Vol 12, No 1 (2020)

Aim of the study: examine the relationship between the concentration of fibroblast growth factor-23 and central hemodynamics in patients with chronic kidney disease (ckd). material and methods. a total of 78 patients were examined, including 45 women and 33 men. the average age of the examined patients is 55 years old (minimum 23, maximum 84). All patients underwent a comprehensive clinical and laboratory examination. the parameters of central hemodynamics [systolic blood pressure (SBP, mm hg), diastolic blood pressure (DBP, mm hg) and central systolic pressure (blood pressure, mm Hg) were investigated]. Fibroblast growth factor- 23 (fgf-23) (pmol/L) concentrations were determined, phosphorus (mmol/L), c-reactive protein (CRP, iu/L) and creatinine (mmol/L) of blood plasma. to calculate the glomerular filtration rate (gfr, ml/min), the formula ckd-epi (Chronic kidney disease epidemiology collaboration) 20H was used. According to the kdigo recommendations (Kidney Disease: Improving Global Outcomes) of 2002, the diagnosis of ckd was established on the basis of changes in urinary sediment or a decrease in estimated gfr (<60 ml/min), an increase in blood plasma creatinine for more than three months. results. the mean age, body mass index, and central and systolic blood pressure (bp) values were significantly higher in patients with stage 4 ckd. persons with a high content of c-reactive protein were significantly more often detected in stages 3b and 5 of ckd. the level of phosphatemia was significantly higher among patients with stages 4 and 5 of ckd. median and interquartile plasma fgf-23 concentrations were significantly high at stages 3a, 4, and 5 of ckd. the existence of a close relationship between the content of fgf-23 and the level of central and systolic blood pressure, the concentration of phosphorus and creatinine. An inverse relationship was obtained between a decrease in glomerular filtration rate and an increase in the concentration of fgf-23. Conclusions. In ckd patients, plasma fgf-23 concentration begins to increase even at the pre-dialysis stage. at the same time, high levels of fgf-23 blood plasma is recorded at the 4th stage of ckd and is associated with an increase in central and systolic blood pressure, body mass index, including hyperphosphatemia.

Aim. to estimate ability of candesartan to decrease mean systemic blood pressure (bp) and pulmonary artery pressure (pap) levels among patients on maintaining hemodialysis. material and methods. to perform prospective survey, 30 patients were randomized into two groups, taking candesartan and usual hypotensive drugs. results. at the end of study in patients that took angiotensin receptor blocker mean systemic bp and mean pap decline was registered (from 104,7±12,3 to 97,8±10,4 mm hg; P=0,03 and from 27 (26,4-32,5) to 22,7 (20,3-28,2) MM hg; p=0,02 respectively). in group which subjects received standard hypotensive drugs mean systemic bp and mean pap didn’t changed (100,2±ii and 101,3±12,i mm hg; p=0,58, and 29,5 (26,4-38,6) and 26,4 (23,4-31,3) mm hg; p=o,ii accordingly). adverse reactions as potassium and creatinine serum elevation were not registered (4,7±o,72 and 4,8±o,61 mmol/l; p=o,52, 749±143 and 749±131 MCMOL/L; P=0,98, RESPECTIVELY). Conclusion. Candesartan showed it’s efficacy and safety in lowering systemic bp and pap that elevated levels are predictors of unfavorable outcomes.

The review presents the main mechanisms of development and treatment of membranous glomerulonephritis (GLN) with an emphasis on the primary (idiopathic) form. The leading role of anti-PLA2R antibodies in the development of primary membranous gln has been shown. some genetic aspects of the occurrence of primary membranous gln are considered. The development factors and pathogenetic mechanisms of secondary membranous gln are described. The main provisions in the treatment of the primary form of membranous gln are considered.