From the view of system approach a problem of cardiorenal relations is considered. It is assumed that within the next 5 20 years the progress of computer technologies and its advance toward the analysis of complex biological systems in medicine will reach a level that will significantly change the traditional approaches. Medicine in general, and probable to think nephrology as part of it, will become: personalized, predictive, preventive and participatory, and so will acquire the P4 format.

In the review modern data on a morphological picture, mechanisms of formation and approaches to drug therapy of chronic kidney disease (CKD) in patients with chronic cardiorenal syndrome are generalized. Principal causes of occurrence and progressing of chronic “heart” nephropathy – neurohumoral activation and infringement of system arterial and venous hemodynamics, starting
neurohumoral, hemodynamics and hypoxic mechanisms of renal sclerotic damage. Earliest of them is compensatory by the nature narrowing efferent glomerular arterioles, promoting increase in filtration fraction and occurrence of steady glomerularhypertension causing mechanical damage of fenestrial endothelium, podocytes and glomerular mesangial cells. In formation of this renal hemodynamics defect the mainly role is played with hyperactivity of circulating reninangiotensinaldosterone system
(RAAS) and renal tissue reninangiotensin system (RAS). In process of the further infringement postglomerular blood flow and occurrence in persons with expressed chronic heart failure (CHF) anemia syndrome the mechanism of renal sclerotic damage joins renal tissue hypoxia, the leader to development of hypoxic glomerulosclerosis and tubulointerstititial fibrosis, accelerating loss of kidney function. In CKD progression with CHF also participates to uremic toxin indoxyl sulfate, which possesses the expressive nephrotoxic action. For treatment of chronic kidney disease in patients with CHF, receiving usual drug therapy, various therapeutic approaches are used. They include prevention of intrarenal hemodynamics infringements (correction of dozes of angiotensin converting enzyme (ACE) inhibitors, purpose of preparations with mainly hepatic elimination, addition to ACE
inhibitors AT1angiotensin receptor blockers), easing hypoxic damage of renal tissue (treatment of an anemia by erythropoietin, darbepoetin and iron preparations) and decrease damaging actions on kidneys diuretics and aldosterone receptor antagonists.

On the basis of analysis of main multicenter trials discusses the mechanisms of nephroand cardioprotection of angiotesin I converting enzime (ACE) inhibitors and blockers receptors of angiotensin, whose use for treatment of cardiac patients and patients with diabetic and nondiabetic nephropathies is constantly increasing, but in some situations the appointment of rennin angiotensinaldosterone system (RAAS) blockers unpromising. In elderly patients with high cardiovascular risk use of ACE inhibitors and blockers receptors of angiotensin, especially in combined form, is associated with development of serious complications, including decrease renal function.

The purpose of research was to study the features of clinical and laboratory manifestations of chronic pyelonephritis in the Far North residents of the Tyumen region. PATIENTS AND METHODS. A survey of 128 patients with secondary chronic pyelonephritis (CPN) on a background of urolithiasis (UL) in a phase of active inflammation, among them 43 people indigenous people of the North Polar (Nenets), 44 people the alien population of the North Polar (Slavs) and 41 newcomers Circumpolar North (Slavs). Using clinical, laboratory, instrumental and special biochemical methods of diagnosis. The latter include: the study of lipid peroxidation, levels of fatsoluble antioxidant alphatocopherol, the major fractions of phospholipids and cholesterol in erythrocyte membranes. RESULTS. Patients CPN living in the Polar North (newcomers) marked the highest frequency of exacerbations of the
disease, the greatest severity of pain, intoxication, dysuric syndromes, as well as the syndrome of hypertension, compared with the indigenous people of this region (Nenets) and migrant population Circumpolar. Do indigenous peoples (Nenets) North Polar observed particularly in the lipid phase of cellular membranes of red blood cells: a higher content of diene conjugates, malonic dialdegtda, the total content of phospholipids and their degradation products, cholesterol and its esters in the comparison group had to the population of the Far North. CONCLUSION. Revealed features of clinical and laboratory manifestations CPN the inhabitants of the Far North of the Tyumen region, which must be taken into account in diagnostic and therapeutic and preventive measures.

