Vol 12, No 2 (2020)

The article provides a brief review of the literature on Takotsubo syndrome (TS) in a pandemic of a new coronavirus infection. A clinical case of TS development in a young patient with COVID-19 who received immunosuppressive therapy early after allotransplantation of a cadaveric kidney is described. The diagnosis of TS was established on the basis of clinical, echocardiographic and ECG data. In the present observation, the course of COVID-19 was extremely unfavorable and ended in death. An autopsy followed by histological examination of the myocardium confirmed the diagnosis of TS by eliminating other probable causes of acute myocardial injury.

Objective. Evaluation of the kidney condition in patients with spondyloarthritis (SpA) who received therapy with genetically engineered biological drugs (GEBDs) for a year. material and methods. an analysis of the disease activity and the kidney condition in 18 spa patients who received gebds for a year was performed. results. Against the background of the 1-year use of gebds, a significant decrease in glomerular filtration rate with a normal serum creatinine level was noted. the frequency of glucocorticoid administration has been reduced during the treatment with gebds. the importance of early diagnosis of kidney damage and the timely initiation of therapy with gebds in spa patients has been demonstrated. Conclusion. timely prescribing of gebds in most cases allows achieving better control of the spa activity and preventing or reducing the severity of developing complications, including kidney damage. further evaluation of the gebd effect of on renal function is required.

Objective. a retrospective analysis of renal biopsy register data for 7 years. material and methods. a retrospective study on the results of 6387 biopsies of native kidneys performed from 2013 to 2020 at the Moscow state Scientific center on the basis of City Clinical Hospital № 52 of the Moscow Healthcare department. results. The most common indications for renal biopsy included isolated urinary syndrome and nephrotic syndrome (33.0 and 32.5% of cases), as well as newly diagnosed renal failure (27%). less commonly, a biopsy was performed for acute nephritic syndrome (3.5%) and to clarify the morphological picture of an already diagnosed systemic disease (4%). In the structure of glomerular pathology, primary glomerulopathies were detected in 51% of patients, more than half (26%) of which were cases of iga nephropathy. membranous nephropathy, idiopathic fsgs and minimal change disease were detected less commonly (10.5%, 7.5% and 7%, respectively). among secondary glomerulopathies, anca-associated vasculitis (7%) and sle (5%) prevailed, also, lymphoproliferative diseases (3.6%), in most cases represented by al-amyloidosis (2.5%); as well as kidney damage in diabetes mellitus (3.2%) and hereditary nephropathy (2.7%) were detected. Conclusion. The data obtained are consistent with the prevalence of primary glomerulopathies in the structure of kidney pathology, such as iga nephropathy, membranous nephropathy, fsgs and mcD; for rarer variants of kidney pathology, however, the results of the registries can vary significantly depending on the diagnostic criteria and indications for biopsy

Purpose of the study. Assessment of the levels of vascular endothelial growth factor, markers of inflammation and their relationship with vascular stiffness indices in chronic kidney disease. Material and methods. 261 patient with chronic kidney disease (CKD) of stages 1-5 were examined, the average age was 51.з±15.8 years. depending on the cause of the development of ckd, the entire sample was divided into several groups: 1st - arterial hypertension (ah) - 59 (22.6%); 2nd - diabetes mellitus (DM) - 46 patients (17.6%); 3rd - coronary heart disease (CHD) - 48 (18.4%); 4th - chronic obstructive pulmonary disease (COPD) - 23 (8.8%); 5th - chronic glomerulonephritis (CGN) - 38 (14.6%); 6th - chronic tubulointerstitial nephritis (Chtin) - 47 (18.0%) and the 7th group - comorbid pathology - 97 (37.1%) cases. All participants underwent clinical, instrumental and laboratory studies. Vascular stiffness parameters, markers of inflammation, and the concentration of endothelial vascular growth factor (VEGF, pg/ml) were evaluated. glomerular filtration rate (GFR) was calculated using the formula ckd-epi (Chronic kidney disease epidemiology Collaboration). results. levels of central blood pressure were significantly higher in individuals with cp. the highest stiffness index and alternative stiffness index were characteristic for patients with cgn and copd. a significant increase in augmentation index and increase index at a pulse rate of 75 per minute was recorded in the groups of hypertension, type 2 diabetes and cp. higher levels of the vascular wall reflection index were observed in patients with hypertension and cp. median levels of total cholesterol (Ch), triglycerides and low density lipoproteins Ch (LDL Ch) in blood plasma were significantly higher in individuals with hypertension. the concentration of high density lipoprotein cholesterol was the lowest among patients with cgn. the proportion of patients with a high content of c-reactive protein (CRP) in blood plasma significantly prevailed in the groups of hypertension (81.3%) and coronary heart disease (79.1%). The median fibrinogen content was significantly higher in individuals with cp. The highest levels of phosphorus were observed among patients with type 2 diabetes and cgn, and calcium in the group of individuals with hypertension. blood plasma vegf concentration was significantly higher in the groups of cgn: 202.08 (91.42-356.48) pg/ml, chtiN: 208.85 (113.h-355.09) pg/ml and KP: 213,54 (95.04-372.71) pg/ml, which was accompanied by an increase in blood plasma creatinine. the calculated gfr was significantly lower in individuals with type 2 diabetes: 46.5 (33.2-62.6) ml/min and CP: 62.0 (27.o-78.0) ml/min. a direct correlation relationship between the vegf concentration and the value of the alternative vascular stiffness index (r=0.440; p<0.001) and fibrinogen (r=0.239; p<0.05) blood was established, and the feedback was correlated with the estimated gfr (r=-0.491; p<0.001). crp levels positively correlated with an alternative vascular stiffness index (r=0.434; P<0.001). Conclusions. a significant increase in the level of vascular endothelial growth factor was observed in patients with chronic tubulointerstitial nephritis and glomerulonephritis, as well as in individuals with comorbid pathology, which was accompanied by an increase in blood plasma creatinine. in chronic kidney disease, the level of endothelial vascular growth factor is a risk factor for a decrease in glomerular filtration rate and vascular stiffness. An increase in the content of C-reactive protein is associated with an increase in the rigidity of the vascular wall, and a concentration of endothelial vascular growth factor is associated with hyperfibrinogenemia.

