R.Virchov’s cellular pathology contains some indirectly instructions: a) there are structural and functional units between cells and organ in vivo and b) mechanisms underlying the condition of health or disease are universal. In order to substantiate similarity of pathogeneses of atherosclerosis, diabetes mellitus, metabolic syndrome and obesity we suggest to use phylogenetic theory. It includes following postulates: 1) consideration of physiological and pathological processes in vivo from the viewpoint of biological functions and biological reactions. 2) Phylogenesis of metabolic regulation at the levels of: a) cells (autocrine), b) paracrine cell communities – structural and functional units of each organ (paracrine level), and c) the entire organism. Biological functions are: trophology, homeostasis, endoecology (“purity” of the intercellular medium), adaptation, locomotion (moving), reproduction, and cognition. 3) A three-step successive phylogenesis of biological functions and pathological responses. Methodological approaches in phylogenesis are: a) succession of biological functions and reactions and b) biological subordination where phylogenetically late humoral mediators cannot abolish the effects of phylogenetically early mediators. Incompliance of humoral regulation at different steps of phylogenesis, autocrine, paracrine and the organism levels is the basis and similarity of pathogeneses of all metabolic pandemias, including essential hypertension and insulin resistance syndrome.

INTRODUCTION. Optimal treatment for secondary hyperparathyroidism (SHPT) is not defined nowadays. The IMPACT SHPT (ClinicalTrials.gov identifier: NCT00977080) research compared 2 treatment regimens of SHPT for intact parathyroid hormone (iPTH) level control in patients receiving haemodialysis: 1) therapy based on dose-titrated paricalcitol with cinacalcet (only for hypercalcaemia); 2) therapy based on coombination of cinacalcet with low-dose vitamin D. PATIENTS AND METHODS. In this 28-week, multicentre, open-label Phase 4 study, participants were randomly selected to receive paricalcitol or cinacalcet with low-dose vitamin D. Randomization and analysis were stratified by paricalcitol injection method [intravenous (IV) or oral]. The primary efficacy end point was the proportion of subjects who achieved medium iPTH level of 150-300 pg/mL during Weeks 21–28. RESULTS. Of 272 subjects of randomized research, 268 received one or more dose of study drug. 101 patients from group with IV injection and 110 from group of oral administration with one or more values during Weeks 21-28 were included in the primary analysis. In IV injection, 57.7% of subjects in the paricalcitol group versus 32.7% in the cinacalcet group (P = 0.016) achieved the primary end point. In the oral administration group, the corresponding proportions of subjects were 54.4% for paricalcitol treatment and 43.4% for cinacalcet therapy (P = 0.260). Cochran-Mantel-Haenszel test, controlling for stratum, revealed overall superiority of paricalcitol (56.0%) over cinacalcet (38.2%; P = 0.010) in achieving iPTH 150-300 pg/mL during Weeks 21-28. Hypercalcaemia occurred in 4 (7.7%) and 0 (0%) of paricalcitol-treated subjects in the IV and oral administration, respectively. Hypocalcaemia occurred in 46.9% and 54.7% of cinacalcet-treated subjects in the IV and oral administration, respectively. CONCLUSION. Paricalcitol versus cinacalcet with low-dose vitamin D provided superior control of iPTH, with low incidence of hypercalcaemia.

AIM OF THE STUDY: evaluation of clinical significance of circulating antibodies to transmembrane phospholipase A2 M-type receptor of podocytes (anti-PLA2R Ab) in patients with primary membranous nephropathy (MN) on the top of already administered therapy. PATIENTS AND METHODS. 20 proved or prospectively observed patients with primary membranous nephropathy on symptomatic treatment with or without immunosuppressive therapy were included into observational study. Clinical data obtained at the moment of biopsy and during prospective follow-up included: gender, age, serum creatinine and albumin concentration, daily proteinuria (DP), AP, estimated glomerular filtration rate. Median of prospective follow-up was 525 (265- 1030) days. Anti-PLA2R Ab of IgG class was detected after treatment by indirect immunofluorescence. RESULTS. Anti-PLA2R Ab was found in 7 patients (group 1) and was absent in 13 (group 2) of 20 patients studied. There were no differences in level of proteinuria, albuminemia, AP and renal function at the time of biopsy. There were no significant changes in level of proteinemia, albuminemia and cases of clinical remissions in group 1 during treatment; in group 2 DP decreased significantly in contrast to initial value, serum albumin level practically normalized and clinical remission was achieved in all patients (3 cases – partial, 10 cases – complete). All cases of complete remission were observed after corticosteroids and cyclosporine combined therapy. CONCLUSION. Absence of anti-PLA2R Ab in patients on therapy is associated with achievement of clinical remission of primary MN; this test can be applied for monitoring of the disease activity, evaluation of treatment efficacy and prognosis.

