Term «acute kidney injury» (AKI) replaced earlier term «acute kidney failure» (AKF). This replacement was determined by a number of reasons including an effort to unify criteria of diagnostics and stratification of severity of acute injury/kidney failure. Advantages and disadvantages of modern AKI classification systems were observed. However they indicate not only «injury» but also organ «failure». Among prospective approaches which provide optimization of classification there are discussed: stage separation (or AKI first stage addition) by transient revelation of AKI biomarkers, at stratification of severity of this state use not relative but absolute variations of serum creatinine concentration (Scr), refusal of criteria based on urinary volume change. AKI classification questions are important because this state is wide-spread, is still significant reason of formation and/or progression of chronic kidney disease, is considered to be important determinant of cardiovascular risk.

The ubiquitous distribution of vitamin D receptors in the human body is responsible for the pleiotropic effects of vitamin D-receptor activation. We discuss the possible beneficial effects of a selective activator of vitamin D receptor, paricalcitol, on the cardiovascular system in chronic heart failure patients and chronic kidney patients, in light of new trials. Paricalcitol should provide additional clinical benefits over the standard treatment for chronic kidney and heart failure, especially in cases of cardiorenal syndrome.

The review presents the modern data about metabolism of succinic acid in the human body and its role in the regulation of metabolic processes.

Modern concepts on the development and progression of phosphate exchange disorders at CKD, based on the novel data on pathophysiology and molecular mechanisms of phosphate-regulating systems interactions are reviewed.

IgA-nephropathy (IgAN) is one of the most common forms of the glomerulonephritis in the world. The aetiology and pathogenesis of IgAN are still unknown. The production of «pathogenic» IgA followed by the formation of immune complexes with high affinity to mesangial cells (MC) of the glomeruli is considered as an initiating factor. In 15-20% of patients, mesangial depositions content secretory IgA1 and this pattern is associated with activation of complement by the lectin path. In the majority of patients with IgAN (70-80%) IgA1 depositions having galactose defect are detected in mesanium. O-glycans without galactose act as autoantigenes these stimulate the producing of antiglacans antibodies from immunoglobulin G class. Such macromolecules containing IgA immunocomplex are not effectively excreted from circulation by reticuloendothelial system that is why they are filtrated and are accumulated in glomerular mesangium. The next stage of IgAN is the interaction between IgA1 deposits and mesangium that stimulates cells proliferation and increases mesangial matrix synthesis.

THEAIM. To determine changes of aKlotho protein kidney expression, circulating levels of fibroblast growth factor 23 (FGF23) and intact parathyroid hormone (PTH) and the parameters of inorganic phosphate (Pi) exchange in experimental modeling of early stages of chronic kidney disease. MATERIAL AND METHODS. The experimental models the chronic kidney injury were 3/4 or 5/6 nephrectomy (NE) in SHR rats while sham-operated SHR rats served as control groups. The duration of experiments was 1 or 2 months. The indices of Pi urinary excretion were determined as well as renal aKlotho protein expression by immunohistochemistry, serum concentrations of FGF23 and PTH (by enzyme-linked immunosorbent assay). RESULTS. The implemented models corresponded to 1C-3C stages of chronic kidney disease. Renal excretion of Pi was significantly increased in the groups of nephrectomized animals. No significant differences were observed in the serum concentration of FGF23 and PTH between control and experimental groups. FGF23 levels were significantly higher only in model of 5/6NE in compare to control groups. In contrary, the renal expression of aKlotho protein was significantly lower in all experimental models of 3/4NE, 5/6 NE compared to the control (sham-operated SHR, 1 month). Moreover, a significant reduction of aKlotho protein was identified at the earliest stage of kidney damage among models applied that was sham-operated SHR, 2 months (vs. sham-operated SHR, 1 month). CONCLUSION. Changes in FGF23/aKlotho system preceeds development of secondary hyperparathyroidism; in early stages of chronic kidney injury the reduction aKlotho in kidney occurs earlier than the systemic increase of FGF23; increase of relative and absolute phosphate excretion in the early stages of experimental CKD is independent from aKlotho, FGF23 and PTH.

INTRODUCTION. Advantages and disadvantages of open (OPN) and laparoscopic (LPN) partial nephrectomy are detailed in literature. Now it is necessary to review priorities of conservative surgeries at renal cell carcinoma because of implantation of robot-assisted partial nephrectomy (RPN). We undertook an investigation to compare all three methods by general signs describing operative measures and patients staying at hospital. PATIENTS AND METHODS. 87 open, 34 laparoscopic and 30 robot-assisted partial nephrectomies were executed to patients with renal cell carcinoma at T1-2N0M0 stage. Main signs were evaluated including thermal ischemia time (TIT), creatinine level, operation time, extent of blood loss, postoperative patient day. RESULTS. Mean duration of OPN was lower than LPN and RPN (102,8, 162,7 and 143,3 min, respectively). Greatest TIT was at LPN (16, 6 min) and there was no significant difference between OPN and RPN (14,5 and 12,9 min, respectively). Mean extent of blood loss at OPN and LPN was significantly higher than at RPN (332, 343 and 128 ml, respectively). Creatinine growth was 28,6%, 14,4% and20,4% for OPN, LPN and rPn, respectively. Greatest postoperative patient day was at OPN and minimal - at RPN (13,0 and 9,0 days,respectively). CONCLUSION. For the first time results of one comparison of three partial nephrectomy methods became available. Most prospective is robot-assisted method, which combine advantages of open and laparoscopic methods.

