No 4 (2014)

Aim. Estimation of risk factors of steroid-resistance, including podocin gene polymorphisms, in patients with chronic glomerulonephritis (CGN) and nephrotic syndrome (NS). Methods. 54 patients (31 male, 23 female, mean age 34 years) with CGN and NS were included into the study. All patients undergone kidney biopsy. Podocin gene polymorphisms were identified. Results. In 66 % of patients rs1410592 mutation of podocin gene was detected, in 50 % - RS1410591 mutation, mutations S1079291, IVS5+69T, RS1079292, IVS7+7AG, GLU87term, RS12401708, RS38185887, RS61747728, RS3738423, RS2274624 were found less often. Patients with CGN and NS, resistant to steroid therapy, who had combination of rs1410592 и rs1410591 podocin gene mutation, had lowest serum albumin levels and maximal proteinuria. Conclusion. Podocin gene mutations can be considered as one of the causes of steroid-resistance in patients with chronic glomerulonephritis and nephrotic syndrome.

Purpose. Based on the evaluation of the urine biomarkers of tubulointerstitial damage (MCP-1 and β2-MG), and the levels of systemic and locally-renal markers of endothelial dysfunction (Mau, et-1), the identification of the factors of progression of renal disease in hypertensive patients with DUAM for prognosis and selection of optimal management tactics. Materials and methods. The study included 81 patients with arterial hypertension of 1 degree, without associated clinical conditions, diabetes mellitus, and metabolic syndrome. Three groups of study were identified: group 1 - with hyperuricosuria (n = 7), group 2 - with hyperuricemia (n = 53), group 3 - with hyperuricemia and renal failure (n = 6). The control group consisted of 15 patients with AH without metabolic imbalance of uric acid, matched by age and sex to study groups. Results. Compared with patients in the control group, hypertensive patients with hyperuricemia (group 2) have higher rates of MAU (P = 0.009), and urinary excretion of β2-MG (P = 0.010), MCP-1 (P = 0.030), as well as the plasma ET-1 levels (p = 0.003). There is a direct correlation between all biomarkers studied and the degree of URICEMIA (Rs = 0.411, p <0.001; Rs = 0.537, P <0.001; Rs = 0,318, P = 0.004; and Rs = 0.453, P <0.001, respectively). Multivariate analysis of the studied clinical and laboratory parameters (multiple linear regression) has confirmed the role of MCP-1, β2-MG, UIA, serum creatinine levels as independent predictors of decreasing the relative density of urine - clinical sign of tubulointerstitial injury/fibrosis; and a wider range of indicators - MAU, interventricular septum thickness, glomerular filtration rate, relative density of urine, systolic blood pressure, MCP-1, low density lipoproteind - as risk factors for progression of renal failure. Conclusion. Identified relationship of urinary biomarkers mau, β2-MG, MCP-1, and plasma ET-1 concentrations with biochemical indices and signs of organ damage in hypertensive patients with hyperuricemia allow to personalize prognosis of renal disease in these patients.

Ischemic and reperfusion injury is a complex, multifactorial process that damage kidney transplant. Understanding pathogenic mechanisms of ischemic and reperfusion damage allows you to apply various biological agents to reduce this damage. However, unfortunately, the application of most of biological agents is still only in the experiment and is not used in wide clinical practice. The purpose of this survey show two main strategies (pretransplantation and post-transplant), competent use of which allows to reduce the severity of ischemic and reperfusion damage.

Pyelonephritis is a leader in frequency among kidney disease patients with different stages of pregnancy, which determines not only medical but also social significance of the problem. The basic component of conservative treatment of acute gestational pyelonephritis is an antibacterial therapy of different groups of antibacterial drugs. However, the hopes assigned to these chemicals are not fully realized, and antibiotic therapy was far from harmless method of treatment, which gives a large number of complications, adverse reactions, allergies, however because of the stability of microflora not always ensure the recovery. Conducted on the basis of the City clinical hospital № 29 work showed that acute gestational pyelonephritis use of combined antibacterial therapy using herbal medicine allows more quickly to arrest the clinical and laboratory manifestations of pyelonephritis and to reduce the frequency of relapse inflammatory process in pokeroom period. Recommendations on the combined treatment of acute gestational pyelonephritis.

Purpose. To determine the role of matrix metalloproteinases and their inhibitors in the progression of Alport syndrome in children for the development of an algorithm for predicting prognosis and the course of the disease. Materials and methods. In 32 children with Alport syndrome, determination of blood and urine levels of the major components of proteolysis - matrix metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10), tissue inhibitors of matrix metalloproteinases (TIMP-1 and TIMP-2), and plasminogen activator inhibitor-I (РAI-I) - was performed. The control group consisted of 10 children without kidney disease. Results and discussion. In children with Alport syndrome, the levels of MMP-2 and MMP-3 inhibitors: TIMP-2, and РАI-1 (antigen) levels in blood, and urine MMP-3/Cr, MMP-9/Cr and TIMP-1/Cr levels were significantly higher compared with the control group. The urine TIMP-1/Cr levels in children with greater daily proteinuria (more than 30 mg/kg/day) were significantly higher and directly correlated with the daily loss of protein regardless of progression. In children with progressive Alport syndrome, direct correlations between the daily proteinuria and MMP-2/Cr in urine, the TIMP-1/Cr in urine, and between creatinine levels and MMP-1 in the blood, and MMP-10 in the blood were revealed; in the group without progression - inverse correlations between MMP-2/Cr in the urine and daily proteinuria and glomerular filtration rate were revealed. Conclusion. Thus, the identified relationships between matrix metalloproteinases and their inhibitors and clinical signs of Alport syndrome in children suggest an important role of matrix metalloproteinases and their inhibitors in the mechanisms of progression of disease, and justify the potentials for their use as criteria for progression of this disease.

Scientific publications of S.S. Zymnitsky in nephrology are discussed. S.S. Zymnitsky contribution in development of diagnosing and treatment of chronic kidney diseases is analyzed.