Vol 15, No 2 (2023)

Objective. Analysis of the results of using remote teleguidance for patients on ambulatory peritoneal dialysis (PD) in preventing the development of dialysis peritonitis.

Material and methods. A retrospective study based on the results of remote monitoring and questionnaires returns of 140 patients on PD, followed-up at the PD Department of the Scientific and Practical Center for Nephrology and Transplanted Kidney Pathology, City Clinical Hospital № 52, using the "Telenefrocenter" platform for remote monitoring and rehabilitation was conducted. Patients were divided according to the method of follow-up: group 1 (100 patients) - patients on PD treatment who were followed-up at the dialysis center for 16 months; group 2 (40 patients) were followed-up at the dialysis center using the "Telenephrocenter" platform for remote monitoring and questionnaires for assessing the quality of life and a specially designed "Peritoneal dialysis" questionnaire.

Results. The study revealed relationship between the use of remote teleguidance and decrease in the development of infectious complications (dialysis peritonitis, infection of the peritoneal catheter exit site).

Conclusion. Remote monitoring using the "Telenefrocenter" platform makes it possible to identify serious symptoms in patients on PD that occur during treatment, which can lead to the development of infectious and mechanical complications of PD. The use of two-way communication with patients provides early detection and prevention of the development of various complications of PD, as well as significantly increases the effectiveness of the method and adherence to treatment.

Objective. Evaluation of the effectiveness of glucocorticosteroid (GCS) treatment in patients with immunoglobulin A nephropathy (IgAN) and the presence of histopathological proliferative changes according to the Oxford classification (MEST-C).

Material and methods. The effectiveness of therapy after 6 months of treatment in 2 groups of patients with IgAN and the presence of histopathological proliferative changes (M1, E1 and/or C1) with glomerular filtration rate >50 ml/min and proteinuria >0.75 g/day (group 1 - ACE inhibitors or ARBs (n=21), group 2 - corticosteroids (n=15)) was evaluated.

Results. Clinical and laboratory parameters improved in both treatment groups, but the overall remission rate in the group 1 was 33%, which was significantly lower compare to the group 2 - 87% (P = 0.023). Patients treated with ACE inhibitors or ARBs had a high incidence of IgAN progression after 6 months of treatment compared with patients treated with corticosteroids (P = 0.001).

Conclusion. Early use of corticosteroids in patients with IgAN and the presence of histopathological proliferative changes provides a significant increase in the incidence of clinical and laboratory remission by 53.4% (P=0.002) without side effects.

Background. Organ-preserving minimally invasive techniques in the treatment of renal parenchymal cancer have now taken a leading position in modern oncology. Intraoperative ultrasound provides navigation in case of intraparenchymal formations of the renal parenchyma of small size. The use of this technique for laparoscopic resection of one's own kidneys is widespread; to date, however, there are no data on the use of intraoperative ultrasound for resection of a kidney graft with a tumor in the world. It should be noted that more than 1,500 kidney transplantations are performed annually in the Russian Federation and the incidence of renal cell carcinoma (RCC) of a transplanted kidney is about 0.5%. Kidney transplant patients have two-fold risk of developing neoplasms compared to the general population, and despite the low incidence in this group, such patients require a non-standard approach from clinicians and represent a difficult clinical case.

Objective. Evaluation of the possibility of using intraoperative ultrasound diagnostics in laparoscopic resection of a kidney graft with a tumor.

Material and methods. 22 patients underwent laparoscopic resection of a transplanted kidney with a tumor at the City Clinical Hospital № 52 from 2016 to 2022. 15 lesions were determined intraparenchymally and were detected only with intraoperative ultrasound.

Results. All patients underwent laparoscopic resection of a transplanted kidney with a tumor using intraoperative ultrasound navigation. There was no bleeding or death.

Conclusion. Intraoperative ultrasound navigation made it possible to identify and visualize intraparenchymal renal graft formations during laparoscopic resection of a transplanted kidney with a tumor. The use of this instrumental diagnostic method in the era of nephron-sparing treatment methods is certainly justified and makes it possible to reduce the volume and duration of the surgery.

Background. Bladder cancer (BC) is one of the most common malignancies in the world and ranks 7th in the structure of oncopathology in men and 17th in women. Patients on renal replacement therapy (RRT) have been shown to have a more aggressive tumor and often a more advanced stage of the disease. In most cases, the disease is asymptomatic at an early stage and difficult to screen. As a rule, clinical manifestations and diagnosis occur at the muscle-invasive stage, where organ-preserving treatment is not possible.

Description of the clinical cases. From 2021 to 2023, 2 patients with muscle-invasive bladder cancer with end-stage renal disease (ESRD), who were on RRT with program hemodialysis, underwent surgery at the City Clinical Hospital № 52. All patients underwent laparoscopic bilateral nephroureterectomy, cystoprostatvesiculectomy, ad bloc ureterectomy.

