Clinical nephrology

Peer-review scientific medical journal

Editor-in-chief

  • professor Oleg N. Kotenko, MD, Dr. Sci. (Medicine), associate professor of the Department of hospital therapy of the Peoples' Friendship University of Russia, chief specialist nephrologist of the Moscow Healthcare Department, Deputy chief physician for Nephrology of the Moscow city clinical hospital No. 52

Publisher

  • LLC “Bionika Media”

Founder

  • Bionika Media Innovations LLC

WEB official

About the journal

The journal supported by:

  • Metropolitan Association of Nephrologists
  • Scientific Society of Nephrologists of Russia
  • Russian Medical Society for Arterial Hypertension
  • Creative Association of Pediatric Nephrologists

THE JOURNAL IS THE OFFICIAL BULLETIN OF THE SPECIALIZED COMMISSION OF THE EXPERT COUNCIL OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION.


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Vol 15, No 3 (2023)

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PROFILE COMMISSION

Nephrological service of the Russian Federation 2022: post-covid period. Clinical nephrology
Shilov E.M., Shilova M.M., Rumyantseva E.I., Batyushin M.M., Bevzenko A.Y., Belskikh A.N., Veselkova N.V., Yesayan A.M., Ivliev S.V., Kotenko O.N., Petrova N.Y., Statsenko M.E., Stolyar A.G.
Abstract

The regular report of the Specialized Commission for Nephrology of the Expert Council of the Ministry of Health of Russia [1] presents data on the state of the nephrological service of the Russian Federation as of December 31, 2022 (the period of recovery from the COVID-19 pandemic), primarily related to renal replacement therapy (RRT), as well as a number of general indicators: number of dialysis centers, beds, medical staff. The data cover 98% of the subjects (excluding Kamchatka and the Altai Republic), representing 99% of the Russian population. The state of the nephrological service during the height of the pandemic was published in previous reports in 2020 and 2021 [2–4].

Clinical nephrology. 2023;15(3):5-17
pages 5-17 views

Original Articles

Prevalence of sarcopenia in patients with chronic heart failure and chronic kidney disease
Sokolova A.V., Dragunov D.O., Arutyunov G.P.
Abstract

Objective. Evaluation of the prevalence of sarcopenia in patients with CKD and CHF.

Materials and methods. The analysis included 107 patients with an established diagnosis of CHF, mean age was 69.6±11.3 years. All patients underwent screening for sarcopenia and CKD in accordance with the recommendations. For statistical analysis of the obtained data, the R language and RStudio software were used.

Results. CKD was detected in 105 patients with CHF: 32 patients had C2, 31 patients had C3a, 32 patients had C3b, 4 patients had C4 (CKD4), and only 2 patients did not have CKD. The largest number of CHF decompensation was detected in patients with CKD3b and CKD4. Presarcopenia was detected in 39% of patients with CHF and CKD, and sarcopenia in 38%. According to multivariate regression analysis, the risk of sarcopenia was most influenced by fat mass OR 1.14, 95% CI [1.01;1.34], P=0.057, muscle mass index OR 0.61, 95% CI [0.42 ;0.79], P=0.002 and male gender OR 1.17, 95% CI [60.9;85.77], P<0.001.

Conclusion. In patients with CHF and CKD, the increase in sarcopenia occurs as the filtration function of the kidneys decreases.

Clinical nephrology. 2023;15(3):18-23
pages 18-23 views
The significance of TNF-α in the pathogenesis of protein-energy malnutrition in patients on program hemodialysis
Yakovenko A.A., Lavrishcheva Y.V., Rumyantsev A.S., Belskikh A.N.
Abstract

Objective. Assessment of the relationship between the blood serum tumor necrosis factor α (TNF-α) level and indicators of protein-energy malnutrition in patients on program hemodialysis (PH).

Material and methods. 645 patients on PH, including 300 men and 345 women aged 56.8±12.8 years were examined. All patients received treatment with program hemodialysis for 8.4±5.3 years. The assessment of nutritional status for the purpose of diagnosing protein-energy malnutrition (PEM) was performed using the method proposed by ISRNM (International Society of Renal Nutrition and Metabolism). Determination of the blood serum TNF-α level was carried out using a method based on a three-stage "sandwich" version of enzyme-linked immunosorbent assay with mono- and polyclonal anti-TNF-α antibodies using commercial kit "alpha-TNF ELISA-BEST", Vector-Best Company, Russia, in accordance with the manufacturer's instructions. Reference values for TNF-α were 0–8.1 pg/mL.

