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No 4 (2018)
- Year: 2018
- Articles: 10
- URL: https://journals.eco-vector.com/2075-3594/issue/view/6524
Articles
Guidelines for hemodialysis/ hemodiafiltration procedure
Clinical nephrology. 2018;(4):6-19
6-19
Post-transplantation diabetes mellitus in patients with kidney allotransplantation
Abstract
Objective. To identify the prevalence and risk factors for the development of post-transplantation diabetes mellitus (PTDM) after kidney allotransplantation (Kat). Material and methods. A retrospective analysis of out-patient medical records of 146 kidney allograft recipients, obtained from 1989 to 2014, was performed. The diagnosis of diabetes mellitus established before the KAT was used as the exclusion criterion for participation in the study. As risk factors, gender, age, KAT duration and the use of glucocorticosteroids (GCS), tacrolimus (Tc), and cyclosporin A (CsA) were analyzed; their significance was assessed using stepwise linear regression analysis. Results. The mean age of the recipients at the time of the study was 42.9±20.2 (years. The prevalence of PTDM in the general group was 21.9% (n=32). AGE (P=0.01), the use of CsA and GCSs, the timing of ATP (P=0.01) and the mode of immunosuppressive therapy (P=0.01) had the greatest influence on the development of PTDM. after the conversion of CsA to Tc, the prevalence of PTDM has increased from 11 (18.6%) to 21 (26%) cases. Conclusion. PTDM was diagnosed in 1/5 of the recipients of the kidney transplant. It was revealed that older patients have a greater risk of developing PTDM than younger recipients. Along with age, the use of immunosuppressive therapy with calcineurin inhibitors in combination with GCSs significantly increases the risk of developing PTDM.
Clinical nephrology. 2018;(4):20-24
20-24
Cytokines and arterial stiffness at the early stage of chronic kidney disease: the relationship and prognostic role
Abstract
Objective. To evaluate plasma cytokine levels (tumor necrosis factor а - TNF-а and interleukin-10 - IL-i0) and their relationship with arterial stiffness parameters in patients with renal dysfunction (RD) at an early stage of the disease. Material and methods. A total of 221 patients with RD aged from 19 to 88 years were examined. To assess the severity of RD, the glomerular filtration rate (GFR) using blood cystatin с level was measured. All examined patients underwent evaluation of the lipid spectrum and plasma uric acid levels. The TNF-а concentration (pg/mL) and IL-io concentration (pg/mL) in the blood plasma were evaluated by the reagent kits (ООО Vector-Best, Novosibirsk) using ELISA technique (stiffness index - SI, augmentation index - AIP, alternative stiffness index -aSI, vascular age - va, age index - agi, reflection index - ri, increase index at a pulse rate of 75 per minute - PR = 75 - AIP 75, and pulse wave amplitude - PWA) on the "AngioScan-01" device. Depending on the TNF-а concentration, all examined patients were randomly divided into two groups: the group 1 (n=166) included patients with TNF-а level <2.0 pg/mL and the group 2 (n=55) - patients with TNF-а level >2.01 pg/mL. results. Patients in the group 2 (TNF-а level >2.0i pg/mL) had higher AIP level - 13.3 (1.20-23.4) versus 9.35 (-3.7-21.5)% (р<0.05) and increase index with a pulse rate of 75 per minute (AIP 75) 16.1 (6.4-25.1) versus 10.5 (1.5-19.4)% (р<0.05) compared with the group 1 (TNF-a concentration <2.0 pg/mL). In the 2nd group, the statistically significant direct relationship between the TNF-a and blood plasma cystatin С concentrations (0.406; P=0.019), as well as the tendency of inverse correlation between TNF-a and the calculated GFR (-0.267; Р=0.051) were also revealed. Conclusion. At an early stage of RD, an increase in the TNF-a concentration is associated with an increase in AIP.
Clinical nephrology. 2018;(4):25-32
25-32
The apartness of HELLP-syndrome from preeclampsia: features of damage of kidney and other organs
Abstract
Background. In recent years, an alarming trend in obstetrics has been noted: an increase in ma-ternal mortality from pre-eclampsia (PE) and its complications is recorded annually, despite the optimization of methods for early diagnosis and approaches to delivery. It is believed that HELLP syndrome complicates 0.8-1% of pregnancies, and in severe PE and eclampsia occurs in 10-20% of cases. Various options and features of the manifestations of HELLP syndrome are little known to doctors. Material and methods. The course and outcome of pregnancies were studied in 141 women di-vided into 4 main groups: HELLP syndrome, severe pre-eclampsia (PE), moderate PE, and the control group. The main laboratory, clinical, biochemical, and immunological parameters, includ-ing imbalance of placental angiogenesis factors (sFlt-1, PLGF), as well as instrumental mrthods of diagnosis, were performed, and results were compared. Results. The sFlt-1/PLGF ratio in women with HELLP syndrome (Mo 254±93.51 pg/mL) was found to be significantly lower than in patients with severe (Mo 439.08±112.29) and moderate PE (306, 62±164.59). In addition to liver damage, almost all patients had signs of involvement of other organs in the pathological process, while renal failure was more pronounced compared with patients with PE (Mo serum creatinine in HELLP syndrome 110.80±20.62 MMOL/L, in SE-VERE PE 73,26±4.55 MMOL/L, and in moderate PE 71.73±6.16 MMOL/L). Conclusion. Probably, HELLP syndrome is not a more severe variant of PE. HELLP syndrome is a clinically manifest variant of thrombotic microangiopathy. It appears that PE is only a trigger for the development of HELLP syndrome.
