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No 1 (2019)

Articles

pages 6-16 views

The role of ICAM-1 and a number of clinical and morphological factors in the development of tubulointerstitial fibrosis in chronic glomerulonephritis

Bayandurova K.M., Batyushin M.M., Sarvilina I.V., Antipova N.V., Sinelnik E.A.

Abstract

Background. Today, it is known that all patients with chronic kidney disease have a progressive decrease in renal function over time due to the formation of tubulo-interstitial fibrosis. At present, it has been established that endothelial dysfunction (Ed) is formed long before the detection of sclerosis in the renal tissue, and exerts its influence on the development of various clinical and morphological manifestations of chronic glomerulonephritis. The intercellular adhesion molecule - 1 (IСАМ-1), involved in the processes of renal inflammation, is one of the factors of Ed. For this reason, the search for non-invasive methods for assessing the state of the renal tissue, including the identification of proteins involved in the processes of renal inflammation, fibrosis, and cell-cell interaction, becomes relevant as it will prevent or delay the progression of a decrease in renal function. Objective. Determination of the blood intercellular adhesion molecule-1 (ICAM-o concentration in conjunction with the clinical and morphological manifestations of chronic glomerulonephritis in the development of tubulo-interstitial fibrosis (TIF) in chronic glomerulonephritis (CGN). Material and methods. Eighty patients with CGN in the acute stage underwent a detailed clinical and laboratory examination, which included determination of the serum ICAM-1 level by enzyme immunoassay, and puncture kidney biopsy with subsequent morphological examination. Statistical analysis was performed using Microsoft Office Excel 2010 (Microsoft Corp., USA) and Statistica 10.0 (StatSoft Inc., USA). Results. a logistic regression analysis to access the impact of ICAM-1 in conjunction with clinical and morphological manifestations on the probability of detection of TIF in the biopsy specimen was carried out. As a result, it was revealed that such clinical and morphological signs as the blood albumin level, narrowing of the arteriole lumen, sclerosis of the glomeruli, along with an increased ICAM-i (Intercellular Adhesion Molecule i) level are factors for the development of TIF. In addition, based on the obtained equations of logistic regression, nomograms to predict the probability of detecting TIF in the kidney biopsy specime were calculated. Conclusion. The results of the study demonstrate the important role of ICAM-1 in the process of development of immunocomplex inflammation in glomerulonephritis and, as a result, increase the risk of developing TIF.
Clinical nephrology. 2019;(1):17-21
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Clinical trial of calcium polystyrene sulfonate for the treatment of hyperkalemia in patients on hemodialysis

Shutov Y.V., Kotlyarova G.V., Lysenko K.M., Fedorov D.V.

Abstract

Introduction. Hyperkalemia is a pathological condition characterized by muscular weakness, hypotension, shortness of breath, cardiac arrhythmias and, as a consequence, an increase in mortality. Its importance is especially substantial in patients on hemodialysis (HD) in interdialytic periods of time. Complications of hyperkalemia are more likely to occur after a two-day break, when fluid overload and potassium concentrations are highest. Objective. To study the safety and efficacy of Kalimeyt in patients who are on renal replacement therapy of HD in interdialytic days with two regimens - 4 and 2 days per week. Materials and methods. 33 stable patients without severe comorbidities with potassium levels of 5,5-7,0 mmol/l before HD after a long interdialysis interval were included in an open prospective cohort study on the safety and efficiency of calcium polystyrene sulfonate (Kalimeyt) administration in interdialysis days with two regimens - 4 and 2 days a week. 1 month was the phase of the drug washing between the different modes of taking the medicine. Acid-base state, blood electrolytes, ECG were determined weekly; general and biochemical blood tests - monthly. Results. During the regimen of Kalimeyt intake 4 days a week (in interdialysis days), the average dose of the drug was 89±2i g /week, and the level of potassium decreased from 6,33±0,5 to 5,17±o,5 mmol/l (p<0,01) after a two-day break. Kalimeyt intake 2 days per week also showed the same effect. The average dose of Kalimeyt was 43,05±7,5 g/week and the level of potassium decreased from 6,2 0,5 to 5,22±0,5 mmol/l (p<0,01). The average level of potassium in one-day interdialysis interval did not differ in both modes (5,4±0,6 mmol/l vs 5,3±0,4 mmol/l). Assessment the dynamics of the QTc interval reliably showed its decline from 0,392±0,062 against 0,327±0,027 ms (р<0,01), which did not go beyond the permissible norm. However, in 7 patients of 27 (25,9%) at the stage of screening the QTc interval duration was above normal values. Serious adverse events in patients taking Kalimeyt were not recorded. Conclusion. Good therapeutic effects of the cation exchange resin Kalimeyt in reducing the potassium level to the target values and a significant decrease in the QTc interval to normal values were demonstrated for the first time in patients on HD, as when taking the medicine every interdialytic day and only in a two-day interdialytic period. There was an equal efficacy of the medicine with a four- and two-day intake. When medicine was taken two days a week, drug load significantly decreased (by 2 times), which reduced the risk of side effects.
Clinical nephrology. 2019;(1):22-27
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Combined positron-emission tomographyand computed tomography scanning of the kidneys and urinary tract

