Pub Date : 2023-04-07DOI: 10.22141/2307-1257.12.1.2023.397
No Authors
No abstract
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{"title":"Abstracts of the scientific and practical conference with international participation “Current issues of nephrology, dialysis and transplantation — Kidney day in Ukraine 2023” (March 24–25, 2023, Kyiv, Ukraine)","authors":"No Authors","doi":"10.22141/2307-1257.12.1.2023.397","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.397","url":null,"abstract":"No abstract","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73537183","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: 10.22141/2307-1257.12.1.2023.389
Background. The purpose of this study was to assess the quality of life (QoL) in patients with pre-dialysis chronic kidney disease (CKD), to reveal the factors affecting the QoL in this category of patients and to investigate the effect of antioxidant therapy on the QoL of patients with CKD stages 1–5. Materials and methods. Patients with CKD (n = 61), whose average age was 44.51 ± 11.90 years, were included in the study. Twenty (32.79 %) men and 41 (67.21 %) women were divided into two groups representative in terms of age and gender composition: group 1 (n = 31) — patients with CKD who took glutathione 100 mg 2 times a day with meals for 3 months, group 2 (n = 30) — those with CKD who took ubiquinone 100 mg once daily with meals for 3 months. The QoL was assessed using the SF-36 questionnaire. Patient adherence to treatment was assessed with the Morisky-Green test. To assess the kidney function of patients, the level of urinary uromodulin excretion (uUMOD), urine albumin-to-creatinine ratio (ACR) were determined. The impact of antioxidant therapy on the QoL of these patients was evaluated and the factors affecting QoL were determined. Results. In the structure of CKD, urolithiasis was most common — 22 (36.1 %) patients, 5 (8.2 %) people had chronic pyelonephritis, 18 (29.5 %) — diabetic nephropathy, 4 (6.6 %) — polycystic kidney disease, 6 (9.8 %) — gouty nephropathy, 1 (1.6 %) — chronic glomerulonephritis and 5 (8.2 %) patients presented with hypertensive nephropathy. The duration of CKD in the first group was 5.42 ± 3.88 (1; 15) years, in the second one — 5.57 ± 3.79 (1; 16) years, no significant difference was found between the groups in terms of age and gender (U = 463m, p = 0.9827). In all patients, the indicators at the beginning were lower than those by the end of the study. The lowest indicator in the first group is general health, in the second — vitality. The psychological component of health (PsCH) was lower than the physical component of health (PhCH) in both groups. A significant positive relationship (p < 0.001) was observed, which was most pronounced for glomerular filtration rate (GFR), ACR, systolic blood pressure, hemoglobin. At the end of the study, 12 (19.67 %) patients had 4 points on the Morisky-Green test, which meant high adherence to therapy. There was a reliable strong positive relationship between the QoL and GFR, ACR, uUMOD. At the beginning of treatment, a significant average positive relationship was found between the QoL (PhCH) and uUMOD: r (59) = 0.372, p = 0.003; between the QoL (PhCH) and GFR, there is a significant positive relationship: r (59) = 0.707, p < 0.001. There is a very insignificant positive relationship between the QoL (PsCH) and patients’ adherence to treatment, r (59) = 0.0882, p = 0.499. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly improves the QoL of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antio
{"title":"Quality of life of patients with pre-dialysis chronic kidney disease, its relationship with oxidant stress and uromodulin excretion","authors":"","doi":"10.22141/2307-1257.12.1.2023.389","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.389","url":null,"abstract":"Background. The purpose of this study was to assess the quality of life (QoL) in patients with pre-dialysis chronic kidney disease (CKD), to reveal the factors affecting the QoL in this category of patients and to investigate the effect of antioxidant therapy on the QoL of patients with CKD stages 1–5. Materials and methods. Patients with CKD (n = 61), whose average age was 44.51 ± 11.90 years, were included in the study. Twenty (32.79 %) men and 41 (67.21 %) women were divided into two groups representative in terms of age and gender composition: group 1 (n = 31) — patients with CKD who took glutathione 100 mg 2 times a day with meals for 3 months, group 2 (n = 30) — those with CKD who took ubiquinone 100 mg