Mixed cryoglobulinemia (MC), type II and type III, refers to the presence of circulating cryoprecipitable immune complexes in the serum and manifests clinically by a classical triad of purpura, weakness and arthralgias. It is considered to be a rare disorder, but its true prevalence remains unknown. The disease is more common in Southern Europe than in Northern Europe or Northern America. The prevalence of ‘essential’ MC is reported as approximately 1:100,000 (with a female-to-male ratio 3:1), but this term is nowused to refer to a minority of MC patients only. MC is characterized by variable organ involvement including skin lesions (orthostatic purpura, ulcers), chronic hepatitis, membranoproliferative glomerulonephritis, peripheral neuropathy, diffuse vasculitis, and, less frequently, interstitial lung involvement and endocrine disorders. Some patients may develop lymphatic and hepatic malignancies, usually as a late complication. MC may be associated with numerous infectious or immunological diseases. When isolated, MC may represent a distinct disease, the so-called ‘essential’ MC. The etiopathogenesis of MC is not completely understood. Hepatitis C virus (HCV) infection is suggested to play a causative role, with the contribution of genetic and/or environmental factors. Moreover, MC may be associated with other infectious agents or immunological disorders, such as human immunodeficiency virus (HIV) infection or primary Sjцgren’s syndrome. Diagnosis is based on clinical and laboratory findings. Circulating mixed cryoglobulins, low C4 levels and orthostatic skin purpura are the hallmarks of the disease. Leukocytoclastic vasculitis involving medium- and, more often, small-sized blood vessels is the typical pathological finding, easily detectable by means of skin biopsy of recent vasculitic lesions. Differential diagnoses include a wide range of systemic, infectious and neoplastic disorders, mainly autoimmune hepatitis, Sjцgren’s syndrome, polyarthritis, and B-cell lymphomas. The first-line treatment of MC should focus on eradication of HCV by combined interferon-ribavirin treatment. Pathogenetic treatments (immunosuppressors, corticosteroids, and/or plasmapheresis) should be tailored to each patient according to the progression and severity of the clinical manifestations. Long-term monitoring is recommended in all MC patients to assure timely diagnosis and treatment of the life-threatening complications. The overall prognosis is poorer in patients with renal disease, liver failure, lymphoproliferative disease and malignancies.

Review of the literature focuses on barriers to nucleation, aggregation-navigation and the growth of crystals of calcium oxalate. Main proteins, inhibiting the formation of kidney stones, are protein Tamm-Horsfalla, osteopontin, bikunin and prothrombin fragment 1. In particular, we analyze the-sti structure and function of these glycoproteins, discusses their likely mechanism of action and role in the pathogenesis of urolithiasis.

Available data indicate that the prevalence of chronic kidney disease (CKD) among patients with chronic heart failure (CHF) ranges from 9.2 for chronic heart failure caused by congenital heart disease, up 71.2% with chronic heart failure caused by coronary heart disease (CHD) and arterial hypertension. Reduced renal function is associated with age and functional class of CHF. However, if the low frequency of CKD among patients with CHF with congenital heart disease can be attributed to young age and non-severe heart failure, the reasons for substantial differences in the prevalence of CKD in patients with CHF due to ischemic heart disease and hypertension, remains unclear. Requires clarification as the prevalence of CKD among patients with CHF in general and in specific groups of patients. Should clarify the causes of gender-specific heart failure associated with CKD. It is advisable to conduct not only clinical but also the clinical and economic studies, it should be borne in mind that the results of foreign researchers, can not be fully used in Russia as there are significant differences in the organization of medical care, and in the range of medicinal products especially drugs, generics used to treat heart failure.

