Journal Ukrainian Journal of Nephrology and Dialysis-
Published: 6 May 2014
Ukrainian Journal of Nephrology and Dialysis pp 25-29; doi:10.31450/ukrjnd.2(42).2014.05
Abstract:The aim of the work: to assess adsorption-rheological state of urine in patients with hemorrhagic vasculitis (HV) with glomerulonephritis (GN), comparing the indicators with the nature of the morphological changes of the glomeruli, tubules, interstitium and vessels of the kidneys. Materials and methods. Microscopy of nephrobiopsy specimens was performed in 21 patients with HVwith GN, urinary syndrome and preserved renal function. Using computer tensiometers “MPT2-Lauda”, “ADSA-Toronto” and “PAT2-Sinterface” indicators of surface viscosity, surface elasticity, module of viscoelasticity, relaxation time (RT), dynamic surface tension (ST) of urine, inclination angle and phasic angle (FA) of tensiongrams were studied. Results and discussion. GN in HV is accompanied by a significant increase in (11%) the equilibrium ST of urine in 57% of patients on the background of decrease (21%) of FA. Adsorption-rheological condition of urine depends on the sex ofpatients and blood pressure level, the relative density of this biological fluid (RT, FA), its content ofprotein and non-protein nitrogen products, glomerular filtration rate and morphological class of GN (ST). The severity of the some renal structures lesion, the level of immune deposits in the mesangium, endothelium of glomerular capillary and podocytes, the degree of plasmatic impregnation arterioles and vascular endothelial proliferation significantly affect the integrated physical and chemical properties of urine. Prognostic significance in relation to the severity of morphological changes in the kidneys has an indicator of ST. Conclusions. Assessment of adsorption- rheological properties of urine is a diagnostic method of GN in HV, and variations of such physic-chemical parameters are determined by morphological class and the clinical course of renal pathology, correlated with the severity of glomerular, tubular, interstitium and vessels lesion
Published: 2 June 2017
Ukrainian Journal of Nephrology and Dialysis pp 47-52; doi:10.31450/ukrjnd.2(54).2017.09
Abstract:Objective: to study the basic quality of life in patients with chronic kidney disease and their relationship, with different numbers formed arteriovenous fistula. Materials and methods. Interviewed 56patients, who are treated with chronic hemodialysis department. To study the quality of life used (KDQOL-SF ™). Also used a questionnaire that enables presence fistula determine the impact on quality of life of patients. Results. Using statistical method cluster analysis, made differentiation studied three groups - clusters, which differ in different levels of the indicators of QOL, namely «Patients middle-manifestation of physical and psychological indicators of QOL» – 40%, «Patients with low the manifestation of physical and psychological QOL parameters «- 25% of subjects, and» Patients with high level of physical and psychological manifestations of QOL performance «- 35% sample of of the patients. Based on statistical comparative analysis revealed differences between the estimated quality of life in men and women. Role functioning due to physical condition in women is slightly lowered than men. In women, there is a greater level of pain than men. Men overall higher rate their health than women. Men are characterized by a higher level of social functioning than women. Conclusions. Patients with chronic hemodialysis age have difficulties in physical functioning and performance of daily affairs. Mental health by increasing the biological age becomes stronger and fitter. His attitude to the presence of fistula in upper limb showing men and women equally, that they feel discomfort and limitations in performing daily routine. The more surgeries performed to form vascular access in patients, the occurrence characteristically uncomfortable sensations in all aspects of life
Published: 30 April 2014
Ukrainian Journal of Nephrology and Dialysis pp 35-38; doi:10.31450/ukrjnd.2(42).2014.07
Abstract:Summary. The aim of the present research was to identify predictors of hospitalization hemodialysis (HD) patients. Materials and methods. The study involved 186 HD patients (49,38±0,94 у.) between Jan 2013 and Jan 2014. We studied the evolution of laboratory and treatment parameters, including dry body-weight, ultrafiltration, mean blood pressure, plasma albumin, Hb, absolute lymphocyte count, absolute neutrophil count, neutrophil-to-lymphocyte ratio, “hemoglobin variability ” all patients. The HD patients were divided for 2 groups: I group of outpatients (n=103), II group of hospitalized patients (n=83). Data from 83 hospitalized patients were compared with non-hospitalized patients. Laboratory and treatment parameters were assessed at least 3 months prior to admission. Results. We found that hospitalization was 45,29±4,20 days, frequency of hospitalization 1,46±0,07. The likelihood of frequency and duration a hospitalization increased with patient age (p
Published: 16 April 2014
Ukrainian Journal of Nephrology and Dialysis pp 37-41; doi:10.31450/ukrjnd.2(46).2015.06
Abstract:Aim. To determine the characteristics of quality of life in patients with chronic kidney disease (CKD ) II–Vst. Methods. 171 patients with CKD II–IVst, except for routine clinical and laboratory examinations, have been studied the quality of life (QOL) using a questionnaire assessing quality of life SF– 36. Results. It was found most of the QOL was significantly worse with the progression of CKD. Total QOL indicators and indicator “effect of kidney disease”. most significantly reduced. Correlation most QOL with age, hemoglobin, blood pressure levels was revealed. Conclusions. QOL decrease with the progression of CKD. Age, hemoglobin level, blood pressure affect QOL.
Published: 30 April 2014
Ukrainian Journal of Nephrology and Dialysis pp 9-14; doi:10.31450/ukrjnd.2(42).2014.02
Abstract:Introduction — the leading mechanism of the kidney infections is the lymphogenous pathogen migration associated with translocation from the mesenteric lymph nodes and blood stream. Reduction in the number of bifidobacteria in the bifidobacteria\enterobacteria balance is an adverse prognostic factor of probably bacteria persistence in the urinary system. The aim of our study was to compare the urine microflora with the microbiocenosis of the intestinal mucous membrane as well as of the nose and throat mucosa in children with recurrent pyelonephritis (PN). Material and methods. Qualitative and quantitative investigation of the microbiological spectrum was per- fomed. In patients with the revealed e. coli the intestinal biocenosis was compared with the biocenosis of the nose and throat mucousa. The repeteated examination of the urine and feces was conducted in 12patients after the probiotic treatment. Results. The predominance of E. coli and conditionally pathogenic microorganismus in the urine tests for patients with chronic PN in active stage as well as in remission coincided with the indicators of the intestine biocenosis. Consistently high inoculation of S. aureus in the nasopharynx of children with acute and chronic PN correlated with the presence of this agent in the urine and feces. Prolonged use of probiotics led to decrease ofenterokoccus and eliminated pathogenic enteroflora, as well as to PN remission with lack of intercurrent respiratory infection in the dynamics of observation. Conclusion.Comparison of urine microflora with nasopharigeal mucosa as well as with intestinal mucosa microflora in patients with recurrent chronic PN gives the opportunity to predict the clinical bechaviour and to correct individually the treatment using probiotics whith antirecurrent purpose.
