[Vascular endothelial growth factor in elderly and senile age: clinical and pathogenetic relationships.]

The aim of the study was to study the role of serum vascular endothelial growth factor and to determine its clinical significance in elderly and senile patients. The study included 124 people (40 men and 84 women) aged 60 to 89 years, the average age was 68,8±7,4 years. Serum levels of vascular endothelial growth factor (VEGF) were studied in the work; blood lipid spectrum parameters, indicators of acute phase blood proteins: C-reactive protein (C-RP), fibrinogen; glomerular filtration rate (GFR) according to the CKD-EPI formula based on serum creatinine and according to the F. Hoek method using cystatin C. In general, 15,3% of the examined individuals had elevated serum levels of VEGF, more often in elderly patients. It was found that serum levels of VEGF are positively associated with the concentration of CRP (r=0,411), the number of platelets in peripheral blood (r=0,358) and positive with the concentration of serum cystatin C (r=0,211). In the subgroup of patients with an elevated serum VEGF level, the platelet count, the concentration of C-RP, fibrinogen, and cystatin C were significantly higher, and the calculated GFR according to F.Hoek was significantly lower. Patients with an elevated serum VEGF level, as a pro-inflammatory and prothrombogenic potential, especially if it is associated with the development of kidney dysfunction in the elderly and senile, should be considered as a risk group for atherothrombotic cardiovascular events.

[Prevalence, age and gender features of chronic kidney disease in patients with diabetes mellitus].

AIM: To study the prevalence, age and gender characteristics of chronic kidney disease (CKD) in patients with diabetes mellitus (DM). MATERIALS AND METHODS: In a case-control study, clinical and laboratory data were analyzed in 683 patients with DM (4.6% of patients with type 1 DM and 95.4% with type 2 DM) and kidney damage. The indicators of anthropometry, hemodynamics and biochemistry were studied. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. RESULTS: The proportion of middle-aged and elderly patients with CKD was the most numerous, amounting to 39 and 38%, respectively. At the same time, anemia was more common in young people, and hypercholesterolemia (35.0%), proteinuria (47.5%) and signs of renal failure (45.0%) - in middle-aged patients with CKD. 47.0% study participants had C1 and C2 categories of changes in renal function. Mean levels of systolic blood pressure (BP), the prevalence of proteinuria were statistically significantly higher in women. When evaluating the correlations, we found statistically significant relationships between the calculated GFR and the level of body mass index, systolic BP, venous blood glucose and Hb in the subgroup of men. Among females, a significant relationship between the calculated GFR value was revealed with indicators of systolic and diastolic BP, venous blood glucose and Hb concentration. CONCLUSION: Our data indicate the existence of differences in the prevalence of CKD and associated risk factors for the progression of renal failure, depending on gender differences and living conditions of patients. In urban residents, CKD was most often associated with arterial hypertension and renal failure, while overweight, obesity, and proteinuria were significantly more common in rural areas. The incidence of proteinuria and mean levels of systolic BP were significantly higher in females. Further study of the issue under discussion seems promising from the standpoint of a personalized approach and the search for a new preventive strategy to combat both end-stage renal failure and its complications.

[Urolithiasis in HIV-positive patients: prevalence and risk factors].

Today, the total number of people living with the human immunodeficiency virus (HIV) is 43.8 million. From the moment of infection to the terminal stage of the disease, the risk of stone formation progressively increases. A prevalence and role of individual risk factors for urolithiasis in patients with HIV are reviewed in the article. It is shown that in HIV-positive individuals, urolithiasis takes a leading position among renal diseases, with a prevalence ranging from 8 to 27%. The main risk factors for urolithiasis in HIV are: dietary factors, age, comorbid pathologies, use of protease inhibitors, changes in the ionic composition of urine, etc.

[Inflammatory markers, lipid metabolism and renal functional state in young, middle, elderly and senior patients with high cardiovascular risk.]

