Background Hypertension (HTN) is a well-known complication among patients on pediatric kidney replacement therapy (KRT). We aimed to evaluate demographics, longitudinal changes and outcomes of high blood pressure (BP) among children and adolescents on KRT. Methods Data on BP and antihypertensive (AH) medications reported to the ESPN/ERA Registry on 6071 patients from 28 European countries starting KRT < 20 years of age between 2007 and 2021, were included. Results Hypertension (HTN), AH medication use, and uncontrolled HTN were reported in 60.7%, 45.0%, and 32.0% of patients, respectively. Prevalence of uncontrolled HTN was 49.7% in HD, 42.3% in PD, and 27.3% in transplanted patients. Younger age, dialysis, and shorter KRT vintage were risk factors for uncontrolled HTN. AH medication use was lower among young patients, females and those on dialysis, and higher with a shorter KRT vintage and non-CAKUT kidney disease. Among AH medication users, 27.9% of transplantation, 48.1% of PD and 58.9% of HD patients showed a systolic BP > 95th percentile. Uncontrolled HTN significantly decreased over time in HD patients (52.3% at dialysis start vs. 42.5% after 5 years; annual percentage change [APC] - 3.5%; 95%CI: - 6.2; -0.7), despite similar AH medication use. After 5 years, transplanted patients showed a significant reduction in both prevalence of uncontrolled HTN (APC - 3.6%; 95%CI: - 5.7; - 1.5) and AH medication use (APC - 1.6%; 95%CI: - 2.6; - 0.6%). No trends were found for PD patients. Uncontrolled HTN was not associated with mortality (aHR 1.02; 95%CI: 0.79-1.33). Conclusions HTN is highly prevalent in children and adolescents on KRT. Younger children and HD patients should be carefully evaluated for BP status after entering dialysis or shortly after transplantation

Background: Artificial intelligence (AI) is increasingly used in nephrology, including rehabilitation planning for patients with chronic kidney disease (CKD). However, most AI systems are predominantly trained on English-language data, which may influence the quality and clinical relevance of the generated recommendations. Objective: To evaluate the impact of query language on the quality and clinical applicability of AI-generated exercise programs for CKD patients undergoing renal replacement therapy. Methods: We conducted a structured qualitative comparison using predefined evaluation criteria based on KDIGO and ERA rehabilitation guidelines. Outputs were assessed for structure, clinical detail, safety framing, and adaptability. Identical prompts were formulated in Ukrainian and English. Generated exercise programs were assessed for alignment with international guidelines (KDIGO, ERA), level of clinical detail, progression, safety considerations, and adaptability. Results: All AI systems produced safe exercise programs incorporating aerobic, resistance, flexibility, and relaxation components. However, significant differences were observed depending on the query language. Ukrainian-language outputs were simpler and focused on general well-being, with limited progression and monitoring. In contrast, English-language outputs demonstrated greater clinical depth, including structured progression, intradialytic adaptations, and the use of validated monitoring tools (e.g., Borg RPE scale). Copilot provided the highest clinical precision, ChatGPT delivered structured programs, and Gemini emphasized safety and motivation. English-language prompts produced more detailed and guideline-aligned outputs, whereas Ukrainian-language prompts generated simpler, wellness-oriented recommendations. Conclusions: Query language influences the structure and clinical completeness of AI-generated rehabilitation programs. English-language prompts currently yield more detailed and guideline-aligned outputs. Further multilingual model development is needed. English-language queries currently yield more clinically robust outputs. Development of multilingual AI systems and standardized prompt frameworks is essential to ensure equitable access to AI-assisted healthcare.

This study evaluates the effectiveness of combination antiviral therapy for COVID-19 using Umifenovir and Oseltamivir compared with standard treatment. A total of 85 outpatients with confirmed COVID-19 were randomly assigned to two groups: 43 patients received combination antiviral therapy (Umifenovir 200 mg 4 times daily, Oseltamivir 75 mg twice daily for 7 days), and 42 received standard therapy based on WHO recommendations. The study spanned 16 months. Primary endpoints included the number of