Clinical nephrology. 2018;(4):33-41
33-41
The first russian darbepoetin alfa bioanalogue: results of a double-blind, randomized clinical study of efficacy and safety for patients with nephrogenic anemia on programmed hemodialysis
Abstract
Objective. to prove the equivalent efficacy and safety of Darbestim (ZAO BIOCAD, Russia) and Aranesp (Amgen Europe B.V., The Netherlands) when used to maintain target hemoglobin levels in patients with end-stage chronic kidney disease (CKD) on hemodialysis. Material and methods. a double-blind, randomized, parallel group comparative clinical study of the efficacy and safety of Darbestim and Aranesp included 196 patients with anemia against the background of end-stage CKD (CKD 5D) who were on program hemodialysis and regularly received recombinant human erythropoietin (rhEPO) preparations. Participants were randomly assigned to two groups of therapy: patients in the first group (n=98) received Darbestim, patients in the second group (n=98) - Aranesp. The main stage of the study lasted from the 1st to the 24th week of therapy inclusive; after it was completed, an analysis of the efficacy, safety and immuno-genicity of the drugs was performed; the results of analysis are presented in this article. After the 24th week, all patients continued to receive therapy for up to one year in order to further assess the safety and efficacy of long-term therapy. The primary endpoint of effectiveness was a change in hemoglobin level. Results. Efficacy analysis was conducted in the population of patients who completed 24 weeks of therapy (per protocol population (n=176): in group 1 (Darbestim) 86 patients were included in the analysis, in group 2 (Aranesp) - 90. Average value of change in hemoglobin level in the group I was 4.7±ii.0 g/L, in the group 2 -4.6±9.0 g/L (P=0.9717). The 95% confidence interval (Cl) for the between-group difference of arithmetic mean values of the indicator "change in hemoglobin level during the evaluation period compared with the initial level" was [-3.04; 2.93]; the DI within the pre-defined boundaries of [-5.00; 5.00] indicate the equivalent efficacy of the two drugs being compared. Safety analysis between the test drug and the reference drug revealed no differences in both the spectrum and the frequency of the registered AEs and SAEs. Conclusion. In the framework of this study, the equivalent efficacy and safety of Darbestim (ZAO BIOCAD, Russia) and Aranesp (Amgen Europe B.V., The Netherlands) were proved.
Clinical nephrology. 2018;(4):42-54
42-54
Experience of the use of iron oxyhydroxide complex for the treatment of hyperphosphatemia in patients with stage 5 diabetic chronic kidney disease at the stage of starting dialysis therapy
Abstract
Objective. To evaluate the efficacy and safety of the use of iron oxyhydroxide complex (Velphoro 500) in the treatment of hyperphosphatemia in patients with diabetic CKD 5D stage. Materials and methods. The study included 30 patients with diabetic CKD 5D stage (18 men and 12 women, average age was 58.6±11.5 years). The median duration of CKD was 13 years [3; 28], CKD 3A-5 stages - 3.8 years [1; 6.2], DM2 - 18 years [6; 32.5]. Patients underwent initiation of hemodialysis treatment with subsequent follow-up for 2 months. Initially, patients did not receive phosphate-binding drugs (PBDs); they only kept a diet aimed at reducing hyperphosphatemia. Due to inefficiency of dietary therapy, Ca-free PBD was administered - an iron oxyhydroxide complex (Velphoro®500) at the initial dose of 3 tablets/day, followed by dose adjustment after 1, 2, 4, and 8 weeks. Results. The use of the iron oxyhydroxide complex ensured the achievement of target phosphate levels of less than 1.49 mmol/L within 2 months of treatment in 29 of 30 treated patients. In the majority of patients (87%), target phosphate levels were noted after 4 weeks of therapy, in two of them - by the end of the first week. Analysis of possible adverse effects when using the iron oxyhydroxide complex showed that diarrhea was observed in 2 cases out of 30 (6.7%). Diarrhea was mild and resolved spontaneously for 1-3 days. Conclusion. Combined therapy of hyperphosphatemia with the use of iron oxyhydroxide complex in diabetic CKD stage 5D demonstrates its high efficacy and safety in the absence of manifestations of drug-drug interaction with atorvastatin and oral antidiabetic drugs.
