[COVID-19 in haemodialysis patients: result analysis of the first year of the pandemic].

BACKGROUND: Present concepts of the novel coronavirus infection prognosis in haemodialysis (HD) patients are rather controversial. There is little information on therapy efficiency and safety in such patients. We studied COVID-19 course specifics, prognostic factors associated with fatal outcomes, therapy efficiency and its transformation at different stages of the pandemic first year. MATERIALS AND METHODS: Single-centre retrospective uncontrolled study included 653 COVID-19 HD-patients treated at Moscow City Nephrology Centre from April 1 to December 31, 2020. RESULTS: This period mortality rate was 21.0%. Independent predictors of COVID-19 unfavourable outcome in HD patients were pulmonary lesion extension (CT grades 34), high comorbidity index, and mechanical ventilation. Approaches to COVID-19 treatment modified significantly at different periods. Immunomodulatory drugs (monoclonal antibodies to IL-6, corticosteroids) were used largely at later stages. With tocilizumab administration, mortality was 15.1%, tocilizumab together with dexamethasone 13.3%; without them 37.8% (р0,001). Tocilizumab administration in the first 3 days after hospitalization of patients with CT grades 12 was associated with more favourable outcomes: 1 out of 29 died vs 6 out of 20 (tocilizumab administered at later periods); p0.04. There was no significant difference in death frequency in patients with CT grades 34 depending on tocilizumab administration time. CONCLUSION: COVID-19 in HD patients can manifest in a severe course with unfavourable outcome. It is urgent to identify reliable disease outcome predictors and develop efficient treatment in this population.

[A rare concurrence of polymyalgia rheumatica and AA-amyloidosis]. / Redkoe sochetanie revmaticheskoi polimialgii s AA-amiloidozom.

Polymyalgia rheumatica (PMR) is a rare chronic inflammatory disease. It predominantly affects the elderly. The disease has a slow onset, pain and stiffness in the muscles of the shoulder and pelvic girdle, fever, weight loss, and a high acute-phase inflammatory response. The disease is concurrent with giant cell arteritis in a quarter of cases, which allows some authors to consider them as two different manifestations of the same pathological process. The kidneys are rarely involved. This disease is rarely complicated by AA amyloidosis. The authors describe a case of RPM in a patient who has developed secondary AA amyloidosis.

[Chronic HCV infection: An internist's opinion (Part 2)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (II chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. In addition to lymphoproliferative and autoimmune disorders discussed in Part 1 of this review, many other diseases turned to be associated with chronic HCV infection. Part 2 of this review is dedicated to the analysis of the relationship of chronic HCV-infection to the development of some endocrine diseases, such as thyroiditis and diabetes mellitus, and cardiovascular disorders. It also provides the characteristics of the currently available antiviral agents and considers whether they may be used in patents with extrahepatic manifestations of chronic HCV infection.

[Chronic hepatitis C virus infection: An internist's opinion (Part 1)]. / Khronicheskaia HCV-infektsiia: vzgliad internista (I chast').

Hepatitis C virus (HCV) infection results in not only chronic hepatitis and subsequent complications as liver cirrhosis and hepatocellular carcinoma, but also in a significant number of other diseases, the so-called extrahepatic manifestations of chronic HCV infection. This is because of viral hepatotropicity and lymphotropicity. The most striking example of the course of chronic HCV infection, in which the infectious and inflammatory processes are concurrent with autoimmune disorders and carcinogenesis, is mixed cryoglobulinemia and B-cell non-Hodgkin's lymphoma. The pathogenesis of these diseases is based on the clonal expansion of B cells, which occurs under their prolonged stimulation with the virus or viral proteins. Part 1 of this review is devoted to the analysis of a correlation of chronic HCV infection with lymphoproliferative and autoimmune disorders, as well as its association with kidney injury.

[RHEUTMATIC MYALGIA COMPLICATED BY AA-AMYLOIDOSIS].

Rheumatic myalgia is associated with intense inflammation and, unlike other diseases, is very rarely complicated by AA- amyloidosis. Only 12 such cases have been described worldwide, most of them in combination with giant cell arteritis. The present article reports the first case of rheumatic myalgia complicated by AA-amyloidosis encountered in Russia and the relevant literature review.

[Hepatitis E: current concepts].

Hepatitis E belongs to the group of enetral hepatites. Its earlier cases caused by genotype I and II viruses were reported largely from epidemics affecting tropical and subtropical countries. Sporadic cases of hepatitis E recorded later in West Europe, North America, Southeast Asia, and Oceania were caused by genotype III and IV viruses. Until recently the disease has been supposed to be reversible and have positive outcome barring women at late stages of pregnancy in whom cases of fulminate clinical course and death were described. This review focuses on recent publications devoted to hepatitis E in immunodeficient patients, such (as recipients of solid organ transplants, HIV-infected subjects and those treated with chemotherapy. Immunosuppression was shown to turn the disease into the chronic form or liver cirrhosis. Also, the infection has extrahepatic, mostly autoimmune complications. Current approaches to antiviral therapy and prevention of hepatitis E are discussed.

[Chronic hepatitis B, hemosiderosis, and hepatic fibrosis in a renal graft recipient].

