Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

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Background and Aims Pregnant women with chronic kidney disease (CKD) are at risk of developing/exacerbating urinary tract infection (UTI) due to the presence of additional (“specific”) risk factors. The aim of our study was estimation the features of UTI in women with CKD during pregnancy. Method The study included 139 women with CKD G1-G3 who had UTI during pregnancy. Most women (63) had chronic glomerulonephritis, 47 had with chronic pyelonephritis, and the rest had diabetic nephropathy (11), chronic tubulointerstitial nephritis (9), renal transplant (7) and lupus nephritis (2). An analysis of the bacteriological examination of urine, the sensitivity of pathogens to antibiotics, clinical manifestations and perinatal complications was performed. Results The following forms UTI are diagnosed: asymptomatic bacteriuria (50.4%), exacerbation of chronic pyelonephritis, including renal transplant (33.1%), acute pyelonephritis (16.5%). The true bacteriuria is determined identically at all stages of CKD, in those with chronic pyelonephritis in 70%, chronic glomerulonephritis in 45% of cases (p = 0.02). Gram-negative microorganisms become apparent in 73.6% of pregnant women with CKD, less often in patients with glomerular pathology than with chronic pyelonephritis (66% versus 81%). Escherichia coli among gram-negative microorganisms was 74.4%, a high frequency of detection of strains with the production of extended-spectrum β-lactamases was established. The course of asymptomatic bacteriuria in pregnant women with non-diabetic glomerulopathy was characterized by a moderate tendency to relapse and moderate release of resistant pathogens. The course of asymptomatic bacteriuria in patients with diabetic nephropathy and after kidney transplantation, on the contrary, had a pronounced tendency to relapse and the frequent release of resistant pathogens. Exacerbation of chronic pyelonephritis proceeded with minimal clinical manifestations, a vivid clinical picture of exacerbation of the disease was determined in one third of pregnant women. It was characterized by a high tendency to relapse and the development of systemic infection, a high frequency of release of resistant pathogens. Pregnant women with CKD who underwent UTI had a high risk of giving birth to premature babies (23% versus 11% p=0.01) who were required to carry out artificial lung ventilation and transfer to stage nursing (34% versus 16%, p=0.01). Conclusion The course of UTI in pregnant women with CKD is characterized by a high prevalence, dependence on primary renal disease, the release of resistant pathogens, and a high probability of an atypical clinical picture.

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Emergency drainage of the upper urinary tract for obstructive uropathy and/or acute pyelonephritis in pregnant women is a vital operation. Objective-to compare complications due to internal and external drainages of the upper urinary tract in pregnant women with obstructive uropathy in order to choose the most optimal method. Subject and methods. Among 48 treated pregnant women (28 patients with obstructive uropathy and 20 with acute pyelonephritis), 41 patients underwent follow-up, examination, and treatment and were divided into 2 groups. Group 1 included 21 pregnant women with obstructive uropathy at 12-32 weeks' gestation, in whom double-J upper urinary tract stenting was chosen as a drainage procedure; group 2 consisted of 20 pregnant women with clinical signs of acute pyelonephritis at 22-23 weeks' gestation who had percutaneous needle nephrostomy. All emergency surgical interventions were performed within 24 hours of admission and antibiotic therapy. Results. It was established that Group 1 undergoing upper urinary tract stenting showed the largest number of complications (stent dislocation and encrustation, vesicoureteral reflux, and reflux pyelonephritis), which required the highest number of therapeutic measures. In Group 2, the complications were associated with drainage dysfunction (salt-induced obstruction, spontaneous drainage discharge) and were observed much less frequently. Contraindications to ureteral stenting and indications for contact ureterolithotripsy, minimally invasive surgery, were developed. Percutaneous needle nephrostomy is a universal method of upper urinary tract drainage, which can be used at any gestation period and for any reason of obstruction. Conclusion. The high rates of drainage-associated complications necessitate a differentiated approach to choosing a drainage method for obstructive uropathy or acute pyelonephritis in pregnant women and to preventing catheter-associated complications in previously performed stenting.