Currently, we are witnessing the process practical medicine growing to a new stage in its development. In the world of medical science is created and gaining its strength a new concept of «personalized medicine». On the basis of such medicine lie the 21^st century advances in genetics (pharmacogenetics), molecular biology, biochemistry, physiology (experimental studies). A striking example is the nearly 30-year history of research on the effectiveness of cyclosporine in the treatment of nephropathy. It can now be considered proven that cyclosporine acts not only on immunocompetent cells, but is able to restore the complex structural and functional organization of podocytes significantly damaged during glomerulopathies of different genesis. Currently, an increasing number of researchers are inclined to think that in a number of nephropathies (steroid resistant minimal changes disease, mebranous nephropathy, focal segmental glomerulosclerosis) a combination of cyclosporine with low-dose glucocorticoids can and should be treated as first-line therapy.

Erythropoiesis stimulating agents (erythropoietin), firmly established in clinical practice in the treatment of renal anemia in patients with chronic kidney disease (CKD). At the same time, still be confirmed the safety profile of these drugs, depending on age, presence of cardiovascular disease, cerebrovascular events, diabetes and some other factors. In this review article an analysis of the results of major clinical studies of risk of adverse cardiovascular events during therapy with erythropoietin - CHOIR, CREATE, and the most recent large-scale randomized, placebo-controlled study TREAT (The Trial to Reduce Cardiovascular Events with Aranesp Therapy) with darbopoetin- α in diabetes mellitus complicated by chronic kidney disease are discussed. The organizers of the study on a large evidence base (4,038 patients) demonstrated no statistically significant differences in the frequency of major adverse cardiovascular events and total mortality, as well as a very significant increase in the incidence of stroke on a background therapy darbepoetin-α – up to 5% vs 2.6 % in the placebo group. After the results of the study group of experts TREAT Community European Renal Best Practice highlights the need to more closely monitor the safety profile of treatment with erythropoietin in patients with CKD on the background of diabetic nephropathy, especially with a history of stroke or cardiovascular disease, subject always to the maximum target levels hemoglobin in this patient population no more than 110 – 120 grams per liter.

THE AIM: to study prevalence of clinical displays of lesion of kidneys in patients with a chronic heart failure (СHF) and their importance for progressing CHF. PATIENTS AND METHODS. 600 patients with CHF are surveyed. In patients with a CHF studied prevalence of chronic kidney disease (CKD), distribution of sizes of a glomerular filtration rate (GFR), creatinine and urea ofblood serum, perform the analysis of occurrence of anomalies of a urine sediment and displays of renal dysfunction. RESULTS. At all 600 patients with a CHF revealed CKD 1-4 stages. In 93,2% of cases there was decrease GF less than 90 ml/min/1,73m². Proteinuria has been revealed in 14,2%, erythrocyturia – in 8,0%, leucocyturia – in 7,8%. With increase a functional class (FC) of a CHF occurrence macrohematuria, oliguria and nocturia increased. FC increase of a CHF did not affect decrease GFR. With progressing CHF authentically associated hypercreatininemia and macrohematuria. CONCLUSION. Damage tissues of kidneys at patients with CHF promotes progressing CHF, but is not connected with change of a glomerular filtration in kidneys.

THE AIM. The purpose of the research was to estimate structural-functional changes in the kidney at HIV-infected of patients with the displays of urinary syndrome. PATIENTS AND METHODS. Evaluated the character of functional changes of kidney in 119 patients at the Regional Center of prophylaxis and fight against AIDS stationar of Odessa. Morphological research of kidney was conducted on material when got from 53 dead patients AIDS and 7 patients in whom HIV/AIDS was not exposed, but a concomitant disease was pyelonephritis. RESULTS. The signs of urinary syndrome were determined practically for all of patients with AIDS. Thus at 61,9% patients without a concomitant pyelonephritis the presence of urinary syndrome is marked. Morphological research of tissue of kidney is marked by the diffuse, deep structural changes of cortex and medulla. CONCLUSION. A pyelonephritis was exposed in 84% patients, while in 78,2% were determined the signs of urinary syndrome. Morphological changes exposed at histological research of kidney, carry dystrophic-atrophic character.

