Signs Of Chronic Kidney Disease Research Articles

Unobvious long-term effects of COVID-19 for kidneys. The literature review

The impact of COVID-19 on the course of chronic kidney disease (CKD) has already been confirmed by researchers around the world. Basically, studying kidney damage in COVID-19, the authors pay attention to the new coronavirus infection in terms of the development of acute kidney injury (AKI) or mortality from it in patients with existing CKD, especially patients receiving hemodialysis or having a transplanted kidney, providing an analysis of mortality, risks and forecasts. However, there is still no published description of how this infection can affect the function of kidneys that did not have signs of CKD before COVID-19. Currently, studies devoted to the analysis of long-term results of observation and treatment of such patients are especially scarce. The review examines foreign and domestic studies concerning both the influence of chronic kidney disease on the severity of coronavirus infection and the risks of developing kidney disease after COVID-19, including the development of acute kidney injury and in the long term. This approach can highlight the relevance of timely identification of patients with developing CKD in the early stages among patients with COVID-19 for the purpose of their further follow-up and timely prescription of nephroprotective therapy. The search for literature sources was carried out using PubMed, Science Direct, eLibrary using the keywords “coronavirus”, “COVID-19”, “SARS-CoV-2”, “acute kidney injury”, “chronic kidney disease” and their combinations covering publications from 2019 to 2023 in Russian and English.

Pathogenic pathways of renal damage in Fabry nephropathy: interplay between immune cell infiltration, apoptosis and fibrosis.

Fabry nephropathy is a consequence of the deposition of globotriaosylceramide, caused by deficient GLA enzyme activity in all types of kidney cells. These deposits are perceived as damage signals leading to activation of inflammation resulting in renal fibrosis. There are few studies related to immunophenotype characterization of the renal infiltrate in kidneys in patients with Fabry diseaseand its relationship to mechanisms of fibrosis.This work aims to quantify TGF-β1 and active caspase 3 expression and to analyze the profile of cells in inflammatory infiltration in kidney biopsies from Fabry naïve-patients, and to investigate correlations with clinical parameters. Renal biopsies from 15treatment-naïve Fabry patients were included in this study. Immunostaining was performed to analyze active caspase 3, TGF-β1, TNF-α, CD3, CD20, CD68 and CD163.Clinical data were retrospectively gathered at time of kidney biopsy. Our resultssuggest the production of TNFα and TGFβ1 by tubular cells, in Fabry patients. Active caspase 3 staining revealed that tubular cells are in apoptosis, and apoptotic levels correlated with clinical signs of chronic kidney disease, proteinuria, and inversely with glomerular filtration rate. The cell infiltrates consisted of macrophages, T and B cells. CD163 macrophages were found in biopsy specimens and their number correlates with TGFβ1 and active caspase 3 tubular expression. These results suggest that CD163+ cells could be relevant mediators of fibrosis in Fabry nephropathy, playing a role in the induction of TGFβ1 and apoptotic cell death by tubular cells. These cells may represent a new player in the pathogenic mechanisms of Fabry nephropathy.

Kidney damage in hypertension disease

Essential hypertension (EH) is the most common cardiovascular disease and the leading cause of chronic kidney disease (CKD) worldwide. The aim of the study was to investigate the frequency and nature of kidney damage in hypertension. 189 patients (69 men and 120 women) with hypertension (stages I, II, and III) aged 43 years and older were examined. The average age of the patients was 61.2 ± 8.7 years. Clinical and biochemical tests were conducted on all patients, including red blood cell indices, C-reactive protein (CRP), lipid profile, fibrinogen, electrolytes, glucose, uric acid, creatinine, and cystatin C. The duration of hypertension was also recorded for each patient. Kidney function was assessed using serum creatinine (CKD-EPI) and cystatin C (F. Houcke). Patients were categorized according to the degree of decrease in glomerular filtration rate (GFR) based on the recommendations of the Russian Nephrology Society. Patients with kidney damage were divided into two groups: Group 1 consisted of patients with hypertension without signs of CKD (GFR calculated by cystatin C ≥ 60 ml/min), while Group 2 consisted of patients with hypertension complicated by CKD. The results showed that hypertension was accompanied by target organ damage in 70.8% of cases. The prevalence of CKD among patients with hypertension was 28.5%. Proteinuria was mainly detected in patients with renal insufficiency. The frequency of GFR categories according to CKD-EPI and F. Houcke formulas was as follows: G1 — 54.4% and 13.7% (p < 0.05); G2 — 35.9% and 57.6% (p < 0.05); G3a — 5.2% and 19.5% (p < 0.05); G3b — 3.1% and 5.2% (p < 0.05); G4 — 0.5% and 3.1% (p < 0.05) and G5 — 0.5% and 0.5%, respectively. There was a strong correlation between GFR and serum creatinine (r = –0.439; p < 0.05) and cystatin C (r = –0.866; p < 0.0001). Patients in Group 2 (hypertension with kidney damage) had significantly higher levels of CRP, low-density lipoprotein cholesterol, cystatin C, and longer duration of hypertension, but lower levels of total calcium than patients in Group 1. In conclusion, CKD was present in 28.5% of patients with hypertension, and proteinuria was mainly detected in patients with renal insufficiency. Serum cystatin C levels most accurately reflect kidney filtration function.

