Stage Renal Failure Research Articles

#4425 EZH2 PROMOTES RENAL INTERSTITIAL FIBROSIS THROUGH DOWNREGULATION OF PHOSPHOENOLPYRUVATE CARBOXYKINASE 1 MEDIATED GLUCONEOGENESIS

Abstract Background and Aims Renal fibrosis is the common pathological pathway of various chronic kidney diseases progressing to the end stage of renal failure. The methyltransferase enhancer of zeste homolog 2 (EZH2) has been identified as a therapeutic target to inhibit renal interstitial fibrosis. However, the mechanism underlying the role of EZH2 in renal fibrosis is not completely understood. Method Unilateral ureteral obstruction (UUO), unilateral ischemia-reperfusion injury (UIRI) mouse models were established. PCR, cleavage under targets and tagmentation (CUT&Tag) and Western blotting was performed to evaluate the expression of EZH2 and phosphoenolpyruvate carboxykinase 1 (PCK1). Results By using EZH2 inhibitor 3-DZNeP and Ezh2 conditional knockout mice, we confirmed the pro-fibrotic effect of EZH2 in unilateral ureteral obstruction (UUO). Through RNA sequence and cleavage under targets and tagmentation (CUT&Tag) sequence analysis, we found that the phosphoenolpyruvate carboxykinase 1 (PCK1), a critical enzyme in gluconeogenesis, is negatively regulated by EZH2 in fibrotic kidneys, which was further confirmed by quantitative PCR, CUT&Tag and Western blotting. We further showed that deletion or inhibition of EZH2 inhibited renal fibrosis and enhanced PCK1 expression and activity in unilateral ischemia-reperfusion injury (UIRI) and folic acid induced mouse nephropathy. Moreover, the dysregulated production of renal glucose and lactate in mouse UUO kidneys was restored after EZH2 inhibition by 3-DZNeP. Finally, inhibition of PCK1 by 3-mercaptopropionic acid (3-MPA) abrogated the anti-fibrotic effect of 3-DZNeP in UUO kidneys. Conclusion We conclude that EZH2 promotes renal interstitial fibrosis through inhibition of PCK1 mediated gluconeogenesis.

Experience of conducting the first Russian cardiology hackathon Cardio data hack

This article is about the experience in organizing and conducting the first Russian cardiology hackathon Cardio data hack UFA 2022 which took place in Ufa in November 2022. It describes the preparation stages and organizational conditions of the hackathon conducting, the ways of interacting between the event organizer and participants, and the methods of evaluating the tasks. The first hackathon case was the recognition of ventricular bigeminy in patients with 24-hour ECG recording; the second case was performing a meta-analysis of the studies which assessed efficacy and safety of oral anticoagulants in atrial fibrillation and chronic renal failure stages IV and V. The hackathon attracted 179 registered participants who formed 42 teams, but further only 37 of them confirmed their participation and formed 8 teams. 7 teams gave the final solution of the tasks, and 5 of them presented their results with 3 of them giving solutions for both cases. Eventually, there were obtained the prototypes of solution for bigeminy recognition during Holter monitoring and high-quality meta-analyses evaluating the efficacy and safety of oral anticoagulants.

Evaluation of Adjusted Calcium Levels in Patients of Chronic Renal Failure with Hypo-Albuminemia

Objective: To compare adjusted calcium levels with ionised Calcium in chronic renal failure patients with hypoalbuminemia for the correct assessment of their Calcium status.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar 2020 to Jan 2021.
 Methodology: A total of 304 individuals aged 18 to 90 years, of either gender were included in the study. Participants were differentiated into stages of Chronic renal failure based on the estimated glomerular filtration rate calculated through the Chronic Kidney Disease Epidemiology Collaboration equation. Serum total Calcium, urea and creatinine were analysed on ADVIA 1800R Clinical Chemistry Auto analyser. In addition, ionised Calcium was analysed on Cobas b221 blood gas and electrolyte analyser.
 Results: Mean age of the study participants was 56.3±16.03 years. 130(42.5%) individuals had stage-5 while 102(33.3%) had stage 4 chronic kidney disease. Based on ionised Calcium concentration, 37.3% of participants had hypocalcaemia, 57.2% had normocalcaemia, and 4.9% had hypercalcaemia. 57.5% had albumin concentration between 20-29g/L. Cohen’s Kappa statistical analysis showed adjusted Calcium to be a poor predictor of the correct Calcium status of the patients with hypoalbuminemia.
 Conclusion: Adjusted Calcium, using the Modified Payne formula, overestimates Calcium status in patients of chronic renal failure with hypoalbuminemia when compared with total unadjusted Calcium levels hence misclassifying true hypocalcaemic patients as normocalcaemic.Keywords: Adjusted calcium, Chronic renal failure, Estimated glomerular filtration rate, Hypoalbuminemia, Ionised calcium.

