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Clinical case of hydronephrotic form of multicystic dysplastic kidney complicated by pyelonephritis in adults 成人多囊性发育不良肾积水并发肾盂肾炎1例
Pub Date : 2022-07-13 DOI: 10.22141/2307-1257.11.2.2022.369
O. Chub, S.O. Reshetniak, Y. Dumanskiy, A. Maltsev
Multicystic dysplastic kidney (MCDK) is a renal dysplasia characterized by the presence of multiple cysts that are non-communicating, varying in size, separated by dysplastic parenchyma that consume the renal cortex resulting in a non-functional kidney with the absence of a normal pelvocaliceal system. The incidence of MCDK is approximately 1 : 4300 of live births, with males being affected more often than females. Many concurrent urinary tract abnormalities have been described in patients with MCDK. The most common and potentially significant urologic defect seen is vesico-ureteral reflux to the contralateral kidney. In our clinical case, multicystic dysplastic kidney complicated by hydronephrotic transformation and septic obstructive pyelonephritis, which deve­loped on the base of undiagnosed vasorenal conflict.
多囊性发育不良肾(MCDK)是一种肾脏发育不良,其特征是存在多个囊肿,这些囊肿不相通,大小不一,由消耗肾皮质的发育不良实质隔开,导致肾脏功能不全,缺乏正常的盆腔系统。MCDK的发病率约为活产的1∶4300,男性比女性更容易受到影响。许多并发尿路异常已被描述为MCDK患者。最常见和潜在重要的泌尿系统缺陷是膀胱输尿管反流到对侧肾脏。在我们的临床病例中,多囊肾发育不良并发肾积水转化和脓毒性梗阻性肾盂肾炎,这是在未确诊的血管肾冲突的基础上发展起来的。
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引用次数: 0
The value of proteomic studies of the latest markers of kidney damage in the urine to assess the course, progression and complications in patients with CKD 尿中最新肾脏损害标志物的蛋白质组学研究对评估CKD患者的病程、进展和并发症的价值
Pub Date : 2022-07-13 DOI: 10.22141/2307-1257.11.2.2022.363
Запрошені статті
Сhronic kidney Disease (CKD) is the cause of both morbidity and mortality worldwide. In Ukraine, 12 % of the population is diagnosed with CKD. Significantly worsen the quality of life in patients with CKD progression of renal fibrosis and impaired mineral homeostasis. Early diagnosis and treatment are the main measures to prevent CKD progression and delay adverse effects. Deficiency of early, non-invasive biomarkers adversely affects the ability to rapidly detect and treat CKD. Proximal tubular lesions play an important role in the progression of CKD. There are new markers of kidney damage, such as uromodulin (UMOD), Klotho protein and post-translational modifications of fetuin A (FtA). Treatment of CKD in the early stages may improve renal function and/or slow the progression of CKD.
Сhronic肾脏疾病(CKD)是世界范围内发病率和死亡率的主要原因。在乌克兰,12%的人口被诊断患有慢性肾病。CKD患者肾纤维化进展和矿物质平衡受损的生活质量显著恶化。早期诊断和治疗是预防CKD进展和延缓不良反应的主要措施。缺乏早期、非侵入性的生物标志物会对快速检测和治疗CKD的能力产生不利影响。近端肾小管病变在CKD的进展中起重要作用。肾损伤的新标志物如尿调素(UMOD)、Klotho蛋白和胎蛋白A (FtA)的翻译后修饰。早期治疗CKD可以改善肾功能和/或减缓CKD的进展。
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引用次数: 3
Infusion reactions to rituximab administration: algorithm of management 利妥昔单抗输注反应:管理算法
Pub Date : 2022-07-13 DOI: 10.22141/2307-1257.11.2.2022.364
D. Ivanov, I. Zavalna
Background. Allergic reactions to rituximab, which have been used for the past 20 years, are common in 32–62 % of patients. The purpose of the study: to develop an algorithm for controlling adverse reactions that occur during the introduction of rituximab. Materials and methods. The personal experience of treatment of 46 patients with various kidney diseases who received rituximab according to the indications according to the established diagnosis was analyzed. Evaluation of infusion allergic reactions was performed according to P.М. Kasi et al. (2012) for 5 classes of side effects. Results. It was found that allergic reactions to ritu­ximab occurred in 46 % of patients in the range from 1 to 4 classes. The probability of their occurrence according to the class was almost the same, but somewhat less documented for the 4th grade. Re-administration of diphenhydramine, methylprednisolone 125 mg or hydrocortisone 125 mg, if necessary salbutamol, oxygen allowed to eliminate most of the reaction, and then resumed the introduction of rituximab, starting from 25 mg/h, gradually increasing to 300 mg/h. This administration, performed 1–2 times, was effective in 1–3 classes of allergic reactions. For fourth grade, one patient required omalizumab. Generalized experience allowed to give a graphical and descriptive algorithm of actions in case of infusion side effects for rituximab. Conclusions. Based on special data and literature analysis, an algorithm for controlling infusion allergic reactions with intravenous rituximab was formulated.
