Pub Date : 2023-03-07DOI: 10.36485/1561-6274-2023-27-1-41-47
A. Vinogradov, N. Chebotareva, A. Bugrova, A. G. Brzhozovskij, T. Krasnova, S. Moiseev, A. Kononikhin
BACKGROUND. Primary focal segmental glomerulosclerosis (FSGS) and membranous nephropathy (MN) are diseases with primary podocyte damage with high proteinuria and nephrotic syndrome. While the mechanisms in primary MN are well understood, the pathogenesis of primary FSGS is still unknown, and therefore, the search for biomarkers that could expand ourunderstanding of its pathogenetic mechanisms. THE AIM: to determine the urine proteomic profile of patients with primary podocytopathies – FSGS in comparison with MN. PATIENTS AND METHODS. The study included 48 patients with a morphologically confirmed diagnosis of CGN occurring with nephrotic syndrome – 32 men and 16 women. In 18 patients, a decrease in glomerular filtration rate < 60 ml/min/1.73 m2 was observed. The histological diagnosis was confirmed by biopsy: 31 patients had FSGS, 17 patients with MN were included as a comparison group. The study of the urinary proteome was carried out by high performance liquid chromatography/mass spectrometry. RESULTS. In patients with FSGS, compared with the MN group, an increased content of 22 different proteins was noted, the most abundant were apolipoprotein A-I, hemopexin, vitronectin, pigment epithelial growth factor, components of the complement system (C3, C4b, factors B and H), retinol – and vitamin D-binding proteins, alpha-2-HS-glycoprotein, histidine-rich glycoprotein, plasma C1 protease inhibitor. In MN, increased urinary excretion of the complement component C2, fibrinogen alpha chain, osteopontin, and the SH3 domain-binding glutamic acid-rich-like protein 3, was detected. CONCLUSION. The proteomic profile of urine in FSGS, compared to MN, reflects the activation of variety of pathological processes – podocyte damage, involvement of parietal epithelial cells, tubulo-interstitial damage, accumulation of extracellular matrix, and complement activation process.
{"title":"Urine proteome profile in primary podocytopathies","authors":"A. Vinogradov, N. Chebotareva, A. Bugrova, A. G. Brzhozovskij, T. Krasnova, S. Moiseev, A. Kononikhin","doi":"10.36485/1561-6274-2023-27-1-41-47","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-41-47","url":null,"abstract":" BACKGROUND. Primary focal segmental glomerulosclerosis (FSGS) and membranous nephropathy (MN) are diseases with primary podocyte damage with high proteinuria and nephrotic syndrome. While the mechanisms in primary MN are well understood, the pathogenesis of primary FSGS is still unknown, and therefore, the search for biomarkers that could expand ourunderstanding of its pathogenetic mechanisms. THE AIM: to determine the urine proteomic profile of patients with primary podocytopathies – FSGS in comparison with MN. PATIENTS AND METHODS. The study included 48 patients with a morphologically confirmed diagnosis of CGN occurring with nephrotic syndrome – 32 men and 16 women. In 18 patients, a decrease in glomerular filtration rate < 60 ml/min/1.73 m2 was observed. The histological diagnosis was confirmed by biopsy: 31 patients had FSGS, 17 patients with MN were included as a comparison group. The study of the urinary proteome was carried out by high performance liquid chromatography/mass spectrometry. RESULTS. In patients with FSGS, compared with the MN group, an increased content of 22 different proteins was noted, the most abundant were apolipoprotein A-I, hemopexin, vitronectin, pigment epithelial growth factor, components of the complement system (C3, C4b, factors B and H), retinol – and vitamin D-binding proteins, alpha-2-HS-glycoprotein, histidine-rich glycoprotein, plasma C1 protease inhibitor. In MN, increased urinary excretion of the complement component C2, fibrinogen alpha chain, osteopontin, and the SH3 domain-binding glutamic acid-rich-like protein 3, was detected. CONCLUSION. The proteomic profile of urine in FSGS, compared to MN, reflects the activation of variety of pathological processes – podocyte damage, involvement of parietal epithelial cells, tubulo-interstitial damage, accumulation of extracellular matrix, and complement activation process.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76576585","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 : 2023-03-07DOI: 10.36485/1561-6274-2023-27-1-69-77
S. Mazurenko, Y. A. Nakatis, O. Mazurenko, A. N. Vasilyev, A. A. Enkin, K. G. Staroselsky, N. A. Samokhvalova, T. S. Semenova, A. K. Grusmanov
BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them. THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD. PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study. RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ. CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.
