The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

The article presents the contemporary views of the role of aldosterone in the progression of cardiovascular and renal diseases. It addresses matters related to the efficacy and safety of mineralocorticoid receptor antagonists in patients with chronic heart failure, chronic kidney disease at various stages including terminal renal failure, dialysis therapy, and kidney transplantation.

Currently, extensive amount of material was accumulated based, includingly, on the placebo-controlled, multicenter studies, which allows us to recommend the use of angiotensin II receptor blockers for the treatment of dialysis patients in order to normalize blood pressure, myocardial and vascular remodeling and, ultimately, reduce mortality in this group of patients.

Rationale: Thromboembolic complications in patients on hemodialysis have a  significant impact on the duration and quality of life. Aim: To study the functional status of platelets in chronic kidney disease stage 5D (CKD-5D). Materials and methods: We examined 61 patients with CKD-5D. The duration of renal replacement therapy was 133 (74 to 177) months. The functional activity of platelets was evaluated in the adenosine diphosphate and adrenaline tests. Results: The functional activity of platelets in the adenosine diphosphate test was reduced in 35 (57.4%) of patients and unchanged in 26 (42.6%) patients. The functional activity of platelets in the adrenaline test was reduced in 38 (62.3%), normal in 8 (13.1%) and increased in 15 (24.6%) patients. Conclusion: In our study, only the adrenaline test was able to identify hyperactivity of platelets. We believe therefore, that the test with adrenaline is preferred for the study of the functional activity of platelets in CKD-5D.

THE AIM: phase III multicenter open-label randomized comparative trial on efficacy and safety of calcium polystyrene sulfonate for correction of hyperkalemia in patients with renal failure not requiring dialysis compared with low potassium diet was performed for evaluation of efficacy and safety in 5 investigational sites of Russia. PATIENTS AND METHODS: the study included patients with level of potassium in the plasma 5.5 -6.5 mmol/L. Patients received calcium polystyrene sulfonate 30 g per day during 5 days and kept a low potassium diet. Control group was treated with only low potassium diet. Primary end-point was reduction in serum potassium concentration by Day 5 of treatment compared to baseline. RESULTS: 64 patients randomized to calcium polystyrene sulfonate [n = 32] and control diet therapy [n = 32] groups. There were no differences between groups in general parameters including demographic data and the characteristics of concomitant disorders. The level of potassium observed at the visit of Day 5 of treatment reduced by 0.837 ± 0.475 mmol/L in calcium polystyrene sulfonate group and by 0.497 ± 0.409 mmol/L in the diet group; the differences between the groups were statistically significant (p = 0.0434). As a confirmation of the second end-point, ratio of reaching normal potassium level probability on Day 5 of treatment compared to diet therapy group was 1,45 (95% CI 1,04 - 2,03). CONCLUSION: calcium polystyrene sulfonate provides significant reduction of serum potassium in patients with hyperkalemia with chronic kidney disease (CKD) which are not requiring dialysis; it has the favorable safety profile and tolerability.

The aim of our study is to introduce a safe and easy way to perform partial nephrectomy via different approaches with a set of our specially engineered instruments for parenchyma clamping. Between January 2011 and October 2013 we performed a total number of 110 open, laparoscopic and robotic partial nephrectomies (PN) in patients with RCC stage T1-2N0M0. Eighty-six and 24 patients underwent PN with traditional vascular clamping (VC group) and selective parenchyma clamping (PC group), respectively. We worked out 3 types renal parenchyma clamps (patented inventions): one for laparoscopic/robotic PN and two kinds for open procedures (upper/lower pole and middle segment of kidney). We measured glomerular filtration rate (GFR) before the procedure and 24 hours and 1 year after. We also measured operative time, blood loss, warm ischemia time and parenchyma clamping time. In VC group depression of GFR 24 hours and 1 year after the operation was 22% and 33%, respectively. Deterioration of GFR 24 hours and 1 year after surgery in PC group was 5% and 12%, respectively. In both groups patients didn’t face any perioperative complications or reinterventions. Cancer-specific survival rate was 100% in both groups during 1 year follow-up. NSS can be performed in a safe manner under regional ischemia with selective parenchyma clamping. Regional ischemia shows better functional results immediately and 1 year after the surgery and can be achieved by using specially designed parenchyma clamps during open, laparoscopic and robotic partial nephrectomy.

THE AIM OF STUDY was to find out the beginning of the acute kidney injury (AKI) after partial or radical nephrectomy. PATIENTS AND METHODS. 17 patients with renal cell carcinoma were treated either via radical (5 cases) or partial (12 cases) nephrectomy. The procedures were performed through open, laparoscopic or robotic approaches. Partial nephrectomies were made under regional (local) ischemia by putting special clamps on renal parenchyma. The serum creatinine was measured before procedure and 24 h later. Plasma NGAL levels was measured before surgery and 2 hours later. Urine NGAL was measured before surgery after 2, 4 and 8 hours. RESULTS. The histological diagnosis was RCC in all cases. In groups of radical and partial nephrectomy initial level of blood serum creatinine, blood serum NGAL and urine level didn’t exceed normal values. In radical nephrectomy group urine NGAL level increased 2 hours after surgery. Maximal values were detected at 8 hours after surgery (increase of factor to 123,4±29,1 ng/ml). In group of partial nephrectomy urine NGAL begin to increase at 2 hours after surgery too. Maximal values were detected after 8 hours after surgery 25,4±14,6 ng/ml. CONCLUSIONS. Concentration of urine NGAL over time provide to reveal acute kidney injury 2 hours after surgery.

