Disorders in the System of Mineral and Bone Metabolism Regulators—FGF-23, Klotho and Sclerostin—in Chronic Kidney Disease: Clinical Significance and Possibilities for Correction

The chapter discusses the current understanding of the system of mineral and bone metabolism regulators—FGF-23, Klotho and sclerostin—disturbances in chronic kidney disease (CKD). In the chapter we presented the date, including our own results, which allow to suggest the change in the ratio of FGF-23-Klotho-sclerostin in CKD as an early biomarker not only for the chronic kidney damage but also for high cardiovascular (CV) risk. Results of studies show that disorders in FGF-23-Klotho-sclerostin ratio correlate with the frequency and severity of hypertension, vascular calcification, cardiac remodelling, anaemia, malnutrition, inflammation and strong aggravate CV risk in CKD. It was found independent from blood pressure (BP) action of increased serum FGF-23 on the myocardium as well as the correlation of serum high-sensitive troponin I with increased serum FGF-23 and low Klotho levels in CKD patients. At the same time, it was shown that renoprotective therapy, including renin-angiotensin blockers, low-protein diet with amino/keto acid supplementation and phosphate binders, erythropoiesis stimulators, vitamin D metabolites used to get the target levels of BP, serum phosphorus, haemoglobin, parathyroid hormone and nutritional status disorders correction can reduce the risk of CV events, as the major cause of death in CKD patients

Nutritional Status Disorders in Chronic Kidney Disease: Practical Aspects (Systematic Review)

Despite the significant achievements in the management of chronic kidney disease (CKD) patients, the mortality rate of these patients still remains high. Nutritional status disorders (NSD) are considered now as one of the prognostic risk factors not only for dialysis but also for predialysis CKD stages. Since the publication of KDIGO 2012 guidelines for CKD patient’s management, there has been some significant advancement in our understanding of main NSD mechanisms in CKD, including different nosological group patients (first, in diabetic and systemic diseases patients). At the same time, there is still an urgent need for randomized trials for better-informed decisions and future optimization of CKD patients’ care. This chapter provides the current data on all aspects of NSD in CKD: etiology, diagnosis, prevention, and treatment approaches, as well as on risk factors of NSD at predialysis stages and in chronic hemodialysis patients. Considerable attention was devoted to the diagnosis and differential diagnosis of NSD in CKD patients. It was determined that the overall strategy for dietary treatment contributed to improving the life quality of patients and slowing down of CKD progression. The review is written based on the published results of clinical studies performed on the position of evidence-based medicine

Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)

Anemia in chronic kidney disease (CKD) has been recognized as a separate independent risk factor of cardiovascular (CV) events. The aim of the review is to provide a literature summary concerning early diagnosis and treatment of anemia in CKD that may be useful for clinicians and contribute to decrease CV mortality. Literature searches were made in such major databases as: PubMed, Medline, Embase, Cochrane Library, CINAHL, Wiley Online Library, Scopus, Web of Science, e-library, and website of WHO. This search encompassed original articles, systematic reviews, and meta-analyses relevant to CKD and anemia over recent 15 years. A total of 54 references from 562 reviewed articles were selected as they met to the search criteria (anemia and CKD, including diabetes mellitus, systemic diseases and post-transplant anemia). The publications included 27 randomized controlled trials, 20 experimental studies representing new data on the links of CKD anemia and cardiovascular risk markers (cytokines, Klotho, fibroblast growth factor (FGF-23), hyperglycemia, hypoalbuminemia and some others), 4 systematic reviews and 3 clinical practice guidelines. The main attention was devoted to the analysis of the studies provided an early diagnosis of anemia, an ability to minimize the factors contributing to its severity that have allowed to improve CV and total outcomes and to reduce costs of hospital treatment of CKD patients with anemia

Serological Assays for Alveolar and Cystic Echinococcosis-A Comparative Multi-Test Study in Switzerland and Kyrgyzstan.

