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Vol 12, No 4 (2020)
- Year: 2020
- Articles: 12
- URL: https://journals.eco-vector.com/2075-3594/issue/view/6531
Articles
Nephrological service of the Russian Federation in 2019-2020: report of the presidium of the specialized commission on nephrology of the expert council of the ministry of health of the Russian Federation
Clinical nephrology. 2020;12(4):5-35
5-35
Bendopnea as a predictor of CHF decompensation in patients with CKD and COVID-19
Abstract
Objective. evaluation of the effect of the presence of chf and/or ckd or their symptoms in patients on the incidence and/or mortality from sars-cov-2. Materials and methods. a retrospective case-control study was conducted, and 165 patients were included in the final analysis. For statistical processing of the data obtained, the R language and the RStudio software environment was used. results. only 18 of all the patients included had covid-19. by the method of cluster analysis, all patients were divided into three clusters: the first one included 53.9% of patients, the second one - 21.2% and the third one - 24.8%. patients with covid were included in the first cluster (12 patients), in the second cluster there was only 1 patient with covid, in the third - 5 (X-squared = 3.1, df = 2, p value = o.22). cluster з was characterized by changes echo-cg indices, demonstrating higher values of esv, edd, lvpw, ivs and lower ef than in other clusters (patients with severe chf). cluster 2 was characterized by a lower gfr throughout the entire follow-up period, as well as negative dynamics of gfr (45 [38, 35; 57, 65] ml/ min) during the year (patients with severe ckd). cluster 1 was represented by remaining patients. assessment of the symptoms (dyspnea, edema, bendopnea, ascites) in the studied cohort of patients revealed significant differences only in the presence of the symptom of bendopnea (P value = o.015), and the odds ratio of covid-19 was higher in the group of patients with symptom of bendopnea (OR = 5,8 (1.2; 26.7). Conclusion. Thus, despite the high potential risk of illness and/or death from covid-19 in clusters 3 and 2 (i.e., the group of patients with severe chf and ckd, respectively), no increase in morbidity and/or mortality from covid-19 was revealed. on the contrary, the covid incidence in cluster 1, which included patients with more favorable clinical indicators of chf and ckd, was higher, but did not reach the statistical significance (P = o.222). apparently, it was attributable to the greater mobility of patients in this category as compared to patients in clusters 2 and 3.
Clinical nephrology. 2020;12(4):36-42
36-42
Renal status, blood d-dimer and procalcitonin levels in COVID-19
Abstract
Objective. assessment of the renal status, d-dimer and procalcitonin levels in patients with the novel coronavirus disease (COVID-19). material and methods: the study included 123 patients diagnosed with covid-19 and pneumonia. the indices of the estimated glomerular filtration rate (egfr) were considered according to the ckd-epi (Chronic kidney disease epidemiology Collaboration) and mdrd (Modification of Diet in renal Disease) formulas. The creatinine clearan the concentration of creatinine, d-dimer, and procalcitonin levels were determined. results. the median and interquartile egfr values according to the ckd-epi and mdrd formulas were 80.o (68.0; 95.0) and 78.o (67.0; 94.0) ml/min, respectively. a decrease in gfr <60 ml/min according to the ckd-epi, mdrd and Cockcroft-gault formulas was found in 14, ii and 12 patients with covid-19, respectively. the creatinine clearance according to the Cockcroft-gault formula was 85.o (68.0; 102.0) ml/min. proteinuria was noted in 48 (39.o%) patients with covid-19. a negative relationship between the blood procalcitonin level and gfr calculated using the mdrd formula (r=-0.307; p<0.05) and creatinine clearance using the Cockcroft-gault method (r=-0.313; p<0.05) was found. a direct dependence of proteinuria on the blood d-dimer (r=0.437; p<0.05) and procalcitonin (r=0.409; p<0.05) concentration was shown. the blood procalcitonin level positively correlated with the urea concentration (r=0.448; p<0.05) and blood residual nitrogen (r=0.399; p<0.05). Conclusion. a slight decrease in renal function was detected in 26.8% of patients with covid-19, a moderate decrease - in 4.i%, a significant decrease - in 3.2%, and renal failure - in 4.i%. proteinuria was recorded in 39.o% of patients with covid-19. an d-dimer concentration was found in 47.9% of patients with covid-19, and increase in the procalcitonin level - in 49.5%. the laboratory predictor of deterioration in renal function in patients with covid-19 was the blood procalcitonin level. the risk of developing proteinuria was closely related to the blood D-dimer concentration
