey methods included transthoracic echocardiography, single photon emission computed tomography (SPECT) at rest and with pharmacological stress ATP, bicycle ergometry, ECG monitoring. RESULTS. It was found that the thickness of the left ventricle in patients with DN, higher than that in patients without DN. The progression of DN was associated with an increase in left ventricular mass (LVMM) and LVMM index, end systolic and end diastolic volume, decreased left ventricular ejection fraction. It was shown a reduction in absolute parameters of transmitral flow in combination with an increase in the index E/A in patients with microalbuminuria and pseudonormalization specified rate in patients with proteinuria. In patients with proteinuria during cycle ergometry were more prevalent ischemic myocardial changes, but according to pharmacological stress SPECT revealed no deterioration in coronary perfusion compared with the rest in either group. CONCLUSION. Microalbuminuric stage of diabetic nephropathy is characterized by myocardial hypertrophy and diastolic left ventricular dysfunction, reduced systolic function at the intellectual and emotional stress. Proteinuric stage of diabetic nephropathy is associated with myocardial hypertrophy and diastolic left ventricular dysfunction, reduced global myocardial
contractility at rest, a significant deterioration in coronary blood flow. Leading role in reducing coronary blood flow with the progression of diabetic nephropathy is microvascular ischemia.

THE AIM: to carry out the bioimpedance analysis of a parenchyma of a kidney in the conditions of acute and chronic renal insufficiency with the subsequent comparison of the received data to a morphological picture of an investigated pathology. MATERIAL AND METHODS. Experiments are perform on 36 rats of both sexes in mass of 180250 g. The impedance analysis of a parenchyma of a kidney carried out in the time of operation for 7 days and later 2 months after modeling of acute renal insufficiency by G. Greven method. RESULTS. Significantly decrease of an impedance of a renal cortex at time of experiment duration was observed. Cortical impedance/medullar impedance ratio decreased in 2 months after modeling of renal insufficiency. CONCLUSION. The bioimpedance analysis of a kidney parenchyma can be one of additional methods of diagnostics of renal insufficiency. However it is necessary to conduct additional researches on search of reliable criteria, applicable in the clinic.

THE AIM. To study the efficiency of use vasoactive drugs in complex treatment of women with overactive bladder (OAB). PATIENTS AND METHODS. 150 women with OAB were treated. In addition to standard anticholinergic therapy, some patients, noted a lack of efficacy of treatment, was additionally appointed corrector of microcirculation. RESULTS. Studies have shown high efficiency of the joint appointment of anticholinergic and vasoactive drugs for the treatment of OAB. Conducted therapy
resulted in a significant reduction in severity of symptoms of OAB. CONCLUSION. Lack of efficacy of Mcholinergic OAB therapy was due to impaired blood flow in the wall of the bladder in such patients. It seems appropriate an inclusion of vasoactive drugs in complex therapy of OAB.

THE AIM. Assess the impact of glucocorticoid and cytostatic therapy on the formation of the reproductive system in girls and reproductive status of women with the nephrotic syndrome with minimal changes (NSMC). PATIENTS AND METHODS. The reproductive health in 30 patients with NSMC in age from 14 to 35 years, who received glucocorticoid (GPC) and cytostatic therapy (CS) were discussed. RESULTS. The evaluation showed that the sequence of development of secondary sexual characteristics is not impaired in 30 patients. A total score of sexual development (according L.G. Tumilovich) in the group of patients with NSMC was 11,92 ± 0,4 sexual development appropriate to the age. Among the 28 patients who were examined in stable remission for 233 years, regular menstrual cycles occurred in 100%. In patients with NSMC in 1 case observed disruption of the menstrual cycle on a background of prolonged GPC and in 2 cases mentioned menstrual disorders by type opsomenoreya against cytostatic therapy. Of the 21 patients of childbearing age with a stable remission NSMC, 8 reported normal ran through pregnancy and childbirth, culminating in the birth of live fullterm infants with no relapse of nephrotic syndrome. CONCLUSION. The use of GPC
in hormone sensitive NS in a neutral period does not lead to violations of sexual development and menstrual function. In women of childbearing age with a stable remission of the National Assembly, received GPC and CS therapy in childhood, are registered properly flowed pregnancy and childbirth, the birth of live fullterm infants with no recurrence of the National Assembly.

