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Aim. To study the features of lipid metabolism disorders in patients with acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) and smoking factor. Materials and methods. The study included 142 ACS patients (mean age – 59.66 ± 0.78 years). All the patients were divided into two groups according to GFR. Group I comprised 57 individuals with GFR

The aim. To establish the relationship between coronary bed lesions and glomerular filtration rate (GFR) calculated on the basis of creatinine, cystatin C and urine albumin-creatinine ratio in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and methods. We examined 286 patients with STEMI, aged 39 to 87 years (mean age 62.8 ± 9.8, median age 64, interquartile range 56 to 71 years), 202 (70.6%) were men and 84 (29.4%) were women. All the patients underwent general clinical tests, coronary angiography with subsequent percutaneous coronary intervention, and echocardiography. Results. The most frequent infarct-related coronary artery (CA) was the anterior interventricular branch of the left coronary artery in the proximal and middle segments, and the right coronary artery in the proximal segment. In general, there was no significant difference in the number of affected CAs among the examined patients. The division of patients into groups according to the level of GFR, determined both on the basis of creatinine and cystatin C, did not reveal significant differences in the distribution of infarct-related CAs. At the same time, the number of patients with multivessel lesions significantly increases with decreased GFR. Depending on the level of the urinary albumin-to-creatinine ratio, a significant increase in the number of patients with two- and multivessel lesions of the CAs was noted. Conclusions. Close correlations between multivessel lesions of CAs and gender, age, urinary albumin-to-creatinine ratio, GFR, left and right atrial size, duration of history of hypertension and diabetes mellitus, presence of II-III degree atrioventricular block and mortality were established.

Aim – to develop an applied prognostic calculator for the rate of progression of CKD in elderly patients with type 2 diabetes, which makes it possible to identify a group of high rate of GFR reduction in conditions of routine outpatient admission. Material and methods. 69 clinical indicators were studied, the interrelationships and significance of differences in parameters in the groups identified according to the original diagnostic parameter, the glomerular filtration rate reduction index with a threshold value of 3.83 ml/min/1.73 m2 per year, above which the rate of progression of CKD was considered high. Results. By using regression analysis, significant factors for the prognostic calculator were identified: the duration of diabetes and insulin therapy, concomitant diagnosis of obesity, pulse in the ankle artery, severe stage of polyneuropathy, risk group IV of hypertension, treatment with sulfonylureas, the number of antihypertensive drugs taken. When evaluating the information capacity and predictive ability of the calculator, the area under the AUC ROC curve was 0.89 (0.80; 0.99) p 0.001, which characterizes the quality of the diagnostic technique as high. Conclusion. The presented calculator gives the doctor the opportunity to identify a group of patients with the risk of rapid progression of CKD directly on an outpatient basis.

Aim – to develop and provide clinical substantiation of experimental mathematical models for the chronic kidney disease (CKD) progression rate in patients with type 2 diabetes mellitus (T2DM) using the glomerular filtration rate reduction index (RI_GFR) as original diagnostic parameter. Material and methods. A cross-sectional observational study of clinical status indices was performed in a sample of patients with type 2 diabetes. The significant predictors of a high rate of CKD progression were identified by regression analysis, three variants of experimental mathematical models were developed with different combinations of arguments with an emphasis on modifiable factors. Results. The method of one-dimensional logistic regression analysis revealed the indices of clinical status having a significant impact on the rate of CKD progression on the scale of changes in RI_GFR by 1 ml/min/1.73 m2 and on the binary classification of outcomes in the groups of "slow" and "fast" decrease in kidneys filtration function with a threshold value of RI_GFR of 4.21 ml/min/1.73 m2 per year. These indices were age, body mass index (BMI), glycemia and duration of diabetes at the time of visit, history of insulin therapy, acute myocardial infarction in the anamnesis, pulse on the popliteal artery, concomitant retinopathy, hypertension risk group, treatment with sulfonylureas and calcium antagonists. Using multidimensional logistic regression, three types of experimental mathematical models were developed, including various combinations of predictors that demonstrated high values of diagnostic significance. Conclusion. The mathematical modeling of CKD progression in patients with T2DM with the RI_GFR diagnostic index allows for better understanding of the pathology's development patterns. An experimental mathematical model using modifiable drug factors that a doctor can manage during the treatment (administration of sulfonylureas and calcium channel blockers) demonstrated 55.6% sensitivity, 85.3% specificity, AUC 0.76 (0.65; 0.86), which ensured high quality prediction with an accuracy of 77.5%.

Metformin is a sugar-lowering drug that is actively used in long-term therapy of type 2 diabetes mellitus (DM2). The safety of metformin for different groups of DM2 patients is currently well studied. However, the drug is contraindicated for patients with severe renal impairment and should be used with caution in cases of moderate renal impairment. Since contrast agents as well as metformin are excreted by kidneys, patients with reduced renal function taking metformin require special attention due to the risk of lactic acidosis, a life-threatening condition resulting from functional renal failure and accumulation of metformin in tissues. Numerous studies have shown that the risk of lactic acidosis is relatively low and in most cases is not associated with metformin therapy per se, but rather with comorbidities. Initial versions of clinical recommendations related to the use of contrast agents strictly limited the use of metformin before and after examination, but as data on lactate acidosis and possible causes of this condition expanded, the recommendations gradually became less strict. For emergency contrast studies, they are currently unchanged, but data are gradually accumulating on the safety of continuing metformin in these clinical situations. There is no consensus among contrast manufacturers on whether and in what regimen metformin should be interrupted during contrast studies as well as on a number of other related issues. The best strategy for clinicians is to check the instructions for each specific drug before use.

Aim. To study the glomerular filtration rate (GFR) dynamics calculated by creatinine and cystatin C during induction immunochemotherapy in patients with newly diagnosed diffuse large B-cell lymphoma in order to objectify the method for estimation.Materials and methods. The open longitudinal study included 39 patients with newly diagnosed diffuse large B-cell lymphoma who received specialized treatment at the Oncohematology Department of National Medical Research Centre for Oncology (Rostov-on-Don) in 2021. Patients received induction immunochemotherapy according to the R-CHOP regimen (rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisolone) in combination with accompanying therapy (allopurinol 300 mg/day). Blood sampling was carried out at 0, 24, 48, 72, 120 hours and on 21st day of the 1st therapy cycle. Patients were divided into 2 groups depending on the GFR level, calculated by creatinine, before treatment: group A – 27 (69 %) patients with GFR >90 ml/min/1.73 m2, group B – 12 (31 %) patients with GFR

Background. Sympathetic outflow may be capable of selectively increasing or decreasing glomerular capillary pressure and hence glomerular filtration rate (GFR) by differentially activating separate populations of renal nerves. Sympathetic outflow to the kidney is regulated by major cortical, brainstem and medullary areas. The purpose of this study is to find out the relationship between GFR and HRV/EEG parameters as markers of the neural regulation of the kidney. Materials and Methods. The object of observations were 10 men aged 37-69 years without clinical diagnosis tested twice with 7-days interval. The rate of glomerular filtration was calculated according to endogenous creatinine clearance and the Cockcroft & Gault formula. The state of the autonomic nervous system was assessed by the HRV method. Simultaneosly qEEG recorded. Results. For the sample as a whole, a weak (r=0.396; p>0.05) correlation was found between HRV-marker of sympathetic tone and GFR. However, two clusters of individuals can be distinguished: with a strong correlation (r=0.852; n=12) and its complete absence (n=8). The qEEG method revealed neural structures generating delta and theta rhythms that upregulate GFR, and generating beta rhythm that downregulate GFR. The regression model, which includes 16 EEG parameters, allows estimating GFR with a standard error of 3,4 mL/min. Conclusion. Glomerular filtration rate is subject to the modulatory regulatory influence of the nervous system and can be estimated with high accuracy by EEG parameters.

