KIDNEYS最新文献

{"title":"A clinical case of primary membranous glomerulonephritis with nephrotic syndrome and resistance to standard treatment","authors":"L.D. Denova, I. Krasiuk","doi":"10.22141/2307-1257.12.4.2023.431","DOIUrl":"https://doi.org/10.22141/2307-1257.12.4.2023.431","url":null,"abstract":"The incidence of primary membranous glomerulonephritis is 1 case per 100,000 each year (75–80 %), with a male-to-female ratio of 2 : 1. It is the cause of idiopathic nephrotic syndrome in more than 20 % of cases (over 40 % in people aged 60 and older). The problem of membranous glomerulonephritis consists in a difficult differential diagnostic search and frequent cases of resistance to treatment. Resistance to treatment may develop in 10–20 % of patients, resulting in the end-stage renal disease requiring renal replacement therapy (dialysis or kidney transplantation). Our work presents the results of clinical observation of a patient with primary membranous glomerulonephritis, nephrotic syndrome and resistance to standard treatment. This patient had a positive dynamics of clinical-laboratory-instrumental indicators and an improvement in the quality of life against the background of taking rituximab.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139141098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organization of the specialized medical care in conditions of limited resources (military status) (on the example of the provision of nephrology aid in Ukraine)","authors":"MD Dmytro D. Ivanov","doi":"10.22141/2307-1257.12.2.2023.404","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.404","url":null,"abstract":"The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80153125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urological Infections","authors":"No Authors","doi":"10.22141/2307-1257.12.2.2023.401","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.401","url":null,"abstract":"No abstract","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83577004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical case of steroid-dependent nephrotic syndrome in a child","authors":"Ye.K. Lagodych, D. Ivanov, L. Vakulenko, O. Lytvynova","doi":"10.22141/2307-1257.12.2.2023.407","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.407","url":null,"abstract":"Nephrotic syndrome (NS) is a common glomerular pathology encountered in pediatric practice. The main clinical signs are massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Among all cases of NS, 75 % of children have a histological variant of glomerular lesions in the form of minimal change di­sease that is sensitive to hormone therapy, but easily leads to relapse and steroid dependence. These children often need to extend the time of taking hormonal drugs or add other immunosuppressants, which can have significant toxicity. Available immunosuppressant treatment options include cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. The use of rituximab is a possible alternative treatment for steroid-dependent nephrotic syndrome in children. However, the efficacy and safety of ritu­ximab in the treatment of childhood steroid-dependent nephrotic syndrome is still controversial. The purpose was to evaluate the efficacy and safety of rituximab treatment in a child with steroid-dependent nephrotic syndrome on the example of a clinical case from our own practice.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85825820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the index of resistance and excretion of uromodulin in patients with predialysis chronic kidney disease, taking into account the index of comorbidity","authors":"L.D. Denova, D. Ivanov","doi":"10.22141/2307-1257.12.2.2023.403","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.403","url":null,"abstract":"Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small neg","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89611561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plant food in а diet, vegetarianism and kidney function","authors":"I.I. Melnyk","doi":"10.22141/2307-1257.12.2.2023.405","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.405","url":null,"abstract":"A vegetarian diet as a common dietary pattern in the real world is an attractive target for study. Previous studies from different years have shown that a vegetarian diet is associated with a reduced risk of chronic kidney disease progression and a reduction in the annual percentage of physiological loss of glomerular filtration rate. An interesting topic to discuss is vegetarian patients with kidney diseases, in whom we need to monitor kidney function with estimated glomerular filtration rate. In connection with their diet, it is necessary to remember that glomerular filtration rate and blood creatinine level will be low compared to those who consume a lar­ger amount of animal proteins. This is a feature of metabolism and it is related to the way of eating. Monitoring of kidney function in such patients requires reliable diagnostic markers. Here you need to know the nephrological subtleties of excretion of creatinine, urea, uric acid and cystatin C, take into account individual characteristics and use scientific justifications. In order not to miss the progression of kidney disease in vegetarian patients, it is necessary to make a comprehensive assessment of blood parameters: creatinine, urea and uric acid. An alternative to these markers is the possibi­lity of using and prescribing cystatin C to evaluate estimated glomerular filtration rate. Cystatin C would be a more reliable marker than creatinine alone. It will be at the discretion of the nephrologist depending on the situation to decide and use one of the diagnostic options for vegetarian patients.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73363111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Membranous nephropathy: the current state of the problem","authors":"O. Sharapov, S. Abdullaev","doi":"10.22141/2307-1257.12.2.2023.406","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.406","url":null,"abstract":"Membranous nephropathy (MN) is an autoimmune disease of the kidney glomeruli and one of the leading causes of nephrotic syndrome. The disease exhibits heterogenous outcomes with approximately 30 % of cases progressing to end-stage renal disease. The study of MN pathogenesis has steadily advanced owing to the identification of autoantibodies to the phospholipase A2 receptor (PLA2R) in 2009 and thrombospondin domain-containing 7A (THSD7A) on the podocyte surface in 2014. Approximately 50–80 and 3–5 % of primary MN cases are associated with either anti-PLA2R or anti-THSD7A antibodies, respectively. The presence of these autoantibodies is used for MN diagnosis; antibody levels correlate with disease severity and possess significant biomarker values in monitoring disease progression and treatment response.