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Vol 14, No 4 (2022)


Vstupitel'noe slovo

Kotenko O.N.
Clinical nephrology. 2022;14(4):3-3
pages 3-3 views

Analysis of satisfaction with drug therapy for anemia in patients with stage 5 chronic kidney disease on hemodialysis

Kotenko O.N., Abolyan L.V., Kuteinikov V.Y., Vinogradov V.E., Dorofeeva E.G.


Background. In modern scientific literature, assessment of patient satisfaction with treatment is considered as an important method for assessing the results of treatment from the standpoint of the patient. Objective. Comprehensive analysis of satisfaction with drug therapy for anemia in patients with stage 5 chronic kidney disease (CKD) on hemodialysis (HD), taking into account the medical and demographic characteristics of patients, achieved Hb levels, adherence to treatment and health-related quality of life (QoL). material and methods. in the period from august to November 2021, a survey of patients with stage 5 ckd on hd was conducted. the total number of respondents was 515 patients. the dtsq (modified) and kdqol questionnaires were used to assess satisfaction with treatment and QoL of patients. results. a significant positive correlation between patient satisfaction with drug therapy for anemia, hb level, adherence to treatment, quality of life, material wealth and living conditions of patients was found. Conclusion. Comprehensive assessment of satisfaction with drug therapy for anemia among patients with stage 5 ckd on hd is of great importance in the evaluation and selection of effective methods of treatment
Clinical nephrology. 2022;14(4):5-12
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Dynamic monitoring of the cardiovascular system and kidney function in patients with chronic kidney disease who had COVID-19

Zhmurov D.V., Zhmurov V.A., Petrov I.M., Petelina T.I., Gapon L.I., Yaroslavskaya E.I., Petrova Y.A., Reshetnikova T.V., Tolstoukhova N.V., Zhmurova E.A., Ermakova A.A., Ermakova P.A.


Objective. Evaluation of the state of the cardiovascular system and kidney function in patients with chronic kidney disease (CKD) who have had covid-19 during a one-year prospective follow-up. material and methods. a clinical follow-up and examination of 150 patients with ckd who have had covid-19 was carried out. the examination included an assessment of the cytokine profile (interleukin-1 - il-1, il-6, il-8, tumor necrosis factor a - tnf-a), determination of the of high- sensitivity c-reactive protein (CRP), ferritin, natriuretic peptide, cystatin c levels, echocardiogram, 24-hour blood pressure monitoring, estimation of the glomerular filtration rate according to the ckd-epi formula during 12-month follow-up period. results. a change in the pro-inflammatory cytokine levels, an increase in the crp level, a change in the structural and functional state of the cardiovascular system in patients at з and 12 months after covid-19 were found. there was no significant deterioration in the functional state of the kidneys in patients after з months, while after 12 months of follow-up, the number of patients with advanced ckd stages increased, especially in the group of patients with ckd and cardiovascular diseases. Conclusion. Patients with ckd who have had covid-19 need for long-term follow-up by the nephrologist and cardiologist for comprehensive monitoring of the functional state of the kidneys and the cardiovascular system and adequate cardio- and nephroprotective therapy.
Clinical nephrology. 2022;14(4):13-18
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The effectiveness of hydroxychloroquine and its effect on cell-mediated and humoral immunity in patients with immunoglobulin A nephropathy: results of a prospective controlled study

Komissarov K.S., Nizheharodava D.B., Minchenko E.I., Ivanchik G.I., Pilotovich V.S., Zafranskaya M.M.


Objective: evaluation of the clinical efficacy of using hydroxychloroquine (HCQ) compared with glucocorticosteroids (GCS) in patients with immunoglobulin a- nephropathy (Igan) and the effect of the treatment on cell-mediated and humoral immunity. Material and methods. Using flow cytometry and enzyme immunoassay methods, clinical, laboratory and immunological parameters were determined in з groups of patients with igan with glomerular filtration rate >50 ml/min and proteinuria (PU) >i g/day: group 1 - hcq (n=20), group 2 - gcs (n=20) and group з - maintenance therapy (n=12). results. a six-month course of hcq reduced the pu level (P=o.03), the relative number of tnk-cells (P=o.05) and δγT-lymphocytes (p=0.01), as well as their cytotoxic profile, and also reduced the serum April factor and immunoglobulin levels in patients with igan (P = o.05), which led to remission in 60% of patients. conclusion. hcq can be used as an effective alternative therapy in patients with igan.
Clinical nephrology. 2022;14(4):19-26
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Renal cell carcinoma in patients receiving hemodialysis treatment

Lubennikov A.E., Trushkin R.N., Berezhnaya E.E., Isaev T.K., Morozov N.V., Medvedev P.E., Kolesnikov N.O.