Results. The prevalence of PEM diagnosed by the ISRNM method was 24.9% (160 patients). Mean values of TNF-α in patients without signs of PEM were 7.11±3.02, and in patients with PEM they were more than twofold higher - 19.5±5.9 (P<0.001). Patients with elevated TNF-α levels showed statistically significantly lower values of the main indicators of PEM (body mass index, skeletal muscle mass index, percentage of body fat, as well as total protein, albumin, prealbumin, total cholesterol, transferrin, and the number of blood lymphocytes) than in patients with normal TNF-α levels. A significant relationship between the adequacy of the HD dose (spKt/V) and the TNF-α level was not revealed, which was confirmed, in particular, by the Spearman correlation coefficient (Rs=0.012; P=0.754). At the same time, no relationship was found between the TNF-α level and the duration of HD (Rs=0.038; P=0.328).

Conclusion. The prevalence of PEM diagnosed by the ISRNM method in patients on PH was 24.9%. An increase in the blood serum TNF-α level may be an important pathogenetic link in the development of PEU in patients receiving treatment with PH.

Clinical nephrology. 2023;15(3):24-29
pages 24-29 views
Double-blind, randomized, phase I trial comparing the pharmacokinetics and safety of agalsidase beta bioanaloguer (Fabagal®) and the original drug (Fabrazim®) in healthy volunteers
Moiseev S.V., Shchulkin A.V., Abalenikhina Y.V., Mylnikov P.Y., Yakusheva E.N., Khmelevsky M.S., Macyak M.V.
Abstract

Objective. Confirmation of the bioequivalence of agalsidase beta bioanalogue (ISU303, Fabagal®), developed by the Korean company ISU ABXIS Co., Ltd, and the original drug (Fabrazim®) and comparison of their tolerability and safety in healthy volunteers.

Material and methods. Single-center, double-blind, randomized, phase I, parallel-group, active-controlled trial enrolled 52 healthy male volunteers aged 18–45 years who were divided into two equal groups. The study (Fabagal®) and original (Fabrazim®) drugs were administered once intravenously at the recommended dose of 1 mg/kg after premedication with ibuprofen and diphenhydramine. Quantification of agalsidase beta was carried out indirectly by assessing the α-galactosidase A activity by spectrofluorimetric method using the commercial Alpha Galactosidase Activity Assay Kit manufactured by Abcam (USA). The primary criterion for assessing bioequivalence was the area under the plasma concentration-time curve from zero to infinity (AUC0-∞), the secondary criteria were the area under the plasma concentration-time curve from zero to time t (AUC0-t) and the maximum plasma concentration (Cmax). Parameters were studied using an ANOVA model for a parallel design.

Results. The mean parameters of pharmacokinetics of agalsidase beta with the infusion of the study drug (Fabagal®) and the reference drug (Fabrazim®) were similar. The two-sided 93.92% confidence interval (CI) for the geometric mean ratio of AUC0-∞ of agalsidase beta after infusion of study drug and comparator (104.99–122.45%) was within the acceptable range of 80.00–125.00%, established for bioequivalence studies; 90% CI for the ratio of the geometric mean values of AUC0-t and Cmax were 106.25–121.54 and 99.54–112.16%, respectively, and were also within the bioequivalence limits. Side effects, deviations in the results of the physical examination, ECG, laboratory tests were not registered.

Conclusion. The study confirmed the bioequivalence of the agalsidase beta bioanalogue (Fabagal®) and the original drug (Fabrazim®) in a single intravenous injection at the recommended dose of 1 mg/kg and showed a favorable tolerability profile of the study drug in healthy volunteers.

Clinical nephrology. 2023;15(3):30-36
pages 30-36 views
Intestinal fatty acid binding protein as biomarker of enterocyte injury in patients with renal failure
Pyatchenkov M.O., Sherbakov E.V., Trandina A.E., Belskykh A.N.
Abstract

Aim: to evaluate serum intestinal fraction of the fatty acid binding protein (I-FABP) in subjects at different stages of chronic kidney disease (CKD), including those receiving hemodialysis treatment.

Material and methods. The cross-sectional study included 3 groups of patients: 1) 20 relatively healthy individuals with GFR>60 ml/min/1.73 m2; 2) 30 patients with CKD C3a-5 (GFR<60 ml/min/1.73 m2); 3) 38 patients with end-stage renal disease (ESRD) receiving hemodialysis treatment. All participants had no clinical manifestations of intestinal pathology. The concentration of I-FABP in blood serum was assessed by ELISA using commercially available kit.

