Pub Date : 2023-12-30DOI: 10.22141/2307-1257.12.4.2023.431
L.D. Denova, I. Krasiuk
The incidence of primary membranous glomerulonephritis is 1 case per 100,000 each year (75–80 %), with a male-to-female ratio of 2 : 1. It is the cause of idiopathic nephrotic syndrome in more than 20 % of cases (over 40 % in people aged 60 and older). The problem of membranous glomerulonephritis consists in a difficult differential diagnostic search and frequent cases of resistance to treatment. Resistance to treatment may develop in 10–20 % of patients, resulting in the end-stage renal disease requiring renal replacement therapy (dialysis or kidney transplantation). Our work presents the results of clinical observation of a patient with primary membranous glomerulonephritis, nephrotic syndrome and resistance to standard treatment. This patient had a positive dynamics of clinical-laboratory-instrumental indicators and an improvement in the quality of life against the background of taking rituximab.
{"title":"A clinical case of primary membranous glomerulonephritis with nephrotic syndrome and resistance to standard treatment","authors":"L.D. Denova, I. Krasiuk","doi":"10.22141/2307-1257.12.4.2023.431","DOIUrl":"https://doi.org/10.22141/2307-1257.12.4.2023.431","url":null,"abstract":"The incidence of primary membranous glomerulonephritis is 1 case per 100,000 each year (75–80 %), with a male-to-female ratio of 2 : 1. It is the cause of idiopathic nephrotic syndrome in more than 20 % of cases (over 40 % in people aged 60 and older). The problem of membranous glomerulonephritis consists in a difficult differential diagnostic search and frequent cases of resistance to treatment. Resistance to treatment may develop in 10–20 % of patients, resulting in the end-stage renal disease requiring renal replacement therapy (dialysis or kidney transplantation). Our work presents the results of clinical observation of a patient with primary membranous glomerulonephritis, nephrotic syndrome and resistance to standard treatment. This patient had a positive dynamics of clinical-laboratory-instrumental indicators and an improvement in the quality of life against the background of taking rituximab.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":" 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139141098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.404
MD Dmytro D. Ivanov
The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.
{"title":"Organization of the specialized medical care in conditions of limited resources (military status) (on the example of the provision of nephrology aid in Ukraine)","authors":"MD Dmytro D. Ivanov","doi":"10.22141/2307-1257.12.2.2023.404","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.404","url":null,"abstract":"The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"494 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80153125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.407
Ye.K. Lagodych, D. Ivanov, L. Vakulenko, O. Lytvynova
Nephrotic syndrome (NS) is a common glomerular pathology encountered in pediatric practice. The main clinical signs are massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Among all cases of NS, 75 % of children have a histological variant of glomerular lesions in the form of minimal change disease that is sensitive to hormone therapy, but easily leads to relapse and steroid dependence. These children often need to extend the time of taking hormonal drugs or add other immunosuppressants, which can have significant toxicity. Available immunosuppressant treatment options include cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. The use of rituximab is a possible alternative treatment for steroid-dependent nephrotic syndrome in children. However, the efficacy and safety of rituximab in the treatment of childhood steroid-dependent nephrotic syndrome is still controversial. The purpose was to evaluate the efficacy and safety of rituximab treatment in a child with steroid-dependent nephrotic syndrome on the example of a clinical case from our own practice.
