Vol 17, No 4 (2025)

Objective. Evaluation of the efficacy of long-term use of epoetin alfa for the correction of anemia in patients on program hemodialysis (HD).

Material and Methods. A retrospective analysis of anemia treatment in patients on program HD was conducted. The study included patients treated with epoetin alfa in 0.25 ml syringes at a dose of 2500 IU.

Results. Over a 4-year follow-up period, mean hemoglobin, ferritin, and transferrin saturation levels increased statistically significantly, while the epoetin alfa dose and erythropoietin resistance index decreased statistically significantly.

Conclusion. The results of long-term use of epoetin alfa at a single dose of 2500 IU for the correction of anemia in dialysis patients demonstrated its high efficacy and safety. Maintaining optimal iron stores in the body is an important prerequisite for successful anemia correction.

Background. Acute kidney injury (AKI) is an independent predictor of poor outcomes in critically ill patients with multiple injuries, associated with a significant increase in mortality. The inertia of traditional markers of kidney function, particularly serum creatinine (sCr), determines delayed diagnosis and missed opportunities for preventive therapy.

Objective. Evaluation of the predictive value of serum cystatin C (sCyC) as an early biomarker for the development of AKI in patients with severe combined trauma (SCT) and to study the renoprotective potential of N-acetylcysteine (NAC) in this cohort of patients.

Material and methods. A total of 85 patients with SCT (Injury Severity Index (ISS)>16) were included in this randomized study. Patients were randomized to the intervention group (n=43), which received standard therapy plus NAC according to the protocol (loading dose of 150 mg/kg IV, then 50 mg/kg/day by continuous infusion for 72 hours), or the control group (n=42), which received standard therapy. sCyC levels, sCr, estimated glomerular filtration rate (CKD-EPIcr, CKD-EPIcys), markers of tissue damage (creatine phosphokinase, lactate dehydrogenase, myoglobin), and inflammation (C-reactive protein, procalcitonin) were determined at admission (T0), 24 (T1), 48 (T2), and 72 (T3) hours. The primary endpoint was the development of acute kidney injury (AKI) according to KDIGO criteria within 7 days.

Results. AKI developed in 28 (32,9%) patients. An increase in sCyC >1,5 mg/L at T1 demonstrated high predictive value for subsequent manifestation of AKI (sensitivity 92,9%, specificity 89,5%, AUC 0,94; 95% CI 0,88–0.99), while sCr at T1 was non-predictive (AUC 0,62; 95% CI 0,51–0,73). Multivariate regression analysis revealed that the sCyC level at T1 (OR=4,8, 95% CI 2,1–10,9; p<0,001) and the presence of shock on admission (OR=3,2, 95% CI 1,4–7,3; p=0,006) are independent predictors of AKI. The NAC group demonstrated a significant reduction in the incidence of stage 2–3 AKI (9,3% vs 28,6%; p=0,024), the need for renal replacement therapy (RRT) (2,3% vs 14,3%; p=0,045), as well as lower median sCyC values (1,9 mg/L vs 2,8 mg/L; p=0,018) and ICU length of stay (12 days vs 16 days; p=0,038).

Conclusion. sCyC is a highly accurate and early predictor of AKI in patients with SCT, preceding creatinine dynamics by 24–48 hours. Early preventive administration of N-acetylcysteine is associated with a statistically significant reduction in the incidence and severity of acute kidney injury (AKI), the need for RRT, and demonstrates a pronounced nephroprotective effect, justifying its inclusion in complex treatment regimens for polytrauma.

Background. Among childhood kidney diseases, nephrotic syndrome (NS) occupies a special position. This is a group of symptoms characterized by severe proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The incidence of NS in pediatric nephrology remains significant, and research on the formation of nephrotic edema and its treatment continues. The fact that the literature often discusses the relationship between edema syndrome and the morphological type of the disease and sodium retention by the kidneys once again confirms the relevance of the problem.

Objective. Evaluation of the role of renal sodium retention in overcoming edema syndrome in children with nephrotic syndrome.

Material and methods. The survey of 487 children aged 3 to 18 years, including 208 boys and 279 girls, who received treatment with a diagnosis of nephrotic syndrome, was conducted in the Nephrology Department of the Children's National Medical Center from 2021 to 2024. The average age of the children was 11.7 years. The diagnosis of NS was made in all children based on clinical edema syndrome, massive proteinuria (more than 3 g/L per day), hypoalbuminemia and hypercholesterolemia.