Berdichevsky V.B., Berdichevsky B.A., Zhmurov V.A., Barashin D.A., Rasulov F.R., Romanova A.V., Pavlova I.V., Zagorchik E.V.

Abstract

Background. Combined positron-emission tomography and computed tomography (PET/СТ) allows to investigate the functional state of organs and systems in real time in vivo. The basis of the method includes the principle of incorporation of an isotope of vital biomolecules into the structure of actively multiplying or vigorously functioning cells. Objective. Evaluation of the possibility of analyzing the structural and functional state of the kidneys and urinary tract according to the results of РЕТ/СТ whole body scanning of patients with skin melanoma and prostate cancer without signs of metastasis and the presence of neuro-urological anamnesis. Material and methods. a retrospective analysis of 1ОО РЕТ/СТ findings of patients in these groups was carried out. In 50 cases, the scanning was conducted with the choline С ii, and in 50 cases - with the fludeoxyglucose F 18. РЕТ/СТ was performed by the standard method on a РЕТ/СТ scanner (Siemens Biograph, Germany) to assess the possible prevalence of the disease. Results. The obtained data allowed to conclude that РЕТ/СТ imaging of functionally consistent kidneys and urinary tract is possible and rather highly informative. Mathematical calculation of the intensity of radiopharmaceutical agent incorporation into the renal cortex, renal medulla, as well as the renal pelvis, makes it possible to evaluate the functional state of the renal parenchyma in the process of urine formation and urinary tract in the process of urine transport, and also to perform it separately for each organ. Conclusion. Structural and functional changes in the parenchyma of the kidneys and the upper urinary tract during the formation and transportation of urine can be visually and mathematically analyzed using the combined РЕТ/СТ method.
Clinical nephrology. 2019;(1):28-31
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Evaluation of the possibilities of using calculation methods for estimating the glomerular filtration rate depending on the nosological type of socially significant diseases

Murkamilov I.T., Sabirov I.S., Fomin V.V., Murkamilova Z.A.