Chronic hepatitis B is a frequent concomitant disease in recipients of a renal graft that worsens results of kidney transplantation due to renal and extrarenal complications. Much rarer hemochromatosis either has genetic roots (hereditary hemochromatosis) or results from multiple blood transfusions and hemolysis during treatment by hemodialysis (secondary hemochromatosis). Combination of chronic hepatitis B and hemochromatosis increases the risk of chronic liver disease leading to cirrhosis and hepatocellular carcinoma. Success of antiviral therapy combined with massive phlebotomy is illustrated by a case of kidney transplantation to a patient with chronic hepatitis B of large duration and iron overload syndrome.

[Chronic hepatitis B and C in renal graft recipients].

Clinical and morphological features of chronic hepatitis B (CHB), C (CHC), and B+C (CHB+C) were studied in 283 renal graft recipients. High total bilirubin serum levels were detected significantly more often in CHB and CHB+C patients vs. CHC patients. High ALT activity was noted in 65% of CHB patients and only in 45% of CHC patients (p = 0.003). Stable low activity of hepatitis prevailed in renal recipients; it was noted in 56.7% of CHB patients, 66.2% of CHC patients, and 62% of CHB+C patients. The character of pathomorphological liver changes in chronic viral hepatitis was studied in 53 renal graft recipients using puncture biopsy. Histopathological activity index (HAI, Knodell R.G. et al., 1981) witnessed a more severe liver lesion in CHB vs. CHC and CHB+C. Thus, inflammatory activity in CHB was found to be minimal or low in 13 patients, and moderate or high in 11 patients, whilst a minimal or low activity in CHC or CHB+C was found in 16 and 10 patients, respectively, and a moderate activity was detected only in two and one, respectively (p = 0.016 and 0.024 compared with CHB). Advanced hepatic fibrosis or cirrhosis was significantly more frequent (p = 0.006) in CHB patients (eight out of 24) than in CHC ones (none out of 18). The rate of advanced sclerotic changes in CHB+C was lower (one out of 10 patients) than that in CHB, and similar to CHC. Thus, clinico-morphological manifestations were more prominent in renal graft recipients with CHB vs. CHC.

[Distribution and features of infection with hepatitis viruses B and C during hemodialysis treatment]. / Rasprostranennost' i osobennosti infitsirovaniia virusami gepatitov B i C v usloviiakh lecheniia gemodializom.

The prevalence of hepatitides B and C was evaluated in 140 patients treated by hemodialysis. Almost half of patients (48%) had acute hepatitis B which completely resolved. Acute hepatitis B was detected in 6% in the course of observation. In 6% chronic hepatitis B was diagnosed, and in 24% chronic hepatitis C. A combination of hepatitides B and C was diagnosed in 2% patients. Only 12% patients were not infected with hepatitis. Genotype 1b predominated in patients with HCV infection (73%); genotypes 1a, 21, and 3a were equally incident (9%). Replication of HBV and HCV in patients with uremia under conditions of hemodialysis was detected in 83 and 86% patients, respectively. Relationship between HBV and HCV infection and the duration of hemodialysis treatment was analyzed. The percentage of non-infected patients persistently decreased, and the time course of HBV and HCV infection was different. Infection with HBV after the beginning of hemodialysis occurred sooner (16.0 +/- 4.0 months) than with HCV (30.2 +/- 4.6 months, p < 0.04). The levels of SGPT and SGOT in patients with various manifestations of HBV and HCV infection treated by hemodialysis were followed up.

[The tubulointerstitial component of chronic glomerulonephritis: its clinico-functional diagnosis]. / Tubulointerstitsial'nyi komponent khronicheskogo glomerulonefrita: kliniko-funktsional'naia diagnostika.

Tubulointerstitial alterations associated with chronic glomerulonephritis (CGN) are definitely dependent on the clinical type of CGN and are accompanied by a decrease of homeostatic functions (the rate of glomerular filtration, osmotic concentration and dilution of urine, hydruresis, the magnitude of CH2O, excretion of ammonium and hydrogen ions, the ratio of ammonium excretion to hydrogen ion excretion). Maximal osmotic concentration and ammonium excretion show an especially considerable decrease. The clinical type permitting one to diagnose rather than to reject the presence of alterations and the status of certain tubular functions, osmotic concentration in particular and, to a less degree, ammonium excretion, permitting to reject the presence of the tubulointerstitial component (TIC) are of known but restricted importance for TIC recognition. The TIC can be diagnosed more adequately in exploring definite pairs of renal functions, particularly osmotic concentration of urine and ammonium excretion and maximal hydruresis and excretion of hydrogen ions. This approach is both helpful in confirming and rejecting the presence of the TIC. Of special value is the combined assessment of the clinical type and maximal osmotic urine concentration data.

[Prognostic signs of accelerated progression of nephrotic types of chronic glomerulonephritis]. / Predvestniki uskorennogo progressirovaniia nefroticheskikh tipov khronicheskogo glomerulonefrita.