Background. In patients with end-stage renal disease (esrd), renal cell carcinoma (rcc) is detected more often than in the general population. in order to improve the results of treatment of patients in this category, we conducted a retrospective analysis of our own experience. material and methods. During the period from 2010 to 2020, nephrectomy (ne) for rcc was performed in 26 patients treated with hemodialysis (hd) at the city clinical hospital №52 of the moscow healthcare department. To identify predictors of rcc, 100 patients treated with hd during the indicated period were randomly selected as a control group. results. significant risk factors for rcc were only male gender (aor 5.1; 95% cl 1.34-14.4; p=0.015) and the presence of multiple kidney cysts (or=3.2, 95% cl 1.56-16, 43; p=0.008). A bimodal increase in the frequency of rcc was noted: in the first year after the onset of hd and 5 years later. after ne, bleeding due to systemic hypocoagulation was registered only in one case. hyperkalemia was noted in 5 (19.2%) patients immediately after laparoscopic ne. Based on the tnm stage, the uicc (university of california los angeles integrated staging system) nomogram, and the leibovich score, a favorable oncological prognosis was noted in 17 (65.4%) patients. the median follow-up of patients after ne was 20 months (q1-q3: 8.5-45), with a minimum of 2 months and a maximum of 72 months. In none of the cases progression of rcc was noted. Conclusion. the high-risk group for developing rcc was male patients with multiple kidney cysts. After laparoscopic ne, monitoring of blood potassium levels is required. The vast majority of patients after surgical treatment were characterized by a favorable oncological prognosis and they could be considered for kidney transplantation without an additional period of follow-up.
Clinical nephrology. 2022;14(4):27-32
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Modern strategies for the treatment of patients with autosomal dominant polycystic kidney disease

Trushkin R.N., Medvedev P.E., Isaev T.K., Klementieva T.M., Morozov N.V., Ivanov K.V.


According to who data for 2019, kidney disease ranks 10th in the structure of the leading causes of death in the world with a total number of deaths of 1.3 million people. Based on large cohort studies, the global prevalence of chronic kidney disease (ckd) in the general population, averaged 13.4%. Autosomal dominant polycystic kidney disease (ADPKD) deserves special attention; it is characterized by the formation of cysts, a progressive increase in the volume of the kidneys with destruction of the parenchyma, a decrease in the glomerular filtration rate, and the occurrence of various complications. recently, new targeted therapeutic drugs have appeared, their action is based on the pathogenetic mechanisms of adpkd progression. The article presents a literature review of various methods in the treatment (conservative and surgical) of adpkd
Clinical nephrology. 2022;14(4):33-42
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Therapy for immunoglobulin А-nephropathy: what along with immunosuppression?

Bobkova I.N., Kamyshova E.S.


Immunoglobulin-A nephropathy (IgAN) is the most common form of chronic glomerulonephritis in the world. Unlike other glomerulopathies, which are clinically manifested by episodes of nephrotic and/or acute nephritic syndromes, IgAN in most cases has few symptoms, and the decrease in glomerular filtration rate occurs gradually. The basis of IgAN treatment is individually optimized maintenance therapy aimed at correcting blood pressure, reducing proteinuria, eliminating or minimizing the impact of modifiable risk factors for the progression of chronic kidney disease. This review focuses on modern IgAN maintenance therapy, highlighting both traditional and new directions, and provides a critical analysis of their effectiveness.
Clinical nephrology. 2022;14(4):43-48
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Insulin resistance in chronic kidney disease pages of history

Bachmakov I.E., Fedoseev A.N., Denisova V.E.