Background. Malignant neoplasms are widespread, and the ambiguous relationship between them and hyperglycemia emphasizes the importance of studying them. On the one hand, diabetes mellitus and prediabetes increase the risk of developing malignant tumors. On the other hand, malignant tumors and drugs intended for their treatment can lead to hyperglycemia. Regardless of the origin, diabetes mellitus and prediabetes may develop diabetic nephropathy. Aim of study: to analyze the functional state of the kidneys in patients with diabetes mellitus and prediabetes with kidney neoplasms.Object and methods. There was a study of 141 patients with a kidney tumor who underwent nephrectomy. For histological examination, a fragment of the kidney parenchyma was taken at a distance of at least 4 cm from the tumor. Histochemical stains, immunofluorescence reaction and electron microscopy were performed. Assessment of laboratory parameters was carried out before the surgical treatment, 3 days, 3 months, six months and a year after the operation. Parameters such as the level of protein in the urine, the presence and number of altered erythrocytes in the urine, and the glomerular filtration rate were assessed using the CKD-EPI formula.Result. Diabetic nephropathy was detected in 44 patients (31.2%). Diabetes mellitus was previously diagnosed in 10 patients (22.7%), prediabetes was diagnosed in 34 patients (77.3%). After nephrectomy, patients with prediabetes and type 2 diabetes mellitus showed a sharp decrease in glomerular filtration rate (GFR). In the subsequent period, in patients with type 2 diabetes, there is a stable decrease in GFR. In patients with prediabetes, hyperfiltration is observed within six months, however, a year after the operation, GFR decreases again.Conclusion. Widespread diabetic nephropathy in patients, it is advisable to jointly manage patients with an oncologist, nephrologist, endocrinologist, clinical pharmacologist.

Background. In the article, a clinical case of managing a comorbid 74-year-old patient with a history ofischemic heart disease, who was hospitalized in a vascular center due to myocardial infarction, with subsequently developed acute kidney injury against the background of chronic kidney disease is presented.Objective. The purpose of describing this clinical case is to demonstrate the importance of assessing and considering the significance and modifiability of risk factors for the development of chronic kidney disease, as well as their timely correction. The clinical example illustrates the connection between impaired kidney function and the progression of cardiovascular pathology.Results. The patient described in the clinical case, despite a long history of hypertension, did not receive ambulatory combined antihypertensive therapy in accordance with actual clinical recommendations, but received a monopreparation from the class of angiotensin-converting enzyme inhibitors without achieving the target blood pressure. In 2012, the patient underwent coronary artery stenting due to unstable angina, after which she received only angiotensin-converting enzyme inhibitors and beta-blockers from the drugs recommended by clinicalguidelines and did not receive antithrombotic and lipid-lowering therapy. The patient was diagnosed with type 2 diabetes mellitus 20 years ago without subsequent control of glucose levels and choice of hypoglycemic therapy. In addition, the patient had modifiable risk factors of cardiovascular diseases and chronic kidney disease: long smoking history, obesity. Upon admission to the hospital, coronary angiography was performed with intravenous administration of iodine-containing contrast medium, according to the results of which stenosis of the right coronary artery was detected, and its stenting was performed with drug-coated stents. During the hospitalization period, there was an increase in the level of creatinine and urea in the blood serum with maximum values of 570.7 μmol/L and 37.1 mmol/L respectively. When these changes were detected, the patient was consulted twice by a nephrologist, and a decision was made to conduct sessions of replacement kidney therapy due to severe azotemia with persistent restoration of kidney function. Upon stabilization of the patient’s condition, she was discharged from the hospital with recommendations to continue the program hemodialysis. However, even upon admission to the hospital, the patient’s creatinine level was 260 μmol/L, which may indicate that chronic kidney disease had been developing for a long time before myocardial infarction and before the administration of X-ray contrast medium during coronary angiography.Conclusion. Thus, due to the management of the patient at the outpatient stage without compliance with clinical recommendations, lack of correction of modifiable risk factors for chronic kidney disease and cardiovascular pathology, it was not possible to prevent acute kidney injury against the background of chronic kidney disease and myocardial infarction due to late diagnosis of chronic kidney disease.

In systemic sclersis (SSc), different types of renal involvement occur. Their severity can range from asymptomatic deterioration of renal function to life-threatening damage, which is a complex therapeutic problem. Rituximab (RTM) has been used in the treatment of SSc and other autoimmune diseases with promising results, but its effect on renal function has not been adequately studied. Objective: to evaluate the renal function during complex therapy, including RTM, in patients with SSc over a long-term follow-up (at least 1 year). Material and methods. The study included 90 patients with SSc who were examined at least twice – before and 1–3.5 years after initiation of RTM treatment. Renal function was assessed by glomerular filtration rate (GFR) calculated according to the CKD-EPI formula. The stages of chronic kidney disease (CKD), blood pressure, daily proteinuria, skin score, activity, and indicators of lung function – forced vital capacity and diffusing capacity of the lungs – were also determined. Results and discussion. Against the background of complex therapy with RTM, there was a statistically significant decrease in GFR in the entire group of patients at the end of observation. On the other hand, renal function remained stable in the majority of patients with initially preserved GFR and there was a 25 % decrease – from 20 to 15 patients – in the number of patients with CKD. In more than half of the patients who initially had CKD, GFR increased (n = 11) or stabilized (n = 2) after therapy, and it decreased in a statistically insignificant manner in only 7 patients, whereas the development of a more advanced stage of CKD was observed in only 2 cases. The results of the treatment of 2 patients who had previously experienced scleroderma renal crisis (SRC) are reviewed in detail. Conclusion. In this study, there was no significant effect of RTM treatment on GFR and grade of CKD. Most patients had stable renal function; patients with an initial low grade of CKD showed a tendency toward stabilization of renal function. A significant decrease in GFR during long-term therapy noted in the entire patient group appears to be explained by an increase in renal insufficiency in patients with initially severe scleroderma renal damage, particularly due to SRC. Further studies on the effects of RTM therapy on renal function in patients with SSc are needed.

Aim. To study the glomerular filtration rate (GFR) dynamics during induction immunopolychemotherapy (PCT) in patients with newly diagnosed diffuse large B-cell lymphoma. Materials and methods. The study included 39 patients with newly diagnosed diffuse large b-cell lymphoma who received specialized treatment in oncohematology department of national medical research centre for oncology (Rostov-on-Don). Patients underwent induction pct according to the R-CHOP (rituximab, doxorubicin, cyclophosphamide, vincristine, prednisolone) regimen with accompanying therapy (allopurinol). blood sampling was carried out at 0, 24, 48, 72, 120 hours and 21 days of the 1st PCT cycle. GFR was calculated using the SKD-epicre formula (chronic Kidney disease epidemiology collaboration creatinine-based). statistical data processing was carried out using the IBM SPSS statistics 23 program. Results. According to the gfr level before the start of chemotherapy (0 hours), the patients were divided into two groups: group a with GFR > 90 ml / min / 1.73 m2 and group b with GFR < 90 ml / min / 1.73 m2. In group a, there were no significant dynamic changes in the GFR level during PCT. Group B patients reacted more acutely to the administration of pct, which was manifested in an even greater decrease in the gfr level at 48 hours of PCT, and at 120 hours of PCT, the GFR approached the optimal values. on the 21st day from the start of the 1st pct course, the studied indicator returned to its initial values at 0 hour. further, the patients of these groups were divided into subgroups depending on the disease stage: group a consisted of 12 people with stages I–II and 15 people with stages III–IV. In group B, there were an equal number of patients with stages I–II and III–IV – 6 people. In group a, in patients with stages I–II and III–IV before the start of PCT (0 hours) and during PCT, there were no differences in the GFR level dynamics. In group B, patients with stages I-II and III–IV had similar GFR before the start of PCT, and during treatment, they reflected the previously noted general group trend in GFR level dynamics. Conclusion. The study found that in patients with initially low GFR level, a further, even more pronounced decrease in GFR during pct is observed. at the same time, the absence of significant differences in GFR level depending on disease stage allows us to conclude that the leading role is not so much the stage of the disease and tumor volume, but rather the initial functional status of the kidneys in the development of renal dysfunction in patients with diffuse large B-cell lymphoma during R-CHOP therapy.

