[Low serum Klotho level as a predictor of calcification of the heart and blood vessels in patients with CKD stages 2-5D]

Cardiovascular calcification (CVC) makes a significant contribution to the manifestation of cardiovascular complications in patients with chronic kidney disease. Early CVC markers are currently being actively studied to optimize cardio-renoprotective strategies. We performed a prospective comparative analysis of the following factors: FGF-23, a-Klotho, sclecrostin, phosphate, parathyroid hormone, the estimated glomerular filtration rate (eGFR), central systolic pressure as an independent determinant of CVC.

MATERIALS AND METHODS

The study included 131 patients with chronic kidney disease 25D st. Serum levels of FGF-23, Klotho, and sclerostin were evaluated using the ELISA method. Vascular augmentation (stiffness) indices, central arterial pressure (using the SphygmoCor device), calcification of heart valves and the degree of aortic calcification (aortic radiography) were also investigated. The observation period was 2 years.

RESULTS

According to the Spearman correlation analysis, the percent of calcification increase and the change in Klotho level are most related. According to ROC analysis, a decrease in serum levels of Klotho by 50 units or more is a significant predictor of an increase in aortic calcification of 50% or more with a sensitivity of 86% and a specificity of 77%. Using logistic regression analysis, it was found that a serum Klotho level 632 pg/L predicts an eGFR below a median level of 48 ml/min/1.73 m2 with a sensitivity of 85.5% and a specificity of 78.5%. Wherein OR 17.477 (CI 95% 8.04637.962; p0.001).

CONCLUSION

The factor most associated with CVC is Klotho. Decreased serum level of Klotho is a predictor of aortic calcification. In addition, the initial serum level of Klotho is a predictor of eGFR after 2 years.

[Monoclonal gammapathy of renal significance (MGRS) at the current state: terminology, diagnosis and treatment]

In this article we discussed the current state of monoclonal gammapathy of renal significance (Monoclonal Gammopathy of Renal Significance MGRS) and revealed problems of B-cell clone secreting nephrotoxic monoclonal immunoglobulin identification. We followed 276 patients with monoclonal gammapathy including patients with non-amyloid nephropathy. The majority of patients had systemic AL-amyloidosis. We established better survival of the treated patients with systemic AL-amyloidosis in comparison with retrospective untreated cohort. We considered current treatment of patients with non-amyloid nephropathy and focused on the crucial role of multidisciplinary approach in management of these patients.

[Clinicopatological variants and risk factors for chronic kidney disease in rheumatoid arthritis]

Recent studies have shown a high risk of chronic kidney disease and associated cardiovascular complications in patients with rheumatoid arthritis (RA), which determines the prognosis. However, the prevalence of chronic kidney disease (CKD) in RA has not been established in the Russians.

AIM

Study was to examine the prevalence, risk factors and histological variants of CKD in RA.

MATERIALS AND METHODS

180 patients with rheumatoid arthritis were observed in the Tareev clinic of nephrology, for the period from 2014 to 2019 years. Age, gender, duration of RA, drug therapy, ESR, CRP, DAS28, renal function, proteinuria, histological variants were analyzed. Of the common population risk factors for CKD arterial hypertension, weight index, serum lipids and glucose levels were also assessed.

RESULTS

The prevalence of CKD in RA was 19.7%. Age, presence and stage of arterial hypertension, an increase in body mass index, as well as high rates of disease activity ESR, CRP, DAS28 score and duration of RA were risk factors of CKD in RA. Age, duration of the disease, stage of AH and hypercholesterolemia were risk factors in multifactorial regression analysis. Amyloidosis was the most common histologic pattern (50.0%), followed by chronic glomerulonephritis (30.4%) and tubulo-interstitial nephritis (19.6%). Among chronic glomerulonephritis mesangial glomerulonephritis was the most frequent. Renal amyloidosis was associated with a duration of RA, presence of systemic symptoms and CRP level. An isolated decrease in GFR of less than 60 ml/min was detected in 31 (36.0%) out of 86 patients. Сonclusion. The risk factors for CKD in patients with RA are activity and duration of the disease In addition to common population factors. Amyloidosis was the most common histologic pattern associated with duration of RA and inflammatory proteins levels.