A prognostic value of some clinical and morphological signs was followed up in 43 patients with chronic glomerulonephritis concurrent with the nephrotic syndrome versus 85 with other clinical types of the disease. There was a statistically significant incidence of disease progression in combination with arterial hypertension, resistance of the nephrotic syndrome over 12 months and detection of sclerosing renal glomeruli and interstitium within 2 years after onset of the disease. The protracted course of the nephrotic syndrome is a precursor of occurrence of chronic renal failure. With less prolonged phases of the syndrome there is evidence for a long-term period of functional compensation. Occurrence of arterial hypertension early in the disease, as early renal parenchymal sclerosis, fails to predict the rates of chronic renal failure development. In the absence of these factors, the possibility of prompt disease progression may be rejected in all likelihood.

[Clinical and morphologic predictors of the progress of chronic glomerulonephritis]. / Klinicheskie i morfologicheskie prediktory progressirovaniia khronicheskogo glomerulonefrita.

Observation over 183 patients with a morphologically verified diagnosis of chronic glomerulonephritis (CGN) made it possible to establish on a mathematic basis a highly significant relationship between the disease progress and the clinical and morphological disease patterns. In the active nephritic patterns and in the nephrotic-hypertonic pattern, chronic renal failure (CRF) occurred in the majority of the patients within the first 5 years. Meanwhile in the inactive nephritic pattern and in the nephrotic pattern, a corticoid-sensitive one, characterized by the phasic course, CRF could not almost be seen over up to 20 years after the disease onset. As far as the morphological patterns are concerned, focal-segmental glomerular hyalinosis/sclerosis turned out most unfavourable. In patients with this pattern, CRF was diagnosed during 5 years in almost half of the patients. The mesangio proliferative and membranous patterns appeared most favourable. The incidence of CRF during 5 years after the disease onset, common to the definite clinical patterns, did not depend on the concomitant morphological pattern. Provided there were sclerotic lesions throughout 2 years after the disease onset, CRF occurred in 65% of the cases for 10 years, whereas with their lack in 9% of the cases. The most important predictors of CRF were as follows: the clinical pattern of CGN and the presence of sclerotic lesions in the renal biopsy specimen. Of definite significance might be the morphological pattern of CGN.

[Soluble and membrane-bound forms of neutral alpha-glucosidase in human urine in normal conditions and in kidney diseases]. / Rastvorimaia i membranno-sviazannaia formy neitral'noi alpha-gliukozidazy mochi cheloveka v norme i pri zabolevaniiakh pochek.

Soluble and membrane-bound forms of neutral alpha-glucosidase, which are immunologically similar to the corresponding forms of kidney enzymes, were found in urine of healthy persons and of patients with kidney impairments. Membrane-bound enzyme was only slightly active in urine of healthy persons and constituted 3-10% of total urine activity although the ratio of membrane-bound enzyme was simultaneously elevated under pathological conditions. The increased rate of soluble enzyme secretion was responsible for distinct activation of neutral alpha-glucosidase in urine of the patients with kidney impairments.

[Diagnostic value of determining neutral alpha-glucosidase and N-acetyl-beta-D-hexosaminidase activity in the urine in kidney pathology]. / Diagnosticheskoe znachenie opredeleniia aktivnosti neitral'noi alpha-gliukozidazy i N-atsetil-beta-D-geksozaminidazy v moche pri patologii pochek.

As shown in studies of 123 patients with various nephropathies, activities of alpha-glucosidase and N-acetyl-beta-D-hexosaminidase in urine of the patients correlated with severity and stages of these diseases; at the same time, simultaneous estimation of both enzymatic activities in urine was shown to be more informative in diagnostic of kidney impairments. Low values of correlation coefficient (r = 0.35 +/- 0.09) between daily excretion of protein and the activity of neutral alpha-glucosidase in urine showed that the enzyme activity did not depend on proteinuria and was independent test for kidney impairment. Estimation of alpha-glucosidase activity could be used for control of the therapy; the enzymatic activity in urine correlated distinctly with the clinico-laboratory patterns of the patients studied.

[Neutral alpha glucosidase in human urine as a marker of kidney impairment]. / Neitral'naia al'fa-gliukozidaza mochi cheloveka kak marker povrezhdeniia pochek.

Distinct correlation was found between the activity of neutral alpha-glucosidase in urine and the degree of kidney impairment in 76 patients and in 15 healthy persons. In the patients with non-impaired kidney functions the activity of the enzyme in urine varied within the normal limits (from 12 to 39 microM/hr/mmole of creatinine; normal value being 14.6-15.9 microM), in the patients with moderately expressed disfunction of kidney--from 40 to 79 microM/hr/mmole of creatinine. The enzymatic activity, exceeding 80 microM/hr/mmole of creatinine (up to 227 mM), was observed in cases of severe impairment of the kidney functions. High activity of alpha-glucosidase, correlating with the severity of kidney impairment was found in urine of patients with pyelonephritis albeit the content of protein was quite normal. Interrelationship between the activity of alpha-glucosidase in urine and the state of kidney functions enables to conclude that the enzymatic activity depends on the degree of kidney impairment under various pathological conditions and that estimation of the enzyme activity in urine may be important for diagnosis of kidney diseases as well as for the control of treatment efficiency.