Background. Existing methods for assessing glomerular filtration rate (GF) are invasive. Therefore, we set ourselves the goal of evaluating the rate of glomerular filtration by a non-invasive method. Materials and Methods. The object of observations were 10 men aged 37-69 years without clinical diagnosis tested twice with 7-days interval. The rate of glomerular filtration was calculated according to endogenous creatinine clearance and the Cockcroft & Gault formula. Systolic and diastolic blood pressure was measured three times in a row. The state of the autonomic nervous system was assessed by the HRV method. Results. We confirmed the significant correlation of GF with age and weight. The screening revealed a significant correlation of GF with a number of blood pressure and HRV parameters. If in the classic formula we replace creatinineemia with systolic blood pressure and HRV-markers of sympathetic tone, we get a formula for estimating the GF with a standard error of 10,9 mL/min vs 2,7 mL/min, but without blood sampling. The regression model, which includes HRV and blood pressure parameters, as well as urinary creatinine concentration, allows estimating GF with a standard error of 12 mL/min. Conclusion. The balneotherapy has a significant effect not only on blood creatinine level, but also on HRV and blood pressure parameters, and even more pronounced. Therefore, the estimation of GF based only on the Cockcroft & Gault formula is at least not much more accurate than the one proposed by us, besides, our method is completely non-invasive.

This study examined 37 patients with hepatitis and cirrhosis of the liver and 30 healthy individuals, assessing liver function indicators and renal function under conditions of daily diuresis and after a load of drinking water and a 0.5% sodium chloride solution, at 0.5% of body weight. The study showed that hepatitis and cirrhosis of the liver lead to signs of hepatorenal syndrome development, particularly in patients with cirrhosis, primarily manifested by a reduction in glomerular filtration rate (GFR). The extent of reduction correlated with the severity of liver damage. Simultaneously, it was independent of blood pressure, plasma protein, and renal sodium exchange mechanisms. The primary dysfunction in hepatorenal syndrome was determined to be a reduction in GFR, evidenced by the rise in creatinine concentration, although urea increased only in cirrhosis, requiring further explanation. The results showed that liver diseases, especially cirrhosis, can lead to kidney problems, mainly by reducing the kidney's ability to filter blood, which was shown by higher creatinine levels in the blood.

Introduction. Acute coronary artery disease is the leading cause of death in patients with chronic kidney disease (CKD). In addition, CKD itself is the initiator of acute coronary syndrome (ACS), the prevalence of which is greater, the more pronounced the impairment of kidney function and the more concomitant risk factors in the patient.Aim. To study the predictive value of various laboratory and instrumental markers in identifying the risk of developing ACS in patients with CKD.Materials and methods. A search was made for articles for the last 10 years in the databases: PubMed, Medline, Google Scholar and eLIBRARY by keywords in Russian and English, the articles were selected in accordance with the purpose of the study.Results. ACS manifests itself in CKD patients with an atypical picture, and in 3 % of cases it is generally asymptomatic. The risk of death from cardiovascular complications increases in proportion to the deterioration of the glomerular filtration rate (GFR). This progression also increases the risk of coronary artery calcification. At the same time, it was found that cystatin C is a more universal marker of a decrease in GFR than creatinine. Other laboratory markers that indicate the risk of ACS are inflammatory markers, albuminuria, troponins, natriuretic peptide.Conclusion. So far as ACS is atypical or asymptomatic, in addition to troponins and traditional instrumental diagnostic methods, markers such as GFR, albuminuria, an increase in serum cystatin C, phosphate, fibroblast growth factor-23, interleukin-6, tumor necrosis factor-alpha, total parathyroid hormone, fibrinogen, natriuretic peptide can help in its prediction.

Aim to determine the factors associated with the risk of developing type 2 diabetes in patients with coronary artery disease (CAD). Material and methods.The retrospective data sample included 181 patients hospitalized in the cardiology department of the SamSMU clinics. The patients were divided into two groups: group 1 122 patients without type 2 diabetes (77 (63.1%) men, median age 66.0 (59.0;75.0) years) and group 2 59 patients with type 2 diabetes (29 (49.2%) men, median age 69.0 (63.0;73.5) years). Results.The statistically significant difference (p0.05) was registered in glomerular filtration rate (GFR); no significant differences were demonstrated in other clinical indicators, including age and gender. Expectedly, the patients with type 2 diabetes had higher glucose levels. The parameters of the lipid spectrum and creatinine did not differ between the groups. Conclusion.The factors associated with the risk of developing type 2 diabetes are high glucose concentration and reduced GFR. The application of the developed discriminant analysis model will allow to determine the risk group of type 2 diabetes in patients with coronary heart disease, which will ensure a timely control of the presented indicators.

Aim. Optimization of pharmacotherapy of patients with metabolic syndrome and chronic kidney disease according to the nephroprotective properties of antihypertensive drugs.Methods. 81 patients (38 male, 43 female, age 29-79 years, mean age 53,4± 11,6 years) with metabolic syndrome and normal kidney function were included into the study. In all patients estimated glomerular filtration rate (eGFR) according to the Cockroft-Gault formula and microalbuminuria were determined. Antihypertensive and nephroprotective efficacy of zofenopril, losartan, nebivolol and fixed combination of lisinopril and hydrochlorothiazide were assessed.Results. 57 (70,4%) patients with metabolic syndrome had renal function deterioration: 19 (23,5%) - hyperfiltration (eGFR >110 ml/min/1,73 m2), 38 (46,9%) - hypofiltration (eGFR

Cardiac amyloidosis performance is in many ways similar to hypertrophic cardiomyopathy (HCM), and therefore it is extremely difficult to distinguish these two diseases in practice. The present study was performed to identify features that aid in the differential diagnosis by analyzing clinical, electrocardiographic, echocardiographic and laboratory data in patients with systemic amyloidosis and HCM. In the study, 38 patients with cardiac amyloidosis and 80 patients with HCM were examined. It was found that symmetrical left ventricular (LV) wall thickening, granular and sparkling appearance of the myocardium and thickened heart valves were the best cardiac predictors, and age above 63 years, decreased glomerular filtration rate and proteinuria were the best non-cardiac predictors of cardiac amyloidosis, whereas low QRS voltage and pericardial effusion were of less clinical significance. Systolic anterior motion of the anterior mitral leaflet, asymmetric LV wall thickening, and electrocardiographic signs of LV hypertrophy were highly suggestive of HCM. Thus, standard noninvasive methods may be useful for identifying myocardial infiltrative processes and differentiating cardiac amyloidosis from HCM.