{"title":"Clinical case of steroid-dependent nephrotic syndrome in a child","authors":"Ye.K. Lagodych, D. Ivanov, L. Vakulenko, O. Lytvynova","doi":"10.22141/2307-1257.12.2.2023.407","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.407","url":null,"abstract":"Nephrotic syndrome (NS) is a common glomerular pathology encountered in pediatric practice. The main clinical signs are massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Among all cases of NS, 75 % of children have a histological variant of glomerular lesions in the form of minimal change disease that is sensitive to hormone therapy, but easily leads to relapse and steroid dependence. These children often need to extend the time of taking hormonal drugs or add other immunosuppressants, which can have significant toxicity. Available immunosuppressant treatment options include cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. The use of rituximab is a possible alternative treatment for steroid-dependent nephrotic syndrome in children. However, the efficacy and safety of rituximab in the treatment of childhood steroid-dependent nephrotic syndrome is still controversial. The purpose was to evaluate the efficacy and safety of rituximab treatment in a child with steroid-dependent nephrotic syndrome on the example of a clinical case from our own practice.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85825820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.403
L.D. Denova, D. Ivanov
Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small neg
背景。本研究旨在探讨透析前慢性肾病(CKD)患者尿尿调节素(uUmod)排泄、自主神经系统反应性和肾血液循环受损，以及抗氧化治疗对这些参数的影响。材料和方法。91例1-5期CKD患者参加了ROLUNT (UROmoduLin UbiquinoNe GlutaThione)研究，平均年龄为47.00±12.12岁。将30例(32.97%)男性和61例(67.03%)女性分为年龄和性别构成具有代表性的两组:第一组(n = 46) - CKD分期1 - 5期患者，Charlson合并症指数≤2;第二组(n = 45) - CKD分期1 - 5期患者，Charlson合并症指数≥3。第一组和第二组分为A亚组和B亚组。A亚组包括有植物状态受损的患者，B亚组为无植物状态受损的患者。1A和2B亚组每日两次随食物服用谷胱甘肽100 mg，连续服用3个月;1B和2A亚组给予泛醌100 mg，每日1次，随食物一起服用，连续3个月。在CKD e1 - 5期患者中，评估umod、白蛋白与肌酐比值(ACR)、肾小球滤过率(GFR)。对91例CKD分期1 - 5期患者进行肾脏超声双彩色扫描，并测定其抵抗指数(IR)。结果。配对T检验结果显示，除1A亚组血红蛋白(Hb) (T = -1.5863[-2.0739, 2.0739] 95%置信区间(CI) [-2.4077, 0.3207]， p = 0.127)外，研究开始和结束时各项指标均有显著差异;1B亚组:Hb (T = -0.382 [-2.0739, 2.0739]， 95% CI [-1.3977, 0.963]， p = 0.706);ACR (T = -1.5899[-2.0739, 2.0739], 95%可信区间[-16.7323,2.2105],p = 0.126);收缩压(SBP) (T = -0.5625 [-2.0739, 2.0739]， 95% CI [-2.2414, 1.2849]， p = 0.579);舒张压(DBP) (T = -1.7936 [-2.0739, 2.0739]， 95% CI [-2.3437, 0.1698]， p = 0.087);Chernov问卷(T = 1.5071 [-2.0739, 2.0739]， 95% CI [-0.6083, 3.8431]， p = 0.146);Kérdö指数(T = 0.9392 [-2.0739, 2.0739]， 95% CI [-1.1083, 2.9431]， p = 0.358);2A亚组:ACR (T = -2.0147 [-2.0796, 2.0796]， 95% CI [-39.1946, 0.6219]， p = 0.057);2B亚组:ACR (T = -1.3328 [-2.0739, 2.0739]， 95% CI [-17.4695, 3.7999]， p = 0.196)。Pearson相关结果显示，在1A亚组中，uUmod与eGFR存在显著的平均正相关(r(21) = 0.418, p = 0.047);uUmod指标与年龄呈极微小负相关(r(21) = 0.438, p = 0.037);在1B亚组中，uUmod与Hb指标呈显著正相关(r(21) = 0.513, p = 0.012);uUmod与Morisky用药依从性量表-8 (MMAS-8)指标呈显著正相关(r(21) = 0.515, p = 0.012);uudmod与ACR指标呈极微小负相关(r(21) = 0.441, p = 0.035);在2A亚组中，uUmod指标与Kérdö指数呈极微小的显著负相关(r(20) = 0.427, p = 0.048);在2B亚组中，uUmod指标与Chernov问卷得分呈极微小的负相关(r(21) = 0.421, p = 0.045);uUmod指标与Charlson共病指数呈极微小负相关(r(21) = 0.481, p = 0.020);uudmod与年龄呈极微小负相关(r(21) = 0.471, p = 0.023)。在研究结束时的1A亚组中，以下自变量作为uUmod的预测因子不显著:IRd、IRs、收缩压、舒张压、Hb、ACR、年龄、静脉和Chernov问卷评分、MMAS-8、Charlson合并症指数和Kérdö指数。在研究结束时的1B亚组中，以下自变量作为uUmod的预测因子不显著:eGFR、IRs、收缩压、舒张压、Hb、静脉和Chernov问卷评分、MMAS-8、Charlson合并症指数和Kérdö指数。在研究结束时的2A亚组中，以下自变量作为uUmod的预测因子不显著:eGFR、IRd、IRs、收缩压、舒张压、Hb、ACR、年龄、静脉问卷评分、MMAS-8、Charlson合并症指数。在研究结束时的2B亚组中，以下自变量作为uUmod的预测因子不显著:eGFR、IRd、IRs、SBP、DBP、Hb、ACR、年龄、静脉问卷评分、-MMAS-8、Kérdö指数。结论。谷胱甘肽和泛素抗氧化治疗显著影响CKD患者的检查参数。考虑抗氧化剂治疗的安全性和有效性,我们建议包括抗氧化治疗CKD患者治疗方案。建议进一步研究以建立标准方案。
{"title":"Evaluation of the index of resistance and excretion of uromodulin in patients with predialysis chronic kidney disease, taking into account the index of comorbidity","authors":"L.D. Denova, D. Ivanov","doi":"10.22141/2307-1257.12.2.2023.403","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.403","url":null,"abstract":"Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small neg","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89611561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.405
I.I. Melnyk