once daily with meals for 3 months. The QoL was assessed using the SF-36 questionnaire. Patient adherence to treatment was assessed with the Morisky-Green test. To assess the kidney function of patients, the level of urinary uromodulin excretion (uUMOD), urine albumin-to-creatinine ratio (ACR) were determined. The impact of antioxidant therapy on the QoL of these patients was evaluated and the factors affecting QoL were determined. Results. In the structure of CKD, urolithiasis was most common — 22 (36.1 %) patients, 5 (8.2 %) people had chronic pyelonephritis, 18 (29.5 %) — diabetic nephropathy, 4 (6.6 %) — polycystic kidney disease, 6 (9.8 %) — gouty nephropathy, 1 (1.6 %) — chronic glomerulonephritis and 5 (8.2 %) patients presented with hypertensive nephropathy. The duration of CKD in the first group was 5.42 ± 3.88 (1; 15) years, in the second one — 5.57 ± 3.79 (1; 16) years, no significant difference was found between the groups in terms of age and gender (U = 463m, p = 0.9827). In all patients, the indicators at the beginning were lower than those by the end of the study. The lowest indicator in the first group is general health, in the second — vitality. The psychological component of health (PsCH) was lower than the physical component of health (PhCH) in both groups. A significant positive relationship (p < 0.001) was observed, which was most pronounced for glomerular filtration rate (GFR), ACR, systolic blood pressure, hemoglobin. At the end of the study, 12 (19.67 %) patients had 4 points on the Morisky-Green test, which meant high adherence to therapy. There was a reliable strong positive relationship between the QoL and GFR, ACR, uUMOD. At the beginning of treatment, a significant average positive relationship was found between the QoL (PhCH) and uUMOD: r (59) = 0.372, p = 0.003; between the QoL (PhCH) and GFR, there is a significant positive relationship: r (59) = 0.707, p < 0.001. There is a very insignificant positive relationship between the QoL (PsCH) and patients’ adherence to treatment, r (59) = 0.0882, p = 0.499. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly improves the QoL of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antio","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83794964","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: 10.22141/2307-1257.12.1.2023.391
V. Bezruk, D. Ivanov, I. Shkrobanets
Background. Urinary tract infection (UTI) is an urgent problem in nephrology. The current state of antibiotic resistance to antimicrobial drugs complicates the empirical choice of antibacterial therapy, and indications for the use of antimicrobial drugs are not always clinically justified. The purpose of the study: to compare the antibiotic resistance of the main groups of UTI pathogens during coronavirus 2019 (COVID-19) pandemic in 2020–2022 with the results of 2014–2016 monitoring among children of the Chernivtsi region. Materials and methods. Urine samples were collected from 657 children (0–17 years old) who received specialized medical care in health care institutions of the Chernivtsi region (2014–2016). During 2020–2022, a clinical and laboratory examination of 180 children (0–17 years old) was conducted. Results. The results of the monitoring proved the wave-like nature of changes in antibiotic resistance to semi-synthetic penicillins and cephalosporins with the maintenance of a sufficient level of sensitivity to these antimicrobial drugs among the main groups of UTI pathogens; the data obtained give reason to suggest a negative trend to increasing resistance to fluoroquinolones, tetracyclines over time (2020–2022 — the period of the COVID-19 pandemic); a multidirectional and time-dependent differences were revealed in sensitivity to aminoglycosides: gentamicin, amikacin and kanamycin in children of Chernivtsi region, as well as a negative trend to increasing the share of carbapenem-resistant strains of uropathogens — 55.8 ± 5.1 % (imipenem — χ2 = 5.432; p = 0.020). Conclusions. The monitoring results indicate the need to comply with standards in the provision of medical care (prescribing antibacterial therapy taking into account the data of regional monitoring on antibiotic resistance to antimicrobial drugs), administration of antimicrobial drugs in health care institutions that provide medical care in outpatient and inpatient settings. High level of antibiotic resistance of UTI uropathogens to carbapenems (2020–2022), used for the treatment of severe bacterial infections, requires their exclusively targeted prescription in everyday pediatric practice.