Long-term Results after Endovascular and Open Repair of Ruptured Abdominal Aortic Aneurysm - a Propensity Score Matched Analysis

This retrospective propensity score matched study presents the perioperative mortality and long-term survival up to 9 years after endovascular (EVAR) and open (OAR) repair of patients with ruptured abdominal aortic aneurysm (rAAA) in Germany using health insurance data. 2170 patients treated between January 1st, 2010 and December 31st, 2016, for rAAA within 24 hours of hospital admission and receiving blood transfusions were enrolled in the study and tracked until December 31st, 2018. For better comparability of EVAR and OAR, a 1:1 propensity score matching with 624 pairs according to patient age, sex and comorbidities was carried out using the R program (Foundation for Statistical Computing, Vienna, Austria). In the unadjusted groups, 29.1% (631/2170) of the patients were treated with EVAR and 70.9% (1539/2170) with OAR. EVAR patients had a significantly higher overall rate of comorbidities. After adjustment, EVAR patients showed significantly better perioperative survival (EVAR 35.7%, OAR 51.0%, p=0.000). Perioperative complications occurred in 80.4% of EVAR patients and 80.3% of OAR patients (p=1.000). At the end of follow-up, Kaplan-Meier estimated that 15.2% of patients survived after EVAR vs. 19.5% after OAR (p=0.027). In the multivariate Cox regression analysis, OAR, age ≥80 years, diabetes mellitus type 2 and renal failure stages 3 to 5 had a negative impact on overall survival. Patients treated on weekdays had a significantly lower perioperative mortality than patients treated during the weekend (perioperative mortality on weekdays 40.6% vs. 53.4% during the weekend; p=0.000) and a better overall survival as estimated by Kaplan-Meier. Significantly better perioperative and overall survival was observed with EVAR than with OAR in patients with rAAA. The perioperative survival benefit of EVAR was also found in patients older than 80 years. Female gender had no significant influence on perioperative mortality and overall survival. Patients treated on weekends had a significantly poorer perioperative survival than patients treated on weekdays, and this lasted through the end of follow-up. The extent to which this was dependent on hospital structure was unclear.

Hormonal imbalance in patients with chronic renal failure in the pre-dialysis and dialysis periods (part1)

The review describes the problem of studying progressive changes of hormones concentrations (parathyroid hormone, insulin, somatotropin, prolactin) in patients with chronic renal failure on the pre-dialysis and dialysis stages. The pathogenetic relationships between kidney function deterioration and hormone concentrations as well as changes of their biological effects were evaluated. Parathyroid hormone is considered as an uraemic toxin, since its concentration in the blood begins to increase when the glomerular filtration rate decreases below 50 ml/min. All stages of chronic kidney disease are accompanied by disorders of calcium-phosphorus metabolism. Prolonged excess of parathyroid hormone leads to bone loss and to the progression to secondary hyperparathyroidism that is a frequent complication in patients with the later stages of chronic renal failure and, especially, in those on dialysis treatment. The elevation of insulin level in chronic renal failure is the consequence of progressive decrease in glomerular filtration rate and insulin excretion by proximal tubules. So, it results in insulin half-life prolongation. Long-term dialysis therapy eliminates factors that reduce the degradation of insulin by extrarenal tissues, which results in an improvement of their insulin sensitivity. Experimental and clinical studies have shown that an excess of somatotropin can adversely affect the kidneys that leads to glomerular hyperfiltration and the progression to glomerulosclerosis. The risk of possible side effects on kidneys should be taken into account when prescribing recombinant human insulin-like growth factor. The prolactin concentration is usually increased in chronic kidney disease due to reduced clearance and increased secretion. Hyperprolactinemia manifests as galactorrhea and hypogonadism. Dialysis therapy can’t normalize the increased concentration of prolactin. Modern options for pathogenetic treatment of endocrine disorders in patients with chronic renal failure are outlined in this article. It was found that kidneys play an important role in regulating hormones concentrations in the blood. Endocrine disorders are one of the most important components of the uraemic syndrome, which requires further clinical studies, aimed on the searching of better treatment strategies and prevention of hormonal imbalance on the pre-dialysis and dialysis stages of chronic kidney disease.

