Monoclonal gammopathy of renal significance (MGRS) is a new nosology in modern nephrology and oncohematology. MGRS is defined as kidney injury due to nephrotoxic monoclonal immunoglobulin produced by the B-cell line clone which does not reach the hematological criteria for specific treatment initiation. Monoclonal protein’s pathological effects on kidney parenchyma result in irreversible decline of kidney function till the end stage renal disease that in line with the position of International Consensus of hematologists and nephrologists determinates critical necessity for clone specific treatment in patients with MGRS despite the absence of hematological indications for treatment initiation. Main challenge of MGRS in Russian Federation is an inaccessibility of an in-time diagnostic and appropriate treatment for the great majority of patients due to the following reasons: i) limited knowledge about the MGRS among hematologists and nephrologists; ii) lack of necessary diagnostic resources in most healthcare facilities; iii) lack of approved clinical recommendations and medical economic standards for treatment of this pathological entity. Consensus document comprises the opinion of experts — leading nephrologists and hematologists of Russian Federation — on the problem of MGRS including the incoherence in nosology classification, diagnostics approach and rationale for clone specific treatment. Consensus document is based on conclusions and agreements reached during the conference of leading nephrologists and hematologists of Russia which was held in the framework of symposia «Plasma cell dyscrasias and lymphoproliferative diseases: modern approaches to therapy», 15-16 of March 2019, Pavlov First St-Petersburg State Medical University, St-Petersburg, Russia. The present Consensus is intended to define the principal practical steps to resolve the problem of MGRS in Russian Federation that are summarized as final clauses.

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Цель исследования. Оценка динамики уровня цитокинов, ферритина и эндотелина в периферической крови и фильт рате у пациентов с полиорганной дисфункцией на фоне проведения ПВГДФ. Материал и методы. Обследовано 28 больных в возрасте от 32 до 69 лет с тяжестью состояния по шкале APACHЕ II от 31 до 36 баллов. Результаты. Выявлено, что до проведения ПВГДФ у больных отмечался повышенный уровень провоспалительных цитокинов в плазме крови. Во время ПВГДФ элиминировалось значительное количество цитокинов, причем уровень некоторых цитокинов в фильтрате был выше, чем в плазме крови, вероятно, в результате диссоциации медиаторов воспалитель ной реакции при прохождении через экстракорпоральный контур. Заключение. Отмечено, что уровни TNF α α, IL 2, IL 6 и IL 10 у выживших больных были значительно выше, а IL 1β β и ферритина ниже, чем у умерших. К концу лече ния отмечена тенденция к нормализации цитокинов у выживших больных. После проведения дальнейших исследова ний будут определены возможности использования уровня некоторых цитокинов в качестве прогностических факто ров оценки тяжести состояния больного. Ключевые слова: цитокины, ПВГДФ, полиорганная дисфункция. Objective: to evaluate changes in the levels of cytokines, ferritin, and endothelin in the peripheral blood and filtrates of patients with multiple organ dysfunctions during continuous high volume hemodiafiltration (CHVHDF). Subjects and methods:Twenty eight patients aged 32 to 69 years with the severity of disease of 31 to 36 APACHE II scores were exam ined. Results. Prior to CHVHDF, the patients were found to have elevated plasma proinflammatory cytokines. During CHVHDF, the bulk of cytokines were eliminated, the levels of some cytokines were higher in the filtrate than in the plas ma, presumably, due to the dissociation of inflammatory mediators passing through the extracorporeal circuit. Conclusion. In survivors, the levels of TNF α α, IL 2, IL 6, and IL 10 were much higher, but those of IL 1β β and ferritin were lower than those in deceased patients. By the end of treatment, there was a trend for cytokines to become normal in the survivors. The possibilities of using the level of some cytokines as predictors for the evaluation of patients' condition will be determined after further studies.