Journal Ukrainian Journal of Nephrology and Dialysis-
Published: 6 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 18-23; doi:10.31450/ukrjnd.2(62).2019.03
Abstract:Перкутанна нефролітотомія (ПНЛТ) є основним методом лікування пацієнтів з сечокамʼяною хворобою. Сьогодні стандартне виконання ПНЛТ передбачає завершення операції шляхом встановлення черезшкірного нефростомного дренажу. Бездренажна ПНЛТ асоційована зі зменшенням післяопераційного болю та часу госпіталізації. Незважаючи на переваги, бездренажна ПНЛТ збільшує ризик залишення фрагментів конкременту, що вимагає застосування додаткових процедур та подовження часу госпіталізації. Метою дослідження було порівняти ефективність і безпечність бездренажної та стандартної ПНЛТ із застосуванням нефростомного дренажу. Методи. Проспективне порівняльне дослідження, проведене у відділенні урології Safeer Al-Imam Al-Hussein у Карбалі з січня 2013 року по 31 грудня 2017 року. 1434 пацієнтів з нирковими конкрементами, яким виконано ПНЛТ були розподілені залежно від застосованого хірургічного лікування: 1-й групі пацієнтів (n = 882) виконано ПНЛТ із застосуванням дренажу, у 2-й групі (n = 552) застосовувалась бездренажна ПНЛТ. Результати. Бездренажна ПНЛТ частіше застосовувалась у жінок молодого віку та у хворих з конкрементами лівої нирки з простим доступом, тоді як дренаж частіше використовувався за наявності конкременту правої нирки (р = 0,006). Післяопераційно, бездренажна ПНЛТ була статистично значущо асоційована з низькою частотою залишкових фрагментів конкременту (p = 0,005), кровотеч (p = 0,04) і сепсису (p = 0,01) порівняно із стандартною процедурою. Висновки. Бездренажний варіант ПНЛТ асоціюється з низькою частотою залишкових фрагментів каменів, післяопераційних кровотеч та сепсису, що обґрунтовує ефективність і безпечність його застосування.
Published: 4 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 33-40; doi:10.31450/ukrjnd.2(62).2019.05
Abstract:The objective of the work was to study the survival peculiarities ofend-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) depending on the nutritional status and informative markers associated with it. Methods. 105 ESRD patients who received CAPD treatment during 2012 - 2017 years at the Kyiv Scientific and Practical Center of Nephrology and Dialysis, which is the clinical base of the State Institution "Institute of Nephrology National Academy of Medical Sciences of Ukraine" were included in the cohort prospective open study. The survival analysis was carried out both in the studied population as a whole and in groups depending on the nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA) points: the first group (n = 51) consisted of patients without malnutrition, the second group (n = 30) - patients with a mild degree of malnutrition, the third group (n = 13) - patients with a moderate degree of malnutrition, and the fourth group (n = 11) - patients with a severe degree of malnutrition. The survival analysis was conducted both in the groups in compliance with NS, and depending on the informational markers associated with NS, in particular, albumin, body mass index (BMI), residual renal function (RRF). Survival were calculated using the Kaplan-Meier method, and the difference between survival rates was analyzed using the log-rank test and χ². The starting date of peritoneal dialysis treatment was considered as the starting point of the monitoring. The difference was considered to be accurate at p 24 kg/m2 was apparently higher than those with an indicatorBMI ≤ 24 kg/m2, and it was in 1 and 3 years 94% vs 86% and 79% vs 47%, respectively (p = 0.00321, log-rank test). Veritable differences have been registered in the cumulative frequencies of survivors depending on RRF value: the survival rate was significantly higher among patients with RRF ≥ 5 ml/min/1.73 m² and significantly lower among patients with RRF
Published: 3 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 3-9; doi:10.31450/ukrjnd.2(62).2019.01
Abstract:The aim of the work was 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 performed via 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 national rating of state of renal medical care was identified. Conclusions. Dramatic differences in the specialized nephrological care between the regions of Ukraine are primarily due, in our opinion, to the understanding of its medical and social importance and, hence, the funding level.