Published: 22 April 2014
Ukrainian Journal of Nephrology and Dialysis pp 22-28; doi:10.31450/ukrjnd.2(46).2015.03
Abstract:The aim of our study was to determine the effectiveness of Sodium nucleinate in treatment of patients with recurrent pyelonephritis. Material and methods. This clinical study is a prospective, open, controlled, randomized clinical study. Two types of therapies were evaluated in parallel groups. 98patients with recurrent pyelonephritis were examined in the dynamics of treatment. We investigated the state of the genitourinary system microbiota, mucosal immunity performance of the urogenital tract and contents of blood cytokines. After the examination the patients were divided by the applied therapeutic approach. The first group of the women (n=55) received antibiotic therapy and Sodium nucleinate 0.25 g 4 times per day for 2 weeks. The second group of the women (n=43) received only antibiotics. Results. The frequency of eradication of U. urealyticum (including in association with M. hominis) was significantly higher in patients of the first group. We have identified a significantly higher phagocytic activity and a phagocytosis intensity of neutrophils in samples from the vagina in women of the first group (46 [28-49] vs 17 [13-27.5] p = 0.002 and 3.19 [2.34-4.9] against 2.8 [1.23-3.6] p=0.02, respectively).The study of mucosal immunity has demonstrated a significant decrease the content of lactoferrin and increasing sIg A in the urine of patients of group (6.85 [0.2-80] vs 0 [0-0.4] ng/ml, p=0.01 and 0.42 [0-0,7] vs. 3.2 [0-3,7]g/ml, p=0.04, respectively).In addition, the use of Sodium nucleinate promoted to a significant reduction of high levels of all investigated cytokines: IL-4 (p=0.003), IL-17 (p=0.005), NGAL (p=0.02), TNF-$ (p=0.02) and MCP-1 (p=0.03). In the control group was achieved just the reduction in levels of IL-4 (p=0.007) and IL-17 (p=0.04). Conclusions. Thus, the application of the proposed therapies can improve the effectiveness of the treatment of patients with recurrent pyelonephritis by normalization of mucosal immunity of the genitourinary system and the cytokine profile. We believe that the traditional antibiotic therapy ofpatients with recurrent pyelonephritis advisable to supplement of Sodium nucleinate at a dose of 0.25g 4 times / day for 2 weeks.
Published: 22 April 2014
Ukrainian Journal of Nephrology and Dialysis pp 33-33; doi:10.31450/ukrjnd.2(46).2015.05
Abstract:The aim of study was to determine the quality of sleep and the quality of life in patients with CKD undergoing hemodialysis. Український журнал нефрології та діалізу Оригінальні наукові роботи Methods. This study included 70 patients undergoing hemodialysis (mean age 48,74+1,51 years, mean duration of dialysis 41,55+4,51 months). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Quality of life was measured using questionnaire SF–36. Results. 41 (58,57%) patients with a global PSQI score >5 were considered as a “bad sleeper”. Poor sleep was associated with age (r 0,24, p
Published: 31 March 2014
Ukrainian Journal of Nephrology and Dialysis pp 50-61; doi:10.31450/ukrjnd.2(42).2014.10
Abstract:Summury. Data about lipid disorders at different stages of chronic kidney disease (CKD), including those on dialysis are presented in the review. The possible influence of dyslipidemia on the progression of CKD, as well as the onset and progression of cardiovascular complications in patients with CKD are discussed. The questions of lipid-lowering therapy use, including statins, in patients with CKD on dialysis and predialysis, are disclosed.
Published: 2 August 2016
Ukrainian Journal of Nephrology and Dialysis pp 16-21; doi:10.31450/ukrjnd.3(51).2016.01
Abstract:It was to determine associations the serum levels ofVEGF and with HLA inpatients with chronic glomerulonephritis and nephrotic syndrome (CGN, NS). Materials and methods. There was studied the serum levels of VEGF (80 patients) by ELIZA and HLA-antigens distribution in the CGN, NS patients (534) by typing the lymphocytes with the aid of standard microlymphocytotoxic test (Terasaki’s test). The diagnosis was confirmed morphologically using by nephrobiopsy. Results. The distribution of HLA-A, В antigens of the 2 group patients having the CGN, NS with various serum levels of VEGF is shown. Associations of some HLA-antigens and high levels of vascular endothelial growth factor in blood were noted. Conclusion. High serum level VEGF and HLA-A9, A10 (25+26) and B8 in CGN, NS patients associated with steroidoresistence.
Published: 26 February 2016
Ukrainian Journal of Nephrology and Dialysis pp 52-59; doi:10.31450/ukrjnd.1(49).2016.05
Abstract:The aim of this work was the study of indicators characterizing the local immunity in patients with various forms of glomerulonephritis by presence of herpesviral infection. Materials and methods. A quantitative estimation of the content of sIgA and MCP-1 in urine of 47patients with glomerulonephritis and 10 apparently healthy individuals was conducted. Results. The decrease of sIgA level and reliable increase ofMCP-1 level were observed in urine of patients with glomerulonephritis. There was a significant increase in the level of these indices in hormone-resistant patients with nephrotic form of glomerulonephritis; in patients with severe course of the disease and also in the absence of remission. More such changes were found in children with active (reactivated) herpesviral infections. Conclusion. There has been confirmed the importance of the study of immunologic parameters in the urine of patients with glomerulonephritis to characterize immunopathological process in the kidney and prognosis of the disease.
Published: 7 September 2016
Ukrainian Journal of Nephrology and Dialysis pp 37-41; doi:10.31450/ukrjnd.3(51).2016.05
Abstract:The annual increasing of dialysis population results tofocus world attention on the problems associated with improving of survival among patients with chronic kidney disease stage VD (CKD VD st.)., decreasing iatrogenic complicationfrequency. HD is the most common method ofrenal replacement therapy (RRT). Several studies haveproven the link between the type ofinitial vascular access, and an morbidity and survival of patients with CKD VD st.. Aim. The aim of this study was to explore the effects of an initial vascular access on morbidity and survival inpatients with CKD VD st., which are treated with hemodialysis. Materials and methods. In the study 79HDpatients were included. Patients were randomized into twogroups, depending on the type of vascular access at the start of HD treatment: the first group (n = 47) included patients, who started HD treatment through theformed AVF, patients among which central venous catheter (CVC) was usedfor the HD initiation composed the second (n= 32) group. The endpoints were: the total number of deaths, hospitalizations due to bacterial infections, sepsis, unstable angina and myocardial infarction. All cases that took place from 01.01.2013 to 01.12.2015 year were analyzed. Evaluation of survival wasperformed using the Kaplan-Meier method. Results. The analysis allowed to state that during analyzed period in total were 24 deaths: in the first group ofpatients - 10 (21.28%), and in the second - 14 (43.75%) cases; p = 0.03299. The survival rate ofpatients was significantly lower with the CVC. The 10-years cumulative proportion surviving was 73% and 40% when using of AMT and CVC, respectively. The relative risks and odds ratio for all-cause hospitalization in the second group ofpatients (26 episodes) were significantly higher compared to thefirstgroup (16 cases): RR = 2,387, (95% Cl: 1,550-3,674) and OR = 8,396 (95% Cl: 2,870-24,559). It was established a significant increasing of the hospitalization incidences both due infectious comorbidity (9/21,43% versus 15/46,9%;p = 0,0085), and cardiovascular diseases (7/16.7% vs. 11/34,37%;p = 0,0427) inpatients with a history ofthe CVC use at the HD initiation, compared withpatients who started treatment through theformed AVF. Conclusion. Thus, the obtainedfindings suggest that the use of the CVC at the HD initiation has a significant negative effect onprognosis in thepatientpopulation with CKD stage VD.