Association Between Salivary Cytokines, Chemokines and Growth Factors and Salivary Gland Function in Children with Chronic Kidney Disease.

Chronic kidney disease (CKD) is a systemic inflammatory disease that leads to multiple organ complications not only in the kidneys and the cardiovascular system, but also in the oral cavity. CKD children experience reduced saliva secretion (hyposalivation), which leads to increased incidence of dental caries and significant impairment of patients' quality of life. However, the causes of salivary gland dysfunction in children with CKD are unknown. The present study is the first to evaluate the inflammatory and anti-inflammatory profile in the saliva of children with CKD at different stages of renal failure with normal and reduced salivary gland function. Thirty children with CKD (age 9-16) and thirty age- and gender-matched healthy children were classified for the study. Salivary inflammatory and anti-inflammatory profile were assayed using the multiplex ELISA assay. We demonstrated statistically significant changes in salivary pro-inflammatory (↑TNF-α, ↓IL-7), anti-inflammatory (↑IL-10), Th1 (↑INF-γ, ↑IL-15), Th2 (↑IL-4, ↑IL-5, ↑IL-6, ↑IL-9) and Th17 (IL-17) cytokines as well as chemokines (↑MCP-1/CCL-2, ↑MIP-1α/CCL3, ↓MIP-1β/CCL4, ↓EOTAXIN/CCL11) and growth factors (↑G-CSF, ↑FGF) in unstimulated saliva of children with CKD compared to the controls. Although the evaluation of the salivary inflammatory profile does not indicate a particular dominance of any of the branches of the immune system, we observed a statistically significant increase in the concentration of all Th2 cytokines assayed. The multivariate regression analysis showed that the content of salivary cytokines, chemokines and growth factors depends on the secretory function of the salivary glands, ie, salivary flow, total protein concentration and amylase activity in the saliva. Salivary MIP-1α/CCL3 was the most effective to differentiate children with CKD and hyposalivation from patients with normal saliva secretion. Inflammation is involved in salivary gland dysfunction in children with CKD, although further studies on in vitro and in vivo models are necessary to confirm this hypothesis.

A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POST DIALYSIS HOME CARE AMONG CAREGIVERS OF CHRONIC RENAL PATIENTS UNDERGOING HEMODIALYSIS AT SELECTED HOSPITAL OF DISTT. UNA. HIMACHAL PRADESH

Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end stage kidney disease and death. Chronic kidney disease has become a major cause of global morbidity and mortality in developing countries. The burden of Chronic kidney disease in India cannot be assessed accurately. The approximate prevalence of Chronic Kidney disease is 800 per million population and incidence of end stage renal disease is 150-200 per million population. Chronic Kidney Disease is a progressive, irreversible deterioration in renal function in which the bodys ability to maintain metabolic and fluid and electrolyte balance fails resulting in retention of urea and nitrogenous waste in the blood. There are mainly 5 stages of renal failure. The end stage of chronic renal failure must require the long term treatment including dialysis or kidney transplantation. Dialysis makes it possible to continue living with end-stage kidney disease for many years or even decades. Dialysis is a process of purification of blood used to remove fluid and uremic waste products from the body when kidneys cannot do so. Approximately 1.5 litres of blood are filtered by a healthy persons kidneys each day. People whose kidneys either do not work properly cant remove waste products from body. A dialysis machine removes a small amount of a patients blood through a man-made membrane called dialyzer, or artificial kidney to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body. A quasi experimental study to assess the effectiveness of structural teaching programme on knowledge regarding post-dialysis home care among caregivers of chronic renal patients undergoing hemodialysis at selected hospital of distt. Una. The research design selected for the study was pre-experimental research design. Data was collected from 50 samples using convenient sampling technique. Tool was used to collect the data from samples. It consists of 2 sections. Section-A consists of patients and caregivers demographic variables and Section-B consists of structured questionnaire and was analysed by applying descriptive and inferential statistics. A finding reveals that the out of 50 samples 36% of samples were in the age group of 45-60 years, 54% were male, 36% had got education up-to 12th,56% were unemployed, 62% had income less than 10,000 per month, 96% had rural area as place of residence, 56% had nuclear family, 74% had no family history, 68% were married, 80% had belong to Hindu religion, 66% had health care professionals as source of information regarding post dialysis home care. In pre-test mean knowledge score was 11.18+ 3.706 which was 37.27% of total mean knowledge score percentage. In post-test mean knowledge score 17.98+ 3.727 which was 59.94% of total mean score. The difference in pre-test and post-test mean score was 22.67. Hence it concluded that the structured teaching programme was effective. Pairedt test was calculated to analyse the difference between the pre-test and post-test knowledge scores, shows highly significant difference between pre-test and post-test. Hence the stated null hypothesis was rejected. There was only two significant association found between the knowledge regarding post dialysis home care among caregivers of chronic renal failure patients undergoing haemodialysis i.e. Gender and occupation. There was no other significant association between post-test knowledge scores with selected demographic variables such as age, education, income, place of residence, type of family, family history, marital status, religion, source of information. Thus null hypothesis was accepted.

A STUDY OF THYROID PROFILE AND FASTING LIPID PROFILE IN CHRONIC KIDNEY DISEASE

Background: Chronic kidney disease [CKD] is associated with specific abnormalities in the thyroid and lipoprotein metabolism both in the early and in the advanced stages of chronic renal failure. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure.Our study aimed at to estimate thyroid profile and dyslipidemia in CKD patients on conservative management,on haemodialysisand to compare with healthy controls. Methods: This was a prospective study conducted among the 100 CKD patients and controls over 18 months admitted in the department of general medicine at our hospital. Results: Hundred CKD cases with 70 male and 30 female in a M: F ratio of 2.3:1 were found to be in different stages CKD (12, 29 and 59 in stage-3 to stage-5 respectively). In 59 cases of stage-5 CKD, 32 were on HD and 27 on conservative management. In each grade of CKD, the mean age, eGFR, urea, creatinine, thyroid profile, and lipid profile were computed individually. The levels of urea, creatinine, and eGFR differed significantly across CKD grades 3-5.The thyroid profile differed significantly across CKD grades 3-5. The lipid profile differed significantly across CKD grades 3-5, with p=0.000, >0.05, 0.000, >0.05, >0.05 for total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, respectively. Conclusions: The number of patients increases with decreasing T3 and T4 and increasing TSH proportionate to the severity of the renal failure, hypothyroidism is becoming more common in people with chronic renal disease.All lipid abnormalities found in CKD on HD have reduced HDL levels in serum along with significant rise in serum triglyceride, serum cholesterol serum LDL level and serum VLDL level.Dyslipidemia in CKD worsened as patientsprogresssed to severe stages with significant increase in TG, TC, VLDLc and TC/HDLc confirming presence of atherogenic lipid profile needing early intervention to prevent cardiovascular complications.

Real-world effectiveness of genotype-specific and pangenotypic direct-acting antivirals in HCV-infected patients with renal failure.

