Vol 13, No 2 (2021)

Objective. Provision of information on the organization of renal replacement therapy (RRT) in emergency medicine in hospitals of the Moscow Healthcare Department in the context of a pandemic of the novel coronavirus infection SARS-CoV2 (COVID-19). Materials and methods. The annual reports of the Chief External Expert in Nephrology for 2019-2020 were used. Data were obtained from 43 healthcare organizations (HCO) that use RRT methods, of which 33 HCO used RRT methods for patients with COVID-19. Results and conclusion. The COVID-19 pandemic led to a significant increase in the number of patients receiving RRT in the ICU, amounting to 9434 (of which with COVID-19 - 34.7%), which is 20.7% more than in 2019. Also, the number of patients with acute kidney injury (AKI) and “extrarenal indications” receiving RRT increased in 2020; an increase compared to 2019 amounted to 39.3 and 38.9%, respectively. There were 33.6 and 32.4% patients with COVID-19 in these groups, respectively. At the same time, the number of patients with CKD (55.2% - patients with COVID-19) who underwent RRT in the ICU decreased by 8.1% compared to 2019. The total number of RRT procedures in 2020 increased by 15% compared to 2019, with 34% of the total number for the year performed in patients with COVID-19 Compared to 2019, there was a statistically significant increase in mortality among ICU patients who received RRT in 2020, which amounted to 33.6% and 46.6%, respectively. The mortality rate of patients with COVID-19 was 62.5%, without COVID-19 - 38.1%.

Aim of the study. The treatment of secondary hyperparathyroidism is one of the main tasks in the correction of mineral and bone disorders (MBD) in patients with chronic kidney disease (CKD). However, the results of therapy for secondary hyperparathyroidism are still unsatisfactory. In our prospective randomized controlled trial were evaluated the effect and safety of 26 weeks of treatment with etelcalcetide (intravenous route of administration) compare with cinacalcet (oral administration) on CKD-MBD parameters in patients on program hemodialysis with secondary hyperparathyroidism. Material and methods. The study group included 50 stable patients receiving hemodialysis with secondary hyperparathyroidism (PTH-300 pg/ml) and corrected Ca level greater than 2.2 mmol/L, who were randomized in a 1:1 ratio for treatment with etelcalcetide (n=25) or cinacalcet (n=25) for 26 weeks. All patients were monthly evaluated the levels of P, Ca, intact parathyroid hormone (IPTH), alkaline phosphatase (ALP); the levels of FGF 23, Klotho protein and sclerostin were assessed once in 3 months. The dose of both drugs was adjusted according to the serum iPTH level. The nature, frequency, and severity of treatment-emergent adverse events (AEs) were assessed Results. Therapy with cinacalcet and etelcalcetide led to a significant decrease in the level of iPTH in the blood serum from 613.1±235.1 to 302.2±205.1pg/ml (p<0.01) and from 718,2±272,3 to 320,1±292,5pg/ml (p<0.01), by 50,2% and 55,4%, respectively, by the end of the study. A significant decrease in the levels of corrected Ca was noted in both groups: in the etelcalcetide group from 2.25±0.12 to 2.06±0.18 mmol/l (p<0.05), in the cinacalcet group from 2.23±0.12 to 2.04±0.21 mmol/l (p<0.05). There was no significant change in the P levels. The alkaline phosphatase level significantly decreased in the cinacalcet group (from 178.7±116.8 to 78.9±34.1 U/L; p<0.05) and in the etelcalcetide group (from 170.3±115.7 to 75.8±30.8 U/L; p<0.05). There was a significant increase in Klotho protein levels by the end of the study from 17.9±5.0 to 57.1±9.3 (p<0.05) and from 17.6±3.7 to 91.6±16.2 pg/ml (p<0.05), respectively, in the cinacalcet and etelcalcetide groups. Changes in FGF-23 and sclerostin by 6 months reached statistically significant changes only in the etelcalcetide group, a decrease from the FGF-23 level from 42.7±12.2 to 23.0±12.3pg/ml and an increase in the level of sclerostin from 1, 59±0.31 to 2.20±0.33 ng/ ml (p<0.05). During the study, 2 patients in the cinacalcet group dropped out due to dyspeptic symptoms and 1 patient in the etelcalcetide group dropped out due to hypocalcemia. Conclusion. Etelcalcetide and cinacalcet are effective PTH-lowering drugs with a comparable safety profile. Treatment with etelcalcetide, in contrast to cinacalcet, was associated with significant increases in sclerostin and decreases in FGF-23, which may have beneficial effects on outcomes and requires further study

ANCA-associated systemic vasculitis is characterized by overproduction of ANCA autoantibodies with specificity for myeloperoxidase or proteinase-3, affecting small and medium-sized vessels with the development of necrotizing vasculitis. Pathogenetic therapy includes the use of glucocorticosteroids, cytostatics, and monoclonal antibodies. In case of the development of life-threatening conditions, however, individual approaches to treatment should be used; drug therapy should be combined with extracorporeal methods: hemodialysis, therapeutic plasma exchange and double filtration plasmapheresis in the optimal combination for the patient and the optimal time of their use.

Objective. evaluation of the gender specificities of the reactivity of the sympathoadrenal (sas) and renin-angiotensin (ras) systems in comorbidity of nephrolithiasis with arterial hypertension (ah). Material and methods. The study analyzed the clinical, instrumental and laboratory data of 196 patients with nephrolithiasis. the cohort was represented by 92 men and 104 women. the platelet aggregation was assessed by the turbidimetric method using a ChronoLog analyzer (usa). Adrenaline and angiotensin-2 agonists (Sigma) were used to analyze AT1 and α2-adrenergic receptors. results. ah was detected in 12.o% of the examined men and 10.4% of women. the features of the pathogenesis of nephrolithiasis comorbid with ah in men were associated with hyperreactivity of the α2-adrenergic receptor and the at1 receptor, while in women the at1 receptor had dominant activity. in men with stones in the urinary tract and ah, the values of microhematuria were higher (P <0.001) than in patients without comorbidity. In women with nephrolithiasis, this phenomenon was not manifested - the severity of microhematuria did not differ in the presence and absence of ah. when nephrolithiasis was associated with ah, there was no significant difference between men and women in the severity and frequency of hematuria; however, women had more pronounced leukocyturia (P<0.05). Conclusion. Pharmacological correction of arterial hypertension in the presence of nephrolithiasis is advisable to carry out taking into account the individual reactivity of sas and ras in men and women.

Rheumatoid arthritis (Ra) is currently one of the most common causes of AA amyloidosis; and the renal damage is associated with the severity of systemic inflammation. severe chronic infections can also lead to the development and progression of aa amyloidosis, and acute infections can worsen the course of aa amyloidosis. The evaluation of the features of the course of aa amyloidosis against the background of a new coronavirus infection is of undoubted interest. The article presents authors’ own clinical observation of the development of nephrotic syndrome against the background of SARS-CoV-2 in a patient with seropositive Ra and morphologically confirmed AA-amyloidosis.