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I. Dudar, O. Loboda, V. Savchuk
Ukrainian Journal of Nephrology and Dialysis pp 59-66; doi:10.31450/ukrjnd.4(68).2020.09

The paper presents the summary of recommendation statements of the "KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease" translated into Ukrainian.
M. Kolesnyk, , L. Snisar, L. Liksunova, L. Lebid, M. Velychko
Ukrainian Journal of Nephrology and Dialysis pp 4-10; doi:10.31450/ukrjnd.4(68).2020.01

Flu is the cause of up to 650,000 deaths worldwide each year. According to CDC USA in 2019-2020 the flu caused 86,000 deaths. Patients with chronic kidney disease (CKD) are at high risk for serious complications and adverse effects of influenza infection. A feature of this year is the possibility of combining influenza with COVID-19, which can significantly complicate treatment and worsen the prognosis of CKD patients. Therefore, prevention and adequate management of influenza in this patient cohort are obvious. In this regard, the Expert Group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created adapted clinical guidelines for the prevention, diagnosis and management of influenza in CKD patients.
M. O. Kolesnyk, N. I. Kozliuk, O. O. Razvazhaieva
Ukrainian Journal of Nephrology and Dialysis pp 11-17; doi:10.31450/ukrjnd.4(68).2020.02

The work aimed to conduct a rating of nephrological services in the regions of Ukraine by using the method of complex statistical coefficients. Methods. Evaluation of nephrological services in the regions of Ukraine was made by using indicators of the structure, health care resources, quality and efficiency of renal medical care of patients with chronic kidney disease and patients with acute kidney injury. Results. The place of each province in the national rating of the state of renal medical care was identified. Conclusions. The organization, availability and quality of medical care for nephrological patients in Ukraine do not meet existing needs. The significant differences in the specialized nephrological care between the regions of Ukraine can be solved out through the implementation of appropriate management and financial decisions.
Ergün Parmaksız, Meral Meşe
Ukrainian Journal of Nephrology and Dialysis pp 23-28; doi:10.31450/ukrjnd.4(68).2020.04

Membranoproliferative glomerulonephritis (MPGN) is a heterogeneous disease characterized by a morphological injury pattern that can be seen under various disease conditions that share common pathogenic mechanisms. In this study, we analyzed clinical features, pathological findings, long-term kidney outcomes according to the new pathohistological classification of MPGN. Methods. This retrospective study included 20 CKD patients with biopsy-proven MPGN that had been diagnosed between 2011 and 2019. We reclassified the patterns of MPGN as immune-complexes mediated (ICM) and complement-mediated (CM) according to the new classification. Results. The level of daily proteinuria was lower in the ICM MPGN than the CM MPGN group but was not statistically significant at the end of the study. Histopathologically, the difference in C3 staining was found between the patients with ICM and CM MPGN. At the end of the follow-up period, no patients developed end-stage renal disease, and no death occurred in response to treatment in the ICM MPGN group. In the CM MPGN group, 2 patients evolved to end-stage renal disease and 1 of them had renal transplantation. Conclusion. Larger sample size and longer follow-up may change the relationship between histological factors, treatment strategies, and kidney outcomes. We believe that the use of the new diagnostic approach that applies to the ICM MPGN and CM MPGN will help nephrologists to improve treatment options and renal outcomes for patients with MPGN.
T. Bulduk, A. U. Yalcin, O. M. Akay, , , G. Sahin, G. Temiz, G. Demirel
Ukrainian Journal of Nephrology and Dialysis pp 29-37; doi:10.31450/ukrjnd.4(68).2020.05

Anemia is a common complication of chronic kidney disease (CKD). The most common cause of anemia in CKD is erythropoietin deficiency; and the most important cause of mortality in CKD patients is atherosclerotic vascular complications which are associated with endothelial damage. One of the methods evaluating vascular integrity is the cytometric measurement of circulating endothelial cells and endothelial progenitor cells in peripheral blood. The study aimed to investigate the effects of erythropoietin therapy on endothelial dysfunction by evaluating circulating endothelial cells and endothelial progenitor cells in peripheral blood using the technique of flow cytometry. Methods. A total of 55 hemodialysis patients were evaluated in three groups; those having erythropoietin therapy for at least last 3 months (n = 20) / not having erythropoietin for at least the last 3 months (n = 20) and the patients who started erythropoietin treatment during the study (n = 5). The control group consisted of 20 people. Blood values of the 3rd Group were investigated three times as baseline, 2nd week and 8th week CD34 +, CD105 + cells were evaluated as activated circulating endothelial cells; CD133 +, CD146 + cells were evaluated as activated endothelial progenitor cells. Results. There was no difference between the patients and healthy individuals in terms of circulating endothelial cells and endothelial progenitor cells. In the third group, no differences were observed in circulating endothelial cells / endothelial progenitor cell levels at baseline / 2nd and 8th weeks. There was no correlation between erythropoietin and circulating endothelial cells / endothelial progenitor cells. Conclusion. A correlation is not available between the therapeutic doses of erythropoietin used in hemodialysis patients and circulating endothelial cells / endothelial progenitor cell levels; supratherapeutic doses could change the results.
I. Mykhaloiko, I. Dudar
Ukrainian Journal of Nephrology and Dialysis pp 67-73; doi:10.31450/ukrjnd.4(68).2020.10

Chronic kidney disease (CKD) is a global health problem. Patients with CKD have an increased risk of thromboembolic complications and bleeding. It remains difficult to determine the benefits and risks of antiplatelet and anticoagulant therapy in patients with CKD, so an individualized risk assessment of each patient should be mandatory. To date, there are no specialized scales for assessing the risk of thromboembolic events and bleeding, which are focused on patients with CKD and take into account all the features of the course of CKD and the specific factors of their occurrence. In this work, we decided to conduct a detailed assessment of the accuracy of the currently accepted risk scales for thromboembolic events and bleeding in patients with CKD.
M. Kolesnyk, , I. Dudar, E. Krasyuk, L. Liksunova, L. Snisar
Ukrainian Journal of Nephrology and Dialysis pp 4-9; doi:10.31450/ukrjnd.3(67).2020.01

During the global COVID-19 pandemic, there was an urgent need to make complex clinical decisions about the management of chronic kidney disease (CKD)patients. Since a significant number of CKD patients have impaired renal function or receive immunosuppressive (IS) therapy, they belong to a high-risk group for adverse effects of COVID-19 infection. In addition, the overwhelming majority of CKD patients have co-morbidities, which not only increases the risk of SARS-CoV-2 infection, but also the formation of life-threatening complications of COVID-19. Currently, there are no data on the best practices for the management of CKD patients during the COVID-19 pandemic. However, based on the existing research presented by leading renal associations (ERA-EDTA, Kidney Care UK, The Renal Association), NICE Rapid Guidelines on this topic, and our own experience, the expert group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created the Adapted Clinical Recommendations for the Management Of Patients with CKD stages 1-4 during the COVID-19 pandemic. The proposed clinical guidelines aimed to classify all CKD patients at risk for SARS-CoV-2 infection and hospitalization. The key characteristics of each class of kidney disease are the kidney functional level, determined by the glomerular filtration rate (GFR), daily urinary protein excretion, hypertension, medication intake and other additional characteristics. All of the following clinical guidelines have a level of evidence of 2C.
M. Kolesnyk, , I. Dudar, E. Krasyuk, L. Liksunova, L. Snisar, T. Moroz
Ukrainian Journal of Nephrology and Dialysis pp 10-14; doi:10.31450/ukrjnd.3(67).2020.02

The global COVID-19 pandemic is a critical time for hemodialysis patients as hypertension, diabetes or other co-morbidities, as well as hemostasis disorders, are risk factors for adult distress syndrome, the formation of which significantly worsens the prognosis. Several national associations of nephrologists have created expert working groups to prepare constantly updated clinical guidelines for the management of dialysis patients in the context of the COVID-19 pandemic. According to the experts, to minimize COVID-19 infection of patients and health care workers, the medical staff of dialysis units should undergo training and further retraining, following changes in constantly updated practical recommendations. The expert group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has also created the Adapted Clinical Guidelines for the Management of Hemodialysis Facilities and Services During the COVID-19 pandemic. All of the following clinical guidelines have a level of evidence of 2C.
M. Kolesnyk, , I. Dudar, E. Krasyuk, L. Liksunova, L. Snisar
Ukrainian Journal of Nephrology and Dialysis pp 15-19; doi:10.31450/ukrjnd.3(67).2020.03

