In 2002 a group of experts Acute Dialysis Quality Initiative (ADQI) developed a definition of acute renal kidney failure (ARF) and created a system of its risk stratification. (RIFLE-criteria). In 2004 was proposed a conception of «acute injury» (AKI), and in 2007 an experimental group Acute Kidney Injury Network (AKIN) offered a diagnostic criteria system and evaluation of the degree of such condition (AKIN-criteria), which was a modification of RIFLE classification system. Both systems gave a good showing of themselves in practice for the prediction of the development of AKI and its outcome in patients in critical condition. However, not the RIFLE system, nor the AKIN system initially did not suppose to include the patients with acute primary parenchymatous renal damage, which does not satisfy the nephrological community. A modification of the AKIN system, which allows to dismiss such limitation, was proposed.

Basic mechanisms of the development of protein-energy malnutrition in patients with chronic kidney disease (CKD) in the state of terminal renal insufficiency, with hemodialysis (HD) treatment are shortly evaluated. The role of leptin is described in detail. Leptin is anorexigenic hormone, which is secreted by blood adipocytes in various quantities and controls the mass of adipose tissue, by means of lipid exchange stimulation in the organism. Leptin, by influencing the arcaute nucleus of hypothalamus, leads to decreased food intake and maintenance of lipid exchange on a normal level. Leptin is perceived as hormone that’s prevents overweight. At the same time in most overweight patients was noticed an increased level of leptin in blood, and such hyperleptinemia was interpreted as a proof of decreased sensitivity to physiologic action of hormone. In hemodialysis patients was noticed a higher level of circulating leptin, as opposed to healthy group. Keeping in mind that leptin participates in the regulation of food intake and energy output, was made an assumption that hyperleptinemia in patients with end stage renal disease, can be one of the factors, leading to anorexia and development of malnutrition (or cohexy). Theoretically, this interactions seem quite logical, but the results of the investigations on the connections of hyperleptinemia and excess of malnutrition in end stage renal disease were contradicting. The presence of such contradictions necessitates a more further scientific investigations in such direction.

THE AIM. To determine the character of the connections between the left ventricular function, evaluated during the tissue dopplerography investigation (TDI) and the parameters of phosphorus-calcium balance in hemodialysis patients (HD). PATIENTS AND METHODS. 53 patients were evaluated (29 men, 24 women), in the mean age of 51,6 ± 12,9 years, who were on HD during 73,7 ± 68,6 month, not suffering from rheumatism, infectious endocarditis, cardiomiopathias, with echocardiographic examination performed (EchoCG), with additional TDI. The levels of intact parathormone (PTH), alkaline phosphatase (AP), bone markers of synthesis (osteocalcin) and reabsorbtion (C-telopeptides of type 1 collagen), fibrinogen and C-reactive protein (CRP) were evaluated. The extend of bone-joint pain was evaluated in points. For the evaluation of mineral bone density (MBD) densitometry of the three parts on the skeleton was performed in 25 patients. By means of X-ray the thickness of the cortical layer of the 2 nd middle metacarpal bone and the extend of the calcification of abdominal aorta was evaluated. RESULTS. The systolic dysfunction by means of various methods of EchoCG was discovered in 13,3-49,1% of the patients. In all patients was discovered at least one segment systolic dysfunction. Diastolic dysfunction was diagnosed in 58,5-94,3% of the patients. Diastolic function by E/A segment was worse in patients with lower values of MBD of forearm, with more expressed calcification of abdominal aorta. Diastolic function by E/A (FC MC) was worse in patents with lower MBD of forearm, lower thickness of cortical layer by X-ray, higher calcification of abdominal aorta, higher level of CRP. The speed of diffusion of early diastolic wave was higher in patients with higher values of MBD of forearm, lower level of C-telopeptides of type 1 collagen and osteocalcin. The systolic function by Vs ФК МК was lower in patients with lower MBD of forearm, higher levels of PTH, C-telopeptides of type 1 collagen, CRP, higher extend of bone-joint pain. CONCLUSION. TDI is a more sensitive method of evaluation of cardiac function in comparison with standard methods of EchoCG in patients on HD. For the first time was detected that with the decrease of MBD and extensive calcification of aorta, the systolic and diastolic function of left ventricular was worse by the TDI data.