The aim is to summarize the effectiveness and safety of genotype-specific and pangenotypic hepatitis C virus (HCV) treatments in patients with renal failure. In the EpiTer-2 database, which includes data from 22 hepatology centers in Poland, 593 patients with HCV infection and kidney failure were identified. According to KDIGO 2022, they fulfilled the criteria of chronic kidney disease. Patients were divided into two groups: treated with genotype-specific regimens (n = 428) and pangenotypic options (n = 165), in relation to the stage of kidney disease determined using the glomerular filtration rate (GFR) (Cockcroft and Gault equation). Two separate groups were created for hemodialyzed patients (n = 134) and patients after kidney transplantation (n = 89). In a total of 593 patients, 78.7% were treatment-naïve and 23.9% had liver cirrhosis, in 27.5% of cases decompensated. In both groups, the dominant genotype was GT1b. Among patients treated with genotype-specific regimens, LDV/SOF ± RBV, OBV/PTV/r + DSV ± RBV, and GZR/EBR ± RBV treatments were given to 31.5%, 31.5%, and 34.8% of patients respectively. In pangenotypic regimens, GLE/PIB was chosen in 50.3%. Ninety-six percent and 98.8% of patients in the genotype-specific regimen and 88.5% and 94.8% in the pangenotypic regimen achieved a sustained virologic response at 12 weeks (SVR12) in the intention-to-treat and per protocol population respectively. Liver cirrhosis was identified as a risk factor for virological failure. During the study, 14 patients died, 7 in each of the two groups, none related to the antiviral treatment. Both types of treatment regimens are equally effective and safe in patients with renal failure. The stage of renal failure or transplant does not influence the antiviral response.

Narrative review of migraine management in patients with renal or hepatic disease.

Treatment of migraine in the setting of either renal or hepatic disease can be daunting for clinicians. Not only does the method of metabolism have to be considered, but also the method of elimination/excretion of the parent drug and any active or toxic metabolites. Furthermore, it is difficult to think about liver or kidney disease in isolation, as liver disease can sometimes contribute to impaired renal function and renal disease can sometimes impair hepatic metabolism, through the cytochrome P450 system. A detailed search for terms related to liver disease, renal disease, and migraine management was performed in PubMed, Ovid Medline, Embase, and the Cochrane Library.For each medication, product labels were retrieved and reviewed using the US FDA website, with additional review of IBM Micromedex, LiverTox, and the Renal Drug Handbook. This manuscript provides an overview of migraine drug metabolism and how it can be affected by liver and renal impairment. It reviews the standard terminology recommended by the US Food and Drug Administration for the different stages of hepatic and renal failure. The available evidence regarding the use of abortive and preventative medicines in the setting of organ failure is discussed in detail, including more recent therapies such as lasmiditan, gepants, and calcitonin gene-related peptide antibodies. For acute therapy, the use of NSAIDS should be limited, as these carry risk for both severe hepatic and renal disease. Triptans can be selectively used, often with dose guideline adjustments. Ubrogepant may be used in severe hepatic disease with dose adjustment and lasmiditan can be used in end stage renal disease. Though non-medicine strategies may be the most reasonable initial approach, many preventative medications can be used in the setting of hepatic and renal disease, often with dose adjustment. This review provides tables of guidelines, including reduced dosing recommendations, for the use of abortive and preventative migraine medications in hepatic and renal failure.

A CLINICAL STUDY THROUGH AYURVEDA IN THE MANAGEMENT OF MUTRAGHATA W.S.R. CHRONIC KIDNEY DISEASE (CKD) – A CASE STUDY

Chronic Kidney Disease itself indicates chronicity with irreversible damage to the kidneys due to main leading factor in many cases nowadays as a major cause which is Hypertension and Diabetes mellitus type 2, which clinically presents as symptomless sometimes in initial stages and further presents with pedal oedema, decreased appetite, nausea, difficulty in micturition/decreased urine output, frothy/foamy urine, fatigue. Usually it is manifested through various lab investigations such as kidney function test in which increase in serum urea levels, serum creatinine and other are seen i.e., a waste product made by our muscles, also Kidney’s one of the vital function is production of erythropoietin.Ayurveda has played an essential role in the early stages of renal failure in the hunt for this effective and safe treatment. Mutra is a kleda product, according to Ayurveda. Acharya Sushruta, a worldrenowned surgeon, has a good description of Mutrapravrutti.Creatine and Creatinine are not the same substances. Creatine from liver transported to other tissues. Creatine are 98% present in skeletol and heart muscles.in these muscles it gets converted to high energy source creatine phosphate. In skeletol muscle approximately 1/4th of Creatine exists as free Creatine and 3/4th exists as Creatine phosphate compound. It acts as a storage form of energy in the muscle. The amount of C. phosphate in the body is proportional to the muscle mass