In Ukraine, about 12% of end-stage renal disease patients are treated by peritoneal dialysis (PD). In contrast to the hemodialysis population, PD patients receive treatment at home, which reduces the likelihood of SARS-CoV-2. However, older age, diabetes, hypertension and many other comorbid conditions of PD patients significantly increase the risk of infection. Therefore, maximum adherence to preventive measures for COVID-19 by PD patients and medical staff is an urgent and mandatory task. Based on the published research on COVID-19, the expert group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created the Adapted Clinical Guidelines for the Management of Peritoneal Dialysis Facilities and Services During the COVID-19 pandemic. All of the following clinical guidelines have a level of evidence of 2C.
M. Kolesnyk, I. Dudar, , E. Krasyuk, Yu. Gonchar, O. Loboda
Ukrainian Journal of Nephrology and Dialysis pp 20-27; doi:10.31450/ukrjnd.3(67).2020.04

Acute kidney injury (AKI) is diagnosed in 1–40% of the COVID-19 patients; from 2% to 10% of the patients are required renal replacement therapy (RRT). The mortality rate in this category of patients reached 88%. Early AKI detection in the patients with COVID-19, followed by the use of preventive and therapeutic measures to minimize the incidence or progression is a significant key to reduce the mortality rate and transformation of AKI into chronic kidney disease (CKD). The expert group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created the adapted clinical guidelines for the management of acute kidney injury in patients with COVID-19 or CKD stage 1-4 patients with acute kidney injury in the COVID-19 pandemic. These guidelines are intended for family physicians, general practitioners, physicians, cardiologists, nephrologists, intensivists, endocrinologists, infectious disease specialists and other professionals involved in the provision of specialized medical care to the patients with COVID-19. Specialized medical care for AKI patients infected COVID-19 should be provided by a multidisciplinary team, which has to involve nephrologists, infectious disease specialists and intensivists.
O. Gogayeva, , A. Rudenko, L. Dzakhoieva, O. Yuvchyk
Ukrainian Journal of Nephrology and Dialysis pp 52-58; doi:10.31450/ukrjnd.4(68).2020.08

The study aimed to analyze kidney function for patients with complicated forms of coronary artery disease (CAD) in the perioperative period. Methods. It was a retrospective analysis of 110 high-risk patients with complicated forms of CAD, who were operated on and discharged from the National M. Amosov Institute for the period from 2009 till 2019 years. Kidney function was evaluated by glomerular filtration rate (GFR), calculated online with СKD-EPI formula. Results. Among the included patients there were 86 (78.1%) patients with metabolic syndrome, 81 (73.59%) patients with disorders of glucose metabolism, 82 (74.5%) subjects with chronic obstructive pulmonary disease and 38 (34.5%) patients had chronic kidney disease (CKD) 3-5 stage. Preoperative risk stratification with EuroScore II scale was 9.4%. All operations performed in cardiopulmonary bypass; Custodial cardioplegia was used in 53 (48.1%) patients. The average perfusion time was 111 minutes, average cross-clamping time was 73.9 minutes. Acute kidney injury in the early postoperative period had 9 (8.1%) patients. Conclusions. At the admittance 38 (34.5%) patients with complicated forms of CAD had CKD 3-5 st. Analysis of the GFR dynamic in the early postoperative period shown a decrease in GFR in 71.05% of patients. Transient acute kidney injury with 50% sCr growth had 9 (8.1%) patients but didn’t require hemodialysis.
S.D. Novychenko, L.O. Zub
Ukrainian Journal of Nephrology and Dialysis pp 38-44; doi:10.31450/ukrjnd.4(68).2020.06

The study aimed to investigate the relationship between red blood cell membrane disorders and Doppler ultrasound indices of renal blood flow in patients with chronic kidney disease (CKD) stages1-2. Methods. The complex clinical, laboratory and instrumental (color duplex Doppler scanning of renal parenchyma vessels) examination was conducted in 131 CKD stage 1-2 patients. Among them, there were 47 patients with pyelonephritis, 48 patients with diabetic nephropathy, and 36 patients with primary glomerulonephritis. Each patients’ group was divided into 2 subgroups: with and without arterial hypertension. Twenty healthy volunteers were also included for the study control. Results. A significant correlation between indices of the erythrocytes morphology and basic Doppler ultrasonography parameters of the kidney vessels circulation, namely a.interlobaris was demonstrated in CKD patients with arterial hypertension. The most significant changes were observed in diabetic patients. Conclusion. The results of our study indicated a high informative value of renal Doppler ultrasonography as a non-invasive technique to diagnose the CKD progression in patients with comorbid hypertension
, Ali Gürel
Ukrainian Journal of Nephrology and Dialysis pp 18-22; doi:10.31450/ukrjnd.4(68).2020.03

Acute kidney injury (AKI) occurs in different situations and may have a variable prognosis due to underlying cause, clinical setting and comorbidity. Near-drowning is known to lead to bradycardic rhythms which can lead to hypoxia because of hypoperfusion. AKI has a high risk of mortality and morbidity. However, sequelae of sinus bradycardia are related to its underlying etiology. Urinary, cardiovascular and respiratory disorders are more frequently seen after near-drowning. Near-drowning related AKI and sinus bradycardia are not reported together in the literature. We aimed to emphasize these complications in near-drowning patients.
M. Kolesnyk
Ukrainian Journal of Nephrology and Dialysis pp 73-79; doi:10.31450/ukrjnd.3(67).2020.10

At the beginning of COVID-19 pandemic attention of healthcare professionals and scientists were already drawn to the appearance of markers of pathologic changes of the urinary system in SARS-CoV-2-infected patients, signs of acute kidney disease (AKD) (including acute kidney injury (AKI) or development of AKI in patients with chronic kidney disease (CKD). This necessitates verification of pathologic changes markers of the urinary system in SARS-CoV-2-infected patients and clarification of their nosologic relevance. The present study aimed to analyze the present information regarding the capacity of SARS-CoV-2 to cause kidney injury (acute kidney disease, including AKI) in patients without such changes before infecting or in patients with CKD, and to verify these changes according to the classification of urinary system disease and Nomenclature for kidney function and disease: report of Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference 2020. The presence of the pathologic changes markers of the urinary system in SARS-CoV-2-infected patients necessitates its verification via the use of tools of diagnostics of urinary system disease. Infecting with SARS-CoV-2 may cause (isolated) asymptomatic proteinuria, isolated erythrocyturia, hemoglobinuria; AKD (including AKI) in patients without preexisting urinary system injuries, AKI in patients with CKD, and may complicate hemodialysis and peritoneal dialysis. The frequency of AKI and mortality rate in patients with COVID-19 and CKD are much higher than without the last one. The AKI frequency is higher in ICU (18 – 37,5%) than in patients with moderate or mild COVID-19 (0,5 – 15%). Patients with all CKD stages with moderate or severe COVID-19 must be admitted to the hospital with further determination by a multidisciplinary team (infectionist, nephrologist, ICU physician, etc, according to the clinical situation) of necessary monitoring and treatment capacity for prevention of AKD progression and life-threatening complications or their adequate therapy. After confirmation of SARS-CoV-2 absence and release from the hospital, patients with AKD or all stages of CKD should be followed up, and monitoring frequency depends on AKD or CKD stage.
Ashraf Ibrahim Mohammed Hassan, Bashar M Al-Hammodi,
Ukrainian Journal of Nephrology and Dialysis pp 45-51; doi:10.31450/ukrjnd.4(68).2020.07

This study aimed to compare the identification frequency and composition of bacteria isolated from catheter and urine in urologic patients. Methods: Ninety patients with urethral catheters were involved in the study. Urinary and catheter cultures were taken simultaneously from each patient and cultured on MacConkey's agar. Urine culture and sensitivity were performed for all samples in pre- and postoperative periods. Swab culture and sensitivity from the surface of intraluminal urethral catheters were performed for all cases in the post-operative period. Results: The median indwelling period of the catheters was 8 days (range 3 to 21). The overall positive rate of catheter culture was significantly greater than that of urine culture, even in subjects without a recent antibacterial agent history. Urine cultures and catheter cultures did not match each other completely. The percentage of patients who had the same bacterial species isolated from both specimens increased in a time-dependent manner. Conclusions: Not all species of bacteria colonizing the intraluminal surface of the urethral catheter were detected as urinary bacteria. Bacterial colonization on the intraluminal catheter surface could precede the emergence of bacteriuria.
Ukrainian Journal of Nephrology and Dialysis pp 42-59; doi:10.31450/ukrjnd.3(67).2020.07