THE AIM. To evaluate the connections between myocardial ischemia (MI) and parameters of 24 hours’ blood pressure profile in prevalent group of CHD hemodialysis patients (HD). PATIENTS AND METHODS. During the years 2003 – 2007 we investigated the prevalent group of stable patients of programmed hemodialysis with the stated diagnosis of CHD (n=61). Synchronous ECG monitoring (CM) and BP (in 61 patients during the 1^st 24 hours after hemodialysis, and 43 – after the 2^nd24 hours) were performed to all patients. The amount and total duration of MI; the dynamics of BP changes during the HD procedure; the mean values and quantative indexes of systolic (SBP), diastolic (DBP), pulse (PBP) and mean BP (mBP) in the day and night time of interdialysis period was analyzed. RESULTS. Out of 61 patients with stated diagnosis of CHD, the ischemic changes during CM were detected in 57,4 cases (n=35). During the 1^st 24 hours the ischemic episodes were detected in 34 out of 61 patients (55,7 %). During the next 24 hours the MI was registered almost twice as rare: out of 43 patients, after the second daily CM, the depression of ST was detected in 27 % (n=12). In overwhelming majority, during the second 24 hours the MI was detected in same patients as it was during the first 24 hours (11 out of 12). In the group of patients with MI the day and mean values of PBP during CM were reliably higher. The absolute values of SBP, DBP, PBP and mBP reliably did not differ during various periods of development of MI (during dialysis, 1^st and 2^ndinterdialysis 24 hours). In patients with ECG signs of MI in the 1^st 24 hour after HD the negative correlation connections between total number of ischemic episodes and mean values of PBP at night (R=-0,498, p=0,003) and SBP at night (R=-0,462, p=0,008) were detected. In the group of patients (n=12) with registered during the 2^nd24 hours after HD episodes of depression of ST, the quantity and total duration of the last were obviously inversely connected with day SBP during 1^st and 2^nd24 hours; the quantity of ischemic episodes - with day and night SBP during 1^st and 2^nd24 hours, with day and night PBP in 1^st24 hours, and also with night PBP during 2^nd24 hours. Besides that, the quantity of MI episodes was reliably connected with the day and night values of mAP during the 1^st night and 2^ndday. The values of MI during the 1^st 24 hours had positive connection with quantative indexes of AP, connected with the extend of decrease of threshold levels of day/night SBP and DBP (101/86 and 61/48 mm Hg accordingly). The threshold heart rate in each case of MI was reliably connected only with DBP (p=0,007), and not SBP or PBP. CONCLUSION. The development of MI in patients with CHD on HD was obviously connected with the degree of DBP and SBP decrease in interdialysis time period. The further accumulation of clinical data in this area and investigation of the mechanisms of the influence of system BP on the coronary perfusion may have an important meaning for improvement of the HD treatment.

THE AIM. To analyze the interactions between the damage degree of coronary arteries and the calculated glomerular filtration rate (GFR) in males with ischemic cardiac disease (CHD) without the signs of «primary» renal pathology, taking into consideration the influence of various traditional risk factors of cardio-vascular disease (arterial hypertension, dislipidemia, age, smoking). PATIENTS AND METHODS. 300 males suffering from CHD, with proven coronary angiography (CA) were evaluated. The results of CA were evaluated with semiquantative methods. RESULTS. The severity of the coronary channel damage was in reverse connection with the values of GFR, arterial hypertension levels, age and some figures of blood serum lipidogram. The values of GFR of smoking patients with CHD were much lower, than of ones never smoked. CONCLUSION. The results of the investigation show that the renal dysfunction is often seen in patients with CHD, while they do not have the obvious signs of «primary» renal pathology. And with that, such factors as extend of arterial hypertension,  dislipidemia, age and smoking habits,  probably, act as the predictors,  not only of the severity of the coronary arteriosclerosis,  but also of a renal damage in such patients.