THE AIM of the study. Clarify the meaning of interleukin-6 in the pathogenesis of «uremic malnutrition» in patients with end-stage renal disease (ERSD) receiving chronic hemodialysis (HD). PATIENTS AND METHODS. We examined 86 patients with chronic kidney disease stage V receiving HD treatment, including 40 women and 46 men aged 52.2 ± 1.3 years. The cause of TRD in all cases was primary glomerulonephritis. All patients received hemodialysis treatment program for 6,4 ± 1,1 years. To estimate the daily intake of protein, fats, carbohydrates, total caloric intake, patients filled out food diaries for a week. To assess the nutritional status using kaliperometry and integrated dual frequency impedansometry using an instrument KM - AR - 01 firm «Diamond», Russia. In 78 patients to determine the spectrum of pro-inflammatory cytokines - interleukins - 2, 6, 8, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-g), TNF-αwith the help of Human 8-plex A panel (171-A11080 ) company Bio-rad, USA, a method based on the selective binding of defined cytokines and sorbed on the surface of micro particle antibodies. RESULTS. The interrelation between increased levels of interleukin-6 and «uremic malnutrition» in patients with end-stage renal failure receiving chronic hemodialysis was detected. Was shown that the increase of the duration of hemodialysis therapy was accompanied by increased signs of chronic inflammation. CONCLUSION. Increased IL-6 serum may be one of pathogenetic factors involved in the development of «uremic malnutrition» in patients with end-stage renal failure receiving chronic hemodialysis.

THE AIM. To evaluate an efficiency and safety of SLED-HF/HDF (hybrid methods of renal replacement therapy) in patients with congestive heart failure and refractory volume overload. PATIENTS AND METHODS. Fourteen patients with acute decompensated heart failure and acute volume overload and diuretic-refractory edemas were given SLED-HF/HDF before and after cardiac surgery. Parametrs SLED-HF/HDF including: fluid removal 2457±128 ml during procedure, using low dialysatе flow and acetate-free dialysatе («Krebsol»). RESULTS. Edemas’ and volume overloads regression, improvement of central and pulmonal hemodynamic and renal dysfunctions were achieved in 13 patients. CONCLUSION. Adapted parameters SLED-therapy including on-line blood volume monitoring, using low dialysatе flow (6 l/hour), acetate-free dialysatе («Krebsol») allowed to reduce complications (hypothensia and arrhythmia).

THE AIM of the study was a comparison of the structural adjustment of the kidneys in nephrolithiasis with indicators of free-radical oxidation in blood and tissues of the kidneys. MATERIAL AND METHODS. The experiment was performed on Wistar rats, treated as a drinking a 1% aqueous solution of ethylene glycol for 42 days. Morphologically in the kidney sections was assessed changes in the kidney medulla, especially the distribution of calcium deposits, the location of the connective tissue elements. Biochemical methods evaluated oxidative and antioxidative status of kidneys and blood. RESULTS. In the course of the experiment in slices of kidney calcium deposition was observed in the renal papilla with the growth of connective tissue. The development of nephrolithiasis associated with activation of free-radical oxidation of the kidneys and blood, and the weakening of antioxidant defense due to the inhibition of glutathione peroxidase. CONCLUSION. Thus, when modeling urolithiasis we noted a direct correlation between the activation of free-radical oxidation in the development of oxalate nephrolithiasis.

THE AIM. Comparison of diuretic and saluretic activity furosemide and first received iodderivate furosemide in rats. MATERIAL AND METHODS. In experiments on rats comparing the effectiveness of one time subcutaneous injection of furosemide and iodine- furosemide in equimolar doses of 15 micromol / kg. Urine was collected during the day, determining the amount of urine output, excretion of sodium, potassium and chloride. RESULTS. Introduction of furosemide increased the daily output of 3.2 times, introduction of iodine-furosemide in 5.7 times in comparison with control. Excretion of sodium increase in 6.1 and 11.7 times, potassium - in 1.9 and 3.3 times respectively. With that the ratio of ions excreted by the action of the compared groupswas comparable. CONCLUSION. Founded on the basis of well-known diuretic drug furosemide new substance, 4-chloro-2-((5-iodofuran) methylamino)-5-sulfamilbenzoynaya acid (iodine-furosemide) in experiments on rats showed higher diuretic and saluretic activity against comparable rations excreted ions. This suggests that both compounds interact with the same type of target proteins in the renal tubules, revealing an identical mechanism of diuretic action, which differs only quantitatively.

