Combination of CAKUT-syndrome and axial skeletal abnormalities

Combined anomalies of the urinary system and axial skeleton, including an L-shaped kidney, obstruction of the ureteropelvic junction (CAKUT syndrome, congenital anomalies of the kidney and urinary tract syndrome) and spinal anomalies, are extremely rare. The clinical case gives a description of a similar combined developmental anomaly

The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial: baseline characteristics

Background: The Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD; NCT03036150) trial was designed to assess the effect of the sodium–glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin on kidney and cardiovascular events in participants with CKD with and without type 2 diabetes (T2D). This analysis reports the baseline characteristics of those recruited, comparing them with those enrolled in other trials. Methods: In DAPA-CKD, 4304 participants with a urinary albumin:creatinine ratio (UACR) ≥200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/1.73 m2 were randomized to dapagliflozin 10 mg once daily or placebo. Mean eGFR was 43.1 mL/min/1.73 m2 and median UACR was 949 mg/g (108 mg/mmol). Results: Overall, 2906 participants (68%) had a diagnosis of T2D and of these, 396 had CKD ascribed to a cause other than diabetes. The most common causes of CKD after diabetes (n = 2510) were ischaemic/hypertensive nephropathy (n = 687) and chronic glomerulonephritis (n = 695), of which immunoglobulin A nephropathy (n = 270) was the most common. A total of 4174 participants (97%) were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 1882 (43.7%) diuretics, 229 (5.3%) mineralocorticoid receptor antagonists and 122 (2.8%) glucagon-like peptide 1 receptor agonists. In contrast to the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), the DAPA-CKD trial enrolled participants with CKD due to diabetes and to causes other than diabetes. The mean eGFR of participants in the DAPA-CKD trial was 13.1 mL/min/1.73 m2 lower than in CREDENCE, similar to that in the Finerenone in Reducing Kidney Failure and Disease Progression in DKD (FIDELIO-DKD) trial and the Study Of diabetic Nephropathy with AtRasentan (SONAR). Conclusions: Participants with a wide range of underlying kidney diseases receiving renin–angiotensin system blocking therapy have been enrolled in the DAPA-CKD trial. The trial will examine the efficacy and safety of dapagliflozin in participants with CKD Stages 2–4 and increased albuminuria, with and without T2D

METHODICAL BASES OF ESTIMATION GLOMERULAR FILTRATION RATE IN UROLOGICAL PRACTICE

The article presents a review of methodological issues of estimation of glomerular filtration rate in urologic practice. Author examine the current international and national recommendations, in particular by KDIGO, the recommendations of the scientific society of nephrologists of Russia, Association of urologists of Russia, the results of comparative analysis of different methods of assessing glomerular filtration rate. It is shown that the currently calculated methods of assessment of glomerular filtration rate have advantages over technique of clearance. The advantages and disadvantages of methods for calculating glomerular filtration rate by the formula of Cockcroft-Gault and MDRD. The author lists the pathological conditions in urological practice, in which there is a need to assess glomerular filtration rate, given nomograms and links to online calculators for quick and easy calculation of glomerular filtration rate

Chronic Kidney Disease: Current State of the Problem

Chronic kidney disease (CKD) is characterized by increasing prevalence, catalyzing properties in relation to cardiovascular and general mortality, and, in most cases, is asymptomatic, which means late diagnostic verifiability. The global average prevalence of CKD is 13.4%, and CKD C3-5 is 10.6%. The main causes of CKD C5 are diabetes mellitus (DM, 46.9%), hypertension (28.8%) and to a lesser extent, glomerulonephritis (7.1%) and polycystic diseases (2.8%), while other causes account for a total of 14.4%. Despite the simple diagnosis of CKD, one of the key problems of modern therapeutic and pediatric clinics is its low detection rate at the early stages, which, according to some data, reaches 96.6%. This review provides data on the criteria for the diagnosis of CKD, as well as more detailed consideration of the course of CKD in patients with DM, hypertension, and heart failure. Attention is paid to the medicinal origin of CKD, as well as to the development of anxiety and depressive disorders in CKD. General issues of treatment of patients with CKD are considered in detail. Lifestyle changes are an important part of the fight against the development and progression of CKD. Currently, Smoking, alcohol, and physical inactivity have been shown to have a harmful effect on the risk of developing and progressing CKD. Diet plays a certain preventive role. The main drugs with nephroprotective properties are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both classes of drugs are effective in proteinuric forms of nephropathies and in combination/association of CKD with diabetes or hypertension. The review also provides data on the nephroprotective properties of mineralocorticoid receptor antagonists, endothelin receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Given the high importance of identifying and effectively treating patients with CKD, it is necessary to focus on early detection of CKD, especially in high-risk groups. It is necessary to raise public awareness by creating and implementing programs for primary prevention of CKD, as well as awareness of patients, motivating them to follow the doctor's recommendations for a long time, including as part of the implementation of a non-drug strategy to combat CKD. It is important to use the full range of methods of drug therapy for CKD, including measures of universal nephroprotection. It should be remembered that the cost of late diagnosis of CKD is a reduction in life expectancy, primarily due to high rates of cardiovascular mortality, disability, and high-cost medication and kidney replacement therapy

