IMPORTANCE OF APOPTOSIS MARKERS (MDM2, BCL-2 AND Bax) IN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER.

AIM OF THE STUDY: MDM2, Bcl-2 and Bax are well recognized markers of apoptosis. The goal of the current study was evaluation of the activity of these markers in different cells of BPH, PCa and hormonally treated prostate cancer (CRPCa) tissues. Activity of the markers has been evaluated in: 39 BPH, 28 prostate cancer (PCa) and 10 castration resistant PCa (CRPCa) tissues. Possible association of intensity of the expression with the disease clinical parameters has been assessed. Activity of MDM2 was higher in PCa and CRPCa as compared with BPH. This difference has been detected in epithelial and vascular prostatic cells. Epithelial activity of Bcl-2 was significantly lower in BPH as compared with PCa and CRPCa. Conversely, intensity of pro-apoptotic protein Bax was significantly higher in PBH than in PCa and CRPCa. The Bax activity in acinar and ductal cells of BPH was positively correlated with age. Intensity of Bcl-2 was significantly increasing, while activity of Bax was decreasing with increasing prostate volume. Significant correlation has been detected with the markers' activity and residual urine. In particular, MDM2 activity was increasing while epithelial activity of Bax was decreasing with increasing residual urine. Serum PSA level was positively correlated with MDM2 and negatively correlated with Bax activity. p27(Kip1) cell cycle inhibitor was positively correlated with Bax but negatively correlated with Bcl-2 activities. Proliferation marker Ki67 was positively correlated with MDM2 and Bcl-2. With increasing Ki67, Bax activity was significantly decreasing. Cyclin D3 was positively correlated with Bax. This pilot study has shown importance of apoptosis markers in BPH and PCa. It is the first study showing complex interrelation between apoptosis and cell cycle regulating proteins in BPH and PCa.

INFLUENCE OF TYPE OF ANESTHESIA ON HEMODYNAMIC PARAMETERS AND OUTCOME OF DIALYSIS ARTERIOVENOUS FISTULA OPERATIONS.

The goal of the study was to compare effectiveness of regional and local anesthesia in dialysis arterio-venous fistula (AVF) operations. It was a prospective, randomized study. 103 patients with end stage renal disease underwent AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Duplex sonography evaluation of upper arm vessels was performed pre-operatively and at 1, 3 and 6 months postoperatively. Following parameters were measured on duplex scan: vessel diameter, blood flow rates (PSV and EDV), resistive index (RI) and pulsatility index (PI). Significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group. Time to postoperative pain initiation, need for postoperative pain killers was significantly better in Group II as compared with the Group I. Duration of operation was significantly less in regional as compared with local anesthesia. Postoperative PSV and EDVs were negatively correlated with patient age. The fistula maturation time was positively correlated with age. The vein diameter, postoperative PSV and EDV have been significantly increased in Group I as compared with Group II. The postoperative PI has significantly increased and RI has significantly decreased in Group I as compared with Group II. The total number of dialysis punctures was higher in regional as compared with the local anesthesia. Regional anesthesia provides significantly better analgesia as compared with the local anesthesia in AVF operations. It significantly improves the duplex sonography parameters after AVF formation. It can be a method of choice for some forms of fistulas.

IMPORTANCE OF APOPTOSIS MARKERS (MDM2, BCL-2 AND Bax) IN CONVENTIONAL RENAL CELL CARCINOMA.

The goal of the current study was to analyze the expression of Bcl-2, MDM2 and Bax in benign and malignant renal tissue samples and assess their possible association with different clinical parameters. Prognostic significance of the markers in recurrence-free and cancer-specific survivals has also been evaluated. Activity of MDM2, Bcl-2 and Bax was evaluated in: 24 normal human kidney tissues resected from the patients of different ages (range: 21-80 years), and in 52 conventional RCC samples. Intensity of the markers' expression was compared between the groups and correlation was analyzed with different clinical parameters. Activity of anti-apoptotic MDM2 and Bcl-2 was significantly elevated while activity of pro-apoptotic Bax was decreased in RCC as compared with normal kidney tissues. Bax expression was positively correlated with patient age. Significant association has been detected between the evaluated markers and cancer clinical parameters like: tumor stage, grade, lymph node and distant metastases. The markers' activity was associates with the tumor morphological features, in particular: presence of tumor necrosis and microvascular invasion. Disease recurrence and 5-year patient survival were associated with the markers' activity. Cox regression analyses have shown that tumor size, pathological stage and grade are the risk factors for disease recurrence and patient death. Expression of MDM2 and Bcl-2 is significantly up-regulated, while Bax is down-regulated in RCC as compared with normal kidney tissue. Intensity of the markers'activities is associated with the tumor pathological and clinical parameters (stage, grade, lymph node and distant metastases, tumor recurrence and patient survival). Further studies with more patients and longer follow-up will uncover the clinical importance of the evaluated markers in RCC.