Published: 10 April 2019
Ukrainian Journal of Nephrology and Dialysis pp 41-47; doi:10.31450/ukrjnd.2(62).2019.06
Abstract:Protein-energy wasting as a manifestation of nutritional disorders is one of the central complications in chronic kidney disease (CKD) and largely determines quality and life expectancy. Both decrease in nutritional status and systemic inflammation are independent predictors of general and cardiovascular mortality. Mutual stimulation of these factors determines the search for new directions for the treatment of patients with CKD. The aim of the research was to study the state of systemic inflammation and malnutrition in CKD by assessing the level of interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8) and C-reactive protein (CRP) and serum albumin and to study the effectiveness of therapy with levocarnitine and a solution of a mixture of ketanalogs of irreplaceable and substitute amino acids for parenteral administration in CKD. Results. The level of markers of inflammation IL-1β, IL-6, IL-8 and CRP progressively increased in parallel with the development of renal failure. The level of albuminemia decreased from the I to the V stage of the CKD, in which among patients with glomerular filtration rate 15 - 45 ml/(min · 1.17 m2) in 14% there was a malnutrition of a mild degree; whereas, at CKD of the V stage, malnutrition of a mild degree was in 16% of patients, moderate malnutrition was detected in 10% of the subjects, and 5% suffered from severe malnutrition. After standard therapy the least effect was observed. A more significant decrease in the level of proinflammatory cytokines and CRP was observed with the additional acquisition of levocarnitine. An even better effect was observed in the group of patients receiving Nefrotect. The most significant level of inflammation markers decrease was seen in the group receiving combined Nephrotect therapy with levocarnitine Nefrotect, where the concentration of proinflammatory interleukins decreased more than threefold compared with baseline. The level of albuminemia reached the highest level with combined therapy, compared with standard therapy. Conclusions. Nutritional status of patients with CKD decreases progressively in the fall of kidney function, reaching the level of mild malnutrition at CKD stage III and the severe degree of malnutrition at CKD stage V. With the progression of renal failure, activation of the systemic inflammation, in particular, the increase of the level of circulating in the blood of interleukin 1β, interleukin 6, interleukin 8 and CRP was seen. The efficacy of treatment of systemic inflammation and protein-energy insufficiency by levocarnitine and a solution of a mixture of ketonalogs ofirreplaceable and substitute aminoacids in the cohort of patients with CKD of the І-V stages is proved. This combined therapy significantly lowered the level of interleukin 1β, interleukin 6, interleukin 8, and CRP, as well as elevated serum albumin levels in patients with CKD.
Published: 4 April 2019
Ukrainian Journal of Nephrology and Dialysis pp 24-32; doi:10.31450/ukrjnd.2(62).2019.04
Abstract:Understanding of changes in water compartments during hemodialysis (HD) is an important part of ensuring the effectiveness of the procedure and minimizing both intra- and post-dialysis complications. The purpose of our study was to investigate the direction of changes in water sectors in patients with CKD 5D with preserved residual kidney function (RKF) and without RKF. Methods. Prospective observational study enrolled 88 hemodialysis (HD) patients. All patients performed laboratory examinations and measurements of water balance using the BCM monitor before HD, hourly after the start, and 30 minutes after the end of the session. Depending on the presence of residual kidney function, patients were divided into two groups. The first group with RKF included 52 patients, the second - without RKF - 36. Results. Analysis of water balance parameters allowed to conclude that 26 patients (26.13%) were hyperhydrated (OH/ECW above 15%), including 13 (36,11%) in the group without RKF and 10 (19,2%) - in the group with the preserved RKF. There was no statistically significant difference in the groups. When comparing baseline values between groups of patients, it was found that in the group with preserved RKF the albumin level was significantly higher at 8.94% (p
Published: 4 March 2019
Ukrainian Journal of Nephrology and Dialysis pp 48-53; doi:10.31450/ukrjnd.2(62).2019.07
Abstract:The Fabry Disease in young white man with End Stage Renal Disease was reported. Diagnosis was detected at stage of hemodialysis treatment despite sings which admitted as clinical criteria were found at childhood but did not identify during 20 years due limited awareness of medical community about lysosomal disorders.