{"title":"Densitometric justification of the diagnosis of osteoporosis in patients with chronic kidney disease stage 5D","authors":"S. Mazurenko, Y. A. Nakatis, O. Mazurenko, A. N. Vasilyev, A. A. Enkin, K. G. Staroselsky, N. A. Samokhvalova, T. S. Semenova, A. K. Grusmanov","doi":"10.36485/1561-6274-2023-27-1-69-77","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-69-77","url":null,"abstract":" BACKGROUND. Chronic kidney disease leads to increased bone fragility and fractures. Assessing the risk of fractures is a direct way to prevent them. THE AIM: to assess the possibility of using DXA to predict fracture risk in patients with stage 5D CKD. PATIENTS AND METHODS. The prospective cohort study included 359 patients (166 men, 193 women). BMD was evaluated by DRA. Some markers of mineral and bone metabolism were also analyzed. All fractures in patients were recorded from the moment of inclusion in the study. RESULTS. All patients with fractures had lower BMD and received longer-term renal replacement therapy (RRT). The absolute risk of fractures increased as BMD decreased. Patients with fractures had higher levels of parathyroid hormone and alkaline phosphatase. Stepwise multivariate regression analysis showed that the combination of BMD scores of the forearm, hip, lumbar vertebrae and the duration of RRT best predicts the risk of fractures. The presence of previous fractures also increases risk for the future. Risk of fractures in man and women did not differ. CONCLUSION. The risk of fractures in patients with CKD 5 st. on maintenance hemodialysis increases with a decrease in BMD, an increase in the duration of RRT and the presence of previous fractures, but does not significantly depends on the gender of the patients. It is also can be concluded that it is possible to use criteria reflecting the state of BMD, taking into account their sensitivity and specificity, in assessing the risk of fractures in patients with CKD 5D st.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75275738","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 : 2023-03-07DOI: 10.36485/1561-6274-2023-27-1-78-85
N. Y. Korosteleva, A. Rumyantsev, M. Khasun, B. G. Lukichev, E. B. Lebedeva, E. V. Grigoryan, N. Kulaeva
BACKGROUND. Assessment of physical performance in patients is usually based on the results of the 6-minute walk test, which is primarily associated with heart or respiratory failure. THE AIM: to analyze the results of the 6-minute walk test with clinical and laboratory parameters of patients with CKD 5D, including criteria for protein-energy malnutrition. PATIENTS AND METHODS. 67 people with CKD 5D were examined, including 42 men and 25 women, mean age 49.0 ± 14.9 and 57.2 ± 15.5 years, respectively, p = 0.036. The duration of RRT in men was 96.1 ± 80.3 months, in women 100.7 ± 66.1 months, p = 0.810. The diagnosis of coronary heart disease was established in 22 people, 7 of them had AMI. The muscle strength of the skeletal muscles was assessed using a hand dynamometer, the performance of the skeletal muscles – during a test with a 6-minute walk. All patients filled out food diaries, where they indicated the qualitative and quantitative composition of the food which they consumed for 3 days. RESULTS. Walking load was most easily tolerated by patients without clinical manifestations of CAD. Between patients with and without AMI in history, the number of points on the Borg scale was comparable and reached the maximum values. The highest concentration of C-reactive protein and the lowest concentration of serum albumin were observed in patients who had had AMI. Relationships were found between serum albumin with C-reactive protein and the results of the 6-minute walk test, as well as between the mass index of the left ventricular myocardium with the results of the 6-minute walk test. CONCLUSION. Left ventricular hypertrophy masks the clinical signs of reduced physical performance, but increases the risk of cardiovascular complications. The results of the 6-minute walk test in patients with CAD should be evaluated in more detail. A number of studies are needed to clarify how dietary recommendations should be modified depending on the level of systemic inflammation in CKD.