A vegetarian diet as a common dietary pattern in the real world is an attractive target for study. Previous studies from different years have shown that a vegetarian diet is associated with a reduced risk of chronic kidney disease progression and a reduction in the annual percentage of physiological loss of glomerular filtration rate. An interesting topic to discuss is vegetarian patients with kidney diseases, in whom we need to monitor kidney function with estimated glomerular filtration rate. In connection with their diet, it is necessary to remember that glomerular filtration rate and blood creatinine level will be low compared to those who consume a larger amount of animal proteins. This is a feature of metabolism and it is related to the way of eating. Monitoring of kidney function in such patients requires reliable diagnostic markers. Here you need to know the nephrological subtleties of excretion of creatinine, urea, uric acid and cystatin C, take into account individual characteristics and use scientific justifications. In order not to miss the progression of kidney disease in vegetarian patients, it is necessary to make a comprehensive assessment of blood parameters: creatinine, urea and uric acid. An alternative to these markers is the possibility of using and prescribing cystatin C to evaluate estimated glomerular filtration rate. Cystatin C would be a more reliable marker than creatinine alone. It will be at the discretion of the nephrologist depending on the situation to decide and use one of the diagnostic options for vegetarian patients.
{"title":"Plant food in а diet, vegetarianism and kidney function","authors":"I.I. Melnyk","doi":"10.22141/2307-1257.12.2.2023.405","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.405","url":null,"abstract":"A vegetarian diet as a common dietary pattern in the real world is an attractive target for study. Previous studies from different years have shown that a vegetarian diet is associated with a reduced risk of chronic kidney disease progression and a reduction in the annual percentage of physiological loss of glomerular filtration rate. An interesting topic to discuss is vegetarian patients with kidney diseases, in whom we need to monitor kidney function with estimated glomerular filtration rate. In connection with their diet, it is necessary to remember that glomerular filtration rate and blood creatinine level will be low compared to those who consume a larger amount of animal proteins. This is a feature of metabolism and it is related to the way of eating. Monitoring of kidney function in such patients requires reliable diagnostic markers. Here you need to know the nephrological subtleties of excretion of creatinine, urea, uric acid and cystatin C, take into account individual characteristics and use scientific justifications. In order not to miss the progression of kidney disease in vegetarian patients, it is necessary to make a comprehensive assessment of blood parameters: creatinine, urea and uric acid. An alternative to these markers is the possibility of using and prescribing cystatin C to evaluate estimated glomerular filtration rate. Cystatin C would be a more reliable marker than creatinine alone. It will be at the discretion of the nephrologist depending on the situation to decide and use one of the diagnostic options for vegetarian patients.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73363111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.406
O. Sharapov, S. Abdullaev
Membranous nephropathy (MN) is an autoimmune disease of the kidney glomeruli and one of the leading causes of nephrotic syndrome. The disease exhibits heterogenous outcomes with approximately 30 % of cases progressing to end-stage renal disease. The study of MN pathogenesis has steadily advanced owing to the identification of autoantibodies to the phospholipase A2 receptor (PLA2R) in 2009 and thrombospondin domain-containing 7A (THSD7A) on the podocyte surface in 2014. Approximately 50–80 and 3–5 % of primary MN cases are associated with either anti-PLA2R or anti-THSD7A antibodies, respectively. The presence of these autoantibodies is used for MN diagnosis; antibody levels correlate with disease severity and possess significant biomarker values in monitoring disease progression and treatment response.