Kidney diseases associated with APOL1 polymorphisms are human immunodeficiency virus-associated nephropathy, idiopathic focal segmental glomerulosclerosis, hypertension-attributed chronic kidney disease, lupus nephritis and sickle cell nephropathy. This research aimed to investigate the risk of genetic variants on disease contribution. Methods. In this individual participant data meta-analysis, eighteen patients with kidney dysfunction and at risk of APOL1 genotype were investigated. Clinical features, laboratory data at initial presentation, management and outcomes were collected. The paper has written based on searching PubMed Central and Google Scholar to identify potentially relevant articles. Median, percentage, mean ± standard deviation (SD), two-tailed t and chi-square tests were used for statistical analyses. Moreover, relative risk, odds ratio for statistical analyses were used. Results: The average age of patients at the time of diagnosis in APOL1-associated kidney disorders was 41.09 ± 20.63 years (ranging from 8 years to 70 years). Relative risk for kidney failure and persistent hemodialysis therapy in APOL1-associated nephropathy patients with renal risk variants (RRVs) were assessed 1.13 and odds ratio of 1.5 with 95% CI of 0.08-26.86 and the value of 0.0764 by chi-square test but there was no significant statistical result in this research (p-value of 0.782). The relative risk for patients of allograft failure with RRVs was assessed 1,0 odds ratio of 1,0 95% CI of 0.06-15.99 and p-value of 0.81. Conclusion: The present study revealed the risk and odds of APOL1 gene effect on the onset of kidney failure with replacement therapy in patients at risk of APOL1 genotype but results were not significant statistically. Future clinical research is required for investigating APOL1 gene effect on non-African ancestry.
, P. Semenovykh, T. Shcherban, V. Galchinska, K. Savicheva
Ukrainian Journal of Nephrology and Dialysis pp 60-66; doi:10.31450/ukrjnd.3(67).2020.08

The study aimed to assess serum Klotho protein level in type 2 diabetic patients depending on kidney function. Methods. This observational study included 72 patients with diabetes mellitus (DM) and 26 patients with acute coronary syndrome. The control group consisted of 20 healthy subjects. Depending on the presence of albuminuria and glomerular filtration rate (GFR), the diabetics were divided into the following groups: group I included the patients with normal GFR and without albuminuria (n = 25); group ІІ consisted the patients with normal GFR and albuminuria (n = 23); group III – the patients with reduced GFR and albuminuria (n = 24) and group ІV included the patients with acute coronary syndrome (n = 26). The GFR was calculated using the CKD EPI formula (KDIGO 2012). The concentration of Klotho protein was determined by enzyme-linked immunosorbent assay. Results. The development of diabetic nephropathy in type 2 diabetic patients accompanied by a significant decrease of soluble Klotho compared with the controls and the patients of the1-st group. The level of Klotho protein in the group of patients with albuminuria decreased to (490.66 ± 58.76) pg/ml (p
K. Wendo,
Ukrainian Journal of Nephrology and Dialysis pp 80-93; doi:10.31450/ukrjnd.3(67).2020.11

Three-dimensional (3D) printing is a process that translates a 3D virtual model into its physical 3D replica. In medicine, Neurosurgery, Orthopedics and Maxillo-facial surgery were the first specialties to successfully incorporate this technology in their clinical routine, as an aid to surgical interventions. The study aimed to provide a clear overview of the potential areas of applications of 3D printing (3DP) for management of renal diseases, based on a review of the literature. Method. We carried out a review of the literature according to PRISMA recommendations. We searched three databases (Medline, Scopus and Cochrane) with two specific queries: one using MeSH-terms and the second one based on free terms, all terms were related to nephrology and three-dimensional printing technology. Results. 3D-printed models were mostly employed for the management of renal tumors and lithiasis. They provided enhanced visualization of structures and the possibility to perform procedures rehearsals which seemed to improve surgical procedures. Models were also reported to positively impact patients’ understanding of their condition and the interventions. Trainees and experienced urologists also benefited from the supportive role of 3D-printed models and reported improved confidence and efficiency. Rare reports discussed their use for kidney transplantation, ureteropelvic junction obstruction syndrome treatment, nuclear medicine or cultural issues. Due to a meager data amount and heterogeneity of studies, no advanced statistical analysis was possible. Conclusion. 3D-printed models of renal anatomical structures are feasible and are valuable tools to support renal disease management, and for educational purposes.
O.V. Syniachenko, M.O. Kolesnyk, N.M. Stepanova, M.V. Iermolaieva
Ukrainian Journal of Nephrology and Dialysis pp 74-80; doi:10.31450/ukrjnd.4(68).2020.11

The branch of historical science of numismatics (from the Latin "numisma" - coin) originated in the 19th century and became closely connected with economics, politics, culture and law, it includes a thematic study of coins, medals and plaque. Best of all, the history of uronephrology is illustrated by various forms of medalist educational art (exonum or paranumismatics), and the medal became the prototype of the memorial coin. This work presents a catalog of more than 400 numismatic materials (including some unique, first cited), reflects the stages of development of the study of the structure and function of the kidneys, methods for diagnosing and treating diseases, there are links to significant historical events, brief biographies of physicians who have made an invaluable contribution are mentioned into the formation of this scientific discipline. The work presents a role in the origin of the study of kidney and urinary tract diseases of ancient physicians (Aretea, Aristotle, Galen, Hippocrates, Rufus, Sushruta, Empedocles) and doctors of the Middle Ages (Avicenna, Da Carpi, Panaskerteli, Paracelsus, Sun Simiao).
, Abdülkadir Koçanoğlu, Mehmet Mahfuz Şıkgenç
Ukrainian Journal of Nephrology and Dialysis pp 28-32; doi:10.31450/ukrjnd.3(67).2020.05

In the present case, a 52-year-old female patient has no disease in her medical history. She was brought into the emergency department with muscle pain, nausea-vomiting, acute kidney injury (AKI), tumor lysis syndrome (TLS). Intensive hydration was performed. On the fourth day, venous blood gas, serum kidney function testing and electrolyte levels improved. Thrombocytosis was detected. Our patient with TLS-associated AKI was diagnosed with essential thrombocytosis. We have not previously observed such a case sample in the English literature in the extensive examination.
Omotayo B. Ilesanmi, Temitope T. Odewale
Ukrainian Journal of Nephrology and Dialysis pp 33-41; doi:10.31450/ukrjnd.3(67).2020.06

The objective of this study was to determine the biochemical and morphological changes in the liver and kidney as a result of the acute administration of tramadol and diazepam with classic soft drink Coca-Cola (Coke ). Method: Thirty-six (36) adult male Wistar rats were divided into six groups: Group A-control (distilled water), Group B (Coke ), Group C (tramadol, 50 mg/kg), Group D (tramadol dissolved in Coke, 50 mg/kg), Group E (diazepam, 10 mg/kg) and Group F (diazepam dissolved in Coke 10 mg/kg). All administrations were done intraperitoneal. Twenty-four hours after administration, blood samples were collected via cardiac puncture for evaluation of the liver (Aspartate aminotransferase [AST] and Alanine aminotransferase [ALT]), kidney (urea and creatinine [CREA]) function and the organs were excised and processed for histopathological examination. Result: A significantly increased in AST, creatinine and urea concentrations was observed in Tramadol and Coke Groups compared to control (P0.05), though it caused a significant increase in urea and CREA (P
, Emre Yaşar, , Galip Güz
Ukrainian Journal of Nephrology and Dialysis pp 67-72; doi:10.31450/ukrjnd.3(67).2020.09