Published: 8 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 25-30; doi:10.31450/ukrjnd.4(56).2017.01
Abstract:Cardiovascular complications are the main problems associated with end stage renal disease (ESRD) in adult, which began renal replacement therapy (RRT) in childhood. One of the factors contributing to this can be an imbalance of blood lipids. Aim of the study was to evaluate changes in the lipid profile in children with ESRD, depending on the RRT method and age, and also after kidney transplantation depending on the glomerular filtration rate. Materials and methods. In 91 children with ESRD at the age of 2–17 years who received peritoneal dialysis (PD) or hemodialysis (HD), or after kidney transplantation (Tx), total cholesterol (CH), triglycerides (TG), lipoproteins high density (HDL) ) were measured in 663 samples of blood and calculated fraction of non–HDL (CH – HDL). Dyslipidemia was defined as TG>1,13 mmol/1 (0–9years) and >1,47mmol/l (10–17years), CH> 5,18mmol/l, non–HDL >3,7mmol/l, HDL
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 25-31; doi:10.31450/ukrjnd.1(37).2013.05
Abstract:The aim of our research was to identify the peculiarities of the microbial spectrum urogenital system of the women with recurrent pyelonephritis. Materials and methods. We have conducted a comprehensive micro-biological examination different biological material (urine, vaginal swabs, scraping of urethral and cervical canal’s) of 175 women with recurrent pyelonephritis. The patients were divided in accordance with frequency of recurrent. The microbial spectrum urogenital system of 98 women with recurrent pyelonephritis (group 1) was compared with 77 women with sporadic pyelonephritis (up to 2 times per year) (group 2). The research included the process of identification of bacterial agents, mollicutes, chlamydia as well as yeasts. Results. In the women with recurrent pyelonephritis had the significant increase of frequency of identification of E. faecalis in urine (p=0.03), in urethral canal (p=0.05), and vaginal scraping (p=0.02). 48 women from 1st group had bacterial mix-infection. At the same time, the women from comparative group had only in 25 (32.6%) cases (p=0.027). The direct associative relationship was found between existence of S. epidermidis in urethral canal, in cervical canal, in vagina and the frequency of recurrent pyelonephritis (ρ=0.2, р=0.009; ρ=0.23, р=0.004 and ρ=0.19, р=0.01 respectively); E. faecalis in the urethral canal (ρ=0.19, р=0.02); Candida albicans in the vagina (ρ=0.17, р=0.03). 79.6% examined patients were infected by mollicutes, viruses and chlamydia. Conclusions. Consistent high level of urethral’s and vaginal’s bacterial weight of the women with recurrent pyelonephritis leads to the migration of causative agents into bladder and to activates formation of recurrent of the disease. Identified peculiarities of microbial spectrum prove the necessity mandatory micro-biological research not only urine, but urethra, cervical canal, and vagina.
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 31-36; doi:10.31450/ukrjnd.1(37).2013.06
Abstract:Aims: The purpose of the present study was to compare the levels of anti-inflammatory cytokines in patients with chronic kidney disease, prolonged sessions of hemodialysis, depending on the severity of anemia. Materials and methods: We investigated 155 patients with chronic kidney disease, prolonged sessions of hemodialysis and anemia (mean age 46.4±12.4). Patients were divided into 4 groups depending on expressed of anemia: in the I-st (n=22) group – patients with the level of hemoglobin over 110g/l, in the II (n=66) group hemoglobin 90 - 110g/l, in the III (n=44) group hemoglobin 70-89 g/l, in the IV (n=22) group hemoglobin
Published: 28 November 2014
Ukrainian Journal of Nephrology and Dialysis pp 52-59; doi:10.31450/ukrjnd.4(44).2014.05
Abstract:The article describes approaches to cost optimization of anemia treatment in CKD–VDst. patients by comparison of costs in phase correction and support treatment with long action ESA in patients on HD and HDF. Aims. To reveal the influence of HD and HDF to summary dozes of ESA in anemia treatment, to reveal the influence of different long action ESA to hemoglobin variability and find connection between HD, HDF and ESA type to cost of ESA using. Materials and methods. There were 14 patients on HD and 14 on HDF. All patients were treated with dialysis 3 time per week, session duration was 4,5–5 hours. eKt/У were 1,39±0,06 in HDF group and 1,29±0,07 in HD group. Mean hemoglobin was 98,3±2,46 g/l in HDF group and 92,76±2,46 g/l in HD group. In correction phase we used pegylated erythropoietin–p in both groups before achievement target hemoglobin 110 g/l, then was support phase ofanemia treatment during 6 months with hemoglobin target 100g/l to 120 g/l. Next 6 months patients were switched to darbepoetin alfa. Results. It is investigated optimization of anemia correction with long action ESP in patients on HD and HDF. It is revealed a tendency to decrease treatment cost with pegylated erythropoietin–p compared to darbepoetin alfa (1965,13±250,69 vs 2117,39±147,59 Gr/mth) and HDF group compared HD group with pegylated erythropoietin–p (1983,9±345,9 vs 1950,69±367,1 Gr/mth). Treatment with darbepoetin alfa associated with higher hemoglobin variability compared with pegylated erythropoietin–p. Conclusion. The result of our investigation lead to prove some hope to optimization of anemia treatment in patients with CKD Vst. On hemodialysis, but to have statistically reliability we need lager patients groups.
