Chronic kidney disease (CKD) comprises a group of pathologies in which the renal excretory function is chronically compromised. Most, but not all, forms of CKD are progressive and irreversible, pathological syndromes that start silently (i.e. no functional alterations are evident), continue through renal dysfunction and ends up in renal failure. At this point, kidney transplant or dialysis (renal replacement therapy, RRT) becomes necessary to prevent death derived from the inability of the kidneys to cleanse the blood and achieve hydroelectrolytic balance. Worldwide, nearly 1.5 million people need RRT, and the incidence of CKD has increased significantly over the last decades. Diabetes and hypertension are among the leading causes of end stage renal disease, although autoimmunity, renal atherosclerosis, certain infections, drugs and toxins, obstruction of the urinary tract, genetic alterations, and other insults may initiate the disease by damaging the glomerular, tubular, vascular or interstitial compartments of the kidneys. In all cases, CKD eventually compromises all these structures and gives rise to a similar phenotype regardless of etiology. This review describes with an integrative approach the pathophysiological process of tubulointerstitial, glomerular and renovascular diseases, and makes emphasis on the key cellular and molecular events involved. It further analyses the key mechanisms leading to a merging phenotype and pathophysiological scenario as etiologically distinct diseases progress. Finally clinical implications and future experimental and therapeutic perspectives are discussed.

The review provides information on the role of endoplasmic reticulum stress (EPR-stress) in the development of a number of renal diseases. Participation of EPR-stress in pathogenesis of congenital and hereditary kidney diseases, various forms of glomerulopathies is discussed. Involvement of EPR-stress in development of renal tubules injury, including induced by xenobiotics, as well as in pathogenesis of diabetic nephropathy s considered.

THE AIM OF STUDY was to find out the beginning of the acute kidney injury (AKI) after partial or radical nephrectomy. PATIENTS AND METHODS. 17 patients with renal cell carcinoma were treated either via radical (5 cases) or partial (12 cases) nephrectomy. The procedures were performed through open, laparoscopic or robotic approaches. Partial nephrectomies were made under regional (local) ischemia by putting special clamps on renal parenchyma. The serum creatinine was measured before procedure and 24 h later. Plasma NGAL levels was measured before surgery and 2 hours later. Urine NGAL was measured before surgery after 2, 4 and 8 hours. RESULTS. The histological diagnosis was RCC in all cases. In groups of radical and partial nephrectomy initial level of blood serum creatinine, blood serum NGAL and urine level didn’t exceed normal values. In radical nephrectomy group urine NGAL level increased 2 hours after surgery. Maximal values were detected at 8 hours after surgery (increase of factor to 123,4±29,1 ng/ml). In group of partial nephrectomy urine NGAL begin to increase at 2 hours after surgery too. Maximal values were detected after 8 hours after surgery 25,4±14,6 ng/ml. CONCLUSIONS. Concentration of urine NGAL over time provide to reveal acute kidney injury 2 hours after surgery.

THE AIM of the study was to compare quality of life (QOL) in pts with different stages of chronic kidney disease (CKD) and to analyse QOL during hemodialysis. PATIENTS AND METHODS. Of the 880 pts who participated the study 56 pts were with CKD stages 1–2, 71 – with CKD stages 3–4–5 on the conservative treatment and 753 – on hemodialysis. QOL was evaluated by SF-36. RESULTS. With CKD progress (from predialysis stages to hemodialysis) scores of scales constituting physical dimension of QOL deteriorated significantly. A reduction in Physical Functioning (p=0,001), Role Physical Functioning (p=0,014), Bodily Pain score (p=0,036), General Health perceptions (p<0,0001) and in the Physical Component Summary score (p<0,0001) was observed. With increase of hemodialysis vintage all scores of physical dimension of QOL decreased. As a whole mental QOL scores didn’t undergo significant changes with CKD progress. When hemodialysis duration reached the level of 5–8 years decrease in Social Functioning and Vitality scores was observed. CONCLUSION. CKD progress is followed by significant deterioration of scales constituting physical dimension of QOL. Scales relating to psychosocial (mental) dimension of QOL doesn’t undergo significant changes with decrease of kidneys function.

