THE AIM. Analysis of etiology, clinical and morphological manifestations, of membranoproliferative glomerulonephritis  (MPGN).

PATIENTS AND METHODS. Retrospective analysis focused on etiology, clinical presentation, light and electron microscopy, immunoglobulins (Ig) and C3 complement component  (C3) deposits was done in the cohort of MPGN cases identified in the period 2000-2017. RESULTS. Two hundred and fourteen cases of  MPGN were included in the study (mean age of 44 ± 16 years). Most patients had nephrotic syndrome and significant hematuria. In  58.4% of cases, eGFR was <60 mL/min/1.73 m2, and every fifth  patient had CKD stages 4 or 5. The prevalence of MPGN among all  biopsy-confirmed glomerulopathies was 9.3%. Idiopathic MPGN  (iMPGN) was diagnosed in 30.4% of cases, while the proportion of  iMPGN cases significantly reduced along the study period. Secondary  MPGN (sMPGN) was identified in 69.6% of cases  (autoimmune diseases – 34.1%, infectious diseases – 16.4%,  monoclonal gammopathies – 9.3%, complement-mediated damage – 9.8%). Ig+C3+MPGN was mainly associated with autoimmune  diseases and infections, however 26,6% of such cases remained  “idiopathic”. C3-glomerulopathy or thrombotic microangiopathy were most often causes of Ig-C3+MPGN. Ig-C3-/Ig+C3-MPGN had  heterogeneous etiology.

CONCLUSION. MPGN is a severe variant of glomerular damage with a heterogeneous etiological structure. Targeted routine clinical and  morphological diagnostics of MPGN allows identifying the cause of  the disease in most cases. This approach is reliable for the adequate  treatment choice and improvement of outcomes in sMPGN. Further  improvement in diagnostic and classification approaches in idiopathic MPGN relies on progress in understanding of molecular etiopathogenesis of the disease.

In both atypical hemolytic uremic syndrome (aHUS) and C3 glomerulopathy (C3G) complement plays a primary role in disease pathogenesis. Herein we report the outcome of a 2015  Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference where key issues in the management of  these 2 diseases were considered by a global panel of experts. Areas addressed included renal pathology, clinical phenotype and  assessment, genetic drivers of disease, acquired drivers of disease, and treatment strategies. In order to help guide clinicians  who are caring for such patients, recommendations for best  treatment strategies were discussed at length, providing the  evidence base underpinning current treatment options. Knowledge gaps were identified and a prioritized research agenda  was proposed to resolve outstanding controversial issues. 

Disturbance of the thyroid function is often detected in patients with different profiles. A special feature of patients with chronic kidney  disease is the higher incidence of various thyroid function  disturbances, especially hypothyroidism. It is known that in patients  with chronic kidney disease (CKD) iodine excretion from the body is  violated, since normally 90% of iodine is excreted in urine.  Accumulation of high concentrations of inorganic iodine leads to the  formation of the Wolf-Chaikoff effect: suppression of iodine  organization in the thyroid gland and disruption of the thyroid  hormones synthesis. Peripheral metabolism of thyroid hormones is  also disturbed, namely, deiodinase type I activity is suppressed and  peripheral conversion of T4 into T3 is inhibited (so-called low T3  syndrome). Therefore, patients with CKD are often diagnosed with  hypothyroidism, and the origin of hypothyroidism is not always  associated with the outcome of autoimmune thyroiditis. The article  presents an overview of a large number of population studies of  thyroid gland dysfunction in patients with CKD, as well as  experimental data specifying the pathogenetic mechanisms of  thyroid dysfunction in patients with CKD. Therapeutic tactics are still  not regulated. However, in a number of studies, replacement therapy with thyroid hormones in patients with CKD had some advantages.

Improvement of diagnosis and prediction methods of the chronic kidney disease is associated with the identification and studying of new  biomarkers, not depending on kidney filtration function. In this literature review we present the research data of Lipocalin-2 associated with  neutrophilic gelatinase in diagnostics, assessment of severity and rate of  progression of chronic kidney disease both in adults and children.

