No 4 (2017)

In the summer of this year, revised kdigo clinical recommendations on mineral and bone disorders (MBD) in chronic kidney disease (CKD) were revised; they were previously adopted in 2009 (CKD-MBD-2009). The article discusses updates in more details. The changes that appeared in the updates (CKD-MBD-2017) concern several chapters: Chapter 3.2: "Diagnosis of CKD-MBD: Bones", Chapter 4.1. "Treatment of CKD-MBD targeted at lowering high serum phosphate and maintaining serum calcium", Chapter 4.2. "Treatment of abnormal PTH levels in CKD-MBD" (PTH - parathyroid hormone), Chapter 4.3. "Treatment of bone with bisphosphonates, other osteoporosis medications, and growth hormone", Chapter 5. "Evaluation and treatment of kidney transplant bone disease". Thus, the updates are related to the diagnosis of MBDs in CKD, the issues of phosphate-lowering therapy, therapy aimed at reducing PTH levels, and management of MBDs in patients with kidney transplant. Updates allow for the diagnosis and management of MBDs in CKD, taking into account modern views on this problem.

Aim. Evaluation of the effect of chemolitholysis with Blamaren in combination with allopurinol or febuxostat therapy on the course of hyperuricemic Tin. Patients and Methods. To achieve this goal, study included 43 patients at the age of 42.7±11.2 years (28 men, 15 women) with hyperuricemic Tin and urate urolythiasis, CKD 1-ЗВ stages, with single or multiple concrements not more than ЗО mm in diameter. The duration of the CKD was 3.7±4.2 years. The number of concrements was 1.4±1.1, the average size was 2.3±0.7 cm. The chemical analysis of urine and concrements in case of their discharge confirmed their urate nature. Results. There was a decrease in the number of concrements during the treatment and at the end of the 9th week. As a result, concrements remained only in two of 43 patients (5 and 5 mm). In relation to these patients, it was decided to prolong the course of therapy with Blemaren for another 9 weeks. As a result, in one patient the concrement was lysed, and in the second patient it has decreased in size to З mm and discharged. Against the background of therapy, normalization of uric acid levels was observed, and it was accompanied by a gradual improvement in renal function (decrease in creatinine levels and increased GFR). This therapy had an effect on the severity of pathological changes in urinary sediments. In particular, there was a decrease in the proteinuria and albuminuria levels, as well as the severity of erythrocyturia. Conclusion. The evaluation of the efficacy of uricostatics in combination with Blamaren in patients with hyperuricemic tubulointerstitial nephritis in combination with urate urolythiasis has demonstrated high efficacy not only in terms of chemolitholysis, but also in relieving the manifestations of nephritis and restoration of renal function.

Aim. Identification of the relationship between excessive salt intake and signs of kidney TIT damage (degree of inflammation, fibrosis, the degree of activation of sodium transporters) in hypertensive patients. Material and Methods. The collection of morphological material - kidney and small intestine - in sudden death cases, with further histological and immunohistochemical studies, was performed (the following markers were determined: tubular NF-kB, TGF-ß,, MCP-і, Osteoponin, Na+,K+-ATPase, ТНР, NНЕ-3). study included 10 men and 8 women. The mean age was 40±10 years, the mean waist measurment - 102±12.5 cm, and mean height - 170±7.7 cm. Results. In the study group compared to the control group, there was increase in the intensity of expression of inflammatory markers in kidney tit (1.9-fold increase in tubular NF-kB, 2.1-fold increase in TGF-ß,, 1.6-fold increase MCP-і, 3.8-fold increase in ТНР and 1.6-fold increase in osteoponin levels), and their relationship with the sodium transporter marker levels was revealed (the most significant statistical relationship of ТНР and MCP-і marker levels with the activity of sodium transporter markers); the increase in the activity of transporter markers (1.3-fold increase in kidney Na+, K+-ATPase level, 1.8-fold increase in intestinal NHE-3 level, and 3-fold increase in intestinal Na+, K+-ATPase level) was determined, which confirms the in-life excessive salt intake. The most significant markers, whose level influences the intensity of inflammation in the kidney tit, included a combination of a high sodium transporter marker levels, Na+, K+-ATPase in the kidney and NHE-3 in the intestine. Conclusions. The results of this study show a clear relationship between the level of expression of sodium transporter markers and the level of expression of inflammatory markers of the kidney tit, which in turn is related to the severity of ah. It was shown that kidney tit damage already presents in ah of the 1st stage.

The article discusses in detail the issues of modern therapy for HCV-associated cryoglobulinemic vasculitis by the example of a clinical case.

The article presents a clinical observation illustrating the possibility of a severe course of IgA-nephropathy when it combines with thrombotic microangiopathy (ТМА). The reasons for the development of TMA are discussed. The features of this clinical observation also include malignant hypertension (MHT). The possible mechanisms of this unusual course of IgA-nephropathy, which is generally a benign disease, are discussed in the article