Specifičnosti u lečenju hipertenzije kod bolesnika sa hroničnim bubrežnim oboljenjem

Today, it is believed that all over the world about 10% of the population has a kidney lesion, most often chronic kidney disease (CKD). Hypertension and diabetes mellitus are the most common causes of chronic kidney damage, and in everyday clinical practice, we often wonder whether hypertension is a consequence of a lesion of the kidney parenchyma and vasculature or is its cause. Patients with CKD have high cardiovascular (CV) morbidity and most often die from CV disease. The specificity of blood pressure treatment in patients with chronic kidney damage is that good control of hypertension not only leads to a reduction of CV risk but also to a slowing of the progression of chronic to terminal renal failure. There is no doubt that the first line of treatment for hypertension in patients with CKD is angiotensinconverting enzyme inhibitors (ACEi) and angiotensin-2 receptor blockers (ARB). They are recommended especially for those patients with diabetic nephropathy because, in addition to their antihypertensive effect, they reduce proteinuria, slow down the progression of chronic kidney failure, especially if given in the early stages of CKD, and reduce CV risk. However, for a long time, there have been controversial opinions about whether in the advanced stages of renal failure, when the glomerular filtration rate (GFR) is < 30 mL/min/1.73 m2, these drugs should be excluded. According to the latest KDIGO guidelines in 2021, renin-angiotensinaldosterone (RAAS) blockers are the first line in the treatment of proteinuric CKD patients, with and without diabetes mellitus, and in stage 4, with a note that these drugs should be continued in therapy unless there is marked hyperkalemia (potassium > 6 mmol/L), acute kidney damage or decrease in estimated glomerular filtration rate > 30%. The most important thing is to individualize the optimal therapy for each patient. In the guidelines for the treatment of hypertension in patients with CKD, there are no clear recommendations for the treatment of unregulated hypertension when target pressures cannot be achieved with RAAS blockade and when there are contraindications for the administration of this group of drugs. The addition of calcium channel blockers, diuretics, and beta blockers is based on expert opinion.

Associations between visceral adiposity index and incident nephropathy outcomes in diabetic patients: Insights from the ACCORD trial.

Visceral adiposity index (VAI) was a reliable marker for visceral adiposity accumulation and dysfunction. The association between VAI and nephropathy outcomes remains uncertain in patients with type 2 diabetes (T2DM). We aimed to evaluate the longitudinal relationships between VAI and incident nephropathy outcomes in T2DM patients. Ten thousand one hundred and thirty two participants with T2DM from the ACCORD trial were included in the present study. Cumulative average VAI based on VAI measurements at baseline and follow-up was used to represent long-term VAI status. The primary outcome was the incident composite nephropathy outcome defined as: (1) serum creatinine doubling or >20ml/min decrease in eGFR; or (2) development of macro-albuminuria; or (3) renal failure or end stage kidney disease (dialysis) or serum creatinine >3.3mg/dl. During 26,168 person-years follow-up duration, 6094 (60.1%) participants developed the incident composite nephropathy outcome. When assessing cumulative average VAI as quartiles, compared with those in the 1-2 quartiles (<2.6), a significantly higher risk of incident composite nephropathy outcomes was observed among participants in the 3-4 quartiles (≥2.6, adjusted HR: 1.09, 95% CI: 1.01, 1.18). Moreover, the positive association was consistent in participants with or without single abnormal VAI components, including general obesity, abdominal obesity, elevated triglycerides, and low high-density lipoprotein cholesterol, or with different numbers of abnormal VAI components. Additionally, the positive association was stronger in participants with cumulative average systolic blood pressure <130mmHg (vs. ≥130mmHg; p-interaction<0.001). In T2DM patients, higher cumulative average VAI was associated with a higher risk of incident composite nephropathy outcomes. clinicaltrials.gov, identifier: NCT00000620.

