Vol 91, No 6 (2019)


Russian Therapeutic School: D.D. Pletnev, A.L. Myasnikov, E.I. Chazov

Chuchalin A.G.


Данная статья написана к 90-летию со дня рождения академика Российской академии наук, Героя Социалистического Труда СССР, лауреата Нобелевской премии мира Е.И. Чазова. Деятельность Е.И. Чазова многогранна; в этой статье автор хотел бы привлечь внимание читателя к школе терапевтов, представителем которой является Евгений Иванович.
Terapevticheskii arkhiv. 2019;91(6):4-7
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Academician E.I. Chazov’s contribution to cardiology

Oschepkova E.V.


10 июня 2019 г. Евгению Ивановичу Чазову - ученому с мировым именем - исполняется 90 лет. С позиций сегодняшнего дня многогранная деятельность Евгения Ивановича на протяжении долгого времени все ярче вырисовывает его огромную роль в создании отечественной кардиологии, достойно обеспечивая преемственность принципов отечественной медицины его выдающихся учителей, в первую очередь - академика Александра Леонидовича Мясникова.
Terapevticheskii arkhiv. 2019;91(6):8-10
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Recent advances in diagnosis and management of atrial fibrillation

Mironov N.Y., Laiovich L.Y., Mironova E.S., Sharf T.V., Aparina O.P., Mironova N.A., Stukalova O.V., Yuricheva Y.A., Sokolov S.F., Novikov I.A., Maykov E.B., Pevzner A.V., Golitsyn S.P.


Alterations of heart rhythm are a common clinical event. They can be caused by almost any kind of heart disorder. Atrial fibrillation (AF) is the most common type of abnormal heart rhythm. Prevalence of AF in the general population is 1-2%, and given that AF incidence rate continues to increase it can be predicted that the number of patients will be doubled within the next 50 years. This review provides the most recent diagnostic and treatment methods, including both unique domestic antiarrhythmic drugs and non - drug methods for AF treatment which were developed and implemented in clinical practice at NMRC of Cardiology of the Ministry of Health of the Russian Federation.
Terapevticheskii arkhiv. 2019;91(6):11-18
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Antithrombotic therapy of coronary heart disease: time - tested essential principles

Panchenko E.P.


History of antithrombotic therapy in cardiology has almost 70 years, and it is undoubtedly the importance of the achievements of Soviet scientists. The creation of a domestic thrombolytic fibrinolysin at MSU G. V. Andreenko, its first successful application in patients with myocardial infarction (MI), conducted by E. I. Chazov, and then by other domestic researchers, played a crucial role in proving the need for a quick restoration of the patency of infarct related artery. The world's first intracoronary thrombolysys, conducted by E. I. Chazov, together with the staff of the all-Union cardiological center, allowed to verify thrombosis as the cause of MI and demonstrate the effectiveness of thrombolytic therapy. One of the most important achievements of domestic researchers of the 60s of the last century was the understanding of the need not only to eliminate the thrombus by using of fibrinolysin, but also to prevent its recurrence, with administration of heparin with transition to VKA. This conclusion, in fact, is a statement of the need for long - term antithrombotic therapy in patients with сoronary artery disease (CAD). Over the past 70 years, antithrombotic therapy in CAD has undergone significant changes, this was facilitated by the undoubted progress in understanding the mechanisms of atherosclerosis and thrombosis development. Nevertheless, the basic principles of antithrombotic therapy, laid down by the national school in the 60s of the last century, have survived.
Terapevticheskii arkhiv. 2019;91(6):19-24
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The evolution of myocardial infarction treatment over the past decades. The significance of E.I. Chazov works

Shakhnovich R.M., Ruda M.Y.