{"title":"Physical performance of patients with chronic kidney disease stage 5D and coronary heart disease","authors":"N. Y. Korosteleva, A. Rumyantsev, M. Khasun, B. G. Lukichev, E. B. Lebedeva, E. V. Grigoryan, N. Kulaeva","doi":"10.36485/1561-6274-2023-27-1-78-85","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-78-85","url":null,"abstract":" BACKGROUND. Assessment of physical performance in patients is usually based on the results of the 6-minute walk test, which is primarily associated with heart or respiratory failure. THE AIM: to analyze the results of the 6-minute walk test with clinical and laboratory parameters of patients with CKD 5D, including criteria for protein-energy malnutrition. PATIENTS AND METHODS. 67 people with CKD 5D were examined, including 42 men and 25 women, mean age 49.0 ± 14.9 and 57.2 ± 15.5 years, respectively, p = 0.036. The duration of RRT in men was 96.1 ± 80.3 months, in women 100.7 ± 66.1 months, p = 0.810. The diagnosis of coronary heart disease was established in 22 people, 7 of them had AMI. The muscle strength of the skeletal muscles was assessed using a hand dynamometer, the performance of the skeletal muscles – during a test with a 6-minute walk. All patients filled out food diaries, where they indicated the qualitative and quantitative composition of the food which they consumed for 3 days. RESULTS. Walking load was most easily tolerated by patients without clinical manifestations of CAD. Between patients with and without AMI in history, the number of points on the Borg scale was comparable and reached the maximum values. The highest concentration of C-reactive protein and the lowest concentration of serum albumin were observed in patients who had had AMI. Relationships were found between serum albumin with C-reactive protein and the results of the 6-minute walk test, as well as between the mass index of the left ventricular myocardium with the results of the 6-minute walk test. CONCLUSION. Left ventricular hypertrophy masks the clinical signs of reduced physical performance, but increases the risk of cardiovascular complications. The results of the 6-minute walk test in patients with CAD should be evaluated in more detail. A number of studies are needed to clarify how dietary recommendations should be modified depending on the level of systemic inflammation in CKD.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82565765","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 : 2023-03-06DOI: 10.36485/1561-6274-2023-27-1-18-30
M. Amiryan, Zh. G. Leviashvili, N. Savenkova
This review presents the latest data on the classification, pathogenesis, clinical and genetic features, and therapy of primary hyperoxaluria types I, II, and III in children with autosomal recessive inheritance. ORPHA portal of orphan diseases presents genes responsible for primary hyperoxaluria type I AGXT (93598); type II and type II GRHPR (93599), type III HOGA1 (93600). Worldwide genetic studies have established the pathogenesis, clinical phenotype and genotype features of primary hyperoxaluria. The pathogenesis of primary hyperoxaluria in children is based on impaired hepatic glyoxylate metabolism. The enzyme AGT catalyzes the conversion of L-alanine and glyoxylate to pyruvate and glycine, with vitamin B6 (pyridoxine) serving as a coenzyme for this reaction. Increased production of endogenous oxalate leads to increased blood oxalate concentrations and urinary oxalate excretion with the formation of renal calcium oxalate crystals and radiopaque concrements (calcium oxalate monohydrate – vevelite, calcium oxalate dihydrate – vedellite). High risk of progression to chronic kidney disease in primary hyperoxaluria in children of types I and II. Systemic oxalosis develops with increasing serum oxalate levels and the formation of calcium oxalate crystals with deposition in many organs and tissues. Therapy for primary hyperoxaluria in children includes: hydration (3l/m2/day) and citrates 100–150 mg/kg/day (potassium citrate 0.3–0.5 mmol/kg/day), pyridoxine at a dose of 5 to 20 mg/kg/day for vitamin B6 sensitive type I primary hyperoxaluria. Administration of oxalobacter formigenes and diet is effective. Combined liver and then kidney transplantation or simultaneous liver and kidney transplantation in patients with type I PH in B6-insensitive and isolated liver transplantation in B6-sensitive variants are performed. Timely molecular genetic testing in children with nephrocalcinosis makes it possible to establish a clinical and genetic diagnosis of type I, II, III PH, to carry out a personalised approach to treatment and to predict future health status.
