The article observes the main successes and aims of modern Nephrology. The necessity of an integrative approach in format A4 is demonstrated.

The problem of general pathology of lungs and kidneys, in particular bronchial asthma and chronic kidney disease is discussed. The literature review on the possible general cell and molecular mechanisms of pathogenesis of asthma and chronic kidney disease is presented.

Present review describes the mechanisms of podocytes damage at diabetes, their relationship with metabolic and hemodynamic disorders, the results of recent experimental and clinical studies on these issues are presented. The authors present biomarkers reflecting the intensity of podocyturia dysfunction and structural-functional changes in the nephron in diabetic nephropathy, modern opportunities of such disorders correction to prevent the progression of kidney injury are discussed.

Full morphological analysis renal biopsy held in Rostov region in the South of Russia, including two Federal regions - the South and the North Caucasus (the SFR and NCFR) and with 13 subjects of the Russian Federation. Over the past five years was formed integrative scheme for the diagnosis and treatment of patients with renal profile, combining the territories of the South of Russia. If we consider, that there is held annually around 226 renal biopsies in Rostov-on-don, 95 full analyses (three types of microscopy) and 131 - incomplete (partially microscopy is carried out in the region where made partially in our morphological centers - increasingly electronic microscopy). Of them renal biopsies are perdormed to residents of the Rostov region - 31.5%, other areas of the SFR and NCFR - 10.5%, other FR - 58%. According to the 2014 60% of biopsies in our clinic were performed to extraterritorial patients. At a high level of biopsy in the Rostov region 1: 60563 (procedure: the population), kept on a low level procedures in other regions of the South of Russia - 1: 940000. Thus, it is deemed advisable to empower the use of needle biopsy in the subjects of the SFR and NCFR to minimum requirements in this procedure, which in our opinion is determined by the level of 1: 60000.

It is presented the case of rare aHUS that developed late in the second trimester of pregnancy, and showed severe multiple organ pathology, including the kidneys, heart, lungs, nervous system and placenta. As a result, early diagnosis and timely plazmotherapy started in conjunction with LMWH acute TMA eliminated with full restoration of function of damaged organs.

AIM OF THE STUDY. It is traditionally believed that uromodulin (Umo) may participate in urinary stone formation. However, there is evidence that Umo can be operated in other mechanisms, especially damaging tubulointerstitial renal compartment and promotional arterial hypertension. In this regard, we attempt to compare the levels of the Umo in urine and blood serum with the morphological characteristics of kidney lesions and some clinical functional parameters in patients with various nephropathies. PATIENTS AND METHODS. Twenty eight patients (Pts; M: F 11: 17) with various nephropathies, aged 28 - 74 years were examined. Everybody was performed renal biopsy with semi-quantitative assessment of renal injury severity using light-optic analysis. There were measured UMO, creatinine and urea levels in blood serum, UMO and protein concentration in urine, was estimated glomerular filtration rate (eGFR; CKD-EPI). In twenty Pts 24-hour blood pressure monitoring was performed. RESULTS. Urinary Umo concentration significantly inverse correlated (Spearmen rank correlation coefficient) with degree of tubular atrophy (TA; Rs=-0.39; P=0.038), mononuclear infiltration of interstitium (Rs=-0,37; P=0,05) and mean systolic BP at the day time (mSBPday; Rs=-0.49; P=0.028). Serum Umo concentration was directly associated with eGFR (Rs=0.53; P=0.007) and inverse - with tubular atrophy (Rs=-0.39; P=0.038), degree of perivascular stromal fibrosis (Rs=-0.44; P=0.019), Scr (Rs=-0.64; P<0.001) and serum creatinine and urea concentration (Rs=-0.60; P<0.002). TA directly correlated with mSBPday (Rs=-0.50; P<0.001). There were no associations between serum Umo concentration or urine Umo concentration and glomerular lesions or proteinuria. Serum and urine Umo concentrations didn’t correlate between each other. In the case of hyaline casts in the tubular lumen serum Umo level was significantly lower than in Pts with no casts. CONCLUSION. Umo concentrations in urine and serum are associated with the severity of tubulointerstitial lesions in patients with different nephropathies. Reduction of the urinary and serum Umo levels may reflect a decrease of nephron mass and more local tubulointerstitial lesions.