背景。对利妥昔单抗的过敏反应在32 - 62%的患者中很常见,利妥昔单抗已经使用了20年。本研究的目的:开发一种算法来控制引入利妥昔单抗期间发生的不良反应。材料和方法。分析46例不同肾脏疾病患者根据既定诊断,根据适应症接受利妥昔单抗治疗的个人经验。输液过敏反应评价参照P.М。Kasi et al.(2012)研究了5类副作用。结果。结果发现,在1 ~ 4级患者中,46%的患者发生了对利妥昔单抗的过敏反应。根据班级的不同,发生这种情况的概率几乎相同,但四年级的记录较少。重新给予苯海拉明、甲基强的松125mg或氢化可的松125mg,必要时给予沙丁胺醇,使氧消除大部分反应,然后恢复引入利妥昔单抗,从25mg /h开始,逐渐增加到300mg /h。本药1-2次,对1-3类过敏反应有效。对于四年级,一名患者需要使用omalizumab。广义经验允许给出一个图形和描述性算法的行动,在情况下输注副作用的利妥昔单抗。结论。在特殊数据和文献分析的基础上,制定了一种控制静脉注射利妥昔单抗输液过敏反应的算法。
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引用次数: 1
Peritoneal dialysis in 2022: an accidental renaissance? 腹膜透析:2022年的意外复兴?
Pub Date : 2022-07-13 DOI: 10.22141/2307-1257.11.2.2022.368
D. Ivanov
The review focuses on peritoneal dialysis as a renal replacement therapy for stage 5 chronic kidney disease (CKD). About 10 % of the world’s population suffers from CKD, but its prevalence and incidence vary widely across the world due to social and economic conditions. The main areas of renal replacement therapy today are haemodialysis and peritoneal dialysis, the beginning of which is recommended for CKD stage 5. Both me­thods are effective and have similar survival and mortality rates. Both techniques are used successfully around the world, but peritoneal dialysis is less resource-intensive, making it the method of choice in many less affluent countries. The advantages of peritoneal dialysis can be: shorter sessions, limited patient movement, being in the family circle and better quality of life according to the patients themselves. Numerous studies are being conducted to improve the reliability and quality of peritoneal dialysis, including access and prevention of infections.
本综述的重点是腹膜透析作为5期慢性肾脏疾病(CKD)的肾脏替代治疗。世界上约有10%的人口患有慢性肾病,但由于社会和经济条件的不同,其患病率和发病率在世界各地差异很大。目前肾脏替代疗法的主要领域是血液透析和腹膜透析,建议在CKD 5期开始。两种方法都很有效,生存率和死亡率相似。这两种技术在世界各地都得到了成功的应用,但腹膜透析的资源密集程度较低,使其成为许多不太富裕国家的首选方法。腹膜透析的优点是:疗程较短,患者活动受限,在家庭圈子中,根据患者自己的生活质量更好。目前正在进行大量研究,以提高腹膜透析的可靠性和质量,包括获取和预防感染。
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引用次数: 0
World Kidney Day 2022 in Ukraine 乌克兰2022年世界肾脏日
Pub Date : 2022-05-24 DOI: 10.22141/2307-1257.11.1.2022.361
No Authors
No abstract
没有抽象的
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引用次数: 0
Kidney replacement therapy and global issues: world experience and our challenges 肾脏替代疗法和全球问题:世界经验和我们的挑战
Pub Date : 2022-05-24 DOI: 10.22141/2307-1257.11.1.2022.358
D. Ivanov
The problem of renal replacement therapy (RRT) is relevant in today’s world due to a large number of people with chronic kidney disease (CKD). According to current data, about 10–11 % of people suffer from CKD, of which up to 5 % need RRT. Unfortunately, the number of people with CKD in the world is increasing, which determines the growing need for RRT. There are three types of RRT, namely: hemodialysis, peritoneal dialysis, and kidney transplantation. Kidney transplantation is the most effective method of RRT, but its possibilities in the world are limited. Therefore, most people receive hemo- or peritoneal dialysis. But the long-term effects of choosing a dialysis method are not always predictable. The peritoneal dialysis and hemodialysis show similar effectiveness during the first two years. Subsequent studies compa­ring the efficacy of the two methods do not provide a clear picture due to differences in patient initial parameters and differences in treatment initiation time. It is clear that peritoneal dialysis can have significant advantages in low-income countries due to the resource costs of the latter. The known benefits of peritoneal dialysis, such as flexibility of use, high quality of life, and preservation of residual renal function, increase its attractiveness, especially for young people with stage 5 CKD. The main strategies today are timely detection and prevention of CKD, control of comorbidities, as well as the development of documents and recommendations for standardization and improving the quality of renal replacement therapy.