This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD). Insulin resistance is often associated with CKD even independent of presence of obesity or diabetes mellitus and may be both a consequence of renal impairment and accelerate development of kidney disorders. Factors playing a role in development of insulin resistance in CKD patients include both lifestyle characteristics (e.g., physical inactivity, unhealthy diet) and chronic renal dysfunction (e.g., metabolic acidosis, vitamin D deficiency, renal anemia, and uremic toxins), while obesity and diabetes mellitus may additionally exacerbate decline in insulin sensitivity. There is extensive evidence showing that chronic systemic inflammation, oxidative stress, dysregulation of adipokines secretion, and activation of renin-angiotensin-aldosterone system (RAAS) are involved in mechanisms of ir development in patients with ckd. In research and clinical practice, dynamic (e.g., oral glucose tolerance test based on changes in blood glucose and insulin concentrations in response to standard oral glucose load) and static (e.g., НОМА-ir insulin resistance index utilizing fasting glucose and insulin concentrations) ir models are widely used for assessment of insulin sensitivity in ckd due to their sufficient accuracy, practicability, and low cost. Since ir is associated with both the risk of cardiovascular morbidity and mortality and accelerated development of cardiovascular and renal complications in patients with ckd, it is important to take effective measures for the prevention and treatment of this condition as early as possible, including lifestyle modification, targeted pharmacotherapy, and - in the terminal stage kidney disease - renal replacement therapy.
Clinical nephrology. 2022;14(4):49-58
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In memory of the great clinician-innovator and humanist academician of the USSR Academy of medical sciences Vladimir Kharitonovich Vasilenko (1897-1987). To the 125th anniversary of the scientist’s birth

Morgoshiia T.S., Turabova N.M.


The article analyzes the key milestones in the life and work of the great soviet therapist and clinician v.h. Vasilenko. it is noted that a talented scientist, a faithful follower of F.G. Yanovsky and N.D. Strazhesko, V.h. Vasilenko, for more than 60 years, with his vigorous scientific and practical activities, brilliantly developed Soviet medicine, enriching it with both experimental and significant clinical experience. Vladimir Kharitonovich’s scientific works are diverse and are represented by diseases of the kidneys, respiratory organs, cardiovascular system, digestive tract organs, topical issues of propaedeutics of internal diseases, etc. in 1926, he brilliantly defended his PhD thesis on the topic “The clinical significance of aromatic compounds of blood and urine in kidney diseases”. it is shown that he first described (1931) the atrial tone of the heart and the syndrome of acute left atrial insufficiency in mitral cardiac stenosis. of course, Academician of the ussr Academy of medical Sciences V.Kh. Vasilenko remains a shining example for us, doctors, for our youth, who should draw on the wisdom of clinical thought and the experience of an outstanding Russian scientist of the XX century.
Clinical nephrology. 2022;14(4):59-63
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ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment

Philip Kam-Tao Li -., Kai Ming Chow -., Yeoungjee Cho -., Stanley Fan -., Ana E Figueiredo -., Tess Harris -., Talerngsak Kanjanabuch -., Yong-Lim Kim -., Magdalena Madero -., Jolanta Malyszko -., Rajnish Mehrotra -., Ikechi G Okpechi -., Jeff Perl -., Beth Piraino -., Naomi Runnegar -., Isaac Teitelbaum -., Jennifer Ka-Wah Wong -., Xueqing Yu -., David W Johnson -.


Перитонит является серьезным осложнением перитонеального диализа (ПД), и его профилактика и лечение имеют большое значение в снижении заболеваемости и смертности пациентов. в обновленных рекомендациях ISPD 2022 года пересмотрены и уточнены определения следующих понятий: рефрактерный перитонит, рецидивирующий перитонит, удаление катетера, связанное с перитонитом, перевод на гемодиализ, связанный с перитонитом, смерть, обусловленная перитонитом, и госпитализация, связанная с перитонитом. Определены новые категории перитонита и исходы, включая пре-перитонит, кишечный перитонит, катетер-ассоциированный перитонит и излеченный перитонит. Новые целевые показатели, рекомендованные для общей частоты заболеваемости перитонитом, должны составлять не более 0,40 эпизода в год с учетом риска, а процент пациентов, не заболевших перитонитом в единицу времени, должен составлять >80% в год. Также включены пересмотренные рекомендации по управлению контаминацией систем для ПД, антибиотикопрофилактике для инвазивных процедур, обучению и оценке ПД. Выделены новые рекомендации по управлению модифицируемыми факторами риска перитонита, такими как домашние животные, гипокалиемия и блокаторы Н2-гистаминовых рецепторов. Обновлены рекомендации по эмпирическому выбору антибиотиков и дозировке антибиотиков, по выбору стратегии лечения перитонита, вызванного специфическими микроорганизмами, также даны новые рекомендации по дополнительной пероральной терапии N-ацетилцистеином для смягчения ототоксичности аминогликозидов. Предложены новые направления для будущих исследований в области профилактики и лечения перитонита, связанного с ПД.
Clinical nephrology. 2022;14(4):64-99
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Assotsiatsiya «Professional'naya assotsiatsiya nefrologov»

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Clinical nephrology. 2022;14(4):101-106
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