AIM OF THE STUDY. Regulatory T-cells (RTC) are one of mechanisms of immune tolerance development and support. The aim of this research was evaluation of the content of circulating RTC expressing markers CD4, CD25 and Foxp3 in patients with functioning kidney transplant (KT). PATIENTS AND METHODS. 30 stable KT recipients with duration of post-transplant care from 6 to 24 month (averagely 353 days (95%CI 246-459), 7 patients within 1-3 month after KT and 5 healthy persons were enrolled the observational study. All patients received anti-CD25 monoclonal antibodies induction (anti-CD25МАb – basiliximab). Research of CD4, CD25 and FoxP3 lymphocyte expression in peripheral blood was provided by flow cytrometry method. RESULTS. The proportion of CD4+CD25+high FoxP3+ cells from total CD4+ cells number varied widely and was significantly lower than in healthy persons. The total expression of FoxP3 in lymphocytes had highly significant positive correlation with CD4+FoxP3+ cells content. The correlation between absolute number of T-cells with marker FoxP3 and RTC with CD4+CD25 + high FOXP3+ phenotype was revealed (rpearson=0,86; p<0,001). Averagely percentage of RTC from absolute number of FoxP3 expressing cells was 55% (95%CI 43-68). Also positive correlation was revealed between common expression of FoxP3 in CD4+ lymphocytes and RTC with CD4+CD25 +high FOXP3+ phenotype (rpearson=0,95; p<0,001). No correlation was found between СD4+СD25+ cells and RTC(rpearson=-0,08; p=0,68). Ratio or RTC and all cells expressing FoxP3 had distinct tendency to growth with increase of post-transplant period (rpearson=0,42; p=0,024). In patients surveyed within 1-3 months after transplantation and basiliximab content of CD25 on lymphocytes and number of cells with triple mark (СD4+СD25+ high FoxP3+) was very low, approaching to zero. At the same time, expression of CD4 and FoxP3 was high enough in these patients, significantly without differing from patients surveyed in later terms after operation. CONCLUSION. Received data indirectly testify that RTC pool after kidney transplantation is mainly defined by lymphocytes ability to express FoxP3. Causes for decreased RTC content in KT recipients, particulary role of anti-CD25МАb, demand follow up studies.

AIM: to estimate level of fibroblast growth factor 23 (FGF23) in renal allograft recipients and to evaluate interaction between FGF23 level and some clinical laboratory factors in early and long date after cadaver renal allografting (CRA). PATIENTS AND METHODS. Research included 46 renal allograft recipients, where 21 patient’s postoperative period was less than 24 months on the research period (group 1) and 26 patients with postoperative period more than 24 months (group 2). All patients were performed laboratory research complex, renal allograft ultrasound, serum FGF23 level detection by enzyme-linked immunoelectrodiffusion essay. RESULTS. In group 1 revealed statistically significant correlations between serum FGF23 level and clinical laboratory factors. FGF23 level directly correlate with age of patients (r=0,472; P=0,031), renal replacement therapy (RRT) duration before CRA (r=0,474; P=0,030), systolic blood pressure (BPs) level (r=0,482; P=0,027), erythrocyte sedimentation rate (ESR) (r=0,753; P<0,0001), creatinine (r=0,523; P=0,015), urea (r=0,483; P=0,026), sodium (r=0,634; P=0,002), uric acid (r=0,712; P<0,0001), triglycerides (r=0,476; P=0,029), glucose (r=0494; P=0,023), serum alkaline phosphatase (r=0,506; P=0,019) and proteinuria (r=0,615; P=0,003). High levels of FGF23 were noticed in patients with lower GFR values (r=-0,493; P=0,023). FGF23 feedback with phosphor level was noticed (r=-0,439; P=0,046). In second group FGF23 authentically increased in proportion to allograft function deterioration: direct correlation with serum creatinine (r=0,430; P=0,031) and invert correlation with GFR (r=-0,542, P=0,005). Proteinuria augmentation was involved with high level of FGF23 (r=0,637, P=0,001). In second group serum phosphor directly correlated with FGF23 (r=0,413, P=0,04) (fig. 2). CONCLUSION. In early periods after CRA noticed FGF23 level decreasing in proportion to phospho-calcium homeostasis factors normalization, when in the following in proportion to nephropathy progression in transplant, phospho-calcium metabolic imbalances increase, leading to increased FGF23 synthesis. Maybe in future FGF23 will become new therapeutic target for results improvement in postoperative period.