THE AIM. To study of the data of clinical, laboratory and instrumental parameters associated with arterial hypertension (AH) in the prevalent group of programmed hemodialysis (PHD) patients. PATIENTS AND METHOS. The medical examination was carried out in a prevalent group of patients (n=75) without of cardiovascular insufficiency and who had relatively compensated anemia. They received adequate standard PHD 3 times a week. Their mean arterial pressure (APm) measured 5 minutes before the beginning of a hemodialysis session was more than 107 mmHg. A clinical, laboratory and instrumental examination of the patients was conducted. RESULTS. Among the patients involved in the research 3% had «soft», 54% «moderate» and 43% «grave» AH. It has been ascertained that AH is associated with a shorter dialysis experience (r =-0.21), higher mass of a body index (IMB) (r =0.22), presence of pericardium friction noise (r =0.30), dullness of the percussion sound in iferolateral sections of lung fields (r =0.45), presence of moist rales (r =0.71), worse correction of anemia (r=-0.45), lesser iron reserves (r =-0.37) and lesser international normalized relation (INR) (r =0.37). A higher AP is associated with a higher content of C-reactive protein (CRP) (r =0.37), a atherogenic index (r =0.28), higher values of triglycerides (r =0.29), predialysis plasma sodium (r =0.34), potassium (r =0.43) and phosphorous (r =0.14). In addition to that, a high level of AP is associated with the presence of exudation in the pericardium (r =0.23), a higher left ventriculi mass index (LVMI) (r =0.17), a larger size of the right atrium (r =0.21), a higher pressure in the pulmonary artery ( r =0.34) and a lesser ejection fraction (r =0,32). CONCLUSION. Presented clinical, laboratory and instrumental parameters associated with AH may be of practical value for PHD patients' correction therapy.

THE AIM. To assess the effect of antioxidant therapy on renal structure in rats with experimentally induced calcium oxalate nephrolithiasis. MATERIAL AND METHODS. In rats with experimentally induced calcium oxalate nephrolithiasis evaluated structural changes in renal medulla, particularly the distribution of calcium compounds and their size. The oxidative damage (malonic dialdehyde) and antioxidant (mitochondrial superoxide dismutase) markers expression were determined by immunohistochemistry. RESULTS. There are picture of pathohistological restructuring of the renal tissue. Calcium compounds in the tubular system and interstitial space was noted. The morphological signs of activation of oxidative stress and the weakening of the antioxidant defense took place. In a-tocopherol use as antioxidant therapy was noted a certain reduction of expression of the structural adjustment renal oxidative damage to tissues and cells and maintaining a system of enzymatic antioxidant defense. CONCLUSION. Thus, the use of antioxidants has a beneficial effect on morphological structural restructuring kidney in animals with induced nephrolithiasis.

HE AIM. Evaluate the effectiveness of the transurethral contact ureterolitotripsy. PATIENTS AND METHODS. In 89 patients were evaluated the results of transurethral contact ureterolithotripsy. RESULTS. Of the 89 patients with ureteral stones in 87 (97.7%) patients with contact uretherolitotripsy managed to destroy the stone to fragments the size of 1-3 mm. In 2 (2.2%) patients when performing transurethral contact ureterolitotripsy concrements migrated in pyelocaliceal system of the kidney, the latter was drained a stent to use the distance shock-wave lithotripsy. In 1 (1.1%) patient during transurethral contact ureterolithotripsy with a positive effect was perforated wall of ureter. CONCLUSION. Transurethral contact ureterolitotripsy is an effective treatment of ureteral stones high density, are in the middle or lower third of the ureter. However, the invasiveness and trauma of this method limit its application.