Options for approaches to nephrectomy in patients with end-stage chronic kidney disease caused by autosomal dominant polycystic kidney disease: A review

Autosomal-dominant polycystic kidney disease is a common kidney disease that affects all racial groups around the world, occupies one of the leading places in the structure of urological diseases and forms a significant contribution to the structure of all causes leading to the end stage of chronic renal failure, disabling patients in this group and hence leading to the inevitability of renal replacement therapy. A highly effective clinical method for replacing lost kidney function is kidney transplantation. Based on the fact that the number of patients with this pathology is increasing, it is necessary to search for and introduce clear criteria for the best care, taking into account the high likelihood of developing infectious complications, hematuria, the absence or presence of diuresis, arterial hypertension in this category of patients. The article reflects the various methods of nephrectomy in patients suffering from autosomal dominant polycystic kidney disease, as well as how approaches to nephrectomy have evolved. The results of complications, as well as patient and graft survival in domestic and foreign studies, in which bilateral or ipsilateral nephrectomy was used using open or laparoscopic access before, during or after kidney transplantation, are demonstrated. Preference is rightfully given to minimally invasive methods of surgical treatment. Taking into account the already reduced resources of the organism of these patients, the volume and method of surgical treatment should be carefully chosen, taking into account safety, efficacy and risk minimization.

The level of serotonin and its metabolite in hemolytic-uremic syndrome in children

Hemolytic-uremic syndrome includes a triad of symptoms: microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Given the progressive course of hemolytic-uremic syndrome, up to the terminal stage of renal failure, it is necessary to search for early markers of renal tissue damage as prognostically significant factors in the development of nephrosclerosis, which is of particular importance in childhood to optimize the management of such patients. The analysis of the literature data demonstrates the actual role of serotonin and platelet-mediated effect of serotonin on fibroinflammatory processes in kidney vessels. Thus, changes in the serotonergic system in patients already at the onset of hemolytic-uremic syndrome are of great interest in order to develop new diagnostic approaches that allow optimizing early diagnosis and slowing down the progression of renal damage in this category of patients. These studies will expand knowledge about the role of the serotonergic system in the formation of chronic kidney disease in children with hemolytic-uremic syndrome.

OPEN SURGICAL TREATMENT OF BILATERAL CORALLOID AND MULTIPLE NEPHROLITHIASIS COMPLICATED WITH CHRONIC RENAL FAILURE

This articles describes the improved preoperative techniques for preparing to the surgical operations for bilateral coralloid and multiple nephrolithiasis complicated with chronic renal failure and discusses the treatment outcomes. Materials and methods. During 2000-2020, at the Department of Urology of the Azerbaijan Medical University, more than 3,000 open surgical operations were performed on for kidney and ureter stones. 974 (32.47±0.85%) paitents had the operations for coralloid and multiple nephrolithiasis; 700 (23.33±0.77%) of them were found to have unilateral and 274 (9.13±0.53%) had bilateral coral stones. Results. The results of open surgical operations of 274 patients operated on for bilateral coralloid and multiple nephrolithiasis in the 2000-2020 period were analyzed. 190 (69.3±2.8%) of them, 105 men and 85 women, had renal insufficiency, 162 (59.1±3.0%) patients (82 men, 80 women) had the diagnosis of chronic renal failure, and 28 (10.2±1.8%) patients (19 men, 9 women) had acute chronic renal failure. The implementation of the preoperative preparation techniques, taking into account the stage of chronic renal failure, was presented. Out of 274 operated patients, the intervention was performed in 47 (17.2±2.3%) with nephrostomy (24 right, 23 left), in 28 (10.2±1.8%) with pyelostomy (16 right, 12 left), in 110 (40.1±3.0%) with intrarenal stenting (60 right, 50 left), in 6 (2.2±0.9%) with nephrostomy and intrarenal stenting (2 on the right, 4 on the left). Along with this, 56 (20.4±2.4%) patients had clamping of the renal artery from one side or another. After surgery, 48 (17.5±2.3%) patients experienced the exacerbation of chronic pyelonephritis. In patients with diabetes, the exacerbation of chronic pyelonephritis had a more severe course. 26 (9.5±1.8%) patients experienced the exacerbation of chronic renal failure, of them, 6 (2.2±0.9%) had a creatinine level exceeding 500 mmol/l, that was the reason for haemodialysis. Anaemia was observed in 49 (17.9±2.3%) patients with chronic pyelonephritis and chronic renal failure in the postoperative period. In patients with anaemia, the haemoglobin level was 50-85 g/l (average 71.9 ± 0.4 g/l). 11 (4.0±1.2%) of them received blood transfusions in the postoperative period. In 5 (1.8±0.8%) cases, transfusion was performed during haemodialysis. In general, 270 patients out of 274 with bilateral coralloid and multiple nephrolithiasis had open surgical treatment completed successfully, and 4 (1.5±0.7%) had fatal outcomes. In 254 (92.7±1.6%) cases, an organ-preserving operation was performed on, and in 20 (7.3±1.6%) cases, surgical resections were carried out. The study has shown the preoperative preparation and the choice of the correct surgical tactics during the operation considerably contributes to successful treatment outcomes among the patients with severe chronic renal failure.

