The aim of the study was to investigate the remodeling process in the extracellular matrix by the matrix metalloproteinase-2 and 9 serum level activities (MMP-1, MMP-9) in children with glomerulonephritis, state of apoptosis control system, and to specify their role in disease progression. Materials and methods. MMP-2 and 9, caspase-3 were studied in children with glomerulonephritis, nephrotic syndrome (GN) at the different disease stages (active stage and remission). There was documented Chronic Kidney Disease stage I (CKD I: n = 25) and CKD II-III (n = 13) depends on the Glomerular Filtration Rate (GFR). Apoptosis level was determined in renal biopsy sample with focal segmental glomerulosclerosis (TUNEL-test, n=8). Results. Significant increase in MMP-2 and 9 was found dominated in CKD II-III. Clinical remission of GN after therapy was associated with decreased endopeptidases level only of safe GFR (CKD I). It was found that high levels of remodeling processes (MMP) were accompanied by apoptosis activation. This is confirmed by a significant increase in of proapoptotic effector caspase-3 (prevalence in CKD II-III), and a high level of apoptotic cells in sclerosal glomerulus or in periglomerular area, in tubules and interstitium at global renal sclerosis. Conclusions. Progression of renal damage in children with GN and GFR delay is accompanied by high serum levels of MMPs and caspase-3, expansion of apoptosis in the kidney, indicated the activation extracellular matrix remodeling process.

The aim of the study was to investigate the efficiency of mycophenolate mofetil (MMF) in the treatment Protocol in children with steroid sensitive nephrotic syndrome (SS NS). Patients and methods. Disease outcome was studied in 20 patients treated by MMF after relapse in years 2004-2007 (selected occasionally), and in 30 children with early relapse after alkylating agent treatment (years 2008-2012). MMF was administered in dose 500-600 mg/m2/day for 12 months after induction remission by steroids (Protocol MMF). Results. In first group (years 2004-2007) after Protocol MMF withdrawal remission persisted in 50.0% at 24 months, and in 35.0% at last follow up (60 months). Patients from the second group (years 2008-2012) maintained remission at 24 months in 60.0% Furthermore, the early relapses level in the second group decreased threefold (6.7% vs. 20.0% in years 2004-2007). Conclusion. The proposed Protocol MMF had a reason and a good safety profile in children with SS NS. Reduction of relapse risk and prolongation of remission were observed in patients with second relapse of NS. Protocol MMF in patients with early relapse after treatment by prednisone and alkylating agent has contributed to avoid steroid dependence and frequent relapsing NS course.

Methods.Morphological and functional state of the myocardium was evaluated in 28 children with terminal chronic renal failure on dialysis treatment. Results. Normal geometry of the left ventricle was found only in 14.3% of children surveyed. Concentric hypertrophy of the left ventricle (LV) was revealed in 71.4% of patients, excentric hypertrophy - in 10.7 . Signs of cardiac dysfunction were found in 85.7% of children, in 41.7% of them being accompanied with left ventricular cavity dilation. Signs of systolic and diastolic left ventricular dysfunction was found in 58.3% of patients with LV remodeling. Significant dilatation of the LV was strongly associated with the development of left ventricular systolic dysfunction (54.5%) and left ventricular diastolic dysfunction (18.2%). That fact makes it a significant marker of myocardial dysfunction in children with uremic cardiomyopathy. Conclusions. Concentric left ventricular remodeling pattern revieled to be more favorable and less often accompanied with the development of cardiac dysfunction, unless it is combined with significant dilation of the left ventricle

The article describe physical principles of convective dialysis modalities, show data about positive influences of hemodiafiltration to frequency of intradialysis complications, anemia, mineral disturbance, elimination of ß2-microglobulin and other middle molecular substances, mortality of patients with CKD-VD.

We analyzed the clinical case of a patient with chronic kidney disease stage III with diabetes mellitus and anemia. Marked errors of the patient with the KDIGO clinical practice guideline for anemia in chronic kidney disease 2012, identified key areas for further treatment of anemia.

Represented by the following protocols: 1) Prevention, Diagnosis and Treatment of asymptomatic bacteriuria in pregnancy; 2) The Prevention, Diagnosis and Treatment of Pregnant Women with Acute Pyelonephritis; 3) Diagnosis and Treatment of Women with Acute Uncomplicated Pyelonephritis; 4) Diagnosis and Treatment of Lower Urinary Tract Infections; 5) Diagnosis, Prevention and Treatment of Recurrent Urinary Tract Infections.