{"title":"Monitoring and features of antibiotic resistance during the COVID-19 pandemic","authors":"V. Bezruk, D. Ivanov, I. Shkrobanets","doi":"10.22141/2307-1257.12.1.2023.391","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.391","url":null,"abstract":"Background. Urinary tract infection (UTI) is an urgent problem in nephrology. The current state of antibiotic resistance to antimicrobial drugs complicates the empirical choice of antibacterial therapy, and indications for the use of antimicrobial drugs are not always clinically justified. The purpose of the study: to compare the antibiotic resistance of the main groups of UTI pathogens during coronavirus 2019 (COVID-19) pandemic in 2020–2022 with the results of 2014–2016 monitoring among children of the Chernivtsi region. Materials and methods. Urine samples were collected from 657 children (0–17 years old) who received specialized medical care in health care institutions of the Chernivtsi region (2014–2016). During 2020–2022, a clinical and laboratory examination of 180 children (0–17 years old) was conducted. Results. The results of the monitoring proved the wave-like nature of changes in antibiotic resistance to semi-synthetic penicillins and cephalosporins with the maintenance of a sufficient level of sensitivity to these antimicrobial drugs among the main groups of UTI pathogens; the data obtained give reason to suggest a negative trend to increasing resistance to fluoroquinolones, tetracyclines over time (2020–2022 — the period of the COVID-19 pandemic); a multidirectional and time-dependent differences were revealed in sensitivity to aminoglycosides: gentamicin, amikacin and kanamycin in children of Chernivtsi region, as well as a negative trend to increasing the share of carbapenem-resistant strains of uropathogens — 55.8 ± 5.1 % (imipenem — χ2 = 5.432; p = 0.020). Conclusions. The monitoring results indicate the need to comply with standards in the provision of medical care (prescribing antibacterial therapy taking into account the data of regional monitoring on antibiotic resistance to antimicrobial drugs), administration of antimicrobial drugs in health care institutions that provide medical care in outpatient and inpatient settings. High level of antibiotic resistance of UTI uropathogens to carbapenems (2020–2022), used for the treatment of severe bacterial infections, requires their exclusively targeted prescription in everyday pediatric practice.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90678642","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: 10.22141/2307-1257.12.1.2023.393
T. Gruzieva, O. Antonyuk
Global aging has accompanied the worldwide increase in average life expectancy over the past century. The coronavirus disease (COVID-19) pandemic has increased morbidity among all groups of the population, but it poses a particular threat to people of older age groups. Multiple concomitant pathologies form an unfavorable background for the course of COVID-19. It was found that the level of in-hospital mortality in the care of older age groups was high, including in countries with high-income levels and expenditures on health care. We have identified predictors of the severe course of COVID-19. In our opinion, such predictors should be considered when identifying risk groups and applying anticipatory strategies to them, in particular, timely hospitalization, the administration of antiviral therapy, and treatment of concomitant pathology (chronic kidney disease, hypertension, diabetes mellitus, etc.). The question of testing elderly patients for the presence of SARS-CoV-2 is especially relevant when weakness increases, the state of consciousness worsens, and/or dyspnea appears or worsens. Postponement of hospitalization can negatively affect the results of treatment. Thus, interleukin-6, C-reactive protein, the absolute level of lymphocytes, albumin, and ferritin can be used when evaluating the criteria for hospitalization in this group of patients. Interleukin-6 and C-reactive protein are positively associated with body mass index. The excess of adipose tissue is considered an independent predictor of severe COVID-19 and, unlike age, can be modified. We suggested that a hospital mortality risk calculator based on the personalized lethality risk index on admission should be used in practice. Adequate therapy of concomitant pathology is also important in the prevention of COVID-19 complications. Protection of susceptible groups at high risk of severe COVID-19 has strategic importance in preventing high mortality rates in population regardless of age.