Evaluation of efficacy of regional and local anesthesia techniques in arteriovenous fistula criation for dialysis.

Both, regional and local anesthesia are used for dialysis arterio-venous fistula (AVF) formation in end-stage renal disease patients. There are no prospective, randomized clinical trials comparing effectiveness of these types of anesthesia in these patients. It was a prospective, randomized study. 103 patients with ESRD underwent dialysis AVF operations on upper limb. The patients have been randomly divided in two groups. Group I: 49 patients in whom the operations have been done under the local anesthesia; and Group II: 54 patients in whom the operation has been performed under the vertical infraclavicular block. Radio-Cefalic, Brachio-Cefalic and Brachio-Basilic(I stage transposition) fistulas have been created in all patients.Influence of the type of anesthesia on intra- and postoperative pain has been evaluated and compared between the groups. The mean follow-up was 359.5 days in Group I and 340.5 days in Group II (p-NS).The mean patients age was 59.7±13.1 years and 60.1±14 years in local and regional anesthesia groups, respectively (p=NS). For the whole group, significantly less number of patients with regional anesthesia required additional perioperative analgesics as compared with the local anesthesia group (p=0.0363). Time to postoperative pain initiation was significantly higher in Group II (2.3 hours) as compared with the Group I (1.7 hours, p=0.0477). The need for postoperative pain killers was significantly less in regional as compared with the local anesthesia (p=0.0318). Duration of operation was significantly less in regional (67.5 min.) as compared with local anesthesia (134.7 min. p=0.0007) group. This difference has been detected in Brachio-Cefalic and Brachio-Basilic fistulas (p=0.0257 and 0.001, respectively) but not in Radio-Cefalic one. No anesthesia related complications have been detected. Insufficiency of regional anesthesia has been identified in 3 cases (5.5%).In 5 patients from regional anesthesia group (9.4%) as a result of vasodilation have made more simplified operation. Regional anesthesia provides significantly betterperiperativeanalgesiaas compared with the local anesthesia in AVF operations. It can change the tactic of surgery, significantly decreases the operation time and should be a method of choice for some forms AVF operations.

The first kidney transplant in HIV infected patient in Georgia.

Highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with HIV. As a result, kidney transplantation is considered an viable treatment option for HIV infected patients with end stage renal disease. The first living-related kidney transplant in Georgia has been performed between non-identical twin sisters in July 2013. In this paper we give the detailed case report and short overview of the existing literature. This is the first report of the successful kidney transplant in HIV infected patient in East Europe and former Soviet Union Countries including the Central Asia.

Transplanting kidneys with small renal masses: a new source of renal allografts.

The number of publications on transplanting kidneys with small renal masses is steadily growing. There are several transplant centers worldwide with organized programs of transplanting such kidneys. Nevertheless, despite growing number of reports this practice remains controversial. The existing guidelines for kidney transplantation give controversial recommendations concerning transplantation of the kidneys with renal masses. There are arguments in favour as well as against this policy. Importance of the subject is emphasized by calculations showing that about 3000 kidneys with tumors could be transplanted in the United States annually. Based on the results reported in the literature the risk of occurrence of de novo graft tumor is extremely low and varies from 0.24% to 0.46%. A risk of getting a transmitted cancer is even lower and reported as 0.015-0.2%. The patient and graft survival rates of these kidneys are comparable to that of the standard criteria deceased and living transplant. More studies with higher number of patients are needed to prove the functional and oncological safety of this practice.

The value of nephron-sparing surgery for the treatment of renal cell carcinoma 4 to 7 cm in size.

