Extended daily dialysis (EDD) is becoming increasingly popular method of extracorporal substitutive therapy for patients with acute lesion of kidneys in practice of the department of intensive care (DIC). Long dialysis time (usually 8-18 hours), low flow of dialysate and blood are the key elements of EDD as a method of substitutive renal therapy. Prospective controlled investigations of patients in critical state confirm that clearance of low-molecular substances used in DIC can be compared with interrupted hemodialysis and uninterrupted veno-venous hemofiltration even when the latter was used with high speeds of liquid substitution. In addition, the cardio-vascular stability in patients with EDD was similar with that in uninterrupted methods of substitutive renal therapy. The regimen of performing daily dialysis at night has an additional use because it does not cut down the access of the DIC personnel to the patient during day, minimize the interaction of the substitutive renal therapy with other DIC procedures. Thus EDD has a combination of both intermitting hemodialysis and uninterrupted procedures, that make it a practically ideal method to treat patients with renal failure under conditions of practice of resuscitation. Although, the prospective clinical investigations have not been finished yet, all the available at present data show that outcomes of treatment of the patients on EDD are not different in predicted degree of the disease from the results of treatment using uninterrupted substitutive renal therapy. Hence, many Centers of the world are already using this “hybrid” technique, using modified standard dialysis equipment. EDD also proposes sufficient possibilities for the interaction between nephrologists and resuscitators with divided responsibility. The nephrological personnel are responsible for the prescriptions, beginning and maintenance of the treatment, while specialists of DIC are responsible for monitoring, variants of ultrafiltration, complications and completion of the procedures. Such joint access to the management of the patients is optimal for the patients in critical state, where new accesses and knowledge of two specialties in DIC are used. We think that EDD will be the principal method of substitutive renal therapy in acute lesion f the kidneys in patients in critical state.

The review includes data of outstanding prospective and retrospective researches on the spread of with the development of nephropathy in the world, based on the results of prolonged observations of the large samplings. Main mechanisms of participation of the kidneys in the development of essential hypertension are presented, as well as histological alterations appearing in the renal tissue with the given pathology.

The work briefly discusses the problems of rendering specialized pediatric nephrological medical care in the Russian Federation. Special attention was given to necessary maintenance of possibility of highly qualified specialized nephrological care at all links for children and adolescents, more importance of the out-patient link, development of nephrological sanatoria for children as the State institutions of health protection. Performance of measures for enlargement of specialized care to children in daily nephrological hospitals is a modern approach of hospital-substituting technologies. An important direction in the improvement of organization of specialized pediareic nephrological care is guaranteeing availability of highly technological (expensice) help to children and adolescents at specialized centers, centers of dialysis and transplantation.

Cause-effect relations formed in the process of the development of diabetic nephropathy, dynamics and mechanisms of impairments of the tubular system were analyzed which by means of tubule-glomerular feedback can induce progress of the pathological process in renal corpuscles and in a matter of fact, determine the terms of manifestation of renal dysfunction in diabetes mellitus. At the same time the state of the tubule-interstitial apparatus of the kidney aggravated in dysfunction ofthe vascular glomerules due to the elevation of the volumetric loading of the tubules in hyperfusion of the nephrons, progress of proteinuria and increase production and filtration of cytokines. The presented facts open a new page in molecular biology of transport processes in the kidney, in particular with diabetes mellitus. The elucidation of the mechanisms of molecular remodeling of the renal; tubules, induced by pathogenetic factors of diabetes mellitus allows the strategy of diagnosis of diabetic nephropathy to be developed at the preclinical stage and to determine a new stratery of prophylactics and correction of tubular dysfunction in this condition.