Clinical nephrology. 2020;12(4):43-50
43-50
Assessment of cardiovascular risk in type 1 diabetes mellitus taking into account various markers of kidney damage
Abstract
Objective. assessment of the relationship of markers of diabetic nephropathy (DN) with scales specific for type 1 diabetes mellitus (DM1) and predicting the risk of cardiovascular diseases (CVD). methods. screening of 176 dmi patients was carried out: mean age - 32 years [25.5-42.5]; dmi duration - 15 years [9- 20]; hbaic - 8.2% [7.2-9.6]. Microalbuminuria was not detected in 68.2% of the examined patients, 27% of patients had microalbuminuria, 4.5% had macroalbuminuria; the median albuminuria was 25.5 mg/day [15.o-36.5]. mean egfr (CKD-epi) was 80.55±18.13 ml/min/1.73 m2: ci - 30.i%, C2 - 58.5%, C3a - 8.5% and C3b - 2.9 %. the steno ti risk engine score assessing the 5-year cvd risk was 3.7% [2.i-8.0], the 10-year risk was 7.1% [4.2-8.15]. the Swedish tid risk score, which estimates the 5-year cvd risk, was o.93% [0.50-i.79]. the mean cvd risk in the group was assessed as low according to both scales. results. there was a significant moderate direct correlation of the albuminuria stage and an inverse correlation of egfr with 5-year risk (r=0.388 and r=-0.506; p<0.0001), 10-year risk (r=0.393 and r=-0.500); p<0.0001) according to the steno scale and the Swedish tid risk score (r=0.189; p=0.012 and r=-0.497; p<0.0001). there was a strong positive correlation between the steno risk score and the Swedish risk score (r=0.893; p<0.0001). Conclusion. The steno and Swedish tid risk scales correlate with the DN stage and are equivalent to each other for assessing cardiovascular risk in dmi patients. Swedish tid risk score does not require quantification of albumin loss and is more convenient in clinical practice. Thus, cvd risk assessment in dmi patients can be adequately carried out in routine clinical practice without determining microalbuminuria.
Clinical nephrology. 2020;12(4):51-55
51-55
Glomerular filtration rate in patients with spondiloarthritis against the ackground of long-term therapy with NSAIDS -results of prospective observational study
Abstract
Objective. evaluation of the changes in glomerular filtration rate (GFR) in patients with spondyloarthritis (Spa) taking nonsteroidal anti-inflammatory drugs (nsaids) for a long time. materials and methods. a prospective observational study included 82 patients with spa who took nsaids for a long time. gfr was assessed at baseline and over time every 24-зо weeks. for the safety of treatment, a patient with a decrease in gfr of less than 90 ml/min/1.73 m2 was excluded from the study and transferred to another therapy. patients took nsaids in two regimens: continuous regular intake of nsaids and continuous irregular intake of fixed or arbitrary doses of nsaids (continuous intermittent intake). results. the mean gfr for the entire group of patients was 104.8 [94.6; 118.2] ml/min/1.73 m2. after 6-12 months of followup, the mean gfr in 68 patients was 95.5 [85.5; iio.O] ml/min/1.73 m2 (P = о.оз2 relative to the baseline mean gfr in these 68 patients), 15 patients showed a decrease in gfr of less than 90 ml/min/1.73 m2. these patients were excluded from the study. after 12-18 months of follow-up, the remaining 53 patients had an mean gfr of ioi.o [86.0; iii.O] ml/min/1.73 m2 (P>o.05 relative to the previous level), 18 patients showed a decrease in gfr less than 90 ml/min/1.73 m2. after 18-24 months of follow-up, the mean gfr was 102.о [91.0; ii9.0] ml/min/1.73 m2 (P>o.05); the decrease in gfr less than 90 ml/min/1.73 m2 was not identified. further, only 22 patients took part in the study, their mean gfr after 24-зо months of follow-up was 106.о [106.0; ii8.5] ml/min/1.73 m2 (P>o.05 relative to baseline level). the features of gfr changes with different nsaid intake were revealed. conclusion. observational study revealed that in patients with spa with initially unimpaired gfr, taking nsaids for a long time (at least 2 years), gfr may not change significantly and remain normal. Against the background of long-term therapy with nsaids, some patients with spa may have a decrease in gfr of less than ml/min/1.73 m2, but no severe kidney injury was noted. with dynamic follow-up, it was found that in patients taking nsaids in an intermittent mode, a decrease in gfr occurs more often than in patients taking nsaids regularly.