Nephron-sparing surgery (NSS) is a treatment of choice for renal cell carcinoma (RCC) less than 4 cm. in size. However its efficacy in the treatment of RCC from 4cm to 7 cm is not well defined and is still controversial. We retrospectively reviewed the records of 57 patients who underwent NSS at our institution for RCC of 4-7 cm in size, from 1994 to 2011. NSS was done by means of enucleoresection and/or eucleation. The mean follow-up was 70.1 months (range: 10-157 months). Mean patient age was 53.1 years. NSS was performed for absolute indications in 5 (8.8%), for relative indications in 11 (19.3%) and for elective indications in 41 (71.9%) patients. The tumour size was significantly higher in the patients with absolute indication as compared with the patients operated for relative and elective indications (p<0.04). The difference between the later two groups was not significant. The tumour recurred in 6 (10.5%) patients. Of them, local recurrence was detected in 2 (3.5%) and systemic recurrence in 4 (7%) patients. At the end of follow-up overall survival was 85.8%, disease-free survival was 82.4%. Both, overall and disease-free survivals were significantly better in the patients operated for relative and elective indications as compared to absolute indication (p<0.014 and p<0.023, respectively). NSS is a feasible procedure for RCCs 4 cm to7 cm in size. Local cancer control can be achieved in most patients. Oncological outcome was negatively related with the tumor size. Long-term prospective studies are required to prove the similar oncological efficacy of NSS and radical nephrectomy (RN) in RCC of 4 cm to7 cm in size.

Metastasis of renal cell carcinoma to contralateral adrenal gland: case report and review of the literature.

Isolated metastasis of renal cell carcinoma (RCC) to the contralateral adrenal gland is a rare complication occurring in 2.5% of cases. The optimal diagnosis and treatment of this condition is not well defined. We present our experience of treatment of four patients with contralateral adrenal metastasis of RCC. Six hundred twenty nine patients with RCC have been operated at our institution from 1991 to 2005. Four cases (0.6%) of isolated contralateral adrenal metastasis have been diagnosed on CT with the mean follow-up of 83.3 months (range: 23-196 months). The metastases have been detected synchronously in one and metachronously in three cases. All patients underwent adrenalectomy through flank incision above the 11th rib. Pathological stage of the tumor was pT2N0 and pT3aN0 in two patients each. Grade 2 tumor was detected in one and grade 3 in three cases. Adrenalectomy was uneventful in all patients. The mean operation time was 136 minutes (range: 110-160 minutes). No serious perioperative complications have been detected. Two patients are alive 47 and 63 months after adrenalectomy without signs of disease recurrence. Two patients died from multiple metastases 19 and 38 months after adrenalectomy, including patient with synchronous contralateral adrenal metastases. Isolated metastasis of RCC in the contralateral adrenal gland is a very rare complication. Surgical treatment is feasible and should be recommended in all cases as long-term curable effect can be observed in some cases.

Paired kidney donation: outcomes, limitations, and future perspectives.

It has been calculated that approximately one-third of willing, otherwise appropriate donor-recipient pairs are biologically incompatible due to blood group differences or positive crossmatches therefore cannot proceed to living donor transplantation. Paired kidney donation (KPD) may overcome this problem. Several types of KPD are in practice today and is a good alternative for incompatible donor-recipient couples. According to the existing data, KPD can increase the number of kidney transplants form living donors while providing excellent clinical results. This is also a cost-effective treatment as compared with dialysis and desensitization protocols. However, there are several barriers and limitations of this program. This article analyzed the advantages as well as the drawbacks and shortcomings of KPD programs.

Incentives for organ donation: pros and cons.

Altruism still remains the main principle of organ donation worldwide. However, since the current practices has not met the demand for organs, new strategies should be found to encourage organ donation. Implementation of financial incentives in transplantation is a matter of debate among experts in the fields of transplantation, ethics, law, and economics. It should be acknowledged that donors incur many expenses while participating in the transplant process, which seems unfair. Various forms of incentives have been suggested and are currently used worldwide. This article describes current attitudes toward incentives for in transplantation used in different countries, arguing in favor as well as against them.

The quality of life analysis in renal transplant recipients and dialysis patients.

