Розглянуті основні проблеми гострого пошко­дження нирок (ГПН). Обґрунтована необхідність впровадження концепції ГПН у практику вітчизняної охорони здоров’я. Наведені конкретні рекомендації з діагностики, моніторингу, профілактики та терапії цього небезпечного стану.

Aim. To assess the significance of the serum uromodulin (Tamm-Horsfall protein - THP) concentration (Sumo) as an early biomarker of tubular atrophy (TA) and interstitial renal fibrosis (IF) in patients with glomerulopathies. Materials and methods. 84 patients with glomerulopathy and 11 practically healthy persons (control) were examined. Uromodulin concentrations in serum and urine (Uumo) were measured, renal excretion of this protein and the estimated glomerular filtration rate (eGFR) were established. A semi-quantitative assessment of nephrobioptates was performed. Results and discussion. Sumo decreases with a minimum expression of tubular atrophy (TA) or interstitial fibrosis (IF), when the values of eGFR still remain normal. Variations of such excretory parameters of THP as Uumo, daily excretion, and ratio: urinary uromodulin / urinary creatinine, did not manifest a similar trend. Conclusion. Sumo is promising as an early biomarker of fibrotic and atrophic renal damage. The parameters of renal excretion of THP do not seem to have this property. The reason for the delay in the decline of Uumo in the progression of CKD as compared to the decrease in Sumo seems to be the need to maintain a sufficient Uumo to counteract urinary tract infection and stone formation.

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Background. Even a moderate decrease in glomerular filtration rate leads to an increased risk of cardiovascular diseases (CVD), which is the leading cause of mortality in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) underlies CVD development in renal dysfunction. The prevalence of LVH in patients with CKD stages 2–4 is 50–70 % and reaches 95 % at the beginning of dialysis, which significantly exceeds the number of cases in general population (15–21 %). Common hemodynamic factors associated with chronic kidney damage —hypertension (HTN), activation of the renin-angiotensin system, anemia, fluid and sodium retention, and others largely explain the high prevalence of LVH among patients with CKD. Nevertheless, the existence of additional non-hemodynamic mechanisms of myocardial remodeling (MR) is evident.Objective. To investigate the associations between the MR physiological/histological characteristics and laboratory parameters of calcium-phosphate metabolism in the initial stages of experimental CKD. Design and methods. Four groups of spontaneously hypertensive rats (SHR) were studied (n = 35): 3/4 nephrectomized rats (Nx) one month exposed after surgery (Nx(1), n = 9), 5/6 Nx two months after surgery (Nx(2), n = 8), sham operated rats one month after surgery (SO(1), n = 9) and two months after surgery (SO(2), n = 9). Myocardial mass index (MMI), systolic blood pressure (BP), proteinuria, creatinine (Cr) concentration, total calcium (Ca) and inorganic phosphate (Pi), 25-OH vitamin D (25OHD) and parathyroid hormone (PTH) in serum, myocardial morphology were studied in all experimental animals.Results. The models corresponded to the 1–3 stages CKD. There were no significant changes in serum total Ca (p = 0,066), Pi (p = 0,051) and PTH (p = 0,015) concentrations, the level of 25OHD was significantly lower in Nx(2) rats vs control (p = 0,015). MMI increased in all nephrectomized rats (p = 0,008). The cardiomyocytes (CM) thickness increased in Nx(1) and Nx(2) animals compared to the corresponding controls (p = 0,010, p = 0,002). A significant increase in interstitial (IF) and perivascular (PF) fibrosis occurred in Nx(2) rats with more damaging influence (p = 0,017, p = 0,004). CM thickness, IF and PF increased with the elevation of BP (r = 0,39, p = 0,038, r = 0,47, p = 0,026, r = 0,49, p = 0,031) and serum Cr (r = 0,68, p = 0,001, r = 0,61, p = 0,003, r = 0,69, p = 0,001), and the decrease in serum 25OHD concentration (r = –0,045, p = 0,047, r = –0,50, p = 0,020, r = –0,52, p = 0,012). Multiple linear regression analysis showed, that 25OHD is an independent predictor of myocardial fibrosis (IF: β = –0,38 ± 0,18, p = 0,047, PF: β = –0,34 ± 0,15, p = 0,032).Conclusions. The initial stages of CKD accompanied with HTN are associated with serum 25OHD concentration decrease CM hypertrophy and myocardial fibrosis. The CM growth is an earlier event in relation to the interstitial fibrosis. The obtained data suggest a possible role of vitamin D deficiency in the development of myocardial fibrotic lesions.

