Improving medical standards of care to children of an early and preschool age with urinary tract infections at the primary care stage

Timely diagnosis, prognostic value of clinical signs and further treatment of patients of an early age with urinary tract infections (UTI) during outpatient stage are important constituents of an integrated management of patients in childhood. The article deals with new approaches concerning clinical algorithm in diagnosis of urinary tract infections in children. The algorithm of diagnostic and therapeutic measures for providing care to children under 5 years of age with urinary tract infections, in particular at the stage of primary care, includes: diagnosis of urinary tract infection in young children using The Diagnosis of Urinary Tract infection in Young children, patient’s examination by Gorelick Scale and UTIcalc, imaging methods with mandatory ultrasound of the kidneys and bladder, micturating cystogram after the first episode of infection in boys and the second — in girls, the prescription of antibiotic therapy based on data from regional monitoring of antibiotic resistance of the main groups of uropathogens, monitoring antibiotic resistance using electronic means and the implementation in microbiological laboratories of the guidelines of the European Committee on Antimicrobial Susceptibility Testing, as well as introduction of the prescription sale of antibiotics.

Uromodulin as a potential candidate marker for predicting the course of chronic kidney disease

Uromodulin is a nephrospecific protein that is most common in normal urine. And although it has been known for more than 70 years, the function of uromodulin remains unclear. Uromodulin is involved in regulating the transport of salts, protects against urinary tract infections, namely, the mucous membrane of the bladder, and prevents the formation of kidney stones, as well as plays a role in kidney damage and innate immunity. Serum uromodulin and uromodulin of urine, daily excretion and excretion of uromodulin per 1 milliliter of creatinine clearance are actively studied. Complete genome studies of the association have established a correlation between uromodulin gene mutations and autosomal dominant tubulointerstitial kidney disease.

Cyclosporine A nephropathy, its pathogenesis and management

CsA, obtained from a fungus called Tolypocladium inflatum came into medical use in 1983. Organ transplants have shown great success after the use of Cyclosporine, especially in 3- and 5-year graft survival. However, nephrotoxicity seen in the early and late periods complicates its use. It is very important to distinguish especially early toxicity from rejection attacks; because the treatments of both processes are completely different. While vasocostriction in the renal artery system is prominent in the early period, the underlying factor for late toxicity is the thickening of the arteriolar intima and the consequent decrease in tissue oxygenation. The article discusses the variants of toxicity caused by the use of cyclosporin A. Morphological changes with the use of cyclosporin A are shown in rat models. The results of our own observations on the use of prostaglandin, which demonstrated the effect of vasodilation, are also presented, which can probably be used for further studies in order to reduce the nephrotoxicity of cyclosporin A. In particular, we found that PGE2 significantly reduced vasoconstriction and reduced the toxic effect due to CsA. The limitations was the usage of these agents once, so we couldn’t continue and only gave them intravenously. However, the results obtained were found to be significant.

The opportunity of stem cells application in kidney transplantation: clinical studies (review)

Kidney transplantation remains the optimal method of end-stage renal disease treatment, but the result of such ope­rations depends on the immune response of the recipient to the transplanted organ. Side effects of modern immunosuppressive drugs, such as nephrotoxicity, opportunistic infection, and increased risk of cancer, negatively affect the long-term results of transplantation. In recent years, studies of the properties and uses of stem cells have aroused considerable interest and expectations. The biological characteristics of stem cells, inclu­ding multi-row differentiation, self-guidance, paracrine effects, immunomodulation, ability to suppress the immune response against graft, have opened new horizons for their use in kidney transplantation, but according to different studies, the safety and effectiveness of stem cells clinical use remain controversial. The use of stem cells in animal models with renal failure shows better results in the postoperative period and provides an opportunity for clinical research in the context of creating alternative induction therapy in kidney transplantation. The preclinical efficiency of stem cells in the chronic renal failure model and renal allotransplantation in laboratory animals showed their unique potential to improve function and repair the damaged kidney. They also demonstrate immunosuppressive effects that realize in the inhibition of T-cell proliferation and dendritic cells maturation, the induction of Т-regulatory cells, which can improve the long-term results of kidney allotransplantation. This review summarizes the results of previous studies and is aimed to provide an objective point of view based on a comprehensive analysis of currently known advantages and disadvantages of stem cell therapy in kidney transplantation and highlights aspects that require further research.

