Progress of nephrology is closely related to achievements of the allied sciences that developed particularly intensively at the end of XX century. The key role in nephrological development strategy is played by investigation of individual processes regulation nature providing activity of the organism as a whole. Renal function specification is seen as combination of its excretory and incretory functions, mechanisms of influence on it by regulatory systems and disfunction mechanisms are analyzed. Basically are used molecular systems with wide variety of types and subtypes of receptors, interaction of different varieties of cotransporters, pumps, water and ion channels, which provide high effectiveness of coordinated kidney work for stabilization of physicochemical data of internal environment. Development of physiology is important for clinical medicine progress, its achievements predetermine understanding of function mechanisms, identification of defect that formed basis of disfunctions, development of impaired functions compensation methods.

The review considers the possibility of an endogenous indicator of renal function -cystatin C (Cys C). The estimation results of the use of Cys C as a marker of glomerular filtration rate (GFR) in adults and children. The prospects of this parameter in the diagnosis of acute kidney injury. Evaluated the feasibility of its use in cardiology and diabetology. Available data suggest that this compound may provide a fairly objective estimate of GFR. In addition, Cys C seems somewhat superior to other routine methods for determining GFR in children and patients with diabetes mellitus. Nevertheless the results use of Cys C in clinical practice is inconclusive and require further research.

AIM. To estimate frequency and intensity of acute kidney injury (AKI) by RIFLE and AKIN criteria at patients with ST-elevated myocardial infarction (STEMI), to specify connection between AKI and mortality and effectivness of thrombolytic therapy (TLT). PATIENTS AND METНODS. 165 patients (134 men and 31 women, average age 56,6±10,43 years) with STEMI, who were performed TLT. AKI was diagnosed and classified by RIFLE and AKIN criteria by creatinine (RIFLECr, AKINCr) and diuresis (RIFLEOU, AKINOU). RESULTS. TLT was effective at 115 patients (70%). According to RIFLECr AKI was diagnosed at 87 patients (53%), by AKINCr criteria – at 101 patients (61%). According to RIFLEOU and AKINOU criteria AKI was noticed at 56 patients (34%). 9 patients (5%) died. Logistic regression analysis showed that AKI about RIFLEOU and AKINOU was time and age independent from the beginning of characteristic clinical picture till hospitalization associated with intrahospital mortality (hazard ratio 17,1; 95% CI 2,01 – 146.46; p=0,006). CONCLUSION. More then half of patients with STEMI have AKI by RIFLECr and AKINCr criteria. AKI frequency by RIFLEOU and AKINOU is twice as little in comparison with evaluation by AKINCr and 40% fewer in comparison with evaluation by RIFLECr, AKI presence is associated with effect absence from thrombolytic therapy and increased intrahospital mortality.

THE AIM. To study the relationship between baseline Doppler parameters of arterial blood flow in the ischemic kidney and the functional state of organs after revascularization in patients with atherosclerotic renal artery disease (ARAD). PATIENTS AND METHODS. In 64 patients with haemodinamically significant ARAD (40 men and 24 women at the age of 47-78 years, average age 60±8 years) were analyzed the following parameters: blood flow peak systolic velocity, end-diastolic blood velocity (EDBV), pulse index (PI), resistive index (RI) and blood flow acceleration time (BAT) defined in renal artery (RA) and intraparenchymal arteries in 85 ischemic kidneys depending on renal function (RF) status after kidneys revascularization (KR). Also morphometric analysis of arterioles was performed. RESULTS. At patients with distant RF mend after its revascularization RI and PI were significantly lower in distal third of RA, segmental and interlobar arteries. The thickness of media and vascular index were significantly higher in ischemic kidneys of patients with distant GFR decline after KR. On the contrary, inner lumen of the arteries with external diameter>100 μm was less. The latter was directly related to the EDBV and back - with the RI in segmental arteries. CONCLUSION. Renoprotective effect of KR is detected by relative dynamics of GFR in pre- and postoperative periods, irrespective of blood pressure decreasing and is determined by intrarenal arterial bed status. After blood flow recovery in ischemic kidneys GFR can be increased at decreased intrarenal peripheral resistance which appears by saved EDBV and also low values of PI and RI at Doppler examination.