Results. I-FABP levels significantly increased in parallel with an advance of renal insufficiency and reached maximum values in patients with ESRD: 1719,5 (1279,8–1979,6), 3533,2 (2449,5–4234,1), 6340,7 (5436–6732,3) pg/ml respectively. In subjects at the predialysis stages of CKD, a strong inverse correlation of I-FABP with GFR was found (R=0,946, p<0.001).

Conclusion. A decrease in GFR leads to a significant increase of serum I-FABP levels in patients with impaired renal function. This should be taken into account when using I-FABP as a biomarker of enterocytes injury in patients with renal failure.

Clinical nephrology. 2023;15(3):37-41
pages 37-41 views

Nephrourology

The use of bilateral total transarterial kidney embolization for the combined treatment of patients with symptomatic autosodominant polycystic kidney disease and end-stage renal disease
Vtorenko V.I., Trushkin R.N., Medvedev P.E., Vinogradov V.E., Isaev T.K., Sokolov S.A., Bondarenko S.A., Kolesnikov N.O., Ivanov K.V.
Abstract

Background. Bilateral transarterial renal artery embolization (TAE) is an effective and minimally invasive technical procedure that can be used in the combined treatment of patients with autosomal dominant polycystic kidney disease (ADPKD) and end stage renal disease (ESRD). The combined use of TAE with subsequent delayed bilateral nephrectomy (NE) provides new opportunities in the treatment of patients with ESRD and ADPKD. Consideration of TAE of the kidneys as an alternative method of radical treatment of patients with symptomatic ADPD requires additional study today.

Material and methods. From 11/01/2022 to 05/01/2023, 12 patients underwent surgery in Urology Department of the City Clinical Hospital № 52 of the Moscow Healthcare Department. Patients were randomized into 2 groups. Patients of the group 1 (6 people) 3 months before laparoscopic bilateral NE underwent bilateral TAE (by one X-ray endovascular surgeon) in order to reduce the volume and symptoms, as well as to prevent the risk of hemorrhagic complications, because all patients were on program hemodialysis (PHD) for a long time. Patients of group 2 underwent laparoscopic bilateral NE without prior embolization.

Results. The combined use of TAE of the kidneys before the upcoming bilateral NE contributed to the reduction of symptoms of compression in 100% of cases, because the initial volume of the kidneys decreased after the TAE procedure by an average of 25.4% within 3 months. This circumstance made it possible to plan the surgical treatment of patients with adequate preoperative preparation. Operative support in patients with prior renal TAE significantly reduced the time of surgery, in this regard, we did not observe AVF thrombosis in patients; the risk of hyperkalemia significantly decreased, and a clinically significant decrease in blood loss was noted, which prevents the risks of hemorrhagic complications and the production of autoantibodies in case of possible transfusion donated blood. The reduction in the postoperative bed-day due to the smaller amount of surgical trauma in the early postoperative period in patients who underwent TAE caused activation on average 1–2 days earlier, which improves the economic results of treatment of such patients. There was a need for emergency NE in none of the cases during 3 month follow-up after TAE.

Conclusion. Indications for renal TAE have not yet been established. We perform renal TAE in anuric patients on PHD who are symptomatic and require renal TAE. Current research indicates that TAE is a successful and minimally invasive option for reducing kidney volume for transplant requirements and alleviating the symptoms of compression caused by enlarged kidneys. However, there are still no studies demonstrating the results of long-term follow-up of patients after TAE, which would show a pronounced contractile effect of this procedure, which would allow us to consider this method of treatment as an independent one.

Clinical nephrology. 2023;15(3):42-51
pages 42-51 views
Choice of surgical tactics for calculous anuria in infants
Nasirov A.A., Khotamov K.N., Baiakhmedov F.F., Khoshimov T.R.
Abstract

Objective. The choice of tactics of surgical treatment depending on the duration and complication of calculous anuria i n infants.

Material and methods. We followed-up 53 children aged from 4 months to 3 years. The patients were divided into 2 groups: group 1 – 35 (66%) patients with anuria duration not more than 3 days, group 2 – 18 (33.9%) patients with anuria duration more than 3 days.

Results. The choice of surgical tactics for calculous anuria in infants depended on the severity of symptoms due to the presence of concomitant and background diseases, the duration of anuria.