Role of beta 2 microglobulin in chronic kidney disease

The aim: to study the relationship of beta-2-microglobulin (beta-2 MG) with clinical and laboratory manifestations of chronic kidney disease (CKD).Patients and Methods. The results of a comprehensive examination of 284 people (118 males and 166 females) aged 18 to 86 years with various types of socially significant diseases were studied. All patients underwent thorough collection of clinical and anamnestic data, laboratory monitoring with the determination of the level of systolic and diastolic blood pressure (BP), body mass index, red blood, beta-2-microglobulin (B2M), lipid profile and proteinuria. Kidney function was assessed according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula using serum creatinine. The main group included 113 patients (55 men and 58 women, mean age 50.9±15.8 years), diagnosed with chronic kidney disease (CKD). The control group consisted of 171 people (63 men and 108 women) with various forms of socially significant diseases, but without signs of CKD. Statistical analysis was carried out using the programs Statistica 10.0 (StatSoft Inc., USA) and Microsoft Office Excel 2010 (Microsoft Corp., USA).Results. In the subgroup of patients with CKD, signs of renal failure were observed in 46 people in 40.7 % of cases. As CKD progressed, the signs of impaired metabolism of B2M were more severe: its serum level was 8.646 (7.892; 12.231) mg/l at C4 and 18.444 (11.225; 23.717) mg/l at C5 stages of CKD, and urinary excretion was 2.502 (0.305; 6.313) mg/l at C4 and 2.614 (1.535; 25.812) mg/l at C5 stages of CKD. Regardless of renal dysfunction, the median serum B2M level was clinically significantly higher in females (p>0.05). Single-factor one-way correlation analysis showed statistically highly significant relationship was between serum B2M and creatinine levels both in the subgroup of patients with CKD (r = 0.905; p = 0.001) and in the total sample (r = 0.749; p = 0.001). There was a strong negative relationship between serum B2M levels and estimated glomerular filtration rate (GFR) (r = -0.717; p = 0.001). In individuals without CKD, an increase in serum creatinine was closely associated with an increase in urinary excretion of B2M (r=0.252; p=0.005). Simultaneously, in this category of patients, there was a close correlation between estimated GFR with serum B2M level (r= -0.433; p=0.002) and its urinary excretion (r= -0.247; p=0.005). A direct relationship between an increase in serum B2M and an increase in diastolic blood pressure (r=0.274; p=0.034) among CKD patients was established. In the total sample, a direct relationship between the value of systolic BP and serum B2M level (r= 0.223; p=0.01) was registered, as well as between diastolic BP (r= 0.268; p=0.01) and urinary excretion of B2M.Conclusion. As a result of the study, metabolism of B2M and its relationship with the clinical and laboratory manifestations of CKD were evaluated. The data obtained show high prognostic potential of changes in metabolism of B2M in the population of patients with various forms of socially significant diseases, as well as CKD, which allows to identify among them groups of patients with high and/or very high renal and cardiovascular risk, in order to take timely targeted therapy.

Need to determine the residual concentrations of direct oral anticoagulants in patients with atrial fibrillation undergoing transcatheter implantation of the aortic valve

Introduction. Lengthening the period of direct oral anticoagulant (DOAC) withdrawal before intervention is not allowed. Chronic kidney disease (CKD), impaired liver function, extremely low or high body mass, chronic heart failure (CHF), and age > 90 years can increase blood DOAC levels. DOAC therapy does not require routine laboratory monitoring. However, there are coagulation tests that can be used to detect the presence of a drug in blood. Duration of DOAC discontinuation and the appropriateness of assessing residual anticoagulant concentrations before intervention with a high bleeding risk in a special category of patients is to be defined.Aim. To measure residual concentrations of anticoagulants and their association with perioperative bleeding risk in patients with AF using DOACs in blood samples collected immediately before TAVI.Materials and methods. The 94 patients with atrial fibrillation (AF) included in the study were characterized by senile age, a high risk of thromboembolic complication (ТС), many comorbidities, and a high prevalence of senile asthenia. The apixaban and rivaroxaban concentrations were measured according to the value of anti-Xa activity and control plasmas with normal levels of coagulation factors (Diagnostica Stago, France).Results. The median time of DOAC withdrawal before TAVI was 60 hours [47.5; 72]. However, the DOAC concentration exceeded 30 ng/ml in 1/5 patients (19.2%), and stage 3 or more CKD was more common in these patients. Our study showed the relationship between DOAC concentration and the duration of DOAC withdrawal period. However, the relationship between DOAC concentration and bleeding that occurred in the perioperative period could not be found. Patients with signs of CKD were older and had a lower BMI as compared to patients without CKD.Conclusion. Our data showed the relationship between the DOAC concentration and the duration of DOAC withdrawal period. No relationship was found between DOAC concentrations and bleeding.