{"title":"Membranous nephropathy: the current state of the problem","authors":"O. Sharapov, S. Abdullaev","doi":"10.22141/2307-1257.12.2.2023.406","DOIUrl":"https://doi.org/10.22141/2307-1257.12.2.2023.406","url":null,"abstract":"Membranous nephropathy (MN) is an autoimmune disease of the kidney glomeruli and one of the leading causes of nephrotic syndrome. The disease exhibits heterogenous outcomes with approximately 30 % of cases progressing to end-stage renal disease. The study of MN pathogenesis has steadily advanced owing to the identification of autoantibodies to the phospholipase A2 receptor (PLA2R) in 2009 and thrombospondin domain-containing 7A (THSD7A) on the podocyte surface in 2014. Approximately 50–80 and 3–5 % of primary MN cases are associated with either anti-PLA2R or anti-THSD7A antibodies, respectively. The presence of these autoantibodies is used for MN diagnosis; antibody levels correlate with disease severity and possess significant biomarker values in monitoring disease progression and treatment response.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79183393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-11DOI: 10.22141/2307-1257.12.2.2023.402
O. Chub
IgA nephropathy is the most common pattern of primary glomerular diseases worldwide and remains a leading cause of chronic kidney disease and kidney failure. The incidence of IgA nephropathy is 2.5 per 100,000 population per year. Presentation ranges from isolated haematuria to significant proteinuria, acute kidney injury and even chronic kidney disease. The 10-year risk of progression to end stage kidney disease or halving of GFR is 26 %. The basis of management of IgA nephropathy is goal-directed supportive care in the form of rigorous blood pressure control, use of renin-angiotensin system blockers in the maximum tolerated dose, and a focus on life-style modification that includes smoking cessation, weight management, and restriction of sodium intake. However, supportive therapy does not always achieve its goals and cannot affect the autoimmune pathogenesis of the disease, while the role of immunosuppressants and systemic glucocorticoids remains controversial. This review presents an analysis of clinical trials and our own experience regarding the role of steroids and supportive therapy in the treatment of IgA nephropathy.
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Pub Date : 2023-04-07DOI: 10.22141/2307-1257.12.1.2023.396
I.I. Melnyk
For almost 20 years, the issue of hyperuricemia has been studied in nephrology, rheumatology, cardiology, endocrinology, and neurology areas of medicine. In all countries of the world, new aspects of this clinical symptom are being revealed almost simultaneously, some facts are being disproved, and updated practical recommendations are being implemented. The main medical axiom now is that hyperuricemia is a symptom of chronic kidney disease (CKD) of any stage, but the pathogenetic mechanisms of the effect of a high uric acid level on kidney function are not known for sure. It is necessary to correct its level under certain clinical and laboratory criteria in order to reduce the risk of cardiovascular disease and the risk of increased mortality, to influence the course of diabetes and possibly prevent obesity. There are still a lot of questions and unexplained facts. For example, what is the role of hyperuricemia in CKD, what level of uric acid reduction is safe and appropriate? What is the causal relationship between uric acid levels and CKD progression? Is the treatment of asymptomatic hyperuricemia effective for absolutely all patients? Is a differentiated approach to lowering the level of uric acid necessary depending on the stage of CKD? When should one take into account the physiological positive effect of hyperuricemia on kidney and vascular cells and not prescribe urate-lowering therapy? Our observation of two patients, which took place within the randomized patient-oriented study “Development of technology to preserve kidney function in patients with CKD and hyperuricemia”, does not provide direct answers to all these questions, but allows us to assume that hyperuricemia can be compensatory for kidney function, and it will not always be appropriate to actively reduce its level. The article aims to draw attention to the fact that when hyperuricemia causes hyperfiltration to preserve kidney function, lowering its level may be inappropriate for absolutely all patients. And maybe in certain conditions and individual clinical situation, the doctor has the option not to prescribe this type of therapy without negative consequences for kidney function.
