The cardiorenal syndrome includes the widely known relationship between kidney function and cardiovascular disease. A large number of patients have various degrees of heart and kidney dysfunction worldwide, both in developed and developing countries. Disorders affecting one of themmostly involve the other. Such interactions represent the pathogenesis for a clinical condition called cardiorenal syndrome. Renal and cardiovascular disease shares similar etiologic risk factors. The majority of vascular events arecaused by accelerated atherosclerosis. Moreover, cardiovascular events rarely occur in patients without underlying disease; rather, they typically take place as the final stage of a pathophysiological process that results in progressive vascular damage, including vital organ damage, specifically the kidney and the heart if these factors are uncontrolled. Chronic kidney disease is a novel risk factor included at this stage that accelerates both vascular and cardiac damage.

This review briefly summarizes the current understanding about of acid-base transport in the kidney and the regulation of these processes. Attention was turned to range of questions which are deficiently observed in national science-medical literature: molecular structure of some transporters, involved in these processes, role of local pH, pCO2 and bicarbonate sensors, characteristics of gases transport through cell membranes etc. Was made an effort to show defects in which mechanisms of proton and bicarbonate translocation in renal tubules form the basis for rare and unique diseases – renal tubular acidosis.

Ischemic and reperfusion injury (IRI) of cadaver kidney allograft (CKA) generates cascade of pathological processes after reperfusion, which reach its maximum 5–7 hours later. Time duration when effective correction of IPI consequences and prevention of its progression is possible is terminated by 12–14 hours. Consequently, conduct therapy must be well-timed, high-efficiency and give the quick direct effect. Among factors typing IRI severity and survivability prognosis and CKA functioning durability, nonspecific factors (cold and heat ischemia duration decrease, condition monitoring improvement on preagonal stage, transplant conservation methods development etc.) are essential. Further improvement of kidney transplantation results researches link to introduction of new technologies based on direct and single-step effect on different components of ischemia/reperfusion syndrome pathogenesis.

THE AIM. The study was aimed to analyze long-term course of myocardial ischemia (MI) in pts on haemodialysis (HD). PATIENTS AND METHODS. 119 stable pts on HD entered the study (67 males, mean age 50±13 years). Mean HD vintage was 50 month (95% CI 39-60). Prospective observation was started on June, 2002 and finished on May, 2009. Mean observational period was 1518 days (95%-CI 1373-1666), 495 pts-years in total. End-points of MI and cardiovascular disease (CVD) progression were registered during the study. RESULTS. Clinical signs of MI was found in 60 pts (50,4%) at the time of inclusion: typical angina in 52%, silent MI in 23%, mixed MI in 25%. Pts with and without MI differ by age, pulse arterial blood pressure (ABP), apolipoprotein A1, troponin T (TnT), frequency of aortic/mitral valves consolidation/calcification. 51 pts died in observation period, among them 39 (32,8%) due to CVD. In 66 of 119 who had at least one CV event death rate was 59%, prevalence of MI – 86%, MI progression rate – 82%. Incidence of clinical MI de novo was 35%. Pts with MI progression or MI de novo were older, had higher serum levels of TnT and immunoglobulins, and diameter of ascending aorta. In regression analysis age was the only clinical predictor of MI progression, while baseline clinical MI and TnT serum level were significantly and independently associated with CV survival. CONCLUSION. MI has an important clinical and prognostic significance and requires a careful evaluation and appropriate treatment to improve outcomes in pts on HD.