With increasing age in the human body, various pathophysiological changes are observed in response to the effects of various factors, taking into account the genetic predisposition. Among the possible factors causing an increase in cardiovascular risk in the general population are the level of blood pressure, changes in lipid metabolism and inflammation markers, as well as the magnitude of the filtration function of the kidneys. This publication examined inflammatory markers, lipid metabolism, and renal function in 269 (136 males and 133 females) young, middle, elderly, and senile patients at high cardiovascular risk. It was shown that among the elderly, the frequency of overweight was 31%. The prevalence of obesity of the 1st degree was relatively higher in patients of middle (25,4%) and elderly (28,7%) age. In senile (62,5%) and young (48,3%) people, the most frequently recorded increase in heart rate was ≥80 beats per minute. The prevalence of arterial hypertension was 31,6% in young people and 59,4% in middle-aged people. The number of patients with hypertension increased among the elderly and senile participants, 68,9 and 62,5% respectively. Systolic blood pressure levels were higher in the elderly compared to young and old people. The diastolic blood pressure and hemoglobin levels were significantly lower among elderly patients. Levels of total cholesterol, cholesterol of low density lipoproteins and triglycerides were significantly higher in middle-aged people. Serum levels of tumor necrosis factor-alpha (TNF-α), as well as C-reactive protein, were significantly higher among elderly patients. A significant decrease in the filtration function of the kidneys was observed among elderly and senile patients.

[Modern biomarkers of renal dysfunction in the elderly and senile age: clinical and prognostic significance.]

In the presented work, the role of modern biomarkers of kidney dysfunction in elderly (n=97) and senile (n=18) patients was investigated. A clinical and laboratory examination was performed with an assessment of the glomerular filtration rate (GFR) using the CKD-EPI formula. Serum levels of cystatin C and metabolism of beta-2-microglobulin (ß2-MG) were assessed. In the presented sample, the prevalence of a decrease in GFR <60 ml/min was 30,4% of cases. The frequency of individuals with elevated serum cystatin C, depending on the GFR category (CKD-EPI), was as follows: C1 - in 79,9%; C2 - in 77,6%; C3A - in 74%; C3B - in 80,6%; C4 - in 100%; C5 - in 100%. An increase in the serum level of ß2-MG was observed in 51,8 and 58,4% of patients, respectively, on C1 and C2 gradations of renal function. An increase in urinary ß2-MG excretion was found in 40,7% of patients at C1 and 41,5% at C2 gradations of renal function. The number of patients who had elevated levels of ß2-MG excretion in the urine at C3B and C4 gradations of GFR reduction was 75 and 88,6%, respectively. At the terminal stage of CKD, almost every patient showed an increase in ß2-MG excretion in the urine. A statistically significant relationship between the metabolism of ß2-MG and the nitrogen excretion function of the kidneys was established. In elderly and senile people, the determination of serum levels of cystatin C and ß2-MG makes it possible to detect a decrease in the filtration function of the kidneys at an earlier stage compared with the assessment of GFR calculated from the level of blood creatinine. Elevated levels of cystatin C and ß2-MG are additional risk factors for cardiovascular complications.

[Functional state of kidneys and cardiovascular risk in patients with urolithiasis in an outpatient setting].