The review is a brief historical insight into the study of myocardial infarction, in which the main discoveries are analyzed that have played an important role in improving the diagnosis and treatment of the disease. A special place in the review is occupied by the work of the outstanding cardiologist and health care organizer E.I. Chazov. More than the half - age, E.I. Chazov investigated various aspects of myocardial infarction, organized a system of medical care for heart attack at all stages. Many studies E.I. Chazov are recognized worldwide.
Terapevticheskii arkhiv. 2019;91(6):25-33
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Burden, access, and disparities in kidney disease

Crews D.C., Bello A.K., Saadi G.


For the World Kidney Day Steering Committee Kidney disease is a global public health problem that affects more than 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries. These disparities exist across the spectrum of kidney disease - from preventive efforts to curb development of acute kidney injury or chronic kidney disease, to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.
Terapevticheskii arkhiv. 2019;91(6):34-39
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Predictors of clinical events in patients with Fabry disease: the role of chronic kidney disease

Moiseev S.V., Karovaikina E.A., Bulanov N.M., Moiseev A.S., Fomin V.V.


Fabry disease is a rare disorder characterized by high frequency of severe organ manifestations in young patients. Aim. To determine predictors of clinical events in patients with Fabry disease. Materials and methods. We recruited 100 adult (over 18 years) patients with Fabry disease that was confirmed by enzymatic and genetic studies. The main outcome was a composite of end - stage renal disease, cardiac (arrhythmia and cardioverter/pacemaker implantation) and cerebrovascular (transient ischemic attack, stroke) events. Kaplan-Meier analysis was performed for event - free survival. Cox regression model was used to examine the risk of composite endpoint. Results and disscussion. Forty - seven of the 100 patients (38 males and 9 females) experienced clinical events. The median age of the first event was 39 [32; 49] years. In Kaplan-Meier analysis, the age of the first event was significantly lower among men than women, (p<0.0001), patients with decreased glomerular filtration rate (eGFR) at the time of first detected kidney involvement (p=0.002) and patients with proteinuria (p<0.0001). Using Cox regression analysis, eGFR<60 ml/min/1.73 m2 (HR 3.79, 95% CI 1.87-7.66, p<0.0001), high proteinuria (HR 1.29, 95% CI 1.04-1.59, p=0.022) and increased left ventricular myocardial mass index (LVMMI, HR 1.01, 95% CI 1.002-1.02, p=0.015) were associated with greater risk of developing a composite event after adjustment for gender and age. Eleven males were died. All deceased patients had end - stage renal disease. High proteinuria (HR 1.57, 95% CI 1.05-2.35, p=0.029) and increased LVMMI (HR 1.006, 95% CI 1-1.012, p=0.038) were predictors of death after adjustment for gender, but lost its effect on event occurrence after adjustment for hemodialysis duration. The type of mutation in the GLA gene was not a predictor of clinical events. Conclusion. Chronic kidney disease was an important risk factor of clinical events. Increased LVMMI and high proteinuria were both predictors of death and composite event. Estimated GFR lower than 60 ml/min/1.73m2 at the time of first detected kidney involvement was also associated with greater risk of developing a composite event.
Terapevticheskii arkhiv. 2019;91(6):40-46
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Low protein diet with essential amino acids ketoanalogues combination can affect serum FGF-23 and Klotho levels in chronic kidney disease 3b-4 stages patients: randomized pilot study

Milovanova L.Y., Kozlovskaya(Lysenko) L.V., Androsova T.V., Lebedeva M.V., Taranova M.V., Milovanova S.Y., Kondratyeva T.B., Zubacheva D.O., Tchebotareva N.V., Kozlov V.V., Kuchieva A.M., Li O.A., Reshetnikov V.A.