Acute kidney injury and kidney failure represent critical health challenges, requiring continuous and specialized care. The impact of natural disasters, such as earthquakes, floods, and hurricanes, alongside man-made crises like armed conflicts and pandemics, exacerbates the complexities of managing these conditions. Disasters disrupt health care infrastructure, cause resource shortages, and pose ethical dilemmas in care allocation, often leading to surges in acute kidney injury cases and interruptions in kidney failure treatment. This article examines these challenges and underscores the importance of resilience and adaptability in nephrology care during crises. Recent advancements, including portable dialysis technologies, telemedicine, and remote monitoring systems, have demonstrated significant potential to mitigate disaster-induced disruptions. Moreover, adaptive care models—centered on preparedness, ethical resource allocation, and patient empowerment—are crucial for improving outcomes. Collaborative efforts by international nephrology organizations, nongovernmental organizations, and local health care systems play a pivotal role in integrating kidney care into disaster response frameworks. This comprehensive review synthesizes lessons learned from past crises and provides a framework for enhancing acute kidney injury and kidney failure management during disasters. By leveraging innovative technologies, fostering collaboration, and addressing the psychological and logistical needs of patients and providers, the nephrology community can improve care delivery and build resilience for future emergencies.

The monograph is dedicated to functional renal reserve—an important measure of the kidneys' ability to adapt under stress. It examines the main mechanisms of renal reserve formation, assessment methods, and its role in diagnosing and predicting kidney diseases. Special attention is given to the significance of renal reserve in patients with chronic kidney disease, hypertension, diabetes, and other comorbid conditions. This monograph will be useful for nephrologists, researchers, and medical students who aim to deepen their understanding of kidney function and optimize treatment for patients at risk of kidney failure

Background. Obesity has a significant impact on the course of chronic kidney disease (CKD), as it contributes to the occurrence of oxidative stress, inflammation and activation of the renin-angiotensin-aldosterone system. The mechanisms of obesity influence on CKD are not fully understood. A new approach is needed to assess obesity status in patients with CKD. The purpose of the study: to investigate the relationship between overweight or obesity in patients with CKD stage I–III and the course and development of CKD complications depending on uromodulin levels. Materials and methods. A prospective randomized cohort study ROLUNT (uROmoduLin, UbiquinoNe, glutaThione), in which 123 patients participated in 2021–2023. It was conducted at ­VETA-PLUS LLC, Professor Dmytro Ivanov Nephrology Clinic LLC and CDC of Brovary Multidisciplinary Clinical Hospital, which are the clinical bases of the Department of Nephrology and Renal Replacement Therapy of the Shupyk National Healthcare University of Ukraine. Participants were divided into 3 groups: group 1 (n = 21) — patients with CKD stage I–III and body mass index (BMI) < 25 kg/m2, group 2 (n = 58) — those with CKD stage I–III and BMI of 25–29.9 kg/m2, and group 3 (n = 44) — patients with CKD I–III stage and BMI > 30 kg/m2. Results. The average age of participants is 49–50 years, there were 44 men (35.77 %), 79 women (64.23 %). All groups had no statistically significant differences in age and gender. In the structure of CKD, the most common pathology was tubulointerstitial nephritis of unknown etiology — 27 patients (29.67 %). During kidney ultrasound, a significant share belonged to urinary salt diathesis — in 55 patients (44.72 %). The median BMI in groups 1, 2, and 3 were 22.1, 27.6, and 32.9 kg/m2, respectively. The average values of urinary uromodulin (uUmod), daily excretion of uromodulin (uUmod24), urinary albumin (uAlb), serum uromodulin (sUmod) for group 1 are 25.06, 56.18, 17.95, 47.22, respectively, the median values of these indicators for groups 2 and 3 are 26.2 and 26.15; 57 and 53.75; 26.7 and 28.55; 47.65 and 49.4, respectively. Correlation analysis in group 1 revealed statistically significant strong direct relathionship between uUmod and uUmod24, uUmod/sUmod, uUmod24 and uUmod, uUmod/sUmod, uUmod/estimated glomerular filtration rate (eGFR), sUmod and uUmod/eGFR. Correlation analysis in group 2 demonstrated a statistically significant strong direct relationship between uUmod24 and uUmod/eGFR, uUmod and sUmod, eGFR. Correlation analysis in group 3 revealed a statistically significant strong direct relationship between uUmod and uUmod/sUmod, uUmod24 and uUmod/eGFR. Conclusions. Statistical analysis showed that in all 3 groups, uUmod has a significant direct strong correlation with the uUmod/sUmod concentration index. In all 3 groups, uUmod24 has a significant direct strong correlation with the uUmod/eGFR index. But only in group 2, there is a significant strong direct correlation between uUmod and eGFR and a significant strong inverse correlation between uUmod and uAlb/urinary creatinine, fractional excretion of uromodulin, serum urea, urea nitrogen, serum creatinine.

