Since the publication of the first issue, NKF-DOQI Guidelines emphasize an increasing consensus that arteriovenous (AV) fistulae are the best choice for creation of initial vascular access in patients suffering from chronic renal insufficiency (CRI) or end-stage renal disease (ESRD) nearing or initiating haemodialysis (HD) therapy. Additional types of vascular access are AV grafts preferably made from ePTFE (expanded polytetrafluoroethylen) and catheters placed into central veins.To realize this goal, a couple of problems arise from the rapidly growing population of diabetic, aged and hypertensive patients. Here, the preexisting damage of the vascular anatomy and the high cardiovascular comorbidity makes it more difficult to construct a well functioning arteriovenous fistula. Late referral to the nephrologist causes delay in timely placement the first AV fistula or another appropriate type of vascular access thus increasing the use of temporary and/or cuffed tunneled catheters with all their potential risks. Nevertheless, there are stategies and tools to overcome these problems: Early referral results in venous preservation based on an early selection of side, site and type of initial vascular access. Ultrasound findings, if available, have shown as an essential component partof preoperative investigations. Special attention is payed to the quality of the arterial vasculature including flow measurements of the brachial artery and description of calcified arterial segments. Dedicated, meticulous surgery is mandatory. Fistula monitoring and elective revision of the failing AV fistula will reduce morbidity and costs. Functionality and longevity of the access to circulation are the welcomed result of all these efforts. The best results will be obtained by an interdisciplinary approach.

The paper summarizes the data obtained by different investigators on the clinical application of Doppler index of resistance in uronephrology: acute urinary tract obstruction, non-obstructive kidney diseases, kidney transplants, only one kidney, kidney tumor, violations of intrarenal hemodynamics caused by the central hemodynamic changes. Recognized that the index of resistance can be effectively used in the study of renal blood flow in a number of nosology. We present our own data, indicating the need for a systematic approach to the study of renal hemodynamics. According to syndromes the state is reviewed, accompanied by changes in blood flow in the main renal arteries with increased resistance index and with its decline, and their pathophysiological aspects. Is made a reasoned conclusion that the calculation of resistance index values fully into account the parameters of central hemodynamics such as the magnitude of the pulse rate, blood pressure, cardiac output; of intracardiac hemodynamics (with valvular heart diseases), systolic/diastolic dysfunction, age-related changes of the kidneys, the availability of system disease patients makes it more correct approach to its clinical application.

In the review are examined the contemporary concepts about the mechanisms of development and progression of hypertensive nephropathy, which is of the main reasons for the chronic kidney disease. Hypertensive nephropathy is the consequence of disruption of the work of renal hemodynamic mechanisms, which protect glomeruli from the damaging action increased arterial pressure. As a result in the kidneys are developed two principally different pathologic processes – ischemic and hypertrophic damage of the glomeruli, which lead to the formation of focal-segmental glomerulosclerosis and increasing loss of renal function. The reason for the first of them is the excessive autoregulatory reaction, which is complicated by obstructive hyalinosis of afferent arterioles, by the ischemic damage of glomeruli and by the loss of the part of functioning nephrons. Simultaneously the ischemic damage of the kidney in the preserved nephrons compensating by its nature phenomenon of hyperfiltration, which leads to the loss of renal autoregulation and steadfast glomerular hypertension, which becomes the major factor for future progression of the glomerular damage, is developed. As a result these hemodynamic disturbances in the kidney is developed hypertrophic (proliferating) glomerulosclerosis. The key role in its formation plays the hyperactivity of the cellular RAS of podocytes, which accompanied by the excess produce of TGF-β₁ , VEGF and PDGF, causing profibrotic structural-functional reconstruction of podocytes and mesangial cells. The significant contribution to this pathologic process introduces also the direct mechanical damage of podocytes and mesangial cells, the facilities their sclerotic regeneration and development of inflammatory reaction in the surrounding mesangial tissue.