THE AIM. Assess the relationship cryoglobulinemia (CGE), associated with systemic lupus erythematosus (SLE) with features of the clinical course of SLE. PATIENTS AND METHODS. A total of 100 patients with systemic lupus erythematosus, 65 of whom had KGE were examined. All patients evaluated the presence of complement components C3, C4, CEC, RF, IgG and IgM, antibodies to native and denatured DNA, lymphocyte, CD3, CD4 and CD8, CD4/CD8, and the presence of Cor-NS-unstructured antigens, determination of HCV RNA C and HBV DNA by PCR, IgM and IgG antibodies to the herpes virus by ELISA. Cryoglobulins (CG) were determined in serum by the method of Meltzer and assessed in terms of cryocrit, as well as spectrophotometrically at a wavelength λ= 492 nm. To assess the relationship CGE with features of the clinical course of SLE were examined 50 patients in the dynamics of next year. The control group consisted of 30 persons. RESULTS. Patients with CGE had significantly more severe course of illness, often with renal, central nervous system, blood and heart diseases, which was accompanied by lower levels of CD3+, CD4+, and C3-complement component with an increase in CD8+ compared with patients without CGE. Titer of antiphospholipid antibodies was higher in the group with CGE. Observation of the dynamics showed that in patients with CGE often revealed disease progression with the development of cerebrovasculitis, recurrence of active lupus nephritis with severe nephrotic syndrome. In 3 cases there was death, which was not in patients without CGE. CONCLUSION. The presence of CGE in SLE patients is associated with clinical and immunological features of the disease and contributes to an unfavorable course of the process.

THE AIM of the study was to assess the dynamics indices related to hemodialysis (HD) adequacy (including chronic inflammation factors, indices of the erythropoiesis) in patients with chronic kidney disease (CKD) at the stage of program haemodialysis from the point of view of the influence of extracorporeal autohemomagnetic therapy (EAHMT). PATIENTS AND METHODS. 88 patients (control-43, experiment-45) with ESRD were under 2-years observation. Course of EAHMT (6 procedures) was used during of a haemodialysis session and was repeated in 4 months. RESULTS. Significant elevation of Kt/V, URR, erythrocytes, hemoglobin, albumin, but ferritin plasma level was decreased after the course of EAHMT. CONCLUSION. Risk of the complications from disorders, related to ESRD, stresses the necessity of timely detection and adequate correction of them. Periodical courses of EAHMT can be included in traditional treatment in ESRD patients, and also to low such a risk and to elevate permanent haemodialysis adequacy.

THE AIM of the study – to assess the state of endothelial function and indices of aggregation of platelet function, coagulation hemostasis and anticoagulant activity in patients on program hemodialysis treatment. PATIENTS AND METHODS. Examined 89 patients on hemodialysis. All patients measured the concentration of stable metabolites in blood serum (nitrites, nitrates, total metabolites of nitric oxide), indicators of lipid profile, homocysteine levels. The aggregation of platelets, coagulation hemostasis, anticoagulation activity, activation of blood coagulation tests were studied. RESULTS. Mean concentrations of homocysteine, von Willebrand factor in hemodialysis patients were higher than in the comparison group. The concentration of stable metabolites of nitric oxide in the studied group was significantly lower than in healthy individuals. Significant improvement of atherogenic lipoproteins in patients on hemodialysis was discovered. The changes in hemostasis indicate the presence of signs of activation of intravascular coagulation. According to the correlation analysis, multivariate regression analysis indicated the existence of a relationship between homocysteine concentration, indicators of atherogenic lipid profile, von Willebrand factor and indicators hemostaziogrammy. CONCLUSION. In patients receiving hemodialysis treatment there is activation of intravascular coagulation of blood does not reveal the routine coagulation studies. In patients on hemodialysis was revealed endothelial dysfunction. According to the correlation analysis, multivariate regression analysis there is an interrelation between indices of endothelial function and hemostasiogramma.