Abstract Background: The ISN Green Nephrology Initiative, coupled with limited capacity in low-middle-income countries and the challenges posed by military conflicts, necessitates innovative solutions in pediatric nephrology for optimizing the treatment of children with kidney diseases. This study aims to assess the effectiveness and safety of Rituximab (RTX) usage in children with glomerular diseases, with an extension of clinical indications.Methods: We initiated an ongoing open-label, multicenter, randomized, patient-oriented study, termed RIME ("RTX in glomerulopathies"), focusing on children with glomerulopathies in Ukraine during martial law (enrolled 2022–2023). Inclusion criteria comprised patients with steroid-dependent (SDNS) or frequently relapsing nephrotic syndrome (FRNS) and progressive glomerulopathies, as determined by eGFR (estimated glomerular filtration rate), ACR (albumin-to-creatinine ratio), and kidney biopsy results. RTX was explored as an alternative to glucocorticoid re-administration and a potential treatment to decelerate renal function decline. The primary endpoint was eGFR and ACR up to 6 months from RTX initiation, with the secondary endpoint assessing the delayed effect at 1 year.Results: As of November 2023, results were available for 19 children, including 7 with FRNS and 12 with progressive loss of renal function and/or increased ACR. RTX use resulted in stable remission of steroid-dependent FRNS, with statistically significant urinalysis normalization and hyperfiltration by the 6th month, leading to eGFR normalization within a year. RTX demonstrated a 75% success rate in achieving a stable trend in reducing ACR and restoring eGFR in progressive glomerulopaties. In this group, stable trends did not receive statistically significant changes, which is obviously due to the small size of the sample. Tolerability was observed in 80% of patients, allowing completion of the full course of therapy.Conclusions: RTX, if tolerated, proved highly effective as a steroid-sparing agent and demonstrated efficiency in slowing the pathological process in progressive glomerulopathies, indicating the potential for ACR reduction and renal function restoration. Future studies should assess the balance between treatment cost, convenience, adherence to Green Nephrology principles, and the feasibility of a virtual nephrology approach in conflict zones.

BackgroundThere is a lack of information on the current healthcare systems for children with kidney diseases across Europe. The aim of this study was to explore the different national approaches to the organization and delivery of pediatric nephrology services within Europe.MethodsIn 2020, the European society for Paediatric Nephrology (ESPN) conducted a cross-sectional survey to identify the existing pediatric nephrology healthcare systems in 48 European countries covering a population of more than 200 million children.ResultsThe reported three most important priorities in the care of children with kidney diseases were better training of staff, more incentives for physicians to reduce staff shortages, and more hospital beds. Positive achievements in the field of pediatric nephrology included the establishment of new specialized pediatric nephrology centers, facilities for pediatric dialysis and transplant units in 18, 16, and 12 countries, respectively. The most common problems included no access to any type of dialysis (12), inadequate transplant programs for all ages of children (12), lack of well-trained physicians and dialysis nurses (12), inadequate reimbursement of hospitals for expensive therapies (10), and lack of multidisciplinary care by psychologists, dieticians, physiotherapists, social workers and vocational counsellors (6). Twenty-five of 48 countries (52%) expected to have a shortage of pediatric nephrologists in the year 2025, 63% of clinical nurses and 56% of dialysis nurses. All three groups of health care professionals were expected to be lacking in 38% of countries. Prenatal assessment and postnatal management of renal malformations by a multidisciplinary team including obstetricians, geneticists, pediatricians, and pediatric surgeons was available in one third of countries.ConclusionsOur study shows that there are still very marked differences in pediatric health care systems across the European countries and highlights the need need for appropriate services for children with kidney disease in all European countries.