Published: 25 November 2014
Ukrainian Journal of Nephrology and Dialysis pp 31-40; doi:10.31450/ukrjnd.4(44).2014.02
Abstract:According to opinion of European researchers the expenses, associated with in–patient treatment, constitutes the significant part of health service expenditure in population of patients on renal replacement therapy (RRT). Only in few studies the hospitalization levels were compared for population ofpatients on hemodialysis (HD) and peritoneal dialysis (PD). Aim. The aim of this study was analysis the hospital morbidity pattern in patients with CKD stage 5D on HD and PD. Materials and methods. It was performed the retrospective (for period 01 Jan to 31 Dec 2013) analysis of hospitalization structure and rate for patients, were treated by RRT. All hospitalization admissions were assessed in view of modality and duration of RRT, demographic/gender characteristics, and renal affection type. In 2013 the RRT treatment were provided to 351 patients, including the 296 on HD and 55 on PD. Results. Overall 173 cases of hospitalization were recorded, including 142 (82,08%) primary and 31 (17,92%) readmissions. Irrespective of RRT modality the three most common causes of hospitalization were cardiovascular diseases (CVD), bacterial infections, and anemia. 41 hospitalization was caused by RRT initiation (28 HD and 13 PD), the most of patients aged 45 years and older. The hospitalization rate in PD patients with was significantly higher than in patients on HD: 70,9±6,1% vs. 34,8±2,8%, respectively;p
Published: 14 February 2014
Ukrainian Journal of Nephrology and Dialysis pp 33-36; doi:10.31450/ukrjnd.1(41).2014.06
Abstract:To investigate indexes ofdaily blood pressure (BP) in patients with chronic glomerulonephritis (CGN) and normal renal function.
Published: 27 June 2014
Ukrainian Journal of Nephrology and Dialysis pp 22-27; doi:10.31450/ukrjnd.3(43).2014.04
Abstract:In Ukraine the increase of amount of teenagers registers with the infection of the urinary system. Materials and methods. A bacteriological investigation of urine of324 teenagers is undertaken in the Chernivtsi region. Family and specific belonging of the distinguished stamms in the standards of urine was conducted by the generally accepted microbiological methods. Results. The dynamic increase ofpercent of selection is educed etiologfc and clinically meaningful stamms among the teenagers of both sexes. Selection ofpercent etiologfc and clinically meaningful stamms among girls–teenagers (3,75% – 18,52%) prevails by comparison to their coevals (1,02% – 12,50%). A negative dynamics is marked in megascopic percent of results of bacteriological investigation of urine (1,46% – 14,81%) in a group «Height it is not educed». Conclusions. Infections of the urinary system children have the issue of the day of nephrology, and needs complex going near the study of the age–related and gender factors of prevalence of Infections of the urinary system among child’s population of the different age–related groups.
Published: 3 March 2017
Ukrainian Journal of Nephrology and Dialysis pp 26-31; doi:10.31450/ukrjnd.1(53).2017.04
Abstract:Anemia is an integral component of CKD. The prescribing of erythropoiesis stimulating agents (ESA) for the treatment of anemia constitutes a significant burden on health budgets. Using of continuous erythropoietin receptor activator (CERA) and convective techniques can improve health indicators and economic results. The aim of the study was to evaluate the effects of hemodiafiltration treatment (HDF) on the pharmaco-economic efficiency of anemia treatment in comparison with haemodialysis (HD). Methods. A prospective cross-sectional study involving 40 patients with CKD stage V who receiving dialysis treatment at the LLC “Fresenius Medical Care Ukraine ” Medical center in Cherkasy city. The follow-up period was 2 years. First, data was analyzed while patients received HD over a period of twelve months. Then, the same patients were evaluated during treatment with HDF for at least another twelve months. Result. The average dose of CERA reduced from 60 mg to 44 mg per month (p = 0.002) after the transferred ofpatients to HDF treatment. There were a significantly increased the levels of Kt / V (p = 0.04) and serum albumin (p = 0.04). A higher number of patients achieved the target hemoglobin results. Conclusions. The comparison of pharmaco-economic component of anemia correction with CERA cross-sectional study demonstrates significant advantages of HDF treatment compared to HD.
Published: 3 March 2017
Ukrainian Journal of Nephrology and Dialysis pp 70-73; doi:10.31450/ukrjnd.1(53).2017.10
Abstract:This work is devoted to the problem of malnutrition in patients who are treated by peritoneal dialysis, also the role of chronic inflammation was described.
Published: 29 August 2016
Ukrainian Journal of Nephrology and Dialysis pp 32-37; doi:10.31450/ukrjnd.3(51).2016.04
Abstract:Chronic kidney diseases are etiology of complications in cardiovascular system. Structural and functional changes ofendothelium on a background ofimmunoreactions lies in basis ofthese disorders and complications. The aim of research was to study of morphologicalfeatures of kidneys and immune reactions in the vessels of kidneys, heart, aorta inpatients with CDK. Materials and methods. An autopsy material of the 20 dead’s age from 45 to 55 was investigated . The deceased had signs ofchronic desease of kidneys (CDK). Theprimary monoclonal antibody (PMA) company ofDAKO (Denmark) Rady - to - Use were used to reveal of features of cellular immunoreactions in the zones of inflammatoryprocess. We used microscope Primo Star (Carl Zeiss) with theprogram AxioCam (ERc 5s). Results and discussion. Changes of kidneys vessels, coronary arteries and aorta were characterized of transformation similar with immune inflammation. Condition of endothelium was characterized disorder of endothelization and manifest irregularity, lumpiness with outcrop of wide intercellular connections. All this proses bring to activation of apoptosis. Conclusion. Disturbance of vessel morphology and activity of immunoinflammatory reaction can be one of main cause ofdeveloping cardio-vascular complication.
Published: 23 June 2014
Ukrainian Journal of Nephrology and Dialysis pp 42-48; doi:10.31450/ukrjnd.3(43).2014.07
Abstract:Summary: The aim of our study was to compare the performance of mucosal immunity in urine and saliva of patients with chronic recurrent pyelonephritis subject to availability of hyperoxaluria. Material and methods. To observational cross–sectional study included 40 women with chronic recurrent pyelonephritis, aged 21 to 48 years (31.6±7.7). Depending on the availability hyperoxaluria (oxalate excretion in the urine than 0.45 mmol per day) patients were divided into II Groups: for I (n=29) included women with hyperoxaluria, to II (n=11) – includes patients with normal excretion oxalate (7.2±2.4 vs 43.8±5.2; p
Published: 3 June 2016
Ukrainian Journal of Nephrology and Dialysis pp 52-55; doi:10.31450/ukrjnd.2(50).2016.04
Abstract:The aim of the study is to determine the prevalence of plasmid-mediated resistance genes among uro- pathogens from hospitalized patients with chronic pyelonephritis. Methods. A cross-sectional study of 105patients with chronic pyelonephritis and different stage of chronic kidney disease, was carried. Screening for the presence ofplasmid-mediated genes was performed by polymerase chain reaction. Determining the risk factors was performed by analysis of prevalence Odd-ratio. Results. The prevalence of plasmid-mediated resistance mechanisms among uropathogens is 36.7%, mainly due to extended-spectrum p-lactamase (25%). The main factors related with appearance of plasmid-mediated resistance genes were age range above 55 years (OR 3.05), hypertension (OR 2.57), Chronic Kidney Disease stage ІІІ (OR 2,03) and V (OR 1,1), in-patient treatment history (OR 2.02), duration of CP more than 10 years (OR 1,97), history of using antibiotics last year (OR 1,41). Conclusion. Isolation and detection of plasmid-mediated resistance mechanisms among urinary strains are essential for the selection of the most effective antibiotic for the empiric treatment.