Risk of Chronic Kidney Disease in Hospitalized Patients with Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) is associated with several comorbidities such as diabetes mellitus and cardiovascular diseases. These comorbidities are also risk factors for chronic kidney disease (CKD), yet little is known about the risk of CKD in HS patients. Objectives: The objective was to study the prevalence of CKD in HS patients. Methods: Cross-sectional population-based study using the United States National Inpatient Sample database between January 1, 2002 and December 31, 2012 was performed. Results: We identified 23,767 hospital admissions for HS patients and 95,068 admissions for age- and gender-matched controls. The prevalence of CKD in HS patients was 6.3% (1,497/23,767) compared to non-HS controls which was 4.3% (4,052/95,068). The association of CKD was strongest in HS patients, who were ≥60 years old, 16.9% (475/2,811), male 7.3% (695/9,556), obese 7.8% (407/5,209), diabetic 12.5% (890/7,105), hyperlipidemic 13.3% (416/3,126), and had cardiovascular diseases 12.5% (631/5,045). The crude odds ratio of CKD in HS patients was 1.5 (95% CI: 1.420–1.605) compared to non-HS patients. The association remained significant after adjusting for important covariates with adjusted odds ratio of CKD in HS patients of 1.1 (95% CI: 1.014–1.176) compared to non-HS patients. Conclusions: Our findings show that there is a possible association of HS with CKD. Any signs of CKD should be assessed by a nephrologist as early diagnosis can hopefully prevent further progression.

Compact Point of Care Ultrasound Reveals Hemodynamic Abnormalities in Children with Sickle Cell Disease

In sickle cell disease (SCD), kidney related morbidity and mortality are significant, with ~80% of patients displaying signs of chronic kidney disease (CKD) by age 401 and kidney related mortality being the third leading cause of death (16.4%)2. Children with SCD are also prone to kidney disease with 20% of 12 years-old displaying microalbuminuria4 and enuresis and hyposthenuria commonly observed in infants4. Current clinical guidelines are insufficient as they ignore pediatric disease until the development of late signs like proteinuria or large drops in eGFR have occurred5. A major limitation in the assessment of kidney disease in children with SCD is the incomplete understanding of disease progression and the lack of suitable biomarkers to discriminate health and disease. Serum creatinine based eGFR is the most common biomarker of kidney function but is poorly validated and relatively insensitive in SCD patients due low muscle mass and hyperfiltration6. Point of care ultrasound (POCUS) offers a non-invasive alternative to blood based biomarkers. POCUS has proven clinical utility in decreasing primary and secondary stroke7. Additionally, POCUS technology now offers compact, cartless systems, with tablet and smartphone compatibility, multiprobe functionality in a single probe and an economical price point (<3000$)8. Therefore, the goals of this study were two-fold. 1) Determine the feasibility of renal assessment using compact POCUS in children with SCD in a clinical setting. 2) Establish normative values for possible compact POCUS biomarkers that could supplement existing biomarkers of kidney disease in SCD. Methods: Studies were performed with informed consent under an IRB approved protocol. 18 patients with SCD were recruited during their routine clinical visit to undergo a 10-20 minute ultrasound examination. All POCUS exams were performed in supine position, on the right kidney by an experienced imaging researcher (AB, +10 years). Images were acquired with a Butterfly IQ+ (Burlington, MA, USA) system and an Apple Smartphone (Cupertino, CA, USA). The abdominal preset and B-mode imaging was used to determine the long axis renal length and echogenicity of the renal/liver parenchyma. The cardiac preset, pulsed Doppler mode was used to determine the peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI = (PSV-EDV)/PSV) of the main right renal artery. Images were saved to a cloud based, HIPPA protected database, downloaded to a local workstation and processed using custom MATLAB scripts. An angle correction of 1/cos(60°) was applied to the uncorrected velocity values. Results: Renal length and serum creatinine was measured in 18 patients with SCD (3 HbSC, 15 HbSS) and pulsed Doppler estimates were obtained in 14 of 18 subjects (hemoglobin 9.9±2.3,12 male). The average renal length was 8.7±1.3 cms and serum creatinine was 0.69±0.16 and showed a statistically significant increase with respect to age (Figure 1). The average angle corrected main renal artery PSV was 74.5±64.4 cm/s and RI was 0.49±0.33 and both decreased with respect to age (Figure 1). The average echogenicity ratio between kidney and liver parenchyma was 0.64±0.14 and was uncorrelated with age. Discussion: This work demonstrates that high quality structural and hemodynamic images can be acquired with low cost, compact POCUS in a clinical setting. The age dependent increase in serum creatinine9 and kidney length10 were in good agreement with prior cart-based sonography work in healthy children. Conversely, the age dependent drop in main renal artery PSV and RI was in opposition to work in healthy children that showed no change11 or an increase with age12. The clinical significance of abnormally elevated velocity in young children with SCD and its impact on the development of sickle nephropathy should be studied in more detail. Future work comparing cross-sectional and longitudinal variability in compact POCUS and physiologic biomarkers of kidney function in both pediatric and adult subjects with and without SCD is ongoing.