To prevent acute or chronic rejection in renal transplant recipients, immunosuppressive treatments are applied. However, immunosuppressive treatments increase the risk of cytomegalovirus (CMV) infection. The aim of this study was to evaluate the differences in efficacy and cost of prophylactic and preemptive treatment strategies applied in respect of CMV infection to renal transplant recipients. Methods. Patients who underwent renal transplantation in our center between 2010 and 2015, were retrospectively analyzed. The patients were allocated in two groups as those who received prophylaxis or preemptive treatment. A record was made of the kidney function tests (KFT), CMV PCR copy numbers, the presence of CMV infection, antiviral treatments received, and the costs were calculated of the tests and treatments. The groups were compared in respect of CMV infection and costs. Results. A total of 71 patients with a median age of 38 years (range, 19-74 years) were included in the study. The prophylaxis group included 43 patients and the preemptive group included 28 patients. CMV infection was detected in 7 (16.3%) of the prophylaxis group and 2 (7.1%) patients of the preemptive group (p=0.467). The cost per month of the tests and treatment was lower in the preemptive group than in the prophylaxis group (p
I. Dudar
Ukrainian Journal of Nephrology and Dialysis pp 52-61; doi:10.31450/ukrjnd.2(66).2020.08

Systemic chronic inflammation (SCI) is a common feature of chronic kidney disease (CKD) which is most pronounced in dialysis patients. SCI is associated with cardiovascular pathology, various comorbid conditions and high mortality risk in dialysis patients. The existing dialysis methods are ineffective for removing substances involved in SCI (medium molecular uremic toxins: cytokines, growth factors, adiponectin, hormones, and other substances). The dialysis technology development has always aimed to create the membranes that will be as close as possible to the natural glomerular membrane. Currently, Middle Cut-Off membranes have been created. The use of Middle Cut-Off membranes is implemented in a new method of dialysis therapy entitled expanded hemodialysis (HDx). Further studies will determine the expected perspective of these membranes and HDx in the treatment of dialysis patients.
, M. Jabin, Z. Chowdhury, , S.M. Ali, R. Tamanna, R. Rezwan, S.B. Alomgir
Ukrainian Journal of Nephrology and Dialysis pp 3-8; doi:10.31450/ukrjnd.2(66).2020.01

Rapid progression of chronic kidney disease (CKD) is seen in patients with hepatitis C virus (HCV) infection compared with uninfected patients. Despite the high efficacy of direct-acting antivirals (DAAVs), their cost represents a limiting factor to their use in developing countries. Aim. This study aimed to evaluate the efficacy of low dose Sofosbuvir along with Daclatasvir in the management of HCV infection in end-stage renal disease (ESRD) patients. Methods. A total of 82 HCV positive patients on ESRD were included in this study. The patients were observed for six months without antiviral drugs. Patients who remained seropositive were divided into two groups. The first group included 26 (37%) patients who were treated with half-dose Sofosbuvir 200 mg and Daclatasvir 60 mg and the second group consisted of 44 (63%) patients who have been treated with full-dose Sofosbuvir 400 mg and Velpatasvir 100 mg irrespective of HCV infection genotype for 12 weeks also. Results. 12 (14%) patients became seronegative spontaneously. All patients (100%) of both groups achieved sustained virological response with undetectable HCV RNA in 12 weeks of the treatment. There were nonsignificant gastrointestinal side effects in the full dose Sofosbuvir group. All patients tolerated the DAAs well. No patient discontinued antiviral therapy due to side effects Conclusion. In this study, the spontaneous seroconversion of HCV was 14%. Low-dose Sofosbuvir along with Daclatasvir was safe and as effective as full-dose Sofosbuvir and Velpatasvir in the treatment of HCV in ESRD patients. Low-dose Sofosbuvir regimen can be recommended for HCV infection treatment in ESRD patients.
, G. Nergizoglu
Ukrainian Journal of Nephrology and Dialysis pp 9-16; doi:10.31450/ukrjnd.2(66).2020.02

The risk of cardiovascular disease begins to increase from the early stages of chronic kidney disease (CKD). Abdominal aortic aneurysms are the most common arterial aneurysms of peripheral arterial diseases. The frequency of abdominal aortic aneurysm varies according to the population studied. This study aimed to determine the prevalence of abdominal aortic aneurysm in patients with stage 3-4 CKD and investigate CKD is a risk factor for abdominal aortic aneurysm formation. Methods. Patients aged 55 years and older who were followed up in the internal medicine outpatient clinics were enrolled. Two hundred CKD patients with glomerular filtration rates between 15-59 mL/min per 1.73 m2 were included in the study group, and 110 patients with glomerular filtration rates of 60 mL/min per 1.73 m2 or above were assigned to the control group. An ultrasonography device with a 3.5 MHz probe was used for screening. Abdominal aortic diameters of 3 cm and above were accepted as abdominal aortic aneurysms. Results. Eighteen patients in the study group (9%) and four in the control group (3.6%) had an abdominal aortic aneurysm. The prevalence of abdominal aortic aneurysms was higher in the CKD group. However, the difference was not statistically significant (p=0.078). Moreover, the median aortic diameter was 21.8 mm (14-44 mm) in the study group, compared to 21.0 mm (14-46 mm) in the control group. The prevalence of the abdominal aortic aneurysm was 14.9% in stage 4 CKD patients and 6% in stage 3 CKD patients (p=0.038). Conclusion. An abdominal aortic aneurysm is more common in patients with CKD although it does not reach statistical significance. The median aortic diameter was significantly wider in CKD patients compared to the control group . The prevalence of abdominal aortic aneurysm increased with an increase in the CKD stage .
L. Surzhko
Ukrainian Journal of Nephrology and Dialysis pp 47-51; doi:10.31450/ukrjnd.2(66).2020.07

In the field of hemodialysis technologies, as in other fields of medicine, evolutionary changes are constantly taking place. The innovations are driven by unachieved clinical outcomes and desire to improve the quality of care of patients with CKD 5D. Recent advances in dialysis techniques resulted in the possibility to expand the permeability of dialysis membranes for a wider spectrum of uremic toxins that lead to the enhancement of long-term outcomes improving quality of life and reducing the mortality rate of dialysis patients. The inadequacy of existent dialysis techniques, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules, which are poorly or even not removed during dialysis. A gradual improvement in the elimination of uremic toxins is observed as a result of the development of new alternative approaches of hemodialysis therapy, such as high-flux hemodialysis, hemodiafiltration, expanded hemodialysis (HDx). However, some techniques have had limited success due to a host number of organizational, technological, financial and human factors. Expanded hemodialysis offers a novel blood purification technology in removal of the large spectrum of uremic toxins, in particular large medium molecules, due to the new structure of the dialysis membrane. There are a number of studies that prove the potential benefits of a new method of dialysis therapy over the previous ones, suggesting a reduction in cardiovascular mortality, vascular calcification and inflammation. In addition, there is evidence of a positive effect of HDx on the quality of life in dialysis patients. In particular, to minimize the manifestations of skin itching, restless legs syndrome, asthenic syndrome.
, V. Harbuzova, A. Ataman, Ye. Harbuzova, A. Kolnoguz
Ukrainian Journal of Nephrology and Dialysis pp 17-23; doi:10.31450/ukrjnd.2(66).2020.03

The aim of the current study was to investigate the possible association of HOTAIR gene rs1899663 polymorphism with kidney cancer patients survival and clinicopathological characteristics of kidney cancer. Methods. The whole venous blood of 101 patients with clear cell renal cell carcinoma (CCRCC) (42 women and 59 men) was used in the study. Genotyping of rs1899663 HOTAIR gene polymorphic locus was performed by polymerase chain reaction followed by restriction fragment length polymorphism analysis (PCR-RFLP). Statistical analysis was performed using SPSS (version 17.0). The Kaplan-Meier test and the Cox regression were used to test the possible association between rs1899663 polymorphism of long non-coding RNA HOTAIR gene and the age of CCRCC onset. P values ​​< 0.05 were considered as statistically significant. Results. The results of HOTAIR gene rs1899663 polymorphism genotyping showed that the ratio of GG-homozygotes, GT-heterozygotes and TT-homozygotes in CCRCC patients was 39.6%, 52.5%, and 7.9%, respectively. This distribution did not deviate from the expected by Hardy-Weinberg law (P = 0.143). Results of one-way ANOVA showed that rs1899663-locus of HOTAIR gene was not associated with tumor size of CCRCC patients (P > 0.05), was not related to body mass index, erythrocyte sedimentation rate, fasting glucose, hemoglobin, creatinine and leukocyte amount in the blood of CCRCC patients (P > 0.05). In addition, the results of the Kaplan-Meyer test showed that life expectancy until the CCRCC occurrence does not depend on rs1899663 SNP (log-rank P = 0.739). At the same time, the results of Cox regression analysis both before and after adjusting for covariates (sex, body mass index, metastases, smoking habits and alcohol abuse) showed that CCRCC risk development with age does not depend on HOTAIR gene rs1899663 polymorphism (P > 0.05). Conclusions. This is the first report about the possible link between HOTAIR gene polymorphism and survival of kidney cancer patients both in Ukraine and worldwide. The rs1899663 polymorphic site of HOTAIR gene is not associated with the age of CCRCC onset in the Ukrainian population. In addition, the rs1899663 SNP is also not related to tumor size and clinical фтв laboratory data in patients with kidney cancer.
M. Kolesnyk
Ukrainian Journal of Nephrology and Dialysis pp 62-70; doi:10.31450/ukrjnd.2(66).2020.09

