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Herbal medicines make up a large part of all medicinal products in the Russian market. Complex combinations of biologically active substances that are used as components in herbal medicines not only determine their therapeutic efficacy, but can also cause adverse reactions. The aim of this review was to analyse data on adverse effects of herbal medicines, and reasons and mechanisms behind their development. Special attention should be given to hepatotoxic and nephrotoxic effects of biologically active substances that are used as components in herbal medicines, because liver and kidney failure may lead to life-threatening conditions. The paper addresses hepatic adverse effects, including sinusoidal obstruction syndrome, caused by toxic biologically active substances of the pyrrolizidine alkaloids group. The paper summarises data on herbal medicines and toxic biologically active substances causing acute kidney injury and chronic kidney disease. It analyses potential clinically significant interactions that may occur during co-use of herbal and other types of medicines due to their pharmacokinetic and pharmacodynamic interactions. Further research involving collection, systematisation, and analysis of adverse effects of herbal medicines used alone or in combination with other medicinal products is needed to improve the safety of pharmacotherapy.

About 14‒23% of all clinically used drugs have nephrotoxic potential and are a frequent cause of acute and chronic kidney problems. Acute kidney injury (AKI) is associated with a high risk of repeat hospitalisation, complications, and mortality in adults and children. The aim of the study was to provide an overview of the current approaches to the assessment of drug induced nephrotoxicity. The paper summarises pathogenetic mechanisms of drug induced kidney injury as well as molecular mechanisms at the drug transporters level. It analyses risk factors for drug induced kidney injury—age, sex, ethnicity, comorbidities (chronic kidney disease, diabetes, cardiovascular disease, immune disorders, sepsis, etc.), drug dosage and duration of therapy, pharmacokinetics of drugs, combinations of potentially nephrotoxic drugs, genetic determinants of drug metabolism and transport, etc. It was demonstrated that the traditional nephrotoxicity markers—serum creatinine and urine output—have low sensitivity as indicators of early renal damage. Therefore, new kidney biomarkers are being sought for in order to be used in AKI diagnosis and monitoring in patients with different comorbidities. Some of these biomarkers are already used in drug development, preclinical and clinical trials for assessment and prediction of drug safety. The analysis showed that none of these new kidney biomarkers could be used as an all-purpose tool in routine clinical practice. The development of new AKI biomarkers is a long-range objective and is the path toward early diagnosis and successful treatment of drug-induced nephrotoxicity.

The paper discusses the results of clinically using the interleukin-1_ inhibitor canakinumab in a patient with chronic tophaceous gout, IgA nephropathy, and chronic kidney disease with resistance to traditional anti-inflammatory drugs (colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and high-dose glucocorticoids) and a history of failed urate-lowering therapy. It demonstrates the possibility of safely using subcutaneous canakinumab 150 mg that is superior to therapy with high-dose prednisone (40-80 mg/day) and NSAIDs. Canakinumab has also reduced the risk of exacerbations of arthritis when choosing urate-lowering therapy.

In recent years, both Russian and foreign authors have published many papers on anticoagulant therapy for atrial fibrillation (AF). The largest are devoted to the study of direct oral anticoagulants (DOACs), which have appeared in this field since 2009, and their comparison with vitamin K antagonists (VKAs) in terms of efficacy, safety and other important characteristics. There are far fewer studies on DOACs and their comparison with VKAs and with each other in patients with AF and reduced kidney function. Most of them are retrospective. Meanwhile, the prevalence of chronic kidney disease (CKD) in the population is very high, and doctors are faced with a problem of selecting anticoagulant therapy for these patients.Purpose. To assess the effect of VKAs and DOACs on renal function in real clinical practice in patients with AF depending on the stage of CKD.Materials and methods. A prospective single-centre non-randomized non-interventional observational study in parallel groups was conducted. The study included 92 patients with AF and CKD of 1-4 stages (S1-S4). The comparison group consisted of 35 patients with AF without concomitant CKD. The patients’ age ranged from 44 to 94 years (mean age was 72.2 ± 8.5 years). Patients of both groups received anticoagulant therapy with VKA (warfarin) or one of the registered in the Russian Federation DOACs (dabigatran, rivaroxaban, apixaban). During the observation (median was 10 months), follow-up visits were every 3 months. On visits we conducted the evaluation of effectiveness (strokes / TIA and thromboembolic complications) and safety (major and minor hemorrhagic events) of anticoagulant therapy, as well as the dynamics of kidney function (CC by Cockroft-Gault, GFR by CKD-EPI).Results. The main results are devoted to patients with AF and concomitant CKD. Significant dynamics of the kidney function depending on the anticoagulant taken (VKA or representatives of the DOACs class) were not identified. There were not any thromboembolic complications and major bleedings during the observation period. Statistically significant more minor bleedings on any dose of rivaroxaban in comparison with other anticoagulants were identified.Conclusions. In patients with AF and CKD, there was no significant effect of one or another anticoagulant on the kidney function, which is probably related to the concomitant nephroprotective therapy obtained in a large percentage of cases (ACE inhibitors / ARA, calcium antagonists, statins). Therapy with DOACs and warfarin in patients with AF and CKD for an average of 10 months of followup was effective and safe. In case of AF and CKD combination, the use of dabigatran or apixaban seems to be more preferable in relation to minor bleedings, the use of which less often leads to the development of hemorrhagic events.

