Vol 14, No 3 (2022)

Objective. description of the cytokine model of the development of the cardiovascular changes in patients with chronic kidney disease (ckd) after new coronavirus infection. material and methods. clinical follow-up and examination of 150 patients with ckd after covid-19 was carried out. the examination included the determination of the interleukin-1 (IL-d, il-6, il-8, tumor necrosis factor a (TNF-a), transforming growth factor p (Tgfpd, hscrp, d-dimer, fibrinogen, ferritin, natriuretic peptide, cystatin c levels, echocardiography, 24-hour blood pressure monitoring, calculation of the glomerular filtration rate according to the ckd-epi formula. results. an increase in the pro-inflammatory cytokine levels, an increase in the hscrp, d-dimer, fibrinogen, ferritin, natriuretic peptide levels, a change in the structural and functional state of the cardiovascular system (CVS) in patients, especially in the first 3 months after a coronavirus infection, were found. Significant deterioration of the functional state of the kidneys during 3 months of follow-up was not observed in the majority of patients. Conclusion. Patients with ckd after new coronavirus infection require the supervision of a nephrologist and a cardiologist to monitor the functional state of the cardiovascular system and kidneys, as well as for the cardio- and nephroprotective therapy prescription.

Aim. define clinical, morphological features, factors associated with unfavorable outcome and kidney survival of IgA-nephropathy (IgAN) in city Minsk, republic Belarus. material and methods. it was multicenter clinical trial of 291 patients (31±ii years old, 65,6% male) with igan and initial proteinuria 1,0 [0,42-i,80] g/day, gfr 85 [65-102] ml/min, arterial hypertension 47,4%. 90% of the patients were treated with ace inhibitors. results. multivariate regression analysis revealed independent predictors of unfavorable outcome: arterial hypertension (HR=2,8; p=0,04), gfr<0 ml/min (HR=6,8; p=0,001), tubular atrophy and interstitial fibrosis (T) 26-50% (HR=3,0; p=0,015), t>50% (HR=6,6; p=0,001). the composite 5-, 10-year survival without dialysis and 50% decreasing gfr were 75,7±4 and 47,2±6,8%, respectively. Conclusion. Igan has an unfavorable course of disease in republic Belarus.

Background. Currently, there is an increase in the number of patients with both chronic kidney disease (ckd) and cerebrovascular disease (CVD). patients with cvd that occur secondary to ckd make up a large proportion of patients being followed-up by both nephrologists and general practitioners. the article presents the results of studies conducted with participation of 356 patients with end-stage renal disease. Objective. Evaluation if the prevalence and clinical and functional features of risk factors for cerebrovascular complications in patients with end-stage renal disease. material and methods. 195 men and 161 women with signs of end-stage renal disease were examined. the mean age of the subjects was 57.5 years (minimum - 18 years and maximum - 87 years). As cerebrovascular risk factors, the frequency of cardiac arrhythmias, lipid metabolism disorders, obesity, carotid atherosclerosis, left atrial (la) dilatation, left ventricular hypertrophy (LVH), chronic heart failure (HF), anemia, hyperuricemia, hyperphosphatemia, hypercholesterolemia, dyslipidemia, hypertriglyceridemia, and proteinuria were assessed. in addition, acute-phase blood protein levels were studied. the renal failure severity was assessed based on the serum creatinine and cystatin c levels. the ckd stages were determined by the glomerular filtration rate, which was calculated using the serum cystatin с level. results. in patients with end-stage renal disease, the prevalence of cvd was 17.4%. in the structure of cvd, the most common type was chronic cerebral ischemia - 91.9%, the frequency of ischemic and hemorrhagic strokes was 29.0 and 11.2%, respectively. in terms of gender, the frequency of occurrence of various types of cvd was higher among females. the prevalence of lipid metabolism disorders was 55.8%. la dilatation was recorded in 39.6% of patients. the prevalence of lvh and left ventricular systolic dysfunction was 71.6 and 11.2%, respectively. remodeling of the carotid arteries was noted in 52.5% of the examined patients with end-stage renal disease. in the structure of "renal risk factors" for cerebrovascular disorders, hyperuricemia (48.8%), proteinuria (42.6%), anemia (36.2%) and hyperphosphatemia (23.o%) were common. the prevalence of hypercholesterolemia, dyslipidemia, and hypertriglyceridemia was 35.9%, 33.1, and 31.7%, respectively. an increase in blood fibrinogen level was detected in 23.o% of patients. an increase in circulating platelets in the peripheral blood was noted in 12.6% of cases, and elevated blood с-reactive protein level was recorded in 23.8% of patients. Conclusion. In end-stage renal disease, the most common risk factors for the development of cvd are lvh (71.6%), lipid metabolism disorders (55.8%), carotid artery remodeling (52.5%), hyperuricemia (48.8%), proteinuria ( 42.6%), anemia (36.2%), hypercholesterolemia (35.9%), dyslipidemia (33.i%), and hypertriglyceridemia (31.7%).