Aim. This study aims to investigate the association of cystatin C with changes of left ventricular structure and function in individuals with different cardiovascular risk (CVR).Material and methods. 267 patients with low-moderate (group I, n=58), high (group II, n=80) and extremely high (group III, n=129) CVR were examined. The level of serum cystatin C, creatinine and blood lipid spectrum, filtration rate of the kidneys and echocardiography indicators were estimated.Results. Among all the study participants (n=267), 194 patients (72,6% of cases) had the increased level of serum cystatin C; 165 patients (61,7% of cases) showed the signs of the left ventricular hypertrophy (LVH). The increased level of serum cystatin C was observed in 51,7% of cases in group I; 75,0% — in group II and 80,6% — in group III. The values of glomerular filtration rate (GFR) calculated using the CKD-EPI and F. Hoek formula were the following: 100,2±17,0 ml/min/1,73 m2 and 84,8±15,5 ml/min/1,73 m2, p

Aim. To study clinical and functional manifestations of hypertriglyceridemia and its association with risk factors for cardiovascular and renal complications in individuals with high cardiovascular risk.Material and methods. The study included 272 patients (129 men and 143 women; mean age, 53,9±13,7 years) with a high cardiovascular risk, which was stratified using Systematic Coronary Risk Evaluation (SCORE) model by the presence of cardiovascular disease, and/or diabetes, and/or age ≥65 years, and/or blood pressure (BP) >180/110 mm Hg, and/or total cholesterol (TC) level >8,0 mmol/l. All study participants underwent clinical and paraclinical examination. Serum content of triglycerides (TGs) ≥1,7 mmol/L was considered hypertriglyceridemia (HTG). Depending on TG level, the entire sample was divided into 2 following subgroups: subgroup 1 (n=178) — serum triglycerides ≤1,6 mmol/l; subgroup 2 (n=94) — serum triglycerides ≥1,7 mmol/l, i.e. HTG.Results. We revealed significantly more persons with obesity (46,8%) and type 2 diabetes (28,7%) in HTG subgroup. There were 56,3% and 36,1% patients of HTG subgroup with hypertension (HTN) and coronary artery disease (CAD), respectively. A mid-high TG level (from 1,7 to 2,3 mmol/l) in the subgroup of patients with HTG was detected in 38,3% of cases. The serum content of TG from 2,3 to 5,6 mmol/l was detected in 54,2% of patients. TG level ≥5,6 mmol/l was detected in 7,5% of cases. In the subgroup of patients with HTG, high levels of systolic, diastolic and central (aortic) BP, body mass index, phosphorus, creatinine, cystatin C, estimated glomerular filtration rate (eGFR), and carotid intima-media thickness (IMT) were detected significantly more common. In the general sample, a significant direct relationship between TG concentration and cystatin C (r=0,168) and an inverse (negative) relationship with eGFR (r=-0,220) was obtained.Conclusion. Elevated serum TG levels are often observed in individuals with obesity, type 2 diabetes, hypertension and CAD. Patients with HTG had a pronounced cardiovascular and renal risk, including a significant increase in BP and carotid IMT, high levels of total cholesterol, low-density lipoprotein cholesterol, phosphorus, creatinine, cystatin C, and a decrease in eGFR. HTG was associated with an increase in serum cystatin C and a deterioration in renal nitrogen excretion.

Objective: To study the functional state of the kidneys in men and women with various types of cerebrovascular diseases (CVD)., Material and Methods: The study included 378 patients with CVD: transient ischemic attack (TIA), stroke (ischemic and hemorrhagic), and chronic brain ischemia. The average age of men and women was 61.4±13.0 and 63.8±11.8 years, respectively. The excretory function of the kidneys was assessed in all participants., Results: TIA was recorded in 20.9% of men and 13.4% of women. Stroke was verified in 35.7% of patients (56.4% men and 34.3% women, p< 0.05). Recurrent ischemic stroke was more common in men (12.9%) than in women (6.9%, p< 0.05). The frequency of proteinuria was 34.1%, with nephrotic proteinuria and hematuria more often noted in men. The functional state of the kidneys (optimal, slightly reduced, moderately reduced, and significantly reduced excretory function) was identified in 37.8%, 34.1%, 17.7%, and 6.3% of patients, respectively. Severely reduced kidney function was recorded in 3.4% of patients. The glomerular filtration rate according to the CKD-EPI (67.9±24.1 ml/min), MDRD (62.9±22.8 ml/min), and Cockcroft-Gault (67.7±24.4 ml/min) formulas was lower in men compared to women (78.3±25.3 ml/min, 76.3±3.2 ml/min, 81.2±36.5 ml/min, p< 0.05). In men and women, a correlation was established between pathomorphological changes on brain MRI and the level of red blood cells, glucose, total cholesterol and creatinine., Conclusion: In patients with CVD, the frequency of proteinuria is 34.1%. Nephrotic proteinuria and hematuria are more common in men. Changes in the functional state of the kidneys are manifested as slight and moderate reductions in excretory function. In women, the excretory function of the kidneys and proteinuria are closely related to pathomorphological changes in the brain.

The defeat of the kidneys during obesity is a complex multifactor process, which is a whole cascade of mechanisms. A special role in this chain is given to leptin a hormone fatty tissue. The role of this hormone as a biomarker damage to the kidneys in obese patients was our scientific interest. A clinical study of 110 patients treated in the outpatient department of the Central Consultative and Diagnostic Polyclinic No. 1 of Tashkent city was conducted, divided into 2 groups: group I (n = 55) – patients with obesity and chronic kidney disease; group II (n = 55) – patients with obesity without chronic kidney disease.The control group included practically healthy volunteers from among patients and hospital staff belonging to that age group who do not have hypertension and abdominal obesity.The paper presents data on the evaluation of the functional state of the kidneys in the analyzed groups, the role of leptin in the progression of renal dysfunction in obese patients is determined. It was noted that in obese patients, there are more pronounced functional changes in the kidneys (microalbuminuria, increased leptin levels, decreased glomerular filtration rate). The study found that in patients with obesity that do not have routine clinical laboratory data for renal damage, microalbuminuria is detected in the 1st obesity group with chronic kidney disease 41,7 ± 1,68 mg/l, and in the control group 15,3 ± 0,85 mg/l. Based on the data obtained, the calculation of the glomerular filtration rate according to the chronic kidney disease EPI 2011 formula. (ml/min/1,73 m2) in obesity patients are preferable, since the detection of kidney lesion is greater in patients requiring a special examination, correction of therapy and dynamic observation.It has been shown that microalbuminuria and leptin are among the early markers of kidney damage in obesity. The levels of leptin, plasma insulin and microalbuminuria are significantly higher in obese patients.In patients with obesity in combination with nephropathy, significant correlations between the level of leptin, microalbuminuria and lipid and carbohydrate metabolism were revealed. Application in the clinical practice of determining the level of carbohydrate, lipid exchange indicators, insulin resistance index and serum leptin is a perspective for diagnosing a renal lesion during obesity.

In recent decades, there has been an increase in the prevalence of overweight and obesity. Obesity has become an underestimated pandemic and a public health threat around the world. Adipose tissue is positioned as an endocrine organ that secretes a wide range of pro-inflammatory cytokines and adipokines, inducing a state of chronic subinflammation. The results of epidemiological studies over the past 30 years have also shown that visceral adipose tissue is an independent risk factor for the development of atherosclerosis, cardiometabolic diseases and chronic kidney disease. We performed a systematic review to summarize important aspects of the state of chronic subinflammation in the context of its effect on the decrease in glomerular filtration rate and the development of chronic kidney disease. The review deals with the etiology and pathogenesis of obesity, the hormonal profile of adipose tissue, the molecular mechanisms of the effect of pro-inflammatory cytokines and adipokines on the kidneys, and the pathophysiology of renal diseases. Information on the topic from publications based on the Pubmed database has been used.