Protein restriction diet (PRD) with ketoanalagues of essential amino acids (KA) combination can improve of chronic kidney disease (CKD) course while, the precise mechanisms of PRD + KAA action in CKD are not known yet. We have conducted a prospective, randomized, controlled study of PRD and KAA patient’s group in compare with PRD without KAA group in regarding to serum Klotho and FGF-23 levels in patients with CKD. Materials and methods. The study included 79 CKD 3b-4 stages patients, non - diabetic etiology, used PRD (0.6 g/kg/day). The patients were randomized in two groups: 42 patients, received PRD + KAA (Group 1) and 37 patients continued the PRD without KAA (Group 2). Serum FGF-23 (Human FGF-23 ELISA kit with antibodies to native FGF-23 molecule, Merk Millipore MILLENZFGF-23-32K), Klotho (Human soluble Klotho with antiKlotho monoclonal antibodies, IBL-Takara 27998-96Well) levels, as well as instrumental examination: bioimpedance analysis [assess of muscle body mass (MBM), fat body mass (FBM), body mass index (BMI) and others]; sphygmography [assess of augmentation (stiffness) indices (AI), central (aortal) blood pressure (CBP) by «Sphygmacor» device]; as well as echocardiography [assess of cardiac (valvular) calcification score (CCS) and left ventricular myocardium mass index (LVMMI)], were studded in addition to conventional examination. Results and discussion. To the end of 14th month of the study the PRD group reached a body mass index (BMI) decrease (p=0.046), including MBM in men (p=0.027) and woman (p=0.044). In addition, higher FGF-23 (p=0.029), and lower Klotho (p=0.037) serum levels were revealed in the PRD group compared to the PRD+KAA group as well as the increase in AI (p=0.034), CCS (p=0.048), and LVMMI (p=0.023). Conclusion. Use of PRD + KAA provides adequate nutrition status and more efficient correction of FGF-23 and Klotho imbalance in CKD progression that may contribute to alleviation of both cardiovascular calcification and cardiac remodeling in CKD. Importantly, a prolonged PRD use without supplementation of KAA may lead to malnutrition signs.
Terapevticheskii arkhiv. 2019;91(6):47-56
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Clinical and pathologic features of nephropathy with C1q deposits

Chebotareva N.V., Vinogradov A.A., Grishina A.N., Kozlovskaya(Lysenko) L.V., Varshavsky V.A.


Aim. To determine the frequency, clinical and morphological features of a nephropathy with C1q deposits in chronic glomerulonephritis adult patients. Materials and methods. 296 specimens of kidneys of patients with a chronic glomerulonephritis (CGN) from 2014 for 2018 were analyzed. At the first step, specimens with C1q deposits in glomeruli revealed by immunofluorescent method were chosen. Lupus nephritis and primary membranoproliferative glomerulonephritis were exclusion criteria. At the second step, the retrospective analysis of the clinical characteristics was carried out. Results and discussion. Deposits of C1q in kidneys at 12 of 296 (4.05%) CGN were revealed, m:f ratio 2:1. Average age of the beginning of a disease was 32.1±14.7 years. At a morphological research in 8 membranous nephropathy (MN), in 2 mesangioproliferative glomerulonephritis (MesPGN), in 2 - nephrosclerosis was revealed. Among 12 patients in 5 the disease debuted a nephrotic syndrome, at the others - a proteinuria from 0.5 to 4.0 g/days with the subsequent formation of a nephrotic syndrome. In 5 of 12 patients the disease was characterized by a favor course with preserved kidney function. At 7 patients at the time of inspection decrease in function of kidneys [glomerular filtration rate (eGFR) 31 (30-34) ml/min] was noted. 5 had slow progressing of a renal failure. 2 of 12 progressed to renal failure (eGFR to 19 and 24 ml/min) within a year. Conclusion. Deposits of C1q in kidney were revealed in 4.05% of biopsy specimens in CGN. The most frequent morphological form was the membranous nephropathy. The clinical course was characterized by a nephrotic syndrome, more than at a half of patients - with renal dysfunction.
Terapevticheskii arkhiv. 2019;91(6):57-61
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Factors associated with a reduction in glomerular filtration rate in patients with chronic obstructive pulmonary disease

Bolotova E.V., Dudnikova A.V.


