No 5 (2014)

Purpose. To evaluate the state of "kidney self-defense" system in patients with chronic glomerulonephritis (CGN) according to the major heat shock protein (HSP) levels in the urine, blood, and kidney; to clarify the significance of the changes of these factors for the assessment of activity and prognosis of CGN. Material and methods. The study included 75 patients with active CGN: 34 - with severe urinary syndrome (Group і), 41 - with nephrotic syndrome (Group II), including 31 - with moderate nephrotic syndrome (Group IIA) and 10 with severe nephrotic syndrome (Group IIB). Transient impairment of renal function as a manifestation of the high CGN activity was revealed in 7 patients from Group I and in 14 from Group II. Control groups consisted of 10 patients with inactive CGN and 10 healthy individuals. Using the ELISA, urine HSP-27 and HSP-70, interleukin (IL)-10 and IL-6 levels; serum levels of antibodies to HSP-70, and HSP-70 expression in the kidney tissue were evaluated. Results. With increasing activity of CGN (primarily an increase of proteinuria, development of nephrotic syndrome, especially in combination with impaired renal function), the imbalance of damaging and protective mechanisms develops. Decrease of serum levels of antibodies to HSP-70 and urine IL-10 levels with an increase of urinary HSP-27, HSP-70 and IL-6 excretion indicate the activity of the inflammatory response in renal tissue and severity of cellular damage in patients with CGN. Progression of these disorders is a poor prognostic sign, indicating the risk of chronization of the disease and poor response to treatment. Thus, in 80% of patients with high (greater than 21 pg/ml) levels of antibodies to HSP-79, response to treatment was obtained within 12 months, in 50% of patients - within 5 months. At the same time, in 57% of patients with antibody titers less than 21 pg ml, nephrotic syndrome persisted despite long-term treatment recommended for these forms of the disease Conclusion. The results of the study demonstrate the significance of HSPs as indicators reflecting the activation of cellular defense mechanisms and extracellular effects of regulation of immune inflammation in the kidney.

Aim. The aim of the investigation was to study functioning of the kidneys in overweight patients with hypertension. Materials and methods. 80 patients with stage II hypertension, degree II, with high and very high risk were examined. The patients were randomised into two groups: group I (n=38 patients) having normal body weight and group II (n=42 patients) being overweight. Results. Overweight in the patients with HTN was accompanied by more unfavourable profile of blood pressure and manifested through reliably higher indices for average diurnal systolic, diastolic and pulse pressure. There was also impairment of the circadian rhythm: non-dippers and night-peakers were revealed reliably more often and there was greater variability of blood pressure patterns at different times of the day. In the patients with moderate HTN, there was the maximal systolic and minimal diastolic rate reduction at the level of the segmental artery with simultaneous increase in resistance indices. In the overweight patients these changes were reliably higher. The following signs of subclinical damage to the kidneys were revealed reliably more frequently in the overweight patients with HTN than in the patients of normal weight: hyperfiltration was determined in 10.5% patients of normal weight and in 38% overweight patients, p=0.0002; microalbuminuria was revealed in 21% patients of normal weight and in 45.2% overweight patients, p=0.002.

The review discusses the role of fibroblast growth factor type 23 (FGF-23) in the progression of renal dysfunction and its cardiovascular effects in patients with chronic kidney disease. Differences in the FGF-23 effects at predialysis stage of chronic kidney disease in dialysis patients and renal allograft recipients are analyzed.

Pregnancy in females with chronic kidney disease (CKD) including kidney transplant recipients is associated with increased incidence of obstetrical and perinatal complications. Furthermore diagnostics of preeclampsia in pregnant women with CKD may be difficult because clinical features of preeclampsia and underlying disease are similar. Nevertheless favorable outcome of pregnancy is possible, and presented clinical case confirms it.

Aim. Identification of idiopathic hypercalciuria in children with persistent hematuria (pH). Material and methods. The study included 65 children aged 1 month to 15 years (mean age 6,5±1,3 years) with PH diagnosed during the period 2012 to 2014. The evaluation of genealogical history, assessment of physical status, clinical and biochemical blood and urine tests to determine the serum and urine calcium, phosphorus, urea, and creatinine levels were performed. Calcium/creatinine ratio was calculated. Instrumental methods were used for the assessment of the state of the urinary system. Results. 50.8% of children with PH had experienced infection of the urinary system, 23.1% of patients had abnormal development of the urinary system, and 21.5% had urolithiasis. More than half (56.9%) children with hematuria had burdened familial history of urolithiasis. Clinically, children with PH often had dysuric (44.6%) and pain (24.6%) syndromes. In the urinary sediment, crystalluria, with significantly more frequent oxaluria, was observed in 33.8% of children with hematuria. Idiopathic hypercalciuria was detected in 27 (41.5%) children with ph. Conclusion. Identification of idiopathic hypercalciuria in 41.5% of children with PH suggests a presence of relationship between these pathological manifestations.

In a review article discusses the epidemiological and medico-social aspects of the symptoms of night urination (nocturia), based on the results of modern evidence-based research in this area and our own clinical data. The results of all epidemiological studies show that nocturia is a universal aging phenomenon, gender devoid of color, not just the symptom of men with benign prostatic hyperplasia, as is often assumed so far. Its frequency in both men and women has been steadily progressing with age. Nocturia often occurs and progresses on the background of the majority of age-related diseases, and between them and nocturia there is a reliable two-way communication pathogenetic relation: the emergence of nocturia aggravates the clinical course of the existing of aging psychosomatic pathology and, conversely, any aging diseases can induce and contribute to the progression of nocturia. As a result, not only dramatically reduces the quality of life of older people, but also significantly reduced their survival against the background of an increased risk of death from any causes. This reflects the closed relationship of nocturia with other age-related diseases, is the essence of age and comorbid diseases makes the issue of nocturia one of the most urgent problems of modern integrative interdisciplinary clinical medicine.