AIM OF RESEARCH. To evaluate assotiation between life quality factors (LQ) in haemodialysis (HD) patients and socialdemographic characteristics: gender, age, education and marital status of patient. PATIENTS AND METHODS. 753 patients on HD were examined. LQ was evaluated with the help of SF-36 health survey questionnaire. RESULTS. It was shown that men have higher LQ factors receiving HD. It was noticed that all LQ factors decline by age in patients receiveng HD. According to results of multiple linear step-by-step regression analysis, gender factor is associated with integrated index of physical health of interview schedule SF-36 and age allows to predict integrated index, physical and mental health values. Negative effect of female gender and age on LQ factors is independent in correction of regression models on length of HD treatment, albumine and hemoglobin levels, melancholy, anxiety and trait anxiety intensity. There are no LQ factors differencies between groups of patients with graduate and secondary education, married and lonelyhearts. CONCLUSION. Gender and age effect on LQ of patients receiving HD. Educational level and marital status don’t effect on LQ subjective value of these patients category.

THE AIM: To research spread and structure of pediatric cardiorenal syndrome. PATIENTS AND METHODS: Outpatient spread and structure of morbidity are analyzed with data from 41393 children and in-patient morbidity is analyzed with 4216 children hospitalized to nephrological and cardiological departments. RESULTS: Diseases of cardiovascular system were revealed in 104.1 per 1000 children with urogenital system diseases. Diseases of urogenital system were revealed in 95.8 per 1000 children with cardiovascular system diseases. Spread of cardiorenal syndrome was 4.06 per 1000 children in Saint Petersburg (5,21% of all children with irritation of kidneys and urinary tracts or 6,08% of all children with cardiovascular involvement). Cardiorenal syndrome more rapidly occurs in girls (66,7%). Among all urogenital disorders congenital kidney malformations, glomerulopathy and urinary infections and among all cardiovascular diseases – innate heart defects and disorders of cardiac rhythm and conductivity mostly contributed into the structure of cardiorenal syndrome. Bradycardia, autonomic dependant node dysfunction, short PO and extrasystoles were most frequent among children with cardiorenal syndrome. Minor heart malformations are noted in 21.8% of cardiorenal syndrome cases, with additional chord, prolapsed mitral valve and open foramen ovale most frequently revealed.

THE AIM. To evaluate the clinical relevance of procalcitonin (PCT) determination in urine in children with vesicoureteral reflux (VUR) and reflux nephropathy (RP). MATERIALS AND METHODS. 25 children aged 6 to 10 years (average age 6,34±4,67) with urinary tract infection (UTI), including 17 girls (68%) and 8 boys were examined. Diagnosis verification was carried out on the basis of anamnesis data and uronephrological patient examination. VUR I degree was diagnosed in 2 children (8%), VUR II degree – in 7 (28%), VUR III degree – in 3 (12%), VUR IV-V degree – in 13 children (52%). Depending on existence and severity of RP under results of the DMSA-scan all children were divided into 2 groups: 1 group – 6 (24%) children with VUR without sclerosis focuses, 2nd group – 19 children with RP, including 11 children with I-II degree of RP (type A and B) and 8 patients with III-IV degree of PN (type C and D). All children included in research had no UIT at PCT and DMSA-scan. PCT was inspected in first void urine by immunoassay (Brachms PCT-Q method). RESULTS. It is established that urine PCT excretion level in children with VUR reflects existence and intensity of RP. The highest PCT level in urine was observed in children with RP III-IV degree and was practically 6 times higher than in children without RP according to DMSA-scan data. CONCLUSION. Findings allow to recommend PCT research in urine as an additional noninvasive marker of renal parenchyma injury and also, possibly, for diagnosis latent inflammation in kidney parenchyma at VUR.