Kidney diseases, starting from acute kidney injury, acute kidney disease, or having an uncertain onset, often progress to chronic kidney disease (CKD). The pathomorphosis of this progression typically involves predominant damage to the glo­merulus, affecting either the glomerular filter or the tubules, primarily in the proximal part. International guidelines identify two key indicators for determining the prognosis and progression of CKD: albuminuria and glomerular filtration rate. Additional criteria, such as blood pressure, pathomorphological changes, or multifactorial calculators, are usually proposed for specific nosological forms. However, accurately predicting CKD progression remains a challenging issue. We propose using renal functional reserve to estimate the number of functioning nephrons. Together with blood pressure, degrees of albuminuria, and glomerular filtration rate, this approach provides a more accurate assessment of the future course of CKD.

Background. Renal ultrasound is a convenient, safe, and affordable tool for visualization of the kidneys in the daily practice of nephrologists and doctors of other specialties. Kidney volume, which is calculated by the sonographic method, gives an idea about the state of the kidneys of the patient, but says almost nothing about their function. There are many studies of renal index of resistance (IR) as a marker of kidney function. IR values were compared with serum creatinine levels and/or histological data. And although conflicting research data limit the use of IR as a marker of kidney function, correct interpretation of IR helps restore it to the status of a candidate marker of kidney function. The purpose of the study: to conduct a retrospective analysis of the sonographic renal parameters in patients who sought outpatient medical care at the Brovary medical institution. Materials and methods. Retrospective randomized cohort study was conducted of sonograms of 66 outpatients who sought outpatient medical care at a private medical facility in Brovary from February 2022 to February 2024. They were divided into 2 groups: the first one (n = 31) — men and the second group (n = 35) — wo­men. Results. The results of multiple linear regression in the group 1 for right kidney (RK) showed that the independent variable in this model, RK thickness, is of low significance as a predictor for IR RK, and the following independent variables were not significant as predictors for IR RK: RK length, RK width, RK volume, age. Multiple linear regression results in the group 1 for left kidney (LK) indicate that the independent variable in this model, LK width, is moderately significant as a predictor for LK IR, and the following independent variables were not significant as predictors for LK IR: LK length, LK thickness, LK volume, age. Multiple linear regression results in the group 2 for RK showed that the independent variables in this model, RK width and age, are significant as predictors for IR RK, and the following independent variables were not significant as predictors for IR RK: RK length, RK thickness, RK volume. Multiple linear regression results in the group 2 for LK indicate that the independent variable in this model, LK width, is moderately significant as a predictor for LK IR, and the following independent variables were not significant as predictors for LK IR: LK length, LK thickness, LK volume, age. Conclusions. Renal ultrasound allows predicting the category of patients who will need a consultation with a nephrologist/urologist, identifying risk groups for chronic kidney disease.

Background. This publication initiates the project "Neuro-endocrine regulation of the clearance of nitrogenous metabolites". The first stage of project implementation is the clarification of peculiarities of metabolic and neuro-endocrine accompaniments of urate-losing and urate-retaining kidneys. Materials and Methods. The object of observations were patients with chronic pyelonephritis in the phase of remission (34 males aged 23-70 years and 10 females aged 33-76 years). Testing was performed twice - on admission and after 7-10 days of standard balneotherapy on Truskavets Spa. The battery of tests was created in line with concepts functional-metabolic continuum and NEI network. The content of nitrogenous metabolites and electrolytes was determined in daily urine and blood serum. In addition, indicators of the lipoprotein spectrum and lipids peroxidation, as well as the level of the main adaptation hormones, were determined in the blood. The state of the autonomic nervous system was assessed by the HRV method. Results. In 63.6% of cases, the renal clearance of uric acid was within the classical norm (±2σ), in 12.5% it was moderately reduced, but in the remaining cases it was increased, including drastically in 3 cases. The method of discriminant analysis revealed 20 parameters, according to the totality of which all 4 clusters of uric acid clearance clearly differ from each other (classification accuracy 100%). Conclusion. Constitutionally distinct types of uric acid metabolism (euricosis, urate-losing and urate-retaining kidneys) are characterized by specific constellations of metabolic and autonomic-endocrine parameters.