肾脏替代治疗(RRT)的问题在当今世界是相关的,因为大量的人患有慢性肾脏疾病(CKD)。根据目前的数据,约有10 - 11%的人患有慢性肾病,其中高达5%的人需要RRT。不幸的是,世界上CKD患者的数量正在增加,这决定了对RRT的需求日益增长。RRT有三种类型,即血液透析、腹膜透析和肾移植。肾移植是最有效的RRT方法,但其在世界范围内的可能性有限。因此,大多数人接受血液透析或腹膜透析。但是选择一种透析方法的长期影响并不总是可以预测的。腹膜透析和血液透析在头两年显示出相似的效果。由于患者初始参数和治疗起始时间的差异,后续比较两种方法疗效的研究并没有提供一个清晰的画面。很明显,由于后者的资源成本,腹膜透析在低收入国家具有显著的优势。腹膜透析的已知好处,如使用的灵活性、高生活质量和保留残余肾功能,增加了它的吸引力,特别是对5期CKD的年轻人。目前的主要策略是及时发现和预防CKD,控制合并症,以及制定标准化和提高肾脏替代治疗质量的文件和建议。
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引用次数: 0
Expression of plasmid-mediated resistance genes ESBLs and PMQR among uropathogens, isolated from non-dialysis CKD patients with pyelonephritis 质粒介导的耐药基因ESBLs和PMQR在非透析CKD肾盂肾炎患者尿路病原体中的表达
Pub Date : 2022-05-24 DOI: 10.22141/2307-1257.11.1.2022.354
O. Chub, S. Teslenko, O. Chub
Urinary tract infections (UTIs) are thought to be the most common group of bacterial infections, worldwide. It is estimated that the proportion of UTIs remains at a high level reaching 150 million episodes per year worldwide and accounting for $6 billion in health care expenditures. In USA more than 100,000 hospital admissions per year are the UTIs patients, among them the patients with pyelonephritis are the most frequent. For the US outpatients, approximately 15 % of antibiotics used are prescribed for UTIs. However, recent studies in Europe and the United States have demonstrated a steady increase in the rate of uropathogen resistance to commonly prescribed antibiotics, and this obviously will lead to a reduction in therapeutic possibilities of UTI. CDC has estimated that more thаn 2 million infections and 23,000 deaths are due to antibiotic resistance each year. By 2050, it is estimated, that antibiotic resistance will cause 10 million deaths every year. Infection is an importаnt cause of mоrbidity and mоrtality amоng patients with kidney failurе and is the sеcond lеading causе of death following CVD. At the EU/EEA level, more than half (54 %) of the E.coli isolates reported to EARS-Net for 2020 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e. aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. A majority (87.4 %) of the third-generation cephalosporin-resistant E.coli isolates from 2020 were extended-spectrum beta-lactamase (ESBL) positive. Use of broad-spectrum antimicrobials is a known risk factor for colonization and spread of resistant Enterobacteriaceae, including E.coli. The high levels of ESBLs and increasing resistance to key antimicrobial groups might also lead to an increased consumption of carbapenems, which in turn can increase the selection pressure and facilitated the spread of carbapenem-resistant Enterobacteriaceae. The article presents data on the antibacterial susceptibility of isolated uropathogens, and their association with the presence or absence of plasmid-mediated resistance genes ESBLs and PMQR.