AIM: To analyze the functional state of the kidneys and vascular stiffness in patients with urinary stone disease in an outpatient setting. MATERIAL AND METHODS: A total of 110 patients with urinary stone disease aged 17-72 years were included in the study. The stone size was 2,67 (1,90-3,49) mm. A clinical examination included evaluation of vascular stiffness, serum level of creatinine, cystatin C, calcium, phosphorus, sodium, magnesium, uric acid and total cholesterol. The glomerular filtration rate (eGFR) was calculated based on the formulas CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) and MDRD (Modification of Diet in Renal Disease) and Hoek's equations using creatinine and cystatin C, respectively. RESULTS: Most often, urinary stone disease was associated with arterial hypertension (75%), a sedentary lifestyle (66.3%), hypercholesterolemia (53.6%), obesity (47.2%), hyperuricemia (44.5%) and smoking (40.9%). The median and interquartile range of eGFR according to CKD-EPI, MDRD and Hoek's equations was 100.00 (78.00;113.00) ml/min, 96.00 (71.00;106.00) ml/min and 77.65 (61.50; 93.60) ml/min, respectively. The normal GFR was significantly more often detected by the formula CKD-EPI (66.3%) in comparison with the Hoek's equations (52.7%), p<0.05. A decrease in mild GFR was found in 21 (19.0%) patients according to CKD-EPI and 33 (30.0%) according to Hoek's equations (p<0.05). In the subgroup of patients with a mild to moderate decrease in GFR according to the Hoek's equations, stiffness index and resistive index were significantly higher than in the similar subgroup of patients with decrease of GFR measured using the CKD-EPI formula (p<0.05). A negative correlation between GFR calculated using three formulas and Augmentation Index was established. CONCLUSIONS: In patients with urinary stone disease, potential cardiovascular risk factors are very common. The study of serum cystatin C level with calculation of GFR according to Hoek's equations in individuals with urolithiasis allows to evaluate total renal nitrogen excretion, as well as the level of the cardiovascular risk in the early stages of the disease.

The bi-directional effect of markers of inflammation and a decrease in glomerular filtration rate in chronic kidney disease.

The aim of the study was to analyze and evaluate the relationship between the cytokine profile, C-reactive blood protein, fibrinogen, and glomerular filtration rate in patients with chronic kidney disease. The study involved individuals (n = 816) with chronic kidney disease (CKD) from the 1st to 5th stage of the disease, aged 20 to 76 years. The male to female ratio was 48% and 52%, respectively. All examined individuals underwent a comprehensive clinical and laboratory study evaluating the concentration of interleukins (IL, IL-10, IL-6, TNF-α) and acute phase inflammation proteins (C-reactive protein, fibrinogen) in the blood. CKD categories were evaluated by glomerular filtration rate (GFR), which was calculated using the CKD-EPI formula (Chronic Kidney Disease Epidemiology Collaboration). In individuals with CKD, significantly high concentrations of IL-10 and IL-6 were observed at stage 3b of the disease. Systolic blood pressure, median TNF-α, blood fibrinogen, and the number of individuals with high CRP were significant at stage 4 of CKD. A statistically significant correlation was found between the estimated GFR with the level of IL-6, CRP, blood fibrinogen at the 2nd stage of the disease and the concentration of IL-10 at 3b and TNF-α at the 4th stage of CKD. At the initial stage of CKD, there is a significant relationship between a decrease in estimated GFR and an increase in the level of IL-6, IL-10, TNF-α, as well as an increase in CRP and blood fibrinogen, which becomes pronounced at stages 3b and 4 of CKD.

[Bidirectionality of cardiovascular risk factors in patients with urolithiasis: current state of the problem].

The most common risk factors for cardiovascular disease and urolithiasis are presented in the article. Data on the prevalence of urolithiasis are discussed, as well as the pathogenetic mechanisms of stone formation in patients with metabolic syndrome, dyslipidemia, and arterial hypertension. The bi-directional relationship of cardiovascular risk factors and urolithiasis is generalized. The role of calcium, uric acid, citrate, changes in urine pH and an increase in body weight in the formation of kidney stones is shown.

[Molecular mechanisms of aging: the role of oxidative stress and epigenetic modifications.]

Aging is a multifactorial process characterized by the gradual loss of physiological functions, which leads to increased vulnerability of the organism to age-related diseases and, finally, to death. To explain the nature of aging, several theories have been proposed, one of which relates aging to damage to cell structures and DNA caused by free radicals. However, an increasing amount of evidence suggests that molecular mechanisms of aging are also associated with epigenetic modifications, such as DNA methylation, non-coding RNA and histone changes. In this review, we will analyze the significance of the results of these studies and show how the interrelated effects of oxidative stress and epigenetics can explain the cause of the extinction of physiological functions during aging.

Hypolipidemic Therapy and Chronic Kidney Disease: Effects on Cardiovascular Risks and Renal Dysfunction.