Chronic kidney disease in rheumatoid arthritis patients: prevalence, risks factors, histopathological variants

The present review is focused on risk factors of chronic kidney disease in rheumatoid arthritis (RA). According to recent data, the chronic kidney disease (CKD) in RA patients is more often than at patients without RA. It is closely associated with risk of cardiovascular disease and high mortality. Besides of general population risk factors of CKD, the activity of the disease is independent predictors of reduction in glomerular filtration rate less than 60 ml/min/1.73 m2. In the review, histopathological variants and mechanisms of CKD on basis of international experience are also considered. Suppression of inflammation by basic therapy of RA and biological therapy have changed outcomes RA, prevalence, and structure of kidney involvement in recent years.

Renal lesions associated with monoclonal gammopathies of undetermined significance: clinical forms, mechanisms of development, approaches to treatment

The term «monoclonal gammopathies of undetermined significance» (MGUS) was introduced by R. Kyle in 1978 to designate the condition characterized by the presence ofsmall amounts ofM-protein in the serum. In some patients, such condition remains benign for a long time but predetermines for the development of multiple myeloma and other B-lymphocytic tumours. Also, it can provoke non-cancerous diseases due to the toxic action of monoclonal proteins (immunoglobulins and free light chains) on various organs, especially kidneys. MGUS-associated renal lesions include glomerulopathies with organized deposits, such as AL-amyloidosis (amyloid light chain of immunoglobulin), cryoglobulinic and immunotactoid glomerulonephritis, and with unorganized deposits (light chain deposition and proliferative forms of idiopathic glomerulonephritis. The available experimental data throw light on the possible mechanisms of renal lesions. We summarized the literature data and original observations to describe methods for differential diagnostics of MGUS-associated renal lesions including the highly sensitive test for free light chine identification (Freelite method) and principles of pathogenetic treatment by the impact on the pathological B-cell clone.

[Oligosecretory monoclonal gammopathy with renal involvement]

The article deals with the so-called monoclonal gammopathy of undetermined significance (MGUS), which is being actively explored in the world and has been recently investigated in Russia. It indicates the principles of identifying the phenotypes of MGUS and criteria for assessing the risk of its progression to cancer. There is an update on the possible involvement of monoclonal proteins in the pathogenesis of certain non-neoplastic kidney diseases, renal injuries in particular. The paper gives their classification and enumerates differential diagnostic techniques, including the Freelite method, a highly sensitive one to determine free light chains (FLC), prognostic criteria, and approaches to treating each separate form in relation to the phenotype of a monoclonal protein. The authors present their own data on detection rates for MGUS at a multidisciplinary hospital and a clinical case of MGUS-associated membranoproliferative glomerulonephritis, by justifying a treatment regimen containing bortezomib (velcade).

[EVALUATION OF CARDIOVASCULAR RISKS WITH THE USE OF MORPHOGENETIC KLOTHO PROTEIN IN PATIENTS WITH CHRONIC RENAL DISEASE]

THE AIM

of the study was to explore the Klotho protein significance in patients with different stages of chronic kidney disease (CKD) and to assess the influence of antihypertensive therapy on Klotho protein serum levels.

MATERIALS AND METHODS

130 patients with stage 5 CKD1 were included in the study. Serum PTH, calcium and phosphorus were measured. ELISA was used to determine serum soluble alpha Klotho. Blood pressure including brachial and central (aortic) pressure was measured in all patients together with pulse wave velocity (using a «Sfigmokor» device); in addition, echocardiography (EchoCG), and X-ray examination of the abdominal aorta by Kauppila method were performed.

