Shilov Em

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National guidelines. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches

The effects of long-term treatment with azathioprine and prednisolone on T- and B-lymphocytes were studied in 52 patients with lupus nephritis (LN) and chronic glomerulonephritis (GN). The effect of azathioprine on lymphocyte populations was dose dependent; high doses decreased the number of T- and particularly, B-cells, while smaller doses produced a selective depletion of B-cells. The changes in T- and B-cells during prednisolone treatment were variable with alternating increases and decreases in their numbers. The patients with increased B-lymphocyte levels showed the best response to immunosuppressive therapy.

AIM: To investigate early atherosclerosis (AS) risk factors in patients with systemic lupus erythematosus (SLE) in respect to the presence of lupus nephritis (LN) and antiphospholipid (APL) antibodies. MATERIAL AND METHODS: We analysed case histories of 137 SLE patients observed in E.M. Tareev clinic from 1970 to 2006. AS manifestations were studied by echocardiography, ultrasonic dopplerography of the peripheral vessels, x-ray methods. AS was considered early if it arose at the age under 55 years. Patients with chronic renal failure were not included in the study. RESULTS: AS development was seen in 54 (45%) patients, early symptoms appeared at the age of 25-68 years (mean 54 +/- 10 years). In 37 (31%) patients AS symptoms manifested at the age under 55 years. Significant factors of early AS risk were age, hyperlipidemia, arterial hypertension, menopause for women, APL antibodies circulation, stage IV chronic disease of the kidneys, hyperuricemia, higher blood creatinine, mean dose of prednisolone over 15 mg/day, frequent elevation of the level of C-reactive protein. A direct correlation between lupus nephritis or nephrotic syndrome (NS) and early AS was not found. In LN hyperlipidemia occurred more often (p = 0.055), lipids level and NS were not related during its remission. LN patients developed AS more frequently, had lower complement concentration in the end of the study, were treated with prednisolone more intensively than patients free of renal disease (p < 0.05). CONCLUSION: Early AS develops in more than one third of SLE patients. Main risk factors of early AS are conventional ones and APL antibodies, persistence of chronic inflammation, decreased glomerular filtration rate, prednisolone therapy. LN influence on the process of atherogenesis in SLE may be mediated and caused by high rate of other risk factors.

Background: The Russian Health Care system is faced with a range of problems in the prevention and control of non-communicable diseases (NCDs). The issue of population control of chronic kidney disease (CKD) is reported to be one of the most acute issues due to the absence of good surveillance, imperfect primary and secondary prevention, and insufficient provision of renal replacement therapy.Problem: CKD is a serious medical problem associated with severe social-economic costs in the Russian Federation. This calls for the need for development and implementation of systematic approaches and solutions.Purpose: This article reviews the existing organizational and methodological approaches in CKD prevention and control in the Russian Federation. We purpose to describe and critically assess the CKD situation in the Russian Federation.Overview: We outline the various aspects of the current situation of CKD in the Russian Federation and analyse the organizational mechanisms used in the existing national situation.