THE AIM: to evaluate the efficacy, safety, and tolerability of the preparation of calcium polystyrene sulfonate (Kalimate ® ), clinical observation was conducted in patients with chronic kidney disease who do not need dialysis, using different dosages of the drug with incomplete effectiveness of the hypokalemic diet as monotherapy for hyperkalemia. PATIENTS AND METHODS: the study included 70 patients suffering from chronic kidney disease who do not need renal replacement therapy, and with a plasma potassium level of 5.5 mmol/l or higher, after the use of hypokalemic diet therapy was ineffective. The patients were divided into 4 groups depending on the dose of calcium polystyrene sulfate. The 3 groups differed in the dose of the drug taken, the 4th group consisted of patients with reduced nutrition. Patients in all groups underwent control studies of serum potassium concentration before the start of the study, after 1 week, after 2 weeks, after 1 month, after 3, and after 6 months of treatment. RESULTS: The decrease in the level of potassium in the blood serum of group 1 patients for 6 months was 24.15 % (95 % CI 16.32-31.4 %), which in absolute value was 1.485± 0.513 mmol/l. Similar parameters for groups 2, 3 and 4 were, respectively: 22.59 % (95 %CI 15.57–31.12 %) and 1.38±0.487 mmol/L, 19.72 % (95 %CI 12.08–25.32 %) and 1.215±0.45 mmol/L, 25.24 % (95 % CI 17.86–30.24 %) and 1.58±0.502 mmol/l. CONCLUSION: the effectiveness of reducing serum potassium levels in patients with hyperkalemia on the background of chronic kidney disease who do not receive dialysis and follow only a hypokalemic diet, when using the drug polystyrene sulfate according to the instructions for 15-30 grams per day for at least 1 week with subsequent dose adjustment is an effective way of treating and correcting hyperkalemia.

Objective : to analyze the features of the pattern of lymphocyte subpopulations and the functional activity of peripheral blood mononuclear cells in older adult patients with chronic kidney disease. Materials and methods . The study featured 21 patients with chronic kidney disease (CKD), over 55 years of age, who underwent kidney transplantation (KT) from unrelated suboptimal donors. The average age was 61.4 ± 4.5 years (55 to 69). Comorbidity was assessed using the CIRS-G scale; the average number of points was 13.6 ± 5.09. The control group consisted of 21 volunteers, aged 55–70, without acute inflammatory diseases and signs of chronic kidney disease (CKD). The average age was 61.1 ± 4.4 years, the average CIRS-G score was 12.11 ± 6.04. In all patients, the pattern of lymphocyte subpopulations of peripheral blood was evaluated by flow cytometry. Vital computer laser cytomorphometry was used to assess the functional state of peripheral blood mononuclear cells. The Functional Activities Index (FAI) was evaluated to indirectly assess the degree of functional activity of cells. Results . In CKD patients before KT, there was a decrease in the proportion of CD4 cells (p = 0.009), an increase in the proportion of CD8 cells (p = 0.02), a decrease in the CD4/CD8 ratio (p = 0.017), an increase in the proportion of natural killers (p = 0.025) compared with healthy volunteers. Moreover, a decrease in the total proportion of CD3 cells, an increase in HLA-DR expression on CD3 cells, and an increase in the proportion of B cells were statistically insignificant: p = 0.137, p = 0.072 and p = 0.135, respectively. On the fifth day after KT, the proportion of CD3 cells increased (p = 0.017) mainly due to an increase in the proportion of CD4 cells (p = 0.002) compared to the pre- KT index. The proportion of natural killers (p = 0.002) and HLA-DR expression on CD3 cells (p < 0.0001) also increased. An increase in the proportion of CD8 cells and in the CD4/CD8 ratio, and a decrease in the proportion of B cells were statistically insignificant: p = 0.439, p = 0.277, and p = 0.236, respectively. A decrease in FAI was noted in patients with CKD before KT in comparison with healthy volunteers (p = 0.0138). After ATP, this indicator significantly increased compared to the pre-KT value (p < 0.0001) and exceeded the FAI value in healthy volunteers (p < 0.0001). In healthy volunteers, there was no significant correlation between the functional activity of peripheral blood mononuclear cells and age (r = –0.263 [95% CI –0.6236; 0.1907], p = 0.264, r2 = 0.069). At the same time, significant negative correlation between FAI and age was noted in CKD patients: r = –0.52 [95% CI –0.7771; –0.1135], p = 0.0157, r2 = 0.27 before KT; r = –0.418 [95% CI –0.7559; –0.06256], p = 0.0272, r2 = 0.175 after KT. Conclusion . Older adult CKD patients before and after KT were likely to have significant changes in the morphofunctional state of peripheral blood mononuclear cells and pattern of lymphocyte subpopulations. Moreover, the severity of changes in the functional state of these cells had a strong correlation with age, which was not observed in the group of healthy volunteers. This should be considered when choosing immunosuppressive therapy in older kidney transplant recipients.