Abstract

Objective. Evaluation of the possibility of using various methods for calculating glomerular filtration rate (GFR) with the determination of the incidence of renal dysfunction depending on the nosological type of socially significant diseases. Material and methods. The subjects of the study were represented by 728 patients suffering from various socially significant diseases, 330 (45.3%) men and 398 (54.7%) women aged 16 to 98 years (mean age 5O.5±l4.2 years). Serum creatinine and cystatin с levels were determined. The glomerular filtration rate (GFR) was calculated using the following formulas: CKD-EPI (2011), MDRD (2000), Cokcroft-Gault (1976) and F.J. Hoek (2003). The entire sample was divided into 9 subgroups depending on the nosological type of the disease: 1 - obesity; 2 - arterial hypertension (Ah); 3 - coronary artery disease (Cad); 4 - diabetes mellitus (Dm); 5 - primary nephropathy (chronic glomerulonephritis and pyelonephritis); 6 - chronic obstructive pulmonary disease (COPD); 7 - cerebrovascular diseases (CVDs); 8 - comorbid diseases, and 9 - general group. a comparative analysis of the frequency of occurrence of renal dysfunction depending on the method of calculating the GFR was performed. The median and interquartile range of GFR were calculated depending on the formula for calculating the GFR in different clinical subgroups. a correlation analysis of the relationship between GFR and blood serum creatinine and cystatin с levels depending on the calculation formula in different clinical subgroups was carried out. Results. a decrease in GFR in the range of 90-60 ml/min was detected in 29.3% according to the CKD-EPI formula, in 36.6% - according MDRD formula, in 24.3% - according Cokcroft-Gault, and in 71.2% according the method of F.J. Hoek. The largest number of patients with reduced GFR less than 60 ml/min was noted according to the method of F.J. Hoek (48.2%) and MDRD formula (25.i%). Relatively lower GFR value according to F.J. Hoek was recorded in a subgroup of patients with diabetes and primary renal pathology (glomerulonephritis/pyelonephritis). In patients with obesity, ah, COPD, CVDs and in the total sample, there was a significant decrease in GFR according to the method of F.J. Hoek compared to CKD-EPI, MDRD and Cokcroft-Gault formulas. GFR calculated on the basis of serum creatinine level according CKD-EPI formula gave a statistically highly significant relationship in the subgroup of patients with COPD (R=-0.756; P=O.OOl) and primary nephropathies (R=-0.781; P=O.OOl). a similar significant strong correlation according to the MDRD equation was observed in the subgroup of patients with COPD (R=-O.852; P=O.OOl). Compared to other subgroups, the correlation coefficient between serum creatinine level and estimated GFR using the Cokcroft-Gault formula was not as strong among patients with cad (R=-O.484; P=O.OO5). GFR calculated using the F.J. Hoek method in all the subgroups gave a significant correlation. The correlation of GFR calculated on the basis of serum cystatin с level was stronger in the subgroup of patients with COPD (R=-O.935; P=O.OO1). Conclusion. The prevalence of a mild decrease in GFR according to the F.J. Hoek method in patients with various socially significant diseases was 71.2 and 36.6% according to the MDRD formula. Moderate reduction in renal function in the examined individuals according F.J. Hoek method was revealed in 48.2%, according to the MDRD equation - in 25.1%. The frequency of occurrence of renal dysfunction according to the CKD-EPI and Cokcroft-Gault formulas was equivalent: 29.3; 21.2% AND 24.3; 20.1%, RESPECTIVELY.
Clinical nephrology. 2019;(1):32-41
pages 32-41 views

Pathogenetic features of systemic hypoxia in patients with chronic kidney disease stage 5d on hemodialysis

Bondarenko N.B., Batyushin M.M., Gasanov M.Z., Sarvilina I.V., Golubeva O.V.

Abstract

Material and methods. Eighty patients with CKD 5D on programmed hemodialysis were examined. The study group was represented by 47 men and 33 women, mean age was 51.7±11.6 years, the duration of history of dialysis was 33.5 (19.7-58.25) months. Clinical examination included the assessment of patient complaints, anthropometric examination, and bioimpedancemetry. The HIF-1α level was determined by the quantitative enzyme immunoassay once for all patients of the study group using the Hypoxia-inducible factor (HIF-1α) ELISA Kit (USA). Results. The blood HIF-1α concentration in patients of the study group ranged from 0.16 to 0.27 ng/ml (К-s Index = 0.26; P<0.01; lllliefors P<0.01), the median was 0.17 (0.16; 0.21) ng/ml. There was no independent contribution of anemia to the development of systemic hypoxia: Teh GROUPS DID NOT SIGNIFICANTLY DIFFER IN HEMOGLOBIN LEVELS, AND THE CORRELATION WITH THE HIF LEVEL WAS NOT STATISTICALLY significant within groups (P>0.05). Target hemoglobin levels were achieved by 34/42 (80.95%) and 32/38 (84.2%) PATIENTS; IN THE GROUP WITH ELEVATED HIF-1α, HOWEVER, MODERATE-TO-SEVERE ANEMIA WAS SIGNIFICANTLY FREQUENT: IN 4/42 (10%) and 1/38 (3%) patients, respectively. All patients had an elevated P2-microglobulin level, and there was a weak correlation with the HIF-1α index (r=-0.26; P<0.05), which was confirmed by the difference in the mean values of this index in the groups (24.9±5, 98; 27.61±5.44; P=0.041). Conclusion. The absence of a significant effect of anemia on the HIF-1α level may be associated with different durations of CKD history, previous therapy with erythropoiesis-stimulating agents, and disorders of ferrokinetics.
Clinical nephrology. 2019;(1):42-47
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Prognostic value of sarcopenia in patients with CKD

Sokolova A.V., Dragunov D.O., Arutyunov G.P., Mitrokhin V.M.