OR28-3 Ethnic Differences in Albuminuria among Adults with Diabetes and Normal Range Estimated Glomerular Filtration Rate (eGFR).

Abstract Background Diabetic kidney disease (DKD) develops in approximately 40% of adults with diabetes and is the leading cause of chronic kidney disease (CKD). Less is known about early DKD, particularly in ethnically diverse populations that include Black, Hispanic/Latinx, and Asian Americans. Current guidelines recommend that patients with diabetes be screened annually for DKD. Albuminuria is the first sign of CKD and is associated with CKD progression, cardiovascular events, and death. This study characterizes ethnic differences in the prevalence of albuminuria in a diverse population of adults with diabetes with normal range eGFR. Methods This retrospective study was conducted in a large healthcare system where patients with diabetes are annually monitored for DKD. We identified adults with diabetes aged 45-74 years, eGFR ≥60 mL/min/m2 based on serum creatinine (using the CKD-EPI equation without race), and assessment of urine albumin-creatinine ratio (ACR), urine protein-creatinine ratio (PCR) and/or urine protein dipstick in 2015. Albuminuria was based on urine ACR (95%), otherwise, from urine PCR (1%) converted to ACR, and, if unavailable, from urine protein dipstick (4%) converted to ACR. The cohort was restricted to patients with diabetes onset after health plan enrollment to calculate diabetes duration. Hypertension was identified by clinical diagnosis. Modified Poisson regression with robust variance was used to examine the association of ethnicity and albuminuria, reporting relative risk (RR) with 95% confidence intervals (CI). Results Among 79,184 adults with diabetes, eGFR ≥60, and urine albumin/protein assessment (age 60.5 ±7.7y, 54.0% male), 40.3% were non-Hispanic White, 9.6% Black, 26.3% Asian/Pacific Islander (PI), and 21.0% Hispanic/Latinx race/ethnicity. 69.9% had hypertension. Overall, 81.7%, 13.8%, and 4.6% had urine ACR &amp;lt;30 (normal), 30 to &amp;lt;300 (microalbuminuria), and ≥300 mg/g (macroalbuminuria), respectively, with albuminuria higher in males than females. By race/ethnicity, the prevalence of [micro/macroalbuminuria] was [15.7/5.4%] Asian/PI, [13.8/4.8%] Black, [13.1/4.5%] Hispanic/Latinx, and [12.8/4.1%] non-Hispanic Whites. Among Asian/PIs, prevalence ranged from [19.5/8.4%] Hawaiian/PI and [18.2/7.1%] Filipino to [14.5/3.6%] Chinese and [11.2/3.4%] South Asian. In multivariable analyses, adjusting for age, sex, diabetes duration, and hypertension, Asian/PI (RR 1.3, CI 1.2-1.3) was associated with higher risk of albuminuria compared to non-Hispanic White, but Black (RR 1.0) and Hispanic/Latinx (RR 1.0) were not. Among Asian/PIs, with Chinese as reference, Filipino (RR 1.3, CI 1.2-1.4) and Hawaiian/PI (RR 1.4, CI 1.3-1.6) had higher risk, South Asian had lower risk (RR 0.7, CI 0.7-0.8), and Japanese and Southeast Asian had similar risk of albuminuria. Conclusions The risk of albuminuria in adults with diabetes and normal range eGFR was higher in Asian/PI adults. Among Asian/PIs, the risk was higher among Filipino and Hawaiian/PI and lower in South Asian compared to Chinese adults, supporting the importance of disaggregating Asians when examining microvascular outcomes. Future studies should examine ACEI/ARB use and albuminuria progression. Presentation: Tuesday, June 14, 2022 10:15 a.m. - 10:30 a.m.

