Репозиторий Университета

© 2018; Pediatria Ltd. All rights reserved. Among the leading forms of socially significant pathology is chronic kidney disease (CKD), which has a variety of causes and often originates in early childhood. Risk factors and causes of CKD in children are associated with congenital anomalies in urinary tract (UT) development, accompanied by a persistent chronic infection, urodynamic disorder, remodeling of renal blood flow. Kidneys homeostatic functions disorder causes morphofunctional changes in various organs and tissues, incl. dentoalveolar system (DAS). The negative effect of CKD on the formation of maxillofacial region in children is studied. The data on disorders of jaw bones structures, temporomandibular joint (TMJ) and its function, oral cavity mucous membrane pathology, periodontal diseases, quantitative and qualitative changes in saliva, the defects of teeth hard tissues, pulp calcification caused by this pathology are systematized. The lack of a holistic view of DAS abnormalities development mechanisms in children with kidney damage makes it difficult for the dentist to conduct a timely diagnosis and combine work with doctors of other specialties, such as a pediatrician and a pediatric nephrologist. An integrated approach to managing children with CKD would allow to personify patient management tactics and improve treatment and rehabilitation results.

© 2018, Silicea-Poligraf. All rights reserved. The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Purpose of the study. To examine the frequency and risk factors for the development of diastolic dysfunction (DD) of the left ventricle (LV) of the heart in patients with chronic kidney disease (CKD). Materials and methods. The study included 225 patients with stage I-CKD of non-diabetic etiology (median age 47.0 years, 50.2% of women). Depending on the degree of decrease in the glomerular filtration rate (GFR), all patients were divided into 3 groups. Group 1 (n=70) consisted of patients with GFR 89-45 ml / min / 1.73 m2, group 2 (n=120) - patients with GFR 44-15 ml / min / 1.73 m2, group 3 (n=35) - patients with GFR <15 mL / min / 1.73 m2. The control group includes persons without CKD. All patients underwent general clinical examination and transthoracic echocardiography; in 86 patients the level of cystatin C in the blood serum was determined. Results. Hypertrophy of the left ventricle (LVH) of the heart was detected in 87 (38.7%) of 225 patients with CKD. Hypertrophic type (type I) of myocardial DD is diagnosed in 90 (41.4%) of 225 patients with CKD. The incidence of myocardial left ventricular dysfunction of the 1st type increased with a decrease in GFR, amounting to 30, 40 and 60% in groups 1, 2 and 3, respectively. The systolic function of the left ventricular myocardium was preserved. Patients with DD were older, they had a higher body mass index (BMI), a more pronounced decrease in GFR, a higher level of fibrinogen. They were more likely to have LVH. The level of cystatin C as the kidney function worsened, but when comparing the mean levels of cystatin C in patients with the presence / absence of DD in the groups isolated depending on the stage of CKD, no statistically significant differences were found. According to the multivariate analysis, the independent predictor of DD was the age (odds ratio 1.106, 95% confidence interval 1.051-1.157, p=0.00001). The conclusion. DD of the myocardium of the LV is detected on average in 40% of patients with CKD, the frequency of its development increases with the progression of renal dysfunction. The development of DD is influenced by traditional factors of cardiovascular risk (age, BMI), as well as the decline in GFR and closely related structural remodeling of LV myocardium.

© 2018 Media Sphera Publishing Group. All rights reserved. Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (ÑKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow- up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

© 2018 Media Sphera Publishing Group. All rights reserved. A review deals with the problem of chronic kidney disease (CKD) from the position of a physician and cardiologist. The epidemiology of the disease was discussed both abroad and in Russia, including the most up-to-date data. In Russia CKD markers were detected in 49.4% of hypertensives. Authors describe risk factors and mechanisms of CKD at the most important pathogenetic conditions: hypertension, diabetes and obesity. The current classification and methods for calculating the glomerular filtration rate are given. The review disclose a paradigm of the renal continuum and its relation to cardiovascular diseases. It is well known fact that the final causes of the death of patients with CKD, as a rule, are cardiovascular complications. Based on the literature data, the necessity and expediency of screening for renal dysfunction is justified. In the example of use of an angiotensin receptor blocker II - irbesartan nephroprotective demonstrated possibilities of intervention in patients with renal dysfunction of varying severity.