{"title":"Analysis of risk factors for severe COVID-19","authors":"T. Gruzieva, O. Antonyuk","doi":"10.22141/2307-1257.12.1.2023.393","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.393","url":null,"abstract":"Global aging has accompanied the worldwide increase in average life expectancy over the past century. The coronavirus disease (COVID-19) pandemic has increased morbidity among all groups of the population, but it poses a particular threat to people of older age groups. Multiple concomitant pathologies form an unfavorable background for the course of COVID-19. It was found that the level of in-hospital mortality in the care of older age groups was high, including in countries with high-income levels and expenditures on health care. We have identified predictors of the severe course of COVID-19. In our opinion, such predictors should be considered when identifying risk groups and applying anticipatory strategies to them, in particular, timely hospitalization, the administration of antiviral therapy, and treatment of concomitant pathology (chronic kidney disease, hypertension, diabetes mellitus, etc.). The question of testing elderly patients for the presence of SARS-CoV-2 is especially relevant when weakness increases, the state of consciousness worsens, and/or dyspnea appears or worsens. Postponement of hospitalization can negatively affect the results of treatment. Thus, interleukin-6, C-reactive protein, the absolute level of lymphocytes, albumin, and ferritin can be used when evaluating the criteria for hospitalization in this group of patients. Interleukin-6 and C-reactive protein are positively associated with body mass index. The excess of adipose tissue is considered an independent predictor of severe COVID-19 and, unlike age, can be modified. We suggested that a hospital mortality risk calculator based on the personalized lethality risk index on admission should be used in practice. Adequate therapy of concomitant pathology is also important in the prevention of COVID-19 complications. Protection of susceptible groups at high risk of severe COVID-19 has strategic importance in preventing high mortality rates in population regardless of age.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"256 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77672794","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: 10.22141/2307-1257.12.1.2023.394
S. Resetniak
Background. Currently, kidney cancer is considered one of the most common oncological pathologies, accounting for 2–3 % of all cancers. In 2018, the total number of primary renal cell carcinoma patients in Ukraine was 4,805 cases, with 1,878 patients dying from this disease. Surgical treatment is the only way for 68 % of patients with localized kidney cancer. The main question remains unanswered — an effective surgical treatment of patients with localized renal cell carcinoma. Our aim was to study the kidney function parameters in localized kidney cancer after retroperitoneoscopic resection with preoperative selective embolization compared to standard kidney resection using thermal ischemia. Materials and methods. Data of 65 patients with localized kidney cancer who underwent nephron-sparing surgery were analyzed. They were divided into two groups. The first one included 40 people with localized kidney cancer who underwent standard organ-sparing surgery with duration of thermal ischemia of less than 20 minutes. The second group consisted of 25 patients with localized kidney cancer who underwent computed tomography with renal vessels reconstruction in the preoperative stage. Branch of the renal artery that feeds the area of the kidney with the tumor was identified. As a next step, selective embolization was performed. Retroperitoneoscopic resection was carried out the next day with fluorescence imaging in the infrared light using indocyanine green. Results. Analysis of the data shows that renal function after surgery for local cancer in case of retroperitoneoscopic resection with preoperative selective embolization of renal vessels is more functionally suitable compared to kidney resection using thermal ischemia. Conclusions. Our data suggest that superselective X-ray vascular embolization and intraoperative indocyanine green fluorescence in the surgical treatment of localized kidney cancer has significant advantages over the standard method of surgical treatment.
