卷 16, 编号 4 (2024)

This article is the second part of the annual report of the Specialized Commission on Nephrology of the Ministry of Health of the Russian Federation [1] for 2024, which is published in two parts and presents data on the state of the nephrology service of the Russian Federation as of December 31, 2023. The data cover 98% of the subjects (except for the Chukotka Autonomous Okrug, the Altai Republic, Zaporizhia and Kherson regions), representing 99% of the population of Russia. The first part of the report was published in the " Clinical Nephrology" journal, issue No. 1 for 2024 [2].

Objective: to analyze the causes of late kidney allograft dysfunction according to results of kidney transplant histopathological examination performed from 2013 to 2022.

Material and methods. Analysis of late kidney allograft dysfunction causes was carried out according to 431 reports of kidney transplant biopsies performed in Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Republic of Belarus.

Results. The main causes of kidney transplant dysfunction in late posttransplant period were antibody-mediated rejection – 26.7%, recurrent or de novo glomerular diseases – 22.7%, chronic allograft nephropathy – 16%.

Objective. Evaluation of the blood fibrinogen level and the geometry of the left ventricle (LV) in patients with proteinuric variants of chronic kidney disease (CKD).

Material and methods. The study involved 612 patients with CKD and proteinuria who did not receive renal replacement therapy. The mean age was 38,1±12,7 years. The patients were divided into 2 subgroups depending on the fibrinogen level: the first (n=201) included patients with normal fibrinogen values (<4,0 g/L), the second (n=411) – with elevated levels (>4,0 g/L).

Results. Patients with hyperfibrinogenemia (HF) had significant deviations in laboratory parameters: lower levels of hemoglobin (Hb), erythrocytes, lymphocytes and color index of erythrocytes, as well as elevated levels of leukocytes and monocytes. In this group, significant changes in the levels of albumin, total protein, total cholesterol (TC), low-density lipoproteins (LDL), triglycerides (TG), calcium and sodium were also found. The C-reactive protein level was elevated more often in patients with HF. In the HF group, higher rates of daily proteinuria and a decrease in the estimated glomerular filtration rate (EGR) were observed. The frequency of stable coronary artery disease in this group was higher (26,5% vs. 13,9%; p<0,05). The prevalence of LV hypertrophy (LVH) was 58,2% in individuals with HF. Eccentric LVH was more common in patients with normal fibrinogen levels (64,5% vs. 48,5%; p<0,05), while concentric LVH was higher in patients with HF (51,5% vs. 35,5%; p<0,05). It was found that blood fibrinogen level was closely associated with BMI, diastolic blood pressure, heart rate, Hb level, red blood cell count, total cholesterol, LDL, TG, creatinine, estimated GFR, LV myocardial mass and LV myocardial mass index. Activated recalcification time was closely related to Hb and platelet levels.

Conclusion. In patients with proteinuric variants of CKD and HF, laboratory predictors of renal failure and cardiovascular complications are identified. In HF, the prevalence of concentric LVH increases. A significant relationship was found between blood fibrinogen level and traditional cardiovascular and renal risk factors.

Objective. Evaluation of the effectiveness of alternative treatment options (ATOs) for stage 5 chronic kidney disease in patients aged ≥60 years and development of algorithm for choosing ATOs.

Materials and methods. The historical control group (HCG) (237 patients) received a standard dialysis regimen, while the experimental group (EG) (62 patients) received ATOs (conservative treatment, palliative, incremental, or standard dialysis regimens).

Results. Survival on the 90th day was 73.4±3% in the HCG, 84.4±4.8% in the EG, on the 365th day: 51.4±3.4% in the HCG, 69.6±6.9% in the EG. Evaluation of the adverse outcome risk reduction showed that treatment with ATOs reduced the risk of adverse outcome by 48 (95% confidence interval 12–69)%.

Conclusion. Due to the effectiveness of ATOs, it is necessary to consider the possibility of their inclusion in clinical protocols for the treatment of patients.

Chronic kidney disease (CKD) is associated with severe comorbidity of a wide range of mental and physical conditions. The presence of concomitant pathologies aggravates the course of the underlying disease and contributes to the progression of kidney damage. The article presents a clinical description of a comorbid 80-year-old female patient with multifactorial renal damage due to arterial hypertension, viral hepatitis C, purine metabolism disorders, and markers of autoimmune damage based on the results of serological and intravital pathological examination. The mechanisms of complex renal damage and the importance of influencing them to maintain an optimal quality of life in a comorbid patient are discussed.

The study of the mechanisms of cell death is currently one of the most rapidly developing areas of modern biomedicine. Acute kidney injury is characterized by massive cell death and subsequent marked decline in kidney function. The review presents data on the molecular mechanisms of proximal renal tubule cell death in acute kidney injury. This information will provide characterization of the etiology and pathogenesis of the disease at the molecular level, and also serve as a basis for searching for targets for effective renoprotective therapy in many pathological processes in the kidneys.