Interest in studying the role of the gastrointestinal tract in maintaining homeostasis in chronic kidney disease is a traditional one. It served, in particular, as a starting point for the  creation of enterosorbents. However, if earlier the main attention  was paid to the mechanical removal of a number of potentially  dangerous biologically active substances, recently an intestinal  microbiota has become an object of interest. The first part of the  literature review on this topic is devoted to questions of terminology, the normal physiology of the colon microbiota. A  detailed description of dysbiosis is given. The features of the main  groups of microorganisms are reflected. The hypothetical and  confirmed interrelations of the intestine-kidney axis are presented.  The pathogenetic mechanisms of the colon dysbiosis influence on the processes of local and systemic inflammation are discussed. The  influence of dysbiosis on the state of the kidney parenchyma and its  participation in the progression of CKD are debated.

THE AIM. To assess quality of life (QOL) in kidney transplant recipients (KTR) using the Kidney Disease Quality of Life Short Form  (KDQOL-SFTM) questionnaire which includes specific for renal  replacement therapy questions, and to compare QOL of KTR and hemodialysis (HD) patients.

PATIENTS AND METHODS. 41 KTR and 142 HD patients were included in the study. The KDQOL-SF questionnaire was used for QOL evaluation.

RESULTS. Compared with HD patients, KTR scored higher on the majority of self-assessed physical health parameters (Physical  Functioning, Pain, General Health, Physical Component Summary). Significant differences were observed for two of the five  scales representing psychosocial component of QOL – Vitality and  Social Functioning. Overall health rating was also higher in KTR.  These patients were frustrated by the burden of kidney disease and  its limiting impact on daily activities to a lesser degree. The  frequency of patients’ complaints decreased. 39% of HD patients  reported being bothered by itchy skin, among KTR – only 8%.  Soreness in muscles bothered 44% of HD patients and 22% of KTR,  numbness in hands or feet – 33% of HD patients and 13% of KTR.  Limited ability to travel was bothersome for 75% of HD patients and 42% of KTR. 38% of KTR, and 29% of HD patients were employed.

CONCLUSION. As far as we know, the presented study is the first in our country to report about QOL in KTR where QOL was measured  using a questionnaire containing items specific for renal replacement  therapy. It was shown that KTR scored higher than HD  patients on the majority of KDQOL-SF scales.

THE AIM: to study diagnostic and prognostic significance of blood serum cytokine status evaluation in children with different nosological forms of kidney diseases.

PATIENTS AND METHODS. The study included 255 children with various kidney diseases (kidney stone disease (KSD) – 16, with  infectious kidney diseases (IKD) – 174, with a glomerulopathy (GP)  – 65). In all study groups were dominant children with 1st and 2nd  stage of CKD (100%, 97,5% and 95,4% respectively). The control group included 50 virtually healthy children. All patients  determined level of TNF-α, TNF-RI and TNF-RII, IL-10, TGF-β1 and TGF-β3, IL2, IL2-SR in blood serum.

RESULTS. Increase of TNF-α level in blood serum can be considered as a highly specific marker of acute pielonephritis chronization, as  well as decrease of TNF-RII concentration can be considered as a  marker of full clinical and laboratory pielonephritis remission. The  increase in TNF-α and TNF-RI can also be considered as a marker of autoimmune inflammation. Deficiency of IL-2, IL-10 and TGF-β3  with an increase in IL-2 R in blood should be used as a marker of  bacterial-inflammatory and autoimmune kidney diseases, and TGF- β1 increase as an early marker of nephrosclerosis, especially in  patients with glomerulonephritis. The increase of the inflammatory  index TNF-α / IL-10 more than 4 times, gives us  the opportunity to  position it as an additional diagnostic criterion for infectious and  autoimmune process in the kidneys. The increase in urinary  excretion of TNF-α with the decrease of IL-10 by maintaining  consistently high concentrations of TGF-β1 is a marker of  inflammation and fibrosis in infectious kidney diseases and  glomerulonephritis. Modern nephroprotection therapy directed at  slowing progression of CKD and its complications should include  modulation of cytokine status.

THE AIM: to determine the relationship between non-traditional risk factors and calcification of the aortic valve in patients with CKD C5D.

