области, Самара 2 Самарская областная клиническая больница им. В.Д. Середавина, Самара 3 НИИ скорой помощи имени Н.В. Склифосовского, Москва 4 Национальный медицинский исследовательский центре здоровья детей, Москва 5 Координационный центр органного донорства ФМБА России, Москва 6 Национальный медицинский исследовательский центр гематологии, Москва Резюме. 18.06.2021 в Самарской области в больнице им. В.Д. Середавина состоялась конференция «Высокотехнологическая медицинская помощь пациентам Самарской области -новые горизонты», организованная министерством здравоохранения Самарской области, Самарским региональным отделением Межрегиональной общественной организации «Общество трансплантологов», Медицинским университетом «Реавиз». Работа представляет собой резолюцию президиума конференции. Ключевые слова: трансплантация, организация медицинской помощи, донорство органов.
ГБУЗ «НИИ скорой помощи им. Н.В. Склифосовского Департамента здравоохранения г. Москвы», Москва, Российская Федерация * Контактная информация: Алиджанова Хафиза Гафуровна, доктор медицинских наук, старший научный сотрудник отделения неотложной клинической кардиологии с методами неинвазивной функциональной диагностики НИИ скорой помощи им.Н.В.Склифосовского. Е-mail: doctorhafiza@mail.ru РЕЗЮМЕ Изучение острого коронарного синдрома (ОКС) у больных хронической болезнью почек (ХБП) является одним из направлений современной кардиологии. Распространенность, течение, про-гноз и тактика лечения инфаркта миокарда при ХБП недостаточно изучены. Анализ литературных источников позволяет констатировать: ХБП при ОКС удваивает риск смерти (РС) и неблагоприят-ных сердечно-сосудистых событий в ближайшем и отдаленном периодах; определение стадии ХБП необходимо с целью прогнозирования госпитальной и отдаленной смертности инфарктных больных; диагностика ОКС на поздних стадиях ХБП сложна; ХБП следует считать независимым РС после проведения чрескожных коронарных вмешательств и коронарного шунтирования. Ключевые слова:хроническая болезнь почек, скорость клубочковой фильтрации, атеросклероз коронарных арте-рий, острый коронарный синдром, реваскуляризация миокарда
Introduction. In recipients with pre-existing sensitization with incompatible antigens of the main histocompatibility complex, the kidney graft survival after retransplantations directly depends on the level of anti-HLA antibodies. Despite many years of experience in using various methods: plasmapheresis, cascade filtration, immunosorption, intravenous administration of immunoglobulins, the use of polyclonal anti-lymphocytic agents, the search for more acceptable ways to reduce the level of anti-HLA antibodies still remains relevant nowadays.The purpose of the study was to assess the effect of polymethyl methacrylate membrane-based dialyzers on the decrease in anti-HLA antibody level in renal transplant recipients.Material and methods. The study included 20 kidney transplant recipients. The main study group consisted of 10 patients who underwent early postoperatoive hemodialysis using polymethyl methacrylate membrane-based dialyzers to decrease anti-HLA antibody level. A total of 53 hemodialysis procedures were performed, an average of 5.3 per patient. The comparison group included 10 recipients in whom plasmapheresis had been performed at similar timing after kidney transplantation aimed at reducing the anti-HLA antibody titers and whose data were studied retrospectively. A total of 38 plasmapheresis sessions were performed, an average of 3.8 per patient.Results. In the main study group, a day after the hemodialysis procedure using polymethyl methacrylate membranebased dialyzers the level of anti-HLA antibodies decreased by an average of 28.3% in 6 of 10 patients (60%), and increased in 4 cases. Meanwhile, in the comparison group, the level of anti-HLA antibodies in venous blood after a plasmapheresis session decreased average by 44.6% in 8 patients of 10 (80%), and increased in 2 cases, on the contrary. Of note, there were no significant differences between the patients of the two compared groups either in the number of positive results (p> 0.05, Fisher's exact test), or in terms of the decrease in anti-HLA antibody level (p> 0.05, Mann – Whitney test). On days 2 and 5, in 50% of cases both after the hemodialysis procedure using polymethyl methacrylate membranebased dialyzers and after the plasmapheresis session, the patients showed an increase in the anti-HLA antibodies level compared to the baseline values. In the remaining cases, the level of anti-HLA antibodies in both groups was recorded at a lower range compared to the baseline values.Conclusion. The use of polymethyl methacrylate membrane-based dialyzers in the renal allograft recipients having a high level of preexisting anti-HLA antibodies seems promising for the period of oligoanuria until the renal allograft function is restored, since both hemodialysis and the sorption of pre-existing (and also newly synthesized) antibodies take place simultaneously.