{"title":"Retroperitoneoscopic resection with preoperative selective embolization and indocyanine green fluorescence visualization of vessels in kidney cancer","authors":"S. Resetniak","doi":"10.22141/2307-1257.12.1.2023.394","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.394","url":null,"abstract":"Background. Currently, kidney cancer is considered one of the most common oncological pathologies, accounting for 2–3 % of all cancers. In 2018, the total number of primary renal cell carcinoma patients in Ukraine was 4,805 cases, with 1,878 patients dying from this disease. Surgical treatment is the only way for 68 % of patients with localized kidney cancer. The main question remains unanswered — an effective surgical treatment of patients with localized renal cell carcinoma. Our aim was to study the kidney function parameters in localized kidney cancer after retroperitoneoscopic resection with preoperative selective embolization compared to standard kidney resection using thermal ischemia. Materials and methods. Data of 65 patients with localized kidney cancer who underwent nephron-sparing surgery were analyzed. They were divided into two groups. The first one included 40 people with localized kidney cancer who underwent standard organ-sparing surgery with duration of thermal ischemia of less than 20 minutes. The second group consisted of 25 patients with localized kidney cancer who underwent computed tomography with renal vessels reconstruction in the preoperative stage. Branch of the renal artery that feeds the area of the kidney with the tumor was identified. As a next step, selective embolization was performed. Retroperitoneoscopic resection was carried out the next day with fluorescence imaging in the infrared light using indocyanine green. Results. Analysis of the data shows that renal function after surgery for local cancer in case of retroperitoneoscopic resection with preoperative selective embolization of renal vessels is more functionally suitable compared to kidney resection using thermal ischemia. Conclusions. Our data suggest that superselective X-ray vascular embolization and intraoperative indocyanine green fluorescence in the surgical treatment of localized kidney cancer has significant advantages over the standard method of surgical treatment.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86562021","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: 10.22141/2307-1257.12.1.2023.392
Ye.K. Lagodych
Materials and methods. The article presents the data on the analysis of case histories in 16 children with glomerulopathies who received treatment with rituximab in accordance with the diagnoses. Age of patients was 5 to 18 years, distribution by sex — 5 boys (31.3 %), 11 girls (68.8 %). Twelve children (75 %) received rituximab for frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and 4 (25 %) children for lupus nephritis. Results. In some cases, rituximab was prescribed against the background of glucocorticoids per os. Rituximab therapy followed a protocol with pre-administration of 1 mg/kg methylprednisolone or 100 mg hydrocortisone, followed by 15 mg/kg rituximab at a rate of approximately 50 ml/h using an infusion pump, which had previously been diluted with saline 1 mg/ml, with constant monitoring of the child’s condition. Rituximab was administered at least twice, two weeks apart. If necessary, after monitoring the level of CD20 in the blood serum, and in the presence of any number of cells or the preservation of the activity of the process, rituximab was administered again 6 months after the last injection. During treatment with rituximab, children who received glucocorticoids per os did not receive them, and the next day after the infusion they continued to receive them at the same dose. Nine children received concomitant therapy per os with an angiotensin-converting enzyme inhibitor at a renoprotective dose, which was not canceled on the days of rituximab infusion. During the administration of rituximab, two children reported adverse reactions in the form of a decreased blood pressure and tachycardia, which most likely occurred against the background of an increased rate of administration, and after stopping the infusion and a subsequent decrease in its rate, they disappeared. All other children tolerated rituximab well. The effectiveness of rituximab therapy was evaluated by the level of proteinuria, which at the baseline averaged 4.0 g/l, and after rituximab infusion, it averaged 0.5 g/l. Conclusions. Today, in the conditions of martial law in Ukraine and limited resources, the use of rituximab opens new opportunities in the treatment of nephrological pathology in children, acting as an alternative to the long-term use of glucocorticoids, simplifying treatment and reducing the number of side effects, especially in children with FRNS/SDNS and pathology-mediated AT (lupus nephritis). However, it is important to adhere to the protocol for rituximab administration and especially the rate of administration due to frequent adverse infusion reactions.
{"title":"Use of rituximab in pediatric nephrology practice","authors":"Ye.K. Lagodych","doi":"10.22141/2307-1257.12.1.2023.392","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.392","url":null,"abstract":"Materials and methods. The article presents the data on the analysis of case histories in 16 children with glomerulopathies who received treatment with rituximab in accordance with the diagnoses. Age of patients was 5 to 18 years, distribution by sex — 5 boys (31.3 %), 11 girls (68.8 %). Twelve children (75 %) received rituximab for frequently relapsing/steroid-dependent nephrotic syndrome (FRNS/SDNS) and 4 (25 %) children for lupus nephritis. Results. In some cases, rituximab was prescribed against the background of glucocorticoids per os. Rituximab therapy followed a protocol with pre-administration of 1 mg/kg methylprednisolone or 100 mg hydrocortisone, followed by 15 mg/kg rituximab at a rate of approximately 50 ml/h using an infusion pump, which had previously been diluted with saline 1 mg/ml, with constant monitoring of the child’s condition. Rituximab was administered at least twice, two weeks apart. If necessary, after monitoring the level of CD20 