A number of questions of diagnosis and stratification of chronic kidney disease (CKD) is discussed. We present some of own evidence of the need to find a more adequate way of assessing the estimated glomerular filtration rate (rGFR), the most acceptable for the Russian population. Appropriateness of the division of the third stage of into two substages and the introduction of indexation of stages/substages according to GFR level of albuminuria/proteinuria.

Osteopetrosis («marble bone disease») is a descriptive term that refers to a group of rare, heritable disorders of the skeleton characterized by increased bone density on radiographs. The overall incidence of these conditions is difficult to estimate but autosomal recessive osteopetrosis (ARO) has an incidence of 1 in 250,000 births, and autosomal dominant osteopetrosis (ADO) has an incidence of 1 in 20,000 births. Osteopetrotic conditions vary greatly in their presentation and severity, ranging from neonatal onset with life-threatening complications such as bone marrow failure (e.g. classic or «malignant» ARO), to the incidental finding of osteopetrosis on radiographs (e.g. osteopoikilosis). Classic ARO is characterised by fractures, short stature, compressive neuropathies, hypocalcaemia with attendant tetanic seizures, and life-threatening pancytopaenia. The presence of primary neurodegeneration, mental retardation, skin and immune system involvement, or renal tubular acidosis may point to rarer osteopetrosis variants, whereas onset of primarily skeletal manifestations such as fractures and osteomyelitis in late childhood or adolescence is typical of ADO. Osteopetrosis is caused by failure of osteoclast development or function and mutations in at least 10 genes have been identified as causative in humans, accounting for 70% of all cases. These conditions can be inherited as autosomal recessive, dominant or X-linked traits with the most severe forms being autosomal recessive. Diagnosis is largely based on clinical and radiographic evaluation, confirmed by gene testing where applicable, and paves the way to understanding natural history, specific treatment where available, counselling regarding recurrence risks, and prenatal diagnosis in severe forms. Treatment of osteopetrotic conditions is largely symptomatic, although haematopoietic stem cell transplantation is employed for the most severe forms associated with bone marrow failure and currently offers the best chance of longer-term survival in this group. The severe infantile forms of osteopetrosis are associated with diminished life expectancy, with most untreated children dying in the first decade as a complication of bone marrow suppression. Life expectancy in the adult onset forms is normal. It is anticipated that further understanding of the molecular pathogenesis of these conditions will reveal new targets for pharmacotherapy.

Review of literature devoted to the pathogenesis and clinical features of virus-associated glomerulonephritis in children. It was describe the types of viruses, associated with glomerulonephritis. It was shown, that parameters of renal damage, clinical features, progression of the renal diseases, peculiarity of the therapy and prognosis depending on the type of virus. Attentionwas drawn to the fact that the combination of immunosuppressive therapy to antiviral therapy improves outcomes of treatment.

THE AIM. To asses the endothelial function by examining the endothelium-depended vasodilatation in the test with reactive hyperemia of the humeral artery and the level of microalbuminuria in pregnant with metabolic syndrome. PATIENTS AHD METHODS. Inspected 106 pregnant women with metabolic syndrome and 31 pregnant women without signs of metabolic syndrome. All women conducted a sample survey with reactive hyperemia and determined the level of microalbuminuria. RESULTS. 52% of pregnant women with the metabolic syndrome identified pathological reaction in the test with reactive hyperemia, of them from 78% of pregnant women in the second trimester. Microalbuminuria identified from 38.6% of pregnant women major group of them from 80% in the third trimester. CONCLUSION. During pregnancy in women with metabolic syndrom deteriorates endothelial function as a result of the deterioration of cardiovasсular adaptation of state of pregnancy.

THE AIM. To study the effects of chronic kidney disease (CKD) on prognosis, as well as the frequency, duration of hospitalization and direct medical costs on inpatient care for patients with chronic heart failure (CHF). PATIENTS AND METHODS. The study involved 308 patients with CHF (men – 167, women – 141, mean age – 57. ±10.8 years) during observation period of 60 months. The main cause of CHF was the combination of ischemic heart disease and arterial hypertension – in 193 (63%) patients. The first functional class (FC) was diagnosed in 86.2 FC – at 180.3 FC - in 37, 4 FC – in 5 patients. 47 (15.4%) patients had diabetes. RESULTS. CKD with GFR <60 ml/min/1.73 m² was observed in 108 (35.1%) patients with CHF. The presence of CKD has led to an increase in mortality from all the reasons (relative risk 1.7), increase in average annual number of hospital-governmental organizations in one patient with chronic heart failure for any reason (0.9 [CI 95% 0.2-4.2] against 0.7 [CI 95% 0,09-2.5], p <0.02), and in connection with the aggravation of cardiovascular disease - (0.9 [CI 95% 0.6-5.2] against 0.6 [CI 95% 0.1-3.0], p <0.02). In the presence of CKD with GFR <60 ml/min/1, 73 m² cost of hospital treatment of patients with CHF increased by 21%. CONCLUSION. The presence of CHF patients with chronic kidney disease leads to increased mortality from all causes, increases the number of hospitalizations, duration and cost of hospitalizations for all causes in connection with the escalation cardiovascular disease.