Background and Aims It is traditionally believed that high consumption of sodium chloride leads to the development of arterial hypertension, which, in turn, will cause heart remodeling. However, more and more evidence is accumulating that a high sodium chloride content in the diet can cause heart damage without increasing blood pressure (BP). This is confirmed in experiments on rats. In addition, in animals of this species, supplementing a high-salt diet with soy proteins can prevent cardiovascular damage. Whether such mechanisms operate in primates remains unclear. Method The study was performed on male Macacus fascicularis. Monkeys were included in the experiment at the age of 4.6 -7.0 years and had a body weight of 5,5-7,5kg. Animals were divided into 3 groups. The first (control) included 5 animals, received standard ration; the second – 5 animals, received diet with high sodium chloride content (8 g NaCl/1 kg of the feed); the third – 6 animals, who were on a diet with high salt contents supplemented by soya isolated proteins (200 g/kg of the feed). In anesthetized animals measured blood pressure and performed an echocardiographic investigation. Follow up period lasted four month. Results Initially, in all groups of animals, blood pressure levels (Mean(SEM)) and echocardiographic parameters did not significantly differ. During the observation period, the studied parameters did not change much. For example, in the first group, an ejection fraction (EF) increased from 61.7(1.67) to 71.6(4.74), %; P=0.045. In the same group, a tendency toward a decrease in the left ventricle end-systolic dimension (1.50(0.056)vs 1.29(0.118), mm; P=0.079) was noted. Whereas the level of systolic and diastolic blood pressures in this group (for example, systolic BP: 115.4(3.95)vs 126.0(5.39), mm Hg; P=0.134) as well as in other groups of monkeys did not change significantly. Nevertheless, after four months of observation, the level of systolic blood pressure in the second group (126.0(5.39) mm Hg) of animals was significantly higher than in the first (103.0(5.54), P=0.0118) and nonsignificantly - in the third (104.0(8.39), mm Hg; P=0.065). EF in the end of follow up period in second group (71.6(4.74%) was significantly higher than in control (58.1(2.72),%; P=0.039) but not in the third group (60.9(5.03),%; P=0.162). Tricuspid annular plane systolic excursion in second group (1.02(0.08), mm) had an insignificant tendency to increase in comparison to the first (0.782(0.096), mm; P=0.094) or third (0.818(0.049), mm; P=0.052) groups. Conclusion Our data do not exclude the possibility that a high salt content in the food of lower primates can contribute to an increase in blood pressure and a change in heart function. However, to resolve the issues of the relationship between changes in heart function and the level of blood pressure and the presence of the cardioprotective effect of soy proteins under these conditions, longer observations are needed.

Государственное бюджетное учреждение здравоохраненияГородская клиническая больница им. В.П. Демихова Департамента здравоохранения города Москвы, г. Москва, Россия Цель и задачи исследования: оценить и сравнить результаты хирургического лечения сложных переломов и переломвывихов проксимального отдела плечевой кости различными методами.Материалы и методы: проведен анализ результатов хирургического лечения 202 пациентов с 3-х и 4-хфрагментарными переломами и переломвывихами проксимального отдела плечевой кости за период времени 2015-2017 гг. в ГКБ им В.П. Демихова. Все пациенты были случайным образом распределены в 4 группы. В первую группу вошли 68 человек, которым проведено хирургическое лечение пластинами Philos, во вторую группу (48 пациентов) -штифтами системы Multiloc, в третью группу (32 больных) -гемиартропластика системой Zimmer-Biomet, в четвертую группу (54 случая) -тотальным реверсивным эндопротезом Zimmer-Biomet.Результаты: на основании анализа хирургического лечения 202 больных с переломовывихами и сложными переломами проксимального метаэпифиза плечевой кости в сроки до 7 дней с момента получения травмы мы пришли к заключению, что наиболее эффективным методом является эндопротезирование (ЭП) плечевого сустава реверсивной системой. Этот метод позволяет в ранние сроки реабилитационного лечения достичь максимальной амплитуды движений в плечевом суставе. В основной группе, где применялось реверсивное эндопротезирование, отличные и хорошие результаты по шкалам Constant-Murley и ASES получены у 46 больных (85,2%). Неудовлетворительных исходов не было. Более скромные результаты получены в группах, где выполнялся остеосинтез переломов штифтами и пластинами и признан несостоятельным метод гемиартропластики для хирургического лечения «свежих» переломовывихов и сложных переломов проксимального метаэпифиза плечевой кости.Ключевые слова: переломовывих головки плеча, гемиартропластика, остеосинтез перелома проксимального метаэпифиза плеча, реверсивная артропластика плечевого сустава