{"title":"Hyperurikemia in chronic kidney disease stage 4 — the issue of suitability of urate-lowering therapy","authors":"I.I. Melnyk","doi":"10.22141/2307-1257.12.1.2023.396","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.396","url":null,"abstract":"For almost 20 years, the issue of hyperuricemia has been studied in nephrology, rheumatology, cardiology, endocrinology, and neurology areas of medicine. In all countries of the world, new aspects of this clinical symptom are being revealed almost simultaneously, some facts are being disproved, and updated practical recommendations are being implemented. The main medical axiom now is that hyperuricemia is a symptom of chronic kidney disease (CKD) of any stage, but the pathogenetic mechanisms of the effect of a high uric acid level on kidney function are not known for sure. It is necessary to correct its level under certain clinical and laboratory criteria in order to reduce the risk of cardiovascular disease and the risk of increased mortality, to influence the course of diabetes and possibly prevent obesity. There are still a lot of questions and unexplained facts. For example, what is the role of hyperuricemia in CKD, what level of uric acid reduction is safe and appropriate? What is the causal relationship between uric acid levels and CKD progression? Is the treatment of asymptomatic hyperuricemia effective for absolutely all patients? Is a differentiated approach to lowering the level of uric acid necessary depending on the stage of CKD? When should one take into account the physiological positive effect of hyperuricemia on kidney and vascular cells and not prescribe urate-lowering therapy? Our observation of two patients, which took place within the randomized patient-oriented study “Development of technology to preserve kidney function in patients with CKD and hyperuricemia”, does not provide direct answers to all these questions, but allows us to assume that hyperuricemia can be compensatory for kidney function, and it will not always be appropriate to actively reduce its level. The article aims to draw attention to the fact that when hyperuricemia causes hyperfiltration to preserve kidney function, lowering its level may be inappropriate for absolutely all patients. And maybe in certain conditions and individual clinical situation, the doctor has the option not to prescribe this type of therapy without negative consequences for kidney function.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88679111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-07DOI: 10.22141/2307-1257.12.1.2023.390
I. Zavalna
Background. SARS-CoV-2 infection in patients with chronic kidney disease (CKD) and hypertension degree 1–2 worsens the state of the cardiovascular system and may contribute to cardiovascular events and adverse renal risks. The presence of CKD in combination with hypertension degree 1–2 and its medical correction with renin-angiotensin-aldosterone system (RAAS) inhibitors causes a significant impact on the health of patients infected with SARS-CoV-2. SARS-CoV-2 uses RAAS, namely the receptor for angiotensin-converting enzyme (ACE) 2, as a tool to enter the cell. To choose further approaches and treatment, this combination of three pathological conditions requires careful analysis and research. Objective: to study the functional state of the kidneys in patients with CKD and hypertension infected with SARS-CoV-2. Materials and methods. The article is a fragment of the BIRCOV (ARB, ACE inhibitors, DRi in COVID-19) trial, which was designed according to the POEM (Patient-Oriented Evidence that Matters). The BIRCOV (two-center, open-label, initiative-randomized, in