Aim. Analysis of factors associated with reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. The study included 198 patients with COPD 1-4 degrees of severity (GOLD 2014), who were on examination and treatment in Krasnodar Regional clinical hospital № 2. The control group consisted of 28 healthy volunteers, comparable in age and sex. In addition to clinical research, all patients, we calculated GFR according to the formula CKD-EPI based on cystatin C serum (GFRcys). The contribution of the factors in the risk of developing CKD was determined using multivariate linear regression analysis, as dependent variable used the value of GFRcys. Results and discussion. It was found that more than half (51.5%) of patients with COPD have a decrease in GFRcys <60 ml/min/1.73 m2, which is the basis for the diagnosis of CKD without laboratory and instrumental studies. During the regression analysis with direct step - by - step inclusion of the selected variables, the independent factors associated with a decrease in GFR in COPD patients were determined: the value of FEV1, SpO2, the number of points on the mMRC scale, the level of C-reactive protein, fibrinogen, and the smoker index. The high incidence of CKD in patients with COPD (51.5%), as well as the correlation between the presence of renal dysfunction and the severity of COPD were revealed. The influence of clinical and diagnostic parameters of COPD severity on the development of renal dysfunction was confirmed.
Terapevticheskii arkhiv. 2019;91(6):62-66
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Modern approaches to the detection of monoclonal gammopathy of undetermined significance (MGUS) in patients with kidney diseases

Kozlovskaya(Lysenko) L.V., Chebotareva N.V., Mrykhin N.N., Rameev V.V., Androsova T.V., Roshchupkina S.V., Maryina S.A., Kogarko I.N., Kogarko B.S.


Monoclonal gammopathy (MG) is not only the state preceding of hematological neoplasms, but also associated with non - hematological diseases, in particular kidney damage. Aim. To assess the diagnostic value of “Freelite” methods in addition to electrophoresis (EF) and immunofixation (IF) of serum and urine proteins for detecting MG in patients with kidney diseases. Materials and methods. 87 patients with kidney damage, in which MG was established using the method of electrophoresis of serum proteins (EF), immunofixation (IF) and the method of free light chains determination - FLC “Freelite” were selected. The diagnostic value of three - component serum panel was compared with EF and IF. Results and discussion. AL-amyloidosis with kidney involvement was diagnosed in 41% patients, cryoglobulinemic glomerulonephritis (cryo GN) - in 18%, chronic glomerulonephritis (CGN) - in 35%, also there was small number of patients with light chain disease and cast - nephropathy. Determination of MG using EP was possible only in 38 (44%). Adding to the serum electrophoretic methods instead of the “Freelite” method, the urine EF and IF reduced the number of missed patients with monoclonal gammopathy from 24 (27%) to 11 (13%), including in the subgroup of patients with AL-amyloidosis but did not reach the sensitivity of the three - component serum screening panel. In 10 (11.5%) MG was represented only by intact mIg with one type of light chain, either κ or λ. Most often - in 25% of patients, intact monoclonal gammopathy was observed in HCV (+) cryo GN. A combination of intact mIgM, mIgG or mIgA with mFLC, was detected in 37 (42.5%). In almost half (46%) of the patients, only mFLC was detected - an abnormal κ/λ ratio. Conclusion: The serum screening panel EF + IF + “Freelite” spreads the low - grade monoclonal gammopathy recognition (MGUS) and should be included in the algorithm of examining patients with kidney disease.
Terapevticheskii arkhiv. 2019;91(6):67-72
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Polyvascular disease in patients with myocardial infarction and chronic kidney disease

Karetnikova V.N., Kalaeva V.V., Evseeva M.V., Gruzdeva O.V., Zykov M.V., Kashtalap V.V., Barbarash O.L.


