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The diagnosis of necrobiosis lipoidica is gaining significance owing to the increase in the incidence of diabetes mellitus. Several theories regarding the etiopathogenesis of necrobiosis lipoidica indicate the distinctive role of transport proteins of the Glut family, as well as the role of matrix metalloproteinase in the development of this dermatosis.

The results of clinical observation of a rare dermatosis, pyoderma gangrenosum, and results of successful complex treatment of the disease with systemic GCS, and cytostatic drugs are shown. The review of the literature on the etiology, pathogenesis, and diagnosis of GP is presented.

To determine the frequency, clinical and morphological features of a nephropathy with C1q deposits in chronic glomerulonephritis adult patients.296 specimens of kidneys of patients with a chronic glomerulonephritis (CGN) from 2014 for 2018 were analyzed. At the first step, specimens with C1q deposits in glomeruli revealed by immunofluorescent method were chosen. Lupus nephritis and primary membranoproliferative glomerulonephritis were exclusion criteria. At the second step, the retrospective analysis of the clinical characteristics was carried out.Deposits of C1q in kidneys at 12 of 296 (4.05%) CGN were revealed, m:f ratio 2:1. Average age of the beginning of a disease was 32.1±14.7 years. At a morphological research in 8 membranous nephropathy (MN), in 2 mesangioproliferative glomerulonephritis (MesPGN), in 2 - nephrosclerosis was revealed. Among 12 patients in 5 the disease debuted a nephrotic syndrome, at the others - a proteinuria from 0.5 to 4.0 g/days with the subsequent formation of a nephrotic syndrome. In 5 of 12 patients the disease was characterized by a favor course with preserved kidney function. At 7 patients at the time of inspection decrease in function of kidneys [glomerular filtration rate (eGFR) 31 (30-34) ml/min] was noted. 5 had slow progressing of a renal failure. 2 of 12 progressed to renal failure (eGFR to 19 and 24 ml/min) within a year.Deposits of C1q in kidney were revealed in 4.05% of biopsy specimens in CGN. The most frequent morphological form was the membranous nephropathy. The clinical course was characterized by a nephrotic syndrome, more than at a half of patients - with renal dysfunction.Цель исследования. Определить частоту выявления, клинические и морфологические особенности нефропатии с C1q депозитами среди взрослых больных хроническим гломерулонефритом (ХГН). Материалы и методы. Проанализировано 296 биоптатов почек больных ХГН, которым проведена биопсия почки за период с 2014 по 2018 г. На первом этапе были выделены биоптаты больных ХГН с отложениями C1q в клубочках почек, выявленными с помощью иммунофлюоресцентного метода. Критериями исключения были диагнозы системной красной волчанки с поражением почек (волчаночный нефрит) и первичного мембранопролиферативного гломерулонефрита. На втором этапе проведен ретроспективный анализ данных клинического обследования пациентов. Результаты и обсуждение. Отложения C1q в клубочках почек выявлены у 12 из 296 (4,05%) больных ХГН, соотношение мужчины : женщины составило 2:1. Средний возраст начала заболевания - 32,1±14,7 года. При морфологическом исследовании биоптатов почек на светооптическом уровне у 8 пациентов обнаружена мембранозная нефропатия (МН), у двух выявлен мезангиопролиферативный гломерулонефрит (МезГН), у двух - нефросклероз в исходе мезангиальных форм нефрита. Среди 12 больных у 5 заболевание дебютировало нефротическим синдромом, у остальных - протеинурией от 0,5 до 4,0 г/сут с последующим формированием нефротического синдрома. У 5 из 12 обследованных пациентов заболевание характеризовалось длительным течением с сохранной функцией почек. У 7 пациентов на момент обследования отмечалось снижение функции почек [скорость клубочковой фильтрации (СКФ) - 31 (30-34) мл/мин]. Из них у 5 отмечалось длительное течение до 6 лет и медленное прогрессирование почечной недостаточности. У двоих наблюдалось быстрое, в течение года, прогрессирование почечной недостаточности со снижением СКФ до 19 и 24 мл/мин (МПГН и МН). Заключение. Отложения C1q в клубочках почек выявлены в 4,05% биоптатов почек больных ХГН, наиболее частым морфологическим вариантом являлась МН. Клиническое течение характеризовалось нефротическим синдромом, более чем у половины больных - с нарушением функции почек.