Published: 16 February 2016
Ukrainian Journal of Nephrology and Dialysis pp 32-41; doi:10.31450/ukrjnd.1(49).2016.02
Abstract:Background and objective. Knowledge of local antimicrobial resistance pattern is very important for evidence-based empirical antibiotic prescribing. The main objective of the present study was to evaluate the prevalence and the antimicrobial resistance pattern of the main bacteria responsible for uncomplicated urinary tract infection (UTI) in Kyiv region (Ukraine), throughout a ten year period, in order to establish an appropriate empirical therapy. Materials and methods. A retrospective analysis of the etiological spectrum and antimicrobial resistance of uropathogens in urine samples isolated over the 10-year period, 2005 to 2015, in a single center was performed. Results. In total 380positive urine samples processed at our laboratory of which 193/380 (51 %) had E. coli as the infecting organism. Although E. coli was, as usual, the most common pathogen implicated in UTI, it were observed increasing the share of Enterococcus spp. - 82/380 (21.6%). Ampicillin and trimethoprim were the least-active agents against E. coli with resistance rates of 75% and 70%, respectively. Significant trends of increasing resistance over the 10-year period were identified for trimethoprim, fluoroquinolones ІІ and III generations, penicillins, and carbapenems. Nitrofuran derivative remains a reasonable empirical antibiotic choice in this community with a 10-year resistance rate of 8.3 %. Was determined that recurrent UTI is an independent risk factor for bacterial multidrug-resistance. Conclusions. Over the last 10 years, the proportions of fluoroquinolones resistant E. coli and multidrug-resistant bacteria have significantly increased. The fluoroquinolones shall not be used in the empirical treatment of uncomplicated UTI in Kyiv region patients. For the empirical treatment of uncomplicated UTI in women should be used nitrofuran derivative (furazydyn K). If required of parenteral administration of antibiotics should be used cephalosporins IVgeneration. This data will enable evidence-based empirical prescribing which will ensure more effective treatment and lessen the emergence of resistant uropathogens in the community.
Published: 28 November 2014
Ukrainian Journal of Nephrology and Dialysis pp 54-64; doi:10.31450/ukrjnd.1(45).2015.08
Abstract:The basic features of different clinical studies types and their hierarchy considering strength of the evidence were considered. The quality assessment examples of information in medicine and data presentation options to form of evidence were presented. The role of a clinician as a participant in evidence process was underlined.
Published: 21 November 2014
Ukrainian Journal of Nephrology and Dialysis pp 70-74; doi:10.31450/ukrjnd.4(44).2014.08
Abstract:Renal damage in patients with rheumatoid arthritis (RA) is the most frequent and serious among other systemic manifestations and holds a special place in connection with a significant impact on prognosis and approaches to therapy. Today we know that one of the main possible factors of occurrence and development of RA are external trigger factors, among which the most important factor are infectious, and its pathogenic effect on the body can be done in different ways. Based on the latest scientific evidence on the importance of infectious trigger factors in the manifestation of RA, chronic pyelonephritis among these triggers is one of the leaders. Great interest is also the probability of pyelonephritis manifestation while presence of RA. The aim: to identify predictors ofpyelonephritis manifestation in patients with rheumatoid arthritis. Materials and methods. The authors examined 31 patients with RA with presence of chronic pyelonephritis (CP), 31 patients with RA without presence of CP and 20 healthy individuals. Was used clustering and classification methods of Data Mining on indicators of lipid peroxidation of blood and urine, р2–microglobulin blood and urine, immune factors, that defined progressive CKD on the results of our previous studies (IL–1p,IL–10, TGF–р). Results. Found that patients with diagnosed RA only, mainly are included in the cluster «1» (18patients). Some of them (3 persons) classified as belonging to the cluster «2». Thus, these individuals should have two signs of disease, RA and CP, despite the fact that they have only diagnosed RA. It means that these patients are at risk of developing CP. This analysis gives grounds to consider that RA may be signs of a factor that causes manifestation of CP. It is proved that the main factor that characterizes the individuals belonging to the cluster of healthy is 2– microglobulin in the urine with the same threshold value, but factor in determining membership of a type of disease is a factor MDA of urine. Conclusion. The main predictors of pyelonephritis manifestation in patients with rheumatoid arthritis were 2– microglobulin and MDA in urine and TGF– 1 in blood. A new method of diagnosing ofprognostic factors of CP manifestation in patients with RA which is based on cluster and classification analysis makes it possible to establish the interrelation between a diagnosis of RA and caused by it manifestation of CP.
Published: 3 March 2017
Ukrainian Journal of Nephrology and Dialysis pp 3-12; doi:10.31450/ukrjnd.1(53).2017.01
Abstract:We used the data of “National Register of CKD Patients ” which is formed annually by SI “Institute of Nephrology NAMS of Ukraine”. The results demonstrate the low level of availability of medical care
Published: 24 October 2017
Ukrainian Journal of Nephrology and Dialysis pp 37-41; doi:10.31450/ukrjnd.4(56).2017.03
Abstract:The present study was performed to evaluate the ability of Lactobacillus probiotics to reduce the urinary oxalate excretion level and prevent recurrent pyelonephritis. Methods. The open, 6 months randomized controlled trial was followed up. 80 women with recurrent pyelonephritis, caused by E. coli or S. faecalis, were randomly allocated into 2 groups. The 1st Group (n = 40) took Symbiform® which contained acidophilic and plantar Lactobacilli, Lactococci (lactis and cremoris), Bifidobacteria (adolescentis and bifidum) and thermophilic non–pathogenic Streptococcus. The 2nd one (n = 40) received oxalate–soluble herbal remedy Uronefron® containing 188 mg of city extract from 9 plants. Probiotic was prescribed in a dose of 1 sachet 2 times a day during the first 5 days, followed by a dose reduction of 1 sachet per day for a month. Uronefron® was prescribed in a dose of 3 pills a day for a month. Results. 1 month after the end of the treatment, microbiological studies of the colon microflora demonstrated the increasing level of Lactobacillus spp. colonization more than 7 million CPU/1 g of faeces: 35/40 (87.5 %) in the patients of the 1st Group vs 6/40 (15 %) in the women of the comparison Group f/f = 41.5; p < 0.0001). The levels of daily urinary oxalate excretion were significantly decreased in both groups: the patients of Probiotic Group: 117.6 ± 11.7 vs 71.9 ± 10.07mg/d after the treatment (p < 0.0001) and 122.02 ± 17 vs 84.8 ± 9.8 mg/d (p < 0.0001) in the women of the 2nd Group, respectively. In the 6 months preceding randomization, at least 1 recurrence of pyelonephritis occurred in 2/40 (5 %) women of the Probiotic Group and 9/40 (22.5 %) in the patients of Group II (//= 5,1; p = 0,02). Conclusions. The use of lactobacillus probiotics in non–stone fanners women with recurrent pyelonephritis increases the quantitative content of Lactobacillus spp. in the gut, reduces daily urinary oxalate excretion and the number of pyelonephritis recurrences.