Storage diseases caused by the GLA gene mutations, which lead to a decrease or absence of the activity of the a-GALACTOSIDASE a. The clinical manifestations of FD are quite diverse, therefore, the formulation an accurate diagnosis can take a lot of time, and screening of high-risk groups (selective screening) is used to more effectively identify patients. objective. determination of the prevalence of fd among patients in hemodialysis units. Material and methods. this article provides a review of the literature data on screening for fd among patients in hemodialysis centers and the results of authors’ own experience in screening using an original approach - the determination of the biomarker globotriaosylsphingosine (LysoGb3) in dried blood spots. results. the study included 4077 patients (2454 women, 1623 men) from 5 dialysis centers. 7 patients with fd were identified (6 men, i woman), the prevalence of the disease in this sample was o.17%. Conclusion. The application of a new approach to screening for fd (determination of LysoGb3 concentration in dried blood spots) allows to identify both male and female patients.

Secondary hyperparathyroidism (SHPT) is common in patients receiving maintenance hemodialysis (MHD) and is associated with adverse outcomes. Currently, SHPT is managed by reducing circulating levels of phosphate with oral binders and parathyroid hormone (Pth) with vitamin d analogs and/or the calcimimetic cinacalcet (CC). This article provides a brief overview of the pathogenesis of SHPT in CKD, with particular attention paid to the main molecular regulators that are affected by calcimimetics. Etelcalcetide (EC) is a new second-generation calcimimetic administered intravenously (IV) at the end of a hemodialysis treatment session, effectively reduces pth in clinical trials when given thrice weekly. apart from improving drug adherence, EC has proven to be more effective in lowering pth when compared to cc, with an acceptable and comparable safety profile. Additional clinical effects include reductions in circulating levels of phosphate and FGF-23 and an improved profile of markers of bone turnover. however, despite being administered iv, EC appears to be associated with rates of nausea and vomiting comparable to those of cc. it is likely that EC can be used in the treatment of mhd patients with severe shpt or with hypercalcemia or hyperphosphatemia receiving active metabolites of vitamin d. however, its use should be at least partially constrained by consideration of the risk of hypocalcemia and resultant prolonged electrocardiographic QT intervals in vulnerable patients. because of its effectiveness as a pth-reducing agent administered in the dialysis unit, EC represents a potentially promising new therapeutic approach for the treatment of shpt in hd patients. in this article, we briefly summarize the pathogenesis of shpt in ckd and describe clinical data of the new intravenous third-generation calcimimetic EC.

The paper presents the main scientific and practical achievements of the Italian doctor, anatomist and naturalist - Marcello Malpighi. The name of the scientist is associated with several physiological features - with the biological excretory system, such as the “Malpighian Corpuscles”,”Malpighian pyramids “of the kidneys, and the “Malpighian tubular system” of insects. Splenic lymphoid nodules are often called “Malpighian bodies of the spleen” or “Malpighian corpuscles”. he was the first person to study capillaries in animals, and he discovered a connection between arteries and veins that “eluded” William Harvey. it is noted that Malpighi was one of the first people to observe red blood cells under a microscope, after Jan Swammerdam. His treatise “de polypo cordis” (1666) was important for understanding the composition of blood, as well as how blood clots are formed. The use of a microscope allowed Malpighi to detect that invertebrates use small holes in their skin, called tracheae, rather than lungs for breathing. M. Malpighi also studied the anatomy of the brain and came to the conclusion that this organ is a gland. Since the scientist had extensive knowledge of biology in general, he contributed to the scientific study of plants and animals. The Royal society of London published two volumes of his Botanical and Zoological works in 1675 and 1679. In 1687, another edition was published, and in 1697, an additional volume. studying plants led him to conclude that plants have tubes similar to those he saw in insects such as silkworms (using his microscope, he probably saw stomata through which plants exchange carbon dioxide with oxygen). Malpighi noticed that when the annular part of the bark is removed from the trunk, a tumor occurs in the tissues above the ring, and he correctly interpreted this as growth stimulated by food coming from the leaves and blocked above the ring.