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 70 g/l. Results: We have defined that level of IL-4 was clinically significantly lower (p 0.001) in patients, who have getting hemodialysis by comparison to control group. Levels of IL-4 had a significant differences between all of group of patients and controls (p 0.05). IL-10 had a positive correlation with the level of Hb (r=0.2405; p=0.003). L-4 had a negative correlation with the level of Hb (r=-0.4842; p 0.001). The average level of IL-4 was significantly increased in diabetic patients compared with non-diabetic patients 92±17.7 vs 48.3±28.1 (p 0.05). Conclusions: All of studied patients have had an increased level of anti-inflammatory cytokines. Serum IL-4 was higher in patients with diabetes. The levels of anti-inflammatory cytokines (IL-4 and IL-10) have had a significant correlation with the severity of anemia.

A total of 289 patients with chronic renocardiac syndrome, 204 of them with chronic glomerulonephritis and 85 diabetic nephropathy. The worsening of the lipid metabolism, depending on the degree of chronic renal failure (CRF), I noted in the degree of CKD, manifested increased low density lipoprotein (LDL) of 1.22 times (p=0.004), triglycerides (p=0.02), atherogenicity index (p 0.0001) and="" decreased="" high-density="" lipoprotein="" (HDL="") cholesterol="" (p="" 0.001). The="" coefficient="" of="" LDL="" /HDLratiowasgreatestinpatientswithCRFI,whichindicatesthemostintensepro-atherogenicprocessesinthesepatients.Thebiologicalroleofeducationlipoproteinimmunecomplexes(LPIC)isconfirmedbyusrevealedastatisticallysignificantnegativecorrelationbetweentheratioandtheatherogenicLDLIgG(r=-0,3;p=0.04),andLDLatherogenicfactorIgM(r=-0,46,p=0.01)inpatientswithchronicrenalfailuregroup1.AstatisticallysignificantnegativecorrelationbetweendailyproteinuriaandLDLIgG,LDLIgM(r=-0,3;p=0,005;r=-0,4;p=0.004,respectively),whichsuggeststheassumptionofourdamagingeffectLPIContherenalglomerulus.

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 0,01), and MDA level 0,35±0,05 opt.den.units/ mg of lipids (p 0,01). Levels of catalase, decreased to 0,029±0,0019 mm/l*sec (p 0,001). Also osmotic resistance of erythrocytes significantly decreased. MDA has inverse correlation relationship with hemoglobin in the blood, with a correlation coefficient r=-0,36. Investigation of erythrocyte membrane lipid structure of patients by TLC showed a significant decrease of phospholipids and monoglycerides of higher fatty acids, and the increase of cholesterol fractions. Conclusions. In patients with chronic kidney disease on dialysis replacement therapy anemic syndrome is associated with high activity of oxidative stress, as there is an inverse relationship between the level of hemoglobin and the content of MDA in blood. As a consequence of oxidative stress changes the lipid composition of erythrocyte membranes of the patient, because some fraction of lipids are substrates for oxidative processes. Impairment of lipid membranes of red blood cells of hemodialysis patients is one of the probably causes of anemia.

The purpose of study was determination of HLA -antigens I and II classes as predictors of ineffectiveness of initial steroid therapy, and according prognozonegative markers of chronic glomerulonephritis with nephrotic syndrome. Methods. In 59 chronic glomerulonephritis with nephrotic syndrome patients (steroid sensitive n=33 (1 gr.) and steroid resistant’s n= 26 (2 gr.)) and 350 healthy donors( control group) studied HLA antigens I and II classes of the special anti- HLA-antigens panel (20 antigens of locus A, 31 – of locus B and 9- of locus DR). Result. In patients with chronic glomerulonephritis, nephrotic syndrome with hormone sensitivity relative risk is high at the presents of A28 (RR=8,5, r ? 0,001), it made attributive risk (?=0,37). In comparison with a control group, RR 2 for antigens A11 (RR=2,23), A23 (RR=4,28), A24 (RR=3,3), A29 (RR=10,78) that A30 (RR=11,23); attributive risk more than 0,1 for the antigen A11 (?=0,16) ; A24 (? =0,13), other did not differ from control. Subzero connection is exposed for the antigens of A2 (?0,001), ?9 (?=0,007) In locus antigen B14 (RR=5,65, ? =0,001) are exposed, B44 (RR=48,25, ? =0,004), B51(RR=12,32, ? =0,006) and attributive risk of development of disease (according ? =0,24, 0,12 ; 0,14); and antigens B38 and B41 (RR=11,57, ?=0,05). The steroid sensitivity was associated with the antigens B5 (p=0,033), B12 (p=0,005) and B35 (p=0,021) In locus DR made etiologic faction antigens DR4 (RR=7,0 and ?=0,24) DRw52 (RR=7,0 and ?=0,25). Conclusions. For patients with chronic glomerulonephritis with a nephrotic syndrome antigens of HLA-B14,B38, B51, DRw52 are associated with steroid sensitivity. The attributive risk of steroid resistance is high for split A19+31+32, antigens B8, B55.