Published: 22 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 13-19; doi:10.31450/ukrjnd.1(61).2019.02
Abstract:The aim of the study was to assess a serum level of vascular endothelial growth factor (VEGF) in type 2 diabetic patients depending on kidney function. Methods: we examined 66 type 2 diabetic patients and 20 healthy control subjects. Depending on the presence of albuminuria and glomerular filtration rate (GFR) level, patients with diabetes mellitus (DM) were divided into the following groups: group I - patients with type 2 DM without signs of nephropathy – normal GFR without albuminuria (n = 26); group ІІ - patients with type 2 DM with normal GFR and albuminuria (n = 22); group III - patients with type 2 DM with reduced GFR and albuminuria (n = 18). ІV group - patients with acute coronary syndrome (n = 26). The concentration of the VEGF was determined by enzyme-linked immunosorbent assay. The glomerular filtration rate (GFR) was calculated using the CKD EPI formula (KDIGO 2012). Results: serum VEGF level in patients with diabetic nephropathy (DN) was significantly increased depending on kidney function. VEGF positively correlated with urine albumin and serum creatinine levels and the negative correlation with GFR was found. These findings prove the undeniable role of kidneys in the development of renocardial syndrome in patients with DN. VEGF levels positively correlated with glycosylated hemoglobin and total cholesterol, indicating an unconditional dependence of endothelial dysfunction on lipid and glucose metabolism disorders. Conclusions: Increased levels of VEGF in type 2 diabetic patients without clinical signs of kidney damage may indicate the development of subclinical renal dysfunction. Blood VEGF in patients with DN may be an integral marker of endothelial dysfunction and pathological angiogenesis. Our findings suggest that determination of serum VEGF level in patients with DN may have practical use as an early predictor of cardiac disruption, estimation of the prognosis, as well as improvement of cardionephroprotective strategy.
Published: 20 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 53-59; doi:10.31450/ukrjnd.1(61).2019.07
Abstract:According to current presentations, primary AL-amyloidosis (AL-A) and multiple myeloma, associated and not associated with AL-A, are considered as a part of uniform β-lymphocytic dislocation that is characterized by proliferation of abnormal clone of plasma or β-cells in the bone marrow with excess production of monoclonal immunoglobulins. Objective: to describe our own observations of patients with AL-A, which is an example of complexity of the disease diagnostics, due to the polymorphism of clinical picture and need for immunological verification. It was presented 2 cases of late AL-A diagnostics. Amyloid depositing in different organs determined the diversity of clinical manifestations. AL-A had a consistently progressive character with the gradual involvement of various organs and systems. Results: case 1 demonstrated AL-A with damage of kidneys, heart, liver, spleen, lungs, pleura and subsequent development of ischemic stroke. In the second case AL-amyloidosis with damage of heart, kidneys, lungs, tongue and skin was diagnosed. The severity of the patient's condition was due to severe nephrotic syndrome. AL-A is a serious disease that leads to a lethal end if treatment is not timely. Our observations demonstrate the complexity of AL-A diagnostics, which requires the collaboration of doctors of various profiles. Modern morphological diagnostics of amyloidosis involves not only detection but also mandatory amyloid typing, which determines further therapeutic tactics. Diagnostics of AL-A diagnosis should be based on the morphological study results. The final diagnosis of amyloidosis is established after congolic masses detecting. Biopsy of the affected organ is the most effective diagnostic method. When there is a nephrotic syndrome, kidney biopsy is most appropriate, because amyloid will be detected in 80% of AL-A. The most effective method for AL-A typing is an immunohistological study using the immunoglobulin light chains antisera.
