Vol 13, No 4 (2021)

Objective. to study the features of the use nonsteroidal anti-inflammatory drugs (nsaids) in patients receiving programmed hemodialysis. material and methods. a survey of 200 patients receiving programmed hemodialysis was performed. results. the majority of patients: 162 (81%) took nsaids within the previous 6 months, and 91 (56.2%) patients took nsaids during the last month, of which 64 (70.3%) took the drugs more often than 2 times in week. the main reasons for taking nsaids are headache, joint and muscle pain. the majority of patients took on their own non-selective nsaids, 108 (54%) patients did not know about the risks of undesirable effects when taking nsaids. Conclusion. most patients receiving renal replacement therapy with hemodialysis often and long-term use nsaids. considering the need to use anticoagulants during the hemodialysis procedure, the age of the patients, the presence of comorbid conditions, the use of nsaids in this category of patients is associated with a high risk of complications. in this regard, it is necessary to clarify the intake of drugs by patients, to inform patients in a timely manner about possible complications while taking nsaids, to recommend the safest drugs and schemes for their use.

Background. Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease with an incidence of 1:400 to 1:1000, accounting for 7-10% of all patients with end-stage chronic renal disease. Predicting the rate of disease progression has become especially important today with the advent of tolvaptan, the first drug modifying ADPKD. Patients with a high likelihood of rapid disease progression should be selected for this treatment, as these patients are expected to have an optimal benefit/risk ratio. The system of matrix metalloproteinases (MMPs) and their inhibitors (tissue inhibitors of MMP - TIMP, type 1 plasminogen activator inhibitor - PAI-I) plays a key role in the processes of proteolysis in the kidney. Objective. Determination of the blood serum levels of MMP-2, -3 and -9 and their inhibitors TIMP-1 and -2, PAI-I and their urinary excretion, estimating of the relationship of their changes with the ADPKD progression type, and assessment of the significance of disturbances in the MMP/TIMP system as an additional criterion for the progression of ADPKD. Material and methods. The study included 36 children with ADPKD who were admitted to the Department of Hereditary and Acquired Kidney Diseases named after Prof. M.S. Ignatova of the Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University. The levels of MMP-2, MMP-3 and MMP-9 and their inhibitors TIMP-1 and -2, and PAI-I in blood serum and urine were determined by enzyme-linked immunosorbent assay. Results. As a result of the analysis of the frequency of changes in proteolysis factors in blood and urine in children with ADPKD, depending on the disease progression type (slow progression/progression), the following data were obtained: in children with ADPKD progression, the frequency of increase in the level of TIMP-I in the blood (P=0.010; Cramer's V=0.479; OR=12; 95% CI, 1.79-80.3)) and urine (P=0.015; Cramer's V=0.482; OR=9.8; 95% CI, 1.84-51.9)) was statistically significantly higher. Also, the level of PAI-I in the blood (P=0.039; Cramer's V=0.396) and urine (P=0.022; Cramer's V=0.444) was statistically significantly higher in children with ADPKD progression. The chances of a progressive course increased by 6.3 times (95% CI, 1.27-31.2) with an increase in blood PAI-I level and by 9.0 times (95% CI, 1.55-52.2) with an increase in urine PAI-I level in children with progressive ADPKD compared to slow progression. Conclusion. The ADPKD progression in childhood is manifested by an increase in the number of cysts and in the size of the kidneys with the preserved filtration function of the kidneys for a long time due to hyperfiltration. This study identifies children at risk for rapid kidney enlargement, i.e. a progressive course that may benefit from therapeutic interventions in the future. The data obtained from this study indicate that TIMP-1 and PAI-I can be considered as risk factors for the progression of ADPKD in children

The paper highlights the main scientific and practical achievements of the prominent Soviet therapist and scientist-innovator M.S. Vovsi. The little-known facts from the life of Miron Semenovich as a teacher and a competent clinician are analyzed. it is shown that from 1936 until the end of his life he was the head of the department of internal diseases of the ciu. during the second world war (1941-1950), m.s. vovsi was the chief therapist first of the red, and then of the soviet army. The scientist has written about 60 scientific papers. Among them are monographs that are mainly devoted to research on the physiology and pathology of the kidneys, lungs, heart, and liver and military field therapy. The works of m.s. vovsi on kidney diseases are widely known to domestic doctors. They have become manuals for practitioners of various profiles. Among them are the monographs «Acute nephritis», «nephritis and nephrosis» (together with Professor G.F. Blagman), the manual «Diseases of the urinary system», «Clinical lectures», etc. he was the author of numerous journal articles and reports published in the following publications: Therapeutic Archive, Clinical medicine, collections, proceedings of therapeutic congresses, etc. Every speech and publication in the press of Miron Semenovich was always met by practitioners and clinicians with great interest and attention. m.s. vovsi devoted a lot of time to studying the etiology, pathogenesis, treatment of acute diffuse glomerulonephritis, pneumonia, metabolic disorders in wartime. Military field therapy in the ussr achieved great success thanks to the works of M.s. Vovsi. Russian therapists still pay deep respect to the memory of the outstanding doctor and humanist of our country in the first half of the XX century.