Published: 22 August 2016
Ukrainian Journal of Nephrology and Dialysis pp 22-27; doi:10.31450/ukrjnd.3(51).2016.02
Abstract:The aim of the work was to study of indicators characterizing the state of local immunity, tension of specific immunity in children with variousforms of glomerulonephritis (GN) by presence of herpesviral infection (HVI) in the dynamics oftreatment using antiviral therapy. Materials and methods. A quantitative assessment of the content of slgA, SLPI, MCP-1 and IL-8 in the urine of 37 patients with glomerulonephritis and 10 apparently healthy individuals was conducted. In serum of blood were determined specific IgGand IgMantibodies to HSV, CMVand EBV. Results. The most common HVI was caused by EBV (78,4%) in children with GN. The use of antiviral therapy helped to reduce the level ofspecific IgGin the blood ofchildren with GN in 86.1%of the active (reactivated) HVIand in 38,9% - below the diagnostically significant parameters. Inclusion of antiviral agents to standard therapy of GNpatients in the presence of HVI can reduce the level of MCP-1 and IL-8 in the urine, which indicates the reduction of inflammatory processes in the kidney. There was noted an increase in urine the slgA and SLPI concentrations due to antiviral treatment, but these changes were within the physiological norm, in contrast to patients who had received only standard therapy, which were determined by considerably exceeding the norm value. Conclusion. Appointment of antiviral therapy leads to a transitionfrom active infection to the latent stage of theflow, which improves the clinical condition.
Published: 9 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 48-56; doi:10.31450/ukrjnd.1(57).2018.05
Abstract:The work is dedicated to the practical application of oxidant-antioxidant parameters and the possibility of using them for monitoring and optimize the treatment hemodialysis.
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 30-33; doi:10.31450/ukrjnd.4(40).2013.04
Abstract:IL-10 - one of the central factors in the altered cytokine network of uremia, may play important role in the development of T-helper imbalance, CVD and wasting in dialysis patients. Aim: to evaluate level of ІL-10 in CKD stage 5D patients depending on the body mass index and serum albumin. Methods: Thirty-nine HD patients were included (male/female 20/19, age 21- 53 years, mean dialysis treatment time 4.2 ± 1.21 years). Blood tests were taken before a midweek dialysis session. Serum IL-10, serum albumin and BMI were measured. Results: HD patients had higher serum IL-10 than healthy donors (79.9 ± 7.3 vs. 18.8 ± 1.3 pg/ml, p < 0.001). Patients with low BMI had lower serum IL-10 than patients with normal BMI and large BMI – 31.0 ± 6.3 pg/ml; 76.7 ± 10.1 pg/ml; 117.7 ± 6.2 pg/ml, respectively (p < 0.001). Higher IL-10 was associated with increased serum albumin. Conclusion: Compensative increase of anti-inflammatory cytokine IL-10 in serum is typical in HD patients. Patients with nutrition deficit are characterized by lower serum IL-10.
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 33-38; doi:10.31450/ukrjnd.4(40).2013.05
Abstract:Homeostasis disorders in kidneys damage is accompanied by the accumulation or reduction of trace elements as a component of Chronic Kidney Disease (CKD) progression. The degree of trace elements misbalanced depends on the stage of CKD. The deep disorders are most common during renal replacement therapy (RRT), especially in children due to anatomic and physiological immaturity. Materials and methods: We investigated the 20 trace elements blood concentrations in 42 children with CKD V D depending on RRT duration used the technique of inductive coupled plasma mass-spectrometry (ICPMS). Results: There is detected significant increase of cobalt (in 3,80 times), cadmium (2,66), lead (2,44) and nickel (7,19) in patients with statistically weighty decrease in vanadium (1,49), chromium (1,62), arsenic (9,45), strontium (2,02), barium (5,29), rubidium (2,69 and zinc (1,46). It was found the increasing levels of aluminum, chromium and zinc in RRT duration enlargement (p
Published: 3 March 2017
Ukrainian Journal of Nephrology and Dialysis pp 13-20; doi:10.31450/ukrjnd.1(53).2017.02
Abstract:Despite of significant development of dialysis technology, mortality rates of CKD V D stage patients remain unsatisfactorily high. Next to cardiovascular diseases, infections are seems to be as a major causes of morbidity, hospitalization and mortality in this population. Staphylococcus aureus, especially MRSA, infections are a major cause of morbidity and hospitalization in CKD V D stage patients. Preceding MRSA colonization views as a risk factor for subsequent MRSA infections in future. Aim. The aim of this study was to explore the effects of opportunistic pathogens colonization on survival in patients with CKD VD stage. Materials and methods. This prospective cohort, open-label study included 255patients with CKD V D st. (198 HD and 57 PD patients). Patients were randomized into two groups, depending on the MRSA colonization history: first group (n=66) included patients with identified MRSA colonization and the second group (n=189) included patients with colonization of other opportunistic pathogens. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The endpoint was the total number of deaths. All cases, which took place from 01.08.2011 to 01.08.2016 year, were analyzed. The Kaplan-Meier method was perfomed for evaluation of survival. Results. The analysis allowed to state that during analyzed period in total were 75 deaths: in the first group ofpatients - 32 (48.5%), and in the second - 43 (22.8%) cases; %2= 14,38, p = 0,000078; RR – 2,131, 95% ffl: 1,484-3,060. The survival rate of patients was significantly lower in the first group, irrespective of RRT modality. The 3-years cumulative proportion surviving was 53% and 79% in the first (MRSApositive) and second groups, respectively; p< 0,001. Conclusion. This study demonstrated that MRSA asymptomatic colonization has a significant negative effect on survival in the patient population with CKD VD stage
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 21-25; doi:10.31450/ukrjnd.1(37).2013.04
Abstract:The article presents research data of oxidative stress role in the pathogenesis of anemia in patients with CKD V stage, who receive hemodialysis replacement therapy. Background. Oxidative stress is a part of the pathogenesis of many complications in patients with CKD stage V on replacement therapy with hemodialysis. Anemia syndrome is the most frequent complication of this patient`s population. Aim. The aim of this study was to study indicators of oxidative stress in patients with CKD stage V and anemia on replacement therapy with hemodialysis. Materials and methods. We studied laboratory parameters in 42 hemodialysis patients with CKD V stage. Biochemical methods are used for investigation of lipid peroxidation processes: studied diene conjugates (DC), malondialdehyde (MDA), total lipids and catalase, lipid’s structure of erythrocytes membranes and their osmotic resistance. Results. We found that in dialysis patients anemic syndrome was associated with high activity of oxidative stress. Also increased destruction of red blood cells depends from high activity of oxidative stress. In the blood of the patients concentration of DC was 1,12±0,26 opt.den.units/ mg of lipids (p