Hepatorenal syndrome (HRS) is a unique form of acute kidney injury (AKI) developing in patients with end‐stage liver disease. AKI is a frequent complication in advanced cirrhosis patients which is associated with increased hospital admissions and decreased survival. The definition of AKI in cirrhosis has been recently modified and the new diagnostic criteria are based on small changes in serum creatinine with respect to previous values, occurring within a short period of time. Systemic circulatory dysfunction and marked kidney vasoconstriction play a key role in the development of HRS. The modification of the AKI definition has also led to a change in the diagnostic criteria of HRS. The new diagnostic criteria are based on AKI stages and there is no need to reach a specific serum creatinine threshold. The use of the new HRS definition may lead to an earlier identification of renal impairment and better prognostic stratification. According to these new criteria, treatment with vasoconstrictors and albumin for the management of HRS will be started at lower serum creatinine values, with expected higher response rates. There are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase‐associated lipocalin), may be useful in daily clinical practice for the differential diagnosis of the cause of AKI in cirrhosis. Various HRS treatment regimens are available worldwide and all are designed to increase the mean arterial pressure by increasing the central blood volume and decreasing splanchnic vasodilation, and to serve as bridge to liver transplantation.
Ukrainian Journal of Nephrology and Dialysis pp 24-31; doi:10.31450/ukrjnd.2(66).2020.04

Asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a confirmed factor that affects the frequency of comorbid bacterial infections and mortality in patients with end-stage renal disease (ESRD). The aim was to study the frequency of comorbid conditions and their dynamics in ESRD patients depending on their MRSA status. Methods. To prospective cohort study included 265 ESRD patients, 204 of whom were treated by hemodialysis (HD) and 61 by peritoneal dialysis (PD). All recorded comorbidities, their frequency and the dynamics of change, polymorbidity indices, were analyzed depending on whom had MRSA nasal colonization (group 1, n = 92) and without it (group 2, n= 173). The most common cause of ESRD was glomerulonephritis - 161 patients (60.75%). The groups were representative according to gender, age, type of kidney injury and modality of renal replacement therapy (RRT). Results. According to the results of a 3-year study investigation, the patients with MRSA carriage had a statistically significant higher level of comorbid conditions frequencies compared to the patients who had opportunistic pathogenic bacteria carriage, namely: prevalence of coronary artery disease (55.4% vs 30.1%, р=0.0001), heart failure (44.6% vs 25.4%, р=0.0015), secondary hyperparathyroidism (61.9% vs 45.1%, р=0,009), chronic obstructive pulmonary disease (31.5% vs 17.3%, р=0.0082), peripheral vascular disease (39.15 vs 17.9%, р=0.0001). The increase in the modified polymorphism index in patients of Group 1 and Group 2 during the observation period, was 30 % and 5% respectively. One hundred thirty three hospitalization cases were detected during follow-up period: among patients from Group 1- 66 (71.34%) cases, Group 2 - 67 (38.73%); χ² = 26.180, р < 0.0001; RR – 1.8524, 95% ДІ: 1.4760 – 2.3247. Conclusions. Asymptomatic MRSA nasal colonization is a factor that can increase the incidence of coexisting diseases as well as the total number of comorbid conditions in dialysis patients.
, Kristin P. Dewi, N. Mardiana
Ukrainian Journal of Nephrology and Dialysis pp 32-39; doi:10.31450/ukrjnd.2(66).2020.05

Hypertension is still the most prevalent non-communicable diseases in Indonesia. Renovascular hypertension is one type of secondary hypertension. It is commonly caused by the presence of renal artery stenosis (RAS). Whereas, atherosclerosis (ARAS) and fibromuscular disease (FMD) are the most common causes of RAS. Early diagnosis is necessary because it has the potential to be cured by eliminating stenosis of the renal artery. However, the signs and symptoms of renovascular hypertension are not specific. The supporting examination to diagnose RAS is also expensive. So, screening in the population at risk is needed. The examinations to prove the presence of RAS are arteriography, captopril renogram, renal ultrasonography, renal Doppler ultrasonography, magnetic resonance angiography (MRA), and computed angiographic tomography (CTA). Until now, three therapeutic modalities can be selected in the management of renovascular hypertension; pharmacological therapy, surgical intervention, percutaneous intervention angioplasty with and without stenting. This narrative review summarizes the literature focused on the diagnosis and therapy of RAS.
, A. Petrova
Ukrainian Journal of Nephrology and Dialysis pp 36-47; doi:10.31450/ukrjnd.1(65).2020.06

Current scientific studies’ results have shown the relationship between the epiphysis functional state and the kidneys function. However, the impaired of the epiphysis melatonin-forming function (MFE) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) is a poorly understood issue. Methods. 130 HD patients (50% of men) were examined in this study. Based on the melatonin level, the patients were allocated into 2 groups: group I included 110 HD patients with impaired MFE and group II consisted of 20 HD patients with preserved MFE. 20 healthy individuals were included in the control group. Results. The melatonin level was significantly lower in HD patients compared to the control group at daytime and night (p
M. Kuru, Z. Talat, , Ç. Demirdağ
Ukrainian Journal of Nephrology and Dialysis pp 20-28; doi:10.31450/ukrjnd.1(65).2020.04

The gold standard method for prostate cancer diagnosis is a transrectal ultrasonography-guided prostate biopsy. The detection rate of prostate cancer using the biopsy is approximately 25-30%. A non-invasive method Technetium-99m methoxy-isobutyl-isonitrile single-photon emission computed tomography (technetium-99m-MIBI-SPECT) could be used in prostate cancer detected. The study aimed to try to show that Tc99m-MIBI-SPECT, which is performed as a non-invasive method before biopsy in patients with prostate biopsy indication, may prevent unnecessary biopsy among these patients. Methods. Fifty-six patients who were admitted to our clinic for any lower urinary tract symptoms or routine control and who had a digital rectal examination or PSA value indication for prostate biopsy were included in this retrospective study. Technetium-99m-MIBI-SPECT our patients before the biopsy was performed, radiopharmaceutical uptake by the intensity and localization of the prostate was detected. Technetium-99m-MIBI-SPECT localization and intensity of involvement by prostate biopsy results were evaluated by nuclear medicine specialists. Results. The patients’ age and PSA level were 62.8 (31-78) years and 11.3 (2.5-100) ng/ml, respectively. Prostate cancer was detected in 27/56 (48.2%) patients. The suspicious diagnosis in technetium-99m-MIBI-SPECT images was observed in 36/56 (64.3%) patients, but prostate cancer was detected in 20 of them only. The sensitivity and specificity of technetium-99m-MIBI-SPECT were 74% and 45%, respectively. The positive and negative predictive values were 55% and 45% respectively. The diagnostic value of technetium-99m-MIBI-SPECT methods was considered as 58%. Conclusıon: The technetium-99m-MIBI-SPECT method in this study had low sensitivity and specificity for prostate cancer diagnosis. Therefore, we came to the conclusion that technetium-99m-MIBI-SPECT cannot be an alternative diagnostic method.
, V. Lisovyi, M. Kolesnyk, E. Sokol, R. Tomashevskyi, N. Kotulevych, L. Mykhailiuk
Ukrainian Journal of Nephrology and Dialysis pp 58-64; doi:10.31450/ukrjnd.1(65).2020.08

Since 2011, at the Department of Industrial and Biomedical Electronics, NTU "KHPI" together with KNPE of KRC "RMCCUN n. a. V. I. Shapoval” with the participation of State Institute “Institute of Nephrology of the National Academy of Medical Sciences of Ukraine” is carrying out research aimed at improving patient safety the hemodialysis (HD)or hemodiafiltration (HDF) procedure. Especially prepared water ensures the safety and quality of the HD or HDF procedure. For the carrying-out, one HD session is necessary more than 150 liters of permeate. Poor quality permeates causes various complications, even can lead to fatal consequences. Therefore a constantly guaranteed qualitative permeate is an important component of safe HD or HDF.
Muhammad Izzuddin Hamzan, ,
Ukrainian Journal of Nephrology and Dialysis pp 7-12; doi:10.31450/ukrjnd.1(65).2020.02