Rehabilitation Measures Planning based on the Analysis of Functional Impairments and Disabilities due to Chronic Kidney Disease: a Retrospective Study

INTRODUCTION. Quality of functional impairments analysis and the degree of disability associated with chronic kidney disease is a key factor of the effectiveness of the rehabilitation measures organization for persons with disabilities with the above pathology. AIM. To assess the degree of physical dysfunction of the disabled persons due to the chronic kidney disease on the basis of the clinical and functional disorders to determine the need for rehabilitation measures. MATERIAL AND METHODS. The study was generated in the form of the Excel spreadsheet using the following methods: documentary, excerpting data in the volume of 265 units. For quantitative variables, statistical indicators were used: mean and median. To compare two independent groups, the reliability index was used, the X2 statistic and Spearman’s rank correlation coefficient were performed. The significance level for testing statistical hypotheses was assumed to be 0.05. Processing and analysis was performed in the R environment (environment for statistical data analysis. http://www-r-project.org). RESULTS AND DISCUSSION. In these patients, the largest proportion in the structure of physical dysfunctions were limitations to self-care, first-degree movement, labor activity and second-degree self-care, and third-degree labor activity. Analysis of the degree of severity of disability depending on the stage of the disease, which determines the structure of social insufficiency and reduced quality of life, can be accepted as a basis for planning rehabilitation measures. At the same time, due to the predominance of general symptomatology, analysis of clinical signs of chronic kidney disease, taking into account the stage of the disease, can be recognized only as an auxiliary mechanism. CONLUSION. Expert-rehabilitation diagnostics among persons who have undergone primary and repeated examination allows us to get an idea of the rehabilitation measures amount required for them, taking into account the stage of the process in certain subgroups. When forming an individual rehabilitation program, the use of ICF is indispensable.

Results of morphological examination of blood of service dogs with signs of chronic kidney disease

The paper presents the results of a morphological study of the blood of dogs of service breeds, in which signs of chronic kidney disease were detected. Often, the pathological condition of the kidneys develops as a secondary process due to intoxication of endo- or exogenous origin, infectious and invasive diseases. The danger of chronic kidney disease is that the owners or maintenance staff notice the appearance of animal health problems already in the late stages, when conservative treatment most often cannot give positive dynamics. During a clinical blood test, it was found that the dogs of the experimental group (patients) had erythropenia and hypochromemia, which were most likely associated with impaired renal function, and, as a consequence, decreased erythropoietin secretion. Of course, the decrease in the number of red blood cells caused a significant decrease in the hematocrit value to the level of 31.5 ± 5.6 l/l, which was 26.9% lower than the level of this indicator in healthy animals. When analyzing the leukogram, a picture of neutrophilia with a shift of the nucleus to the right was noted. The percentage of lymphocytes in the leukogram of sick dogs was 2.7 times lower than in healthy dogs, which can be considered a relative change in the percentage due to increased neutrophil counts. If we talk about the total content of leukocytes in the blood, no significant changes were found. Thus, during the study of the blood of dogs of service breeds with signs of chronic kidney disease, signs of hypochromic anemia were established.

Endothelial dysfunction in patients after COVID-19

Relevance: Over the past two years, the COVID-19 infection has gained unprecedented relevance at the global level. All countries are spending significant resources in the fight against COVID-19 [1 2]. The purpose of the work is to clarify the issue of the state of the kidneys in the distant post-covid period (after 2-3 months), we conducted a study of the kidneys simultaneously with the desquamation of the endothelium, as one of the probable mechanisms of the nephrotic effect of the COVID-19 virus. Materials and methods: 29 people participated in the study. Patients with post-covid syndrome (n=10) were treated on an outpatient basis at the "KNP "Center of primary medical and sanitary (medical and sanitary) care No. 3, Odesa" of the Odesa City Council" in the period from 2020 to 2021. The control group consisted of patients without cardiovascular and endocrine disorders, comparable in terms of gender and age, who were examined in 2018 at the Odesa Regional Clinical Medical Center of the Odesa Regional Council. Endothelial dysfunction "ED" was determined by the intensity of desquamation of the endothelium according to the method of J. Hladovec as modified by M.M. Petryschev. and other. (2001). Statistical analysis was performed using Status software [https://status-please.herokuapp.com/]. Mean values ​​(M) and its standard deviation (SD) were used to describe quantitative data, and percentages were used for qualitative data. For comparison, data were presented as M and standard error of the mean (SEM). Analysis of normality was performed using the Shapiro-Wilk test. Levene's test was used to assess homogeneity of variances. Differences between groups were determined using Student's t-test and one-way analysis of variance (ANOVA). The relationship and presence of correlation between the studied parameters was determined using the Pearson correlation coefficient (r). The correlation coefficient in the range of 0.5≤|r|&lt;1 indicated a strong correlation relationship, 0.3≤|r|&lt;0.5 – a relationship of medium strength, 0&lt;|r|&lt;0.3 – on a weak correlation. Statistical significance was established only at the level of p &lt; 0.05. Results: 17 men and 12 women aged from 32 to 80 years who suffered from a disease of moderate severity participated in the study. The average age of the group of patients with post-covid syndrome (n=9) is 55.9±14.47 years, the average age of the control group (n=20) is 55.95±14.47 years. There were no complaints from the urinary system in the examined patients. According to blood serum tests, it was established that the creatinine level among patients with post-covid syndrome was on average 113±11.91 μmol/l, the urea level was 8.11±1.2 mmol/l, the GFR level was 55.06±12, 19 ml/min/1.73. m2. In the control group, the numbers were as follows: creatinine level was 73.2±8.5 μmol/l, mean urea level was 4.61 mmol/l, GFR was 94.78±13.76 ml/min/1.73 m2. Conclusions: 2-3 months after the transfer of COVID-19, the examined patients show signs of chronic kidney disease. After a disease with COVID-19, an increase in CEC is detected, which is a manifestation of endothelial dysfunction.