Published: 11 December 2014
Ukrainian Journal of Nephrology and Dialysis pp 59-64; doi:10.31450/ukrjnd.4(44).2014.06
Abstract:The purpose of the research was to identify the role of chronic inflammation in mechanisms of cardiac valve calcification (CVC) in patients undergoing chronic hemodialysis (HD) by determining the relation of inflammatory markers with valve calcification and the correlation of the latter with endothelial damage indices. Methods. The research included 94patients undergoing chronic HD (males, 52, age, (46,4±11,2) years, duration of HD, (28,9±32,4) months). Patients with chronic glomerulonephritis (47,9 %) dominated. All subjects underwent echo– cardiographic examination for detection of CVC. The intensity of the inflammatory process was estimated by the serum content of fibrinogen (FG), amount of circulatory immune complexes (CICs), concentration of C–reactive protein (CRP) and middle molecules (MM). The nitric oxide (NO) production was studied on the plasma content of nitrite–anions (NO2–) by spectrophotometric method, the amount of circulating endothelial cells (CECs) in platelet rich plasma under the method (Hladovec J. et al., 1978), modified by (Susla A.B., Mysula I.R., 2011). Results. The CRP, FG, CICs indices in patients with CVC exceeded in those without the calcification by 44,2 (р=0,009), 18,4 (р
Published: 12 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 38-43; doi:10.31450/ukrjnd.1(57).2018.03
Abstract:Girls performed the vast majority of patients with urinary system infections. The prevalence of acute disease and specific gravity of chronic kidney impartments have been increasing with the age and were often accompanied with concomitant urological, gynecological and sexual pathologies. The purpose of the work was to determine the etiological and clinical preconditions of relapse and chronic pyelonephritis in girls. Materials and methods. An analysis of the clinical course of187 cases ofpyelonephritis in girls of the age of1 - 18 years had been performing in period from 2008 to 2018 years. The 60 patients in observed group had acute process and 127 ones were with the chronic course of the disease. Rresults. E. coli was the main etiological factor of the inflammatory process in kidneys. Thus, cases of acute and chronic pyelonephritis composed 63,5% and 44,2% in observed group appropriately. Furthermore, the proportion of grampositive flora increased in the cases of chronic pyelonephritis. In addition, almost 56,7% ofall girls with pyelonephritis had sexually transmitted infections, more likely the patients with chronic forms of the disease (69,3% and 30,0%, respectively (p
Published: 12 December 2017
Ukrainian Journal of Nephrology and Dialysis pp 51-57; doi:10.31450/ukrjnd.3(39).2013.08
Abstract:This review is dedicated to drugs` pharmacokinetics and pharmakodynamcs in patients with renal dysfunction.
Published: 8 May 2014
Ukrainian Journal of Nephrology and Dialysis pp 45-50; doi:10.31450/ukrjnd.2(42).2014.09
Abstract:In the present review considers the mechanisms of resistance induced by plasmids and associated with development of resistance genes
Published: 11 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 9-12; doi:10.31450/ukrjnd.2(58).2018.02
Abstract:The chorionic gonadotropin (CGT) test is used to diagnose and monitor the course ofpregnancy, including ectopic, to detect fetal abnormalities, trophoblastic diseases, preeclampsia, ovarian tumors, lungs, stomach, intestine, bladder, kidneys, prostate. The level of CGT is often elevated in postmenopausal women treated with hemodialysis (HD). Its significance is still not well understood, and therefore requires further study. The aim of our work was to investigate the level of CGT in postmenopausal women treated with HD. Methods. The determination of the level of CGT in 23 postmenopausal women treated with HD. The main inclusion criteria were as follows: oral informed consent of the patient to participate in the study, the presence of CKD stage VD and treatment of HD for at least 6 months. Exclusion criteria: severe functional disorders (liver, heart, respiratory failure), cancer processes, smoking, taking substitution hormonal therapy, lack of consent of the patient. The results were compared with the CGT levels in 20 healthy menopausal women (group II). Results. A statistically significant difference was found between the I group (postmenopausal women treated with HD) and II group (women without chronic kidney disease (CKD) (t = 3.62, p = 0.001). It was also found that CGT was increased in 9 (39%) of 23 women treated with HD. The norm of CGT in postmenopausal women is
Published: 17 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 18-28; doi:10.31450/ukrjnd.2(58).2018.04
Abstract:The purpose of our work was to investigate the effect of immunomodulatory medicines on the intensity of oxidative stress (OS), the cytokines level and the activity of renospecific enzymes in patients with recurrent pyelonephritis (rPN). Methods. A prospective, randomized, open-label study involved of 100 women aged 33.4 ± 8.8 year old. According to the sensitivity of the detected pathogens all patients received antibacterial therapy for two weeks. Along with the main course of antibiotic therapy, 25 patients were assigned Sodium nucleinate at a dose of 0.25 g 4 times per day during 14 days, 18 patients were prescribed Galavit intramuscularly 2 ml per dayfor 10 days, and 27patients were prescribed Proteflazid according to the manufacturer’s instructions. The comparison group consisted of 30 women with rPN who received antibiotic therapy exclusively.Women were screened before and after the treatment. The content of malondialdehyde (MDA), ceruloplasmin (CP), transferrin (TF) and sulfhydryl groups (SH-groups) were determined in the blood by colorimetric method. Oxidative stress index (OSI) was calculated. The concentration of interleukins (IL) -1f, -4, -8, -10, -17, tumor necrosis factor a (TNF-a), transforming growth factor f (TGF-f), monocytic chemoactive protein-1 (MCP-1) and interferon y (IFN-y) were analyzed in the blood of the women using an ELISA. To evaluate the functional state of the renal parenchyma the activity of tubular lysosome enzymes a total f-N-acetylhexosaminidase and f-galactosidase were determined in urine. Results. The use of Sodium nucleinate decreased of the OS activity by reducing MDA level (p
Published: 5 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 29-33; doi:10.31450/ukrjnd.2(58).2018.05