Steady increase in the prevalence of chronic kidney disease (CKD) is a serious public health problem, since CKD potentially leads to the development of end-stage renal disease (ESRD) that requires high-cost replacement therapy and is closely associated with increased risk of developing cardiovascular diseases (CVD), which are the cause of death in most patients. Progression of renal dysfunction and development of CVD are significantly affected by hyper- and dyslipidemia. This review contains results of studies evaluating the effect of hypolipidemic therapy on reduction of cardiovascular risk and slowdown of renal dysfunction in patients with CKD at pre-dialysis and dialysis stages of renal failure, as well as in patients with kidney transplant. In addition, recommendations on nutrition and new therapeutic approaches to lipid-lowering therapy in patients with CKD, as well as prospects for the usage of new hypolipidemic drugs are also presented.

[Circulating microRNAs as potential biomarkers of chronic kidney disease].

Chronic kidney disease (CKD) is a supra - nosological term that reflects the progressive nature of chronic kidney diseases, which are based on the mechanisms of nephrosclerosis. Diagnosis of CKD at the earliest stages is of great importance, because it allows, by using therapeutic agents, to slow the progression of renal dysfunction and the development of cardiovascular complications. However, the currently available methods for diagnosing renal function impairment, including the determination of endogenous creatinine clearance, can detect renal dysfunction too late, when around 40-50% of the renal parenchyma is already reversibly or irreversibly damaged. In this regard, there is an active search for new, more sensitive and specific biomarkers for early diagnosis of CKD. Recent studies in cellular and animal models of CKD have demonstrated the important role of microRNA, a new class of posttranscriptional regulators of gene expression, in physiology and pathophysiology of kidneys. In particular, it has been shown that their expression profile in blood or urine can reflect changes in cells involved in a particular pathological process, since these cells can secrete a specific population of microRNAs, for example, through secretion of microRNA-containing exosomes. This gave grounds for considering increased or decreased expression of individual microRNAs in renal tissue or biological fluids (including urine) as new biomarkers for the diagnosis and monitoring of CKD. This review presents the results of recent experimental and clinical studies on these issues.

[The relationship of hypertriglyceridemia and left ventricular remodeling types in patients with chronic kidney disease].

AIM: To assess the relationship between hypertriglyceridemia (THG) and left ventricular remodeling types in patients with chronic kidney disease(CKD). MATERIALS AND METHODS: A total of 152 patients with CKD from stages 1 to 3 were examined, 98 of them with CKD without THG (subgroup 1) and 54 with CKD and THG. All patients were assessed for the parameters of anthropometry, hemodynamics, lipid spectrum, uric acid, calcium, C-reactive protein (CRP), and serum cystatin C measurement with calculation of glomerular filtration rate. The parameters of vascular stiffness (augmentation index and stiffness) and echocardiography are analyzed. RESULTS AND DISCUSSION: In the 2nd subgroup (CKD + THG), the number of patients suffering from type 2 diabetes, a stable form of coronary heart disease, gout, and their combination with hypertension, as well as cerebrovacular disorders and hyperuricemia was significantly higher compared with patients with CKD without GTG (p.

Pentoxifylline and nephroprotection: effects on renal dysfunction and cardiovascular risks.

Generalized data on nephroprotective efficacy of pentoxifylline in chronic kidney disease (CKD) are presented. The potential of this drug in treating people suffering from CKD and cardiovascular diseases (CVD) with a high risk of developing the terminal stage of renal dysfunction is considered. Antiproteinuric, antifibrotic and anti-inflammatory effects of pentoxifylline significantly reduce the risk of progression of CKD and joining of CVD in the future. Efficacy in preventing the onset of the uremic stage of CKD, safety andapplicability at all stages of renal dysfunction development make pentoxifylline a very appealing drug not only for nephrologists but also for physicians. Keywords: chronic kidney disease, progression, pentoxifylline, nephroprotection, cardiovascular diseases.

[Bilateral impact of cardiorenal relationships in the nephrotic syndrome.]