BACKGROUND. Мonoclonal gammopathy (MG) is not only the state preceding of hematological neoplasms, but also associated with non- hematological diseases, in particular damage of kidneys. Earlier diagnosis of MG represents an important area in treating patients with renal diseases associated with MG. THE AIM: To determine the frequency of MG among therapeutic and nephrological patients for optimization of methods of their diagnosis and treatment. PATIENTS AND METHODS: In common, 11392 patients were analyzed within 4 years (2013-2016). The standard clinical examination was conducted. Method of an electrophoresis of proteins of serum of blood and the 24-hour urine, method of immunofixation of proteins of serum and urine, and method of free light chains definition in serum (Freelite) were used for MG identification. RESULTS: MG is diagnosed in 174 of 11392 patients: 49 % of men and 51 % of women aged from 18 up to 85 years. MG was found 2.1 times more often in nephrological patient than in patients of therapeutic departments. Among patients of this group, AL-amyloidosis with kidney involvement was diagnosed in 41 %, cryoglobulinemic glomerulonephritis – in 18 %, chronic glomerulonephritis – in 35 %, also there was small number of patients with light chain disease and cast-nephropathy. 86 % of nephrological patients had less than 5 g/l of monoclonal protein that corresponds oligo secretory MG, and at 46 % from them – less than 1 g/l, other 10 % had MG of 5-10 g/l, and only in 4.42 % of patients MG more 10g/l was defined. CONCLUSION: We conclude that MG, especially oligo secretory form, play a significant role in pathogenesis of renal damage. It is important to apply sensitive methods – immunofixation of proteins and method «Freelite» for nephrological patients.

Kidney involvement in the onset of lymphoproliferative diseases (LPD) detected rarely, observed mainly at tumor progression or relapse. Objective : to determine the clinical and morphological features of kidney damage in the initial manifestation of LPD. Materials and methods : 19 patients with LPD and kidney damage were included in the study. The diagnosis of non-Hodgkin’s lymphomas was established according to 2008 WHO classification. Histological and immunohistochemical, immunofluorescent and electron microscopic studies of nephrobiopsy have been performed. Results . Patients were aged 46-83 years (median 63 years), of which 13 were men and 6 women. Chronic lymphocytic leukemia / small cell lymphocytic lymphoma was established in 12 patients, marginal zone lymphoma – in 4 pts, follicular lymphoma – in 1 patient, Waldenstrom's macroglobulinemia – in 1 patient and diffuse large B-cell lymphoma (DLBCL) in 1 patient. Proteinuria was observed in 18 patients, microhematuria – in 6 pts, arterial hypertension – in 8 pts, nephrotic syndrome – in 3 pts and renal failure in 18 patients. The mean creatinine level was 330.9 ± 52.3 µmol/L, the average glomerular filtration rate was 25.7 ± 12.9 ml/min. Monoclonal IgMκ secretion was detected in 6 patients, BJκ protein – in 9 pts, increased free light chain level – in 4 pts, cryoglobulin – in 4 pts (type II cryoglobulin in 3 of them, type I – in 1 patient). Morphological study of nephrobiopsy revealed tumor lymphoid infiltration of kidney interstitium in 10 (52.6 %) cases. Diffuse small cell lymphoid proliferation was detected in 1 patient, local infiltration – in 9 pts, in 3 of them in combination with glomerulonephritis, and in 4 cases with kidney carcinoma. Local large cell lymphoid proliferation was found in 1 patient with DLBCL. Amyloidosis was detected in 2 pts and thrombotic microangiopathy – in 2 patients. Glomerulopathy was revealed in 10 patients (52.6 %): mesangioproliferative glomerulonephritis (MPGN) – in 4, mesangiocapillary glomerulonephritis – in 3, fibrillar glomerulonephritis (FGN) – in 1, immunotactoid glomerulonephritis – in 1, and glomerulonephritis with minimal changes – in 1 patient. Conclusion . Kidney damage in the onset of lymphatic tumor does not always manifest with proteinuria, hematuria, nephrotic syndrome and renal failure. In most cases, secretion of BJ protein, free light chains, monoclonal immunoglobulin and cryoglobulin are detected. Morphological changes are heterogeneous, including lymphoid proliferation, various types of glomerulopathies, amyloidosis and thrombotic microangiopathy.