Aim. To study polyvascular disease in patients with myocardial infarction (MI) and chronic kidney disease (CKD). Materials and methods. A total of 954 patients older than 18 years old with ST-segment elevation MI (STEMI) up to 24 hours of pain onset were included in the study. Clinical and demographic data were collected for all patients, including physical examination, 16-lead electrocardiogram recording, echocardiography, laboratory assessment with the measurements of cardiospecific enzymes and serum creatinine. Glomerular filtration rate (GFR) was estimated according to the CKD-EPI equation. Of them, 771 (81%) underwent coronary angiography, duplex scanning of the brachiocephalic (BCA) and lower extremity arteries (LEA). Patients with stage 1-4 CKD diagnosed according to the criteria provided by the Russian Society of Nephrologists were allocated into a separate group (n=281; 36.5%). CKD stages were determined with the level of GFR. Patients with stage 5 CKD were excluded from the study. Renal dysfunction was defined as the presence of an estimated GFR less than 60 ml/min/1.73 m2. Results and discussion. The results of the study indicate a high prevalence of PolyVD in patients with CKD. Every second patient had LEA stenosis (p<0.001), and every fifth patient had multiple arterial bed lesions (≥3 arterial beds; p=0.018), multiple coronary artery disease (p<0.001), independently from kidney function. Patients with stage 1 and 2 CKD commonly had hemodynamically insignificant arterial stenoses (<30%; p=0.036), whereas stage 3 and 4 CKD patients had significant stenotic lesions (p<0.05). Patients with stage 3 and 4 CKD more frequently suffered from three and more arterial bed lesions (p=0.030). Logistic regression reported that renal dysfunction (stage 3 CKD and above) was considered as an independent predictor of PolyVD. Conclusion. CKD is associated with highly prevalent and severe PolyVD. The severity of PolyVD is directly related to the stage of renal dysfunction (CKD stage).
Terapevticheskii arkhiv. 2019;91(6):73-79
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Protein - energy wasting of haemodialysis patients

Jakovenko A.A., Rumyantsev A.S.


Aim. To assess the prevalence of protein - energy wasting (PEW) of haemodialysis patients (HD). Materials and methods. A total of 645 patients receiving treatment with programmatic bicarbonate HD for 8.4±5.3 years, including 345 women and 300 men, the average age was 56.8±12.8 years. Nutritional status was assessed using the method recommended by the Ministry of Health of the Russian Federation (MHRF) (accounting form № 003/U), as well as the method proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). The nature of the change in appetite was determined by the Appetite and diet assessment tool (ADAT) and KDQOL-SF (version 1.3). Evaluation of the adequacy of the diet was performed using filled in patients for 3 days food diaries. Results and discussion. A decrease in appetite was recorded in no more than 5% of patients, while these changes were of a persistent, lasting nature. Inadequate intake of essential nutrients, taking into account the recommendations of the ERBP, was found in 9.7% of patients, while inadequate intake of protein was noted. The prevalence of PEW by the method of MHRF was 75.3%, by the method of ISRNM the prevalence of PEW was 51.2%. There were no statistically significant differences between the patient groups depending on age and the presence of PEW according to the MHRF method (χ2=7.072; p=0.069). Similar data were obtained for the method of diagnostics PEW ISRNM. Statistically significant differences between groups of patients were obtained depending on the duration of HD and the presence of PEW according to the MHRF method (χ2=22.580; r=0.0001). The prevalence of PEW by the MHRF method increases with increasing duration of HD (Rs=0.184; p=0.0001). Similar data were obtained for the method of diagnosis of PEW ISRNM. Conclusion. The prevalence of PEW in haemodialysis patients was 51.2% according to the ISRNM method and 75.3% according to the MHRF method.
Terapevticheskii arkhiv. 2019;91(6):80-84
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Serum troponin-I as a marker of fibroblast growth factor-23 (FGF-23) cardiotoxic effect, in patients with chronic kidney disease

Taranova M.V., Milovanova L.Y., Kozlovskaya(Lysenko) L.V., Milovanova S.Y., Androsova T.V., Zubacheva D.O., Lebedeva M.V., Dobrosmyslov I.A., Kozlov V.V., Kuchieva A.M., Li O.A., Reshetnikov V.A.