THE AIM of the study was to examine the relationship of quality of life (QoL) and clinical and laboratory characteristics of renal transplant recipients (RTR). PATIENTS AND METHODS. The survey of 86 RTR included studying QoL using the general questionnaire SF-36. The nature of the disease, leading to end-stage renal failure, duration of renal replacement therapy before renal transplantation, type of donor, kidney graft function in the early postoperative period, the base immunosuppressive drug, duration of the functioning graft, the presence/absence of chronic graft dysfunction, number of comorbidities, the need for antihypertensive therapy, body mass index, the level of hemoglobin, albumin of the blood were analyzed. RESULTS. The main impact of the majority of clinical and laboratory symptoms traced in patients' satisfaction regarding their physical condition. Greatest importance were pre-transplant diabetes mellitus, delayed graft function and duration of functioning renal transplant, the value of the glomerular filtration rate and albuminemia. Not found to significant effect of the therapy on QoL of RTR. Related kidney recipients were given a higher score of QoL compared to cadaveric transplantation. CONCLUSION. The combination of subjective and objective measures of health forms the most complete picture of condition of patients with transplanted kidney, allows to predict QoL of patient with transplanted kidney, and correction of modifiable clinical and laboratory changes can improve satisfaction of RTR of health-related quality of life.

AIM OF RESEARCH: to evaluate the impact of bacterial infections on the frequency of acute rejection, the survival of recipients and renal graft; and also identify risk factors for infection in kidney transplant recipients. PATIENTS AND METHODS. Long-term results of 330 cadaveric kidney transplants were analyzed. RESULTS. We identified specific risk factors for bacterial infections. Infection significantly reduced survival of grafts and recipients. There is also a relationship between frequency of bacterial infections and the incidence of acute rejection. CONCLUSION. Analysis of risk factors, the specific time of infection and the level of the infection impact on survival of grafts and recipients can improve the kidney transplantation results.

THE AIM OF RESEARCH was to study clinical and laboratory manifestations of chronic pyelonephritis (ChrPN) with arterial hypertension at the stage of remission. PATEINTS AND METHODS. More than 120 patients were observed with (ChrPN) associated with kidney stone disease (KSD) and dysmetabolic nephropathy (DN) at clinical and laboratory remission. At 60 patients at the age of 18-59 years ChrPN was associated with arterial hypertension (AH). For patients investigation we were used clinical, laboratory, instrumental and special biochemical diagnostic methods. Latest methods included study of lipid peroxidation processes, alpha tocopherol lipid soluble antioxidant level, general phospholipids and cholesterine in membranes of polymorphonuclear leucocytes (PML). RESULTS. It was revealed that in patients with ChrPN associated with nephrolithiasis and DN on clinical and laboratory remission are registered: different manifestations of asthenovegetative syndrome, increase of left ventricular mass index (LVMI) is discovered, lipid peroxidation processes activity alteration is revealed associated with decrease of antioxidant protective function in membranes of neutrophils with domination of intensity of these disorders in group with symptomatic arterial hypertension. CONCLUSION. As a result undertaken studies represent maintenance of clinical and laboratory manifestations of disease even on remission, which demand continuation of remedial measures for patients on clinical and laboratory remission of ChrpN associated with AH.

THE AIM of the study was to: research of renotropic effects of adenosine triphosphate-sensitive potassium channels activator Flocalin. MATERIAL AND METHODS. The experiments were made in laboratory non-linear white rats 0,15-0,17 kg of weight under conditions of 5% water load. The first series of experiments consisted of intraventricular administration of Flocalin with a tube in the dose of 5 mg/kg on 1% amylum mucus over the period of 7 days. In the second series of experiments Flocalin was administered once in 2 hours after modeling of toxic nephropathy by subcutaneous injection of mercuric chloride 1 mg/kg. Urine and plasma levels of sodium and potassium ions were measured using flame photometry. Quantitative analysis of creatinine was performed with colorimetric assay. Urine protein was estimated using sulfosalicylic acid test. RESULTS. The repeated administration of Flocalin to the rats increased diuresis, as well as creatinine excretion and glomerular filtration rate (GFR). We observed elevation of plasma potassium levels and diminution of urine potassium concentration. At the same time plasma sodium levels and natriuresis decreased. After Flocalin administration in the model of sublimate nephropathy we observed the increase of diuresis, creatinine excretion and GFR, decrease of proteinuria and elevation of urine potassium levels and kaliuresis. This was followed by plasma sodium level rate normalization and increment of potassium ions excretion in the urine. CONCLUSION. A more pronounced reaction of water excretion after administration of Flocalin to the rats under conditions of sublimate nephropathy contributes to the increase of renal sodium and potassium excretion with the absence of electrolyte changes in blood plasma. Elevation of GFR and antiproteinuric effect determine renoprotective action of Flocalin in toxic nephropathy.