Conclusion. Analysis of the restoration of homeostasis after deblocking showed that the normalization of clinical and biochemical parameters in patients with a longer period of anuria (more than 3 days) was much slower than in patients with a shorter period of anuria. At the same time, the dynamics of metabolic processes depended on the duration of anuria and the severity of the patients' condition. Preliminary nephrostomy and stabilization of the condition of patients contributed to a more rapid recovery of disorders caused by anuria than after radical removal of the stone.

Clinical nephrology. 2023;15(3):52-55
pages 52-55 views

Literature Reviews

Development of ideas about urolithiasis
Subotyalov M.A.
Abstract

The article presents the prerequisites, formation and development of ideas about urolithiasis. The purpose of this review was to analyze the basic ideas about the urolithiasis, starting from the era of the Ancient World and ending with studies of the Modern period. In preparing the text of this publication, articles in publications included in the RSCI, PubMed were used. The depth of the search for publications was 15 years, and a number of earlier works corresponding to the research topic were also included in the review. The results of the process of formation and development of ideas about the urolithiasis are presented. So, already in the ancient era, healers asked questions about the causes, the process of development of the urolithiasis. In the Middle Ages, the accumulation of empirical knowledge in this area continued. The understanding of the methods and means of treating urolithiasis was expanding and deepening. In modern times, the concept of the ICD received a more complete description. Risk factors and mechanisms for the development of this disease began to be studied. Today, research in this area continues.

Clinical nephrology. 2023;15(3):56-60
pages 56-60 views
Acute tubulointerstitial nephritis of medicinal etiology: the focus is on antibacterial drugs
Murkamilov I.T., Fomin V.V., Sabirov I.S., Yusupov F.A., Satkynalieva Z.T.
Abstract

The urgency of the problem of acute tubulo-interstitial nephritis (TIN) in the clinic of internal diseases continues to grow. The widespread and uncontrolled use of drugs, in particular antibiotics, is accompanied by a high risk of developing acute TIN, since the high metabolic load and relatively lower blood supply make the tubulointerstations of the renal tissue very vulnerable. Due to the lack of widespread renal biopsy in the CIS countries, including the Kyrgyz Republic, the prevalence and incidence of acute TIN is underestimated. The article provides data on the nephrotoxicity of a number of antibacterial drugs, which are especially popular among doctors in the CIS countries. The diagnostic value of renal biopsy in the verification of acute TIN with a progressive decline in renal function has been shown. The article presents the results of studies that have shown the therapeutic efficacy and safety of the steroids in the treatment of acute TIN. The review article presents scientific data on clinical cases of acute TIN associated with antibiotics, including their combined use. Early recognition and appropriate treatment of antibiotic-associated TIN will ultimately reduce the likelihood of developing chronic kidney disease. The data of the review article emphasize the need for a personalized approach when prescribing antibiotics, especially in the presence of comorbid situations, including in elderly and senile people.

Clinical nephrology. 2023;15(3):61-68
pages 61-68 views

EXPERT OPINION

Formulas for estimating glomerular filtration rate: correct and incorrect use
Shilov E.M.
Clinical nephrology. 2023;15(3):69-71
pages 69-71 views

CONSENSUS

The burden of COVID-19 in a heterogeneous population of immunocompromised patients – realities of the postpandemic. Terapevticheskii Arkhiv (Ter. Arkh.)
Avdeev S.N., Chulanov V.P., Alekseeva E.I., Alyoshina O.A., Bereznikov A.V., Kotenko O.N., Lila A.M., Mutovina Z.Y., Parovichnikova E.N., Fomina D.S., Frolova N.F., Shevchenko A.O.
Abstract

The Chairmen of the Council - Acad. S.N. Avdeev, Prof. V.P. Chulanov

On July 3, 2023, an Interdisciplinary Council of Experts "The burden of COVID-19 in a heterogeneous population of immunocompromised patients - post-pandemic realities" with participation of leading experts in the field of pulmonology, rheumatology, hematology, oncology, nephrology, allergology-immunology, transplantology and infectious diseases was held in Moscow. The purpose of the meeting was to discuss the current clinical and epidemiological situation related to COVID-19, the relevance of disease prevention for high-risk patients. The following questions were discuuses by the experts:

1. Burden of COVID-19 disease in 2023 for immunocompromised patients in various therapeutic areas.

2. Place of passive immunization with monoclonal antibodies as a method of preventing COVID-19 among immunocompromised patients.

3. Necessary conditions for the introduction of passive immunization of immunocompromised patients into routine practice.

Clinical nephrology. 2023;15(3):72-79
pages 72-79 views

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