THE AIM. To specify the role of leptin in the development of protein-energy malnutrition (MN) in hemodialysis patents. PATIENTS AND METHODS. 86 HD patents with chronic renal disease stage 5, out of whom 40 women and 46 mane of mean age 52,2 =-1,3 years, were evaluated. The cause of ESRD in all cases was primary glomerulonephritis. All patients were treated with programmed hemodialysis during the mean of 6,4 ±1,1 years. For the evaluation of the daily consumption of proteins, fats, carbohydrates, total calorie content the patients filled out food diaries during one week. For the evaluation of the nutritional status caliperometry and integral dual-frequency impedancemetry with the KM-AP-01 device produced by “Diamant”, Russia with the determination of muscular and fatty mass were used. In 78 patients was measured the concentration of leptin in blood serum by means of radioimmuno assay (Active Human Leptine Elisa, 10 – 23100i, DSL, USA). RESULTS. The interconnection between hyperleptinemia and malnutrition in chronic hemodialysis patients was determined. It was shown the hyperleptinemia contributes to the development of malnutrition mainly in the early periods of hemodialysis therapy and in patients with increased fat body mass. It was determined that bioimpedancemetry is preferred method for the evaluation of body mass composition of the HD patients, in comparison with caliperometry. CONCLUSION. Hyperleptinemia can be one of the pathogenetic factors, participating in the development of MN in various patients with TNI.

THE AIM. To asses the  influence of the  left ventricular hypertrophy and  its forms of the efficiency of dosed  physical activity in hemodialysis patients.  PATIENTS AND METHODS. 107 clinically stable hemodialysis patients were evaluated. All patients had spiroergometry and echocardiography. RESULTS. In 80% of the patients the left ventricular hypertrophy was revealed:  in 52 - concentric and in 37 - eccentric forms. Initial physical work capacity was decreased in all patients, maximum oxygen consumption (MOS) did not exceed 25 ml/min/kg. Regular physical training contributed to the increase of the MOC to 15%. In patients with LVH the effect was minimal as opposed to the patients without it. CONCLUSION. The presence of eccentric LVH, the duration of hemodialysis for more than 1 year and training less than 7 times per week decreased the efficiency of physical training.

THE AIM. To study the influence of magnesium salt on the development of calcium-phosphate nephrolithiasis. MATERIALS AND METHODS. 42 male rats were on a calcium superfluous diet during 70 days (the content of elementary calcium in the diet exceeded in 1,8 times the normal daily need). After the level of crystaluria and calciuria of the animals with model-based pathology was reliably different from the control group, magnesium chloride, magnesium L – asparaginat, its combinations with vitamin B₆, magnesium sulphate and magne-B₆ in the dose of 50 mg of elementary magnesium on kg body weight was introduced per os through the stomach pump. RESULTS. After 70 days of the diet was noted the higher level of calcium and phosphate in the urine (to 49 % and 40 % than in the control group), twice increased the urine Ca/Mg ratio, appeared crystaluria. Inclusion volume fraction of calcificates in renal parenchyma was 14 %. In groups receiving magnesium salts and its combinations with vitamin B₆, was noted the lower level of calcium and phosphates in blood serum and urine, lower extend of crystaluria, lower volume and size of calcificates. The most effective was magnesium L – asparaginat, its combination with vitamin B₆ and magne-B₆. CONCLUSION. The further study of following magnesium salts as the remedy for the treatment of calcium-phosphate nephrolithiasis seems very promising.

THE AIM. A comparative evaluation of the efficiency of the modern methods of treatment of patients with coral nephrolithiasis. PATIENTS AND METHODS. Under medical observation were 138 patients with coral nephrolithiasis, who were, according to the classification proposed on the IV all-union urologists’ congress (1990), divided into 4 groups, the patents were examined before the treatment, in the near postoperative period and after 6 month – 9 years after the discharge. The examination included the clinical, laboratory, ultrasound, X-ray and radiological methods. The density of the calculus was determined by the Hounsfield scale. More often the patents had the distant shock-wave lithotripsy and percutaneous nephrolithotripsy. RESULTS. After the treatment the total destruction of the coral calculi was noted in 90,6% patients The most effective was the «sandwich» therapy, which included percutaneous nephrolithotripsy with the following distant shock-wave lithotripsy of residual calculi. CONCLUSION. The choice of the method of the treatment of the patients with coral nephrolithiasis depends on the form, volume and density of the calculi, clinical manifestations of the illness, complications, renal function and the state of the urodynamics of the upper urinary tract.