This review of literature devoted to the current understanding of the mechanism of the formation of oxalate crystals in nephrolithiasis. According to current concepts, the most important link of pathogenesis of oxalate nephrolithiasis is the formation in the interstitial space between the basal membranes thin loops of Henle and the renal papilla of the mineral-organic deposits (Randall plaques), their discovery in the urinary space leads to damage or destruction nephrocyteds, and formation them the driving forces for crystallization of calcium oxalate stones. In the presence of metabolic disorders (hypercalciuria, hyperphosphaturia, hyperoxaluria), this fact seems, became crucial in the development of oxalate nephrolithiasis.

THE AIM. Study of localization of vasopressin receptors in the structures of human kidney. PATIENTS AND METHODS. Renal tissue studied 12 children with different morphological forms of glomerulonephritis. Localization of V1a- and V2-receptor studied by light and electron microscopy, immunohistochemistry and immunoelectron microscopy. RESULTS. In the glomeruli and the epithelium of the proximal tubules of the nephron were identified changes in the ultrastructure of cells. The cells of distal segment of the nephron were not expressed by the changes. Using specific antibodies revealed that the V2-receptors localized in the cells of the collecting duct and the distal segment of the nephron, V1a-receptors – in the mesangial cells, the walls of blood vessels, the distal segment of the nephron and interstitium. CONCLUSION. For the first time presents data on the localization of V1a- and V2-receptors in the kidneys of children. The observed distribution of V-receptors in the structures of the kidney are well comparable with the results of the study of the functional response of the kidneys to vasopressin.

THE AIM. Cardiorenal syndrome (CRS) – pathophysiological state in which acute or chronic dysfunction of one organ leads to acute or chronic dysfunction of another. The purpose of this study - to present characteristics of patients who have chronic heart failure associated with chronic kidney disease. PATIENTS AND METHODS. The study involved 368 patients (187 – male, 181 – female) with chronic heart failure (CHF) II-IV FC at the age of 18 to 84 years (average age – 60 ± 10 years). The majority of patients – 247 (67%) had heart failure with preserved ejection fraction. Glomerular filtration rate was calculated by the MDRD formula, chronic kidney disease diagnosed according to NKF-K/DOQI, Guidelines, 2002. RESULTS. GFR was 68,8 ± 20,9 ml/min/1.73 m² (from 18.4 to 142.6 ml/min/1, 73 m²), while in 136 (37%) patients had GFR <60 ml/min/1.73 m² . Patients with CKD were older, predominantly women, among them there were more patients with diabetes. 42 patients had diabetes mellitus and to determine the causal relationship between cardiac and renal dysfunction was not possible. CONCLUSION. Renal impairment occurs in one third of patients with chronic heart failure (chronic cardiorenal syndrome). In patients with diabetes mellitus revealed causal relationship between the pathology of heart and kidney in many cases impossible, these clinical situations are not reasonably regarded as cardiorenal or renocardial syndromes. Need to develop uniform criteria for cardiorenal relationships (renocardial and cardiorenal syndrome), an option the authors proposed a variant of classification.

THE AIM. Comparative analysis of the manifestations of chronic systemic inflammation (CSI) and MIA-syndrome (malnutrition-inflammation-atherosclerosis syndrome) in patients with end stage renal disease (ESRD). PATIENTS AND METHODS. The study included 40 patients with ESRD with and without MIA-syndrome and two control groups (50 and 22 people respectively). The presence of MIA-syndrome, determined based on levels of serum albumin and body mass index. As indicators CSI measured serum levels of C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor (TNFα), soluble IL-2 receptor, eosinophil cationic protein, D-dimers, cortisol, myoglobin, troponin, calculated integral indicators of systemic inflammatory response (coefficient and the level of reactivity). RESULTS. It was revealed that the ESRD, regardless of nosology of this condition is characterized by the development of a model of the pathological process - CSI. The absence of statistically significant differences for most parameters CSI of patients with absence and presence of MIA-syndrome questions the fact of the greater severity of the typical model of the pathological process in the latter. In favor of this is the evidence of the lack of correlation between markers MIA-syndrome and indicators CSI. CONCLUSION. ESRD is characterized by the development of a model of the pathological process – chronic systemic inflammation, the mechanisms which contribute to the manifestation of some specific features MIA-syndrome.

