No 3 (2009)

This leading article is devoted to 100th anniversary of Russian scientific medical society of physicians. The issues of nephrology have always played prominent role in its activities

Urinary angiotensinogen concentration adequately reflects the activity of the kidney pool of renin-angiotensin-aldosterone system (RAAS). Experimental and clinical studies allow considering this indicant as a reliable early marker of cardio-renal syndrome, reflecting the formation and progression of kidney damage and characterizing the effectiveness of RAAS blockers

Thrombophilia is defined as predisposition of the organism to thrombosis development. There are acquired and inherited thrombophilia; both of them are considered as risk factors for arterial, venous and microcirculatory thrombosis. Kidney disease in patients with a genetic polymorphism of coagulation factors are manifested as renal vein and artery thrombosis, and thrombosis of renal microvasculature - thrombotic microangiopathy. Combination of thrombotic microangiopathy and chronic glomerulonephritis further the disease progression due to progressive nephrosclerosis

We discuss the approaches to the differential diagnosis and management of pericarditis, which occur in patients with chronic renal insufficiency, including patients treated with programmed hemodialysis. Mechanisms of the genesis and principles of treatment of cardiac tamponade are particularized

Purpose. Evaluation of efficacy and safety of EPO drug in patients treated with programmed hemodialysis in real clinical practice in Russia. Material and methods. Observational, noninterventional study include 431 patients with terminal renal insufficiency treated with programmed hemodialysis for at least 12 months and regularly received EPO drug. The study was conducted in 11 hemodialysis centers. We have assessed the adequacy of management of patients and the adverse events rates. Results. 49.9% of patients received Recormon, 36.7% - Eprex, 9.0% - Epocrin, and 4.4% of patients - Eralfon. When comparison of hemodialysis centers, we have observed significant differences in the survey protocol and management of patients, leading to reduction of efficacy of EPO drug. Correction of hemoglobin was used only in 21.2% of patients; 78.8% of patients received erythropoietin on conventional regimen. At a time when correction was used, target level of hemoglobin was achieved in 69% of patients. In contrast, target level of hemoglobin was achieved in 31% of patients only with "routine" administration of EPO drugs. Periods of achieving of target level of hemoglobin against the background of correction use were 3 times shorter compared with its absence. Conclusion. The actual practice of use of EPO drugs in patients treated with programmed hemodialysis requires further optimization.

Currently we have accumulated considerable experience of hydrochlorothiazide use in hypertensive patients justifying substantially decrease of risk of cardiovascular complications. The article discusses clinical studies confirming the advisability of hydrochlorothiazide use in patients with hypertension, as well as ways to prevent adverse events associated with its use, including type 2 diabetes mellitus

We discuss the results of the HOPE study showing significant prognosis improvement in high-risk patients treated with ramipril, and important implications of this finding for real clinical practice