To study and analyze the cardiorenal relationships in nephrotic syndrome, taking into account sex differences. A total of 272 patients with nephrotic syndrome (NS) aged 16 to 65 years were examined. All patients underwent general clinical examination, electro-and echocardiography, assessment of peripheral and biochemical blood counts. NS was determined with daily proteinuria of more than 3.5 g/1.73 m2 per day, hypoalbuminemia (albumin less than 30 g/l) and hyperlipidemia (total cholesterol more than 5.1 mmol/l). The duration of the National Assembly ranged from 3 months or more. Depending on the gender, the total sample (n=272) was divided into two subgroups: the 1st subgroup - patients with female NS (n=88), the 2nd subgroup - males with NS (n=184). The mean systolic, diastolic, pulse and mean arterial pressure (BP) were significantly higher in male NS patients (p<0.05). Supraventricular and ventricular ectopic activity was significantly more common in males. In the subgroup of women with NA, sinus tachycardia was significantly more frequently detected, a slowing down of the impulse conduction along the bundle of His, a violation of the processes of repolarization of the LV (p<0.05). The final systolic and diastolic sizes of the left ventricle (LV), the thickness of the interventricular septum and the posterior wall of the left ventricle, the diameter of the aorta, the longitudinal size of the left atrium and the right ventricle were significantly larger in the group of males with NA. Significantly lower concentrations of hemoglobin, hematocrit, erythrocyte counts were observed in the subgroup of females with NS compared with men (p<0.05). In the cohort of men with HC, there was a significant decrease in the content of total serum protein (44.8±11.0 g/l versus 49.2±11.2 g/l; p=0.003) as compared with females. In the male subgroup of HC, serum creatinine concentration [97 (81;143) mmol/l versus 86 (68;123) mmol/l; p=0.005] and the degree of daily protein excretion [6,490 (4,865;9,661) g versus 5,585 (4,168;7,625) g; p=0.034] with urine were significantly higher compared with the female subgroup (Table 2). At the same time, in the cohort of men with HC, there was a significant decrease in the calculated GFR [62.3 (46.2; 114.9) ml/min versus 87.0 (67.7;127.5) ml/min; p=0.002]. In case of NS in females, factors of deterioration of cardiorenal interrelations are anemia, sinus tachycardia, slowing down of impulse conduction along the bundle of His. Whereas in the NA subgroup of men, negative factors of cardiorenal interrelations are hypoproteinemia, increased systolic, diastolic, pulse and mean blood pressure, creatinine concentration and daily proteinuria, which was accompanied by a decrease in glomerular filtration rate and an increase in the linear dimensions of the heart.

[Renal dysfunction and indicators of arterial hormity in persons of elderly and senile age.]

In the presented paper had been examined parameters of arterial stiffness (stiffness index, SI m/s; reflection index, RI%; augmentation index, Alp; biological age of the vascular system, VA years; age index, AGI; alternative stiffness index, aSI; index of increase in HP=75, Aiр 75%), central arterial pressure and cystatin C content in serum. A totally were examined 98 persons (women, n=45 and men, n=53) elderly and older. A comparative analysis of arterial stiffness and its relationship with blood cystatin C in the examined groups with gender differences taken into account. In the elderly and older women, the augmentation index and its increase at a pulse rate of 75, atherogenic lipids (total cholesterol, low-density lipoprotein cholesterol and serum triglycerides) were significantly higher, and the indicators of the alternative stiffness index were significantly lower compared to men elderly and older. The greatest number of correlation interrelations was found between the indices of arterial stiffness and the level of cystatin C in the group of women of elderly and senile age.

[Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis].

PURPOSE: to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. MATERIALS AND METHODS: We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. RESULTS: Atherosclerotic changes of CA were found in 79 patients (29.3 %). Four patients (1.4 %) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75 %; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25 % vs. 62.16 %; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. CONCLUSION: We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[The gender features of disorders of composition of lipids of blood serum in patients with chronic pathology of kidneys.]