AIM OF RESEARCH. To analyze effect of high soya protein diet on expression levels of transforming growth factor (TGFβ-1), nuclear transcription factor (NFkB) and intensity of morphological characteristics of fibrosis and inflammation in renal tissue of rats with unilateral ureteral obstruction (UUO). MATERIALS AND METHODS. Unilateral left kidney ureter ligature was performed in 6 Wistar rats keeping standard diet (20% of animal protein; control group) and 7 animals (experiment group) after ureter ligature were put on diet with 50% soya protein (soybean isolates SUPRO 760, Solae Europe S.A., Switzerland). Follow-up period after UUO was 14 days. In experimental animals checked mean arterial pressure (AP) value, was performed light-optic morphologic research and estimated expression levels of NFκB and TGFβ-1 in renal tissue. RESULTS. In both, experimental and control groups no significant changes of average AP value in rats in 2 weeks after operation in comparison with presurgical level was revealed. Relative expression level of nuclear transcription factor NFκB in left kidneys (with ureteral obstruction) in control group was 1,5 times higher than in contralateral organs. In rats from experimental group no significant differences in relative expression levels of NFκB observed in both, right (healthy) and left (experimental) kidneys. Immunohistochemical activity of TGFβ1 in kidneys with ligatured ureter distinctly increased in both groups, but in rats on soya diet it was lower. Also in both groups in kidneys with ligatured ureters revealed distinct morphological characteristics of tubulointerstitial inflammation and fibrosis. However popularity of these alterations in rats receiving soya diet was significantly lower. CONCLUSION. Results of the research testified that: (1) prescription of diet with 50% soya protein significantly reduces intensity of inflammatory-fibrotic alterations in renal interstitium of rats after unilateral ureteral obstruction; (2) decrease of tubulointerstitial damage severity in this model is associated with decrease of expression of TGFβ-1 and NFκB; (3) mechanisms of soya protein direct effect on expression of genes TGFβ-1 and NFκB in renal parenchyma are being discussed.

AIM OF RESEARCH: to compare diuretic activity of arbutin and gidroquinon. MATERIALS AND METHODS: reference material of arbutin and chemically clean gidroquinon was inserted to rats orally and parenterally in doses of 18 mcM/kg and 54 mcM/kg. Diuretic activity of substances was evaluated by urinary volume. In urine fixed sodium and porassium ions. RESULTS: at oral insertion arbutin and gidroquinon have diuretic activity. Most likely that diurectic activity of arbutin and gidroquinon responds to their metabolites.

THE AIM OF STUDY: to evaluate the reasons of persisting dysuria after operative treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: complex urological examination, including urodynamic study, were performed at 73 patients (middle age 63,4±1,2 years) with disuria after operative treatment BPH. Disease duration was 3,4±0,5 years. Control group consists of 36 BPH patient with absence of dysuria after operative treatment of BPH. Middle age of patients in the control group was 64,1±1,2 years. RESULTS: Persisting dysuria after surgery at patients with poor results of BPH treatment commonly was caused by detrusor pathology: detrusor hyperactivity and impaired contractility. These conditions were diagnosed at 46 (63,0%) and at 26 (35,6%) patients. Based on results of urodynamic study at 19 (26%) patients was diagnosed both detrusor hyperactivity and impaired contractility. Less frequent reason for persisting dysuria was infravesical obstruction diagnosed at 9 (12,3%) patients. Based on results urodynamic study at 5 incontinence patients was diagnosed stress urinary incontinence due to sphincter impairment and at 16 patients mixed incontinence was found out due to detrusor dysfunction and sphincter impairment. CONCLUSION: Urodynamic examination of patients with poor results of operative treatment BPH allowed to define reason of dysuria, including incontinence. At majority patient persisting dysuria was caused by detrusor hyperactivity or/and impaired detrusor contractility.

Renal cell carcinoma (RCC) frequency steadily grows in the entire world as a result of objective growth of such patients number, but because of its detection at early stages with wide use of noninvasive diagnostics methods (ultrasound investigation, computerized tomography, etc.). Oncologic sirvival rate of patients with RCC essentially improved and in in this case increased significance of conservative surgeries for prevention of development or progression slowdown of already existing chronic kidney disease (CKD) – key factor of cardiovascular morbidity and mortality.

AIM OF RESEARCH: to evaluate glomerular filtration rate dynamics before and after the various options and volume of surgery in patients with kidney malignant neoplasms. PATIENTS AND METHODS: We examined 62 patients (men – 41, women - 21) surgically operated with malignant renal tumors (open, laparoscopic, or robot–assisted total nephrectomy or partial nephrectomy). The group 1 (n = 28) – tumor resection, group 2 (n = 34) – nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated by several methods: a brief MDRD formula [7], D.W. Cocroft and M.H. Gault formula (CCG) [8], the equations of CKD-EPI [9] and MCQ. RESULTS: showed that surgical operation led to authentic increase of SCr and Sur and significant decrease of eGFR regardless of the extent of surgical intervention. Intergroup differences in all researched parameters after surgery has not been established, although there was a trend downwards concerning all used eGFR methods in patients with nephrectomy (not statistically significant due to the considerable scatter of data). CONCLUSION: Surgical interventions in patients with renal cancer in the great majority of cases induce the development of chronic kidney disease 2–3 and, even 4 stages – an independent predictor of cardiovascular morbidity and mortality.

The systematic sequence index of articles published in v. 16 of the «Nephrology» journal in 2012.

Author Index.