Changes in renal function in patients with hypertension and chronic obstructive pulmonary disease according to retrospective analysis of medical records

Background. Hypertension determines both the social and economic component of the impact on the health of the population with a tendency to a significant increase in this pathology rate. Another common disease that can be prevented and treated is a chronic obstructive pulmonary disease (COPD). The concept of comorbidity implies the formation of relationships and interactions due to the common pathogenetic mechanisms, namely chronic inflammation, oxidative stress, and endothelial dysfunction. Hypertension is both a cause and a consequence of chronic kidney disease (CKD) and contributes to its progression. Patients with COPD have a higher risk of comorbidities. Aim. To study the dynamics of renal function and frequency of CKD development in patients with hypertension and COPD based on the retrospective analysis of case reports and outpatient medical records. Materials and methods. According to the criteria of inclusion and exclusion from the study, 188 patients were selected, which were divided into three groups by the clinical diagnosis: group 1 consisted of 64 patients with hypertension, group 2 — 58 patients with hypertension and chronic obstructive pulmonary disease, and group 3 — 66 patients with chronic obstructive pulmonary disease. The average age of patients with hypertension was 61.0 (57.0; 72.0) years, patients with hypertension and COPD — 62.3 (11.5), the average age of patients with COPD — 58.5 (55.0; 62.00). The physical examination, the laboratory tests of blood and urine were analyzed in all patients by studying the case reports and outpatient medical records. The obtained results were processed using biostatistical methods (Statistica v.6.1). Results. Important significance between the frequency of anemia in patients was not found, but there was a tendency to increase in anemia frequency in hypertensive patients — 14.1 % and in the comorbidity of hypertension and COPD — 8.6 %. The lowest incidence of anemia was recorded in patients with COPD and was 7.6 %. The level of total cholesterol in the respective groups did not differ statistically and was equal to 4.8 (4.2; 5.3), 4.7 (4.0; 5.4), and 5.3 (4.5; 5.9) mmol/l. The highest values ​​of total blood cholesterol were determined in patients with hypertension and chronic obstructive pulmonary disease. The highest level of blood creatinine was determined in patients with hypertension and COPD, and the lowest — in patients with COPD. Thus, the patients with hypertension had the lowest GFR and the patients with COPD had the highest one. Conclusions. COPD has a tightening effect on the renal function of patients with hypertension and leads to an increase in blood creatinine levels with statistical significance. Also, in the group of patients with hypertension and comorbid pathology, a higher incidence of anemia was registered than in the group of patients with COPD. But, in turn, the filtration function of the kidneys, which was determined by GFR, was the lowest in hypertension.

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

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Appeal of Editor-in-Chief

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2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction

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Renoprotective opportunities of Lespedeza capitata in patients with chronic kidney disease and type 2 diabetes mellitus

Background. Today, issues of renoprotection have gone beyond the use of antihypertensive therapy alone. Stable glucose-lowering and urate-lowering therapy are integral parts of modern renoprotection, which improve the functional state of the kidneys by increasing the glomerular filtration rate (GFR) and reducing the albumin excretion rate (AER) and the albumin-to-creatinine ratio (ACR). Nevertheless, hypoazotemic therapy aimed at reducing the content of nitrogenous wastes remains the leading component of the treatment of patients with chronic kidney disease (CKD). The aim of the study is the assessment of the renoprotective potential of the drug Libera (Lespedeza capitata) in patients with CKD stages 2–3 on the background of type 2 diabetes mellitus (DM). Materials and methods. The study included 107 patients with type 2 DM, aged 19 to 75 years (female — 41.1 %, male — 58.9 %), CKD stages 2–3, micro- and macroalbuminuria (category A2 and A3). The patients were divided into two groups: group I — traditional stable glucose-lowering and antihypertensive therapy (n = 50) and group II — traditional stable glucose-lowering and antihypertensive therapy in combination with Libera (Lespedeza capitata) (n = 57), which was prescribed 1 capsule t.i.d. regardless of food intake for 3 months. The criteria for the effectiveness of treatment were dynamics of GFR, AER/ACR in daily urine. The observation period for the patients was 3 months. Results. The renoprotective potential of Lespedeza capitata (Libera) was demonstrated after 3 months of treatment in the form of a significant increase in GFR in patients with CKD stage 2 in group II up to 79.0 ± 1.4 ml/min/1.73 m2 in comparison with the initial data (p < 0.01) and the results obtained in group I after 3 months of using only traditional stable glucose-lowering and antihypertensive therapy (p < 0.05). The use of Libera in the complex treatment of patients of the II group with CKD stage 3 against the background of type 2 DM for 3 months had a positive effect on nitrogen and water excretory kidney function, which manifested itself in an improvement in GFR to 56.6 ± 2.1 ml/min/1.73 m2 in comparison with the initial data (p < 0.05) and the results obtained in group I — 50.8 ± 1.9 ml/min/1.73 m2 (p < 0.05). In group I with traditional stable glucose-lowering and antihypertensive therapy, only 3 patients (9.1 %) transferred from category A2 to category A1 (normoalbuminuria) after 3 months and 2 patients (11.8 %) from category A3 to category A2. In group II, the appointment of Lespedeza capitata (Libera) in combination with stable glucose-lowering and antihypertensive therapy facilitated the transfer of 10 patients (27.8 %) from category A2 to A1 and 7 patients (33.3 %) from category A3 to A2 (p < 0.001). Conclusions. Lespedeza capitata (Libera) in combination with traditional stable glucose-lowering and antihypertensive therapy contributes to the preservation and improvement of the filtration function of the kidneys, a decrease in AER/ACR in patients with CKD stage 2–3 (3a і 3b) against the background of type 2 DM and proves renoprotective efficiency and safety.

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics)

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