The work contains data of the effects of aldosterone when binding with epithelial and non-epithelial mineral corticoid receptors. The pathophysiological role of this steroid hormone is shown in the development of cardiovascular complications in chronic diseases of the kidneys as well. The data of experimental and clinical investigations are presented demonstrating the ability of aldosterone to cause fibrosis of the myocardium and vessels

Arterial hypertension (AH) in patients with chronic renal pathology is a result of a damage and impaired function of the kidneys involved in the maintenance of the water-salt and circulatory homeostasis. The progressing damage of the renal tissue, in addition to activation of the circulating renin-angiotensin- aldosterone system (RAAS) characteristic of the hyper-renin form of nephrogenic AH, brings on reflectory stimulation of the central structures sympathetic system, which lead to growing sympathetic influence on the cardiovascular system and kidneys. A characteristic feature of the neuro-humoral status of patients with normo- , and especially with hyporenin forms of nephrogenic AH is an elevated activity of endothelin system of the vessels. Formed in the kidneys disbalance of neurohumoral systems is accompanied by excessive reabsorption of sodium, which not only suppresses the mechanism of pressor natriuresis contributing to stabilization of AH at a higher level, but causes its delay in organism, providing for the development of volume-dependent and salt-sensitive AH.

THE AIM of the work was to assess effects of Omakor on the indices of lipid metabolism in children having glomerulonephritis with nephritic form (NF) of chronic glomerulonephritis (CGN). PATIENTS AND METHODS. Examinations were performed on 62 sick children (34 boys and 28 girls) with NF CGN, mean age 11,6±0, 17 years, prescription of the disease 4,31±0,31 years.In 13 children there were impaired functions of the kidneys. In the first group 38 children were given standard therapy; 24 children of the second group were given Omakor 1 capsule a day (in the morning after meal) during 15 days against the background of standard therapy. Indicators of the lipid specter were estimated with a biochemical autoanalyzer «Daytona» from Randox. RESULTS. Inclusion of Omakor in the complex of standard therapy resulted in a reliable decrease of total cholecterol (TCS) in children with the savedand impaired function of kidneys as compared with the initial values the1.2 and 1.4 times respectively, triglyceride (TG) – 1.24 and 1.23 times, cholesterol of lipoproteins of low density (CS-LPLD) – 1.32 and 1.64 times. The level of cholesterol of very low density lipoproteins (CS VLDL) had a tendency to decrease, cholesterole of high density lipoproteins (CS HDL) to increase. Such alterations in the patients’ l.ipid specter of blood serum promoted decreased coefficient of atherogenicity to 3.26± 0.15 and 3.29±0.83. CONCLUSION. Standard therapyNF CGN fails to substantially influence on dyslipoproteidemia. Inclusion of Omakor in the standard therapy promoted a reliably decreased levels of TG, TCS, CS -VLDL and CS –HDL, and as a consequence, atherogeneity coefficient.

THE AIM of the investigation was to study the occurrence and clinic-pathogenetic value of prothrombotic genotypes which are of the greatest clinical and prognosic value among hematogenic thrombophilias. PATIENTS AND METHODS. Examination was performed in 180 patients with chronic glomerulonephritis (mean age 22.3±0.8 years). In addition to complete clinical and instrumental examination used at the specialized nephrological clinic, with the help of polymerase chain reaction the diagnosis of a single nucleotide change of C677T in the gene of methylenetetrahydrofolate reductase, punctated gene mutation of V factor of blood coagulation, and G20210A mutation in 3’ nontranslated area of gene of II factor of blood coagulation (samples of genomic DNA was obtained from peripheral blood leukocytes by the method of phenol-chloroform extraction). The control group included 100 healthy subjects with similar demographic characteristics. RESULTS. It was found thst protrombogenic mutations under study can be found in patients with chronic glomerulonephritis more often than among healthy subjects. These nucleotide changes are associated with the development of hypercoagulation syndrome and high risk of renal failure in patients with chronic glomerulonephritis. CONCLUSION. The results of thisinvestigation show that at least part of the patients with chronic glomerulonephritis have genetically determined elevation of thrombogenic potential of blood.