Clinical nephrology. 2018;(4):62-65
62-65
Microangiopathic antiphospholipid syndrome in obstetric practice - the risk of generalized thrombotic microangiopathy
Abstract
A systematic analysis of the data available in the modern literature on the microangiopathic antiphospholipid syndrome (APS) and other variants of the development of thrombotic microangiopathy (TMAP), incl. HELLP-syndrome and preeclampsia, up to 20 weeks of gestation, options for management of such pregnancies and the risks of obstetric complications in patients with APS was performed. a description of 2 clinical cases of various microangiopathic APS in obstetric practice, complicated by the development of HELLP-syndrome up to 20 weeks of gestation, is presented. These cases not only demonstrate the possibility of HELLP-syndrome debut before the 20th week of pregnancy, but also the development of HELLP-syndrome with a normal SfltI/PLGF level, which seems to confirm the apartness of HELLP-syndrome from pre-eclampsia. In both cases, positivity for all three groups of main antiphospholipid antibodies was registered, which initially increased the risk of obstetric complications, despite the adequacy of treatment. The need to isolate a microangiopathic APS is confirmed by the danger of development of all cases of TMAP signs in APS patients: the risk of TMAP generalization up to the catastrophic APS is unreasonably high. Only the use of heparins (including low molecular weight heparins) in combination with acetylsalicylic acid can be considered as the “gold” standard for the management of such patients. Addition of hydroxychloroquine may improve the outcome of such pregnancies, which requires confirmation in large multicenter studies.
Clinical nephrology. 2018;(4):66-73
66-73
Acute kidney injury in patients who underwent cardiac surgery
Abstract
Acute kidney injury (AKI) is a serious complication of cardiovascular surgery, and its detection rate, depending on diagnostic criteria and the severity of AKI, ranges from 12 to 55%. The development of AKI is caused by the repeated effects of aggressive factors on the kidneys, occurring before and after surgery. AKI remains a strong independent factor of increased risk of progression of chronic kidney disease and is associated with high hospital mortality and late adverse cardiovascular events. To improve the long-term prognosis, more attention should be paid to the prevention of AKI after cardicac surgery. Severe AKI, requiring renal replacement therapy, is rare, but mortality ranges from 40% to 80%. This fact emphasizes the primary importance of therapeutic interventions that can maintain renal function during the perioperative period, especially in high-risk patients.
Clinical nephrology. 2018;(4):74-81
74-81
Right to medicine
Clinical nephrology. 2018;(4):82-86
82-86
Scientific worldview of Academician S.R. Mirotvortseva (1878-1949) (on the 140th
Abstract
The article presents the main milestones in the life and work of S.r. Mirotvortsev. Little-known facts from the biography of the professor are mentioned. The awarding of two gold medals for student works "Vessels and nerves of the human plantaris tendons" (together with student v. p. Vorobyev) and "Dislocation of the carpal bones" are analyzed. It is noted that during the Russo-Japanese War, he spent 11 months in the besieged Port Arthur and stayed there with the injured soldiers who were captured by the Japanese. From 1905 to 1914, he worked at the Military Medical Academy, first under the guidance of Professor S.P. Fedorov, then as an assistant to Professor V.A. Oppel. It is shown that from 1914 until the end of his life he worked in Saratov, at the Department of General Surgery, from 1920 - at the Faculty Surgical Clinic. From 1922 to 1928, he was the Rector of the Saratov University. During the Great Patriotic War, he was the Chief Surgeon of Saratov and the Saratov region. S.r. Mirotvortsev published about 150 scientific papers on clinical and military field surgery. The article analyzes that in 1908 he proposed the original operation of ureteral transplantation into the rectum, and passed his doctoral thesis defense on this subject (1909). It is noted that his research on malignant tumors, in particular tubular bone sarcoma, became widely known. He developed methods for unilateral shutdown of the colon, duraplasty with an omentum, and treatment of burn wounds with potassium permanganate solution. S.r. Mirotvortsev suggested the use of the hemostatic properties of catgut for local stopping of bleeding from parenchymal organs and dural sinuses. Of the many works on field surgery, detailed statistical compilation of data on 180 thousand cases of gunshot wounds during the First World War, 1914-1918, is particularly valuable. It is noted that Department of Faculty Surgery of the Saratov Medical Institute and the street in Saratov were named after S.r. Mirotvortsev. He was awarded the Order of the Red Banner of Labor, the Order of the Red star, and medals.
Clinical nephrology. 2018;(4):87-91
87-91