in the blood serum, and in the presence of any number of cells or the preservation of the activity of the process, rituximab was administered again 6 months after the last injection. During treatment with rituximab, children who received glucocorticoids per os did not receive them, and the next day after the infusion they continued to receive them at the same dose. Nine children received concomitant therapy per os with an angiotensin-converting enzyme inhibitor at a renoprotective dose, which was not canceled on the days of rituximab infusion. During the administration of rituximab, two children reported adverse reactions in the form of a decreased blood pressure and tachycardia, which most likely occurred against the background of an increased rate of administration, and after stopping the infusion and a subsequent decrease in its rate, they disappeared. All other children tolerated rituximab well. The effectiveness of rituximab therapy was evaluated by the level of proteinuria, which at the baseline averaged 4.0 g/l, and after rituximab infusion, it averaged 0.5 g/l. Conclusions. Today, in the conditions of martial law in Ukraine and limited resources, the use of rituximab opens new opportunities in the treatment of nephrological pathology in children, acting as an alternative to the long-term use of glucocorticoids, simplifying treatment and reducing the number of side effects, especially in children with FRNS/SDNS and pathology-mediated AT (lupus nephritis). However, it is important to adhere to the protocol for rituximab administration and especially the rate of administration due to frequent adverse infusion reactions.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74584694","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: 10.22141/2307-1257.12.1.2023.395
V. Demchenko, M. Myroshnychenko, M.M. Tsymbal, V.L. Lysachenko, O. Dyadyk, M. Zhelieznikova
COVID-19 against the background of the respiratory system damage often causes changes in the morpho-functional state of the kidneys, accelerates the progression and development of complications of chronic kidney disease, and is the cause of a high mortality rate in kidney transplant recipients. In the article, the authors conduct a detailed clinical and morphological analysis of a fatal case report of acute kidney transplant rejection of antibody-mediated and cell-mediated genesis, the development of which was determined by the presence of COVID-19 in the patient. The authors emphasize that the morphological study is crucial for the diagnosis of renal transplant rejection. This clinical and morphological analysis of a case report shows the need for an individual approach to this category of patients for the purpose of timely diagnosis, treatment and prevention of COVID-19.
{"title":"COVID-19 as a cause of acute kidney transplant rejection: clinical and morphological analysis of a fatal case report","authors":"V. Demchenko, M. Myroshnychenko, M.M. Tsymbal, V.L. Lysachenko, O. Dyadyk, M. Zhelieznikova","doi":"10.22141/2307-1257.12.1.2023.395","DOIUrl":"https://doi.org/10.22141/2307-1257.12.1.2023.395","url":null,"abstract":"COVID-19 against the background of the respiratory system damage often causes changes in the morpho-functional state of the kidneys, accelerates the progression and development of complications of chronic kidney disease, and is the cause of a high mortality rate in kidney transplant recipients. In the article, the authors conduct a detailed clinical and morphological analysis of a fatal case report of acute kidney transplant rejection of antibody-mediated and cell-mediated genesis, the development of which was determined by the presence of COVID-19 in the patient. The authors emphasize that the morphological study is crucial for the diagnosis of renal transplant rejection. This clinical and morphological analysis of a case report shows the need for an individual approach to this category of patients for the purpose of timely diagnosis, treatment and prevention of COVID-19.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90884886","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 : 2023-01-20DOI: 10.22141/2307-1257.11.4.2022.382
L.D. Denova
Chronic kidney disease has a major impact on global health, causing both morbidity and mortality worldwide. Bioethics (from Greek: βιοσ — life, ετηοσ — custom) is a science that analyzes and studies the morality of human actions in the field of health care and in the biological and medical fields in accordance with its moral standards and values. The modern concept of bioethics is closely intertwined with the concepts of deontology, doctor’s code of ethics in the medical practice of a nephrologist. In the medical practice, there is a tendency to spread of absolutization of drug therapy, fetishization of laboratory, instrumental, hardware research methods, medical aggression. The patient’s contact with the doctor should begin with a conversation. On the part of the doctor, such a conversation should be based on the principles of empathy. The doctor must be able to dispel passivity and depression of patients, to strengthen social contact, and expand the space of their intellectual interests. The behavior of the doctor, who demonstrates a lack of understanding of the patient’s problems and does not consider psychosocial relationships, often causes mistrust and even becomes the cause of a conflict between the doctor and the patient. Issues of medical ethics in case of the need for kidney replacement therapy remain difficult. The offer of peritoneal dialysis, hemodialysis can be perceived positively from the first word, or it can be categorically negative, depending on the character and emotional state of the patient. The purpose of our article is to consider the peculiarities of the implementation of bioethical principles in the treatment and rehabilitation of patients with chronic kidney disease. The object of the work was the articles of philosophers, doctors, and lawyers who studied ethical relations in the medical environment in general and nephrology in particular. The subject of the study was the ethical norms and rules fixed in the documents. The article uses methods of historical approach, research of historical documents.