Research progress of risk factors and early diagnostic biomarkers of gout-induced renal injury.

Gout renal injury has an insidious onset, no obvious symptoms, and laboratory abnormalities in the early stages of the disease. The injury is not easily detected, and in many cases, the patients have entered the renal failure stage at the time of diagnosis. Therefore, the detection of gout renal injury–related risk factors and early diagnostic biomarkers of gout renal injury is essential for the prevention and early diagnosis of the disease. This article reviews the research progress in risk factors and early diagnostic biomarkers of gout renal injury.

Relationship of proliferative diabetic retinopathy and severe stages of chronic renal failure

Diabetic nephropathy, as a frequent complication in patients with diabetes mellitus (DM), is increasing due to the rapid increase in the prevalence of diabetes, which is considered one of the leading causes of chronic renal failure (CRF). Diabetic retinopathy (DR) and diabetic nephropathy are the two main microvascular complications of DM. Studies show that the prevalence and severity of visual pathology is significantly higher among patients with severe stages of CRF, which is associated with the following risk factors: hypertension, metabolic disorders, uremia, anemia, and the use of anticoagulant therapy. The leading forms of eye pathology in patients with DR and CRF are proliferative DR, macular edema, and vitreous hemorrhage. The main structural changes in the choroid and retina in patients with CRF are the thickness of the choroid, accompanied by a decrease in the density of vessels and the volume of perfusion in the surface capillary layer of the choriocapillaries, which is aggravated with the aggravation of the stage of the disease and is interconnected with impaired renal function. Literature data indicate a positive effect of the hemodialysis procedure on DR. It should be borne in mind that in patients with end-stage chronic renal failure, a hemodialysis session may be accompanied by pain in the eye associated with an increase in blood pressure. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure improved and adequate treatment of patients with CRF and proliferative DR.

FEATURES OF NERVOUS SYSTEM DAMAGE IN CHILDREN WITH CHRONIC KIDNEY DISEASE

In this article, the authors present a review of published studies in recent years that analyze the neurocognitive and psychosocial consequences of chronic kidney disease (CKD) in children of different ages and at different stages of renal failure. Particular attention is focused on summarizing peer-reviewed studies that describe the relationship between kidney function and neurocognitive and neurophysiological functions. The authors suggest that the results of the presented studies in children with chronic kidney disease will provide additional guidance for clinicians and researchers working with children and adolescents with neurological consequences in CKD.

Diagnosis of chronic renal insufficiency by Cockcroft formula in elderly adults with Diabetes Mellitus type ll

Objective: To determine the diagnosis of Chronic Renal Insufficiency, by Cockcroft formula, in type II diabetic patients aged 40 to 80 years old from the community of Santa Cruz, Hecelchakán during the period from August 2020 to July 2021. Materials and methods: This is a prospective, cross-sectional, descriptive and observational study in which the diagnosis of renal failure in any of its 5 stages will be investigated. Patients were asked for laboratory tests of plasma creatinine, weight and age, to later calculate the creatinine clearance using the Cockcroft and Gault formula and classify the stage of renal failure in which each patient is to formulate plans of practice of according to your state. Results: We found 10 cases with chronic kidney disease in stage 1, 3 men and 7 women, in stage 2 8 patients were found, 2 men and 6 women, and 5 patients with stage 3, all of them female. Conclusions: In the community of Santa Cruz, Hecelchakán, there is a prevalence of 3.9% in diabetes mellitus, 42 people who come monthly from a total population of 1,060 according to the November 2020 population census.