Effect of Bariatric Surgery on Albuminuria in Non-Diabetic Non-Hypertensive Patients with Severe Obesity: a Short-Term Outcome

BackgroundObesity is a risk factor for chronic kidney disease and albuminuria. Despite the well-documented obesity association with diabetes mellitus and hypertension, its predisposition to albuminuria is not related to these comorbidities, and, in some times, its occurrence is independent of DM or hypertension.Purpose of the studyThe present study aimed to evaluate bariatric surgery effect on albuminuria in patients with severe obesity with no DM or hypertension.Materials and methodsThe study consisted of 137 patients with extreme obesity and albuminuria scheduled for bariatric surgery and did not have diabetes or hypertension. They underwent an assessment for 24-h urinary albumin at baseline (T0) and 6 months postoperatively (T2).ResultsAlbuminuria remission occurred in 83% of patients; there was a statistically highly significant difference between the baseline and the 6-month postoperative in the 24-h urinary albumin assessment. Weight loss and BMI at T2 were independent predictors of albuminuria remission.ConclusionThe current work emphasizes the importance and promising role of bariatric surgery as an effective weight reduction management method in improving albuminuria, an early sign of chronic kidney disease, and a potential risk factor for cardiovascular disease.

Diagnosis of diabetic nephropathy and chronic kidney disease in prepubertal children with type 1 diabetes mellitus

The state of renal function in children with type 1 diabetes mellitus and small, up to 5 years old, disease experience was studied. The aim of the study was to determine the indicators of the initial stages of the formation of diabetic nephropathy and chronic kidney disease. A prospective cohort study of a group of 46 prepubertal patients with type 1 diabetes mellitus and less than 5 years of illness was carried out. Diabetic nephropathy at the stage of microalbuminuria was detected already in 8% of children. Signs of the first, preclinical stage of chronic kidney disease, manifested by hyperfiltration, were found in 20% of patients, impaired tubular functions — in 28%. A moderate decrease in glomerular filtration rate corresponding to stage 2 of chronic kidney disease was observed in 4% of children with diabetes. An increase in the concentration of endothelial growth factor in the blood serum and the morning portion of urine, as well as monocyte chemoattractant protein-1 in the blood serum are sensitive highly specific markers of the formation of chronic kidney disease in patients of prepubertal age with a history of diabetes mellitus of less than 5 years. The relationship between the characteristics of the course of diabetes mellitus with endothelial growth factor and monocyte chemoattractant protein-1 was not revealed, which reflects the independent mechanism of the influence of neoangiogenesis and the reaction of non-infectious inflammation on the formation of diabetic nephropathy and chronic kidney disease. The relationship between vascular endothelial growth factor and monocyte chemoattractant protein-1 with the formation of early signs of chronic kidney disease and diabetic nephropathy has been revealed. The results obtained can be used for early diagnosis of diabetic nephropathy and the formation of a risk group for kidney damage in children with diabetes mellitus.

Venous thromboembolic complications in patients with chronic kidney disease: prevalence and features of drug treatment

The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate 30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.

Clinical profile of children incidentally found to have advanced kidney failure.

No data exist on the epidemiology of children incidentally diagnosed with advanced kidney failure (KF) during evaluation for non-specific symptoms. This is likely related to unrecognized symptoms and signs of CKD. The objective of our study was to evaluate incidentally diagnosed patients with advanced KF requiring long-term kidney replacement therapy (KRT). An IRB-approved retrospective chart review of children who started KRT with dialysis (hemo- or peritoneal) was conducted. Included were children with no prior knowledge or diagnosis of underlying kidney disease with chronic kidney disease (CKD) disease stage 4 (GFR 15-29mL/min/1.73 m2) or 5 (GFR < 15mL/min/1.73 m2) at initial presentation and started on chronic KRT within 2months of presentation. Of 177 patients initiating KRT during the study period, 26 (15%) were categorized as incidental advanced KF. This cohort with mean age 12.25years consisted of 42% males, 54% African Americans included 46% with glomerular, and 54% with non-glomerular etiology for kidney failure. Vomiting (42%) and fatigue (39%) were most common, while growth failure (19%) and hyperkalemia (7%) were less frequent on initial presentation. Anemia (100%), hypertension (96%), hyperparathyroidism (96%), and hyperphosphatemia (92%) were the most frequently seen CKD comorbidities. Chronic KRT was started within 24h in 62% and within 2weeks in 88% of the cohort. Under-diagnosis of patients with advanced KF is most likely related to milder non-specific clinical symptoms and normal growth in the majority of patients. A higher resolution version of the Graphical abstract is available as Supplementary information.