Introduction. An original research work was performed to assess split kidney function by glomerular filtration rate (GFR) with mathematical analysis of the kidneys computed tomography (CT) data in patients with kidney stone disease (KSD). Objective was to evaluate the GFR and the parenchyma structure of each kidney and identify the possible patterns of contrast medium intrarenal transport with mathematical analysis of the kidneys CT data in patients with KSD.Materials and methods. Data of 27 patients of both genders with KSD were retrospectively analyzed. To evaluate GFR separately for each kidney we analyzed the data of contrast-enhanced CT (GFR reference values are 0.55 % of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size ≤1,5-2,0 cm, no obstruction of the urine flow registered; 3) no kidney or upper urinary tract surgical history; 4) age - ≤45 years; 5) no severe chronic diseases. All of these allowed to minimize influence of any other disorders on split renal function except for SKD and conduct per se research.Results. The mathematic analysis of the contrast-enhanced CT data revealed GFR changes in 26 (96.3 %) out of 27 patients. Hyperfiltration was found in 12 (44.4 %) patients: right kidney GFR - 0.6-0.77 %, mean value - 0.65 %; left kidney GFR - 0.59-0.79 %, mean value - 0.67 %. Hypofiltration was found in 13 (48.1 %) patients: right kidney GFR - 0.2-0.54 %, mean value - 0.37 %; left kidney GFR - 0.2-0.53 %, mean value - 0.4 %. The GFR values significantly differed between the groups both for the right (p = 0.000014) and left (p = 0.000045) kidneys. We found no significant age-related difference between the groups (p = 0.895). As well as that no significant differences in Resistance Index both in magistral (right kidney: p = 0.221; left kidney: p = 0.850) and segmental (right kidney: p = 0.306; left kidney: p = 0.957) arteries between the groups with hyperfiltration and hypofiltration were observed. One patient demonstrated no changes in GFR, and the other one had hyperfiltration (0,62 %) in one kidney and hypofiltration (0,48 %) in another.Conclusion. Most of the patients (92.6 %) with SKD demonstrate GFR changes (either hyperfiltration or hypofiltration) that may indicate the disturbed intrarenal blood and urine flow through the kidney.

Infectious process is an important cause of morbidity and mortality among patients with chronic kidney disease. Prescription of antibacterial drugs should take into account the pharmacokinetic parameters of the medicine and the individual characteristics of the patient. Adequate antibiotic dosing is crucial for positive treatment outcome and minimisation of side effects. The aim of the study was to analyse scientific literature on factors affecting the dosing of antibacterials in patients with chronic kidney disease. Since most antibacterial medicines are eliminated by the kidneys, a decrease in glomerular filtration rate or kidney function should be followed by the dose adjustment in order to prevent the medicine accumulation and reduce the risk of side effects. Antibiotic dosing in such patients should be accompanied by kidney function assessment and be adjusted to ensure effective and safe treatment, as well as prevention of bacterial resistance. The review provides data on the dosing of some antibiotic groups (beta-lactams, aminoglycosides, fluoroquinolones) at different creatinine clearance rates. Extrarenal excretion of medicines does not usually require the dose adjustment in patients with chronic kidney disease.

The article is devoted to modern approaches to the treatment of diabetes mellitus complicated by kidney damage. Diabetes mellitus is the most important problem of modern medicine, which is primarily due to the high prevalence of the disease among the working-age population. Diabetic nephropathy is one of the severe chronic complications of diabetes, which increases the disability and mortality of patients. Diabetic nephropathy is the main cause of the development of end-stage renal failure in developed countries and eventually affects about 30% of patients. Kidney damage in patients with diabetes occurs in 6-7% of cases out of the total number of nephropathies in patients receiving treatment in a specialized nephrological department of a multidisciplinary hospital. The first manifestations of diabetic nephropathy develop 3-4 years after the onset of the disease, and reach their peak in 15-20 years. The concept of «chronic kidney disease» includes kidney damage regardless of the primary diagnosis and is characterized by such basic diagnostic criteria as urinary albumin excretion and glomerular filtration rate values, which are markers of kidney damage. Methods for preventing the progression of diabetic nephropathy include general measures to change the lifestyle, control of glycemia and blood pressure, correction of lipid metabolism disorders in combination with nephroprotective therapy. Currently, when choosing therapy in patients with type 2 diabetes mellitus in combination with chronic kidney disease, along with taking metformin, preference is given to sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 receptor agonists with a nephroprotective effect.

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p < 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

Rationale: Acute infectious diarrhea (AID) is the fourth leading cause of death among children < 5 years worldwide. Kidney damage is one of the poorly studied aspects of pediatric AID. The level of serum cystatin C is independent on gender and age, and it is highly informative even in the early stages of renal dysfunction.Aim: To optimize diagnosis of renal dysfunction in children with moderate AID through comparison of different methods of glomerular filtration rate (GFR) calculation and determination of serum cystatin C level.Materials and methods: Observational cross-sectional study enrolled 80 children in pediatric hospital with moderate AID not followed by hemolytic uremic syndrome. Serum creatinine and serum cystatin C levels were determined in all the patients in acute period with GFR calculating according to Schwartz equation in unmodified (1976) and modified (2009) versions. GFR was also calculated using a single-factor equation based on serum cystatin C level.Results: GFR in acute period, calculated according to unmodified and to modified Schwartz equation was in patients < 3 years (n = 40) 115.47 ± 3.33 ml/min/1.73 m2 and 98.56 ± 2.84 ml/min/1.73 m2 (p < 0.001), in patients 3-7 years 132.13 ± 4.2 ml/min/1.73 m2 and 108.85 ± 3.84 ml/min/1.73 m2 (p < 0.001), respectively. Increased serum cystatin C level (> 950 ng/ml) occurred in 18 patients (22%). In other patients level of serum cystatin C remained within the reference range or lower. The risk of acute kidney injury development based on two indicators - GFR according to the modified Schwartz equation and GFR according to the equation used cystatin C level - occurred in 4 (10%) patients aged 1-3 years and in 1 (2.5%) child in the age group 3-7 years; risk, based on one indicator - the calculation of GFR according to the formula using cystatin C - in 8 (20%) and 9 (22.5%) children, respectively, and based on the assessment of only GFR according to the modified Schwartz equation - in 3 (7.5%) children of both age groups.Conclusion: We have confirmed that the GFR values calculated with usage of unmodified Schwartz equation (1976) are higher than those calculated with usage of modified Schwartz equation (2009) and taking into account the level of cystatin C.Thus, usage of unmodified Schwartz equation for GFR calculation in infants and preschool children seems incorrect. Level of serum cystatin C is promising marker permitted to select patients with risk of acute kidney injury development among children in acute period of moderate AID.

The presented review discusses the mechanisms of development, the issues of diagnosis and the possibility of therapy for IgAnephropathy. IgA-nephropathy is an immunocomplex lesion of the glomeruli, characterized by the predominant deposition of immunoglobulin A in the mesangia. IgA-nephropathy meets all the criteria of an immune-inflammatory disease and is a common type of chronic glomerulonephritis in all countries of the world. Changes in the molecular structure of IgA, disturbances in the processes of its glycosylation and polymerization, as well as the deposition of polymeric IgAl in the glomerular mesangium underlie the pathogenesis of the disease. There are primary, secondary, sporadic and familial forms of IgA-nephropathy. According to the clinical course, the classical, asymptomatic and atypical variants of the course of IgA-nephropathy are distinguished. Clinical manifestations of IgA-nephropathy consist of macro- or microhematuria, proteinuria and arterial hypertension. The final diagnosis is made with nephrobiopsy. Differential diagnosis is made between urolithiasis, renal tumor, secondary nephropathy, Alport syndrome, disease of thin basement membranes. In the treatment of IgA-nephropathy, blockers of the renin-angiotensin-aldosterone system are used; a positive effect of tonsillectomy is possible. Glucocorticoids and cytostatics are recommended for nephrotic proteinuria, rapid disease progression, or signs of renal activity on morphological examination. The prognosis is good, although approximately 40% of patients develop dialysis-dependent end-stage renal disease after 15 to 20 years.

Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.

The history of glomerular filtration rate assessment is presented, an important step of which was the glomerular filtration rate evaluation by the endogenous creatinine clearance (known as the RehbergTareev test). The article highlights the diagnostic value of the RehbergTareev test and its place among modern methods for assessing glomerular filtration rate.