Aim. It has been established that an increased fibroblast growth factor (FGF-23) serum levels significantly contribute to the heart and blood vessels remodeling in patients with chronic kidney disease (CKD). But the precise mechanisms of the FGF-23 cardiac effect are currently being actively studied. At the same time, it is believed that the cardiac effects of FGF-23 may be due to the increasing deficit of Klotho protein as CKD progresses. In parallel with these changes, a number of studies indicate the persistence of the detectable troponins serum levels in CKD patients, even in the absence of clear clinical manifestations of cardiovascular diseases (CVD). The aim of the study was to confirm / exclude the existence of a causal relationship between elevated FGF-23, reduced Klotho and elevated troponin-I (as the most specific troponin in CKD). Materials and methods. The study included 130 CKD stages 1-5D patients without clinically pronounced symptoms of СVD (Coronary artery disease, CCS class 2-4, Chronic heart failure, NYHA 24, myocarditis, pericarditis, arrhythmias), as well as the severe arterial hypertension (BP >160/90 mm Hg), according to the laboratory and instrumental methods of examination. The selected group of patients was studied: serum levels of FGF-23 (Human FGF-23 ELISA kit), Klotho (Human soluble Klotho with antiklotho monoclonal antibodies), troponin-I (high - sensitive assay), and also data from instrumental examination methods: electrocardiography (ECG), echocardiography (left ventricular myocardial mass index (LVMI), cardiac (valvular) calcification score (CCS) using a semi - quantitative point scale), sphygmagraphy (augmentation (stiffness) indices of vessels (AI), pulse wave velocity (PWV), central (aortic) blood pressure (CBP), blood supply of subendocardium (BSE) - using "Shygmacor" device (Australia)). Results and discussion. The changes in serum levels of FGF-23, Klotho and troponin-I (Tr-I) depended on the stage of CKD. The following correlations were identified: FGF-23 and: Tr-I (r=0.601; p<0.01), LVMI (r=0.528; p<0.05), eccentric type of myocardial remodeling (MR; r=0.509; p<0.01), left ventricular diastolic dysfunction (DD; r=0.458; p<0.05), BSE (r=-0.499; p<0.05), PWV (r=0.514; p<0.01). Importantly, mean serum FGF-23 levels were not statistically significantly different in patients with elevated levels of CBP (CBP >120/80 mm Hg), and in patients with normal levels of CBP (CBP=90-120 / 60-79 mm Hg; p=0.071). At the same time, the serum level of Tr-I correlated with LVMI (r=0.567; p<0.05), eccentric type MR (r=0.461; p<0.01), DD (r=0.473; p<0.05), duration of CKD (r=0.512; p<0.05), BSE (r=-0.497; p<0.01), CBP (r=0.534; p<0.01). We revealed negative correlations between serum levels of Klotho and followed parameters: Tr-I (r=-0.537; p<0.01), PWV (r=-0.647; p<0.01), CCS (r=-0.612; p<0.01), LVMI (r=-0.539; p<0.01), concentric type MR (r=-0.528; p<0.01). According to multivariate analysis (logistic regression), a significant association there was only between elevated FGF-23 and elevated Tr-I in CKD patients without CVD. Conclusion. Detectable Tr-I serum levels without clinical signs of CVD and severe AH in patients with CKD is associated mainly with elevated serum levels of FGF-23.
Terapevticheskii arkhiv. 2019;91(6):85-92
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The relationship of hypertriglyceridemia and left ventricular remodeling types in patients with chronic kidney disease

Murkamilov I.T., Sabirov I.S., Fomin V.V., Aitbaev K.A., Murkamilova Z.A.