THE AIM. The aim of the study was to evaluate the effectiveness of combined treatment of women with mixed urine incontinence. In this case, examine the possibility and feasibility of joint use of an anticholinergetic drug solifenacin and biofeedback method (BFB) and its separate use in this category patient. PATIENTS AND METHODS. The basis of this work the results of a comprehensive
urological examination and treatment of 347 women suffering from various forms of disorders of urinary system in age from 18 to 90 years. Among the patients observed in 120 women revealed a mixed urinary incontinence, in 137 – an isolated urge incontinence, while 90 patients have symptoms of overactive bladder (OAB) with no urinary incontinence. RESULTS. The findings suggest that
high performance solifenacin in the treatment of women suffering as urgent urinary incontinence and mixed urinary incontinence. Efficacy of treatment greatly increased the use of adapted by the authors in this category of patients the method of biofeedback. Also proved the possibility of using biofeedback in the form of monotherapy in patients with low efficiency or poor tolerability of
anticholinergetic drug herapy. CONCLUSION. The inclusion of biofeedback technique in the combined treatment increased the effectiveness of anticholinergetic therapy in women with mixed incontinence, as well as patients with urgent incontinence and symptoms of OAB without incontinence.

The literature analysis testifies the uniform pathogenetic mechanisms of development and progressing of the pathology of kidneys and cardiovascular system, including the cerebrovascular diseases; about set in parallel proceeding pathophysiological processes in brain, kidney and heart. At the comparative analysis of the risk factors the general come to light for all listed systems mechanisms of development and disease progressing, i.e. risk factors cerebrovascular diseases simultaneously are also risk factors of the cardiovascular illnesses and chronic kidney disease. The conclusion that, along with introduction of concepts «cardiorenal continuum», «chronic kidney disease», defensible is occurrence of the overnosological new concept – «cerebrocardiorenal syndrome» or «cerebrocardiorenal continuum» becomes. Introduction of this concept predetermines necessity of the interdisciplinary approach under the authority of geriatric patients.

Clinical cases of hypocomplementemic urticarial vasculitis with kidney injury are presented in this article for the first time in russian nephrological literature. Practical aspects of diagnostics are discussed as well.

THE AIM. Comparison of values of the glomerular filtration rate (GFR), received by a referential method (a plasmatic clearance 99mTcDTPA GFRDTPA) with results of determination of the given parameter on a creatinine clearance (CСr), to equations MCQ (eGFRMCQ), CKDEPI (eGFREPI), MDRD7 (eGFRMDRD) and formula D.W. Cockcroft, M.H. Gault (CCG) at patients of chronic kidney disease (CKD). PATIENTS AND METHODS. 98 patients with CKD with value eGFRMDRD ≥90 (n=18); ≥60 <90 (n=30), ≥30 <60 (n=33) and <30 (n=17) ml/min/1.73 m2 are investigated. At all the parameters specified above are defined. All patients were inhabitants of St.Petersburg (Russia) and belonged to Caucasian race. RESULTS. In whole group average value GFRDTPA (71.9±2.7) was significantly more low, than CСr (84.3±3.7; P <0.0001), eGFRMCQ (77.6±3.5; P=0.006) and CCG (78.2±3.7; P=0.026), but significantly higher, than eGFRMDRD (60.0±2.7; P = <0.0001) and eGFREPI (64.8±2.8; P <0.0002). In the general group highly significant direct correlation between GFRDTPA and all other estimations GFR (Pirson’s linear correlation coefficient from 0.67 to 0.82; P <0.0001 in all cases) took place. At the same time in the separate studied ranges conformity between GFRDTPA and all other estimations GFR has appeared not satisfactory. CONCLUSION. The obtained results, specifies in necessity of working out of ways of determination eGFR, adapted for features of concrete population.