Type 2 diabetes mellitus (T2DM) is the cause of the development of diabetic nephropathy — a complication that determines the high degree of disability and mortality of such patients. Until recently, approaches to normalizing glucose levels did not have a significant possibility of influencing the outcome of kidney damage in diabetes. Type 2 sodium glucose cotransporter inhibitors (SGLT2) are a new class of glucose-lowering drugs that improve glycemic control due to an insulin-independent mechanism of action associated with increased urinary glucose excretion. The review provides an analysis of the results of studies on the assessment of nephroprotective actions — one of the pleiotropic actions of this drugs group. These materials show the properties of SGLT2 inhibitors to reduce the risk of developing and the progression of albuminuria, to save glomerular filtration rate, to reduce the frequency of end-stage renal disease and the need for renal replacement therapy in patients with T2DM. The article gives and analyzes the currently existing hypotheses of the mechanism of action of these glucose-lowering drugs. The risk of the most common renal complications with the use of SGLT2 inhibitors is considered. The practical aspects of the use of SGLT2 inhibitors in modern algorithms for the care of patients with T2DM are indicated, as well as the prospects for new randomized clinical trials.

Introduction. At present, it is obvious that the prognosis for the life of patients with essential hypertension, according to the cardiovascular continuum, is clearly determined primarily by the involvement in the pathological process of target organs and the severity of their structural and functional changes.The aim of the study is to identify the clinical-diagnostic and prognostic value of B2-MGU as a marker of kidney damage in essential hypertension.Materials and methods. To achieve this goal, 46 patients with essential hypertension (45.65% women and 54.35% men) aged from 28 to 71 years (mean age was 51.88 ± 2.17 years), I-II stage of the disease with level of hypertension I-III degree, varying degrees of risk, who did not receive systematic adequate antihypertensive therapy and in which as a result of comprehensive clinical, laboratory and instrumental studies there were no evidence of clinically significant chronic kidney disease. The control group consisted of 17 healthy individuals.Results. In patients with essential hypertension is forming hypertensive nephropathy, which is characterized by statistically significant excessive excretion of beta-2-microglobulin in the urine compared with almost healthy individuals. In patients with increased excretion of beta-2-microglobulin violations of intrarenal hemodynamics were registered significantly more often, violations of functional renal reserve, violations of vascular resistance of renal vessels, in a significantly higher percentage there were pathological changes in circadian rhythm of blood pressure and renal filtration function, the prevalence of concentric and eccentric hypertrophy, proteinuria, which indicates an important clinical, diagnostic and prognostic value of hyper-beta-2-microglobulinuria.Conclusions. The indicator beta-2-microglobulinuria can be used as an adequate marker of hypertensive nephropathy, as having high sensitivity, specificity, positive and negative prognosis.

Chronic kidney disease (CKD) is characterized by increasing prevalence, catalyzing properties in relation to cardiovascular and general mortality, and, in most cases, is asymptomatic, which means late diagnostic verifiability. The global average prevalence of CKD is 13.4%, and CKD C3-5 is 10.6%. The main causes of CKD C5 are diabetes mellitus (DM, 46.9%), hypertension (28.8%) and to a lesser extent, glomerulonephritis (7.1%) and polycystic diseases (2.8%), while other causes account for a total of 14.4%. Despite the simple diagnosis of CKD, one of the key problems of modern therapeutic and pediatric clinics is its low detection rate at the early stages, which, according to some data, reaches 96.6%. This review provides data on the criteria for the diagnosis of CKD, as well as more detailed consideration of the course of CKD in patients with DM, hypertension, and heart failure. Attention is paid to the medicinal origin of CKD, as well as to the development of anxiety and depressive disorders in CKD. General issues of treatment of patients with CKD are considered in detail. Lifestyle changes are an important part of the fight against the development and progression of CKD. Currently, Smoking, alcohol, and physical inactivity have been shown to have a harmful effect on the risk of developing and progressing CKD. Diet plays a certain preventive role. The main drugs with nephroprotective properties are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both classes of drugs are effective in proteinuric forms of nephropathies and in combination/association of CKD with diabetes or hypertension. The review also provides data on the nephroprotective properties of mineralocorticoid receptor antagonists, endothelin receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Given the high importance of identifying and effectively treating patients with CKD, it is necessary to focus on early detection of CKD, especially in high-risk groups. It is necessary to raise public awareness by creating and implementing programs for primary prevention of CKD, as well as awareness of patients, motivating them to follow the doctor's recommendations for a long time, including as part of the implementation of a non-drug strategy to combat CKD. It is important to use the full range of methods of drug therapy for CKD, including measures of universal nephroprotection. It should be remembered that the cost of late diagnosis of CKD is a reduction in life expectancy, primarily due to high rates of cardiovascular mortality, disability, and high-cost medication and kidney replacement therapy.

Aim. To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity. Materials and methods. We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared. Results. In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed. Conclusion. Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.

Chronic kidney disease (CKD) is a complex of syndromes that occurs as an outcome of various kidney diseases or as a complication caused by diseases of other organs; it often exerts maximum influence on prognosis for a primary disease. It seems an urgent task to improve early CKD diagnostics and reveal risk factors that can cause unfavorable clinical course and development of the pathology. Finding solution to this task will allow reducing terms and improving organization of specialized medical aid provided for patients. The issue related to detection of health risk factors is especially pressing in countries with low and middle incomes. National and international efforts aimed at preventing, detecting, and treating chronic kidney diseases are necessary for decreasing worldwide mortality and morbidity. The article presents a review of literature data accumulated in PubMed, Elsevier, and Google Scholar databases on epidemiologic issues concerning chronic kidney diseases. We managed to find more than 150 materials; more than 40 articles out of them were analyzed and they turned out to dwell on different aspects of the issue. Special attention is paid to CKD prevalence among population depending on a country, ethnic group, age, and sex as well as to examining risk factors occurring in a specific region or a country. Literature analysis allowed concluding that CKD prevalence has grown substantially over the last 10 years. Among risk factors there are medical parameters (prevalence of chronic cardiovascular diseases and endocrine system diseases) and social and demographic conditions. It is shown that CKD tends to occur more frequently among people from black race than those from other races. But black people have higher survivability after dialysis than their white counterparts from the same age groups. Awareness about CKD risk factors among population and doctors providing primary medical assistance predetermines efficiency of early diagnostic and further treatment of the disease in low income countries

Aim. To study the influence of social determinants on the frequency of glomerular filtration rate (GFR) categories of various levels, as well as associations with a number of cardiovascular diseases (CVD) and cardiovascular risk factors among the population of four Russian regions included in the ESSE-RF-2.Material and methods. The study was performed as part of a multicenter epidemiological study “Epidemiology of cardiovascular diseases in the regions of the Russian Federation. The second study (ESSE-RF-2)”. In total, 6681 people 25-64 years old from 4 regions of Russian Federation were included in the analysis. The CKD-EPI formula was used to calculate GFR by blood creatinine level. Groups with normal GFR (≥90 ml/min/1.73 m²), with an initial decrease in GFR (

Aim of the study was to investigate glomerular filtration rate in population of 25–45 years old young people of Novosibirsk city. Material and methods. A survey of Novosibirsk typical district’s population has been carried out by the Institute of Internal and Preventive Medicine since 2013 to 2016. 1074 people (467 males and 607 females of 25–45 years old) have been included into the survey. The levels of glomerular filtration rate (GFR) were chosen according to KDIGO (2012) recommendation, such as: GFR more than 90 ml/min/1.73 cm2 – high or optimal, 60–89 ml/min/1.73 cm2 – slightly reduced, 45–59 ml/min/1.73 cm2 – moderately reduced, 30–44 ml/min/1.73 cm2 – vastly reduced, 1529 ml/min/1.73 cm2 – highly reduced, lower than 15 ml/min/1.73 cm2 – terminal renal failure. Results and discussion. Average GFR(CKD-EPI) level in all age groups was 99,9 ml/min/1.73 cm2 . Average GFR(CKD-EPI) was 104.41 ml/min/1.73 cm2 in 25–34 age group. Male average GFR(CKD-EPI) levels in appropriate age groups were reliably higher comparing to female levels. Both male and female analyzed indicators turned out to be reliably lower in older group than in the younger one. 95.1 % of male participants at the age from 25 to 34 years old had GFR ≥ 90 ml/min/1.73 cm2 , while female indicator was 76.9 %. The indicators in the age group from 35–45 years old were: for males – 86.4 %, for females – 58.3 %. Both male and female groups at the age from 35 to 45 contained people with GFR < 60.ml/min/1.73 cm2 (2 men – 0,8 %; 1 woman – 0.4 %). While GFR calculating according to MDRD and CKD-EPI formulas two dissimilar results were revealed. The advantages of CKD-EPI formulas calculating for higher GFR indicators have been evidenced.