Published: 18 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 39-44; doi:10.31450/ukrjnd.1(61).2019.05
Abstract:The formation in β-structured protein aggregates in tissues and fluids of the body is one of the most dangerouse complications of various diseases. The most famous of them are amyloidoses, but they such deposits are observed at other, much more widespread, diseases. The generally accepted approach to amyloids’detectionis based on high-specific coloring by Congo Red dye. However, the Abbe's diffraction limit excludes the seeing of the objects smaller than 0.61 wavelengths (about 240 nm). Such nanoscale formations are capable to disrup the functioning of surrounding tissues, to causethe complications and recurrences of the disease, and to pass through biological barriers with the following accumulation in body’s fluids. It’s likely that these conditions are the cause of the urinary congophilia, that is associated with preeclampsia at pregnancy and chronic kidney disease. Nor the less suspicious object is the Bens-Jones protein that appears in the urine at multiple myeloma and some other diseases, which are in more or less extent,are related to the disturbance of protein metabolism. The purpose of this study was to clarify the aggregate state of the Bens-Jones protein as a possible β-structured supramolecular associate. Methods.The subject of the study was the freshly received urine from a patient with multiple myeloma. The presence of the Bens-Jones protein was checked by thermopacification of the acidified sample. For control, the urine was used by a healthy person with the addition of certain amounts of human serum albumin ("Reanal", Hungary) with a concentration of 0, 0.01, 0.1 and 1%. Result. The obtained data testify to the appropriateness of such a point of view and create preresquites for the expanding of diagnostic possibilities. Conclusions.The results obtained during the study testify to the peculiarity of the structure of the Bens-Jones protein, which is nano-sized beta-structured supramolecular
Published: 15 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 20-28; doi:10.31450/ukrjnd.1(61).2019.03
Abstract:The aim of our study was to increase the effectiveness of treatment of comorbid pneumonia in patients with CKD VD stage. Materials and Methods. 73 patients with CKD VD st. (59 on HD and 14 on PD) with mild to moderate comorbid pneumonia who received renal replacement therapy (RRT) during 2013-2016 were included in the observational prospective open-label randomized trial. Patients were randomized into two groups: group 1 (n = 42) included patients who in addition to the conventional therapy of pneumonia received medication «Lipin» as a complex therapy; group 2 included patients (n = 31) who received only basic (traditional) therapy. The groups were representative by the main demographic, social and clinical-laboratory findings, severity of pneumonia, duration and modality of RRT. The primary endpoints were death from any cause and episodes of rehospitalization. The overall assessment of the clinical efficacy of the therapy was based on a comparison of the duration of hospitalization, antibiotic therapy, intoxication syndrome, and regression of X-ray changes. Survival in observation groups was determined by the Kaplan-Meier method. Analyzed cases were included to October 31, 2018. The markers of oxidative stress (OS) were determined in 29 patients of group 1 and 14 patients of group 2 before treatment and after 14 days while treatment of pneumonia was started. Results. The analysis demonstrated that during a 1-year period a 17 (25,76%) episodes of rehospitalization were recorded: 11 causes (35.5%) in group 1 and 6 (14.3%) in group 2 (χ² = 4.486, p = 0.035). In total, 29 deaths were recorded during the study period: 10 (23.8%) cases in group 1, and 19 (61.3%) - in group 2 (χ² = 8.957, p = 0.003, RR - 2.574, 95% CI: 1.400-4.733). The three- and five-year cumulative survival rates were 83% vs. 21% and 59% vs. 21%, in the group 1 and group 2, respectively (p = 0.00003). It was stated that the duration of hospitalization, antibiotic therapy, intoxication syndrome and X-ray regression were significantly lower in group 1 compared with group 2 (p