Complications of the radical prostatectomy were analyzed. Radical prostatectomy was performed to 128 patients in urology department FSPMU in period from 2005 to 2012 years. The mean age of patients was 66 years (from 52 to 81 years). Complications were divided into three groups: intaoperative, early (up to 1 month after surgery) and late (more than 1 month after surgical treatment). Intraoperative complications included rectum injury at 4 patients (2.3%) and damage to the urethra in 1 patient (0.7%). Late complications were: stricture urethrovesical anastomosis - in 5 patients (3.9%), urinary incontinence after 12 months after the operation - in 5 patients (3.9%). Continence in the postoperative period was affected by the duration of the procedure and volume of intraoperative blood loss. Introduction of new operative technologies, improvement of the techniques of surgical treatment and the accumulation of experience has abled to reduce the amount of intraoperative blood loss and to reduce the duration of the operation. The technique of a continuous suturing vesicourtehral anastomosis was allowed early removal of urethral catheter and reduced the percentage of postoperative anastomosis insolvency. In the statistical analysis did not identify factors influencing to the development of anastomotic strictures.

AIM. The aim of this study was to assess the incidence and severity of the acute kidney injury (AKI) in patients with stroke and investigate the relationship between AKI and in-hospital mortality. PATIENTS AND METHODS. 98 patients (54 (55%) men and 44 (45%) women, mean age was 63±11 years) with acute stroke were studied. Diagnosis was confirmed by tomography. 66 (67%) patients had ischemic stroke and 32 (33%) - hemorrhagic stroke . AKI was defined according to KDIGO Guidelines (2012). RESULTS. AKI was revealed in 30 patients (31%): 19 (20%) with first stage, 6 (6%) with stage 2 and 5 (5%) with stage 3. The incidence of AKI was significantly higher in patients with hemorrhagic stroke, than with ischemic stroke (50% and 21%, respectively, p=0,004). The AKI patients had a higher NIHSS (National Institutes of Health Stroke Scale) severity scores (p=0,001) and lower Rivermed mobility index (p=0,0007) compared with patients without AKI. Previous chronic heart failure was the independent predictor of AKI (relative risk 6.7, 95% confidence intervals 1.8 to 20.0). The in-hospital mortality rate was 18%. AKI was independent predictor of in-hospital mortality (relative risk 5.4, 95% confidence intervals 1.5 to 19.3). CONCLUSIONS. Our results show that the incidence of AKI in patients with acute stroke is 31%. The ischemic stroke patients had a twice higher rate of AKI compared with hemorrhagic stroke patients. Previous chronic heart failure was the predictor of AKI. AKI was significantly associated with in-hospital mortality.

AIM OF RESEARCH. The aim of this study was to evaluate the capabilities of the bioimpedance vector analysis to assess aggregate hydration and nutritional status in hemodialysis patients and correction of «dry weight». PATIENTS AND METHODS. The study included 66 hemodialysis patients ($ = 42, $ = 24). The analysis of the blood pressure dynamics at each hemodialysis session as well as recording complications during the procedure were carried out during one month prior to the determination of the bioimpedance and «dry weight» correction and one month after the correction,: hypotension, seizures, hypertension episodes. In addition, the quality of life assessment using SF-36 questionnaire as well as nutritional status were performed prior to the determination of the bioimpedance. Bioimpedance was performed by multifrequency phase-sensitive bioimpedance analyzer NutriGuard-M (Data Input GmbH). Measurement of resistance (R) and reactance (Xc) were carried out at 5, 50 and 100 KHz. Bioimpedance vector analysis was performed at 50 KHz based on R and Xc axes, each of which were adjusted to the patient’s height. Simultaneously with assessment of the fluid status by bioimpedance vector the phase angle was also estimated. Achievement of the «dry weight» recommended after measuring of the bioimpedance was carried out gradually, depending upon the adaptive characteristics of each patient. RESULTS. The correction of «dry weight» was performed according to the results of the comprehensive evaluation of the patient hydration status: in 26 patients recommended weight was reduced by an average of 1,30±1,26 kg, in 20 patients the weight was increased by 0,60±0,29 kg, while in 20 patients the recommended weight was not changed. The frequency of hypertensive episodes after «dry weight» correction decreased by 0.44 episodes per month (95% CI: -0,84 ^ -0,08; p = 0.018) in whole group. Among patients with episodes of hypertension (44%) its frequency declined by 1.16 episode per month (95% CI: -1,87 ^ -0,45; p = 0.002). Among patients prone to hypotensive episodes its frequency decreased by 0,94 episedes per month (95% CI: -1,74 ^ -0,1; р=0,024). Such bioimpedance parameters as the phase angle, the cell mass proportion, the ratio of extracellular mass to body cell mass were significantly different in patients with serum albumin levels below and above 37 g/l (median). In addition to clinical and laboratory values the bioimpedance parameters were associated with the quality of life scales, mostly - with physical scales. CONCLUSION. The «dry weight» correction according to the results of bioimpedance vector analysis can improve blood pressure control and reduce the incidence of intradialytic complications. The phase angle, the cell mass proportion and the ratio of extracellular mass to body cell mass are directly linked with quality of life in the physical scales, as well as with nutritional status indicators.