No 2 (2017)

Several studies describe the trajectories of reduction in glomerular filtration rate (GFR) before starting dialysis. The trajectories of reduction in GFR may affect the conditions for starting dialysis and long-term prognosis. Material and methods. Among 1029 unselected patients who started dialysis in St. Petersburg in 2012-2014, 481 (46.7%) were observed for a long time in the City nephrology Center, and included in the City Register of patients with CKD. The mean age was 63±12 years, 47.4% women, 21.8% diabetic patients. The median of the number of visits with an assessment of the estimated (e)GFR was 7 (interquartile range - IR 5÷9); the duration of follow-up for 352 (73.1%) patients exceeded 36 months, for the remaining 129 (26.9%) patients was 21 (14÷28) month. Results. The initial eGFR was 43±22 ml/min/1.73 m2; median proteinuria - 1.4 g/day (0.5÷3.1). The mean rate of decrease in eGFR in the whole group was -3.94 ml/min/1.73 m2 per year (95% confidence interval [Сі] -6.48÷-1.87). We identified three types of trajectory of the decrease in eGFR: slow progression (-2.58, 95% CI - -4.95÷-0.67 ml/min/1.73 m2 per year) from cKD-3B-cKD-4 - 73% of patients, fast progression (-7.81, 95% CI - -10.32÷-5.71) from CKD-З -22% of patients, accelerated progression - initial absence of progression ( + 0.31, 95% CI - -1.61÷-2.16), followed by an acceleration in the reduction of eGFR (-21.3, 95% CI --32.4÷11.7) from CKD-3-5% of patients. Dialysis was started at eGFR 7±3 ml/min/1.73 m2 in the "slow" group (32% started dialysis urgently), 6±4 - in "fast" group (52% - urgently), and 5±4 ml/min/1.73 m2 - in the group of "accelerated" progression (58% - urgently). In addition to differences in eGFR at the start of dialysis, patients differed in the anemia, hyperphosphataemia and blood pressure levels; differences between groups in the structure of diagnoses did not reach statistical significance. Conclusion. CKD progression before dialysis happens in different ways, which can affect the conditions for starting dialysis and planning the management of a patient with CKD.

Aim. To investigate the characteristics of vegetative homeostasis and quality of life indicators in children with neurogenic bladder disorders, depending on the manifestations of the syndrome of connective tissue dysplasia (CTD). Material and methods. The study comprised 26 children aged 5 to 12 years (mean 8.3±і.7 years) diagnosed with "neurogenic bladder dysfunction" (NBD). Diagnostic evaluation included genealogical history, clinical manifestation of the disease, complete blood count and chemistry profile, kidney and bladder ultrasound, duplex scanning of brachiocephalic vessels, echocardiography (EchoCG). The severity of urinary disorders was assessed using a clinical qualimetric table for children aged 4 to 15 years. CTD was diagnosed by scoring external and visceral signs of systemic involvement of connective tissue ranked by importance. Quality of life was assessed using a PedsQL™ questionnaire (j. Varni, 1999). Results. Clinical symptoms of autonomic dysfunction were more often detected in NBD patients who had more severe manifestations of mesenchymal dysplasia. Cardiointervalography (CIG) showed that major changes in the initial autonomic tone regardless of the degree of dysplasia were sympathetic - hypersympathicotonia type changes. Quality of life assessment in children with NBD showed a significant reduction of scores on all scales regardless of CTD severity. Conclusion. Clinical signs of autonomic dysfunction were most often detected in patients with moderate CTD. The average number of vegetative symptoms per child in this group was 5.5 versus 2.2 in the group with mild dysplasia. CIG results did not depend on the severity of the CTD, and were characterized by sympathicotonia-type changes in the initial autonomic tone, which was observed in 55.5% of children with moderate CTD and in 64.8% of children with mild CTD. There was a significant decline in the quality of life in NBD patients with concurrent CTD. No association between the quality of life and CTD - severity was observed.

The article presents the case of clinical observation of a child with atypical hemolytic uremic syndrome, who is on therapy with eculizumab. The clinical picture of the disease is described; the results of a comprehensive examination of the patient, the dynamics of clinical and laboratory data on the background of treatment are given.

The article describes a case of development of renal cell carcinoma in one's own kidneys and in a renal transplant recipient 10 years after transplantation. a brief literature review is provided.

This brief review analyzes the leading factors for development and progression of chronic kidney disease (CKD) in patients with chronic obstructive pulmonary disease (COPD). The article provides current epidemiological data and outlines pathophysiological aspects of renal dysfunction in this group of patients. The role of smoking, dyslipidemia, hypoxia and high medication load is shown in developing CKD in patients with COPD.

The article presents clinical observation of the patient after allotransplantation of the cadaveric kidney with functioning arteriovenous fistula (AVF). At the time of admission, there was a severe congestive heart failure (CHF) with preserved graft function. During the examination, severe symptomatic aortic stenosis (AS) and clinical and instrumental signs of heart failure with high cardiac output (HFHCO) due to a long-functioning AVF with excessive blood flow were detected. For the objectification of the CHF genesis, temporary occlusion of AVF during echocardiography (EchoCG) and during the catheterization of the right heart was performed. The results of the examination made it possible to clarify the specific hemodynamic model of AS (high gradient/high blood flow) and to formulate indications for ligation of AVF. After surgical closure of the vascular access, the signs of CHF completely resolved within 10 days. The control EchoCG confirmed the reduction of pulmonary hypertension and an improvement in the left ventricle diastolic function. Ligation of AVF allowed to establish a real severety of AS (severe asymptomatic) and determine the urgency of surgical correction of the defect. a diagnostic algorithm for examining patients with AS and functioning AVF, which allows to determine the true severity of the defect and to assess the presence and hemodynamic severity of the concomitant HFHCO, is discussed. a brief literature review is presented.

The article presents data on the role of proinflammatory cytokines in the progression of renal dysfunction and cardiovascular complications. The results of a number of studies showing the activity of interleukin-1, -6, and tumor necrosis factor-а in the light of renocardial relationships are analyzed..