All over the world the increase in quantity of patients with vascular complications of chronic inflammatory diseases of kidneys is marked. The interrelation of morphological and biochemical markers of atherosclerotic lesions were studied in 41 patients with coronary artery disease (CAD) (group 1) and 62 - with CAD and chronic glomerulonephritis (CGN) (group 2). An extracranial carotid artery (CA) status was investigated by duplex ultrasonography. VE-cadherin content determined by ELISA. States of the antioxidant system was evaluated by the concentration of malondialdehyde (MDA) and sulfhydryl groups (SH-groups) in the blood plasma by the photometric method. The levels of nitric oxide stable metabolites – NO2 and total (NO2+NO3) in plasma was determined by the photometric method. There was found that the frequency of CA plaques detection in groups 1 and 2 did not differ (27,6% and 31,0%, respectively), but patients of group 2 were reliably younger. Pronounced VE-cadherin increase (3,6-fold, p 0,01) at the background of the deterioration of renal function (2,24 -fold GFR decrease, and urinary protein excretion reaches (0,20?0,98) g / day) was observed in group 2. The content of NO2 in group 2 was significantly lower than in controls, and total (NO2+NO3) was increased as compared with control (2,40-fold, P 0,01), and with patients of group 1 (in 1,86-fold, p 0.05). Increase of MDA level in patients of group 2 (2,61-fold, P 0,01) accompanied by reduction of SH groups content – by 25,2% (P 0.05) compared with control. Thus, in patients with combined pathology revealed the most pronounced disorders of endothelial integrity and function, which was worsening by imbalance in the pro-antioxidant system. Accelerated atherosclerotic vascular changes in these patients are probably related to the chronic inflammatory process.

Work of department of HD of GI "Institute of nephrology of NAMSU" is analyzed and compared to mean for Ukraine and some regions according National register of patients with chronic kidney diseases 2011

This is a draft of national clinical guidelines of diagnosis, prevention and treatment of acute kidney injury

This article is a review of the literature. Peritoneal dialysis (PD) was the first method of dialysis renal replacement therapy (DRRT), used for the treatment of patients with acute kidney injury (AKI). PD is able to correct metabolic, electrolyte, acid-alkali disorders and hypervolemia in patients with AKI. Continuous equilibration PD and continuous flow PD can provide of dialysis dose compared with extracorporeal methods of DRRT. However, PD is considered less effective than hemodialysis. In this regard, PD has used in patients with AKI, especially those who are hemodynamically unstable or at risk of bleeding because of severe coagulation abnormalities, in infants and children with AKI, and in patients with circulatory failure.

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 (?=0.2, ?=0.009; ?=0.23, ?=0.004 and ?=0.19, ?=0.01 respectively); E. faecalis in the urethral canal (?=0.19, ?=0.02); Candida albicans in the vagina (?=0.17, ?=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.

Studies of the mortality structure in patients receiving hemodialysis (HD) remain relevant and are the basis for developing measures and recommendations directed to increase the lifetime of patients. Aim. The aim was to study the assessment of death causes in patients who received programmed hemodialysis, based on the demographic and gender characteristics, the duration of dialysis treatment. Methods. Mortality causes in 137 patients who received programmed hemodialysis from 2007 to 2011 years in Kyiv City Scientific and Practical Center of Nephrology an Dialysis were analyzed. Results. The leading cause of death was cardiovascular complications, but their decreasing has been observed since 2008. Fatality rate in young and middle-aged women with cardiovascular diseases (CVD) was almost two times higher than that of men. At the same time CVD is a predominant cause of men’s death at the age older than 44. Cerebrovascular complications were permanently in the second place of the mortality structure. About 30% of deaths occurred during the first 90 days of HD treatment, 72,5% of them were among males. Conclusion. Gender characteristics influence the structure of death causes in patients received programmed hemodialysis depending on age.