Studies of inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease, is highly relevant due to their growing incidence and prevalence, and a wide range of extraintestinal manifestations. The paper deals with the discussion of renal damage types in IBD. Renal damage in IBD refers to rare cases of extra-intestinal manifestations and could both originate by the immunological mechanism common with IBD and directly related to inflammatory activity in the intestine, as well as be unrelated to the immunological activity of the bowel disease and be associated with metabolic disorders that develop in IBD. Finally, kidney damage in IBD can be caused by side effects of treatments. As an example, we present a case of mesangioproliferative glomerulonephritis as an extra-intestinal manifestation of ulcerative colitis and discuss the challenges of therapy and the effectiveness of genetically engineered biological agent golimumab. An algorithm for the differential diagnosis of the renal damage in patients with ulcerative colitis and Crohn's disease is proposed to be used in real clinical practice, with recommendations for monitoring of patients with IBD as those at risk for the development of chronic kidney disease.

The authors present a review of current national and international literature related to the specifics of primary hip joint arthroplasty in patients with end-stage of chronic kidney disease. epidemiology aspects of such pathology are covered in detail. Screening of the patients with hip joint pathology undergoing substitute renal therapy remains a significant issue. The authors present the outcomes of use of various implant types and their fixation in primary hip joint arthroplasty such as cemented, cementless and monopolar prostheses, as well as consider features and structure of complications following primary replacements in such patients. unfortunately, the national literature lacks sufficient number of publications on the present problem. In addition, the paper presents a promising area for development of specialized care to patients on hemodialysis with hip joint pathology.

Gastroesophageal reflux disease is one of the most common diseases of the gastroenterological profile. There are several forms of illness, including non-erosive forms, erosive esophagitis, Barrett esophagus. The article provides an overview of the drugs used to treat the erosive form of GERD and long-term supportive therapy from the perspective of evidence-based medicine. The main objectives of the treatment of erosive esophagitis are to heal esophagus mucosa lesions, achieve long-term remissions, and normalize the patients’ life quality. The proton pump inhibitors (PPIs) have steadily become the mainstay in treatment of erosive esophagitis. These drugs are used at all stages of treatment, both for the relief of symptoms and healing of oesophagus mucosa lesions, and as the long-term supportive therapy. Due to the need for long-term use of IPI, their safety are open to question. The recent publications reported an increased risk of chronic kidney disease, myocardial infarction, pneumonia, calcium, magnesium, iron, vitamin B12 deficiency. At the same time, the analysis of studies underlying the risks of long-term PPI use detected some significant disadvantages that reduce their evidence-based value. This paper provides data on the most frequently discussed risks and critical assessment of them.

The paper discusses the present-day idea on a relationship between atrial fibrillation and chronic kidney dis~ase, the specific features of therapeutic policy, and the place of antithrombotic therapy in particular."Based on the results of population-based studies,the authors set forth the specific features of cardiac arrhythmias concurrent with kidney injury, as well as promising directions to optimize management schemes for this category of patients.В статье обсуждаются современные представления о взаимосвязи фибрилляции предсердий и хронической болезни почек, особенности терапевтической тактики, в частности место антитромботической терапии. На основании результатов популяционных исследований излагаются особенности сочетания нарушений ритма сердца с поражением почек, а также перспективные направления оптимизации схем ведения пациентов данной категории.

The paper presents the pharmacological characteristics of L-carnitine and evaluation of the effectiveness of its application in nephrology practice. Discussed the evidence of the use of levocarnitine for chronic kidney disease and chronic renal failure., В работе представлена фармакологическая характеристика левокарнитина и оценка эффективности его применения в нефрологической практике. Обсуждены доказательные данные использования левокарнитина при хронической болезни почек и хронической почечной недостаточности., В роботі представлена фармакологічна характеристика левокарнітину та оцінка ефективності його застосування в нефрологічній практиці. Обговорено доказові дані використання левокарнітину при хронічній хворобі нирок і хронічної ниркової недостатності.

The paper discusses current international recommendations on the diagnosis and treatment of anaemia in chronic kidney disease. Presents a detailed analysis of the alpha-erythropoietin, discussed the advantages and disadvantages of its application in clinical practice., В работе рассмотрены современные международные рекомендации по диагностике и лечению анемии при хронической болезни почек. Представлен детальный анализ альфа-эритропоэтинов, обсуждены преимущества и недостатки его применения в клинической практике., В роботі розглянуті сучасні міжнародні рекомендації з діагностики та лікування анемії при хронічній хворобі нирок. Представлений детальний аналіз альфа-эритропоэтинов, обговорені переваги і недоліки його застосування в клінічній практиці.