[Impact of kidney biopsy on the management of patients in the rheumatology department: retrospective study].

BACKGROUND: Kidney involvement is a common manifestation of the systemic autoimmune rheumatic diseases. Kidney biopsy is the gold standard for the diagnosis of kidney diseases, however this method has not yet become the standard-of-care in rheumatology practice. AIM: To assess the diagnostic value of kidney biopsy in the management of patients of the rheumatology department. MATERIALS AND METHODS: In this retrospective observational study we analyzed the medical documentation including kidney morphology findings in the patients of the Department of Rheumatology at Tareev Clinic of Internal Diseases. All patients included in the research had signs of kidney involvement and had undergone needle biopsy of the kidney or re-evaluation of the kidney tissue received previously. RESULTS: From June 2016 to October 2021, 3110 patients were admitted to the rheumatology department. Among them 63 (2%) underwent kidney biopsy and were included in the study. Twenty (32%) were male. Mean age was 42.513.9 years. The most common preliminary diagnoses before kidney biopsy were ANCA-associated vasculitis (n=17), systemic lupus erythematosus (n=12), and AA-amyloidosis associated with inflammatory joint diseases (n=7). In 14 (27%) patients diagnosis was unspecified at the time of biopsy. Among 49 patients with established preliminary diagnosis morphological findings were in line 38 (78%) with the pre-liminary diagnosis. However, in 11 (22%) patients morphological findings resulted in the change of the diagnosis. In all 14 patients with unspecified condition kidney biopsy helped to establish clinical diagnosis. Ultrasound evaluation demonstrated hematoma formation in 18 (31%) patients, and among them two required blood component transfusions. CONCLUSION: Our study demonstrates significant value and safety of kidney biopsy in the patients with autoimmune rheumatic conditions. We suggest that kidney biopsy should be implemented in the management of this category of patients.

[Rapidly progressive glomerulonephritis in ANCA-associated vasculitis: a course, treatment efficacy, prognosis].

AIM: To study efficacy of ANCA-RPGN treatment with corticosteroids and cyclophosphamide or mycophenolic acid drugs. MATERIAL AND METHODS: We treated 28 patients (17 males and 11 females aged 19-71 years) with morphologically verified ANCA-associated crescentic RPGN (crescentic median 79 (63:88)%. The patients received corticosteroids and cytostatics. RESULTS: The response to the treatment was registered in 22 (78%) patients in 8-16 weeks: a complete remission was achieved in 8 patients, a partial one--in 14 patients. In partial remission renal functions recovered incompletely (median Pcr 200 (180;255) mcmol/l) in persistence of moderate proteinuria (median 0.7 (0.6;1.3)g/day) and absence of microhematuria. Probability of the treatment success depended on severity of glomerulosclerosis and weakly depended on activity of extracapillary reaction. Severe renal failure was not an absolute predictor of treatment failure. CONCLUSION: In the absence of advanced nephrosclerosis early treatment with corticosteroid in combination with cytostatics can produce a positive effect in 70-80% patients with ANCA associated RPGN.

[Transplantation of the kidney--optimal treatment of patients suffering from diabetes mellitus type 1 with terminal chronic renal failure].

AIM: To assess long-term results of renal transplantation in patients with diabetes mellitus of type 1 (DM-1) with terminal chronic renal failure (tCRF); to detect risk factors of low survival of the patients and development of dysfunction of renal transplant. MATERIAL AND METHODS: A retrospective comparative analysis of 418 recipients of the kidney with non-diabetic nephropathies (NDN) and 113 recipients with DM-1. RESULTS: Survival of DM-1 patients with tCRF after allotransplantation of the kidney was lower than in patients with NDN. Low survival risk factors for DM-1 patients after transplantation of the kidney are: DM-1 duration up to tCRF 25 years and more, minimum 3-year history of dialysis before transplantation, age at transplantation over 45 years, persistence of anemia (hemoglobin < 110 g/l) after operation. Survival of the transplanted kidney in DM-1 and NDN patients was the same. Risk factors of dysfunction of the transplanted kidney are the following: acute crises of rejection and delayed function of the transplant, arterial hypertension > 130/80 mmHg, proteinuria > 300 mg/day. Survival of the transplanted kidney is higher in transplantation from the relative donor, does not depend on the kind and duration of previous dialysis. Causes of a decline in the function of the transplanted kidney (by the data of puncture biopsy of 34 transplants) are the following: acute rejection crises (38%), chronic transplantation nephropathy (24%), toxic nephropathy (18%), recurrent diabetic nephropathy (6%), chronic pyelonephritis (6%). Lethality in DM-1 patients after renal transplantation is 2 times higher than in patients with NDN. Death was due to cardiovascular diseases, gangrene of the lower limbs, infectious complications (in 31%, 15% and 35% cases, respectively). CONCLUSION: Transplantation of the kidney is an optimal treatment in DM-1 patients with tCRF.

[A renoprotective effect of enalapril in chronic transplantation nephropathy]. / Renoprotektivnii éffekt énalaprila pri khronicheskoi transplantatsionnoi nephropatii.

AIM: To study safety and efficacy of ACE inhibitor enalapril in chronic transplantation nephropathy (CTN) as well as nephroprotective efficacy of this drug in various clinical variants of CTN. MATERIAL AND METHODS: A retrospective study covered 220 recipients with CRF. The patients were divided into the study group (n = 103) and the control group (n = 117). The study group was given ACE inhibitor enalapril the efficacy of which was assessed by arterial pressure (systolic, diastolic, mean) dynamics, 24 h proteinuria and the rate of CTN progression. This rate was suggested by probability of plasm creatinin doubling (Kaplan-Meier technique). RESULTS: Enalapril significantly inhibited CTN progression running with minimal or marked proteinuria, had a pronounced hypotensive effect, promoted stabilization of minimal proteinuria (in CTN with minimal proteinuria) or reduction of protein excretion (in a proteinuric variant of CTN). CONCLUSION: Use of enalapril in CTN in a daily dose 10 mg maximum is safe and can be used for inhibition of CTN progression.