Health-related quality of life (HRQoL) is becoming an important outcome measure in evaluation of various forms of renal replacement therapy (RRT). The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24) and Zerssen's Mood-Scale (Bf-S) are internationally validated questionnaires for the assessment of HRQoL. The goal of the current study was to evaluate and compare the HRQoL of patients on different forms of the RRT. The study population consisted of: 1) 120 patients on hemodialysis (HD); 2) 43 patients on peritoneal dialysis (PD); 3) 9 recipients who lost their grafts and went back to dialysis (PT); 4) 120 age- and sex matched healthy individuals (Controls); and 5) 48 renal transplant recipients (T). The SF-36, GBB-24 and Bf-S questionnaires have been used for the assessment of HRQoL. The mean SF-36 scores were not significantly different between: a) control group and transplant recipients; b) hemo- and peritoneal dialysis patients including previously transplanted patients. The dialysis patients scored significantly worse in all eight SF-36 domains as compared with the transplant recipients and healthy subjects. In all GBB-24 components the transplant recipients scored significantly higher than HD and PD patients. In the following components: "Fatigue tendency", "Limb pain" and "Cardiac complaints", recipients scored significantly higher than the control group subjects. The mood analysis (Bf-S) has shown that the scores of transplant recipients and controls did not differ and were significantly higher than that of the dialysis patients. The HRQoL of patients on hemo- and peritoneal dialysis is similar and lower than that of the general population. Renal transplantation significantly improves HRQoL at least to the level of the healthy individuals. The graft loss is associated with the significant worsening of HRQoL.

Assessment of health-related quality of life in renal transplant recipients and dialysis patients.

Health-related quality of life (HRQoL) is becoming an important outcome measure in evaluation of various forms of renal replacement therapy (RRT). The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24), and Zerssen's Mood Scale (Bf-S) are internationally validated questionnaires for the assessment of HRQoL. The goal of the current study was to evaluate the HRQoL of renal transplant recipients and compare it with that of patients on different forms of RRT. The study population consisted of: (1) 120 patients on hemodialysis (HD); (2) 43 patients on peritoneal dialysis (PD); (3) nine recipients who lost their grafts and went back to dialysis; (4) 120 age- and sex-matched healthy individuals (controls); and (5) 48 renal transplant recipients. The mean SF-36 scores were not significantly different between control group and transplant recipients as well as HD and PD patients including previously transplanted patients. The dialysis patients scored significantly worse in all eight SF-36 domains compared with transplant recipients and healthy subjects. In all GBB-24 components, the transplant recipients scored significantly higher than HD and PD patients. In the "fatigue tendency," "limb pain," and "cardiac complaints" components, recipients scored significantly higher than control group subjects. The mood analysis (Bf-S) showed that the scores of transplant recipients and controls did not differ, being significantly higher than those of dialysis patients. The HRQoL of patients on HD and PD were similar and lower than that of the general population. Renal transplantation significantly improved HRQoL at least to the level of healthy individuals. Graft loss was associated with significant worsening of HRQoL.

Assessment of health-related quality of life in living kidney donors.

The health-related quality of life (HRQoL) is frequently applied to assess surgical or other treatment modalities. We evaluated the HRQoL of 57 kidney donors for comparison with 120 age-and sex-matched healthy individuals and 52 patients who underwent nephrectomy due to a renal tumor. The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24), and Zerssen's Mood Scale (Bf-S) questionnaires were used for this purpose. The evaluation procedure was completely anonymous and free of charge for all respondents. The mean scores of various domains calculated for all three questionnaires were compared between the groups. In three of eight SF-36 items--"social function," "bodily pain," and "vitality"--donors scored significantly better than the controls and patients. In all five GBB-24 items, donors scored higher than controls and patients. For "gastric complaints," the difference was significant. The mood analysis showed significant differences between the groups in favor of donors. The HRQoL of living kidney donors was not different from that of healthy subjects and significantly better than the HRQoL of urologic patients after nephrectomy. Donors should be monitored for both physical and psychosocial outcomes of the procedure. Further prospective studies are needed to facilitate potential donors' understanding of the complex issues related to organ donation.

Treatment of renal cell carcinoma in pregnancy: simultaneous nephron-sparing surgery and Caesarian section (case report).

We present a case of a 33-year-old pregnant woman with renal cell carcinoma diagnosed at 24 weeks of gestational age. Simultaneous nephron sparing surgery (NSS) and Caesarean section (CS) was performed at 33 weeks of gestation. The successful cases of radical nephrectomy performed in pregnancy have been reported earlier however, we believe this is the first case of NSS and CS performed simultaneously. This approach can be used in the second and third trimester of pregnancy.

Health-related quality of life after radical nephrectomy and kidney donation.