One of the most relevant issues of nephrology, neurology, and cardiology is the management and treatment of patients with chronic kidney disease and stroke. Patients with chronic kidney disease have a risk of both thrombotic complications and bleeding, and they have a high risk of both ischemic and hemorrhagic stroke. Chronic kidney disease significantly worsens the outcome of stroke by limiting the treatment due to reduced drug clearance and side effects. Hemodialysis which causes drastic hemodynamic and biochemical changes leads to the "stress" of the cerebral vascular system, increasing the risk of stroke; kidney transplantation reduces the risk of stroke due to functional recovery. Chronic kidney disease and stroke have significant socio-economic consequences. Patients with end-stage chronic kidney disease, as a rule, are not included in clinical trials; and stroke treatment tactics have not been developed for them. This review examines the interaction between kidneys and brain, the pathophysiology and epidemiology of stroke in all stages of chronic kidney disease, after kidney transplantation and discusses the management and treatment of chronic kidney disease patients with stroke.The investigation of the factors responsible for the high prevalence of brain lesions in chronic kidney disease will allow developing new treatment methods.
Introduction. All over the world and in Russia, the number of patients requiring dialysis therapy and kidney transplantation for chronic renal failure in the end-stage of the renal disease is increasing. In many countries of the world, the number of dialysis patients over 60 years of age accounts for 30 to 45% of all patients with chronic renal failure. Meantime, taking into account the improved methods for early diagnosis of chronic renal failure and the treatment methods for chronic kidney disease, including the renal replacement therapy, we can expect an increase in the number of elderly potential kidney transplant recipients. The likelihood of receiving a renal graft in elderly patients is significantly lower than in young recipients. Elderly patients are known to have a higher risk of death while waiting for a kidney transplant due to higher morbidity and lethality on dialysis. For this reason, the urgency of increasing the availability of kidney transplantation in elderly patients is growing over time. One of the solutions can be the use of kidneys from suboptimal donors with a far from ideal graft quality, but which could meet the needs for transplant care of the older age group of patients. The older age of a recipient entails a certain risk of developing a graft dysfunction due to the presence of concomitant diseases, and the potential risk increases even more with kidney transplants from expanded criteria donors. If a reduced functional reserve of kidneys removed from donors with extended criteria is identified, two-kidney transplantation is possible, which provides fairly good long-term results. To reduce the risk of a kidney graft loss, a careful selection of recipients is necessary, taking into account their co-morbidities, including the presence of urological diseases that impair the function of the upper and lower urinary tract. Their timely identification and correction makes it possible to raise the availability of kidney transplantation for elderly patients and improve its results. This review presents the results of the studies conducted in various world transplant centers, covers the mortality rates, kidney graft and recipient survival rates.The study purpose was to summarize the actual data and the results of the study on kidney transplantation in elderly patients with urological pathology.
Insulin-like growth factor-1 (IGF-1), parathyroid hormone (PTH), biochemical markers of bone resorption and formation, bone mineral density (МПК) in spine and hip were determined in 46 recipients following heart transplantation (HI) and 79 -following kidney transplantation (KT) receiving triple immunosuppressive therapy. Serum IGF-1 in total recipients group (n=125) in mean was significantly lower then in health volunteers (187±102 and 250±51 ng/ml respectively; p
The number of patients with chronic kidney disease (CKD) and end-stage renal disease is steadily growing. With the failure of kidney function, the risk of developing acute myocardial infarction (AMI) with severe coronary artery stenosis and hospital mortality is growing. Case management of CKD and AMI is a complicated task. This review reflects the distinctive features of the course of AMI in hemodialysis patients, patients with kidney transplantation, their diagnosis and treatment.
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