Renal cell carcinoma (RCC) accounts for 3.9 % of all cancers. In 2018, 24,291 and 63,990 new cases of RCC were recorded in Russia and the US, respectively. The most common approach to early stage RCC treatment consists in either radical or partial nephrectomy. This article presents a clinical case of the successful treatment of a localized renal cell carcinoma T3аN0M0 in a 65-year-old man. 8 weeks after the performed kidney resection, the biochemical blood parameters and glomerular filtration rate did not significantly differ from the initial values (p > 0.05). A control CT examination of the abdominal cavity and the retroperitoneal space (after 12 weeks) detected no enlarged regional, paraaortic and paracanal lymph nodes. Partial nephrectomy is considered to be an alternative surgical treatment of localized RCC forms due to its potential for maximal organ preservation. Partial nephrectomy should be a method of choice in cases where it is technically and strategically feasible, since this type of surgical intervention provides for a better preservation of renal function under a lower risk of postoperative complications.

Aim. To assess the significance of changes cystatin C-based estimated glomerular filtration rate (eGFRcys) in predicting inhospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI).Material and methods. In 133 patients with STEMI, serum creatinine and cystatin C were determined. Creatinine clearance (CrCl) was estimated according to Cockcroft-Gault equation. Creatinine-based estimated glomerular filtration rate (eGFRcr) was assessed using the MDRD (eGFRcr_MDRD) and CKD-EPI 2009 (eGFRcr_CKD-EPI). In addition, eGFRcys and a combination of serum creatinine and cystatin C (eGFRcr-cys) was assessed using the CKD-EPI 2012 equation at admission and 24-48 hours after PCI. In the groups of deceased patients and survivors, the studied parameters were compared. Their relationship with imhospital mortality was assessed by logistic regression adjusted for acute kidney injury (AKI) and GRACE risk. To assess the informativeness of identified independent predictors, an ROC analysis was performed.Results. After PCI, serum creatinine level increased by 9,8%, cystatin C — by 38,2%. CrCl decreased by 9,0%, eGFRcr_MDRD — by 10,2%, eGFRcr_CKD-EPI — by 5,2%, eGFRcys — by 29,5%, eGFRcr-cys — by 19,3%. AKI was diagnosed in 21 people (15,8%). Among the deceased patients (n=12), compared with the survivors, serum creatinine level was higher at baseline and after PCI, cystatin C — after PCI, eGFR of any calculation method was lower, while AKI developed more often. According to multivariate regression analysis, the eGFRcr-cys after PCI and the GRACE risk score were independent predictors of the endpoint. The area under the ROC curve for eGFRcr-cys after PCI was 0,835 [0,712-0,958], while the cut-off point was 38 ml/min/1,73 m2, below which the odds ratio of developing a fatal outcome was 22,2 with a 95% confidence interval of 5,7- 86,8.Conclusion. Estimated GFR determined 24-48 h after PCI based on the combination of serum creatinine and cystatin C using the CKD-EPI 2012 equation was an independent predictor of inhospital mortality in STEMI. The cut-off point of this parameter was 38 ml/min/1,73 m2, below which the death risk increases significantly. The results indicate the viability of introducing novel methods for assessing renal function based on cystatin C to improve the quality of prediction in STEMI.

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Objective: to study the risk factors for acute renal injury, the dynamics of renal function and prognosis in patients with acute coronary syndrome with ST-segment elevation (STEACS) with contrast-induced nephropathy (CIN) after primary percutaneous coronary intervention (PCI).Materials and methods. We studied 20 patients with STEACS, who developed СIN after PCI (follow-up group), and 98 patients with STEACS without СIN (comparison group). All patients were measured plasma creatinine level and glomerular filtration rate by the formula CKD-EPI before and 48 hours after PCI. CIN was detected with an increase in creatinine levels in the blood by more than 26.5 µmol / l from the baseline 48 hours after administration of radiopaque drug (RCP). Endpoints were evaluated at the hospital stage and within 12 months after PCI.Results. CIN after PCI occurred in 16.9 % of patients with STEACS. Among patients with СIN, persons aged over 75 years (60 %), with diabetes mellitus (45 %), chronic kidney disease (75 %), postinfarction cardiosclerosis (50 %), chronic heart failure of functional class III–IV (80 %), developed acute heart failure T. Killip III–IV (90 %) were significantly more often observed. The left ventricular ejection fraction was lower in patients with СIN (p

BACKGROUND: A growing body of evidence demonstrates increasing prevalence of normoalbuminuric chronic kidney disease (NA-CKD) in subjects with type 2 diabetes (T2D), while proportion of albuminuric pattern is decreasing. AIMS: To determine the clinical and laboratory parameters associated with different patterns of CKD in patients with T2D. METHODS: This observational, single-center, cross-sectional study included 360 patients with T2D duration ≥10 years. Patients with urinary albumin/creatinine ratio (UACR) 60 ml/min/1.73 m2 were classified as no-CKD group (n=89). Patients with UACR 1 (p=0.01) and HbA1c levels >8% (p=0.005). The duration of T2D ≥15 years (p=0.01) and the use of dihydropyridine calcium channel blockers (p=0.01) were associated with A-CKD+. In T2D groups, the urinary excretion of nephrin and podocin was increased (all p

Objective of the study. To assess the clinical and pathogenetic significance of serum interleukin-6 (IL-6) in patients with chronic kidney disease.Materials and methods. A cross-sectional study enrolled 288 patients with chronic kidney disease (CKD) aged 16 to 86 years, average age (54.5 ± 14.5) years. The study enrolled 146 (50.7%) women and 142 (49.3%) men. Depending on the value of estimated glomerular filtration rate (eGFR), all the examined patients were divided into two groups: 1st (n = 154) - persons with eGFR > 60 ml/min; 2nd (n = 134) - patients with eGFR < 60 ml/min, i.e. renal failure. CKD was identified when there was evidence of damaged and/or reduced renal function. Glomerular filtration rate was calculated using the Hoek equation based on measurement of serum cystatin C, and severity of CKD was based on eGFR values. All patients had concentration of creatinine, cystatin C and IL-6 in their blood serum studied.Results. In the 2nd group of patients with eGFR below 60 ml/min, average age [(57.9 ± 14.5) years vs. (51.6 ± 13.9) years; p < 0.05], systolic blood pressure [(142 ± 24) mm Hg vs. (133 ± 22) mm Hg; p < 0.05], cystatin C [1.815 (1.430-3.070) mg/l vs. 0.980 (0.900-1.100) mg/l; p < 0.05)] and IL-6 [2.761 (1.400-6.495) pg/ml vs. 1.754 (0.849-3.226) pg/ml; p < 0.05)] levels in blood serum were significantly higher compared with the 1st group. An inverse correlation was found between serum IL-6 and eGFR level (r = -0.144; p = 0.018).Conclusion. In patients with chronic kidney disease with an eGFR level below 60 ml/min, an increase in systolic blood pressure and serum IL-6 concentration was observed. In chronic kidney disease, an increase in the content of IL-6 was accompanied by a decrease in glomerular filtration rate and an increase in diastolic blood pressure.