Abstract

Objective. Evaluation of the prognostic role of sarcopenia in patients with CKD. Materials and methods. The study included 79 patients with an proven diagnosis of CKD and ah or cad. GFR was calculated using the CKD-EPI formula. The diagnosis of CKD was verified in accordance with the KDIGO recommendations; the diagnosis of sarcopenia - in accordance with the EWGSOP recommendations. Progression of CKD was determined as an increase in the CKD stage during the year. The end points were the presence of any cardiovascular events, including coronary intervention, and/or the death of the patient. For statistical analysis of the data obtained, the R language RStudio software (packages psych, epiR, ggplot2, dplyr) was used. Results. The mean age of patients was 74.97±8.27 years, CHF was detected in 34.2% of patients, and progression of CKD was detected in 40.5% of patients, of which 20.3% of patients had sarcopenia. a direct, reverse, significant relationship was found between the progression of CKD and the presence of sarcopenia in patients (P=0.043). 23 endpoints were registered. In patients with sarcopenia, there was a tendency to increase the IL-18 and IL-6 levels, and a decrease in the anti-inflammatory cytokine IL-io level. However, no differences were found in the IL-18 and IL-6 levels in patients with and without sarcopenia. The data obtained demonstrates that with an average log IL-18 level equal to 4.7, an increase by 1 leads to an increase in log IL-6 by 0.23. The logit regression model and or showed that the IL-18 level most influences the risk of the end points being studied. The risk of end-point development increases by 5.76 times when patients with CKD have high IL-18 levels. Conclusion. Thus, it can be concluded that anti-inflammatory system of interleukins has a greater prognostic value for patients with CKD and sarcopenia.
Clinical nephrology. 2019;(1):48-55
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Prolonged therapy with non-steroidal anti-inflammatory drugs in patients with axial spondyloarthritis: renal status

Rebrov A.P., Aparkina A.V., Khondkaryan E.V., Gaidukova I.Z.

Abstract

Objective. Analysis of the renal status in patients with axial spondyloarthritis (SpA), taking non-steroidal antiinflammatory drugs (NSAIDs) continuously for 24 months. Material and methods. 12 and 24 months from the start of continuous administration of NSAIDs, the glomerular filtration rate (GFR), urine α1-MicROGLOBULiN and albumin levels equivalent to 1 g of urinary creatinine were determined in 36 patients with SpA without an initial renal failure. results. 24 months after start of study, the average GFR was 107.0 [93.0; 125.0] ml/min/1.73 m2, urine ai-Microglobulin was 24.78 [19.87; 34.73] mg/g (P>0.05 for differences with baseline value) against the background of continuous use of NSAIDs. a marked increase in the urine albumin level TO 44.24 [28.46; 85.96] mg/g (P=0.035 compared with baseline level and with urine albumin levels after 12 months of treatment). After 24 months of follow-up, the deviation in three indicators (GFR, microglobulin, urine albumin level) was revealed in 2 (5.6%) patients with SpA. An increase in the urine albumin or α1-Microglobulin level or a decrease in gfr of less than 90 ml/min/ 1.73 m2 was detected in 10 (27.8%) patients. 7 (19.4%) patients showed abnormalities in two markers of renal damage. Overall, kidney damage was recorded in 18 (50%) patients with SpA. In all patients, gfr corresponded to chronic kidney disease stage 1-2. Conclusion. Against the background of continuous use of NSAIDs for 24 months, 18 (50%) patients with SpA showed some changes in the renal status. Kidney damage from all established cases was more common in patients taking diclofenac sodium.
Clinical nephrology. 2019;(1):56-60
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The evolution of anemic syndrome against the background of chronic kidney disease in real clinical practice

Korneeva S.I., Pribylov S.A., Bezgin A.V., Trigub A.