Fibroblast growth factor 23 and Klotho protein: assessment of the role in the development of secondary hyperparathyroidism in patients with various stages of chronic kidney disease

Background. Secondary hyperparathyroidism (SHPT) is universal complication of chronic kidney disease (CKD), the likelihood of which increases as renal function decreases. Currently, SHPT is considered in the context of mineral and bone disorders associated with CKD. Mineral and bone disorders associated with CKD include, in addition to SHPT, disorders of calcium-phosphorus metabolism, bone pathology and metastatic calcification, which determine poor outcomes of the disease. The purpose of the study was to evaluate the serum concentrations of fibroblast growth factor (FGF) 23 and Klotho protein in patients with various stages of CKD and their relationship with SHPT, vitamin D levels, and calcium-phosphorus metabolism in patients with varying degrees of decreased renal function. Materials and methods. Serum concentrations of FGF 23, Klotho protein, parathyroid hormone (PTH), 25(OH)D, calcium and phosphorus were evaluated in 229 patients with various stages of chronic kidney disease and in 40 people without signs of CKD. Results. It has been shown that individuals with CKD are characterized by overproduction of humoral phosphatonin FGF 23 and Klotho deficiency, which increase as renal failure worsens. A significant relationship was established between FGF 23 and the levels of PTH and blood phosphorus; Klotho protein — with the patient’s age and serum vitamin D. An early marker of disorders in the FGF 23-Klotho system is a decrease in the Klotho protein concentration, which occurs in the early stages of CKD and is aggravated with the progression of renal failure. A statistically significant overproduction of FGF 23 associated with secondary hyperparathyroidism was registered in patients with glomerular filtration rate less than 35 ml/min/1.73 m2. Conclusions. An early marker of disorders in the FGF 23-Klotho system is a decrease in the concentration of the Klotho protein, which occurs in the early stages of CKD and is aggravated with the progression of renal fai-lure. The relationship between Klotho deficiency and the formation of SHPT has not been found. As kidney function decreases, excess production of PTH and FGF 23 appears and increases, hyperphosphatemia progresses. This proves the pathogenetic relationship between the formation of SHPT and the overproduction of humoral phosphatonin FGF 23, since it is this glomerular filtration rate that determines the growth of PTH above the upper limit of the general population reference interval.

АRTERIAL STIFFNESS AND CENTRAL AORTAL PRESSURE AS SIGNIFICANT PREDICTORS OF COMPLICATIONS AFTER OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

Some studies have shown that an increase in arterial stiffness and central aortic pressure increase the risk of postoperative complications for off-pump coronary artery bypass grafting (off-pump CABG). AIM: To determine the significance of arterial stiffness and central aortic pressure indicators for predicting acute kidney injury (AKI) and cardiac events in patients after off-pump CABG. MATERIALS AND METHODS: An analysis of off-pump CABG outcomes was carried out in 196 patients (mean age 62.7 ± 5.3 years) without clinical signs of chronic kidney disease. The patients were divided into a test (n = 56) and control (n = 140) groups, depending on the presence or absence of AKI, acute coronary syndrome (ACS), or cardiac arrhythmias in the early postoperative period. Pulse wave velocity indicators (PWV) were processed on the carotidfemoral (cf PWV) and brachio-ankle (baPWV) segments, and the results of measuring central aortic pressure (CAP). RESULTS: It has been proven that the incidence of AKI is significantly higher in patients with higher cf PWV (n &lt;0.001), baPWV (n = 0.034) and systolic aortic pressure (SAP) (n = 0.013). ACS was more often observed in patients with higher SAP (n &lt;0.001) and diastolic (DAP) (n = 0.005) aortic pressure, and cardiac arrhythmias in patients with higher SAP and office systolic pressure (n &lt; 0.001). Based on the results of logistic regression analysis, it was determined (by regression coefficients — B) that an increase in cf PWV by 1 m/s increases the risk of AKI by 85.0%. An increase in SAP by one unit significantly increases the risk of ACS by 111.0% and cardiac arrhythmias by 58.0%. It was shown that the measurement of CAP has a greater diagnostic value than the office measurement of blood pressure. CONCLUSION: Arterial stiffness is an independent predictor of AKI for off-pump CABG. A decrease in PWV value is accompanied by a decrease in the incidence of AKI. CAP indices have a more significant prognostic value with respect to the likelihood of cardiac events after an off-pump CABG than the data of measurement of blood pressure.