PROFESSOR ALEXANDER I. IGNATOWSKI A FOUNDER OF THE THEORY OF ATHEROSCLEROSIS

Biography of Professor Ignatowski A.I. is an example of outstanding personality in the history of medicine, beginning of XX century. Collecting information about this scientist, we managed to trace his whole life path. In this article we tried to concentrate on the most important events of his bright life and professional activity. Alexander I. Ignatowski (1875-1955) — therapist, doctor of medicine, professor, the first head of the Faculty therapeutic Department of the Imperial University of Warsaw from 1915 to 1920 in Rostov-on-Don, State Councilor, Knight of the Order of St. Anna 2 class. Studies carried out in his laboratories and dedicated to the search for the relationship between cholesterol and fatty foods experimental atherosclerosis did Ignatowski one of the founders of the doctrine of atherosclerosis in the world. This achievement was recognized in the United States as one of the 10 most important discoveries in medicine and is described in the book of the same name. His pioneering work laid a solid foundation for further research in the field of lipidology. In Germany, prof. K.T. Far, in Russia — Anichkov N.N. And Khalatov S.S. were among the first scientists who used the experimental protocols of Ignatowski and successfully reproduced his experiments. Thanks to this extensive work, today we have detailed knowledge of the pathophysiology of atherosclerosis, the causes of its occurrence, the consequences of its development, the methods of diagnosis and treatment, and can calculate the risk of cardiovascular events and influence life expectancy. The rich scientific heritage left after him, still has not lost its relevance, and the hypothesis put forward by him almost 100 years ago, repeatedly confirmed

EFFECT IMBALANCE AQUEOUS BODY FLUIDS, AND RENAL DYSFUNCTION, CARDIOVASCULAR SURVIVAL IN PATIENTS AFTER AN ACUTE CORONARY SYNDROME, MYOCARDIAL REVASCULARIZATION

Objective. Analysis imbalance aqueous body fluids on the prognosis of cardiovascular events in the late period after an acute coronary syndrome (ACS) and myocardial revascularization based on indicators of renal function.Materials and methods. The study included 120 patients with ACS, including unstable angina was diagnosed in 68 patients, 52 patients — acute myocardial infarction. All patients underwent myocardial revascularization. To register the presence of albuminuria in the range of 30-300 mg/l, and glomerular filtration rate (GFR). It makes calculations indicators aqueous body fluids — the total volume of water (TVW), the total fluid, intracellular fluid (IF), extracellular fluid. The endpoint of the study was the presence of cardiovascular complications within 6 months after ACS.Results. It is found that the presence and magnitude of albuminuria was significantly increase the risk of the end point of the study. In patients with GFR less than 60 mL/min/1,73m2 studied the risk is higher by 17.1%, compared with patients with a GFR above this limit. Analysis of the distribution of the water body fluids showed a significant increase in the average TVW and IF. Through statistical analysis of survival found an increased risk of cardiovascular complications in the late period after ACS in patients who have an increase IF on the stage of development of coronary catastrophe.Conclusion. The study demonstrated the predictive value to stratify cardiovascular disease risk, not only the presence of albuminuria, but its level and value of GFR less than 60 mL/min/1,73m2. Redistribution of aqueous body fluids in the form of increased IF is a marker of adverse cardiovascular events in the late period after ACS. These data indicate the need for a comprehensive and integrated analysis of existing pathogenetic changes occurring in ACS, as well as the status of the patients premorbid factor for improving risk stratification of cardiovascular complications in the long term after a cardiovascular accident

ANALYSIS OF THE DISTRIBUTION OF BODY FLUIDS VOLUMES IN PATIENTS WITH ACUTE CORONARY PATHOLOGY WITH REGARD TO REMODELING OF THE LEFT VENTRICLE MYOCARDIUM