Illicit penile augmentation is thought to be a common practice in Southeast Asia. This article aimed to explore the demographics of the patient who had illicit penile augmentation, its complications, surgical methods employed for removal as well as the long-term outcome following treatment, specifically on sexual satisfaction. Method. Records of patients with a penile foreign body to the Reconstructive Science Unit were retrieved. Demographics, presenting symptoms, surgical methods and outcomes were recorded and analyzed. Results. A total of 14 patients was identified. The median age at implantation and duration is 36 years old and 48 months respectively. The penile subdermal injection was the sole method utilized with the use of liquid silicone in 7 patients. Constant pain, painful erection, and discomfort were common symptoms (42.8%). All patients underwent surgical excision followed with either native (penile skin) full-thickness skin graft (FTSG), distant donor FTSG or primary closure. Five out of 7 patients report improved sexual satisfaction post-surgery. Conclusion. This report demonstrated two groups of men with distinct age, duration of implant and possibly differing motivation for penile augmentation. The various complications presented stem from inflammation and scarring. Distant FTSG donor has a superior take rate compared to native FTSG. Long term outcome following treatment on sexual well-being is generally good. Illicit penile augmentation is generally unsafe, however, a large-scale study is required to establish the prevalence of the practice.
M. Kolesnyk, , L. Snisar, L. Lebid, V. Nepomnyaschii, S. Savchenko
Ukrainian Journal of Nephrology and Dialysis pp 29-35; doi:10.31450/ukrjnd.1(65).2020.05

The current study aimed to evaluate whether serum uric acid (SUA) level is associated with the risk of kidney failure in primary glomerulonephritis patients (PGN) with nephrotic syndrome. Methods. During 2019, 38 patients with newly-diagnosed PGN and the nephrotic syndrome were prospectively considered for the study which is a fragment of the ongoing study "To evaluate the effect of oxalates and urates metabolism on the evolution of renal diseases". In addition to routine clinical and laboratory examination, the concentration of serum (SUA) and urine uric acid was determined. According to the CKD-EPI formula, the glomerular filtration rate (GFR) was calculated. Hyperuricemia was considered to be a uric acid concentration ≥420 μmol / l (7 mg/dl) in men and ≥360 μmol / l (6 mg/dl) in women. All patients enrolled in the study underwent a lifetime renal biopsy under ultrasound. Results. There were 26/38 (68.4%) men and 12/38 (31.6%) women. The patients’ age ranged from 18 to 69 years and averaged 37 [28-48] years. The CKD duration at the time of hospitalization and carrying out the kidney biopsy was 11.0 [5,2-37,4] months. Hyperuricemia was defined in 14/38 (37%) patients. SUA had an inverse correlation with the patients’ GFR (r = -0.44; p = 0.003). Uraturia level was associated with the chronic changes’ gradе on the kidney biopsy specimens (r = 0.66; p ˂ 0.00013). A multivariate logistic analysis (adjustment for albumin, serum creatinine, total blood protein, daily proteinuria, patient age, and hypertension) SUA had an effect on the GFR level (OR 19.2 (95% CI 1.8; 209.5), χ2 = 8.4; p = 0.003). Conclusions. Hyperuricemia was observed in 37% of PGN patients with nephrotic syndrome and was an independent risk factor for CKD progression. Recruitment of patients continues to complete the statistical analysis and confirm our hypothesis. Patient recruitment is still ongoing to finalize the statistical analyses and to confirm our hypothesis.
, , V. Vasylchenko
Ukrainian Journal of Nephrology and Dialysis pp 30-38; doi:10.31450/ukrjnd.4(64).2019.05

This study aimed to investigate the arylesterase activity of paraoxonase 1 (PON-1) in patients with end-stage renal disease (ESRD) and its relationship with oxidative stress markers. Methods. We conducted a one-time prospective observational study involving 58 ESRD patients. Among them, there were 20 hemodialyses (HD) patients and 38 patients treated with peritoneal dialysis (PD). The activity of PON-1 in serum was determined spectrophotometrically by the number of phenolic complexes formed using phenylacetate. Besides, spectrophotometrically the concentrations of malondialdehyde, serum concentrations of ceruloplasmin, thiol groups and total peroxidase activity (TPA) of erythrocyte were determined. The reference group consisted of 30 conditionally healthy individuals. Results. The arylesterase activity of the PON-1 in reference group was 6.57 kU/L versus 2.25 kU/L in HD patients and 4.26 kU/L in PD patients (p ˂ 0.0001). A direct correlation was found between arylesterase activity of PON-1 and ceruloplasmin concentration (p = 0.004), and TPA (p = 0.02) in HD patients. The activity of PON-1 in the serum of PD patients was associated with high-density lipoproteins (p ˂ 0.0001). Conclusions. We observed a decrease in the arylesterase activity of PON-1 in ESRD patients compared to the control group. The lowest activity of PON-1 is determined in HD patients. Moreover, the association of the PON-1 activity with a decrease in antioxidant blood markers was found. The enzyme activity in PD patients correlated with increased blood HDL. Further studies involving a larger dialysis cohort of patients are needed to determine the pathogenetic role of PON-1 activity in the development of cardiovascular events in ESRD patients.
Ie. A. Burlaka, I.V. Bagdasarova
Ukrainian Journal of Nephrology and Dialysis pp 15-19; doi:10.31450/ukrjnd.4(64).2019.03

Hypoxia-related disorders play an important role in irreversible kidney tissue damage via activation of certain secondary processes, i.e. apoptosis. This study aimed to investigate the levels of apoptosis controlling factors and nuclear transcriptional factor NF-κB in relation to the value of kidney function impairment; to evaluate possible protective effects of conventional therapy with the addition of an antioxidant agent tocopherol in pediatric patients with nephrotic syndrome. Methods. An examination of blood samples of 53 patients (aged 10 to 15 years) with nephrotic syndrome was performed. Conventional clinical investigations, immunoblotting were used in this study. Results. We demonstrate that nephrotic patients reveal a high level of pro-apoptotic marker Bax, low level of anti-apoptotic factor BcL-xL and anti-apoptotic unit of NF-κB (p65). Their dependence on level of kidney function impairment was detected. Applied treatment composes conventional scheme and tocopherol shows a restored balance of apoptosis controlling factor and NF-κB activity. Conclusion. Hypoxia-induces disorders in nephrotic children resulted in apoptosis controlling system disturbances can be attenuated by the antioxidants application.
Nihat M Hokenek, Mehmet O Erdogan, Davut Tekyol, Hakan Hançer, Ergul A Kozan, Ummahan Dalkilinc Hokenek
Ukrainian Journal of Nephrology and Dialysis pp 11-14; doi:10.31450/ukrjnd.4(64).2019.02

Pericardial effusion secondary to contrast nephropathy is a very rare clinical condition. Patients have a volume load increase secondary to acute renal failure. In such a case, the progression of pericardial effusion with tamponade may follow a very rapid course contrary to what is believed. In this case, a 78-year-old male patient with diabetes mellitus and hypertension was admitted to the emergency department with complaints of decreased urine output, nausea, and vomiting. The patient was diagnosed with acute renal failure secondary to contrast nephropathy. Pericardial effusion amount was found to be 2 cm by thorax tomography. As the patient who had no urine output when his vital signs were stable became unstable during dialysis preparation and manifested clinical symptoms of cardiac tamponade, immediate pericardiocentesis was performed. Following that, he became stable and was transferred to the intensive care unit. In current guidelines regarding indications for pericardiocentesis, it is stated that drainage should be performed when the amount of effusion is more than 2 cm in the absence of tamponade, suspected bacterial infection or neoplastic etiology. However, in contrast to the standard approach to patients with acute renal failure, our suggestion is that the indications for pericardiocentesis may be broader in the presence of pericardial effusion.
M. Kolesnyk, L. Liksunova, T. Selezneva, T. Maistrenko
Ukrainian Journal of Nephrology and Dialysis pp 4-10; doi:10.31450/ukrjnd.4(64).2019.01

