No 1 (2009)

Growing albuminuria was considered to be a marker of early stages of hypertonic and diabetic nephropathy for a long time. Now days it has the meaning of the integral marker of unfavorable prognosis. Its forecasting role is very important due to the fact that it reflects the generalized endothelial dysfunction, determining the injury of target organs (myocardium, vascular wall, kidney). This damage is well observed even for insignificant increase of albumin excretion. A lot of therapeutic strategies, applied to decrease cardiovascular risk and kidney injury, can reduce albuminuria, but the most effective one includes the use of angiotensin-converting enzyme inhibitors and angiotensin II receptors blockers

This state-of-art lecture is dedicated to erythropoietin influence on not hemopoietic tissues, the opportunity of this mediator to decrease the expression of tissue damage at experimental hypoxia and ischemia

Due to permanent increase of arterial hypertension prevalence and the frequency of hypertensive nephropathy development, as well as significant increase of cardiovascular complications risk after the appearance of microalbuminuria (MAU), special attention should be paid to patients with hyperfiltration, condition that leads to MAU development. The most common theory of hyperfiltration development is the theory of intact nephron. Methods of hyperfiltration detection includes instrumental and laboratory, predictive formulas for screening (e.g. Mayo), tests with protein upload. It is proven fact that hyperfiltration is associated with risk factors of metabolic syndrome. approaches for hyperfiltration correction are not standardized but established hyper activation of RAAS lets to offer ACE inhibitors and ARA as first line therapy

The interest to direct pharmacological active renin blockade is explained by the need of its homodynamic and tissue effects removing, that are realized mostly through interaction with pro-renin receptors. Renin activity control provides the effective control of the activity of the most RAAS components. Direct renin inhibitor aliskiren with proven in large clinical trials efficacy can be especially effective at hypertensive patients for kidney injury prevention

136 patients with chronic glomerulonephritis with normal renal function; 100 of them had normal renal function and 36 were normotensive. Heart rate variability was evaluated by of 24-h ECG monitoring. Plasma renin and aldosterone levels were measured in all patients. Heart rate variability disturbances became more prominent in patients with highest blood pressure. In patients with chronic glomeprulonephritis and arterial hypertension grade II and II plasma renin activity and aldosterone concentrations were increased. Conclusion. In chronic glomerulonephritis progression of arterial hypertension is associated with heart rate variability anomalies and plasma renin activity and aldosterone concentration increase

46 patients with III-IV staged CKD caused by systemic diseases (33 - by systemic lupus erythematosus and 13 - different systemic angiitis), were randomised to 3 groups: 1st - 18 patients (10 with III and 8 with IV stages) - during observational time (24-48 months) got LPD (0,6 g protein kg/day) with balanced content of essential amino- and ketoacids; 2 nd - 18 patients (10 with III and 8 with IV stages) - got LPD as well, but with increased level of plant protein till 0,3 g/kg/day owing to high-purity soy protein in the content of high-energetic nutrition mix; 3d - 10 patients (7 with III and 3 with IV stages) - control group - free diet. Both variants of LPD was prescribed to all patients of 1 and 2 groups without difference due to nutritional status. Nutritional status was evaluated on the basis of anthropometrical and some other standard parameters. Protein intake and food calories was counted according to 3-days food diery. Among 46 patients with systemic diseases and III-IV staged CKD nutritional status disorders were found almost at half (45,7%). Both variants of LPD were well tolerated, as a result of their use correction of nutritive disorders was achieved at patients that previously had them, and the prevention of nutritive disorders was got at the rest of the patients of 1 and 2 groups. In 3 group we found the increased frequency of nutritional status disorders with the progression of renal failure by 1,5 times (from 40% to 60%). At patients who took LPD not less than 1 year, we found slowing of GFR decrease, that was more significant with the use of high-energetic nutrition mix. Conclusion Early (at the stage before dialysis) protein intake constriction (0,6 g/kgг/day) with content in the diet of essential amino- and ketoacids and high-energetic nutrition mix has beneficial effects on nutritive status of patients with CKD and leads to slowing of GFR decrease

Indications, controversies and limitations of ACE inhibitors are discussed with the special reference for hyperkalemia.