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Pub Date : 2023-01-20DOI: 10.22141/2307-1257.11.4.2022.384
L. Khimion, I. Nayshtetik, O. Burianov, S. Rotova, S.I. Smyian, H.M. Lapshyna, S. Danyliuk, T. Sytiuk, N. Kicha, T.O. Lebedeva, V. V. Trofanchuk
Background. Clinical studies of urate-lowering therapy (ULT) use in multimorbid patients, including those with chronic kidney disease (CKD), are important in modern medical science. The purpose was to determine the efficacy and safety of ULT in patients with hyperuricemia and comorbid conditions, including people with chronic kidney disease, in real clinical practice. Materials and methods. This prospective comparative clinical study “Liquestia: comparative efficacy and safety in gouty arthritis patients with comorbid diseases and in patients with hyperuricemia and chronic kidney disease” was conducted in real clinical practice with the involvement of 124 patients with hyperuricemia, who were prescribed either febuxostat (Liquestia, JSC “Farmak”/Adenuric, Berlin Chemie) or allopurinol as ULT. Results. Individuals who received febuxostat significantly more often and faster reached the target levels of uric acid compared to patients who underwent treatment by allopurinol, regardless of glomerular filtration rate (GFR), except those from dialysis subgroup, and the presence of comorbidities. Patients in febuxostat subgroups during the study showed an increase in GFR after 6 months of treatment — at the level of the trend in the group with baseline GFR ≥ 60 ml/min and at a statistically significant level — in CKD stage 3–4, which could be the evidence of renoprotective effect of febuxostat with reduced GFR, while people receiving allopurinol tended to further decrease of GFR in 31.8 % of cases. Conclusions. The use of Liquestia for the treatment of patients with hyperuricemia and various comorbid conditions is no less effective than the use of Adenuric and more effective than allopurinol and helps achieve the target levels of uric acid in 90 % of cases within 6 months of treatment, which accompanied by a statistically significant increase in GFR in patients with CKD stage 3–4.
背景。在包括慢性肾脏疾病(CKD)在内的多病患者中应用降尿酸疗法(ULT)的临床研究在现代医学中具有重要意义。目的是在实际临床实践中确定ULT对高尿酸血症和合并症患者(包括慢性肾脏疾病患者)的疗效和安全性。材料和方法。这项前瞻性临床比较研究“Liquestia:对伴有合并症的痛风性关节炎患者以及高尿酸血症和慢性肾病患者的比较疗效和安全性”是在真实的临床实践中进行的，涉及124名高尿酸血症患者，这些患者服用非布司他(Liquestia, JSC“Farmak”/Adenuric, Berlin Chemie)或别嘌呤醇作为ULT。结果。与接受别嘌呤醇治疗的患者相比，接受非布司他治疗的患者明显更频繁、更快地达到尿酸目标水平，无论肾小球滤过率(GFR)如何(透析亚组除外)，以及是否存在合并症。研究期间，非布司他亚组患者在治疗6个月后GFR增加，与基线GFR≥60 ml/min组的趋势水平一致，在CKD 3-4期具有统计学意义，这可能是非布司他降低GFR的肾保护作用的证据，而接受别嘌呤醇治疗的患者在31.8%的病例中GFR有进一步下降的趋势。结论。使用Liquestia治疗高尿酸血症和各种合并症患者的效果不低于使用腺嘌呤，比别嘌呤醇更有效，并帮助90%的病例在治疗6个月内达到尿酸的目标水平，同时伴有CKD 3-4期患者GFR的统计学显著增加。
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