The main negative consequences of ischemia-reperfusion of the kidneys are the early developing severe chronic dysfunction of the graft, and in the most severe cases the function of the transplanted kidney is not restored (primary non-functioning graft). As a result of loss of transplant function, the patient usually returns to dialysis. These complications are more common in kidney transplants from “donors with extended criteria,” since these organs are most sensitive to damage resulting from ischemia-reperfusion syndrome (IR syndrome). At the same time, the share of such (suboptimal) donors is gradually increasing in Russia. Cold preservation of the organ in special solutions remains the gold standard for kidney transplantation, however, it is not able to fully protect the organ. The article presents the main promising methods that reduce the severity of ischemic and reperfusion injury: donor conditioning, ischemic preconditioning, various variants of kidney preservation, effects on inflammatory mediators, application of biological target drugs. Nevertheless, the pathogenesis of ischemia-reperfusion syndrome has been studied much better than the methods of its correction. Currently, there are only indirect or experimental evidence that the severity of the syndrome of IR can be reduced due to the pharmacoprotection of the ogran before donation, during preservation, as well as in the early postoperative period. Further research is needed to find ways to reduce the severity of ischemic and reperfusion injury of the graft.

This article highlights the main factors of the pathogenesis of ischemia/reperfusion syndrome of renal allograft. Cellular, humoral, and nonspecific mechanisms of renal damage development are described. The possibilities of effective influence on it are limited by objective difficulties, which are mainly associated with the presence of a variety of alternative ways, which ultimately lead to severe graft damage, the rapid development of chronic transplant nephropathy and increase the risk of graft loss. Further research is needed to develop ways to target the main links of pathogenesis.

Aim. To study the profile of IL-6 in the early postoperative period after kidney transplantation and the factors that affect concentration of this cytokine.Methods and results. 28 kidney recipients were included in the study. It has been found that in most patients after surgery IL-6 was released, and the absence of such a reaction was a poor prognostic sign. Rate of increasing of the concentration and form of its curve within the first postoperative day depended on the length of preservation, warm ischemia time, type of donor, and differed in recipients with normal and delayed initial graft function.Conclusion. Further study of the role of circulating factors in kidney transplantation would improve patient outcomes.

Сочетанная плазмофильтрация и адсорбция в коррекции синдрома ишемии/реперфузии при трансплантации почки / А. В. Ватазин [и др.] // Экстракорпоральная гемокоррекция в интенсивной терапии критических состояний : тезисы докладов 6-й Междунар. науч.- практ. конф. (23 мая 2013 г., Минск) / Белорус. гос. мед. ун-т; под ред. В. В. Кирковского. - Минск : БГМУ, 2013. - С. 28-33.

Почечный трансплантат после пересадки неизбежно подвергается ишемическому, а впоследствии – и реперфузионному повреждениям. Развивающаяся реакция отторжения способна еще больше ухудшить функцию трансплантированной почки. Для профилактики и лечения осложнений после трансплантации все шире применяются методы экстракорпоральной гемокоррекции. В настоящей работе представлен обзор со-временных перспективных методов коррекции ишемического и реперфузионного повреждений, а также ле-ченияреакцииотторжения.Ключевые слова

A review of literature reveales the current conception of Russian and foreign authors on the cellular and humoral pathogenetic mechanisms of ischemic and reperfusion injury of kidney transplant.