Patient K., 44 years old, has been ill since November 2018, when for the first time, for no apparent reason, noted the appearance of a painful pustule in the anterior surface of the left leg. After spontaneous opening of the element, an ulcer was formed, characterized by rapid growth (in 14 days up to 8-9 cm in diameter). I turned to a dermatologist, after consultation, treatment was carried out (prednisolone 30 mg per day, antibacterial drugs, vascular therapy, non-steroidal anti-inflammatory drugs) with a positive effect in the form of a gradual, complete scarring of the ulcer.

Mycosis fungoides (MF) is the most common primary cutaneous epidermotropic T-cell lymphoma (80%). The accurate diagnosis of MF confirmed only by clinical, histological and immunohistochemical signs amounts to 50-75%.To investigate genetic markers (FOXP3, STAT4, IL-12B) for the early diagnosis of MF, to estimate the informative value of used diagnostic techniques (histology, immunophenotyping), and to determine clonality by the T-cell receptor γ-chain genes.Fifty patients with MF and plaque parapsoriasis (PP) who had been treated at the V.A. Rakhmanov Clinic of Skin and Venereal Diseases and at the National Medical Research Center for Hematology were followed up. A MF group consisted of 27 patients; a PP group included 23 patients, and a control group comprised 10 healthy individuals. The expression of the FOXP3, STAT4, and IL-12B genes was analyzed by TaqMan real time-PCR. The objectives of the study were affected skin portions from patients with MF or PP and healthy individuals.The investigation revealed a increase in the expression level of STAT4 mRNA transcripts by 9 times in patients with MF compared with those with PP and by 553 times in healthy individuals. There was also a statistically significant predominance of the expression level of STAT4 mRNA transcripts in patients with spotted and plaque stages of MF (180; 318) compared with those with PP and healthy individuals, as well as a sharp decrease in those with erythrodermic MF, which was statistically significant.MF cannot be diagnosed without comprehensively assessing the clinical, anamnestic, histological, immunophenotypic, and molecular genetic data. The expression level of STAT4 mRNA transcripts is of great importance for the early diagnosis of MF. Inclusion of the level of STAT4 expression in the list of diagnostic signs increases the accuracy of differential diagnosis of MF and PP from 59.1 to 81.8%, respectively.Грибовидный микоз (ГМ) является наиболее распространенной первичной эпидермотропной Т-клеточной лимфомой кожи (80%). Достоверность диагноза ГМ, подтвержденного только клиническими, гистологическими и иммуногистохимическими признаками, составляет 50-75%. Цель исследования - изучить генетические маркеры (FOXP3, STAT4, IL-12B) для ранней диагностики ГМ, а также оценить информативность используемых методов диагностики (гистологического, иммунофенотипического) и определить клональности по генам γ-цепи Т-клеточного рецептора. Материал и методы. Под наблюдением находились 50 пациентов с ГМ и бляшечным парапсориазом (БП), леченных на базе Клиники кожных и венерических болезней им. В.А. Рахманова и ФГБУ 'НМИЦ гематологии'. Группу ГМ составили 27 пациентов, группу БП - 23, группу контроля - 10 здоровых лиц. Анализ экспрессии генов FOXP3, STAT4, IL-12B проводили методом TaqMan Real time-ПЦР. Объектами исследования были пораженные участки кожи больных ГМ, БП и здоровых лиц. Результаты. В ходе исследования выявлено повышение уровня экспрессии мРНК транскриптов STAT4 у пациентов ГМ в 9 раз по сравнению с больными БП и в 553 раза - со здоровыми лицами. Также было отмечено статистически значимое преобладание уровня экспрессии мРНК транскриптов STAT4 у пациентов с пятнистой и бляшечной стадиями ГМ по сравнению с больными БП и здоровыми лицами, а также его резкое снижение у пациентов с эритродермической формой ГМ, что является статистически достоверным. Заключение. Диагностика ГМ невозможна без комплексной оценки клинико-анамнестических, гистологических, иммунофенотипических и молекулярно-генетических данных. Для ранней диагностики ГМ приобретает большое значение уровень экспрессии мРНК транскриптов STAT4. Включение уровня экспрессии STAT4 в список диагностических признаков повышает точность дифференциальной диагностики ГМ и БП с 59,1 до 81,8% соответственно.

