No 1 (2018)

Purpose. To evaluate the effect of renal artery stenosis on the risk of vascular events in patients with acute coronary syndrome. Material and Methods. The study included a total of 323 patients with acute coronary syndrome, 2і7 (67.i%) men, 106 (32.9%) women. The average age of the examined patients was 59.6±9.2 years. Results. Atherosclerotic lesions of the renal arteries, in addition to magnitude of EF or the size of la, RV, and the thickness of IVS, influenced the risk of non-fatal vascular events (х2=7.46, P =0.024, х2=7.37, P =0.025, х2=11,1, р=0.004, х2=9.52 , р=0.009, respectively). Also, the risk discussed was increased in case of a GFR increase after coronary angiography, х2=9.83, P=0.007. Conclusions. a model for predicting fatal and non-fatal vascular events, proposed in the the study, can be widely used in a comprehensive examination of patients with Acs and atherosclerotic lesions of the renal arteries.

Purpose. Evaluation of the role of renal blood flow in early diagnosis of pregnancy, complicated by pre-eclampsia (PE). Material and methods. The state of renal blood flow was evaluated in detail in 200 pregnant women at the gestational age of 30-34 weeks, 50 of them with the physiological course of pregnancy (Group і), 75 with mild PE (Group 2) and 75 with severe PE (Group 3). The examination of renal blood flow was performed using a Sono-scape SSI 5000 ultrasound scanner (model China) with 3.5 MHz convex probe. Dopplerometric parameters were assessed at the segmental, interlobar, and distal artery levels. The results of the study showed that with increasing severity of the PE course, the resistance of the intravenous segmental and interlobar arteries continued to increase. The resistance index (Ri) of segmental, interlobar and intrarenal arteries in women with severe PE was increased by 3.3% relative to those in the Group 2, respectively (in both groups P>0.05). The RI of the distal parts of the renal artery, remaining unchanged, was 5.8% lower than that of the intravenous segmental arteries and 3.2% lower than the resistance of the inter-renal interstitial arteries. Conclusions. Based on the results of the study, we developed an algorithm that allows to predict the development of pe, to choose the step-by-step tactics of management of pregnant women with this pathology.

The article presents clinical observation and a review of the literature devoted to papillorenal syndrome. Papillorenal syndrome (PRS) is a rare autosomal dominant disease caused by PAX2 gene mutation (OMIM 120330). The phenotypic features of the patient with a mutation in the exon 2 of PAX2 gene include a combination of bilateral kidney hypoplasia and coloboma of optic nerve discs, as well as a syndrome of proximal tubule dysfunction that was not previously described in these patients, manifested by unstable glucosuria, nonselective aminoaciduria, and high ß2 microglobulin level. Through the example of the presented clinical case, the need for an integrated approach to the examination of children with an anomaly of kidney development for the early diagnosis of syndromic pathology variants is shown, which is important for determining nephrologic, vital, social and familial prognosis of the disease.

The imbalance between consumption of salt and its elimination leads to a change in the filling of the vascular system (fluid volume), which changes the blood pressure level, i.e. in real time, the pressure level determines the ability of the kidneys to remove sodium - this relationship was called the "pressure - natriuresis curve". This ratio is continuously changing, converging to equilibrium. It is important to remember that healthy kidneys can withstand the load of salt, about 40-50 times higher than the normal level of the Na+ daily requirement. The current level of knowledge allows us to consider that the mechanisms ensuring the retention of Na+ (ion exchange pumps), in case of excessive salt intake do not have time to reabsorb the proper amount of Na+ cations at the level of the proximal tubules and the ascending limb of the Henle loop. The largest recent studies have shown that a significant amount of sodium can accumulate in the interstitium without causing fluctuations in the plasma sodium concentration and a compensatory increase in the retention of H2O, i.e. with a constant blood sodium concentration, the total sodium level can vary significantly. Glycosaminoglycans (GAGs) "soften" the fluctuations in the plasma sodium concentration, "hide" sodium from the osmoreceptors, which prevents process of increasing vasopressin secretion and the growth of water retention, mandatory in such a situation. On the other hand, the deposited sodium cations do not reach the nephron, which makes them difficult to excrete from the body. With a decrease in the level of sodium intake, the GAGs polymerization decreases, the decrease in GAGs is accompanied by a massive release of sodium from the reserve. With prolonged overload of GAGs by sodium, damage to macromolecules occurs, and the buffer properties of GAGs are violated. In particular, in salt-sensitive patients this will lead to a sharp increase in blood pressure, patients with in CHF - to the RAAS hyperactivation. We can assume a certain parallelism between sodium intake and gag level in the interstitial tissue, which is necessary for its accumulation. The change in the ratio of the structural components of tissues will lead to a change in their properties, incl. physical, for example, myocardium stiffness, its elastic properties, arterial stiffness, and striated muscle exercise capacity.