Kidney injury in patients infected with the human immunodeficiency virus (HIV) has a diverse spectrum. Some antiretroviral therapy (ART) drugs have nephrotoxic effects. We present a clinical case of severe combined kidney injury — chronic kidney disease (CKD) and acute kidney disease (AKD) — in a patient with HIV infection. She was on long-term treatment with a fixed-dose combination of rilpivirine, tenofovir, and emtricitabine and had normal pre-treatment renal function (estimated glomerular filtration rate 69 mL/min/1.73m2 ). There was gradual increase in blood creatinine, but the patient did not visit a nephrologist and the ART was not changed. The patient was admitted to the nephrology department two years later because she had arterial hypertension and hyperazotemia (blood creatinine 718 μmol/l). Diagnosis: chronic tubulointerstitial nephritis, CKD G5 taking into account the gradual increase in blood creatinine during long-term ART. The patient was treated with peritoneal dialysis. There was persistent decrease and stabilization of blood creatinine (210-190 μmol/l was) which indicated in AKD. The presented observation demonstrates that ART in an HIVinfected patient can lead to the development of severe combined chronic and acute kidney injury. HIV-infected patients receiving ART require regular monitoring of renal function and follow-up by a nephrologist.

The efficiency of bortezomib protocols is evaluated in 27 patients with multiple myeloma and renal failure. The mean serum creatinine level in those patients was 642 +/- 55 mmol/liter, glomerular filtration 14.9 +/- 1.3 ml/min. Combined therapy by bortezomib protocols and hemodyalisis was carried out in 14 patients, 13 patients received cytostatic therapy alone. Antitumor response, recovery of renal function parameters, and overall survival were evaluated. Patients receiving antitumor bortezomib therapy in combination with hemodialysis exhibited an objective antitumor response of 63.3%, with substitute renal therapy of 1 to 42 months (median 6 months). Renal function values improved significantly after 6 months of treatment. The need in hemodialysis persisted in 8 (57.2%) patients, in 2 (14.3%) patients hemodialysis had to be resumed after its discontinuation, and no more hemodialysis was needed in 4 (28.5%) patients. The objective response in patients receiving only antitumor bortezomib therapy was virtually the same as in hemodialysis subgroup -61.5%. Renal function improved as well. Survival median in the subgroups was 50 and 48 months, respectively. The study has demonstrated high efficiency of bortezomib protocols for the treatment of patients with multiple myeloma complicated by renal failure. Antitumor therapy was supplemented by hemodialysis in patients with glomerular filtration below 20 ml/min.

А.В. Ватазин, Е.И. Прокопенко, О.Н. Ветчинникова, В.И. Гранкин, Е.О. Щербакова, В.П. Суслов, А.Г. ЯнковойГУ Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ)Статья посвящена 40-летию хирургического отделения трансплантологии и диализа МОНИКИ им. М.Ф. Владимирского. Приведены сведения об этапах развития отделения и его руководителях. Кратко изложены поэтапные структурные и штатные преобразования, итоги клинической и научной работы, результаты работы кафедры эфферентной медицины клинической и оперативной нефрологии. Обозначены дальнейшие направ-ления развития экстракорпоральных методов лечения почечной недостаточности и трансплантации почки.Ключевые слова: острая и хроническая почечная недостаточность, трансплантация почки.HISTORY AND PRINCIPAL STEPS IN DEVELOPMENT OF M.F. VLADIMIRSKY MONIKI SURGICAL DEPARTMENT OF TRANSPLANTOLOGY AND DIALYSIS (40-years jubilee)A.V. Vatazin, E.I. Prokopenko, O.N. Vetchinnikova, V.I. Grankin, E.O. Shcherbakova, V.P. Suslov, A.G. YankovoyM.F. Vladimirsky Moscow Regional Clinical and Research Institute (MONIKI)The article is devoted to the 40-years jubilee of the MONIKI Surgical Department of Transplantology and Dialysis. Information concerning development steps and department heads are presented. Structural and staff transformations are described as well as results of clinical and research work including those of the Chair of Efferent Medicine of Clinical and Operative Nephrology. Further directions of extracorporeal methods development were denoted to treat renal failure and carry out renal transplantation.Key words: acute and chronic renal failure, renal transplantation.В декабре 2010 г. исполнилось 40 лет одному из старейших в России отделений диализа и транс-плантации почки – Московскому областному центру трансплантации и диализа МОНИКИ им. М.Ф. Влади-мирского. В 1970 г. была создана лаборатория «Ис-кусственная почка», основателем и первым руково-дителем которой стал д-р мед. наук Б.Д. Верховский. Подразделение было оснащено четырьмя диализны-ми аппаратами «Искусственная почка» отечественно-го производства «АИП-140». Будучи пионерами в исследовании функции по-чек на различных стадиях острой почечной недоста-точности (ОПН), Б.Д. Верховский и сотрудники воз-главляемого им отделения много лет занимались этой проблемой. Впервые в стране они разработали пока-зания к раннему («профилактическому») диализу при ОПН, что позволило значительно снизить летальность в этой группе больных. Однако уже в первые месяцы своего существования лаборатория «Искусственная почка» принимала на лечение не только больных с ОПН, но и пациентов с терминальной стадией хрони-ческой почечной недостаточности (ХПН).В 1976 г. лаборатория «Искусственная почка» приобрела статус самостоятельного отделения и была перемещена в отдельное здание на территории инсти-тута – в корпус № 6 (бывший родильный дом Старо-Екатерининской больницы). За несколько лет своего существования в отделении был решен ряд вопросов по организации программного гемодиализа: была по-казана эффективность лечения больных с ХПН с при-менением «короткого» гемодиализа, разработаны принципы проведения амбулаторного гемодиализа.12 апреля 1979 г. врачом-хирургом Л.А. Зейдли-цем была выполнена первая трансплантация трупной