RESULTS

The dynamic study of serum Klotho level showed that it changes with decreasing glomerular filtration rate faster than a rise in phosphate and PTH levels starting from stage 3A of CKD. The two later variables increased at stages 4-5.According to the ROC analysis, the values of serum Klotho below 387 pg /ml suggested enhanced risk of myocardial calcification with 80% sensitivity and 76% specificity. In addition, the highest Klotho serum levels were observed in patients whose target BP values were achieved with angiotensin receptor blockers (ARB) compared to those who used other drugs [р<0,01] or failed to reached target BP levels [p=0,008].

CONCLUSION

The study showed the possibility of practical use of Klotho protein as an early diagnostic marker of cardiovascular risk. Reduced serum Klotho was less pronounced in patients who used ARB for correction of high blood pressure. Normal Klotho protein levels in serum have been associated with a lower frequency of heart and vessels calcification in CKD patients.

Decreased Serum Levels of Klotho Protein in Chronic Kidney Disease Patients: Clinical Imortance

Objective: to determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD).Methods: The study involved 130 patients with CKD stages 1–5D (mean age ― 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ― with the help of «Sphygmоcor» (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed.Results: when comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4–5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p0.01) or has not reached the target blood pressure level (p=0,008).Conclusion: The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

[Influence of lithium salt of comenic acid on the state of oxidative processes in brain of stressed animals]

The influence of a new substance, lithium salt of comenic acid, on the oxidative processes in the brain of animals under the conditions of acute and long combined stress has been investigated. It is established that lithium comenate (1 and 2 mg/kg) exhibits pronounced dose-dependent antioxidative stress-protective effect, which is manifested in suppression of the hyperproduction of free radicals and depression of the content of malonic dialdehyde (a secondary product of lipid peroxidation) in the brain of stressed animals. The maximum antioxidative stress protection effect under the conditions of acute and long combined stress has been observed for lithium salt ofcomenic acid in a dose of 2 mg/kg.

[Clinical implications of renal affection among systemic manifestations of infectious endocarditis]

AIM

To assess the importance of renal affection and other systemic manifestations of infectious endocarditis (IE) among factors of unfavourable IE prognosis.

MATERIAL AND METHODS

The examination including bacteriological blood test, transthoracic echocardiography was made in 54 patients with IE (35 males and 19 females aged 17-75 years). Transesophageal echocardiography and coagulogram examination were additionally performed in 11 and 45 patients, respectively.

RESULTS

Modern methods of statistic processing were employed to study systemic IE manifestations. Among them, prognostically significant were singled out and analysed including renal affection. Clinical variants of renal affection were determined in IE patients and their characteristics were determined: high incidence and severity of erythrocyturia, rare occurrence of arterial hypertension, frequent episodes of acute renal failure. A close correlation is shown between IE-associated renal affection, DIC symptoms and thrombocytopenia. Signs of renal damage in IE patients raise probability of other systemic manifestations including prognostically significant ones. This allows one to consider renal affection as a marker of an unfavourable IE course.

CONCLUSION

A complex of significant factors of IE unfavorable outcome is determined including such systemic manifestations as severe renal affection, thromboembolism, splenomegaly. These factors are of importance in deciding on surgical intervention--valve replacement.

[Influence of the peptides, isolated from kumys and a sour milk of Mechikov on some parameters of immunity in animals, who underwent an immobilization-cold stress]

The influence of peptide fractions, discharged of kumys (SK) and a sour milk of Mechnikov (PMS) on some parameters of immunity experimental animal, transferred a stress is investigated. The outcomes of examinations have shown, that SK promotes correction of immune violations called by action of a stress. So the introduction SK animal one day prior to a stress renders expressed immunoregulatory an operation on a content of neutrocytes and metabolism in them, depending from Oxygenium, promotes a raise of number of T lymphocytes in a blood animal transferred a stress. The peptide fraction, discharged of a sour milk of Mechnikov (PMS) does not render essential influence on the above-stated parameters.