THE AIM. The study was undertaken to study the influence of α-tocopherol acetate, a classical anti-oxidant, in the course of experimental nephrolithiasis. MATERIAL AND METHODS. Wistar male rats for 3 weeks were given as a drink 1% solution ethylene glycol, then, within the next 3 weeks, amid continued use of ethylene glycol the oil solution of б-tocopherol acetate 300 mg / kg was injected. In the urine collected per day, measured the concentration of oxalate, calcium and phosphate, pH of urine and the activity of marker enzymes lactatdehydorgenase (LDH), γ-glutamyltransferase (GGT) and N-acetyl-β-D-glucosaminidase (NAG). On the 24-th and 42-th days of the experiment was determined by the activity rate of free radical oxidation in the rat kidney. Histochemical method by Coss has been used for determination calcium-positive deposits on kidney slices of rats. RESULTS. Application of α-tocopherol acetate caused significant relief during the trial of nephrolithiasis. To a large extent suppressed by oxidative stress, decreased to normal values of the activity of marker enzymes, more than 60% decreased the concentration in urine oxalate ions, and decreased to the level corresponding to the healthy rats, the concentration in urine of calcium ions. In addition, рН urine it was displaced in an alkaline side. These changes resulted in a significant decrease in the number and size of calcium deposits in the kidneys. CONCLUSION. As a result of experiments established the important role of antioxidant therapy in the pharmacological correction of experimental nephrolithiasis.

THE AIM. To study the effectiveness extracorporeal shock wave lithotripsy (ESWL) of the ureteral stones. PATIENTS AND METHODS. The remote results of shock wave lithotripsy of the ureteric stones in 163 patients were study. ESWL was performed with lithotriptor «Dornier – 9000» (Germany). This method can disintegrate as X-ray positive and negative stones. RESULTS. Whole fragmentation of ureteric stones after one session of the ESWL occurred in 131 (80.4%) patients, including the localization of stone in the upper ureter in 91 (69.5%) patients in the middle third of the ureter – a 40 (30,5%) patients (χ²= 7,57; p <0,006). Complete stone fragmentation after two sessions ESWL achieved in 18 patients (11.0%) patients: in 6 (33.3%) patients with ureteric stones in the upper thirds and in 12 (66.7%) patients with stones in the middle third of the ureter (χ²= 6,72; p <0,01). Partial fragmentation of stone after two sessions ESWL was noted in 14 (8.6%) patients. CONCLUSION. ESWL is a non-invasive, least traumatic and highly effective method for treatment of patients with ureteric stones measuring up to 1.0 cm, localized inone spot in the urethra at least 1.5 months and having a density of no more than 1200 units on Hounsfild scale.

In this review we analyzed recent data on the etiology, pathogenesis, therapy and prevention of urinary system infection in children. We characterized the taxonomic spectrum of pathogens pyelonephritis with allocation of priority species uropathogens. Intestinal microbiocoenosis plays a great role as a major endogenous source of pathogens, that can cause pyelonephritis. We highlight all the key stages of the pathogenesis of pyelonephritis–premorbid, translocation, colonization, alteration, persistence or recovery. The material on risk factors, uropathogenic agents that can cause pyelonephritis is based on their role of involvement in the stages of pathogenesis. We highlight the principles of diagnosis, therapy and rehabilitation in children with pyelonephritis. The important part in preventing recurrence of pyelonephritis is in correcting dysbiosis.

In the article the new concept of chronic polyorganic insufficiency in geriatric practice – cerebrocardiorenal syndrome – is considered. Cerebrovascular disease, a heart and kidney pathology, is one of the most widespread and socially significant diseases, especially among patients of elderly and senile age. In the research of last years the role of a cardiovascular pathology and chronic kidney disease in development of cerebrovascular diseases was shown. Uniform pathological mechanisms of development and progressing of cerebrovascular and cardiovascular diseases and chronic kidney disease are thus traced. It testifies the existence of close cerebro-cardio-renal interactions.

Authors review modern screening methods of urinary syndrome verification. Methods used in Russian clinical laboratories for «general urine test» as well as results of these tests are considered.

Based on current concepts of mechanisms of action of cyclosporine the practical recommendations on its application in various forms of idiopathic glomerulopathies are provided.