three parallel arms) prospective study enrolled 120 patients with CKD and hypertension degree 1–2, it lasted for 1 year and was registered at ClinicalTrials.gov (NCT03336203). One hundred and twelve outpatients with degree 1–2 hypertension, 83 with combination with CKD, were selected. At the end of the study, 108 patients remained, their results are presented in the article with subsequent statistical processing. Division into groups occurred depending on the drugs received (ACE inhibitors, angiotensin receptor blockers (ARBs) or direct renin inhibitor (DRIs)). Endpoints were: estimated glomerular filtration rate (eGFR), average blood pressure, albuminuria level. In 24 patients, the urine albumin to creatinine ratio was analyzed at the beginning of SARS-CoV-2, then 2, 4, 12, 24 weeks after the onset of the disease. Mathematical processing and statistical evaluation of the research results was done in the medical statistics package. Results. All patients were divided into 3 groups depending on the drug: 35 (32 %) of them received ARBs, 42 (39 %) ACE inhibitors, 31 (29 %) DRIs. At the manifestation of SARS-CoV-2, a decrease in blood pressure was recorded during the first two weeks, with the subsequent return to baseline on week 12 in the group of people who received ACE inhibitors, the lowest indicator was in the DRI group. The use of ACE inhibitors (risk ratio (RR) 1.648, 95% confidence interval (CI) 0.772–3.519, number needed to treat (NNT) 7.0) and ARBs (RR 13.023, 95% CI 1.815–93.426, NNT 19) in the treatment of hypertension significantly increased the risk of withdrawal compared to DRIs. Patients with CKD had similar dynamics of blood pressure during 24 weeks of observation. In CKD, higher mean blood pressure values were obtained compared to other participants of the BIRCOV trial. A simultaneous decrease in eGFR and systolic blood pressure was documented, it was most pronounced in patient
背景。慢性肾脏疾病(CKD)和1-2级高血压患者的SARS-CoV-2感染会恶化心血管系统状态，并可能导致心血管事件和不良肾脏风险。CKD合并高血压1-2度及肾素-血管紧张素-醛固酮系统(RAAS)抑制剂的医学矫正对SARS-CoV-2感染患者的健康有重要影响。SARS-CoV-2利用血管紧张素转换酶(ACE) 2的受体RAAS作为进入细胞的工具。为了选择进一步的方法和治疗，这三种病理条件的结合需要仔细的分析和研究。目的:探讨慢性肾病合并高血压合并SARS-CoV-2感染患者肾脏功能状况。材料和方法。本文是BIRCOV (ARB, ACE inhibitors, DRi in COVID-19)试验的片段，该试验是根据POEM (Patient-Oriented Evidence that Matters)设计的。BIRCOV(双中心，开放标签，主动随机，三个平行组)前瞻性研究纳入了120例CKD和1 - 2级高血压患者，该研究持续1年，并在ClinicalTrials.gov注册(NCT03336203)。选取112例1-2度高血压门诊患者，其中合并CKD患者83例。在研究结束时，108名患者仍然存在，他们的结果在文章中发表，并进行了后续的统计处理。根据接受的药物(ACE抑制剂、血管紧张素受体阻滞剂(ARBs)或直接肾素抑制剂(DRIs))进行分组。终点是:估计肾小球滤过率(eGFR)，平均血压，蛋白尿水平。对24例患者在SARS-CoV-2发病初期、发病后2周、4周、12周、24周的尿白蛋白/肌酐比值进行分析。在医学统计软件包中对研究结果进行数学处理和统计评价。结果。所有患者根据药物分为3组:arb 35例(32%)，ACE抑制剂42例(39%)，DRIs 31例(29%)。在SARS-CoV-2的表现中，在前两周记录了血压的下降，随后在接受ACE抑制剂的人群中，在第12周恢复到基线，最低的指标是DRI组。与DRIs相比，使用ACE抑制剂(风险比(RR) 1.648, 95%可信区间(CI) 0.772-3.519，所需治疗数(NNT) 7.0)和arb (RR 13.023, 95% CI 1.815-93.426, NNT 19)治疗高血压显著增加停药风险。在24周的观察中，CKD患者有相似的血压动态。与BIRCOV试验的其他参与者相比，CKD患者的平均血压值更高。eGFR和收缩压同时下降，在CKD患者中最为明显。服用ACE抑制剂0-24周的患者结果最低，相关系数为0.815。eGFR的降低与CKD的程度相关。在SARS-CoV-2发病后的前4周内，服用ACE抑制剂的28名患者的eGFR下降低于60 ml/min，而使用arb或DRIs的22名患者的eGFR下降低于60 ml/min:绝对风险为0.667 (RR 2.00, 95% CI 1.337-2.92, NNT 3.0)。与所有CKD患者相比，接受ACE抑制剂的患者eGFR降低的相对风险为16.6 (95% CI 5.263-52.360, NNT 1.774)， arb患者为2.049 (95% CI 0.361-11.22, NNT 1.774)， DRIs患者与整个CKD患者相比，eGFR降低的相对风险为1.064 (95% CI 0.116-9.797, NNT 431.6)。随访12周后，CKD 2-3a期患者eGFR几乎恢复到基线水平。在SARS-CoV-2发病后的前12周内，肾功能稳定的CKD患者尿白蛋白/肌酐比值(在发病后24周内未达到基线)升高(2-24周内eGFR平均值无统计学差异)。男性CKD进展为终末期肾脏疾病的风险更高。在SARS-CoV-2患者中，在发病后的第二周，观察到eGFR下降，血尿酸水平相应升高，这与基线值有显著差异。地塞米松的使用伴随着eGFR的降低(Р≤0.05)，并且这些疾病在CKD 3b-4期患者中保存到观察24周(RR 0.686, 95% CI 0.264-1.780, NNT 7.636)。结论。
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