Expenses for the treatment of end-stage renal disease (ESRD) patients with dialysis renal replacement therapy (DRRT) during the 2018 year constituted 2 billion 922 million 460 thousand UAH. Reimbursement from the state budget constituted 1 billion 44 million 800 thousand UAH. Expendable materials were the main component of DRRT. The share of the expendable materials price from total cost for hemodialysis and hemodiafiltration constituted 66%, for continuous ambulatory peritoneal dialysis and automatic peritoneal dialysis was 86.3% and 92.2%, respectively. The results of the investigation can be used for the development of a diversification model (state budget – local budgets – other sources) of financial expenses for the provision of dialysis treatment in ESRD patients as a part of the state program (strategy) health care finance and service delivery.
I. Dudar, I. Mykhaloiko
Ukrainian Journal of Nephrology and Dialysis pp 49-55; doi:10.31450/ukrjnd.4(64).2019.07

Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. At present there is a number of experimental and clinical data that show that one of the important mechanisms of the pathogenesis of CKD is a violation of the blood coagulation system (hemostasis) both locally in the kidneys and with the capture of the microcirculatory channel of other organs, therefore an important task for specialists in the nephrology, as well as doctors of other specialties is understanding the functioning of the system of hemostasis in normal and in various kidney diseases and the correction of this pathology with drugs. There are several types of haemostasis disorders that may occur in CKD: disseminated intravascular coagulation syndrome (DIC), arterial and venous thrombosis and bleeding. In this review, we tried to determine the place of the DIC in the development and progress of the CKD and to assess the prospects for further research.
O. B. Susla, Z. I. Litovkina, O. V. Bushtynska
Ukrainian Journal of Nephrology and Dialysis pp 39-48; doi:10.31450/ukrjnd.4(64).2019.06

Systematic analysis of cardiac remodeling peculiarities in patients with V D stage of chronic kidney disease (CKD VD) caused by diabetes mellitus is important both in the stratification of cardiovascular risk and in the choice of adequate treatment strategies. The purpose of the study was to determine the character of structural and functional reconstruction of myocardium in patients with diabetic nephropathy (DN) on maintenance hemodialysis (HD) by identifying left ventricular hypertrophy (LVH), its geometric types, assessment of the severity of heart dysfunction, pulmonary hypertension (PH), as well as determination of frequency of cardiac valve calcification (CVC), development of defects of mitral (MV) and aortic (AV) valves. Materials and methods. The study included 136 patients on chronic HD (men, 78, age, (53,9±1,0) years, duration of HD, (47,6±4,2) months). Depending on the presence/absence of type 2 diabetes mellitus (DM) with kidney damage, they were divided into two groups: the first one – without DN (n=88); the second one – with DN (n=48). All patients were followed up by standard echocardiography (EchoCG) examination by standard procedure. Results. LVH was diagnosed in 84.6% of patients with CKD VD stage, significantly more often (93.8 vs. 78.4%, p=0.020) in patients with DN, with the incidence of eccentric LVH in the second group being higher (47.9 vs. 28.4%, p=0.023) than in the first one. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p
, A. Yay, T. Ertekin, Ö. Al, D. Ceylan, G. Ö. Önder, M. Kavutcu
Ukrainian Journal of Nephrology and Dialysis pp 20-29; doi:10.31450/ukrjnd.4(64).2019.04

The purpose of this research was to investigate the possible protective effect of melatonin, as a potent antioxidant on I/R-induced renal injury in rats. Methods. We used 28 female Wistar albino rats weight 200-250g. The rats were randomly divided into 4 groups. Control Group (C): They were fed with only standard rat diet and tap water without drug injections or ischemia-reperfusion. Melatonin Group (M): 25 mg/kg melatonin was administered i.p 30 min. Ischemia/Reperfusion Group (I/R): Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Melatonin+ischemia/reperfusion Group (M+I/R): Melatonin (25 mg/kg) was administered 30 min prior to ischemia and immediately before the reperfusion period. Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Results. While MDA levels increased in the I/R group, SOD and GST activities were seen to be significantly increased. Although the increase of the SOD activity was observed in the M+I/R group, no meaningful difference was found. MDA levels were significantly decreased in M+I/R group compared to the control group, CAT and GST activities were significantly increased. Conclusions. Our results show that the treatment with M may prevent kidney damage due to ischemia result in increasing oxidant stress peroxidation damages further. Melatonin or its metabolites are capable of neutralizing free radicals and non-radical oxygen-based reactants. This study suggests that melatonin may be an effective antioxidant agent.
N.G. Aleksieieva
Ukrainian Journal of Nephrology and Dialysis pp 56-61; doi:10.31450/ukrjnd.4(64).2019.08

Chronic kidney disease leads to the accumulation of a wide range of uremic toxins. Negative effects of uremic toxins are most likely due to the combined effects of many uremic solutes, including small molecules, middle molecules, and soluble protein-linked substances. Large and medium-sized molecules are directly associated with chronic inflammation and adverse effects, including major cardiovascular risks and consequently poor prognosis. Recent advances in chemical composition and new production techniques led to improved biocompatibility and selective permeability of dialysis membranes. Specifically, the creation of a new class of membranes provided the possibility to improve the clearance of medium to high molecular weight (MW) solutes (i.e. uremic toxins in the range of 5–50 kDa). The new HDx therapy (expanded HD) is the next evolution in hemodialysis, as it effectively targets the removal of large middle molecules. The HDx therapy is enabled by the THERANOVA dialyzer featuring an innovative membrane that combines a higher permeability than regular high-flux dialyzers with effective selectivity for large proteins. Expanded hemodialysis is an advanced therapy targeting large and medium-sized molecules that are currently not possible to remove by modern dialysis methods including traditional hemodialysis (HD) and hemodiafiltration (HDF). HDx became possible due to THERANOVA, a new dialyzer with an innovative membrane. The THERANOVA-based HDx provides a great new opportunity for dialysis patients, providing unique high-efficiency hemodialysis with the usage of already available infrastructure and standard HD workflows.
, E. Aydoğ, M.C. Karaburun, E. Süer
Ukrainian Journal of Nephrology and Dialysis pp 3-6; doi:10.31450/ukrjnd.1(65).2020.01

Emphysematous cystitis (EC) is a very rare urinary tract infectious disease that can be fatal if not treated. In general, it frequently occurs in diabetic women and is thought to be associated with gas-producing bacteria. Type 2 diabetes mellitus, immunosuppression, drugs (mostly steroids), neurogenic bladder and instrumentation are the major risk factors of this type of infection. We present a case of emphysematous cystitis in a 53-year-old male, in which the patient does not have any classical risk factors associated with EC other than alcohol consumption. To the best of our knowledge, the only case in the literature where this type of infection develops without a classical risk factor and negative urine culture. It is also one of the rare EC cases that may be associated with alcohol use.
M. Kolesnуk, V. Driianska, , O. Lavrenchuk, I. Bagdasarova, T. Poroshina, V. Holod
Ukrainian Journal of Nephrology and Dialysis pp 13-19; doi:10.31450/ukrjnd.1(65).2020.03

Pro- and anti-inflammatory cytokines, SLPI and NGAL are involved in anti-infectious immunity. Studies of these indicators’ role in patients with urinary tract infections (UTIs) may determine their significance as diagnostic and prognostic markers in the case of pyelonephritis and cystitis. The objective of our study was to investigate plasma and urine cytokines and SLPI levels in patients with UTIs, determine the features in children and adults. Materials and methods. ELISA method and related test systems - «Immunotech», «Diaclon» (France); «DRG» (Germany), «Hycult biotechnology» ((Netherlands) were used to study blood cytokine levels in 118 adults and 67 children, SLPI levels in the blood and urine in 59 and 58, respectively. NGAL serum levels of 26 adults with acute pyelonephritis (AP) and 30 adults with chronic pyelonephritis (ChP) were studied using «Human lipocalin-2 / NGAL ELIZA» (Biovendor, Czech Republik) for NGAL. Comparison groups included 10 healthy donors and 11 patients with acute kidney injury (AKI). Results. The study showed an increase in pro- (IL-1, -17, -18, -23, TNF-α, MCP-1) and anti-inflammatory cytokines (IL-17, TGF-β), SLPI, NGAL in patients with UTI, some features in the case of chronic cystitis (ChC), AP and ChP. In adults, TNF-α in the blood and urine, IL-17 in the blood was higher in the case of ChC than ChP. The analysis showed a significant increase in all studied indicators’ levels for AP and ChP in children and adults. The average MCP-1 level in patients with AP was significantly higher than ChP, whereas TNF-α did not differ. In adults, IL-18 and IL-23 were highest in the case of AP, and TGF-β was the highest in the case of ChP. MCP-1, IL-23 levels in the blood of adults were higher than in children in the case of AP, and TNF-α - in the case of ChP. SLPI is involved in the AP pathogenesis and ChP exacerbation. High SLPI levels have been determined in serum and urine (NGAL in the blood) in patients with pyelonephritis (NGAL - AP) who can be used, as well as cytokines, as additional diagnostic and prognostic markers. Conclusions. High levels of TNF-α, MCP-1, and IL-23 in the blood of adults and children confirm their important role in both AP and ChP, but MCP-1 can be considered as an AP predictor/ ChP exacerbation. According to the studied cytokines, adults have a more significant immune response. The SLPI level is an additional feature for diagnosing and monitoring the course of pyelonephritis and cystitis.
Zh. Semydotska, I. Chernyakova, O. Avdeyeva
Ukrainian Journal of Nephrology and Dialysis pp 48-57; doi:10.31450/ukrjnd.1(65).2020.07