The article is devoted to the 40-years jubilee of the MONIKI Surgical Department of Transplantology and Dialysis. Information concerning development steps and department heads are presented. Structural and staff transformations are described as well as results of clinical and research work including those of the Chair of Efferent Medicine of Clinical and Operative Nephrology. Further directions of extracorporeal methods development were denoted to treat renal failure and carry out renal transplantation.

Dialysis Service in Moscow region was described including provision of the end stage renal disease patients with substitution therapy. Over past 6 years, significant rise of patients' provision with dialysis medical care was noted: 2.5 fold increase of dialysis centers number and increase of dialysis-treated patients to 134 per million population. The number of patients receiving hemodialysis increased by 37.7 per million population.

Dialysis Service in Moscow region was described including provision of the end stage renal disease patients with substitution therapy. Over past 6 years, significant rise of patients' provision with dialysis medical care was noted: 2.5 fold increase of dialysis centers number and increase of dialysis-treated patients to 134 per million population. The number of patients receiving hemodialysis increased by 37.7 per million population.

Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.

Selective detoxication of the blood from the portal vein was carried out in 31 patients with peritonitis complicated by multiple organ dysfunction including toxic hepatopathy. Selective extracorporeal detoxication of the blood from the portal vein possesses notable regional hemodynamic advantages in comparison with other variants of vascular approaches and essentially improves the transhepatic bloodflow. The authors emphasize that bifiltration cascade exchange portoplasmapheresis is a method of choice in severe toxic hepatopathy in patients with peritonitis. They recommend alternating bifiltration cascade exchange portoplasmapheresis with portohemofiltration in patients with toxic hepatonephropathy.

To define the criteria for a differential approach to operative treatment of uremic osteodystrophy arising in hemodialysis 51 patients were examined clinically, biochemically and roentgenologically before and after parathyroidectomy. Basing on the X-ray picture, the patients were divided into 3 groups: patients with fibrous osteodystrophy seen at X-ray examination (group 1); patients with fibrous osteodystrophy, osteomalacia in predominance of secondary hyperthyroidism (group 2); patients with osteodystrophy and osteomalacia in predominance of osteomalacia syndrome (group 3); patients with uremic osteodystrophy diagnosed only biochemically. Parathyroidectomy proved most effective in group 1 patients. For group 2 patients it is indicated in a subtotal or partial form in a failure of the conservative treatment. In group 3 patients parathyroidectomy is not recommended to avoid a drastic progress of osteomalacia.

The authors present the results of clinical, x-ray, and biochemical studies carried out in 51 patients with uremic osteodystrophy, treated with hemodialysis, before and after parathyroidectomy. The patients were divided into 4 groups with various patterns of x-ray symptoms. Patients with x-ray signs of fibrous osteodystrophy made up group 1, the second group consisted of patients with a combination of fibrous osteodystrophy and osteomalacia with secondary hyperparathyrosis predominance; the third group, like the second one, included patients with the mixed form of uremic osteodystrophy, but with the predominance of the osteomalacic syndrome; Group 4 patients had no x-ray signs of bone changes, and the diagnosis of uremic osteodystrophy was confirmed by clinical laboratory evidence. Analysis of the clinical and x-ray data before and after parathyroidectomy has brought the authors to a conclusion that such an intervention was effective only in cases with manifest clinical and x-ray symptoms of fibrous osteodystrophy. In Group 2 patients with the mixed form of uremic osteodystrophy and less manifest osteomalacia as against fibrous osteodystrophy, subtotal or partial parathyroidectomy is advisable only in cases when conservative therapy is of no avail and fibrous dystrophy is progressing. Surgical treatment is contraindicated to patients in whom x-ray signs of osteomalacia predominate over fibrous osteodystrophy in the total picture of uremic osteodystrophy; it may result in a rapid progress of osteomalacia.