THE AIM of the study was to develop a diagnostic algorithm of the age androgen deficiency (VAD) in men with disorders of urination based on the complex relationships between clinical and biochemical criteria of androgen saturation of the male body. PATIENTS AND METHODS. The study is based on the results of the study 100 men with urinary disorders caused by benign prostatic hyperplasia, prostatitis and chronic abacterial their combination (64 (64%), 20 (20%) and 16 (16%) patients, respectively). The average age of patients was 58,5 ± 1,2 years. All patients underwent complex clinical, laboratory and instrumental methods of examination, questioning the questionnaire AMS, determination of blood levels of total testosterone binding globulin sex steroids, the calculation of free and bioavailable testosterone. RESULTS. It was found based on the evaluation of responses AMS survey that most complaints have been expressed to reduce the frequency and power of sexual relations, reducing the number of morning erections, and increased sweating. The level of free testosterone most closely match the clinical symptoms of androgen deficiency, but the reliability of the relationship between testosterone concentration and the amount of AMS score was below the threshold. Sensitivity and specificity of the questionnaire in the diagnosis of AMS LOH confirmed by measuring blood levels of free testosterone were 88% and 19% respectively. There was found significant correlation between testosterone concentration of the blood and the number of points obtained in the responses to four survey questions. It was developed an algorithm for diagnosis of age-androgen deficiency in patients with disorders of urination based on the survey and clinical findings. CONCLUSION. The proposed algorithm can improve the diagnosis and to clarify the indications for hormone replacement therapy in men with androgen deficiency age.

The lecture examines the mechanisms of occurrence, clinical significance and diagnostic algorithms of proteinuria in children. Approaches to therapy of this condition are presented.

THE AIM OF THE STUDY - to investigate the features of urinary excretion of MCP-1 in children with various kidney diseases PATIENTS AND METHODS. The study included 25 healthy children, 22 patients with nephrotic syndrome, 19 - with chronic glomerulonephritis with hematuria, 6 - with nephritic syndrome of acute glomerulonephritis, 9 - with acute renal failure, and 2 -with chronic renal failure. Along with traditional methods it was conducted immunological examination including determination of the concentration of serum antibodies (A, F, G,); levels of circulating immune complexes, complement, lymphocyte immunophenotyping. According to the DNA-cytometry of peripheral blood there were assessed ploidy and cell cycle kinetics. The level of MSR-1 in urine was determined by enzyme immunoassay using mono-and polyclonal antibodies (ZAO Vector-Best Novosibirsk). RESULTS. It was established that in the acute period of all forms of renal pathology MCP-1 rise in the urine. As a result of correlation analysis it was revealed association opened the etiopathogenetic mechanisms of disease progression. It was identified criteria to monitor the activity of the process, determine prognosis, treatment strategy and evaluate the effectiveness of therapy. CONCLUSION. Results of the study suggest that detecting the level of urinary excretion of MCP-1 may be used for monitoring process activity and for determining treatment strategy and evaluating the effectiveness of therapy in glomerulonephritis in children.

Two cases of nephrotic syndrome in patients suffering from autosomaldominant polycystic kidney disease is described. During nephrobiopsy were the following morphological diagnoses were stated: IgA-nephropathy and membranous nephropathy. Isolated appointment of ACE inhibitor did not lead to a reduction in proteinuria, but its combination with methyl-prednisolone and cytotoxic drugs for different periods allowed significantly reduce proteinuria and stabilize renal function. Our cases showed the appropriateness of the nephrobiopsy in patients with polycystic kidney disease and nephrotic syndrome in order to determine further management treatment and prevention of progression of renal failure.

D r. Zaharina Dimitrova is a still forgotten Bulgarian scientist who did ground breaking research in the field of histology of the pineal gland. Born in Ressen, Macedonia on 26^-th November 1873, in the family of Bulgarian leader, Dimitrova left to study Medicine in France. Under the supervision of Prof. M. Nicolas, she researched the fine structure of epiphysis cerebri and for the first time made an accurate description of the pinealocytes - the main cells of the gland. D r. Zaharina Dimitrova pointed out the characteristic vacuoles in the nuclei of the cells and related the finding with a possible endocrine function. At present, it is known that the pinealocytes produce the hormone melatonin. On February 27, 1901 she graduated with honors from the Medical School in Nancy, France, and published her PhD thesis «Recherches sur la structure de la glande pineale chez quelques mammiferes». Her highly acclaimed work was awarded the Gold Medal from the Medical School and published in La Nevraxe Journal (vol. 2, 1901, 257-361). The article was consecutively cited by many scientific luminaries such as Prof. Bаrgmann, one of the founders of neurosecretion. After returning to Macedonia, and consequently relocating to Bulgaria, D r. Zaharina Dimitrova established a successful medical practice in the cities of Sliven and Pazardjik. During the last ten years of her life, the famous Bulgarian physician was actively involved in charitable work providing financial support to refugees and supporting education through various organizations. D r. Zaharina Dimitrova died on April 14, 1940.