© 2018 S. Karger AG.All right reserved. Objective: to estimate the state and the rate of bone metabolism in women with chronic kidney disease (CKD) 1-3 stages during pregnancy. Materialsandmethods:observational cross-sectional and prospective study included 137 pregnant women. CKD 1-3 stage had 85 of them: 64 with CKD 1-2 stage, 21 with CKD 3 stage. Median age 29 years, second and third trimester (42 and 37, respectively). The comparison group consisted of 52 pregnant women with of the same age and gestational age without CKD. Dynamic examination was carried out in 18 cases with CKD 1-3 stage. Ionized, total calcium and inorganic phosphorus, 25-OH vitamin D, parathyroid hormone (PTH), the activity of total alkaline phosphatase (ALP), osteocalcin (OC), N-terminal propeptid of type 1 procollagen (P1NP) and β-isomer of C-terminal telopeptide of type I collagen (β-CTX) were determined. Results: serum calcium, phosphorus and PTH levels in all the examined pregnant women were within their normal range. In pregnant with CKD 3 stage, a deficiency of vitamin D was more significant (р0.02) compared to pregnant women without CKD and pregnant with CKD 1-2 stage. The levels OC and P1NP and β-CTX in pregnant with CKD 3 stage were higher than in the control group and pregnant women with CKD 1-2 stage. It was also higher in pregnant women with CKD 1-3 stages in the third trimester in comparison with the second one, although remained within the limits of reference values. Significant direct correlations were found between serum concentrations of P1NP and OC (r=0.575, р0.001), P1NP and ALP (r=0.415, р=0.001), OC and ALP (r=0.276, р=0, 02) and vitamin D and PTH (r=0.235, р=0.04). A significant inverse correlation was found between the blood levels of vitamin D and P1NP (r=-0.344, р=0.002). Conclusions: the peculiarities of bone metabolism in pregnant with CKD of 3 stage are manifested by the vitamin D deficiency and the acceleration of bone formation and resorption to a greater extent in the third trimester.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Steady increase in the prevalence of chronic kidney disease (CKD) is a serious public health problem, since CKD potentially leads to the development of end-stage renal disease (ESRD) that requires high-cost replacement therapy and is closely associated with increased risk of developing cardiovascular diseases (CVD), which are the cause of death in most patients. Progression of renal dysfunction and development of CVD are significantly affected by hyper- and dyslipidemia. This review contains results of studies evaluating the effect of hypolipidemic therapy on reduction of cardiovascular risk and slowdown of renal dysfunction in patients with CKD at pre-dialysis and dialysis stages of renal failure, as well as in patients with kidney transplant. In addition, recommendations on nutrition and new therapeutic approaches to lipid-lowering therapy in patients with CKD, as well as prospects for the usage of new hypolipidemic drugs are also presented.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study a role of cystatin C in the nephrocerebral risk in chronic kidney disease at the initial stage of the disease. Material and methods. One hundred and twenty-eight patients (63 men and 65 women) with chronic kidney disease (CKD) were examined at the pre-dialysis stage of the disease. All patients underwent a complex clinical and laboratory examination with determination of the lipid spectrum, uric acid, fibrinogen, calcium and cystatin C, and subsequent calculation of the glomerular filtration rate (GFR). To assess structural changes in carotid arteries, ultrasound dopplerography was performed. Depending on the thickness of the intima-media (TIM), the entire sample is divided into CKD groups with no signs of carotid atherosclerosis (SC), n=70 and on CKD with SC, n=58. Results. Patients of the second group (CKD with SC), had higher body mass index (p<0.05), systolic (p<0.05) and central (p<0.05) arterial pressure (BP) and blood cystatin C (p<0.05). In the same group, there was a significant decrease in the concentration of high-density lipoprotein cholesterol (p<0.05) compared with those of the first group (CKD). The age of patients and the content of cystatin C (p<0.05) influenced the increase in TIM. Significant positive correlations between cystatin C content and TIM, systolic and diastolic blood pressure (p<0.05), and a negative correlation cystatin C content and GFR were noted in patients of the second group. Conclusion. The increase in the level of cystatin C in blood plasma in CKD indicates the development of structural changes in the carotid arteries, the increase in the levels of systolic and central arterial pressure, the decrease in the concentration of HDL cholesterol, which is associated with significant inhibition of GFR.