The purpose of the study was to investigate gender features of abnormalities of blood serum lipid composition and their relationship with clinical and functional manifestations in patients with chronic kidney disease (CKD). The study covered patients with CKD at pre-dialysis stage of disease, aged 17 - 71 years (average age 37.3±13.0 years). All patients underwent complex clinical and laboratory examination. Depending on gender, the sample (n = 417) was divided into 2 groups: group I - males (n = 277) and group II - females (n = 140). Blood sampling was implemented using venipuncture of ulnar vein after 12-14 hours of fasting in morning time. The lipid analysis of blood serum was performed using the auto-analyzer "Respons 920" (Germany), including detection of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The atherogenic index (AI) was calculated according formula: AI = (TC - HDL-C)/HDL-C. At analysis of the results of lipidogram, the levels of TC (hypercholesterolemia), LDL-C (hyper-beta-cholesterolemia) and TG (hypertriglyceridemia) were considered as increased when their values were ≥5.0 mmol/L, ≥3.0 mmol/L and > 1.7 mmol/L respectively. The level of HDL cholesterol (hypo-alpha-cholesterolemia) was considered as decreased when its concentration was ≤1.0 mmol/L in males and ≤1.2 mmol/L in females. In the group of male patients, hypo-alpha-cholesterolemia was detected in 135 patients (48.7%), hypertriglyceridemia - in 162 (58.4%), and average value of atherogenic index was significantly higher - 3.49 (2.43-5.08) as compared with 3.12 (2.12-3.74) in female patients (p=0.001). The laboratory signs of anemia were significantly more frequent in group of females - 53 (37.8%) as compared with 63 (22.7%) than in males (p = 0.001). In males, average values of HDL cholesterol and total serum protein were significantly lower (1.07 ± 0.44 mmol/L vs. 1.23 ± 0.42, p = 0.000 and 53.3 ± 14.6 g/L vs. 57.4 ± 11.9 g/L, p = 0.007, respectively. The levels of TG - 1.92 (1.23-2.74) mmol/L vs. 1.85 (1.04-2.37); p = 0.034], sodium (140.3 ± 6.20 mmol/L vs. 138.3 ± 6.01 mmol/L, p = 0.010) and uric acid in blood serum were significantly higher (0.38 ± 0,09 mmol/L vs. 0.34 ± 0.01 mmol/L, p = 0.003) as compared with females. In the group II (females), a noticeable slowing of the glomerular filtration rate (GFR) - 68,4 (43,6-98,1) ml/min vs. 87,6 (55,0 - 117,6) ml/min; (p = 0.001) was detected as compared with group I (males). Among male patients, a reliably significant positive relationship was established between TC and BMI, level of diastolic blood pressure and proteinuria; LDL cholesterol level and proteinuria; concentration of TG - and BMI, level of diastolic blood pressure and level of proteinuria. No correlation was established between the concentration of HDL-cholesterol and aforementioned laboratory markers of CKD. In contrast with males, in females, TC demonstrated an inverse relationship with the concentration of Hb, values of GFR and proteinuria, and level of HDL cholesterol - with indices of BMI, thrombocytes and uric acid of blood serum. In females a positive relationship was established between LDL cholesterol and level of diastolic blood pressure, GFR and daily proteinuria, and also between concentration of serum TG and volume of daily proteinuria and BMI. In general group, a reliable positive relationship was detected between TC and BMI and proteinuria, between LDL-C level and proteinuria, and between TG concentration and BMI, level of diastolic blood pressure, sodium content and proteinuria. The negative relationship was established between concentration of HDL cholesterol and BMI and uric acid in blood plasma, and TG level with Hb concentration. In male patients with CKD at pre-dialysis stage of disease, decreasing of level of HDL cholesterol was established as an increased concentration of TG and increasing atherogenic index. The content of triglyceride of blood serum is closely related to body mass index, level of diastolic blood pressure and proteinuria. In females, slowing of glomerular filtration rate is accompanied by development of anemia and atherogenic dyslipidemia.