{"title":"Primary hyperoxaluria I, II, III types in children (review of literature)","authors":"M. Amiryan, Zh. G. Leviashvili, N. Savenkova","doi":"10.36485/1561-6274-2023-27-1-18-30","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-18-30","url":null,"abstract":" This review presents the latest data on the classification, pathogenesis, clinical and genetic features, and therapy of primary hyperoxaluria types I, II, and III in children with autosomal recessive inheritance. ORPHA portal of orphan diseases presents genes responsible for primary hyperoxaluria type I AGXT (93598); type II and type II GRHPR (93599), type III HOGA1 (93600). Worldwide genetic studies have established the pathogenesis, clinical phenotype and genotype features of primary hyperoxaluria. The pathogenesis of primary hyperoxaluria in children is based on impaired hepatic glyoxylate metabolism. The enzyme AGT catalyzes the conversion of L-alanine and glyoxylate to pyruvate and glycine, with vitamin B6 (pyridoxine) serving as a coenzyme for this reaction. Increased production of endogenous oxalate leads to increased blood oxalate concentrations and urinary oxalate excretion with the formation of renal calcium oxalate crystals and radiopaque concrements (calcium oxalate monohydrate – vevelite, calcium oxalate dihydrate – vedellite). High risk of progression to chronic kidney disease in primary hyperoxaluria in children of types I and II. Systemic oxalosis develops with increasing serum oxalate levels and the formation of calcium oxalate crystals with deposition in many organs and tissues. Therapy for primary hyperoxaluria in children includes: hydration (3l/m2/day) and citrates 100–150 mg/kg/day (potassium citrate 0.3–0.5 mmol/kg/day), pyridoxine at a dose of 5 to 20 mg/kg/day for vitamin B6 sensitive type I primary hyperoxaluria. Administration of oxalobacter formigenes and diet is effective. Combined liver and then kidney transplantation or simultaneous liver and kidney transplantation in patients with type I PH in B6-insensitive and isolated liver transplantation in B6-sensitive variants are performed. Timely molecular genetic testing in children with nephrocalcinosis makes it possible to establish a clinical and genetic diagnosis of type I, II, III PH, to carry out a personalised approach to treatment and to predict future health status.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87846479","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 : 2023-03-06DOI: 10.36485/1561-6274-2023-27-1-31-40
I. Karimdzhanov, G. Iskanova, N. A. Isrаilova
The review presents material on the current relevance of AH in children. The prevalence of AH in overweight and obese children aged 6-18 years is 27–47 %, while secondary arterial hypertension remains dominant, especially in children younger than 5 years. AH is a major risk factor for atherosclerosis and cardiovascular disease in adults. The onset of these diseases may occur in childhood or adolescence. The use of modern methods to monitor and control BP is crucial for improving the management of AH and preventing damage to target organs. Twenty-four-hour BP measurements are an important tool in determining the prognosis and treatment of children with AH. AH in children can be classified as primary or essential if there is no identifiable cause, or as secondary AH when it arises from a specific cause. The incidence of primary arterial hypertension increases with age, whereas secondary arterial hypertension predominates in early childhood. The secondary causes of AH also depend on the age of the patient. Thus 34-79 % of patients with secondary forms of arterial hypertension have renal parenchymal disease and impaired renal structure. Signs of AH include headache, visual disturbances, dizziness and nosebleeds. Dyspnoea on exercise, facial paralysis and seizures indicate target organ damage. In children with obesity, diabetes, renal insufficiency, aortic coarctation/repaired coarctation and those receiving medication causing AH, BP should be measured at every visit to the physician. Therapeutic lifestyle changes are an early therapy in the treatment of AH in children. IAPs, BCAAs, BRAs and thiazide diuretics are the most effective drugs for AH in children.