This review briefly summarizes the current understanding about of acid-base transport in the kidney and the regulation of these processes. Attention was turned to range of questions which are deficiently observed in national science-medical literature: molecular structure of some transporters, involved in these processes, role of local pH, pCO2 and bicarbonate sensors, characteristics of gases transport through cell membranes etc. Was made an effort to show defects in which mechanisms of proton and bicarbonate translocation in renal tubules form the basis for rare and unique diseases – renal tubular acidosis.

AIM OF RESEARCH: to evaluate glomerular filtration rate dynamics before and after the various options and volume of surgery in patients with kidney malignant neoplasms. PATIENTS AND METHODS: We examined 62 patients (men – 41, women - 21) surgically operated with malignant renal tumors (open, laparoscopic, or robot–assisted total nephrectomy or partial nephrectomy). The group 1 (n = 28) – tumor resection, group 2 (n = 34) – nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated by several methods: a brief MDRD formula [7], D.W. Cocroft and M.H. Gault formula (CCG) [8], the equations of CKD-EPI [9] and MCQ. RESULTS: showed that surgical operation led to authentic increase of SCr and Sur and significant decrease of eGFR regardless of the extent of surgical intervention. Intergroup differences in all researched parameters after surgery has not been established, although there was a trend downwards concerning all used eGFR methods in patients with nephrectomy (not statistically significant due to the considerable scatter of data). CONCLUSION: Surgical interventions in patients with renal cancer in the great majority of cases induce the development of chronic kidney disease 2–3 and, even 4 stages – an independent predictor of cardiovascular morbidity and mortality.

The aim of the study was to investigate the effectiveness of combined long-term therapy by cytostatics and steroid hormones in older patients with membranoproliferative glomerulonephritis to halt renal failure progression. 27 patients older than 60 years with morphologically proved membranoproliferative glomerulonephritis have been treated. Nephrosclerosis was detected in 40% of studied patients according to results of kidney biopsies. The mean age of the patients was 65.8 +/- 1.5 years. The activity of the disease depended on presence and severity of nephrotic syndrome. 17 (62.9%) patients had coronary heart disease, 7 (25.9%) patients had chronic bronchitis, 7 (25.9%) patients had peptic ulcer disease in a remission phase. Patients received therapy by cyclophosphamide in a dose of 2 mg/kg daily and prednisolone in a dose of 1 mg/kg daily during 2 years. Tolerability of assigned treatment was satisfactory. The main clinical and laboratory signs of nephrotic syndrome were significantly reduced and the proof remission was reached after 8-12 months of combined therapy. During the observation (24 month) the glomerular filtration rate in studied patients didn't decreased over 30-59 mL/min/1.73 m2 and corresponded to stage 3 of chronic kidney disease.

AIM: to estimate level of fibroblast growth factor 23 (FGF23) in renal allograft recipients and to evaluate interaction between FGF23 level and some clinical laboratory factors in early and long date after cadaver renal allografting (CRA). PATIENTS AND METHODS. Research included 46 renal allograft recipients, where 21 patient’s postoperative period was less than 24 months on the research period (group 1) and 26 patients with postoperative period more than 24 months (group 2). All patients were performed laboratory research complex, renal allograft ultrasound, serum FGF23 level detection by enzyme-linked immunoelectrodiffusion essay. RESULTS. In group 1 revealed statistically significant correlations between serum FGF23 level and clinical laboratory factors. FGF23 level directly correlate with age of patients (r=0,472; P=0,031), renal replacement therapy (RRT) duration before CRA (r=0,474; P=0,030), systolic blood pressure (BPs) level (r=0,482; P=0,027), erythrocyte sedimentation rate (ESR) (r=0,753; P<0,0001), creatinine (r=0,523; P=0,015), urea (r=0,483; P=0,026), sodium (r=0,634; P=0,002), uric acid (r=0,712; P<0,0001), triglycerides (r=0,476; P=0,029), glucose (r=0494; P=0,023), serum alkaline phosphatase (r=0,506; P=0,019) and proteinuria (r=0,615; P=0,003). High levels of FGF23 were noticed in patients with lower GFR values (r=-0,493; P=0,023). FGF23 feedback with phosphor level was noticed (r=-0,439; P=0,046). In second group FGF23 authentically increased in proportion to allograft function deterioration: direct correlation with serum creatinine (r=0,430; P=0,031) and invert correlation with GFR (r=-0,542, P=0,005). Proteinuria augmentation was involved with high level of FGF23 (r=0,637, P=0,001). In second group serum phosphor directly correlated with FGF23 (r=0,413, P=0,04) (fig. 2). CONCLUSION. In early periods after CRA noticed FGF23 level decreasing in proportion to phospho-calcium homeostasis factors normalization, when in the following in proportion to nephropathy progression in transplant, phospho-calcium metabolic imbalances increase, leading to increased FGF23 synthesis. Maybe in future FGF23 will become new therapeutic target for results improvement in postoperative period.

The article covers the problem of urinary tract infections, which are the most common infectious diseases in children. The authors analyze etiology, pathogenesis, classification and clinical and diagnostic approaches to such patients. The modern methods of treatment are described in the article . t.