The health-related quality of life (HRQoL) concept is frequently applied for the assessment of surgical or other treatment modalities. We evaluated the HRQoL of 57 kidney donors and compared it to: 120 age and sex matched healthy individuals; and 52 patients who underwent nephrectomy due to renal tumor. The Short Form-36 (SF-36), Giessen Subjective Complaints List (GBB-24) and Zerssen's Mood Scale (Bf-S) questionnaires have been used for this purpose. The mean scores of different domains have been calculated for all three questionnaires and compared between the groups. In three out of eight SF-36 items ("Social function", "Bodily pain" and "Vitality") the donors scored significantly better than the controls and patients. In all five GBB-24 items the donors scored higher than the controls and patients. For the "Gastric complaints" the difference was significant. The mood analysis has shown significant differences between the groups in favour of the donors. The HRQoL of living kidney donors is not different from that of healthy subjects and significantly better than HRQoL of urological patients after nephrectomy. The HRQol of living kidney donors and healthy individuals is similar and better than HRQol of the patients operated due to the medical indications. Further prospective studies are needed to increase our knowledge of factors influencing HRQol of the living kidney donors and patients after nephrectomy.

Prognostic significance of p27(Kip 1) expression in renal cell carcinoma.

The importance of cyclin-dependent kinase inhibitor genes (CDKIG) in benign and malignant urological diseases is a subject of intense ongoing investigation. The goal of the current study was to analyze the expression of p27(Kip 1) CDKIG in benign and malignant renal cells and assess their possible association with different clinical parameters. Expression of p27(Kip 1) CDKIG was evaluated and compared in 24 normal human kidneys and in 46 renal cell carcinoma (RCC) samples. Intensity of the gene expression was compared between the groups and possible association was analyzed with the cancer clinical parameters. The gene was significantly higher expressed in normal than in RCC tissue samples (p=0.0045). Intensity of the marker expression in RCC was negatively correlated with tumor size (Rho=-0.438, p=0.0051) and associated with stage and grade (p=0.0488 and <0.0001, respectively). The patients with symptomatic disease had significantly less marker expression than incidentally discovered tumors (p=0.0301). The marker expression was significantly higher in oncocytomas as compared with conventional RCCs (p=0.0378) The baseline p27(Kip 1) expression level in these patients was significantly lower than in non-recurrent tumors (p=0.04). Disease-related related death was observed in 4 cases. The baseline p27(Kip 1) expression level in these patients was significantly lower than in alive patients (p=0.0106). The Log-Rank analysis showed that loss of p27(Kip 1) expression were the risk-factors of oncological patient death (p=0.005). Expression of p27 is significantly decreased in RCC as compared with normal kidney tissue. Intensity of the gene expression is associated with clinical parameters: tumour size, stage, grade and disease presentation. Loss of p27 expression is a risk-factor for disease progression.

Kidney transplantation in Georgia: a single centre experience with living-related donors.

37 patients underwent living donor kidney Tx at the National Centre of Urology from January 2000 to December 2007. All transplants were performed from genetically related donors. The mean follow-up was 29,5 months. The following parameters were analysed: early and late posttransplant complications, rejection rate, the most recent Cr, patient and graft survival rates. Haemorrhage (5.4%), gastro-intestinal bleeding (10.8%) and graft thrombosis (5.4%) were the most important early complications. 6 (16.2%) episodes of acute cellular rejection were detected of whom 5 were treated successfully with bolus steroids. Two (5.4%) patients developed delayed graft function and needed postoperative dialyses. The mean value of the most recent serum Cr level is 1.6+/-1.1 g/dl (range: 0.7-6.2 g/dl). 1, 2 and 3 year patient survival for the whole group was 89.2%. 1, 2 and 3 year graft survival for the whole group was 89.2%, 83% and 83%, respectively. The mortality rate associated with kidney Tx has decreased from 38% in 1995-2000, to 5.4% in 2000-2007. The results of kidney Tx can achieve the acceptable level with improving surgical technique and experience. The pool of living-unrelated (spouses etc.) donors should be wider used to increase the number of transplants.

Down-regulation of p27(Kip 1) cyclin-dependent kinase inhibitor in prostate cancer: distinct expression in various prostate cells associating with tumor stage and grades.