THE AIM. To study the changes of indices of the prostate gland blood flow of the patients with the benign hyperplasia, during the treatment with Dutasterid. PATIENTS AND METHODS. 29 patients with benign hyperplasia of prostate gland (BHPG) (mean age 65, 21±6,27) were examined. In all patients by means of ultrasound and dopplerometry was examined the maximal systolic and final diastolic velocities of arterial blood flow, venal velocity, resistance index and pulsating index before the treatment, and also after 1, 3 and 6 month of treatment. RESULTS. The decrease of arterial and venous blood flow velocities in prostate gland, resistance index and pulsating index (p < 0,005), with its maximum in the first two month of treatment was noted. CONCLUSION. The use of Dutasterid in patients with BHPG during 1-2 month leads to statistically significant decrease in its blood flow, which allows to think about the decrease of blood loss during and after transurethral resection (TUR). The use of Dutasterid can serve as one of the stages of preoperative preparation of the patients with BHPG.

THE AIM. To evaluate the interrelation between recurrent calculi formation in patients with bilateral nephrolithiasis and the dysfunction in homeostasis system for the pathogenetic correction by fibrinolysis activators and citrate mixtures. PATIENTS AND METHODS. In this study 436 patients with various clinical forms of nephrolithiasis, depending on clinical course, out of whom 110 (25,5%) had one sided renal calculi, 56 (12,8%) were treated regarding urether calculi, 270 (62,0%) had bilateral recurrent renal and urether calculi. The mean age of the patients with nephrolithiasis was 48,6 ± 1,3, in the case of bilateral calculi the mean age of women radically differed from that of men, and if the men’s the mean age was 55,7 ± 2,7, women’s it was 46,1± 2,2. All patents had clinical and special investigations, which let us evaluate the state of hemocoagulation, blood (BFA) and urine (UFA) fibrolitic activity. RESULTS. The conducted study states that hemocoagulation data shows a pronounced increase of the blood coagulating activity in patients with recurrent bilateral nephrolithiasis in comparison with the groups with solitary, firstly revealed concretions of the urinary tract. The more apparent depression of fibrinolysis was noted in the postoperative period. The study of UFA after the operation showed the acute decrease of this index on the 3, 7 and 14 day. For the prophylaxis of the calculi recurrence was used a method, based on the use of citrate mixtures and fibrinolisis activators, which help the lysis of the fibrin in the urinary tract. The results of the BFA investigation in patients receiving the citrates and nicotinic acid showed the increase in its levels by theend of first week after the operation. CONCLUSION. The depression of BFA and UFA during nephrolithiasis pose hazard to the recurrence of the renal concretions. Left in the pelvis and calyx of the kidney the fibrin clots condense and adsorb on their surface the salt crystals, which become a nucleus of recurring concretions. In an effort of metaprophylaxis of recurring nephrolithiasis indicated the means and remedies which increase fibrinolitic behavior of urine and blood.

THE AIM. To create an easy and simple method of urinary bladder drainage (UB) after the reconstructive and plastic operations on extrophy of bladder (EUB). PATIENTS AND METHODS. The results of the operations on EUB in 18 children from the age of 1 month to 3 years old were studied. Independently on the state of mucous tunic and the size of the UB wall, to all patients was performed single-step cistosphincteroplasty. For the urinary bladder drainage we used a four channel catheter of our construction. Our construction guards from clotting by mucosal-excudative discharge, and by that means prevents obturation, which increases the efficiency of drainage and dependability of the device. RESULTS. In the early post operative period 4 patients had urinary fistulas, vesicle - 2 patients, vesicocervical - 1 patients and urethra-cutaneous - 1, which in total amounted to 22,2 %. Vesicouretheral reflux was noted in 2 children (11,1%). Chronic pyelonephritis developed in 6 patients (33,3 %). Our method of drainage in general did not differ from the standard methods. Although we refused from the catheterization of urether. In our patients significantly decreased the possibility of the formation of the uerthercutanous fistulas, vesicoureteral reflux, and chronic pyelonephritis. CONCLUSION. The refusal from long-term drainage of the UB and urether during the reconstructive and plastic surgery, regarding EUB, reliably decreases the formation of vesicoureteral reflux, chronic pyelonephritis and cystitis. The use of our catheter during reconstructive and plastic surgeries now a days is optimal method and decreases the rate of complications. Relatively high frequency of urinary fistulas during cistosphincteroplasty needs further improvement in drainage methods and the plastics of the front abdominal wall, UB, UB cervix and urethra.