Glomerulonephritis is one of the most common kidney diseases in children, which leads to the development of chronic kidney disease, chronic kidney failure, and early disability. According to statistical data (2022), glomerulonephritis is the second most common among acquired kidney childhood diseases after urinary tract infections in Ukraine. The system of standardization of medical care is focused on the development and implementation of medical and technological documents that help a doctor to act effectively in specific clinical situations, avoiding ineffective actions and interventions. The article considers the approaches to improving the quality of medical care for children at the regional level — a local clinical protocol of medical care for children with glomerulonephritis (coordination of the patient’s clinical route and standardization of diagnostic, therapeutic and preventive measures in health care facilities at the level of the hospital district).

Background: Steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS) significantly affect children’s quality of life. There are frequent relapses in SSNS and progression in SRNS. IPNA guidelines suggest that monoclonal antibodies like rituximab (RTX) are promising treatments. Objective: This study aims to evaluate the long-term efficacy and safety of rituximab administration in children with SSNS, encompassing FRNS and SDNS, and SRNS over a two-year follow-up period, facilitating individualized management. Methods: We conducted an open-label, multicenter, randomized, and patient-oriented study (RICHNESS), involving children aged 3–18 with SRNS (18) and SSNS (11) undergoing 2 years continuous RTX therapy. The primary outcome was complete/partial remission (CR/PR), as defined by IPNA/KDIGO guidelines, at 6, 12, 18, and 24 months on RTX; secondary outcomes included adverse events. Key endpoints included the estimated glomerular filtration rate (eGFR), the albumin-to-creatinine ratio (ACR), CD20 levels, IgG levels, and the incidence of infections. Kidney biopsies were performed in 94% of SRNS patients. RTX was administered every 6–9 months, depending on CD20 levels, IgG levels, and the presence of infections. The eGFR and ACR were assessed every 6 months. Results: Some 31 children were selected for RTX treatment. Overall, 2 experienced severe allergic reactions, leading to their exclusion from the final analysis of 29 children. In the SSNS group, all children achieved and maintained complete remission within 2 years. Remission rates in the SRNS group ranged from 39% (RR 0.78; 95% CI: 16.4–61.4%, NNT 9) at the 6th month to 72% (RR 1.44; 95% CI: 51.5–92.9%) over the 2-year follow-up period due to continuous RTX therapy. The median duration of RTX use was 26.1 months, with a median cumulative dose of 1820 mg/m2. Adverse reactions and complications were presented by mild infusion-related reactions in 3 children (10.3%), severe allergic reactions in 2 children (6.2%), hypogammaglobulinemia in 7 children (24%), infections in 3 children (10.3%), severe destructive pneumonia in 1 child, recurrent respiratory infections in 2 children, and neutropenia in 1 child (3.44%). Conclusions: RTX was tolerated well, and proved highly effective as a steroid-sparing agent, offering potential in terms of stopping relapses and minimizing steroid-related side effects. It also demonstrated efficacy in slowing progression in SRNS, indicating potential for use in ACR reduction and renal function restoration, but requires careful use given potential severe allergic reactions and infectious complications. Further studies should focus on long-term cost-effectiveness and deferred side effects.

Managing the activities of the UAN during hostilities is a challenge for doctors and patients themselves. We analyzed the activity of the association since the beginning of the war in Ukraine to formulate further recommendations.

Background. Impaired kidney function has a negative effect on the body’s acid-base status (ABS). However, a violation of ABS can worsen the course of chronic kidney disease (CKD). Therefore, during the examination and treatment of patients with CKD, it is necessary to take into account the ABS. The purpose of the study: to conduct a retrospective analysis of the dynamics of ABS indicators in patients with stage 1–5 CKD who sought outpatient medical care in a medical institution in Kyiv. Materials and methods. A retrospective, randomized, cohort study was performed of 53 medical records of patients (form 025/o) who sought outpatient medical care at the Professor Dmytro Ivanov Nephrological Clinic LLC with a diagnosis of stage 1–5 CKD from February 2022 to February 2023. Participants were examined for ABS indicators three times. They were divided into 2 groups: group 1 (n = 31) — stage 1–3 CKD and group 2 (n = 22) — stage 4–5 CKD. An analysis of ABS indicators was carried out in dyna­mics. Results. Results of multiple linear regression for patients with stage 1–5 CKD (n = 53) showed that there was a strong significant effect between potassium (K+) and glomerular filtration rate (GFR) (F(1, 13) = 10.59, p = 0.006, R2 = 0.45, R2 adj = 0.41). The results of multiple linear regression of indicators in patients with stage 1–3 CKD (group 1) demonstrated a weak insignificant influence between lactate and GFR (F(1, 15) = 1.11, p = 0.310, R2 = 0.07, R2 adj = 0.01). The results of multiple linear regression of indicators in patients with stage 4–5 CKD (group 2) showed that there is a very strong combined insignificant influence between the hydrogen index, partial pressure of carbon dioxide, partial pressure of oxygen, bicarbonate concentration, base excess of extracellular fluid, K+, total carbon dioxide, anion gap with K concentration included in the equation, base excess, lactate and GFR (F(10, –3) = 0.3, p = 58.099, R2 = –65.23, R2 adj = 155.53). Conclusions. When studying ABS in patients with stage 1–5 CKD, a correlation was found between K+ and GFR using the multiple linear regression tool. In the first group, the relationship between lactate and GFR, in the second one, all predictors had a relationship with GFR.