Clinical nephrology. 2020;12(4):56-59
56-59
Features of pathogenetic mechanisms of protein-energy wasting development in patients with chronic kidney disease stage 5D
Abstract
Objective. evaluation of the complex contribution of myostatin (mstn) and protein kinase-b (Akt) to the development of protein-energy malnutrition in patients with chronic kidney disease (CKD) receiving programmed hemodialysis. material and methods. the study involved 80 patients with stage 5D ckd. all subjects underwent general clinical and biochemical examination; the blood serum of mstn and akt levels were determined using enzyme-linked immunosorbent assay, and the severity of protein-energy malnutrition (рем) was assessed using a complex technique. results. the prevalence of pem was 90%. the relationships between the markers of muscle tissue metabolism mstn and akt with iron deficiency, hyperparathyroidism, vitamin D deficiency, as well as with indicators of systemic inflammation were determined. to assess the effect of the mstn/akt signaling pathway on the development of pem in hemodialysis patients, an original muscle tissue catabolism index (MTCi) was developed. conclusion. mstn and akt make a significant contribution to the development of pem in patients with stage 5D ckd. the proposed mtci is promising tool in assessing the severity of not only pem, but also sarcopenia, which is of research interest
Clinical nephrology. 2020;12(4):60-64
60-64
MicroRNAS and their significance in the population of dialysis patients
Abstract
Background. Micrornas play a key role in regulating various functions of both healthy and damaged cells; however, their role in the development of cardiovascular diseases and bone mineral disorders in the population of dialysis patients remains poorly understood. there are also no studies comparing the profile of various mirnas in patients on hemodialysis and peritoneal dialysis. objective. evaluation of the associations between the blood serum mirna-21, mirna-126 and mirna-210 levels and the adequacy of dialysis, left ventricular myocardium contractility (ejection fraction), and lipid metabolism in patients on renal replacement therapy (RRT) with hemodialysis and peritoneal dialysis. materials and methods. the study included 40 patients, of whom 18 received programmed hemodialysis (PhD) therapy, 28 -peritoneal dialysis (Pd). The control group consisted of 28 healthy volunteers. In addition to routine examination methods, assessment of the adequacy of dialysis by kt/v and echocardiography, all patients underwent the determination of the mirna-21, mirna-126 and mirna-210 expression levels by the real-time polymerase chain reaction. results. a highly significant negative correlation between the mirna-126 expression level and the dialysis adequacy indicator by kt/v was revealed (rs = -o.687; p = o.oo2). both mirna-21 and mirna-126 had negative correlation with serum total cholesterol levels (rs = -o.409; p = 0.009 and rs = -o.414; p = o.oo8, respectively). low microrna-21 levels were associated with higher low-density lipoprotein level (rs = -o.4; p = o.oi), while microrna-126 negatively correlated with the high-density lipoprotein level (rs = -o.36; p = o.024). an increase in the mirna-21 and mirna-126 expression levels was observed in patients with atrial fibrillation (P= o.oo3). the mirna-210 expression level negatively correlated with the value of the left ventricular ejection fraction (LVEF) measured by Simpson method according to echocardiography data (rs = -0.5; p = o.oi). Conclusion. a negative association between the mirna-126 expression level and indicators of dialysis adequacy in dialysis patients was found. Indicators of microRNA expression also reflect the state of lipid metabolism in dialysis patients. in particular, low microrna-21 levels were associated with increased proatherogenic low-density lipoprotein levels. microrna-21 and microrna-126 directly correlated with the prevalence of atrial fibrillation, and microrna-210 negatively correlated with the LVEF measured according to Simpson method.