The clinical study enrolled 120 patients, who were hospitalized to the Therapeutic Department of Republican Clinical Hospital No. 5 of Saransk. The patients were divided into 2 groups: Group I (n = 60) included patients with metabolic syndrome; Group II (n = 60) included patients with arterial hypertension. The paper presents data on the assessment of the functional state of kidneys in the analysed groups, defines the role of metabolic disorders in the progression of renal dysfunction in patients with metabolic syndrome and arterial hypertension. It is noted that more pronounced functional changes in the kidneys (microalbuminuria, increased cystatin C levels, decreased glomerular filtration rate) are detected in patients with arterial hypertension and metabolic syndrome, as compared with patients without metabolic disorders. Cystatin C and microalbuminuria have been shown to be one of the earliest markers of kidney damage in hypertension, especially in combination with metabolic disorders. Cystatin C and microalbuminuria level is significantly higher in patients with arterial hypertension and metabolic syndrome, as compared with patients with arterial hypertension, who have no metabolic disorders. Significant correlations were found between cystatin C, microalbuminuria levels and lipid and carbohydrate metabolism in patients with arterial hypertension in combination with metabolic disorders.

Objective: Assessment of the prevalence causes and risk factors for the development of chronic kidney disease (CKD) in the Republic of Tajikistan Methods: Screening of CKD and risk factors for its development among 374 persons in the course of scheduled prophylactic examinations in the urban health centers of Dushanbe city in 2017. The age of residents ranged from 18 to 82 years, averaging 55.2±12.3 years. Of these, 201 (53.7%) were females, 173 (46.3%) were males. The average weight of the examined was 85.9±11.2 kg, height – 168.3±6.92 cm, and body mass index (BMI) – 30.4±3.75. CKD was established on the basis of albuminuria, a reduction in glomerular filtration rate (GFR) and the identification of risk factors. Results: Albuminuria was detected in 63 (16.8%) residents (29 men; 34 women), more often among the age group 45-74 years (46 cases), as well as among patients with the first (n=34) and the second (n=11) degrees of obesity. Increased creatinine level in venous blood was detected in 37 patients with albuminuria (average concentration 165.5±52.5 μmol/l), mainly among people aged 45-74 years (n=23). A decrease in GFR was detected in 18 (9.9% of the total number of the examined) men and 19 (9.9% of the total number of the examined) women. A population-based screening of CKD based on the results of albuminuria, endogenous creatinine, and GFR, and other risk factors allowed us to identify various stages of CKD out of 63 cases of the positive result of albuminuria in 37 cases, which was 9.9%. The first stage of CKD was in 8 (21.6%) patients, the second stage in 15 (40.5%) patients, the third stage in 12 (32.4%) cases, and the fourth stage in 2 (5.4%) cases. Depending on age, CKD prevailed among people aged 45-74 years (62.1%). In young people (18-44 years), it occurred in 9 (24.3%) cases, and in elderly patients (75-90 years) – in 5 (13.5%) cases. Depending on the gender of the surveyed, various stages of CKD occurred in 18 (48.6%) men and 19 (51.4%) women, the diagnosis of CKD among the general population in men was 10.9%, in women – 8.9%. Conclusion: The incidence of CKD among the general population was 9.9%. Diagnosis of CKD is based on the determination of GFR and the detection of albuminuria. For the early diagnosis of CKD and adequate treatment, an algorithm has been proposed that is acceptable both economically and in terms of use in daily clinical practice.

Cardiorenal syndrome in patients with heart failure is a regular link in the chain of cardiorenal continuum. Physicians of various specialties may encounter patients with cardiorenal syndrome: general practitioners, cardiologists, nephrologists, resuscitators, anesthetists, cardiac surgeons, etc. The currently definition, classification, pathogenesis, diagnosis and epidemiology of cardiorenal syndrome in patients with heart failure were presented in first part of our review. In the second part, prognosis, approaches to the prevention and treatment of cardiorenal syndrome in patients with heart failure are discussed. They include the treatment of cardiovascular pathology and heart failure in accordance with current guidelines for the prevention of episodes of acute and decompensated chronic heart failure; diet; smoking cessation, alcohol, nephrotoxic substances; body weight, blood pressure and glycemia control; angiotensin converting enzyme inhibitors, angiotensin receptor antagonists or angiotensin receptors and neprilisin inhibitors (ARNI), statins; reducing of the abdominal pressure and others. It is necessary to develop and introduce new approaches to nephroprotection in patients with cardiorenal syndrome, which is possible with the joint work of a multidisciplinary team.

The article is devoted to analysis of relationship of left ventricular remodeling, plasma renin level, glomerular filtration rate in patients with arterial hypertension and renal additional arteries. It is shown that hormonal and hemodynamic factors in young patients with arterial hypertension of 1–2 degrees with renal additional arteries create a load on left ventricle, contributing to pathological myocardial remodeling in the form of eccentric hypertrophy and concentric remodeling.

The article is devoted to the topical problem — evaluation of renal function in patients with ankylosing spondylitis. This group of patients has an increased risk of chronic kidney disease, due to the presence of autoimmune disease, chronic systemic inflammation, and long-term use of cytotoxic, non-steroidal anti-inflammatory drugs. It was found that most of the patients have a violation of the filtering ability of the kidneys.

In order to identify and stratify kidney dysfunction in children in accordance with the concept of chronic kidney disease, 125 patients aged 4–18 years with type 1 diabetes mellitus were examined. The main categories were identified: albuminuria and glomerular filtration rate. A comparative analysis of the calculation of GFR by two methods — using the Schwarz formula and the level of cystatin C in the blood plasma — indicates that the latter is much more informative in children.

Aim: To evaluate the impact of a decrease in glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyze real clinical practice regarding the frequency of prescribing pathogenetic therapy for CHF, achieving target dosages depending on the gradation of GFR in patients included in the CHF Register of the Tyumen region., Materials and Methods: The analysis included medical data of 4077 patients (1662 men and 2415 women) with NYHA class I-IV CHF who underwent examination and treatment in medical organizations of the Tyumen region for the period from January 2020 to May 2023. Criteria for inclusion in the register: proven heart failure. Chronic kidney disease (CKD) was assessed by GFR calculated using the CKD-EPI formula (ml/min/1.73 m 2 ). The primary end point was defined as death from all causes., Results: GFR<60 ml/min/1.73 m 2 was recorded in 34.6% of patients, more common in women (40.2 and 26.6%, respectively; p <0.001). When dividing patients into phenotypes according to LVEF, no statistically significant differences were found in the distribution of patients according to GFR. In patients with HFrEF and HFpEF GFR<45 ml/min/1.73 m 2 was associated with an increased risk of meeting the endpoint. Analysis of prescribed pathogenetic therapy showed that in patients with HFrEF, the frequency of prescription of ACE inhibitors, â-blockers and MRA decreased ( p =0.023, 006 and 0.01, respectively), and ARNI, on the contrary, increased with a decrease in GFR ( p =0.026). In patients with HFpEF, a similar trend towards a decrease in the frequency of prescription of ACEIs and MCBs with a decrease in GFR ( p <0.001) remained, but it was compensated by an inversely proportional increase in the frequency of prescription of ARBs ( p <0.001). 100% of the target dosage is achieved in more than 90% of patients taking MRA across the entire LVEF range. While for â-blockers and ARNI/ACE/ARB the percentage of patients receiving the full therapeutic dosage of drugs is significantly lower. When analyzing target dosages of pathogenetic drugs, gradations of achieved doses were distributed evenly throughout the entire range of GFR., Conclusion: GFR<60 ml/min/1.73 m 2 occurs in every 3 patients with CHF across the entire range of LVEF. A decrease in GFR worsens the prognosis of patients with both HFrEF and HFpEF, increasing in direct proportion with the severity of the stage of CKD. Inclusion of patients in the monitoring program within the framework of the CHF service allows the treatment to be significantly brought closer to optimal drug therapy, at the same time, certain efforts are required to overcome difficulties with titration to target dosages.