The efficacy and safety of rituximab in childhood steroid-resistant nephrotic syndrome (SRNS) remains unclear. Therefore, we conducted a retrospective cohort study at 28 pediatric nephrology centers from 19 countries in Asia, Europe, North America and Oceania to evaluate this. Children with SRNS treated with rituximab were analyzed according to the duration of calcineurin inhibitors (CNIs) treatment before rituximab [6 months or more (CNI-resistant) and under 6 months]. Primary outcome was complete/partial remission (CR/PR) as defined by IPNA/KDIGO guidelines. Secondary outcomes included kidney failure and adverse events. Two-hundred-forty-six children (mean age, 6.9 years; 136 boys; 57% focal segmental glomerulosclerosis, FSGS) were followed a median of 32.4 months after rituximab. All patients were in non-remission before rituximab. (146 and 100 children received CNIs for 6 month or more or under 6 months before rituximab, respectively). In patients with CNI-resistant SRNS, the remission rates (CR/PR) at 3-, 6-, 12- and 24-months were 26% (95% confidence interval 19.3-34.1), 35.6% (28.0-44.0), 35.1% (27.2-43.8) and 39.1% (29.2-49.9), respectively. Twenty-five patients were in PR at 12-months, of which 22 had over 50% reduction in proteinuria from baseline. The remission rates among children treated with CNIs under 6 months before rituximab were 42% (32.3-52.3), 52% (41.8-62.0), 54% (44.3-64.5) and 60% (47.6-71.3) at 3-, 6-, 12-, and 24-months. Upon Kaplan-Meier analysis, non-remission and PR at 12-months after rituximab, compared to CR, were associated with significantly worse kidney survival. Adverse events occurred in 30.5% and most were mild. Thus, rituximab enhances remission in a subset of children with SRNS, is generally safe and CR following rituximab is associated with favorable kidney outcome.

Background. All over the world, chronic kidney di­sease (CKD) is a global problem. Prevention of CKD development, as well as the rapid progression of CKD, are the priority tasks of modern nephrology. A decrease in estimated glomerular filtration rate (eGFR) of more than 5 ml/min/1.73 m2/year is considered rapid progression of CKD. The purpose of the study was to assess the risk of rapid progression of CKD in patients with stage 1–3 CKD by determining urinary albumin (uAlb)/urinary uromodulin (uUmod) ratio and comparing the obtained results with eGFR and the Charlson Comorbidity Index (CCI) in these patients. ­Materials and methods. Patients were divided into 3 groups: group 1 (n = 46) — individuals with stage 1–3 CKD who had a CCI ≤ 2, group 2 (n = 45) — patients with stage 1–3 CKD who had CCI ≥ 3, and group 3 (n = 32) — people without CKD risk factors and wi­thout symptoms of kidney damage. Results. The results of the study showed that the linear regression between uAlb/uUmod and eGFR in groups 1 and 2 is statistically significant (p < 0.05). In the first group, the correlation coefficient (R) between uAlb/uUmod and eGFR is –0.295. In the second group, the correlation coefficient between uAlb/uUmod and eGFR is –0.32 — there is an average inverse relationship. ­Conclusions. If the ratio of uAlb/uUmod is more than 0.94, there is a risk of rapid progression of CKD. There is a need for further research in this direction to increase the effectiveness of predicting the rapid progression of CKD.