THE AIM: assessment of relationship between level of biomarkers and clinical and pathomorphological signs of glomerular, tubular sclerosis and tubular atrophy in patients with primary glomerular disease. PATIENTS AND METHODS. In cross-section study 71 patients hospitalized in department of nephrology with performed renal biopsies were included. According the results of light and electron microscopy 23 (32.4%) patients had IgA-nephropathy (mesangial proliferative glomerulonephritis), 14 (19.7%) – focal segmental glomerulosclerosis, 22 (31.0%) – membranous nephropathy, 12 (16,9%) – minimal change disease. Besides standard laboratory and instrumental investigations the level of serum cystatin-C and NGAL, urine cystatin-С, NGAL, nephrin were mesaured. Glomerulosclerosis, tubulointerstitial sclerosis and tubular atrophy were estimated quantitatively and semi quantitatively. RESULTS. GFR estimated using cystatin-C most accurately reflects the degree of glomerular sclerosis. Serum NGAL correlated with GFR estimated using cystatin-C and level of nephrinuria. Urine NGAL and tubular atrophy correlated as well; the rates of urine NGAL and cystatin-C excretion were the highest in patients with high range proteinuria. CONCLUSION. The applying of GFR estimated using cystatin-C is preferable in assessment of glomerulosclerosis degree. Urine NGAL excretion most accurately shows the severity of tubular atrophy while serum NGAL reflects the earliest stages of glomerular cell injury. Urine excretion of NGAL and cystatin-C depends on proteinuria and this fact should limit their exploitation in acute kidney injury diagnostics in patients with primary glomerulopathies and high range of proteinuria.

THE AIM. The control of hyperphosphatemia by calcium- or aluminium- containing phosphate-binders leads to other complications like hypocalcemia, soft tissue/vascular calcifications, calciphylaxis. The application of non-calcium- non-alluminium-containing phosphate-binders and calcimimetics is very expensive. The aim of the study was to compare phosphate removal during preand post-dilutional on-line hemodiafiltration (HDF) as well as to compare phosphate removal during HDF with different volume of substitutional solution. PATIENTS AND METHODS. 13 end stage renal disease patients (ESRDP) were included in the study. 49 HDF were realized – 41 with substitution of 8600 ml and 8 – with 12000 ml (HDF-8600 and HDF-12000). Phosphate-Kt/v (Daugirdas 2nd generation) and phosphate-Reduction Ratio (RR; %) were calculated. RESULTS. Phosphate removal according to Kt/v during pre-dilutional and post-dilutional HDF-8600 was similar: 0.915±0.304 (n=24) and 0.908±0.234 (n=17) respectively, P=NS. Phosphate RR (%) achieved by mentioned modalities of HDF 8600 was 52.02±12.28 (n=24) and 51.900±10.810 (n=17), P=NS. During post-dilutional HDF-12000, phosphate removal was lower than that during post-dilutional HDF-8600: Kt/ v=0.689±0.009 (n=8) versus 0.908±0.234 (n=17), P<0.001 and RR=43.62±5.870 (n=8) versus 51.900±10.810 (n=17), P<0.01, respectively. CONCLUSION. (1).There is no difference between phosphate removal during pre- and post-dilutional HDF-8600 according to Kt/v. (2). Phosphate removal is more effective in HDF-8600 compared to HDF-12000 ml according to Kt/v and RR.

THE AIM. The aim of research to study of kidney morfologic injury pattern developing at paracetamol toxic dose effect at subchronic administration and also studying of potential protective effect of CysLT1 receptor blocker – montelukast in respect of paracetamol nephrotoxicty. MATEIALS AND METHODS. Experimental study was carried out on 30 outbred male rats males divided into three groups. First group (10 rats) received paracetamol orally by gastric tube in dose 100 mg/kg, which is equivalent nearly 30-50% of LD50 of this drug. Control group (10 rats) received orally single dose 1 ml of isotonic saline solution. Third group received orally peptide-leukotriene receptor blocker montelukast in dose 40 mg/kg and 1 hour later – paracetamol in dose 1000 mg/kg. Histological research was carried out on 5 μm slices. RESULTS. It is shown that administration of paracetamol at subtherapeutic had nephrotoxic effect on all components of kidney tissue and causes development of excretory necronephrosis with glomerulitis. Pre-administration of antileukotriene medication (montelukast) have protective effect. CONCLUSION. Signs of rat kidneys parenchyma and stroma damage which occur during paracetamol reflect increasing structural functional degradation of organ with risk of kidney failure development. CysLT1 receptor blockers used during experiment reduce and neutralize nephrotoxic effect of cyclooxygenase 2 ingibitors.