Purpose: estimation  of the dynamics of distribution of the organism water environment in patients with acute coronary syndrome (ACS) taking into account the presence of myocardial hypertrophy of left ventricle, at different stages of hospitalization. Materials and methods: we have examined 120 patients  with ACS undergoing restoration of coronary blood flow. The assessment was made traditional and renal risk factors (albuminuria 30-300 mg/l, the value of eGFR), and produced the aqueous environments  of the body. All examined patients  were divided into two groups. The first group includes patients  with left ventricular hypertrophy, the second group included patients  without hypertrophy of the LV myocardium. Results: for both studied groups were characterized  by the increase in the total  water volume (TWV), the total  liquid volume (TLV), the intracellular fluid volume (IFV) at all stages of the study. Summary: in patients with ACS and the presence of LV hypertrophy found a significant increase of the average content  of TWV,  TLV, IFV at all stages of hospitalization. Also in the group of patients  with LV remodeling and hyperhydratation was observed a decrease in GFR, and the presence of albuminuria

ANALYSIS OF THE RELATIONSHIP BETWEEN RENAL REMODELING AND VASCULAR ADHESION-1 PROTEIN (VAP-1) IN CHRONIC PRIMARY GLOMERULONEPHRITIS

Goal. Determination of the relationship between the concentration of VAP-1 and the clinical and morphological parameters of the structural reorganization of the renal tissue.Materials and methods. The study included 80 patients with primary chronic glomerulonephritis in the period of exacerbation. The predominant morphological variants were IgA-nephropathy (42 patients) and focal-segmental glomerulosclerosis (16 patients). All patients underwent general clinical examination, with the establishment of stages of CKD, and nephrobiopsy was performed. Based on the results of morphological analysis, the parameters of remodeling of renal tissue were taken into account. A blood sample was taken to study the concentration of Vascular Adhesion-1 protein (VAP-1). Nine months after the patients were admitted to the study and treated according to standard therapy, several indicators were re-recorded.Results. It was found that the age, duration of the disease, urea, proteinuria of a single and a daily portion of urine were inversely proportional to the level of VAP-1. Moreover, a signifi cant difference was found between the groups of patients ranked by median VAP-1, by prevalence in the group ofpatients with higher VAP-1 concentration of nephritic syndrome, IgA nephropathy, cases with mesangium expansion, mesangial and endothelial hypercellularity, endothelial swelling, IgA immune deposits In mesangium and capillary loops.Conclusion. As a result of the study, the prognostic signifi cance of VAP-1 concentration in patients with chronic glomerulonephritis was demonstrated. The formulas and the table of risk stratifi cation for the development of morphological reconstruction of kidney tissue are presented. It was found that the concentration of VAP-1 is statistically signifi cantly increased in the early stages of glomerulonephritis, with the predominance of infl ammatory and proliferative changes. At the stage of fi brous restructuring of renal tissue, there was no reliable difference. When analyzing the material obtained, it was concluded that it is necessary to determine the level of VAP-1 in patients with chronic glomerulonephritis, especially IgA-nephropathy, in the early stages of the disease, in order to predict its course

Risk Prediction of Early and Late Acquired Glomerular and Tubular Dysfunctions in Patients with Disorders of Carbohydrate Metabolism

The purpose of this study was to create a new system for predicting the risk of glomerular and tubular dysfunctions (GTD) in patients with disorders of carbohydrate metabolism (DCM) based on standard parameters and new molecular markers for the development of kidney damage in patients with impaired glucose tolerance (IGT) and T2DM patients with diabetic nephropathy (DN). Material and Methods: The study included 69 patients: 16 patients with IGT (Group 1), 28 T2DM patients with MAU (Group 2), and 25 T2DM patients with MacAU (Group 3), according to the inclusion/exclusion criteria in the research. All patients were stratified by the MDRD. The control group (Group 4) included 11 healthy individuals. The duration of DN was 10.5 years. At the stage of data collection and screening, the standard methods of identification of IGT, DM and DN were applied. Additional methods are included quantitative analysis of the level of α-GST and π-GST, MMP-9 in urine by ELISA. Result: Analysis of the correlation interactions of the level of standard risk factors for the development of renal damage in patients with IGT and DN with the level of new molecular markers in urine and blood allows us to identify and introduce into clinical practice new screening tests reflecting the key molecular interactions that underlie the development of GTD in patients with DCM