Clinical nephrology. 2020;12(4):65-69
65-69
Chronic kidney disease in patients with impaired thyroid function
Abstract
The prevalence of chronic kidney disease (CKD) is increasing worldwide, reaching epidemic levels. it is known that hyper-and hypofunction of the thyroid gland (TG) can be associated with the development of cardiorenal disorders and lead to a significant worsening of the prognosis in these patients. however, there is evidence that thyroid dysfunction is associated with the development and progression of ckd. the article discusses the issues of epidemiology and pathogenesis of renal dysfunction in patients with thyroid dysfunction. it has been shown that thyroid hormones can have a significant effect on renal function; therefore, it is important to take into account the physiological relationship between thyroid dysfunction and ckd.
Clinical nephrology. 2020;12(4):70-74
70-74
Nephroprotective effects of sodium-glucose linked transporter-2 inhibitors
Abstract
The article presents data on the mechanisms and clinical significance of the nephroprotective effect of sodium-glucose linked transporter-2 inhibitors (glyflozines). the effects associated with the influence of representatives of this pharmacological group on the glomerular filtration rate, glycemic level, diuresis, ketogenesis and other factors are discussed. the results of recent experimental and clinical studies aimed at studying certain aspects of the nephroprotective effect of sglt2 inhibitors in type 2 diabetes mellitus and other pathological conditions are analyzed.
Clinical nephrology. 2020;12(4):75-79
75-79
The contribution of A.M. Shumlyansky (1748-1795), one of the founders of nephrology and microscopic anatomy in Russia, into clinical medicine (on the 225th anniversary of the death of the professor)
Abstract
The main milestones in the life and work of Alexander M. Shumlyansky (1748-1795), a Russian doctor, obstetrician and the first Russian scientist-microscopist, are presented. it is noted that in 1776 he graduated from the hospital school at the Admiralty Hospital in st. Petersburg, received the title of doctor and was sent to study abroad. А.м. Shumlyansky in 1782 graduated from the University of Strasbourg and defended his thesis on the topic “On the structure of the kidneys, physiological and anatomical treatise” (the work was published in 1788). Upon his return to Russia he taught pathology and therapy at a hospital school in Moscow. it is shown that since 1793 А.м. Shumlyansky was a Professor of Obstetrics at the Moscow obstetric school. The fact that А.м. Shumlyansky applied an original technique for injecting kidney blood vessels and urinary tubules in own research is analyzed. he was the first to present and substantiate the pattern of their anatomical relationships. the scientist showed that the renal corpuscles described by professor m. Malpighi (100 years before am Shumlyansky) are not glands, but plexuses of arterial capillaries, surrounded by “some annular border.” it is noted that this was the first (60 years before Bowman) observation of the glomerulus capsule (Shumlyansky - Bowman capsule), the discovery of which was later sometimes attributed to V. Bowman. The works of А.м. Shumlyansky showed that each vascular glomerulus is adjacent to a separate renal tubule, and each tubule is a single tube with straight and tortuous sections. Alexander shumlyansky also proved the falseness of the statement of the prominent anatomist f. ruysch about the presence of so-called open kidney vessels and thereby finally confirmed the assumption that the circulatory system of the kidneys is closed. Alexander m. shumlyansky, being one of the founders of nephrology in our country, as well as the scientific school of clinicians, is rightfully recognized as one of the patriarchs of Russian medicine.
Clinical nephrology. 2020;12(4):80-83
80-83
In Memory of Ivan Glebovich Kayukov (30.11.1951-19.11.2020)
Clinical nephrology. 2020;12(4):83-84
83-84
In Memory оf Lyudmila Mikhailovna Kondrashova (09.06.1965-23.12.2020)
Clinical nephrology. 2020;12(4):84-84
84-84