[Gender features of cardiovascular events in patients with chronic glomerulonephritis at the pre-dialysis stage of the disease]. / Polovye osobennosti serdechno-sosudistykh oslozhnenii u bol'nykh khronicheskim glomerulonefritom na preddializnoi stadii zabolevaniia.

AIM: To identify the gender differences of cardiovascular events in patients with chronic glomerulonephritis (CGN) at the pre-dialysis stage of chronic kidney disease (CKD). SUBJECTS AND METHODS: A total of 170 patients (median age 40±11 years) with CGN who did not receive hemodialysis were examined. According to gender, all patients were divided into 2 groups: 1) 66 female patients with CGN; 2) 104 male patients with CGN. All the patients underwent general clinical examination and transthoracic echocardiography. RESULTS: In the male group, body weight (70.2±12.3 vs 61.1±12.6 kg; p=0.000), daily proteinuria [2.286 (1.230-3.541) vs. 1.421 (0.703-2.408) g; p=0.021], aortic diameter (3.43±0.36 vs 3.15±0.32 cm; p=0.000), left atrial size (3.80±0.55 vs 3.52±0.49 cm; p=0.000), indexed left ventricular mass (LVM) (223.5±57.5 vs 205.5±54.6 g/m2, p=0.044) were significantly higher than those in the female group. Changes (atherocalcification) in the aortic valve structures were more common in the men than in the women (48% vs 22.7%; p=0.001), whereas the women were more frequently observed to have reverse blood flow along the right ventricle. CONCLUSION: In the men with CGN at the pre-dialysis stage of CKD, the increment in LVM index is associated with proteinuria and increases in right ventricle size, frequency of atherosclerotic changes in the aortic valve, and left atrial longitudinal size.

[Liver diseases: The pathogenetic role of the gut microbiome and the potential of treatment for its modulation]. / Bolezni pecheni: patogeneticheskaia rol' kishechnogo mikrobioma i potentsial terapii po ego moduliatsii.

The paper gives an update on the role of the gut microbiome (GM) in the development of nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, alcoholic liver disease, liver cirrhosis (LC), and its complications, such as hepatic encephalopathy (HE) and hepatocellular carcinoma (HCC), and discusses the possibilities of its correction with prebiotics, probiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT). The pathophysiology of the liver diseases in question demonstrates some common features that are characterized by pathogenic changes in the composition of the gastrointestinal tract microflora, by intestinal barrier impairments, by development of endotoxemia, by increased liver expression of proinflammatory factors, and by development of liver inflammation. In progressive liver disease, the above changes are more pronounced, which contributes to the development of LC, HE, and HCC. GM modulation using prebiotics, probiotics, synbiotics, antibiotics, and FMT diminishes dysbacteriosis, strengthens the intestinal mucosal barrier, reduces endotoxemia and liver damage, and positively affects the clinical manifestations of HE. Further investigations are needed, especially in humans, firstly, to assess a relationship of GM to the development of liver diseases in more detail and, secondly, to obtain evidence indicating the therapeutic efficacy of GM-modulating agents in large-scale, well-designed, randomized, controlled, multicenter studies.

[Endothelial dysfunction and arterial wall stiffness: New targets in diabetic nephropathy]. / Disfunktsiia éndoteliia i zhestkost' arterial'noi stenki: novye misheni pri diabeticheskoi nefropatii.

In recent years, one of the promising areas in clinical medicine is the study of impaired ments in endothelial function and arterial wall stiffness, which can be referred to as one of the important predictors of cardiovascular events in patients with chronic kidney disease, including that of diabetic etiology. There is strong evidence that endothelial function and great artery stiffness may be used as reliable clinical and instrumental indicators to evaluate the efficiency of therapeutic measures and the rate of progression of cardiovascular disorders in type 2 diabetes mellitus. The article presents data on the role of endothelial dysfunction and arterial wall stiffness in the progression of chronic kidney disease in type 2 diabetes mellitus and discusses the possibility of their correction with pharmacological agents.