{"title":"Diagnostics, monitoring and treatment of arterial hypertension in children","authors":"I. Karimdzhanov, G. Iskanova, N. A. Isrаilova","doi":"10.36485/1561-6274-2023-27-1-31-40","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-31-40","url":null,"abstract":" The review presents material on the current relevance of AH in children. The prevalence of AH in overweight and obese children aged 6-18 years is 27–47 %, while secondary arterial hypertension remains dominant, especially in children younger than 5 years. AH is a major risk factor for atherosclerosis and cardiovascular disease in adults. The onset of these diseases may occur in childhood or adolescence. The use of modern methods to monitor and control BP is crucial for improving the management of AH and preventing damage to target organs. Twenty-four-hour BP measurements are an important tool in determining the prognosis and treatment of children with AH. AH in children can be classified as primary or essential if there is no identifiable cause, or as secondary AH when it arises from a specific cause. The incidence of primary arterial hypertension increases with age, whereas secondary arterial hypertension predominates in early childhood. The secondary causes of AH also depend on the age of the patient. Thus 34-79 % of patients with secondary forms of arterial hypertension have renal parenchymal disease and impaired renal structure. Signs of AH include headache, visual disturbances, dizziness and nosebleeds. Dyspnoea on exercise, facial paralysis and seizures indicate target organ damage. In children with obesity, diabetes, renal insufficiency, aortic coarctation/repaired coarctation and those receiving medication causing AH, BP should be measured at every visit to the physician. Therapeutic lifestyle changes are an early therapy in the treatment of AH in children. IAPs, BCAAs, BRAs and thiazide diuretics are the most effective drugs for AH in children.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"C-18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85046931","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 : 2023-03-06DOI: 10.36485/1561-6274-2023-27-1-9-17
A. Belskikh, A. V. Marukhov, I. N. Konakova, M. V. Zakharov, N. V. Chubchenko
The course of the COVID-19 pandemic has led to a critical increase in the burden on virtually all major branches of the health care system in our country and abroad. The aim of this article is to analyse the activities of the different parts of the city nephrology service in Saint-Petersburg and to consider promising ways to improve it. The nephrology service for the adult population in St. Petersburg includes: outpatient service; inpatient service - 183 beds in 24-hour inpatient departments of the city; dialysis service - 10 dialysis units in municipal medical organizations, 5 in federal institutions, and 8 centers/departments operating in the framework of private-public partnership. The number of patients on dialysis programme decreased by 10.5 % to 1,839 in 2021. These changes are likely due to an increase in mortality among these patients in 2020 and 2021 which is a consequence not only of COVID-19 but also of the adverse impact of the pandemic on the health system. The proportion of patients treated as outpatients in private dialysis centres increased during the three-year period. The incidence of arteriovenous fistula formation in primary vascular access decreased from 33.2 % to 14.2 % in 2020 compared with 2019. At the same time, the use of temporary central venous catheters as primary vascular access for renal replacement therapy has increased significantly from 43.0 % to 61.9 %. The development of the nephrology service is largely determined by its funding. To compensate the costs of medical in stitutions in the city for conducting renal replacement therapy it is necessary to increase the tariffs of compulsory health insurance (CHI) by at least 50 %. In the medical organizations of Saint-Petersburg municipal and federal subordination the share of "artificial kidney" devices that have used up their resource is 32.2 %, and in a number of medical institutions it exceeds 50 %.
{"title":"Paradigms of megapolis nephrology in a changing world: status, problems and prospects of development of the nephrological service of St. Petersburg","authors":"A. Belskikh, A. V. Marukhov, I. N. Konakova, M. V. Zakharov, N. V. Chubchenko","doi":"10.36485/1561-6274-2023-27-1-9-17","DOIUrl":"https://doi.org/10.36485/1561-6274-2023-27-1-9-17","url":null,"abstract":" The course of the COVID-19 pandemic has led to a critical increase in the burden on virtually all major branches of the health care system in our country and abroad. The aim of this article is to analyse the activities of the different parts of the city nephrology service in Saint-Petersburg and to consider promising ways to improve it. The nephrology service for the adult population in St. Petersburg includes: outpatient service; inpatient service - 183 beds in 24-hour inpatient departments of the city; dialysis service - 10 dialysis units in municipal medical organizations, 5 in federal institutions, and 8 centers/departments operating in the framework of private-public partnership. The number of patients on dialysis programme decreased by 10.5 % to 1,839 in 2021. These changes are likely due to an increase in mortality among these patients in 2020 and 2021 which is a consequence not only of COVID-19 but also of the adverse impact of the pandemic on the health system. The proportion of patients treated as outpatients in private dialysis centres increased during the three-year period. The incidence of arteriovenous fistula formation in primary vascular access decreased from 33.2 % to 14.2 % in 2020 compared with 2019. At the same time, the use of temporary central venous catheters as primary vascular access for renal replacement therapy has increased significantly from 43.0 % to 61.9 %. The development of the nephrology service is largely determined by its funding. To compensate the costs of medical in stitutions in the city for conducting renal replacement therapy it is necessary to increase the tariffs of compulsory health insurance (CHI) by at least 50 %. In the medical organizations of Saint-Petersburg municipal and federal subordination the share of \"artificial kidney\" devices that have used up their resource is 32.2 %, and in a number of medical institutions it exceeds 50 %.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84539468","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 : 2022-11-25DOI: 10.36485/1561-6274-2022-26-4-132-133
A. Editorial
.