THE AIM. Definition of furosemide diuretic activity dependence from time of its introduction to rats and identification of revealed distinctions possible reasons. MATERIALS AND METHODS. In experiments on rats daily fluctuations of furosemide effect was defined and histologically – functional activity of renal tubule cells capacity (by means of cytomorphometry). Diuresis was measured in 6 and 24 hours after administration, containing of Na, K, creatinine and furosemide was detected, nuclearcytoplasmatic relations in epithelial cells of renal tubules and correlation of active and inactive renal cells were counted. RESULTS. Furosemide introduction at 12.00 led to fast increasing of diuretic activity preserving during the day, substantial growth of sodium and potassium rejection, increase of daily creatinine excretion. At furosemide introduction at 24.00 number of quantitative differences was found: more significant diuretic and especially natriuretic effect, increase of potassium and creatinine excretion at night. Cytomorphometry data indirectly confirmed that during the dark period of day functional renal activity of rats is essentially higher then at day-time. CONCLUSION. Diuretic effect of furosemide at rats is subject to circadian fluctuations and is more expressed at night. Daily fluctuations in furosemide effect at rats operation are caused by changes of functional renal activity during the day.

Overactive bladder (OB) is one of the most frequent disfunction of lower urinary tract and clinically occurs by urgency, uresis acceleration and urge urinary continence. Anticholinergic medications are the base of neurogenic OB patients’s therapy. They increase bladder capacity, decrease intravesical pressure, reduce OB symptomatology intensity. Constantly patients with neurogenic OB need anticholinergic medications in higher doses then patients with idiopathic OB. Also, combined administration of several anticholinergic medicationbs is possible. Inefficiency or low tolerance to peroral drug therapy is an indication for neurotoxins intravesical administration, firstly botulinus toxin.

During the period since June 2010 till May 2011 employees of general surgery and urological clinics of Pavlov State Medical University of St.Petersburg and Almazov Federal Heart, Blood and Endocrinology Centre performed 17 robot-assisted laparoscopic nephrectomies and 4 robot-assisted laparoscopic kidney resections with robot-surgical complex «da Vinci» (Intuitive Surgical, USA). Age of patients varied from 47 to 78 years, among them 10 women (47,6%), 11 men (52,4%). Renal adenocarcinoma is histologically verified at all patients. One patient with accompanied cholelithiasis was executed combined surgical intervention – dextral nephrectomy and cholecystectomy. Sizes of tumors varied from 3 to 8 cm. In three cases with tumor sizes less then 4 cm located subcapsular, organ-preserving fractional nephrectomy was performed. One patient had solitary kidney (nephrectomy 5 years ago concerning cancer). Robot-assisted surgeries at kidney tumors have a number of advantages in comparison with laparoscopic operations: ergonomically favorable surgeons position, 3D picture on operative field, 7 movement degrees of blade of an instrument, natural arm tremor liquidation. Such surgeries allows to expect better postoperative effects.

This review is a synthesis of available data about the features of kidney injury in acute poisoning in children. Clinical features of kidney injury in children with poisoning (acute tubulointerstitial nephritis, Fanconi syndrome, acute renal failure) are presented. The terminology and classification of acute kidney injury (AKI) in children in according to etiology, pathophysiologic mechanisms and severity (p-RIFLE) are discussed. We conclude that the implementation of terminology and classification of AKI in pediatric nephrology practice is very important.

The article presents the international approaches to the treatment of patients suffering from systemic lupus erythematosus with renal and Anti-Phospholipid Syndrome. The article presents modern classifications of lupus-nephritis in children and adolescents, given the characteristics of main drugs used as induction and long-term maintenance therapy is given.

THE AIM. To develop a system of immunochemical screening via determination of natural autoantibodies to identify predisposition to renal disease in the newborn and formation of risk groups. PATIENTS AND METODS. We examined 46 newborns who were divided into primary (children born from mothers with pyelonephritis, as well as in women with inflammatory diseases of the pelvic organs) and control (of women without a history of aggravated perinatal diseases of the urinary system) groups. In serum samples of all children examined levels of natural IgG class autoantibodies to antigens of major organs and systems of human body, as well as to antigens of kidney parenchyma. RESULTS. Revealed that newborns with elevated levels of autoantibodies to antigens of kidney tissue was significantly greater in the primary group. CONCLUSION. It is possible to consider autoimmunity research method with auto-AT quantitation to kidney tissues can be considered prognostically significant for early diagnostics of renal pathology formation at newborns. Developed and submitted immunochemical screening protocol.