No 3-4 (2016)

Currently membranoproliferative glomerulonephritis (MPGN) is believed to be a morphological variant of glomerular injury arising in a variety of disease entities. Earlier MPGN was divided into primary, idiopathic and secondary MPGN. The primary MPGN included MPGN і, II and III depending on the localization of deposits. Given recent advances in understanding the etiology and pathogenesis of the disease, this classification has been changed. Studying the composition of deposits with immunofluorescence microscopy allowed to identify a special group of nephritis associated with dysregulation of the alternative pathway of complement. This group became known as СЗ glomerulopathy. The main representatives of this group are dense deposit disease previously known as type II MPGN and СЗ glomerulonephritis. The review presents the new data on the pathogenesis and classification of MPGN.

Purpose. To reveal the significance of prehypertension as a risk factor for CKD. Material and Methods. The study included 94 men with prehypertension and 57 men with I degree arterial hypertension. The examination included detection of risk factors for CKD. Patients were allocated into 3 groups: 1st- with normal blood pressure (NBP), 2nd - with nigh normal blood pressure (HNBP), and 3rd - with I degree arterial hypertension, (і degree ah). Patients of the 2nd and 3rd groups have received advice on non-drug correction of risk factors; in addition, patients of 3rd group have received valsartan (40-80 mg per day). a year later, examination of patients of the 2nd and 3rd groups was carried out. Results. We have identified modifiable hemodynamic and metabolic factors associated with CKD against the background of HNBP comparable to those of I degree ah. In patients with HNBP the use of non-drug methods of correction of CKD risk factors was ineffective: increase in BMI, insulin resistance (Ir), CRP, hyperuricosuria were detected. The number of patients with increased and high urinary albumin excretion (UAE) increased from 47 to 59%, decrease in GFR (<60 mL/min) was observed in 5% of patients. after year of observation, frequency of detection of early stages of CKD has reached 23%, transformation of VNAD in I degree AH was observed in 27% of cases; the detection rate of non-dippers increased from 33 to 38%, LVMMI by 2.1%. The use of valsartan has allowed to control of systolic and diastolic blood pressure (more than in 80% of patients), reduce the proportion of non-dippers by 27%, decrease in UAE by 25%, CRP by 16%, LVMMI by 2.8%, as well as decrease in uricosuria an Ir. The prevalence of CKD has decreased by 37%. Conclusion. According to our data, HNBP, as a form of prehypertension, is a subclinical stage of arterial hypertension, prone to progression, with high risk of CKD and cardiac complications.

Chronic kidney disease and its outcome in the form of end-stage renal disease is a significant medical and social problem. Kidney allotransplantation is the optimal method of renal replacement therapy. Purpose. Evaluation of postransplantation predictors of outcomes after kidney transplantation. Material and Methods. The study included 350 patients who underwent kidney transplantation; mean follow-up period - 79.1 ± 3.4 months, median follow-up period - 68 months. There were 229 men (65.4%). mean age of patients was 37.1 ± 0.6 years (і2-6і); median age - 38 years. The following outcomes after transplantation were assessed: death, renal allograft loss, and development of chronic allograft dysfunction. Statistical analyses were performed using the SPSS software package, version 16. Results. We have revealed significant (Р <0.05) predictors of outcomes after kidney transplantation: the protocol of immunosuppressive therapy on the basis of calcineurin inhibitors, mycophenolate, and corticosteroids, the use of interleukin-2 receptors blockers, monitoring of cyclosporin-A concentrations, delayed graft function, serum creatinine and proteinuria levels after surgery, infectious complications, infection with cytomegalovirus and herpes simplex virus, prophylactic use of antiviral therapy, alanine aminotransferase blood levels, hemoglobin levels, albumin levels, as well as hypertension, labor rehabilitation of the patient, smoking and compliance. Conclusion. Management of identified predictors can improve the prognosis of outcomes after kidney allotransplantation.

Aim. To identify the relationship between dysmetabolic nephropathy in children presenting with the abdominal pain syndrome and the need for its surgical treatment. Materials and methods. The study included 84 children aged from 1 to 17 years admitted to the children's surgery department of Barnaul Children's City Hospital №7 with severe abdominal pain syndrome and suspected acute appendicitis. Clinical assessment included genealogical history, examination of physical status, blood count and urinalysis. To assess the state of the urinary system diagnostic investigations were carried out. Results. All children had acute abdominal pain syndrome (mean time from the onset of the disease was 13.7±1.8 hours). Also presenting symptoms included prominent upper dyspeptic syndrome (32.і%), fever (34.5%). Three patients had dysuria. In 84.5% of cases (71 children), no signs of acute appendicitis were found. In this group, 69% of children had pathological changes in urinalysis. Significantly more children had hypersthenuria (42.2%) and crystalluria (39.4%). In 22 (31%) patients, the urine sediment revealed oxalates and in 6 (8.5%) - urates. Changes in the urinary tract, including signs dysmetabolic nephropathy were detected in 25 (35.2%) children with acute abdominal pain syndrome. Conclusion. The abdominal pain syndrome in children is often coexists with dysmetabolic nephropathy, which requires obligatory examination of the urinary system in these patients.

This article describes two cases of development of tumors 22 and 1 year after kidney transplantation. The possibility and reasonability of the need for use of tumor affected donor organs for transplantation are discussed. The methods for treating tumors of transplanted kidney are described. a brief review of the literature is presented.

The article describes the clinical observation of atypical hemolytic uremic syndrome in young women in the third trimester of pregnancy with a rapid deterioration after delivery.

Chronic obstructive pulmonary disease (Copd) is an important medical and social problem that is connected not only with its high prevalence in the population, increasing mortality, but also with a significant frequency of comorbidity due to systemic effects of copd. Small number of recent studies highlights the relationship of copd with development of kidney dysfunction. Mineral and bone disorders occur in both of these nosologies, which cannot fail to attract the attention of researchers to find the possibility of additional monitoring and improvement of the course of disease in the future. This review considers the main risk factors for the development of mineral and bone disorders, their pathogenetic and clinical aspects with comorbid combination of copd and ckd.

This review summarizes the information about the new iron-containing phosphate-binding agents with equal efficacy and safety to other phosphate binders. The iron oxyhydroxide (Velphoro) reduces the serum phosphorus levels, the significantly reduces pill burden, improving the compliance of patients to therapy and its results, and iron citrate increases the body iron stores, reducing the cost of treatment of anemia in patients with ckd.