THE AIM is to clarify the value of determination of heat shock proteins (HSP) in urine to assess the activity and prognosis of CGN. PATIENTS AND METHODS. Study included 75 patients with active forms of chronic GN: group 1 -34 patients with bladder syndrome and group 2 - 41 patient with nephrotic syndrome who have urinary syndrome was the result of incomplete remission of nephrotic syndrome. The comparison group of 10 patients with proteinuria < 0.5 g/day and 10 healthy. Method ELISA) in serum was determined by the level of antibodies to HSP-70 in urinary levels of HSP-27 and HSP-70, IL-6 and IL-10. In kidney tissue (peroxidase immunohistochemical method) was determined by the expression of HSP-70 in various structures; the expression of FoxP3. RESULTS. Excretion of HSP-27 and -70 urine was increased by increasing the activity of CGN, Established direct correlation to the concentration in the urine HSP-27 and -70 with signs of activity CS. CONCLUSION. Confirmed kidney «self-defense» mechanisms capability assessment using the study of one of its parts - HSP.

AIM. The aim of this study was to investigate clinical features, quality of life and prognosis in patients with chronic heart failure (CHF) and patients with CHF associated with chronic kidney disease (CKD). PATIENTS AND METHODS. 203 patients with CHF (130 males and 73 females, mean age was 61,8±9,6 years) were examined. CHF was defined according to the Russian guidelines for the diagnosis and treatment of chronic heart failure, 2012. CKD was defined according to the Russian guidelines for the diagnosis, prevention and treatment of CKD, 2012.Patients with CHF and CKD with GFR <60 mL/min/1,73 m2were included in group of chronic cardiorenal syndrome (CRS). Charlson comorbidity index, duration of hospitalization for a year follow up, clinical and psychological characteristics and quality of life in patients with CHF were estimated. RESULTS. 89 (44%) patients had chronic kidney disease (CKD) with glomerular filtration rate<60mL/min/1,73 m2 (chronic cardiorenal syndrome). Рatients with chronic cardiorenal syndrome had a higher comorbidity. Patients with CRS were hospitalized due to exacerbation CHF for year more often thanpatients without CRS. Рatients with chronic cardiorenal syndrome had expressed emotional discomfort, the presence of depressive, disadaptive trends, decreased of quality of life, both in the physical and the psychological aspects. CONCLUSION. Chronic kidney disease have a negative impact both on the clinical course and quality of life, psychological status and prognosis of patients with CHF. At the same time, patients with CRS have a high comorbidity, they are characterized by the presence of hypochondria and depression and low quality of life, which should be taken into account in the diagnosis and treatment of this group and assessment of prognosis.

THE AIM of the study is to evaluate interrelation between levels of cystatin C and uric acid with left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). MATERIALS AND METHODS. The study included 86 patients with non-diabetic 2-5 stage CKD (53% male, 47% female, mean age 45±13 years). According to glomerular filtration rate (GFR) decrease they were divided into 3 groups: the 1 one with GFR (n = 33) 89 - 45 ml/min, the 2 (n = 33) - 44 - 15 ml/min and hemodialysis patients (n = 20) were included in the third group. Control group (n=20) included persons with GFR> 90 ml/min. All patients were performedclinical examination and transthoracic echrocardiography, cystatin C and uric acid levels in serum were measured. RESULTS. LVH was detected in 52% (48 form 86) patients with CkD (in 1 group - 42,4%, 2 group - 63,6%, 3 group - 80%). It was correlated with age (p = 0,23 р = 0,016), male gender (p = 0,29 р = 0,003), body mass index (p= 0,38 р < 0,0001), total cholesterol (p = 0,3 р = 0,001) and arterial hypertension (p = 0,56 р < 0,0001). Cystatin C levels in the 1, 2, 3 groups were 1489,49 ± 520,76 ng/ml; 2533,13 ± 621,66 ng/ml; 5166,02 ± 1586,61 ng/ml respectively, in control group - 820,0±224,5 ng/ml. Cystatin C has inverse correlation with GFR (Rs=-0.9; < 0,0001), was positively correlated with arterial hypertension (p = 0,5, р <0,001), left ventricular mass index (p = 0,51, р< 0,0001), concentric and eccentric LVH models (p=0,5, р<0,0001; p = 0,2, р = 0,04 respectively). Multiple regression analysis showed that factors associated with LVH were systolic blood pressure (ß=0,29, p=0,03) and cystatin C (ß=0,46, p= 0,02). Serum cystatin C level С >1150,6 ng/ml had sensitivity 78% and specificity 62% LVH in ROC-curve analysis. Hyperuricemia was found in 76,6% patients with CKD. It was directly correlated with arterial hypertension (p = 0,4 р < 0,0001), left ventricular mass index (p = 0,4; р< 0,0001) and cystatin C (r = 0,5 p < 0,0001) and negatively with GFR (p = -0,57, р < 0,0001). Uric acid level > 424,7 mkmol/l was detected LVH with sensitivity 84% and specificity 61%. CONCLUSION. In stage 3-5 CKD higher levels of cystatin C and uric acid may be associated with left ventricular hypertrophy.