THE AIM. Assess the impact of unilateral ureteral obstruction (UUO) in Wistar rats. MATERIAL AND METHODS. Unilateral ureteral ligation left kidney performed in 6 Wistar rats. Time of observation after the UUO was 14 days. Experimental animals to measure the mass of the kidneys and the level of mean arterial pressure (BP), held light microscopic morphological study and determined the level of expression of the nuclear transcription factor (NFкB) in renal tissue. RESULTS. No significant change in the mean arterial pressure in rats 2 weeks after surgery compared with preoperative levels. Mass left kidney increased after the operation almost 4.5 times for the control right kidney. The relative level of expression of the nuclear transcription factor NFкB in experimental left kidney in 1.5 times higher than in the contralateral organs. It is noted thinning of the cortical and medullary layers, dilatation of the lumen of proximal tubules with flattening and desquamation of the epithelium, degeneration of the epithelium of proximal tubules, the accumulation of lymphocytes-macrophages with the growth of connective tissue in extracellular matrix and stromal edema. In glomeruli involved, area-defined expansion of the urinary space of Bowman capsule, compression and partial collaps of the capillary loops. CONCLUSION. These data suggest that the unilateral ureteral ligation in rats after 14 days leads to a distinct damage of kidney tissue, which are mainly localized in the tubulointerstitial compartment.

THE AIM. Determination of patterns of pathological changes in the kidneys of ethylene glycol model oxalate nephrolithiasis in prolonged use of the drug Maackia amurensis. MATERIAL AND METHODS. Experimental model oxalate nephrolithiasis was performed on 34 Wistar rats of both sexes weighing from 180 to 250 g. A morphological study of kidneys 34 rats was performed. Identification microlites calcium was determined by silver impregnation by Koss method. RESULTS. Established that prolonged use of the drug in terms of ethylene glycol oxalate nephrolithiasis model reduces the size and number of calcium deposits in the distal nephron. CONCLUSION. Application of cell culture extract Maackia amurensiscauses a decrease in the size and number of calcium deposits in a model of ethylene glycol oxalate nephrolithiasis and possibly potentiates the excretion of calcium microliths.

THE AIM. The purpose of this study was to examine the influence of different concentrations of mercury dichloride on osmotic resistance of human erythrocytes in vitro investigations and possible mechanisms of hemolysis of cells. MATERIALS AND METHODS. Determination of osmotic resistance of erythrocytes was carried out on healthy people for a unified method to L.I. Idelson modification. RESULTS. Installed a dose-dependent nature of HgCl₂ on the osmotic resistance of human erythrocytes: small concentrations (0.05-0.1 mmol/L) have a moderate hemolytic, medium (0.2-1.0 mmol/L) - blocking, and large (> 1.0 mmol/L) – a destructive effect on the cells. Statistically significant (p <0.001) reduction of the intensity of hemolysis of erythrocytes in hypotonic medium with mercury, most likely due to the blockade of aquaporins. CONCLUSION. Osmotic resistance of red blood cells is reliable and reproducible index of functional state of the cell, sensitive to the chemical effect. as shown by the example of exposure of erythrocytes HgCl₂ in a wide range of concentrations, differing by three orders of magnitude. In further studies to establish the time parameters of the observed effects of mercury on the osmotic fragility test, the likely participation and contribution of other biochemical mechanisms, as well as to compare the data with the osmotic resistance of various types of cells to mercury and other heavy metals, aquaporin blockers.

The main elements of pathogenesis, clinics, diagnosis and treatment of Bartter and Gitelman syndromes are discussed. Highlighted the possibility of meeting these rare hereditary tubulopathies in the practice of «adult» nephrologist.