Results. The results of the study revealed that fractional excretion of sodium (FENa) was 0.40±0.35%, UNa/Ucrea in children from the control group was 9.04±6.76, UK/UNa+UK – 041±017. These indicators were taken as a standard for patients in the NS group who eat dietary products with a low sodium content. In patients in the steroid-dependent nephrotic syndrome (SDNS) group, FENa (0.09±0.09%) was very low, UNa/Ucrea (2.83±3.31) was the lowest, and UK/UNa+UK (0.76±0.06) was the highest. These markers were significantly different from the markers of other cohorts (p<0.01). During the treatment, 1 patient developed edema syndrome, this indicator was 0.6 (0.42) against the background of low FENa and UK/UNa+UK indicators reaching 0.1 and 2.68%, respectively.

Conclusion. The revealed differences in ultrasound parameters are combined with differences in the urine excretion of electrolytes: in children with steroid-resistant NS, the fractional excretion of sodium is significantly higher, and the potassium content in the urine is lower than in children with SDNS, which confirms the prevalence of a hypervolemic state in the first group and a hypovolemic state in the second ones.

Objective. Evaluation of the rate of progression of chronic kidney disease (CKD) and identification offactors influencing disease progression in residents of the Far North.

Materials and methods. The study analyzed clinical and laboratory data from 243 CKD patients from the outpatient department of the Noyabrsk Central District Hospital, Yamalo-Nenets Autonomous Okrug, Tyumen Region. Clinical, laboratory, and instrumental parameters were examined. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula.

Results. The highest rates of CKD progression after 18 months of follow-up were observed in patients aged 45–59 years, in patients with type 2 diabetes mellitus (DM2), in patients with more advanced stages of the disease (C3b–C4), and in patients with poor treatment adherence. Independent predictors of progressive disease progression included creatinine levels greater than 125.4 μmol/L, uric acid levels greater than 0.43 μmol/L, and decreased hemoglobin levels (a 10 g/L decrease increases the likelihood of progression by 17.5%). Signs of accelerated disease progression included age over 74 years, microalbuminuria greater than 287 mg/day, and pulmonary artery systolic pressure greater than 44 mmHg.

Conclusion. The identified signs of progressive and rapidly progressive CKD can be used in the clinical examination of patients living in the Far North.

Hypothyroidism (HT) is a clinical and laboratory syndrome caused by dysfunction of the thyroid gland (TG) and characterized by a polysyndromic course, especially in the clinical practice of internal medicine. By origin, there are primary, secondary and tertiary HT, by severity - subclinical, manifest (compensated and decompensated) and complicated HT. HT may be masked by various clinical syndromes: cardiovascular, gastrointestinal, neurological, rheumatological, hematological, gynecological and mental. Primary HT occurs in 95% of cases, most often caused by autoimmune thyroiditis or thyroid surgery. HT is especially common among elderly women. Manifest HT is accompanied by an increase in the level of thyroid stimulating hormone (TSH) and a decrease in the level of free thyroxine (fT4); subclinical HT is characterized by an increased level of TSH with normal fT4. HT is considered severe with a TSH level above 10.0 mIU/L, regardless of the fT4 level. HT is often accompanied by a decrease in renal blood flow and glomerular filtration rate (GFR); an inverse relationship has been established between the TSH level and GFR. In the presence of chronic kidney disease (CKD), the incidence of HT increases. Risk factors for CKD in patients with HT include hypercholesterolemia, dyslipidemia, hyperuricemia, elevated C-reactive protein and fibrinogen levels, and decreased blood albumin levels. The goal of replacement therapy is to achieve and maintain normal levels of TSH and thyroid hormones. The drug of choice for the treatment of HT is sodium levothyroxine (starting with doses of 12.5–75 mcg/day). In elderly patients with CKD and concomitant cardiovascular diseases, monotherapy with low doses of levothyroxine with gradual titration is preferable. It should be taken into account that in elderly individuals, the physiological level of TSH may be slightly higher than in young people, which determines the individualization of the target TSH level.

Description of the clinical case. The article presents a clinical case of decompensated manifest HT in an elderly patient after subtotal thyroid resection. The relationship between anemia, cholelithiasis, hydropericardium and episodes of acute kidney injury with severe postoperative HT is demonstrated. HT in elderly patients often occurs latently against the background of comorbid pathology, which requires special alertness of the physician and timely correction of hormonal levels.

Treatment of malignant neoplasms in kidney transplant recipients has distinctive features compared to the non-transplant population. When a tumor is detected in recipients, immunosuppressive therapy is reduced or modified to enhance the natural immune system, followed by treatment. However, some medications that are standard in the non-transplant population are not used or are used only to a limited extent due to the increased risk of kidney graft rejection. The risk of graft rejection, difficulties in therapy, and small patient samples mean that some issues related to cancer treatment in kidney transplant recipients remain controversial and under study.