The goal of the study was to analyze the expression of p27(Kip 1) cyclin-dependent kinase inhibitor protein (CDKI) in different cells of benign, malignant and hormonally treated prostate cancer tissue and assess their possible association with different clinical parameters. Expression of p27(Kip 1) CDKI was evaluated and compared in: 32 BPH, 20 prostate cancer (PCa) and 6 hormonally treated prostate cancer (HTPCa) tissues. Intensity of the expression was compared between the groups and association was soughed with the cancer clinical parameters. Total expression of p27(Kip 1) was significantly higher in BPH as compared with PCa (p=0.0002) and HTPCa (p=0.0324). The difference between PCa and HTPCa was not significant. p27(Kip 1) was higher expressed by epithelial, ductal and vascular prostatic cells of BPH as compared with PCa (p=0.0001, 0.0101 and 0.0224, respectively). The stromal expression of the marker was not different between the groups. Epithelial marker expression was significantly increased in HTPCa as compared with PCa (p=0.0460). In the PCa group, the intensity of the protein expression was negatively associated with the tumor stage, Gleason scores 1, 2, and the Gleason sum (p=0.0453, 0.0202, 0.0074 and 0.0098, respectively). This difference was found in epithelial, vascular and ductal prostatic cells. Down-regulation of p27(Kip 1) CDKI in PCa is detected in epithelial, vascular and ductal, but not the stromal cells. The intensity of the expression in these cells is associated with tumor stage and grades. The hormonotherapy is causing up-regulation of p27(Kip 1) expression in prostate adenocarcinoma cells.

Surgical management of renal cell carcinoma invading the inferior vena cava.

The aim of the study was the evaluation of long-term outcome and prognosis of the patients with renal cell carcinoma (RCC) extending into the inferior vena cava (IVC). Influence of the patient, tumor characteristics and therapeutic interventions on the disease prognosis was also assessed. 24 patients (19 male and 5 female) with RCC extending into the IVC underwent surgical treatment at our institution between 1990 and 2002. The mean patient age was 58.2 years (range: 38-78 years). The level of tumor extension was infrahepatic (level I) in 16 (67%), intrahepatic (level II) in 6 (25%) and suprahepatic without atrial invasion (level III) in 2 (8%) patients. All the tumors were resected via inferior vena cava; median sternotomy with a control of supradiaphragmatic IVC without cardiopulmonary bypass and hypothermia was performed in two cases. Mortality rate was 7.5 %. Complications occurred in 6 patients (25 %). The 5-year Kaplan-Meier survival estimate was 65%, with a mean follow-up of 49.6 months (range: 10-152 months). The tumor grade, radicality of tumor excision and symptoms at the disease presentation (systemic vs. local) were the factors associated with the disease-free survival (p=0.02, 0.002 and 0.03, respectively). There was no significant difference in survival with regard to the level of thrombus extension into the vena cava (p=0.3) Surgical treatment is preferred option in the patients with RCC and IVC tumor thrombus as it provides markedly better results as compared with other therapeutic modalities. The complete surgical excision of the primary RCC and the tumor thrombus with appropriate preoperative staging and surgical technique provides an acceptable long-term patient survival with a good quality of life.

Renal ischemia/reperfusion and its influence on telomere length and expression of cell cycle regulatory genes.

The aim of the study was to evaluate the influence of renal ischemia/reperfusion (I/R) on telomere (T) length and tissue expression of cyclin-dependent kinase inhibitor genes (CDKIG). An experimental model of ex-vivo hemoperfusion of the kidney was used as described earlier. Telomere length measurement and expression of p16((INK4a)), p21((WAF1/CIP1)) and p27((Kip1)) CDKIGs was studied immunohistochemically in kidney biopsy samples at baseline and different time points after the reperfusion. The mean T length decreased after reperfusion from 5.56+/-0.60 kbp to 5.46+/-0.36 kbp (p=NS). All 3 genes were up-regulated in kidney tissue however their activation was different in diverse renal cells according to the reperfusion time. Expression of p16 significantly increased in tubular cells at 180 min of reperfusion as compared with the baseline. Activation of the p27 in glomerular cells was significantly higher at 60, 120 and 180 min of reperfusion as compared with 0 and 15 min. The marker started increasing in tubular cells at 15 min and was elevated at every time point afterwards. p21 was significantly over-expressed in all renal cells after the reperfusion. The current study shows that renal I/R causes T shortening and over-expression of CDKIGs indicating on substantial DNA damage and/or accelerated tissue senescence. The tissue expression of CDKIGs is positively related with the reperfusion time.