The review article analyzes the results of studies of the bi-directional relationship of the intestinal microbiota and kidneys, the so-called colorenal interactive axis of interaction. The intestinal microbiota is considered as a kind of organ that influences the brain, cardiovascular and immune systems, as well as the kidneys of the "host". Short-chain fatty acids (SCFA) formed in the colon as the result of microbial metabolism from plant components of dietary fiber and acting as ligands for the olfactory receptor, paired G-proteins in the kidneys are recognized as the markers of this symbiosis. With the help of modern omix technologies, the development of dysbiosis taking into account patients with chronic kidney disease (CKD) has been proved, which leads to the accumulation of precursors of uremic toxins, a decrease in the production of SCFA, which have nephroprotective properties and play a key role in energy homeostasis. Changes in the composition of the intestinal microbiota in CKD, an increase in the content of uremic toxins in the intestinal lumen contribute to the appearance of the “leaky” intestinal barrier syndrome, the movement of bacteria from the intestine into the general circulation, the development of systemic inflammation, oxidative stress, comorbidity, the progression of CKD, and an increase in mortality. Diets with restriction of protein and potassium quotas, violation of nutritional status lead to the development of dysbiosis in CKD. A decrease in the diet of vegetables and fruit causes the expansion of bacteria producing uricase and urease, which are enzymes in the formation of uremic toxins and reduce the number and variety of bacteria producing short-chain fatty acids. Potential targeted effects on the axis of “intestinal microbiota - chronic kidney disease” are being discussed: the use of a diet enriched in plant fibers, heat-treated, then chilled potatoes and rice as prebiotics (sources of resistant starch), nuts, plant seeds, and pro-, pre-, synbiotics, fecal transplantation. Most of the proposed interventions in the structure and functions of the microbiota are not dangerous, side effects are minimal.
F. O. Prusskiy
Ukrainian Journal of Nephrology and Dialysis pp 53-61; doi:10.31450/ukrjnd.3(63).2019.08

Cardiovascular complications are a leading cause of morbidity and mortality in dialysis patients. Cardiovascular mortality is more than 40% of the total mortality in this cohort of patients. Recently, there has been an increase in publications on the role of uremic toxins, including “middle molecules”, in the development and progression of cardiovascular complications in dialysis patients. Conventional low-flux (LF) hemodialysis well removes small molecular weight uremic toxins not bound with protein. Evidence for the role of "middle molecules" in the development of many complications, including cardiovascular complications, has contributed to the emergence and development of such dialysis therapy methods as high-flux (HF) hemodialysis, hemofiltration (HF) and hemodiafiltration (HDF). Further evolution of membrane technology has led to the development of protein-leaking membranes or super-flux or high cutoff (HCO) membranes. These membranes are capable of removing molecules in excess of the molecular weight of albumin. The use of these membranes is limited because of the risk of hypoalbuminemia. Today, the closest approximation to the natural glomerular membrane is the so-called Middle Cut-Off (MCO) membrane. The use of MSO membranes is implemented in a new method of dialysis therapy - expanded hemodialysis (HDx). The method is defined as a treatment where diffusion and convection are conveniently combined inside a hollow-fibre dialyser equipped with an MCO membrane. A standard hemodialysis machine is used for the HDx. Increased removal of large medium molecules in HDx may lead to an improvement of clinical outcomes, including a decrease of the cardiovascular events incidence, an all-cause and cardiovascular mortality reduction in dialysis patients.
L. Lebid, L. Snisar, L. Liksunova
Ukrainian Journal of Nephrology and Dialysis pp 27-30; doi:10.31450/ukrjnd.3(63).2019.04

HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition are laboratory tests. HELLP syndrome may result in severe morbidity and mortality to both the mother and fetus. In this case, we reported that a patient with chronic glomerulonephritis was diagnosed with HELLP syndrome.The case was collected in Institute of Nephrology of the National Academy of Medical Sciences, Kyiv, Ukraine.
Gokhan Ertugrul,
Ukrainian Journal of Nephrology and Dialysis pp 22-26; doi:10.31450/ukrjnd.3(63).2019.03

Immunosuppressive drugs predispose the kidney transplant recipient to reactivation of сytomegalovirus (CMV) infections. Prophylaxis given to these patients is very important for the prevention of opportunistic CMV infections. The objective of this study was to evaluate the short term and standard-dose valganciclovir prophylaxis for CMV infections in living donor kidney transplantation. Methods. This study is retrospective one. Between April 2014 and April 2019 100 patients after living donor kidney transplantation with results CMV PCR-DNA and prophylactic treatment were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. Results.The mean age was 38.3±15.6 years. 68 (68%) patients were males and 32 (32%) patients were females. All patients were treated with 900 mg daily and 90 days valganciclovir prophylaxis. Mean follow-up was 29.1±15 months. There were not detected CMV infections during the follow-up period. Conclusions: Short term and standard-dosevalganciclovir prophylaxis appears to be successful prevention CMV infections in living donor kidney transplantation.
L. Surzhko, V. Lubashev, I. Poperechnyj
Ukrainian Journal of Nephrology and Dialysis pp 40-46; doi:10.31450/ukrjnd.3(63).2019.06

Residual kidney function (RKF) is a powerful indicator of residual renal functional capacity that eliminates uremic toxins and fluid in hemodialysis patients. The purpose of our study was to investigate the influence of hydrating status on residual renal function in patients with CKD 5HD. Methods. A prospective observational study included 60 hemodialysis patients with CKD VD. All patients were examined - taken general and biochemical blood tests, determined the level of urea and creatinine in the daily urine. RKF was evaluated by urine volume, residual KT / V and KRU. Water balance was measured and evaluated using BCM-monitor. Results.During the analysis of BCM data, hyperhydration (OH / ECW above 15%) was revealed in 15 among all patients included in the study, which amounted to 25%. A statistically significant difference between patients who were hyperhydrated and normohydrated was found in relative (OH / ECW) and absolute hydration (OH), ECW, and ultrafiltration rates. Thus, in the group of hyperhydrated patients, the average relative hydration rate was 14.3% lower compared to normohydrated patients (p < 0.001) and absolute hydration by 2.6 l (p < 0.001). In further analysis, no significant difference between two groups was found in the indicators characterizing the RKF, namely, between the level of urine output, KRU, KT / Vren. The level of ultrafiltration in the group with normal hydration is 900 ml lower than that with hyperhydration (p < 0.005). In study the influence of indicators of hydration status such as OH, OH / ECW, TBW, ECW, ICW on RKF indices no reliable correlation of the above mentioned values ​​with diuresis, KRU, KT / Vren (p > 0.05) was found. A positive correlation was found between KRU, diuresis and KT / Vren, indicating that with increasing diuresis the KRU value and KT / Vren increase (p < 0.001). The same relationship was found between diuresis and KT / Vren, p < 0.001. An analysis of the relationship between absolute and relative hydration with dialysis efficacy (eKT / V) revealed that dialysis efficacy decreases with increase of hydratation in CKD 5HD patients (p < 0.05). Conclusions. The results obtained in our study indicate that the indicators of hydration status at baseline do not allow to find out an influence of them on the baseline level of RKF (diuresis, KRU and KT / Vren) in patients with CKD 5HD. Issues of the influence of hydration status on changes in RKF during the observation will be addressed in the following reports.
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