THE AIM of the investigation was to study the level of the concentration of plasma aldosterone, the state of the hemostasis system and function of endothelium in patients with the V stage chronic kidney disease (CKD) on programmed hemodialysis and to estimate the effects of spironolactone therapy on them. PATIENTS AND METHODS. In the investigated 83 patients with V stage CKD on programmed hemodialysis the following indicators were studied: determination of the concentration of plasma aldosterone (CPA), assessment of the functional state of the endothelium using biochemical markers – plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), endothelin-1, state of thrombocytic and coagulation link of hemostasis were estimated by morphofunctional activation and aggregation of thrombocytes, concentration of fibrinogen after Clauss, activity of antithrombin-III (AT-III), D-dimer level by the method of latex agglutinationb before and after 6-month course of therapy with spironolactone. RESULTS. All the patients initially had considerably elevated level of blood aldosterone -478±99.96 pg/ml (normal – up to 160.0±29.23 PG/MK0 pg/ml). Against the backgroung of spironolactone therapy there was a reliably decreased level of aldosterone up to 346.45±58.1 pg/ml (p=0.009), reliably decreased activity of the endothelial dysfunction markers: endothelin-1 from 0.63±0.09 fmol/ml to 0.23±0.03 (p=0.002), PAI-1 from 5.69± 0.24 up to 3.06± 0.25 U/ml (p<0.001); elevation of the level of t-PA from 5.03±0.3 up to 5.64± 0.3. The investigation of the hemostasis system revealed activation of the thrombocytic link: increased sum of active forms of thrombocytes and greater number of thrombocytes involved in aggregates at the expense of the formation of intravascular aggregates of small size (p<0.05), increased concentration of fibrinogen (p<0.05) as compared with the group of healthy subjects, the value of AT-III was at the low border of the reference values, 30% of patients had higher level of D-dimer. No reliable changes in the indices of hemostasis after treatment with spironolactone were found. CONCLUSION. Spironolactone therapy in patients on programmed hemodialysis results in the better state of the endothelium function. The disbalance in the system of hemostasis remains the same, and is characterized by activation of thrombocytes, tension in the system AT-III, elevation of the D-dimer level, that might increase risk of the development of vascular catastrophies in patients with chronic kidney disease.

THE AIM of the work was to establish structural bases of the impairment of the kidney functions under conditions of difficult blood flow to these organs. MATERIAL AND METHODS. Modelling of chronic renal ischemia was made by growing constriction of the aorta in 30 puppies. The animals were observed during the period from 6 months to 2 years. The level of blood inflow to the kidneys and blood pressure were measured, and the organs were investigated histologically, stereometrically and morphometrically. In the group of control there were 10 dogs of the corresponding age. RESULTS. It was found that constriction of the aorta due to less inflow of blood to the kidneys during certain time resulted in the development of a complex of adaptational and pathological alterations in their vascular system. The first ones appear as lower tone and atrophy of circulatory muscles of the renal arteries bringing the level of the development of the walls to conformity with the functional load, as well as transformation of some of them by the closing type, and the others - to the development of sclerosis and hyalinosis of the renal vessels. The latter is accompanied by disorders of hemocirculation in the blood basin of the kidneys and secondary alterations of glomerules and non-vascular structures of these organs. Renal glomerules were subject to sclerosis, while the renal parenchyma consisting of a system of tubules, to dystrophicand atrophic alterations. On its place there grows the stroma. CONCLUSION. All this complex of morphological alterations is a precondition for disturbaces of kidney functions, that can be observed in the clinic in patients with stenosing atherosclerosis of renal arteries.