Results. All patients underwent minimally invasive surgical treatment. There were no complications in the early and late operative periods, and there were no lethal cases. According to the results of histological examination in all patients, the kidney tissue has sclerotic changes and thinned urothelium without signs of tumor growth, mono- or bilateral apostematous pyelonephritis. The first patient had muscle-invasive urothelial bladder cancer pT2b N0. The second patient has metastases in the lymph nodes of the small pelvis. Also as an accidental finding, prostate cancer pT2N0 Gleason 6 (3+3) was detected. During the follow-up period at the outpatient settings, no data on the progression of the oncological process were received.

Conclusion. On the example of these clinical cases, it can be convinced that the radical treatment of muscle-invasive bladder cancer in patients with ESRD is possible in combination with the removal of a purulent-septic focus, and in some cases it can be a prevention of purulent-septic complications. However, in the treatment of these diseases, it is necessary to apply a multimodal approach to develop optimal methods for diagnosis and treatment.

Background. This clinical case demonstrates the difficulty of diagnosing systemic vasculitis and the effectiveness of immunosuppressive therapy.

Description of the clinical case. The article presents a clinical case of microscopic polyangiitis in a 61-year-old man. The disease proceeded with predominant kidney damage associated with antineutrophil cytoplasmic antibodies targeting proteinase-3, febrile fever, myalgia, arthralgia, weight loss, and polyneuropathy. The material obtained during the primary kidney biopsy was of little information, since it contained less than 10 glomeruli without crescents. The patient abstained from the proposed repeated nephrobiopsy. Taking into account clinical and laboratory data, ANCA-glomerulonephritis was diagnosed, presumably within the framework of microscopic polyangiitis. Immunosuppressive therapy with glucocorticosteroids and cyclophosphamide made it possible to obtain a rapid remission of the disease. Anti-relapse therapy was not carried out. After 2 years, a relapse of the disease with a decrease in kidney function developed. The patient underwent repeated nephrobopsy, signs of ANCA-associated glomerulonephritis with the presence of crescents in 63% of the glomeruli were found. The prescribed immunosuppressive therapy with glucocorticosteroids and cyclophosphamide led to remission of the disease with restoration of kidney function.

Conclusion. The clinical case illustrates the difficulty of early verification of the diagnosis of microscopic polyangiitis, the high efficiency of immunosuppressive therapy, and the need for long-term anti-relapse therapy.

The choice of the method of anticoagulation during various extracorporeal procedures is relevant in view of the increasing frequency of the use of this procedure by doctors of various specialties. Regional citrate anticoagulation (RCA) has a number of advantages over systemic anticoagulation with heparin, including: longer filter life in renal replacement therapy (RRT), lower risk of bleeding. In order to achieve maximum efficiency and safety of RCA, many different citrate dosing algorithms have been proposed; protocol citrate anticoagulation with 4% sodium citrate is the most studied. This literature review discusses the main studies evaluating the efficacy and safety of this technique. Currently, research results allow professional communities to recommend CAR as the method of choice for extended RRT.

The meteoric rise of metabolic syndrome has made it a major global health problem. The results of studies show a higher frequency of kidney pathology in patients of this group. Abdominal obesity, hypertension, dyslipidemia, and insulin resistance are associated with effects on the kidneys through the systemic release of multiple pro-inflammatory cytokines, generalized oxidative stress, and the development of chronic inflammation. This review considers the main pathophysiological mechanisms of kidney damage and variants of their structural changes under the influence of each of the components of the metabolic syndrome. The most significant laboratory markers and possibilities of pharmacotherapy are discussed, the study of these parameters seems important in the timely prevention of chronic kidney disease in such patients.

Currently, chronic kidney disease makes a significant contribution to the general structure of the incidence of the population. The presence of chronic kidney disease several times increases the risk of vascular complications. Thromboembolic complications are one of the most common causes of death from vascular diseases. Chronic kidney disease increases the risk of deep vein thrombosis as a risk factor for pulmonary embolism in people with end-stage renal disease. The coagulation cascade is a complex process involving platelets, endothelial cells, and coagulation factors. In clinical practice, patients with end-stage renal disease often have a tendency to bleed, but thrombotic events such as arteriovenous fistula thrombosis, peripheral arterial occlusive disease and deep vein thrombosis have also been noted. In nephrotic syndrome and membranous nephropathy, venous thrombosis of the lower extremities and renal veins is common. An important role in the occurrence of thrombosis in nephrotic syndrome is played by antithrombin III, which is synthesized mainly in the vascular endothelium, liver and lung tissue. In patients with thrombosis, the recovery of antithrombin III activity is reduced. Factors contributing to the development of thrombosis and embolism in chronic kidney disease are nephrotic proteinuria, decreased levels of albumin, antithrombin III, blood protein C, and atherogenic dyslipidemia. An increase in the concentration of homocysteine, C-reactive protein and blood fibrinogen makes an additional contribution to the formation of thromboembolic complications in patients with chronic kidney disease. The review article provides an overview of clinical trials aimed at analyzing risk factors for the development of thrombosis and embolism in patients with chronic kidney disease.