Background and Aims Glomerular filtration rate (GFR) is the most important and accurate parameter of kidney function in the course of chronic kidney disease (CKD). Renal or plasma inulin, diethylenetriaminepentaacetate (DTPA), ethylenediaminetetraacetate (EDTA), radiocontrast agents (iohexol, iothalamate) and some other substances clearances are the reference methods for determining GFR. However, these methods cannot be applied routinely because of the inconvenience. Several available methods have been developed to estimate GFR in a simpler manner and at low costs. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is widely used to evaluate the GFR in practice. However, this equation is not accurate for the full age spectrum. In 2016, the new equation, full age spectrum equation, based on the serum creatinine (FAScr), was developed and can be applicable to all ages. However, data on the benefits of using the FAScr-method in different populations are contradictory. In particular, it is unclear whether the FAScr provides any advantages over the CKD-EPI method in adults. In this regards, we attempted to compare data obtained FAScr method with results some non-reference and reference methods in adult Russian population. Method We examined 120 Caucasian patients (M:F - 52:68; age 18-76 year) with CKD 1 - 5 stages. Patients with nephrotic syndrome and congestive heart failure were excluded. GFR (reference method) measured by plasma clearance of 99mTc-DTPA (CDTPA). CDTPA determined by one- compartment model 2-4 h method using a Chantler-Barratt linear correction. Estimation GFRs (eGFR) were established by Cockcroft-Gault creatinine clearance (CG), CKD-EPI (creatinine), FAScr and Modification of Diet in Renal Disease (MDRD) methods. Also, renal creatinine clearance (Ccr; UV/P method) was measured. Only GFRs values corrected on 1.73 m2 body surface area had been use. Results The values of GFR (Mean(SEM)) are: CDTPA 67.0(2.46); FAS 69.7(2.50); CKD-EPI 64.3(2.54); MDRD 60.9(2.62); CG 77.6(3.31); Ccr 85.2(3.40), мл/мин/1.73 m2. MDRD was significantly lower (paired Student t-test with correction on multiply comparison by Benjamini-Hochberg method) than CDTPA (P=0.0024), CG (P=0.0001) or Ccr (P<0.0001) were significantly higher. The bias (CDTPA minus non reference GFR) were: FAS -2.67(1.71); CKD-EPI 2.72(1.58); MDRD 6.12(1.78); CG -10.57(2.51); Ccr -18.22(2.26), ml/min. All biases are significantly differ between themselves (P from 0.00064 to <0.000001). The percentage of P30 of the FAS 81.6(3.5) was not significant differ from P30 of CKD-EPI (78.3(3.8); P=0.524) or MDRD (71.7(4.1); P=0.071). However, P30 of CG (67.5(4.3),%; P=0.01) or Ccr (54.2(5.42),%; P<0,001) were significant lower, than P30 of FAS. There were significant comparable direct correlations between CDTPA and FAS (r=0.764), CKD-EPI (r=0.801), MDRD (r=0.756), CG (r=0.656), Ccr (r=0.749); P<0.00001 in all cases. Conclusion In adult Russian population FAScr-method of GFR estimation had not any advantage over CKD-EPIcr-method.

FederationIntroduction and Aims: Loss of podocytes in primary glomerulopathies is crucial for glomerulosclerosis progression which leads to end-stage renal failure in such patients. The mechanism of direct replacement of injured podocytes does not exist so the only way to compensate the integrity of glomerulus is change of cells shape to cover the glomerular tuft with a smaller number of podocytes. Foot process effacement is the typical morphological sign of podocyte respond to stress. Podocyte detachment (PD) from glomerular basement membrane (GBM) develops when podocyte hypertrophy is unsufficient. The aim of investigation was estimation of relationship between range of foot process width (FPW), PD and level of daily proteinuria in patients with primary variants of glomerulopathies. Methods: 42 patients with biopsy proven primary glomerulopathies were included in the study. According to the the results of light and electron microscopy 17 (40,5%) patients had membranous nephropathy, 8 (19,0%) -focal segmental glomerulosclerosis, 12 (28,6%) -minimal change disease and 5 (11,9%) -proliferative variants of glomerulonephritis (2-IgA-nephropathy, 3 -membrano-proliferative glomerulonephritis). Standart laboratory and instrumental investigations were perfomed. Samples of serum and urine were obtained in the day of byopsy. FPW and PD were measured using Image J software (NIH, 1997). FPW was counted as ratio of GBM length to amount of foot processes in every electronogramm using correction factor π/4 as described in previous works. PD was calculated as percentage of bare areas of GBM. Results: There were no statistically significant differences between FPW and PD in patients with different forms of glomerulopathies ( p>0,05). There was negative correlation between 31, p<0,05). Daily proteinuria rate positively correlated with FPW (r=0,52, p<0,05) while inverted relation with level of PD was found (r=-0,36, p<0,05). The same pattern was detected comparing groups of patients with and without nephrotic syndrome. The level of daily proteinuria was higher in patients with more expressed hyaline droplet degeneration of tubular epithelial cells. Conclusions: Unlike data published in recent works we found no difference of FPW and PD rate in patients with different forms of glomerulonephritis. Strong positive correlation of FPW with proteinuria range confirms the role of podocytes in development of high proteinuria and nephrotic syndrome, considering that there were no abnormalities in tubular reabsorbtion of protein. Interestingly the detachment of podocytes from GBM does not increase proteinuria range, more over inverse relationship was detected. Probably this fact can be explained by unknown mechanisms of transcellular transport of protein rather than directly through bare parts of GBM. Nagoya University Graduate School of Medicine, Nagoya, Japan Introduction and Aims: The clinicopathological characteristics of PLA2R-related membranous nephropathy (MN) in Japan remain unclear. Methods: We studied retrospectively the outcomes ...