THE AIM of the investigation is concrete definition of morphogenetic mechanisms of realization of nephroprotective effect of AT₁ receptor blockade in rats after degradation of urodynamics which was produced in the model of acute obstruction of the ureter. MATERIAL AND METHODS. The first group (n=30) included animals without pharmacological correction. Rats of the second group (n=30) were given Lozartan (10 mg/kg a day) during 2 weeks after restoration of urodynamics. The morphological state of the kidney was investigated in 7, 14 and 30 days using quantitative criteria. RESULTS. In 7 days in the second group of animals there was optimization of the glomerular and peritubular blood flow with the decreased degree of alteration of the tubules of the cortical and external medullary substance by 26.41% and 48.51% respectively. The specific volume (SV) of infiltrates in the cortex external and internal medulla of the kidney with AT₁ receptor blockade was respectively 36.57%, 40.34% (p<0.01 and 17.42% lower (p<0.05) that in the first group. Within 14 days in the cortical and external medullary substance of the postobstructive kidneyof the 2 group rats there was decreased intensity of the inflammatory infiltration, normalization of the state of peritubular capillaries, intensification of the reparative processes in the kidney: SV of the tubules with normal structure and regeneration signs was 9.67% (p<0.05) and 59.26% (p<0.01) higher, and SV of the tubules with the signs of alteration – 60.19% lower that in the first group (p< 0.01). By the 30th day restriction of fibrosing in the postobstructive kidney was revealed: the interstitium SV was 21.43%, 25.53% and 17.65% lower than in the first group respectively in the cortical, external and internal medullary substance. CONCLUSION. AT₁ receptor blockade facilitates the restortation of the structural-fuctional state of the cortical substance, completion of the inflammatory-reparative process and limitation of fibrosis in the medullary substance of the postobstructive kidney.

THE AIM of the investigation was to study the state of microcirculation in the urinary bladder wall in patients with hyperactivity of the urinary bladder (HAUB) and its relations with clinical manifestations of the disease. PATIENTS AND METHODS. The state of microcirculation in 48 women with HAUB and 32 healthy women of the control group was studied using intravesicular high-frequency ultrasonic dopplerography by an original technique. The correlation between the state of blood flow in the urinary bladder and the degree of HAUB symptoms were studied. RESULTS. In women with HAUB as compared with the patients of control group there was deterioration of blood flow in the microcirculation bed in its arterial, venous and capillary parts. The degree of a disturbance of microcirculation depended on the degree of prolapse of pelvic organs and was associatedwith the degree of HAUB symptoms. The frequency of imperative vesical tenesmus correlated with the values of the indices of arterial blood flow, and the degree of frequency of vesical tenesmus – with the indices of the venous and capillary blood flow. CONCLUSION. Women with HAUB have disturbed microcirculation in the urinary bladder wall, whose degree is associated with the degree of symptomatology of the disease.

In 1861, Thomas Graham introduced the term «dialysis» to describe the separation of substances across semi-permeable membranes. Between 1912-14, J. Abel, L. Rowntree and B. Turner in Baltimore (USA) created the first «artificial kidney» consisting of several handmade tubes of collodion which served as semi-permeable membrane. The blood of the experimental animal circulated through the extracorporal system using the force of the heart. In Germany, both H.Necheles (Hamburg) and G.Haas (Giessen) built haemodialysis devices with the purpose to remove the uremic toxins from the blood. The apparatus of Necheles consisted of a tube system made of sheep peritoneum. Haas constructed his dialyzer from collodion tubes. All of above mentioned authors used hirudin as an anticoagulant. Georg Ganter (Wurzburg) proposed an alternative mode suggesting the use of peritoneum as an especially large endogeneous membrane. Between 1922-23, he performed serial experiments on ureter-ligated guinea-pigs and rabbits. Ganter was able to demonstrate that the single or repeated instillation of physiological NaCl solution in the abdominal cavity improved both the uremic symptoms and the blood urea nitrogen level. In two patients the new method was implemented only in the form of a single fluid instillation: in a female patient with acute uremia as a consequence of bilateral ureter occlusion due to uterus carcinoma, and in a patient with a diabetic coma. In 1923, G.Ganter published his classical paper «Ueber die Beseitigung giftiger Stoffe aus dem Blute durch Dialyse» («About the removal of toxins from the blood through dialysis»).