尿路感染(uti)被认为是世界范围内最常见的细菌感染。据估计,尿路感染的比例仍然很高,全世界每年达到1.5亿次,占卫生保健支出的60亿美元。在美国,每年有超过10万的住院患者是尿路感染,其中以肾盂肾炎患者最为常见。对于美国门诊病人来说,大约15%的抗生素用于治疗尿路感染。然而,最近在欧洲和美国的研究表明,尿路病原体对常用抗生素的耐药率稳步上升,这显然会导致尿路感染治疗可能性的减少。疾病预防控制中心估计,每年有超过200万例感染和2.3万例死亡是由于抗生素耐药性造成的。据估计,到2050年,抗生素耐药性每年将导致1000万人死亡。感染是肾衰竭患者发生恶性和恶性的重要原因,是继心血管疾病之后的第二大死亡原因。在欧盟/欧洲经济区,向ear - net报告的2020年半数以上(54%)大肠杆菌分离株对定期监测的至少一种抗菌药物耐药,即氨基霉素、氟喹诺酮类、第三代头孢菌素、氨基糖苷类和碳青霉烯类。从2020年开始,大多数(87.4%)第三代耐头孢菌素大肠杆菌分离株呈扩展谱β -内酰胺酶(ESBL)阳性。使用广谱抗菌剂是包括大肠杆菌在内的耐药肠杆菌科定植和传播的已知危险因素。高水平的ESBLs和对关键抗菌素群的耐药性增加也可能导致碳青霉烯类消耗增加,这反过来又增加了选择压力,促进了碳青霉烯类耐药肠杆菌科的传播。本文介绍了分离尿路病原体的抗菌敏感性数据,以及它们与质粒介导的耐药基因ESBLs和PMQR的存在与否的关系。
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引用次数: 0
Improving medical standards of care to children of an early and preschool age with urinary tract infections at the primary care stage 提高初级保健阶段对早期和学龄前尿路感染儿童的医疗护理标准
Pub Date : 2021-12-29 DOI: 10.22141/2307-1257.10.4.2021.247894
V. Bezruk, D. Ivanov
Timely diagnosis, prognostic value of clinical signs and further treatment of patients of an early age with urinary tract infections (UTI) during outpatient stage are important constituents of an integrated management of patients in childhood. The article deals with new approaches concerning clinical algorithm in diagnosis of urinary tract infections in children. The algorithm of diagnostic and therapeutic measures for providing care to children under 5 years of age with urinary tract infections, in particular at the stage of primary care, includes: diagnosis of urinary tract infection in young children using The Diagnosis of Urinary Tract infection in Young children, patient’s examination by Gorelick Scale and UTIcalc, imaging methods with mandatory ultrasound of the kidneys and bladder, micturating cystogram after the first episode of infection in boys and the second — in girls, the prescription of antibiotic therapy based on data from regional monitoring of antibiotic resistance of the main groups of uropathogens, monitoring antibiotic resistance using electronic means and the implementation in microbiological laboratories of the guidelines of the European Committee on Antimicrobial Susceptibility Testing, as well as introduction of the prescription sale of antibiotics.
早期尿路感染(UTI)患者在门诊阶段的及时诊断、临床体征的预后价值和进一步治疗是儿童期患者综合治疗的重要组成部分。本文就儿童尿路感染临床诊断算法的新思路进行了探讨。向5岁以下尿路感染儿童提供护理的诊断和治疗措施算法,特别是在初级保健阶段,包括:应用《幼儿尿路感染诊断》、患者Gorelick量表和UTIcalc检查、强制性肾膀胱超声成像方法、男童首次感染后排尿膀胱造影和第二次感染后排尿膀胱造影诊断幼儿尿路感染在女孩中,根据尿路病原体主要群体抗生素耐药性区域监测数据开具抗生素治疗处方,使用电子手段监测抗生素耐药性,在微生物实验室实施欧洲抗微生物药物敏感性试验委员会指南,以及采用抗生素处方销售。
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引用次数: 0
Uromodulin as a potential candidate marker for predicting the course of chronic kidney disease 尿调蛋白作为预测慢性肾脏疾病病程的潜在候选标志物
Pub Date : 2021-12-29 DOI: 10.22141/2307-1257.10.4.2021.247898
L.D. Denova
Uromodulin is a nephrospecific protein that is most common in normal urine. And although it has been known for more than 70 years, the function of uromodulin remains unclear. Uromodulin is involved in regulating the transport of salts, protects against urinary tract infections, namely, the mucous membrane of the bladder, and prevents the formation of kidney stones, as well as plays a role in kidney damage and innate immunity. Serum uromodulin and uromodulin of urine, daily excretion and excretion of uromodulin per 1 milliliter of creatinine clearance are actively studied. Complete genome studies of the association have established a correlation between uromodulin gene mutations and autosomal dominant tubulointerstitial kidney disease.