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<0.05). Persons with chronic obstructive pulmonary disease, chronic pyelonephritis were significantly more common in the 1st group (p<0.05). In the 2nd group, the BMI (30.1±5.4 kg/m2 vs. 28.1±5.8 kg/m2; p=0.049), the thickness of the posterior wall of the left ventricle (LV) (0.95±0,18 cm vs. 0.89±0.16 cm; p=0.040), the number of patients with a concentric type of remodeling (12.9% vs. 2.0%; p<0.05) and LV hypertrophy (51.8% vs. 26,5%; p=0.005), as well as with a high content of CRP in serum was significantly higher compared with the 1st group. In addition, the concentration of total cholesterol (5.61 [4.82; 6.57] mmol/l vs. 4.77 [4.08; 5.35] mmol/l; p=0.001), low - density lipoprotein cholesterol (cholesterol LDL) (3.49 [3.00; 4.52] mmol/l vs. 3.13 [2.67; 3.86] mmol/l; p=0.031) and uric acid (0.439±0.150 mmol/l vs. 0.376±0.109 mmol/l; p=0.005) serum was significantly higher than similar indicators of the 1st group. In patients with CKD and without THG, the following parameters influenced the magnitude of glomerular filtration rate (GFR): augmentation index (R²=37%; p=0.024), indexed left ventricular myocardial mass (LVMI) (R²=37%; p=0.005), concentrations of uric acid (R²=37%; p=0.009) and serum LDL cholesterol (R²=37%; p=0.002). In the subgroup of patients with CKD without THG, the systolic level (R²=12%; p=0.046) and diastolic blood pressure (BP) (R²=12%; p=0.045), uric acid concentration (R²=12%; p=0.005) and serum LDL (R²=12%; p=0.006). Then whereas the factors affecting the index of LVMI in patients of the 1st subgroup were the augmentation index (R²=19; p=0.045) and the GFR value (R²=19; p=0.038). In the 2nd subgroup, the factors affecting LVMI is the systolic (R²=28; p=0.016) and diastolic blood pressure (R²=28; p=0.023), augmentation index (R²=28; p=0.041), uric acid content (R²=28; p=0.020), LDL cholesterol (R²=28; p=0.032), triglycerides (R²=28; p=0.017) and the level of GFR (R²=28; p=0.007). Conclusion. In CKD with THG, the concentric type of remodeling and left ventricular hypertrophy are significantly more common. In patients with CKD and THG, the frequency of hyperuricemia and an increase in serum CRP was significantly higher. In CKD and THG, the factors affecting the glomerular filtration rate are the values of augmentation index, uric acid concentration, low serum lipoprotein cholesterol and indexed left ventricular myocardial mass. In patients with CKD and THG, the level of systolic and diastolic blood pressure, augmentation index, uric acid concentration and low - density lipoprotein cholesterle had the greatest influence on the value of the indexed mass of the left ventricular myocardium.
Terapevticheskii arkhiv. 2019;91(6):93-99
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Difficulties in diagnosing the syndrome of "aorto - mesenteric tweezers" (nutcracker syndrome) in a patient with macrogematuria

Grigoryeva E.V., Senichkina M.N., Maiorova A.A., Kiseleva O.A.


The clinical observation of a patient with a rare pathology - "nutcracker syndrome". Difficulties of diagnosis verification are described.
Terapevticheskii arkhiv. 2019;91(6):100-102
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Atrial myocarditis in a patient with Takayasu arteritis

Safiullina A.A., Uskach T.M., Zhirov I.V., Pogorelova O.A., Stukalova O.V., Gaman S.A., Gramovich V.V., Novikov P.I., Tereshchenko S.N.