．
{"title":"On the 65th anniversary of academician of the Russian Academy of Sciences professor S.F.Bagnenko","authors":"A. Editorial","doi":"10.36485/1561-6274-2022-26-4-132-133","DOIUrl":"https://doi.org/10.36485/1561-6274-2022-26-4-132-133","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"85 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89340074","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 : 2022-11-25DOI: 10.36485/1561-6274-2022-26-4-119-126
N. V. Khudyakova, I. Pchelin, A. Kotrova, A. Shishkin, V. Bayrasheva, V. Smirnov, O. Vasilkova
Spina bifida is a developmental defect of the spinal cord and/or spinal cord that results from abnormal closure of the embryonic neural tube. Many factors have been described to determine the risks of developing this pathology, but the incidence of the defect is still high. 61% of patients with spina bifida have neurogenic bladder dysfunction based on intravesical hypertension, which contributes to reverse urethral flow and vesico-uretero-renal reflux, associated with chronic inflammatory and obstructive diseases of the urinary tract. Between 25-50% of patients with spina bifida develop chronic kidney disease, significantly reducing their quality of life. In some types of Spina bifida, urological symptoms may be prominent and indicate the presence of this malformation. Therefore, early diagnosis of Spina bifida and timely prophylactic and therapeutic measures are particular importance. This article describes a clinical case of Spina bifida posterior L1-L2 with a closed L1-L2 meningocele in which urological symptoms were the dominant manifestation. The development of secondary complications of neurogenic bladder in the presented patient cannot be excluded, which requires closer monitoring.
{"title":"Neurogenic bladder dysfunction in spina bifida: a case report and a brief review of the literature","authors":"N. V. Khudyakova, I. Pchelin, A. Kotrova, A. Shishkin, V. Bayrasheva, V. Smirnov, O. Vasilkova","doi":"10.36485/1561-6274-2022-26-4-119-126","DOIUrl":"https://doi.org/10.36485/1561-6274-2022-26-4-119-126","url":null,"abstract":"Spina bifida is a developmental defect of the spinal cord and/or spinal cord that results from abnormal closure of the embryonic neural tube. Many factors have been described to determine the risks of developing this pathology, but the incidence of the defect is still high. 61% of patients with spina bifida have neurogenic bladder dysfunction based on intravesical hypertension, which contributes to reverse urethral flow and vesico-uretero-renal reflux, associated with chronic inflammatory and obstructive diseases of the urinary tract. Between 25-50% of patients with spina bifida develop chronic kidney disease, significantly reducing their quality of life. In some types of Spina bifida, urological symptoms may be prominent and indicate the presence of this malformation. Therefore, early diagnosis of Spina bifida and timely prophylactic and therapeutic measures are particular importance. This article describes a clinical case of Spina bifida posterior L1-L2 with a closed L1-L2 meningocele in which urological symptoms were the dominant manifestation. The development of secondary complications of neurogenic bladder in the presented patient cannot be excluded, which requires closer monitoring.","PeriodicalId":19089,"journal":{"name":"Nephrology (Saint-Petersburg)","volume":"48 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89268439","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 : 2022-11-25DOI: 10.36485/1561-6274-2022-26-4-127-131
A. Rumyantsev, A. Kucher, M. Khasun
The problem of studying the functional reserve of the kidneys attracted the attention of nephrologists about 40 years ago. However, to date, a single protocol for performing functional load tests has not been developed. When assessing the excretory function of the kidneys, nephrologists, as before, are guided by the value of the glomerular filtration rate. However, in two patients of the same age and gender, the same value of this indicator cannot be interpreted unambiguously. In this article, we consider the technical features of performing load tests using egg white, "red meat", a mixture of amino acids, 0.5 % sodium chloride solution. All of them require time and labor resources. This limits the possibilities of their use in outpatient settings. We believe that it is necessary to determine the functional reserve in patients without primary kidney pathology, that is, persons with an established diagnosis of diabetes mellitus or hypertension with a disease duration of at least 5 years. Serious nephroprotective measures in them are recommended to begin only at the stage of chronic kidney disease C3a. It is possible that such a late start of secondary prevention partly explains the increase in the proportion of such patients in hemodialysis centers.
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