THE AIM OF THE STUDY was to investigate the effects of drugs with endothelio- and renoprotective activity on the course of acute kidney injury (AKI) in rats after the severe ethylene glycol poisoning. MATERIALS AND METHODS. AKI was examined on rat model by intragastric administration of 2/3 LD50 ethylene glycol. After poisoning rats were divided into groups and treated daily with losartan, vasoprostan and antioxidative formulation (AF) for 7 days. The control group was treated with saline solution. Diurnal dieresis rates, serum creatinine and urea concentrations were analyzed at 3, 7, 14 and 28 days following poisoning. Urinary sediment was also assessed. The received data were compared with intact animals. RESULTS. It was noticed the decrease in lethality in group treated with vasoprostan and AF and 4-fold increase in this rate after losartan treatment. Among all the drugs tested only vasoprostan significantly decreased azotemia level 2 days after exposure to the toxicant. On the contrary, losartan administration leaded to more than 8- and 18-fold increase of creatinine and urea, respectively. Vasoprostan and AF improved the reparation of renal functions from 14 (untreated group) to 7 (treated group) days. Daily urine production in these groups was 1.5- and 4-fold greater than in control and intact rats. Among all the drugs tested only AF administration in 14-28 days after ethylene glycol poisoning resulted in restoration of normal daily urine production. CONCLUSION. Administration of losartan in ethylene glycol poisoning is associated with risk of ARF transition to the decompensation stage. Vasoprostan and AF administration improve restoration of ethylene glycol-induced AKI.

AIM OF STUDY was to report about the novel type of partial nephrectomy performed with the help of special parenchymal clamp for tumors localized in the medial part of the kidney and to show the benefits of regional ischemia over traditional vascular clamping in the terms of early functional outcomes. PATIENTS AND METHODS. Three cases of the open partial nephrectomy with the novel parenchymal clamp were explored. Among the patients there was a man with a solitary kidney. The incision was made under the XIIth rib. All the tumors were localized in the middle part of the kidney laterally. The novel clamp with the semilunar branches was placed around the tumor and 2 cm proximally. The vascular pedicle was not clamped. The procedure then was performed in the bloodless field, after that the kidney wound was sutured. RESULTS. The operation time was 90, 115 and 120 min. Time of local ischemia was 17, 18 and 21 min. There were no complications. In two cases serum creatinine level increased from 0,088 and 0,101 to 0,095 and 0,103 mmol/l respectively 24 hours after the procedure. In the patient with solitary kidney serum creatinine level increased from 0,112 to 0,130 mmol/l. CONCLUSIONS. Regional ischemia provides better early functional outcomes during open partial nephrectomy than traditional total ischemia. The novel clamp helps to reduce the risks and difficulty of the procedure.

THE AIM of the study was to determination of concentration and role of Tamm-Horsfall protein (THP) in the pathogenesis of recurrent nephrolithiasis. PATIENTS AND METHODS. The study included 62 patients with bilateral recurrent nephrolithiasis, 34 patients with unilateral nephrolithiasis and 20 patients in the control group. THP was isolated from the daily urine of patients with light dynamic scattering method, which produces a histogram of particle size distribution in the range from a few nanometers to tens of microns, while maintaining the properties of native substrates. RESULTS. The average value of THP particles length in control group was 138,4 ± 1,7 nm. In the group with unilateral nephrolithiasis mean THP particles length was 186.2 ± 2,1 nm. Mean wavelength of THP in patients with bilateral nephrolithiasis was 1962.4 ± 12.3nm. CONCLUSION. THP concentration in patients with bilateral recurrent nephrolithiasis is much higher than that of patients in study groups, which may be the basis for a new approach to the early diagnosis of urolithiasis, and development of new pharmacological methods of stone formation prevention.

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