Objective. determination of the effect of impaired sleep-wakefulness on quality of life (QoL) indicators in patients suffering from arterial hypertension (ah) and chronic kidney disease (ckd). material and methods. 55 patients including 20 (36.4%) men and 35 (63.6%) women with documented arterial hypertension and ckd were randomized in the study. to assess the sleep quality (SQ), the Pittsburgh qs index (PSQi); the Athens insomnia scale (Ais) were used; qol was assessed using the sf-36 questionnaire. results. most of the study participants showed a decrease in sq and an impaired sleep-wakefulness. this leads to a decrease in qol in patients with arterial hypertension and ckd. Impaired sleep-wakefulness in patients of this group most pronouncedly affect such criteria for assessing quality of life as physical functioning, pain intensity, mental health, and especially life activity. Conclusion. Violation of the sleep quality was inherent in the majority of the examined. Impaired sleep-wakefulness leads to a decrease in qol in patients suffering from arterial hypertension and ckd.

Given the large number of patients with ESRD, kidney transplantation is currently the only effective treatment for this condition. The kidney transplant population has two-fold increased risk of developing neoplasms compared to non-transplant population. modern methods of treating transplanted kidney tumors do not differ from the methods of treating cancer of non-transplanted kidneys. The recurrence rate after organ-sparing surgery is similar to the recurrence rate in the general population. Histologically, transplanted kidney cancer is represented by both clear cell carcinoma (45.7%) and papillary renal cellcarcinima (42.1%), chromophobic kidney cancer represents 3% and other types of cancer account for 9.1% of cases. The treatment of transplanted kidney cancer includes the same methods as in the treatment of non-transpated kidney cancer: resection of the transplanted kidney, radical nephrectomy, percutaneous radiofrequency ablation of the kidney graft, and percutaneous graft cryoablation. despite the wide possibilities for the treatment of transplanted kidney cancer, there is a large percentage of patients with recurrence of both end-stage renal disease and kidney cancer, which indicates the absence of a proven treatment algorithm and provides an opportunity for a creative approach to the problem of transplanted kidney cancer. given the ambiguity of the problem of transplanted kidney cancer, we would like to represent a clinical case of treating a large, up to 100 mm, tumor of kidney graft with good oncological and functional results. despite the fact that the incidence of renal cell carcinoma in patients with a transplanted kidney is only o.19-o.5%, this clinical case is difficult for urologists.

Objective: to evaluate clinical efficacy of the herbal medicine prostanorm® in patients with urolithiasis and ureteric catheter-stent implantations after endoscopic radiology operations. materials and methods: 40 female patients with urolithiasis and ureteral stent catheters were enrolled in the prospective study after endoscopic X-ray endourologic surgery (contact ureterolithotripsy (cult)). The dynamics of a number of clinical and laboratory parameters was estimated after prescription of phytopreparation Prostanorm® in the form of monotherapy in a continuous mode with the duration of use of 1 month. results: against the background of the treatment after stent removal (2 weeks from the beginning of the study) as compared to the control group a decrease of micturation frequency by 30% on the average - 6,0±i,8, regression of erythrocyturia and leukocyturia was noted. One month after treatment had begun bacteriological examination of urine showed absence of microbial growth in 25% of cases. Conclusions: prostanorm® has a good antibacterial effect and can be recommended for long-term treatment and prophylactic therapy in patients with catheter-associated urinary infection.

The main scientific and practical achievements of the great Russian therapist and clinician G.a. Zakharin are presented. The little-known facts from the life of Grigory Antonovich as a teacher and a competent clinician are analyzed. it is noted that the medical activity of Grigory Antonovich Zakharin was of great importance for the development of Russian and world clinical thought. he introduced the concept of the body as an integral system, advocating the introduction of prevention and hygiene in medicine. a clinical method created by the joint efforts of Russian doctors of the xviii and early xix centuries and brought by g.a. zakharin, as the prominent french clinician a. yushar said, to the height of art, became the property of doctors all over the world. For 35 years (1861-1896), G.a. Zakharyin was at the head of the faculty therapeutic clinic of Moscow University, steadily observing the method of individualization in his own clinical activity and tirelessly promoting it among his students-students and doctors. Undoubtedly, in the person of G.a. Zakhariina is a venerable figure of an original Russian scientist, deeply erudite, with broad views on the theory of medicine, the personality of a talented diagnostician and empiricist therapist, who completely subordinated his interests to the tasks of recognizing and treating an individual patient.