THE AIM of the research is to study saluretic and diuretic activity of furosemide in rats with the acidification of urine with ascorbic acid. MATERIALS AND METHODS. Studies conducted on Wistar rats, Control group of rats, which was in conditions of normal drinking water treatment, daily for about 7 days-long inragastrically injected with 3 ml of tap water, the same amount of 5% aqueous solution of ascorbic acid. After determining the pH of urine were injected subcutaneously with furosemide at a dose of 2 mg / kg. We determined the daily urine output and excretion of sodium and potassium. Quantum-chemical calculations were performed using DFT B3LYP/6-311G * using the program GAMESS. RESULTS. The study showed that in the control group of animals urine pH was 7.2, while in the group receiving ascorbic acid – 6,0. In these conditions, and the diuretic furosemide saluretic activity varied significantly. Introduction of furosemide control group of rats caused an increase in daily urine output of 3.2 times, the excretion of sodium – in 6 times, the excretion of potassium – in 1.9 times. Introduction diuretic on the background of the prior application of ascorbic acid induced significantly greater changes: an increase in daily urine output of 5.6 times, and urinary sodium excretion of more than 11 times, and potassium – in 3.3 times. Quantum-chemical analysis showed that these differences are attributable to the increase of molecular and ionic forms of diuretic decrease in the lumen of renal tubules in acidification of urine. CONCLUSION. In experiments on rats showed increased diuretic and saluretic activity of furosemide in a shift of primary urine pH to the acid side. These results open the possibility for varying the therapeutic dose-tics and regulation of some of its side effects. In addition, offer some prospects for the modification of the molecule of furosemide in order to change the isoelectric point of the drug, which, in turn, should lead to an increase in its diuretic activity.

THE AIM of the study the prognostic value of determining the depth of invasion and degree of differentiation of bladder cancer according to WHO recommendations editions 1973 and 2004. PATIENTS AND METHODS. Retrospectively studied the materials of clinical examination 115 patients (ratio of men to women was 9:1, mean age - 63 ± 1,9 years) operated on for transitional-cell bladder cancer (63 (54,8%) - transurethral resection, 14 (12.2%) radical cystectomy, 38 (33%) diagnostic TUR-biopsy followed by radiotherapy. During postsurgical histopathologic examination determined the depth of invasion and degree of differentiation of cancer from the standpoint of the two classification systems and to compare these results with postoperative survival. RESULTS. The low survival rate observed in patients with carcinomas located in the area of the triangle is pouring (rs = 0,64; p = 0,02), multiple tumors (rs = 0.62; p = 0,0.4), recurrent course of cancer (rs = 0.69; p = 0.018). The life expectancy of patients declined with increasing depth of germination of bladder cancer (r = 0.55; p = 0.01), as well as with increasing degree of anaplasia of carcinomas in the evaluation according to the classification in 1973 According to the WHO classification in 2004 the survival rate of patients with poorly differentiated cancer was significantly shorter compared with patients with highly differentiated carcinomas (t = 3.35; p = 0.007; U = 2.00; p = 0.017). CONCLUSION. The study showed that the two categories taken to date classification systems provide a variety of information regarding the flow of bladder cancer and should be used both systematization.

Purpose of the study was to investigate indicators of renal blood flow in patients with ureteral stones on a background retention changes in the upper urinary tract and the influence of different methods of postoperative drainage for the restoration of renal hemodynamics. PATIENTS AND METHODS. Were examined 77 patients with ureteral stones (mean age 47,5 ± 1,8 years). All patients with ultrasound and dopplerographic study determined the spectrum of the velocity of blood flow to the definition of the maximum (peak) systolic velocity (Vmax. c), end diastolic velocity (Vkd) resistance pulsatile index to remove ureteral stones and for 3-5 days after ureterolitoecstraction. RESULTS. 30 patients did not reveal violations of renal blood flow against changes distention of the upper urinary tract caused by ureteral stones. In these patients was statistically significant, it was found that the method of drainage, as well as the refusal of him, had no effect on renal hemodynamics (p> 0.2). In 47 cases were registered for renal blood flow. When postoperative care without drainage showed deterioration of renal hemodynamics. At moderate violations of renal hemodynamics of blood flow was restored the same way as when using ureteral catheter, or during the installation of the stent. It is proved that the expressed infringements of renal blood flow require a longer drainage of the upper urinary tract (p =0,03). CONCLUSION. Application dopplerographichod for determining violations of blood flow in the preoperative period in patients with ureteral stones can develop an appropriate method of drainage of the upper urinary tract in the postoperative period to prevent the development of inflammatory complications.

The resolved the questions of exchange of calcium and phosphorus in the body, including its hormonal regulation, as well as the etiology, symptoms, diagnosis and treatment of hypercalcemia, hypocalcemia, hypophosphatemia and hyperphosphatemia.