Abstract

Objective. Assessment of the individual characteristics of patients with chronic kidney dis-ease (CKD) with the presence of anemic syndrome (As) at various stages of medical care in real clinical practice. Materials and methods. The study included 762 CKD patients who were admitted to the endocrinological, nephrology and dialysis departments, and the results of the examination of which revealed anemia of varying severity. Criteria for inclusion in the study corresponded to modern generally accepted classification categories. Results. In patients with kidney damage, AS was detected already at the stage of non-specialized (endocrinological) department, with a regular increase in the proportion of this cohort of patients and the severity of the condition in the specialized nephrology department, and in the settings of the dialysis department. Gender and age analysis of patients showed that anemia is most often detected in women of older age, which requires tight control of red blood cell parameters in order to timely start antianemic therapy for the improvement of the prognosis of patients. The most "favorable" background for the development of anemia in CKD includes glomerulonephritis, often leading to the most rapid progression of renal failure and direct disruption of the erythropoietin production. Conclusion. In order to improve the prognosis of CKD patients with anemic syndrome, early intervention into pathological process at the stage of non-specialized department is necessary, with close adherence to the principles of continuity of medical care.
Clinical nephrology. 2019;(1):61-66
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Features of regional blood flow in patients with neurogenic dysfunction of urination on the background of connective tissue dysplasia

Lobanov Y.F., Latyshev D.Y., Tekutyeva N.A., Mikheeva N.M., Chicherina A.N.

Abstract

Objective. Determination of the nature of vascular dysfunctions in children with neuromuscular bladder dysfunction, taking into account the severity of connective tissue dysplasia (CTD) syndrome. Material and methods. The study included 60 children aged 5 to 15 years with an established diagnosis of neuromuscular bladder dysfunction. CTD was diagnosed in children when 6 or more external or visceral manifestations were detected, involving three or more organs from different systems. assessment of the ctd severity was carried out according to a scoring system proposed by T.I. Kadurina et al. The result to 12 points was regarded as the absence of dysplasia, 12-20 - i degree dysplasia, from 20 to 30 - ii degree dysplasia, more than 30 points - iii degree dysplasia. Two groups were formed: 37 children with mild ctd manifestations and 23 children with moderate CTD. Duplex scanning of the renal blood flow and brachycephalic vessels was performed on the sonoscape2012 device in the color doppler mode. The significance of differences in qualitative parameters was assessed using the pearson X2-test and fisher test for large groups and small groups, respectively. To assess quantitative parameters, a comparison was performed using the mann - whitney test method; p values <0.05 considered as signiwere ficant. Results. Moderate CTD is characterized by increased mobility of the kidneys and a decrease in vascular resistance in large arteries; in the brachiocephalic blood flow - an increase in the number of “small vessel” anomalies AND hemodynamic disturbances, such as increase in vascular resistance of the vertebral arteries at the extracranial level and venous dysfunction with disturbance of outflow in vertebral veins. Conclusion. In children with neuromuscular bladder dysfunction, two- or one-sided pyeloectasia (36.7%) and diffuse heterogeneous changes in the structure of the renal sinuses (68.8%) are identified with a high frequency. The most characteristic features of CTD include the increase in the number of “small vessel” anomalies: S-shaped tortuosity and ICA abnormalities, VA abnormalities at the extracranial level, and hemodynamic disturbances such as increase in vascular resistance of the VA at the extracranial level and venous dysfunction with disturbance of outflow in VV.
Clinical nephrology. 2019;(1):67-72
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Early stages of CKD: problems and prospects

Dorofeeva E.G.

Abstract

CKD occupies the third place in mortality and the resulting complications among chronic pathologies. The problem of ckd has not only medical, but also economic nature. Hyperlipidemia, arterial hypertension, mineral and bone disorders are those factors that are well controlled and treated at the early stages of kidney diseases. Early diagnosis and timely treatment of complications contribute not only to improving the quality of life, but also to reducing disability, mortality and economic costs. This literature review presents the problems of the early stages of ckd and analyzes recent studies.
Clinical nephrology. 2019;(1):73-81
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Risk factors and prevention of multiple organ dysfunction syndrome (literature review)

Nickolaev A.Y., Filatova N.N.

Abstract

There are numerous causes of multiple organ dysfunction syndrome: infections, inflammation, ischemia, immunopathology, jatrogens, intoxications, endocrinopathies. Risk factors of multiple organ dysfunction syndrome include fulminant infections, postransplant viral infections, systemic vasculitis, thrombotic microangiopathies, primary antiphospholipid syndrome, pre-eclampsia, paraproteinemia, malnutrition, chronic cardiorenal syndrome, uncontrolled diabetes, hyperparathyroidism with skin and vessels calcification, Addison s disease crises, chronic alcoholic intoxication, drug-induced toxicity. The risk of multiple organ failure correlates with the major disease and its activity
Clinical nephrology. 2019;(1):82-87
pages 82-87 views

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