Takayasu arteritis belongs to the group of systemic vasculitis with a predominant lesion of large - caliber vessels and the development of stenosis of their lumen. In world practice, to establish the diagnosis of arteritis Takayasu apply the criteria proposed by the American College of rheumatologists. Currently, there are no randomized clinical trials related to the disease, and the diagnosis and treatment of patients are based on a number of small studies, a series of clinical cases and expert opinion. The described clinical observation of a patient with Takayasu arteritis is of interest in connection with the detected atrial myocarditis during MRI diagnosis of the heart with contrast, which allows us to discuss the feasibility of this imaging technique in complex and doubtful cases.
Terapevticheskii arkhiv. 2019;91(6):103-109
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Chronic kidney disease in the context of toxic effects the working chemical factors (literature review)

Strizhakov L.A., Fomin V.V., Garipova R.V., Babanov S.A., Arkhipov E.V., Lebedeva M.V.


The article analyzes the publications devoted to the problem of professional renal lesions caused by chemical factors. Classification, prevalence, peculiarities of the clinical picture, diagnosis of professional renal lesions caused by chemical factors of the production environment are reviewed. The frequency of professional renal lesions remains underestimated due to low manifestation of symptoms and the influence of environmental factors, which require further investigation of this issue.
Terapevticheskii arkhiv. 2019;91(6):110-115
pages 110-115 views

Modern approaches to conservative therapy of polycystic kidney disease

Rudenko T.E., Bobkova I.N., Stavrovskaya E.V.


Polycystic kidney disease (PKD) is a genetically determined pathological process associated with the formation and growth of cysts originating from the epithelial cells of the tubules and/or collecting tubes. PBP is represented by two main types - autosomal dominant (ADPKD) and autosomal recessive PKD (ARPKD), which are different diseases. The main causes of ADPKD are mutations of the PKD1 and PKD2 genes, which encode the formation of polycystin-1 and polycystin-2 proteins. ARPKD-linked mutation in the gene PKHD1, leads to total absence or defective synthesis of receptor protein primary cilia - fibrocystin. There are relationships between the structural and functional defects in the primary cilia and PBP. Mechanisms of cysts formation and growth include a) mutations of polycystines genes located on the cilia; b) increased activity of renal intracellular cAMP; c) vasopressin V2 receptors activation; d) violation of the tubular epithelium polarity (translocation of Na,K-ATPasa from basolateral to apical membrane); e) increased mTOR activity in epithelial cells lining renal cyst. The most promising directions of ADPKD therapy are blockade of vasopressin V2 receptors activation, inhibition of mTOR signaling pathways and reduction of intracellular cAMP level. The review presents clinical studies that assessed the effectiveness of named drugs in ADPKD.
Terapevticheskii arkhiv. 2019;91(6):116-123
pages 116-123 views

Hepatitis C virus - related cryoglobulinemic vasculitis with renal involvement current possibilities of diagnostic and treatment

Milovanova S.Y., Kozlovskaya(Lysenko) L.V., Milovanova L.Y., Gordovskaya N.B., Ignatova T.M., Taranova M.V., Androsova T.V.


The extrahepatic manifestations of HCV infections, which include mixed cryoglobulinemia (MC), are important for prognosis and determination of the treatment options of these patients. Currently, mixed MC type II is considered as a specific marker of chronic HCV infection. Kidney damage is one of the severe, often determining a prognosis of extrahepatic manifestation of HCV-associated cryoglobulinemic vasculitis. The review discusses the current diagnostic approaches to cryoglobulinemic GN, as well as perspectives for improving antiviral and pathogenetic therapy.
Terapevticheskii arkhiv. 2019;91(6):124-130
pages 124-130 views

Circulating microRNAs as potential biomarkers of chronic kidney disease

Aitbaev K.A., Murkamilov I.T., Fomin V.V.


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.
Terapevticheskii arkhiv. 2019;91(6):131-136
pages 131-136 views

Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis

Antukh D.E., Shchekochikhin D.Y., Nesterov A.P., Gilarov M.Y.


This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.
Terapevticheskii arkhiv. 2019;91(6):137-144
pages 137-144 views

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