Abstract:Patients with chronic kidney disease (CKD) are prone to development hypovitaminosis due to dietary constraints, diseases of the gastrointestinal tract, comorbid conditions, etc. Determination of vitamins level in patients with CKD will allow timely correction of their deficiency, prevent the development of hypervitaminosis and reduce oxidative stress. The purpose of the study was to examine the level of vitamins depending on the stage of CKD. Methods. Vitamin D levels (level 25-hydroxyvitamin D), A, E, B12, K, folic acid were determined in 44patients with CKD stages II-V(mean age 54,63 ± 2,63 years, 24 men 55%). According to the study, patients should not have received any drugs or biologically active additives containing vitamins for 3 months. Results. There was no significant difference in the level of studied vitamins in CKD st. II-III. There was a significant decrease in the levels of vitamin K, folic acid, and vitamin D levels with the progression of CKD. Vitamin A levels in CKD st. IV, V compared to CKD st. II were significantly higher. Considering large number drugs containing vitamins and trace elements and wide uncontrolled use in the population, in particular in patients with CKD, it is important to continue to study the levels of vitamins and trace elements in patients at different stages of the CKD, depending on the CKD nosology. Study of efficiency and safety applying vitamins in patients with CKD, particularly in the late stages of CKD, are appropriate. Conclusions. For patients with CKD characteristic of vitamins deficiency (in our study vitamin K, folic acid), but also an increase in their levels (vitamins A and E). Progression of CKD is accompanied by a change in the levels of vitamins. A significant decrease in the level of vitamin K, folic acid, vitamin D was notedfor patients with GFR
Published: 29 May 2018
Ukrainian Journal of Nephrology and Dialysis pp 34-40; doi:10.31450/ukrjnd.2(58).2018.06
Abstract:Recent scientificstudies have demonstrated the effect of fibroblast growth factor 23 (FGF-23) on the volume and distribution of body fat. The aim of our study was to investigate of lipid metabolism in patients with chronic kidney disease (CKD) and its relationship with FGF-23. Methods. We conducted a single-center, cohort retrospective study involved 106 patients with CKD 1-5 stages. Among the patients were 47 women (44%) and 59 men (56%) aged (49.6±13.9) years. All patients were determined the blood lipid spectrum: total cholesterol level (LDL), high density lipoproteins (HDL) and triglycerides (TG). The lipid profile was examined using a biochemical analyzer Cobas Integra 400 Plus. The C-terminal FGF-23 fragment was determined using a set of reagents for the enzyme immunoassay “Biomedica” (Astria). The glomerular filtration rate (GFR) was calculated using the CKD EPI formula (KDIGO 2012). All the statistical analyses were performed using Statistica 10.0. Results. In patients with CKD, progressive decrease in the level of total cholesterol, LDL cholesterol, HDL cholesterol and the increase in TG concurrent with the fall in GFR was detected (p
Published: 13 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 3-16; doi:10.31450/ukrjnd.3(63).2019.01
Abstract:Institute of Nephrology of the AMS of Ukraine was established in 2001. Today the Institute constitutesserves as national center in nephrology field. Scientific achievements of the institute staff are known both in Ukraine and abroad scientific achievements of the institute. The aim. Analysis of results and forecast of activities of SI "Institute of Nephrology of the NAMS of Ukraine".
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 53-61; doi:10.31450/ukrjnd.3(63).2019.08
Abstract: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.
Published: 4 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 17-21; doi:10.31450/ukrjnd.3(63).2019.02
Abstract:Kidney transplantation is the treatment of choice for end-stage kidney disease.The double J stent is commonly used in kidney transplantation.The incidence of urologic complications varies between 0.22 % and 30 %. Ureteral strictures and urinary leakage are the most common urological complications after kidney transplantation. Use of the double J stent can decrease urological complications after kidney transplantation. However, the double J stent can increase urinary tract infections, suprapubic pain and urinary incontinence. This study aimed to evaluate the outcomes of the use of double J stent in kidney transplantation. Methods. Between April 2014 and April 2019 130 patients with the use of double J stent were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. In these patients, demographic features, clinical features and urologic complications were evaluated. Results. The mean age of the patients was 38.3 ± 15.6 years. 84 (67 %) patients were males and 46 (33 %) were females. Mean follow-up was 29.1 ± 15 months. Mean double J stent removal time was 31.3 ± 2.2 days. During follow-up, there were no ureteral strictures and urinary leakage. Urinary infections were diagnosed in 5 (3.8 %) patients. Conclusions. Use of double J stent appears to be successful to prevent the urological complications in kidney transplantation.
Published: 20 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 40-46; doi:10.31450/ukrjnd.3(63).2019.06
Abstract: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.
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 27-30; doi:10.31450/ukrjnd.3(63).2019.04
Abstract: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.
Published: 4 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 47-52; doi:10.31450/ukrjnd.3(63).2019.07
Abstract:Infections associated with peritoneal dialysis (infection of the catheter, tunnel infection and peritonitis) are the most common complications of this method. Despite significant progress in the methodological approaches to the prevention, diagnosis and treatment of PD associated infections, peritonitis remains the main risk factor for mortality in PD patients (up to 6%) and plays a significant role in more than 1/6 of the deaths associated with non-infectious complications such as cardiovascular and / or cerebrovascular disease. Besides, PD-associated infections are the most common cause of loss of peritoneal function and the patients’ transition to hemodialysis treatment. About 5% of PD patients are converted to hemodialysis treatment in the first year after postponed peritonitis.
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 22-26; doi:10.31450/ukrjnd.3(63).2019.03
Abstract: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.
Published: 14 July 2019
Ukrainian Journal of Nephrology and Dialysis pp 31-39; doi:10.31450/ukrjnd.3(63).2019.05
Abstract:The importance of the problem of acute kidney injury in children is due to the high risk of developing chronic kidney disease as a consequence. Lysosomal enzymes of β-galactosidase (GAL) and N-acetyl-β-D-hexozoaminidase (NAG) in urine are considered to be informative markers of renal parenchyma damage. The objective of this study - to determine the activity of lysosomal enzymes in urine as markers of progression of interstitial nephritis in children after acute kidney injury. Methods. 41 children were examined after acute kidney injury, achievement of self-diuresis and improvement. Group I included 22 patients with a disease period of up to 2 years after acute kidney injury, group II - 19 patients with a disease period of 2 years or more. The control (reference) group consisted of 28 children who were conditionally healthy, without kidney disease, as well as without acute diseases and severe metabolic disorders and anatomical defects. Results. NAG and GAL activity were found to exceed 8 and 3 times parameters in the reference group of healthy children, respectively, in patients who had acute kidney injury during the year (p