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.

Clinical observations of plasma exchange therapy in patients with thrombotic thrombocytopenic purpura (UP) are presented. Difficulties in the early diagnosis and the role of the early use of the pathogenic treatment are considered. The impact of extracorporal therapy in patients with UP is discussed.

Efficiency of the multiple myeloma treatment with chemotherapy including bortezomib was assessed based on determination of the level of immunoglobulin free light chains in blood serum. The method enables estimation of changes in kinetic parameters of the residual tumor, detection of the disease course prognosis, and the choice of the optimal approach to the disease therapy.

Analysis of the complex treatment efficiency was carried out for patients with pancreonecrosis who also underwent extracorporeal hemocorrection. Alterations in the morphofunctional condition of platelets was revealed and assessed during replacement plasmapheresis and semiprolonged hemofiltration at different stages of pathological process. The quantitative criteria were proposed for assessment of efferent therapy efficiency in patients with pancreonecrosis at the stages of enzymatic shock and suppurative complications.

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.

The data presented concern investigation of efficacy and validity of applying a half-extended hemofiltration in complex treatment of patients with surgical sepsis. Under observation there were 33 patients with multiple organ insufficiency against the background of the severe pyoseptic complications of abdominal cavity diseases. On the basis of morphometric data of circulating thrombocytes, criteria were established for estimation of endogenous intoxication severity and prognostication of the course of multiple organ insufficiency during extracorporeal therapy.

Studying efficacy of different hemofiltration modalities in patients with multiple organic inadequacies was carried out against the background of pyoseptic abdominal diseases. Results of treatment of 167 patients with severe pyoseptic diseases are presented. Comparative features of intermitting, semi-extended, and extended hemofiltration were defined along with studying dynamics of endogenous intoxication levels of inflammation markers.

Results of selective hemosorption influence on patients with surgical sepsis were presented. Under observation there were patients with gramm-negative sepsis who underwent hemosorption. In cases of multiple organ failure, the filtration and combined methods of extracorporeal detoxication were added to the treatment. Selective hemosorption leads to reduction of systemic inflammation.

ВладимирскогоПроведено изучение эффективности различных видов гемофильтрации у больных с полиорганной недо-статочностью на фоне гнойно-септических заболеваний органов брюшной полости. Представлены результаты лечения 163 больных с тяжелыми гнойно-септическими заболеваниями. Дана сравнительная характеристика интермиттирующей, полупродленной и продленной гемофильтрации на фоне изучения динамики уровня эн-догенной интоксикации маркеров воспаления.Ключевые слова