Both alveolar (AE) and cystic echinococcosis (CE) are lacking pathognomonic clinical signs; consequently imaging technologies and serology remain the main pillars for diagnosis. The present study included 100 confirmed treatment-naïve AE and 64 CE patients that were diagnosed in Switzerland or Kyrgyzstan. Overall, 10 native Echinococcus spp. antigens, 3 recombinant antigens, and 4 commercial assays were comparatively evaluated. All native E. multilocularis antigens were produced in duplicates with a European and a Kyrgyz isolate and showed identical test values for the diagnosis of AE and CE. Native antigens and three commercial tests showed high diagnostic sensitivities (Se: 86-96%) and specificities (Sp: 96-99%) for the diagnosis of AE and CE in Swiss patients. In Kyrgyz patients, values of sensitivities and specificities were 10-20% lower as compared to the Swiss patients' findings. For the sero-diagnosis of AE in Kyrgyzstan, a test-combination of an E. multilocularis protoscolex antigen and the recombinant antigen Em95 appears to be the most suitable test strategy (Se: 98%, Sp: 87%). For the diagnosis of CE in both countries, test performances were hampered by major cross-reactions with AE patients and other parasitic diseases as well as by limited diagnostic sensitivities (93% in Switzerland and 76% in Kyrgyzstan, respectively)

Serological Assays for Alveolar and Cystic Echinococcosis—A Comparative Multi-Test Study in Switzerland and Kyrgyzstan

Both alveolar (AE) and cystic echinococcosis (CE) are lacking pathognomonic clinical signs; consequently imaging technologies and serology remain the main pillars for diagnosis. The present study included 100 confirmed treatment-naïve AE and 64 CE patients that were diagnosed in Switzerland or Kyrgyzstan. Overall, 10 native Echinococcus spp. antigens, 3 recombinant antigens, and 4 commercial assays were comparatively evaluated. All native E. multilocularis antigens were produced in duplicates with a European and a Kyrgyz isolate and showed identical test values for the diagnosis of AE and CE. Native antigens and three commercial tests showed high diagnostic sensitivities (Se: 86-96%) and specificities (Sp: 96-99%) for the diagnosis of AE and CE in Swiss patients. In Kyrgyz patients, values of sensitivities and specificities were 10-20% lower as compared to the Swiss patients' findings. For the sero-diagnosis of AE in Kyrgyzstan, a test-combination of an E. multilocularis protoscolex antigen and the recombinant antigen Em95 appears to be the most suitable test strategy (Se: 98%, Sp: 87%). For the diagnosis of CE in both countries, test performances were hampered by major cross-reactions with AE patients and other parasitic diseases as well as by limited diagnostic sensitivities (93% in Switzerland and 76% in Kyrgyzstan, respectively). Keywords: ELISA; Echinococcus granulosus sensu lato; Echinococcus multilocularis; Western blot; antibodies; antigens; diagnosis; serology

Human infections with Dicrocoelium dendriticum in Kyrgyzstan : the tip of the iceberg?

Abstract Dicrocoelium dendriticum is the causative agent of a rare food-borne zoonosis of the human biliary tract, dicrocoeliasis, for which few human prevalence data are available. Infection occurs through the ingestion of ants containing metacercariae, whereas pseudo-infections (presence of D. dendriticum eggs in stool in the absence of adult worms) are due to the consumption of infected animal liver. Here, results from a cross-sectional survey carried out among 138 children aged 2-15 yr in a peri-urban area of Kyrgyzstan are reported. Each child provided 1 stool sample that was subjected to the FLOTAC technique. Eggs of D. dendriticum were diagnosed in 11 children (prevalence 8.0%; 95% confidence interval 4.5-13.7%). Although no distinction could be made between true and pseudo-infections, the prevailing animal husbandry system and the diet and hygienic conditions of the study area suggest that the social-ecological system in Kyrgyzstan is conducive for human transmission of D. dendriticum. There is a need to investigate the epidemiology of dicrocoeliasis in Kyrgyzstan, placing emphasis on the distinction between true and pseudo-infection