CYSTATIN C AS A MARKER OF KIDNEY FUNCTION IN PATIENTS WITH DIABETES MELLITUS AND PURINE METABOLISM DISORDERS

Chronic kidney disease is a pressing issue for healthcare systems over the world; its prevalence has reached 13% in Western countries. In recent years, cystatin C has been proposed as a more reliable endogenous marker of renal function, especially for the diagnosis of initial changes in glomerular filtration rate. The aim of this study is to analyze the signs of chronic kidney disease in patients with type 2 diabetes mellitus depending on the level of uricemia by using cystatin C in real clinical practice. The study included 127 patients with type 2 diabetes mellitus (mean age = 60.0 years [52.0; 66.0]; sex ratio: 55 men/ 72 women) who received oral hypoglycemic therapy. All subjects, depending on the stage of diabetic nephropathy were divided into groups: group 1 (n=80) included patients with asymptomatic diabetic nephropathy (normoalbuminuria below 30 mg/day)); group 2 (n=22) involved patients with microalbuminuria (30-300 mg/day); group 3 (n=17) included patients with proteinuria; group 4 (n=8) comprised patients with chronic renal failure. Glomerular filtration rate was calculated according to the formulas of Chronic Kidney Disease Epidemiology Collaboration taking into account the concentration of cystatin C (Chronic Kidney Disease Epidemiology Collaboration cys), by Cockcroft-Gault and Modification of Diet in Renal Disease Study using a calculator of the National Institute of Diabetes and Digestive and Kidney Diseases. In patients with type 2 diabetes mellitus, the development of chronic kidney disease is also predetermined by the following comorbid conditions as hypertension, chronic pyelonephritis, hyperuricemia, and asymptomatic urolithiasis, along with diabetic nephropathy. Glomerular filtration rate values in patients with type 2 diabetes mellitus assessed by Chronic Kidney Disease Epidemiology Collaboration cys are more reliable than those assessed by using the formulas of Cockcroft-Gault and Modification of Diet in Renal Disease Study, especially at the limit level of glomerular filtration rate ˂60 ml/min/1.73m2. In patients with type 2 diabetes mellitus, the level of circulating cystatin C is associated with body mass index, waist circumference, blood uric acid concentration and albuminuria levels. The blood concentration of cystatin C in the patients with type 2 diabetes mellitus is determined by the blood concentration of creatine and uric acid.

Optical coherence tomography angiography in the diagnosis of retinal microvascular changes in chronic kidney disease (clinical observations)

One distinctive pathological sign of chronic kidney disease (CKD) is microcirculatory disorders, which mark it as a microvascular disease. Similarity in the blood supply of the retina and kidneys, in the anatomy of their vascularization lead to identical complications in these organs. The retinal-choroidal microvascular system is easily accessible for clinical and morphological assessment and can be examined by the reproducible and non-invasive method - optical coherence tomography (OCT) and OCT angiography (OCTA). The study of significant diagnostic tomographic retinal biomarkers in CKD and monitoring of their changes are of great clinical importance. The article presents clinical cases of changes in the retina and choroid depending of the stage of CKD. Retinal microvascular changes precede functional impairment. A significant decrease in retinal and choroidal thickness correlates with a decrease in the glomerular filtration rate (GFR) and the degree of albumin excretion in the urine. All clinical cases were observed to exhibit retinal microcirculation disorders, capillary rarefaction in both capillary plexuses accompanied by a decrease in vessel density and a decrease in the circularity index of the foveal avascular zone as a result of regression of the parafoveal capillary networks. OCTA allowed visualization of morphological changes at the microcirculatory level in the form of blunt ends of capillaries, their increased tortuosity and the presence of local areas of decreased perfusion. The severity of retinal microvascular changes varied depending on the stage of CKD and was not associated with either age or the presence of diabetes mellitus. Assessment of the retinal microvasculature can help with monitoring of microvascular lesions, early prediction of the risk of development and progression of decreased renal function, as well as allow avoiding aggressive diagnostic biopsy.

Doppler ultrasoundgraphy capability in the evaluation of renal circulation in patients with type 2 diabetes mellitus and chronic kidney disease

Abstract. The 72 patients with type 2 diabetes mellitus and chronic kidney were examined to clarify Doppler ultrasound capability in assessing the renal circulation. Hemodynamics changes in kidney tissue appeared on early stage of diabetic kidney disease. Intrarenal hemodynamics disturbances in patients with type 2 diabetes mellitus is revealed through a decrease in the minimum blood flow velocity and an increase in the intrarenal vascular resistance parameters. We found the correlation between dopplerographic indicators, kidney functions and other parameters (age, disease duration, glycated hemoglobin level), which play a pathogenetic role in diabetic kidney disease. Serum creatinine level and glomerular filtration rate were indicators of renal hemodynamic changes. Resistant index above 0,7 conventional units, pulsatility index above 1,54 conventional units, systolic diastolic ratio above 3,8 conventional units were ultrasound signs of kidney damage. Patients without standard signs of chronic kidney disease have diagnostically significant index of resistance in 72% of cases, a pulsation index in 50%, a systolic-diastolic ratio in 28%. Renal blood flow examination in right segmental artery area will be use for non-invasive diagnosis and estimation of kidney dysfunction in patients with type 2 diabetes mellitus.