THE AIM. To evaluate the influence of mineral water Essentuki №17 and Essentuki №20 on the diuretic activity of furosemide in rats. MATERIALS AND METHODS. Studies conducted on male rats Wistar, which were maintanied on a standard diet. For two weeks, the animals in group I received as drinking tap water, II group – alkaline mineral water Essentuki №17, III group – slightly acid mineral water Essentuki №20. Once furosemide was administered subcutaneously at a dose of 10 mg / kg, for a duration of 5 days to 5 mg / kg. The measurement of pH of urine, daily diuresis, urinary excretion of sodium and potassium was perfprmed. RESULTS. These pH-metry before the experiment in all three groups showed the value of 7,2 ± 0,2. After two-week drinking water treatment in groups I and III, significant changes in pH of urine were found. In Group II with mineral water Essentuki №17, urine pH increased to 8.0. Difference in magnitude of the diuretic effect of furosemide in animals of all three groups was not identified. CONCLUSION. These results suggest that diuretic and saluretic activity of furosemide does not change during treatment with therapeutic mineral waters Essentuki №17 and Essentuki №20. Apparently, they cause changes of acid-base composition of the urine of rats are not sufficient for significant changing balance between ionic and molecular forms of furosemide, and therefore – for the corresponding changes in activity of the diuretic.

THE AIM of this study is to evaluate the effectiveness and informative value ¹¹C-choline positron emission tomography (PET) in diagnosis of local recurrence of prostate cancer (PC) in patients after radiotherapy. PATIENTS AND METHODS. The research is based on the results of the survey and treatment of 52 patients examined in the clinic Urology Medical Center, University of Groningen (Netherlands) following radiotherapy at the hystologicaly confirmed prostate cancer. The comparison was made between the clinical and morphological parameters in patients with signs of local recurrence after radiotherapy of prostate cancer detected by PET, with hystopatomorfologicheskimi results of a biopsy of the prostate. RESULTS. According to PET, local recurrence was diagnosed in 42 patients: in 15 (36%) patients – a single focus of recurrent tumor, in 27 (64%) – «scattered» hot spots. This coincidence PET findings with the results of prostate biopsy in the diagnosis of recurrence occurred in 32 (76%) patients. Of the remaining 10 patients: three patients had distant metastases according to PET, confirmed by the results of computed tomography and bone scintigraphy, two of the patients had hormone therapy in connection with rapidly progressive disease, five patients underwent local cryotherapy, were was observed reduction in prostate antigen (PSA) in blood plasma. In general, using PET morphologically confirmed local recurrence of prostate cancer was detected in 37 out of 42 (88%) patients. The coincidence of the results of PET and biopsy results with regard to the localization of recurrence was noted in 7 of 15 (47%) patients who had revealed a unilateral (one share of the prostate), prostate cancer recurrence, and in 11 out of 27 (41%) – with bilateral neoplastic process ( in both lobes). CONCLUSION. Application of ¹¹C-choline PET in most cases to identify local recurrence of prostate cancer patients undergoing radiotherapy. However, the accuracy of this method in determining the prevalence of foci of recurrent tumors of prostate cancer is insufficient reliable data can be obtained only by using a biopsy of the prostate.

THE AIM – to examine FGFR3 gene mutation and expression of p53 gene to determine the prognosis of patients with bladder cancer. PATIENTS AND METHODS. A total of 25 patients with bladder cancer were investigated. Materials for molecular genetic studies were surgical specimens. Genomic DNA from tumor and blood were obtained using a set GenElute (USA), and mutational damage was determined in the genes FGFR3 (exon 7) and p53 (exons 5, 6, 7). RESULTS. According to our data, mutations of exon 7gena FGFR3 characterizes the favorable course of disease, and mutations in exons 5, 6, 7 p53 gene is observed in the poor course of bladder cancer. CONCLUSION. To determine the prognosis of bladder cancer is useful to determine the FGFR3 gene mutations and p53.

THE AIM. To develop a method for determining reduced detrusor contractility according to urodynamic studies in patients with benign prostate hyperplasia (BPH). PATIENTS AND METHODS. 138 patients with BPH, the average age of 63 ± 1.4 years old, had full urological examination including urodynamic investigation, which included uroflowmetry and micturating cystometry (the study of «pressure-flow»). Interpretation of the results of cystometry for determination of detrusor contractility and IVO was performed by W. Shafer and P. Abrams method. RESULTS. For the analysis were identified two groups of patients with very weak and the weak contractility of detrusor with Schafer nomogram. In the first group was 21 patient with BPH and low index discharge (less than 60%), the second – 36 patients with an index value discharge more than 60%. We assessed the reliability of indicators micturating cystometry in the diagnosis of lower detrusor contractility in patients with BPH. Based on the most reliable urodynamic parameters, we developed a formula for the diagnosis of lower detrusor contractility on the basis of a comprehensive performance assessment micturating cystometry. Diagnosis of detrusor contractility according to our proposed formula is based on a comprehensive assessment of the most informative indicators cystometry. In this regard, the reliability of diagnosis of detrusor contractility using the formula is higher, than in determining on the basis of evaluation of a single parameter cystometry. CONCLUSION. Based on the evaluation of urodynamic parameters, we developed a formula for the diagnosis to reduce detrusor contractility on the basis of a comprehensive evaluation of the parameters of micturating cystometry with detrusor contraction force, and the index discharge.

The description of a rare disease of primary intestinal lymphangiectasia – Waldmann disease is discussed. The clinic of disease is presented by edema of the lower course limbs combined with dilatation of lymphaic vessels of small intestine and development on this background of enteropathy with polideficiency state (hypoproteinemia, hypoglobulinemiya, reduction of fat-soluble vitamins 25(OH)D₃, folic acid). Etiology and pathogenesis of the disease is not currently understood.