尿调蛋白是一种在正常尿液中最常见的肾特异性蛋白。尽管人们对尿调素的认识已有70多年,但其功能仍不清楚。尿调蛋白参与调节盐的运输,防止尿路感染,即膀胱粘膜,防止肾结石的形成,并在肾脏损伤和先天免疫中发挥作用。积极研究血清尿调素和尿液尿调素,每日排泄量和每毫升肌酐清除尿调素的排泄量。全基因组研究证实尿调蛋白基因突变与常染色体显性小管间质性肾病之间存在相关性。
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引用次数: 3
The opportunity of stem cells application in kidney transplantation: clinical studies (review) 干细胞在肾移植中的应用机遇:临床研究(综述)
Pub Date : 2021-12-29 DOI: 10.22141/2307-1257.10.4.2021.247897
A. Voroniak, R. Zograbyan
Kidney transplantation remains the optimal method of end-stage renal disease treatment, but the result of such ope­rations depends on the immune response of the recipient to the transplanted organ. Side effects of modern immunosuppressive drugs, such as nephrotoxicity, opportunistic infection, and increased risk of cancer, negatively affect the long-term results of transplantation. In recent years, studies of the properties and uses of stem cells have aroused considerable interest and expectations. The biological characteristics of stem cells, inclu­ding multi-row differentiation, self-guidance, paracrine effects, immunomodulation, ability to suppress the immune response against graft, have opened new horizons for their use in kidney transplantation, but according to different studies, the safety and effectiveness of stem cells clinical use remain controversial. The use of stem cells in animal models with renal failure shows better results in the postoperative period and provides an opportunity for clinical research in the context of creating alternative induction therapy in kidney transplantation. The preclinical efficiency of stem cells in the chronic renal failure model and renal allotransplantation in laboratory animals showed their unique potential to improve function and repair the damaged kidney. They also demonstrate immunosuppressive effects that realize in the inhibition of T-cell proliferation and dendritic cells maturation, the induction of Т-regulatory cells, which can improve the long-term results of kidney allotransplantation. This review summarizes the results of previous studies and is aimed to provide an objective point of view based on a comprehensive analysis of currently known advantages and disadvantages of stem cell therapy in kidney transplantation and highlights aspects that require further research.
肾移植仍然是治疗终末期肾病的最佳方法,但这种手术的结果取决于受体对移植器官的免疫反应。现代免疫抑制药物的副作用,如肾毒性、机会性感染和癌症风险增加,对移植的长期结果产生负面影响。近年来,对干细胞特性和用途的研究引起了人们极大的兴趣和期待。干细胞的多行分化、自我引导、旁分泌作用、免疫调节、抑制移植物免疫反应等生物学特性为其在肾移植中的应用开辟了新的前景,但根据不同的研究,干细胞临床应用的安全性和有效性仍存在争议。干细胞在肾功能衰竭动物模型中的应用在术后表现出较好的效果,为在肾移植中创建替代诱导疗法的临床研究提供了机会。干细胞在慢性肾功能衰竭模型和实验动物肾异体移植中的临床前效率显示了它们在改善功能和修复受损肾脏方面的独特潜力。它们还显示出免疫抑制作用,实现在抑制t细胞增殖和树突状细胞成熟,诱导Т-regulatory细胞,这可以改善肾脏移植的长期结果。本综述总结了以往的研究结果,旨在通过对目前已知的干细胞治疗在肾移植中的优缺点进行综合分析,提供一个客观的观点,并指出需要进一步研究的方面。
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引用次数: 1
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