C1q glomerulopathy is a rare variety of chronic glomerulonephritis manifested as C1q deposition revealed by immunofluorescence microscopy. The pathogenesis and etiology of the disease have not been studied. The paper deals with the results of clinical, morphological, immunofluorescence, and electron microscopic examinations in 13 patients with C1q glomerulopathy. Light microscopy more commonly revealed membranous nephropathy, mesangioproliferative glomerulonephritis, and nephrosclerosis. Immunofluorescence microscopy detected a C1q fraction in association with other deposits, more frequently IgM and IgG ones. A correlation was found between the clinical presentation and morphological form of chronic glomerulonephritis.C1q-гломерулопатия - редко встречающаяся разновидность хронического гломерулонефрита, при которой выявляется отложение C1q в депозитах при иммунофлюоресцентной микроскопии. Патогенез и этиология заболевания не изучены. Приведены результаты клинико-морфологического, иммунофлюоресцентного и электронно-микроскопического исследований у 13 пациентов с C1q-гломерулопатией. При световой микроскопии чаще выявлялись мембранозная нефропатия, мезангиопролиферативный гломерулонефрит, нефросклероз. При иммунофлюоресцентной микроскопии C1q-фракция обнаруживалась в ассоциации с другими компонентами депозитов, чаще IgM и IgG. Выявлена связь при сравнении клинических проявлений заболевания и морфологической формы хронического гломерулонефрита.

Renal cell carcinoma (RCC) ranks the first death rate among the urogenital tumors, whereas its incidence follows the incidences of prostate and bladder cancer. The diagnosis of RCC at early stages allows immediately undertaking appropriate treatment, which significantly increases patients' survival rate. Early and accurate diagnosis avoids inadequate treatment, provides the disease progression forecast, and permits to apply more efficient therapy. Unfortunately, the small renal tumors are usually asymptomatic resulting in the late diagnosis and, therefore, low efficacy of treatment. Thus, sensible and preventive biomarkers are essential for early RCC detection and monitoring of its progression. So far, many attempts were performed aimed at recognizing novel informative kidney tumor biomarkers applicable for early detection of the disease and possessing prognostic and predictive capabilities. This review summarizes recent advances in renal tumor biomarkers recognition, their diagnostic and prognostic values, and clinical feasibility.

BACKGROUND Early diagnosis of prostate cancer (CaP) can be addressed by studying prostatic intraepithelial neoplasia (PIN) as precancer (high-grade PIN or HGPIN). This article attempts to analyze the diagnostic role of telomerase as an early marker of carcinogenesis. METHODS Complex urological patient evaluation and assessment of telomerase activity. RESULTS Out of 92 patients 44% were diagnosed with CaP, 49% with low-grade PIN (LGPIN) in association with benign prostatic hyperplasia (BPH), and 7% with HGPIN in association with BPH. Active telomerase (AT) in prostate biopsy specimens was detected in 98% of patients with CaP, in 33% of patients with HGPIN, and in 20% of patients with LGPIN. In the event of simultaneous detection of AT and PIN in initial prostate biopsy specimens, further monitoring for 0.5–4.0 years revealed CaP development in 50–56% of cases. Further follow-up of patients with PIN and absent telomerase activity in initial biopsy specimens did not demonstrate the development of CaP. The PSA level was significantly higher in patients with active telomerase in the prostate tissue than in telomerase negative patients. CONCLUSIONS Telomerase activity in the prostate tissue increases the risk of CaP development in patients with PIN. Detection of telomerase activity in prostate biopsy specimens from patients with PIN enables selection of a group of patients with high risk of CaP development and reduction of the number of prostate biopsies performed in other patients. Prostate 74:1043–1051, 2014. © 2014 Wiley Periodicals, Inc.

The renal cell carcinoma is the ninth most common cancer with an increasing occurrence and mortality. Recoverin is the first retina-specific photoreceptor protein that was shown to undergo aberrant expression, due to its promoter demethylation, as a cancer-retina antigen in a number of malignant tumors. In this work, we demonstrated that recoverin is indeed expressed in 68.4 % of patients with different subtypes of renal cell carcinoma, and this expression has tendency to correlate with tumor size. Interestingly, 91.7 % of patients with the benign renal tumor, oncocytoma, express recoverin as well in their tumor. Epigenetic analysis of the recoverin gene promoter revealed a stable mosaic methylation pattern with the predominance of the methylated state, with the exception of -80 and 56 CpG dinucleotides (CpGs). While the recoverin expression does not correlate withoverall survival of the tumor patients, the methylation of the recoverin gene promoter at -80 position is associated with better overall survival of the patients. This work is the first report pointing towards the association of overall survival of renal cell carcinoma (RCC) patients with promoter methylation of a cancer-retina antigen. Taken together, these data allow to consider recoverin as a potential therapeutic target and/or marker for renal tumors.