No 4 (2013)

Results of the MDRD study are discussed with the emphasis on role of diet protein restriction in halting of progression of chronic kidney disease.

Aim. Estimation of prevalence of hyperphosphatemia and prognostic sighnificance of parameters, characterizing bone and mineral disorders in patients on hemodialysis. Methods. 70 prevalent hemodialysis and 175 new hemodialysis patients, in whom hemodialysis was started in one clinical center in 2006-2012 were included into the study. Multiple regression Cox analysis was performed with inclusion of mean levels during follow-up period of calciemia, phosphatemia, parathyroid hormone (PTH), demographic, clinical and laboratory parameters. Results. 63 patients of 245 died during follow-up period, 1-year mortality was 8%. Patients in middle tertile of phosphatemia (1,95-1,95 mmol/l) had 57% elevated mortality risk, patients in highest phosphatemia group (> 1,95 mmol/l) had more than 8-times elevation of mortality versus patients with lowest level of phopsphatemia (<1,59 mmol/l). Calciemia did not play a significant role as a prognstic parameter. Every 100 pg/ml elevation of PTH level was associated with 23% decrease of mortality risk. When PTH level was analyzed as categorial variable according to KDIGO recommendations, groups of patients with lower and higher level of this parameter were characterized with 29% and 69% elevation of mortality risk compared with patients with target PTH level (130-585 pg/ml). When KDOQI categories of PTH level was used, mortality risk was higher only in patients with parathyroid hormone level <150 pg/ml. Conclusion. Hyperphosphatemia in dialysis patients is frequent and associated with significant deterioration of prognosis. Existing approaches of its correction are suboptimal. There is convincing evidence that modern calcium-free phosphate binders allow significantly decrease mortality in patients on hemodialysis.

Use of Prolit and mineral water “Silver spring” in coplex therapy of nephrolithyasis is discussed.

Aim. Assessment of severity of podocyte damage in patients with chronic glomerulonephitis (CGN) according to proteinuria level and urinary excretion of interleuki-6 (IL-6) and heat shock protein-27 (HSP-27). Methods. 73 patients with CGN were included into the study; 30 of the — with nephrotic syndrome. Podocyturia was assessed by floucytometry with podocalixin-marked antibodies, urinary levels of IL-6 and HSP-27 were detetmined by Elisa. Results. Pateints with active CGN demonstrate high levels of podocyturia, correlating with proteinuria, seveirity of nephrotic syndrome and urinary excretion of IL-6. Podocituria detects unfavorable renal prognosis. Conclusion. Podocituria can be used as a marker of disease severity and prognosis in patients with chronic glomerulonephritis.

Aim. Estimation of role of plasmapheresis in protection of renal transplant function. Methods. 80 renal transplant recipients were included into the study. In 40 of the plasmapheresis was perfomed during 1st 24 hours of transplant repefusion; 40 patients did not undergo plasmapheresis. Immusupressive therapy was equal in both groups. Renal transplant function was estimated according to serum creatinine level, glomerular filtration rate (GFR), and hemodyalisis requirement after renal transplantation. Results. Plasmapheresis, performed during 1st 24 hours after start of renal transplant reperfusion, lead to more prominent elevation of GFR and decrease in serum creatinine concentration. Number of patients, who required hemodyalisis after renal transplantation, was more than 5 times less in plasmapheresis group. Conclusion. Plasmapheresis can be used for protection of renal transplant ischemia-reperfusion damage.

Role of metabolic syndrome and diabetes mellitus as risk factors for urinary tract infection is discussed. Use of Canephron N in treatment of urinary tract infections is reviewed.

Pathomorphological changes of ureteropelvic segment in children with inborn hydronephrosis are characterized.