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79183393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoids for the treatment of IgA nephropathy: pros and cons. Research data and own experience","authors":"O. Chub","doi":"10.22141/2307-1257.12.2.2023.402","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.402","url":null,"abstract":"IgA nephropathy is the most common pattern of primary glomerular diseases worldwide and remains a leading cause of chronic kidney disease and kidney failure. The incidence of IgA nephropathy is 2.5 per 100,000 population per year. Presentation ranges from isolated haematuria to significant proteinuria, acute kidney injury and even chronic kidney disease. The 10-year risk of progression to end stage kidney disease or halving of GFR is 26 %. The basis of management of IgA nephropathy is goal-directed supportive care in the form of rigorous blood pressure control, use of renin-angiotensin system blockers in the maximum tolerated dose, and a focus on life-style modification that includes smoking cessation, weight management, and restriction of sodium intake. Ho­wever, supportive therapy does not always achieve its goals and cannot affect the autoimmune pathogenesis of the disease, while the role of immunosuppressants and systemic glucocorticoids remains controversial. This review presents an analysis of clinical trials and our own experience regarding the role of steroids and supportive therapy in the treatment of IgA nephropathy.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82465237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperurikemia in chronic kidney disease stage 4 — the issue of suitability of urate-lowering therapy","authors":"I.I. Melnyk","doi":"10.22141/2307-1257.12.1.2023.396","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.396","url":null,"abstract":"For almost 20 years, the issue of hyperuricemia has been studied in nephrology, rheumatology, cardiology, endocrinology, and neurology areas of medicine. In all countries of the world, new aspects of this clinical symptom are being revealed almost simultaneously, some facts are being disproved, and updated practical re­commendations are being implemented. The main medical axiom now is that hyperuricemia is a symptom of chronic kidney disease (CKD) of any stage, but the pathogenetic mechanisms of the effect of a high uric acid level on kidney function are not known for sure. It is necessary to correct its level under certain clinical and laboratory criteria in order to reduce the risk of cardiovascular disease and the risk of increased mortality, to influence the course of diabetes and possibly prevent obesity. There are still a lot of questions and unexplained facts. For example, what is the role of hyperuricemia in CKD, what level of uric acid reduction is safe and appropriate? What is the causal relationship between uric acid levels and CKD progression? Is the treatment of asymptomatic hyperuricemia effective for absolutely all patients? Is a differentiated approach to lowering the level of uric acid necessary depending on the stage of CKD? When should one take into account the physiological positive effect of hyperuricemia on kidney and vascular cells and not prescribe urate-lowering therapy? Our observation of two patients, which took place within the randomized patient-oriented study “Development of technology to preserve kidney function in patients with CKD and hyperuricemia”, does not provide direct answers to all these questions, but allows us to assume that hyperuricemia can be compensatory for kidney function, and it will not always be appropriate to actively reduce its level. The article aims to draw attention to the fact that when hyperuricemia causes hyperfiltration to preserve kidney function, lowering its level may be inappropriate for absolutely all patients. And maybe in certain conditions and indivi­dual clinical situation, the doctor has the option not to prescribe this type of therapy without negative consequences for kidney function.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88679111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal function in patients with chronic kidney disease and hypertension degree 1–2 against the background of SARS-CoV-2","authors":"I. Zavalna","doi":"10.22141/2307-1257.12.1.2023.390","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.390","url":null,"abstract":"Background. SARS-CoV-2 infection in patients with chronic kidney disease (CKD) and hypertension degree 1–2 worsens the state of the cardiovascular system and may contribute to cardiovascular events and adverse renal risks. The presence of CKD in combination with hypertension degree 1–2 and its medical correction with renin-angiotensin-aldosterone system (RAAS) inhibitors causes a significant impact on the health of patients infected with SARS-CoV-2. SARS-CoV-2 uses RAAS, namely the receptor for angiotensin-converting enzyme (ACE) 2, as a tool to enter the cell. To choose further approaches and treatment, this combination of three pathological conditions requires careful analysis and research. Objective: to study the functional state of the kidneys in patients with CKD and hypertension infected with SARS-CoV-2. Materials and methods. The article is a fragment of the BIRCOV (ARB, ACE inhibitors, DRi in COVID-19) trial, which was designed according to the POEM (Patient-Oriented Evidence that Matters). The BIRCOV (two-center, open-label, initiative-randomized, in three parallel arms) prospective study enrolled 120 patients with CKD and hypertension degree 1–2, it lasted for 1 year and was registered at ClinicalTrials.gov (NCT03336203). One hundred and twelve outpatients with degree 1–2 hypertension, 83 with combination with CKD, were selected. At the end of the study, 108 patients remained, their results are presented in the article with subsequent statistical processing. Division into groups occurred depending on the drugs received (ACE inhibitors, angiotensin receptor blockers (ARBs) or direct renin inhibitor (DRIs)). Endpoints were: estimated glomerular filtration rate (eGFR), average blood pressure, albuminuria level. In 24 patients, the urine albumin to creatinine ratio was analyzed at the beginning of SARS-CoV-2, then 2, 4, 12, 24 weeks after the onset of the disease. Mathematical processing and statistical evaluation of the research results was done in the medical statistics package. Results. All patients were divided into 3 groups depending on the drug: 35 (32 %) of them received ARBs, 42 (39 %) ACE inhibitors, 31 (29 %) DRIs. At the manifestation of SARS-CoV-2, a decrease in blood pressure was recorded during the first two weeks, with the subsequent return to baseline on week 12 in the group of people who received ACE inhibitors, the lowest indicator was in the DRI group. The use of ACE inhibitors (risk ratio (RR) 1.648, 95% confidence interval (CI) 0.772–3.519, number needed to treat (NNT) 7.0) and ARBs (RR 13.023, 95% CI 1.815–93.426, NNT 19) in the treatment of hypertension significantly increased the risk of withdrawal compared to DRIs. Patients with CKD had similar dynamics of blood pressure during 24 weeks of observation. In CKD, higher mean blood pressure values were obtained compared to other participants of the BIRCOV trial. A simultaneous decrease in eGFR and systolic blood pressure was documented, it was most pronounced in patient","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85822993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}