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The purpose of the study was to investigate gender features of abnormalities of blood serum lipid composition and their relationship with clinical and functional manifestations in patients with chronic kidney disease (CKD). The study covered patients with CKD at pre-dialysis stage of disease, aged 17-71 years (average age 37.3±13.0 years). All patients underwent complex clinical and laboratory examination. Depending on gender, the sample (n = 417) was divided into 2 groups: group I - males (n = 277) and group II-females (n = 140). Blood sampling was implemented using venipuncture of ulnar vein after 12-14 hours of fasting in morning time. The lipid analysis of blood serum was performed using the auto-analyzer "Respons 920" (Germany), including detection of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The atherogenic index (AI) was calculated according formula: AI = (TC - HDL-C)/HDL-C. At analysis of the results of lipidogram, the levels of TC (hypercholesterolemia), LDL-C (hyper-beta-cholesterolemia) and TG (hypertriglyceridemia) were considered as increased when their values were ≥5.0 mmol/L, ≥3.0 mmol/L and > 1.7 mmol/L respectively. The level of HDL cholesterol (hypo-alpha-cholesterolemia) was considered as decreased when its concentration was ≤1.0 mmol/L in males and ≤1.2 mmol/L in females. In the group of male patients, hypo-alpha-cholesterolemia was detected in 135 patients (48.7%), hypertriglyceridemia - in 162 (58.4%), and average value of atherogenic index was significantly higher - 3.49 (2.43-5.08) as compared with 3.12 (2.12-3.74) in female patients (p=0.001). The laboratory signs of anemia were significantly more frequent in group of females - 53 (37.8%) as compared with 63 (22.7%) than in males (p = 0.001). In males, average values of HDL cholesterol and total serum protein were significantly lower (1.07 ± 0.44 mmol/L vs. 1.23 ± 0.42, p = 0.000 and 53.3 ± 14.6 g/L vs. 57.4 ± 11.9 g/L. p = 0.007, respectively. The levels of TG - 1.92 (1.23-2.74) mmol/L vs. 1.85 (1.04-2.37);p = 0.034], sodium (140.3 ± 6.20 mmol/L vs. 138.3 ± 6.01 mmol/L, p = 0.010) and uric acid in blood serum were significantly higher (0.38 ± 0,09 mmol/L vs. 0.34 ± 0.01 mmol/L, p = 0.003) as compared with females. In the group II (females), a noticeable slowing of the glomerular filtration rate (GFR) - 68,4 (43,6-98,1) ml/min vs. 87,6 (55,0-117,6) ml/min; (p = 0.001) was detected as compared with group I (males). Among male patients, a reliably significant positive relationship was established between TC and BMI, level of diastolic blood pressure and proteinuria; LDL cholesterol level and proteinuria; concentration of TG - and BMI, level of diastolic blood pressure and level of proteinuria. No correlation was established between the concentration of HDL-cholesterol and aforementioned laboratory markers of CKD. In contrast with males, in females, TC demonstrated an inverse relationship with the concentration of Hb, values of GFR and proteinuria, and level of HDL cholesterol - with indices of BMI, thrombocytes and uric acid of blood serum. In females a positive relationship was established between LDL cholesterol and level of diastolic blood pressure, GFR and daily proteinuria, and also between concentration of serum TG and volume of daily proteinuria and BMI. In general group, a reliable positive relationship was detected between TC and BMI and proteinuria, between LDL-C level and proteinuria, and between TG concentration and BMI, level of diastolic blood pressure, sodium content and proteinuria. The negative relationship was established between concentration of HDL cholesterol and BMI and uric acid in blood plasma, and TG level with Hb concentration. In male patients with CKD at pre-dialysis stage of disease, decreasing of level of HDL cholesterol was established as an increased concentration of TG and increasing atherogenic index. The content of triglyceride of blood serum is closely related to body mass index, level of diastolic blood pressure and proteinuria. In females, slowing of glomerular filtration rate is accompanied by development of anemia and atherogenic dyslipidemia.