Risk factors of frequent relapses of steroid-sensitive nephrotic syndrome in children

Objective: to identify risk factors of frequent relapses nephrotic syndrome in children to choose an optimal treatment policy. Materials and methods. Sixty-six case histories of children with steroid-sensitive nephrotic syndrome were retrospectively analyzed. We investigated relationship between frequency of relapses and clinical manifestations of the disease, namely: gender; age; duration of steroid therapy; time to achieve remission during steroid therapy; time to develop the first relapse of nephrotic syndrome. Results. The age at the onset of nephrotic syndrome younger than 2 years; therapy with daily oral prednisolone (2 ing/kg/day) less than 4 weeks; the total duration of steroid therapy at the onset of disease less than 3 months; the time to achieve remission after initiation of steroid therapy more than 10 days and the time to develop the first relapse less than 5 months after manifestation of nephrotic syndrome are the risk factors of the frequently relapsing disease. Conclusion. The found risk factors of frequent relapses of nephrotic syndrome in children proves the need for adequate steroid therapy in the onset of disease and indication for appointment steroid-sparing agents at the early date to prevent side effects of prednisolone therapy

The rate of urinary tract abnormalities and the functional state of kidneys in relation to the degree of connective tissue dysplasia in children

The paper is devoted to the study of the rate of urinary tract abnormalities and kidney functions in children with mild, moderate, and severe connective tissue dysplasia. Severe connective tissue dysplasia was found to prevail in children with urinary tract abnormalities and to be characterized by a variety of urodynamic urinary tract abnormalities. Urinary system infection occurred equally frequently in both patient groups and its rate did not depend on the degree of the dysplasia. Some children with severe connective dysplasia were noted to have diminished renal filtration function. High-grade vesicoureteral reflux, tubular disorders as nocturias, and lowered urine osmolarity were more common in children with severe dysplasia. Hypertension was seen equally often in both patient groups, no matter what the degree of connective tissue dysplasia

Vesicoureteral reflux and its complications in children in relation to the degree of connective tissue dysplasia

The paper deals with an association of connective tissue dysplasia with vesicoureteral reflux and its complications in children. Highgrade vesicoureteral reflux was found to be typical of children with severe connective tissue dysplasia; moreover, its repeated endoscopic correction is required in 27% of cases. The frequency of vesicoureteral reflux complications as hypertension and focal nephrosclerosis did not depend on the degree of connective tissue dysplasia. Urinary tract abnormalities were more specific to children with severe connective tissue dysplasia. The children, mainly girls, with severe connective tissue dysplasia showed a propensity to have recurrent urinary tract infection

Clinical and diagnostic significance of urinary neutrophil gelatinase-associated lipocalin-2 measurement in children with microbial inflammatory kidney and urinary tract diseases

Objective: to study the clinical and diagnostic significance of urinary neutrophil gelatinase-associated lipocalin-2 (NGAL) measurement in children with urinary tract infection (я=15) and pyelonephritis (я=15). The patients' age was 1 to 16 years (mean age, 7.32+4.52 years). The diagnosis was verified on the basis of clinical and laboratory findings and medical history and instrumental examination data. Urinary NGAL levels were measured by enzyme immunoassay (a Bio\fendor Laboratory Medicine kit) and calculated with reference to mg of creatinine. Urinary NGAL levels were established to depend on the degree of renal parenchymal damage. The investigation showed a relationship between the excretion of NGAL during the acute phase of pyelonephritis and the detection of renal scarring, as evidenced by statistical DMCA nephroscintigraphy. The acute pyelonephritis group exhibited a moderate direct correlation between the renal excretion of NGAL and the degree of leukocytosis and the blood levels of C-reactive protein. The findings allow recommendations for measuring urinary NGAL levels as an additional noninvasive marker for the early detection of renal parenchymal damage

Molecular stress and chronic metabolic disorders

Stress is the response of the organism to various external and internal events. All response reactions change from metabolic processes to metabolic stresses in minutes or even seconds. The scientists most often discuss oxidative, nitrosative and carbonyl stresses which are characterized by the accumulation of free radicals and other reactive oxygen species, as well as active carbonyl compounds, in the cells and extracellular fluid. These active (signal) molecules are powerful nonspecific modifiers of the structure and function of proteins, lipids, carbohydrates, and they interfere with bioenergetics. Small doses of active signal molecules are necessary for adaptive reactions of the body, they inhibit metabolic disorders, especially protein disorders, but their excessive accumulation causes pathological processes with pronounced modification of proteins and cardiovascular, neurodegenerative, autoimmune, connective tissue diseases and cancer. The authors discuss possible protection and prevention measures of metabolic stress

MOLECULAR NEPHROPATHOLOGY: NEW OPPORTUNITIES FOR KIDNEY DISEASES DIAGNOSTICS

In the era of modern medicine fundamental scientific installation is emerged in the diagnosis of diseases of the kidneys, which are based on traditional diagnostic tools. The presented article describes the modern view on the possibility of diagnosis of kidney diseases, based on genetic studies. The necessity of active development for molecular diagnostic methods of kidney diseases is revealed, which not only complement the traditional methods of research, but also provide insight in point of view of the molecular pathophysiology. Further study of kidney diseases from a position of molecular biology will allow us to take a modern look at the pathogenesis of many diseases and solve a number of problems from the standpoint of personalized therapy that takes into account the genetic characteristics of the patient

MECHANISMS OF RESISTANCE TO IMMUNOSUPPRESSIVE THERAPY IN PATIENTS WITH NEPHROTIC SYNDROME

The present article provides a modern look at the main mechanisms of resistance to immunosuppressive therapy in patients with nephrotic syndrome. The urgency of the problem is because, in most cases, the molecular basis of steroid-resistant nephrotic syndrome is not known, which has now led to the study of the pharmacokinetic, dynamic and genetic aspects of immunosuppressive drugs used to treat nephrotic syndrome, as well as the possibility of genotyping before treatment. The article deals with mechanisms and causes of resistance to the main immunosuppressive drugs used to treat nephrotic syndrome, which fully reflects the need for further study of pharamcogenomics and pharmacokinetics of this disease. We also consider the possibility of genotyping before treatment, which in the long term will allow us to take into account the patient's genotypic characteristics for the purpose of prescribing optimal regimens for immunosuppressive therapy and for carrying out a personalized therapy for nephrotic syndrome