PATIENTS AND METHODS. We examined 103 patients receiving treatment with program hemodialysis (53 men and 50 women, mean age 54.8 ± 15.2 years). A traditional nephrological examination was  carried out, including the determination of synchronous 24-hour ECG  and AD monitoring, an echocardiographic study evaluating the  thickness of the carotid arteries intima-media complex. In 79 patients, the status of vitamin D was determined by the enzyme immunoassay.

RESULTS. Traditional (age over 50, male and dyslipidemic) and non- traditional (duration of hemodialysis more than 5 years, calcitriol  level less than 10 pmol/L) risk factors for the calcification of the  aortic valve were revealed. The average concentration of calcifediol  in serum was 33.3 ± 13.8 nmol /L, calcitriol – 11.5 ± 6.9 pmol /L.  Calcification of the aortic valve was detected in 48 patients, 2 times  more often in men. Stenosis of the aortic valve was found in 28% of  men and 22% of women. During the first five years of HD, the  prevalence of aortic valve calcification increased 1,5 times and  continued to increase later, however, not to the degree of stenosis.  The risk of stenosis increased by age over 50 years (3,6 times), whereas the use of alfacalcidol was accompanied by a 70% decrease of stenosis risk. Deficiency of calcitriol (but not calcifediol) increased  the risk of calcification (but not stenosis) of the aortic valve in 2 times.

CONCLUSION. Vitamin D deficiency is associated with an increased risk of developing extraosteal calcification, including aortic valve. A  decrease in the concentration of calcitriol in the blood serum is a  predictor for a specific lesion of the aortic valve. Adequate correction of phosphoric calcium exchange can serve as one of the methods for its prevention.

AIM: To evaluate risk factors and prevalence of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) in the early period after isolated coronary artery bypass graft (CABG).

PATIENTS AND METHODS: The study included 830 patients with  isolated CABG. All surgeries were performed in 2016. To evaluate  kidney function in preoperative period glomerular filtration rate  (GFR) was estimated by Chronic Kidney Disease Epidemiology  Collaboration (CKD-EPI) formula. AKI was diagnosed according to  KDIGO criteria. Patients were stratified into two groups according to  estimated glomerular filtration rate (eGFR).

RESULTS: The prevalence of AKI in patients group without CKD after CABG was 11,5% (n=59), in CKD-AKI group – 12,3% (n=39).  In patients with CKD and after intraoperative inotropic/vasopressor  therapy use of only 2 medicinal drugs of this group the probability of  AKI development increases 11,16 times (OR 11,46; 95% CI 3,47- 37,83; р<0,01). During complete bypass (CB) when haematocrit  decreases on 1% AKI probability increases on 12,36% (OR 0,89; 95% CI 0,81-0,98; р=0,02). The necessity of haemodialisys,  duration of stay in intensive care unit and hospitalization duration  were equal to all groups. AKI-CKD development significantly increases intrahospital mortality (p<0,05). 

CONCLUSIONS: History of CKD increases probability of severe AKI and also mortality in early postoperative period. Revealed risk factors for AKI development are potentially modifiable.

The article reflects modern ideas about the causes and mechanisms of the physical functioning disorders in patients with chronic kidney  disease receiving program hemodialysis. Various types of physical  activity are considered and the rationale for their use in dialysis  patients is justified. The diagnostics possibilities of the protein- energy deficiency main variants are presented. Possible directions  for their correction are outlined. The possibilities and methods of  regular physical training in such a complex cohort of patients with  changes in almost all the basic systems of the body are described in  detail. For patients who cannot perform physical exercises in a  training mode, a new rehabilitation technique was developed and  tested on a representative sample, and a new rehabilitation  technique that was not previously used in nephrology – a cutaneous  bilateral electrostimulation of the muscles of the lower extremities –  was justified and considered in detail. The authors give their own data on long-term follow-up of patients, which confirm the  possibilities of the presented methods not only in terms of improving physical performance, but also in improving the adequacy  of dialysis and the quality of life.

Current review provides data of etiology, pathogenesis and clinical evidences of urinary tract infection (UTI) in adolescents in connection  with physiology of pubertal period. Data of congenital and acquired  factors leading to origin and chronicity of the inflammation are  presented. Treatment and rehabilitation approaches for adolescents with UTI are provided. Authors emphasize that metabolic disorders appeared  in active stage of inflammation do not disappear when clinical symptoms  of UTI, bacteriuria and leukocyturia are gone.