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.

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.

THE AIM. To assess the safety and tolerability of management with dual-component ((lisinopril, and valsartan) and «triple-component» (lisinopril, valsartan, and spironolactone) pharmacological blockade of the renin-angiotensin-aldosterone system (RAAS) in patients with end stage renal disease treated with maintenance hemodialysis (MHD). PATIENTS AND METHODS . Patients was into the two groups: Group 1 (36 patients) receiving the «triple-component» scheme of RAAS blockade, and Group 2 (35 patients) received the «dual-component» therapy (lisinopril, valsartan). The duration of treatment period was 6 months. In both groups serum potassium concentration (SK) has been measured after 3 and 6 months of treatment. RESULTS . There were no clinically significant changes of SK in both groups during the entire period of treatment. Tolerability of both schemes was good. Nobody of patients experienced any side effects during the trial. CONCLUSIONS. Management with combined RAAS blockade (lyzinopril, valsartan, and spironolacton or lyzinopril, and valsartan) in MHD patients doesn’t induce hyperkalemia. It allows to continuing the investigation of cardioprotective efficacy of dual or triple blockade of RAAS in MHD patients.

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.

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.

THE AIM. To assess the safety and tolerability of management with dualcomponent ((lisinopril, and valsartan) and «triplecomponent» (lisinopril, valsartan, and spironolactone) pharmacological blockade of the reninangiotensinaldosterone system (RAAS) in patients with end stage renal disease treated with maintenance hemodialysis (MHD). PATIENTS AND METHODS. Patients was into the two groups: Group 1 (36 patients) receiving the «triplecomponent» scheme of RAAS blockade, and Group 2 (35 patients) received the «dualcomponent» therapy (lisinopril, valsartan). The duration of treatment period was 6 months. In both groups serum potassium concentration (SK) has been measured after 3 and 6 months of treatment. RESULTS. There were no clinically significant changes of SK in both groups during the entire period of treatment. Tolerability of both schemes was good. Nobody of patients experienced any side effects during the trial. CONCLUSIONS. Management with combined RAAS blockade (lyzinopril, valsartan, and spironolacton or lyzinopril, and valsartan) in MHD patients doesn’t induce hyperkalemia. It allows to continuing the investigation of cardioprotective efficacy of dual or triple blockade of RAAS in MHD patients.