THE AIM. The study of shock wave damaging effect during extracorporeal shock wave lithotripsy (ESWL) in patients with nephrolithiasis. PATIENTS AND METHODS. Information about the shock wave damaging effect at extracorporeal shock wave lithotripsy in 120 patients with nephrolithiasisis given, laboratory research settings immunograms, lipid peroxidation (LPO), selectivity of proteinuria and glomerular filtration rate were studied to assess the early and late complications. RESULTS. ESWL is accompanied by complications due to a direct effect of the shock waves on the kidney and urinary tract occlusion and infection. This requires targeted measures aimed at improving the stability of kidney to effects of shock wave and prevention of infectious and inflammatory process. The nature of immune response may be an additional diagnostic test for the selection of patients for ESWL and preventive actions. CONCLUSION. Comprehensive drug treatment, carried out in the pre-and postoperative periods, when properly perform lithotripsy can reduce the degree of ischemia and microcirculatory disorders from traumatic impact of shock wave and to restore kidney functions to 4-5 days and to prepare it for a possible repeat session of lithotripsy.

THE AIM: increase of treatment efficacy of urinary bladder leukoplakia in women at postmenopausal period. PATIENTS AND METHODS. For 34 patients aged from 52 to 74 years were carried out check-up, diagnostic and treatment of chronic cystitis grouped with urinary dder leukoplakia in urology clinic. All women with pathological diagnosis “urinary bladder leukoplakia” were preformed laser ablation of mucosal changes by laser system with wave length 970 nm. RESULTS. Urinary bladder changed mucosa laser ablation efficiency was proved. It clinically manifested by decreasing of pain syndrome, reduction of dysuria, improvement of life quality. CONCLUSION. Safety and minimal invasiveness of the technique, absence of intraoperative complications, rapidly recovery in postoperative period are unquestionable efficacy of laser ablation of mucosal changes of the bladder in older women.

THE AIM. To study role of transrectal ultrasonography (TRUS) with Doppler sonography in planning prostate biopsy to increase the efficiency of the differential diagnosis of diseases of the prostate. PATIENTS AND METHODS. In urologic department since 2010 to 2011 year 98 prostate gland biopsies were performed. All patients before biopsy were performed prostate gland vessels Doppler sonography to find out prostate gland zones priority for biopsy. RESULTS. Use of Doppler sonography at TRUS revealed significant differences of bloodstream factors in prostate gland between patients with cancer and patients with benign prostate hyperplasia. CONCLUSION. Use of Doppler sonography provides to reveal blood flow enhancement zones in prostate gland. Use of Doppler sonography at biopsy planning increase efficacy of this diagnostic method.

THE AIM: study of kidney pathology in patients with gout. PATIENTS AND METHODS. 232 patients with gout were observed. All patients performed ultrasonography of the kidneys, as well as determination of the concentrations of creatinine, urea and uric acid in the blood serum. RESULTS. Kidney pathology in patients with gout occurs by nephrolithiasis and nephratony. Also for patients was typical a combination of kidney disease with involvement in the inflammatory process more joints, more frequent acute attacks of arthritis and the formation of more tophi. CONCLUSION. Therefore renal injury in gout is usually associated with rather severe underlying disease course.

Gout and metabolic syndrome are widespread diseases of the present, especially at elderly patients. Gout is often characterized by renal irritation. On a clinical example the typical questions arising at diagnostics of hyperuricemia and gout are considered.

The case of granulomatous interstitial nephritis in sarcoidosis are presented. This case characterized by the formation of granulomatous interstitial nephritis, accompanied by the rapid development of renal dysfunction. The diagnosis, differential diagnosis, and treatment of kidney damage in sarcoidosis are discussed.

Ashot Movsesovich Essaian.

Anatoly Ivanovich Gozhenko.