[Dynamics of osteopontin in serum and urine in the early postoperative period after percutaneous nephrolitho- tomy].

AIM: To evaluate the dynamics of plasma and urine level of osteopontin in the early postoperative period after percutaneous nephrolithotomy (PCNL) in patients with pelvic stones. MATERIALS AND METHODS: A total of 110 patients with pelvic stones up to 20 mm in size without urinary tract obstruction were included in the study. The patients were divided into two groups based on the results of intraoperative monitoring of intrarenal pressure. In each of the groups, PCNL or mini-PCNL were performed in same proportions. Intraoperative monitoring of intrarenal pressure was done in all cases according to the authors method. Sampling of plasma and urine for enzyme immunoassay was performed on the 0, 7 and 30 days after the procedure. Plasma and urine osteopontin level was measured using a commercial Human Osteopontin ELISA Kit for enzyme immunoassay. RESULTS: In patients with increased intraoperative intrarenal pressure pyelonephritis developed, accompanied by hyperthermia from 3 to 7 days in 70% of cases, and leukocytosis and leukocyturia in 100% of cases. The number of hemorrhagic complications did not differ in both groups. An increase in serum osteopontin level was seen, which was significantly more pronounced in the group with increased intraoperative intrarenal pressure. Urinary osteopontin level, on the contrary, tends to decrease, more pronouncedly in patients with normal intraoperative intrarenal pressure. CONCLUSION: The rate of decrease in urinary osteopontin level indicates the stabilization of injury and the restoration of renal function after PCNL. An increase in serum osteopontin level is associated with the development of postoperative inflammatory complications, which demonstrates the immune functions of serum osteopontin.

[The use of laser doppler flowmetry to assess the microcirculation of the kidney before and after percutaneous nephrolithotomy].

AIM: To evaluate intraoperative changes in renal microcirculation during percutaneous nephrolithotomy (PCNL), as well as its dynamics in the early postoperative period. MATERIALS AND METHODS: A total of 240 patients treated in the Urology Clinic of the Saratov State Medical University in 2021-2022 were included in the study. All patients underwent PCNL. In the first group (n=105) the standard PCNL through 30 Ch access was done. In the second group (n=135), the procedure was performed through an access of 16 Ch. Intraoperatively, intrapelvic pressure was evaluated according to the authors method, which consists in direct measurement in the collecting system during the procedure, allowing for a faster and more accurate assessment. Prior to surgery, Doppler mapping of the renal blood flow was performed, and indirect registration of the microcirculation index (MCI) was done directly on the operating table using laser Doppler flowmetry (LDF). The diagnostic study was performed at the point of intersection of the 12th rib and the psoas muscle, both on the ipsilateral and contralateral side. In addition, during the procedure, a registration of MI of the mucosa of the calyceal fornix accessible in the direct vision through the access tract for 4 minutes was carried out twice. RESULTS: The index of microcirculation (IM) in the fornix of the upper calyx before the fragmentation of the stone in the 1st group of patients was 26.67+/-4.7 pf.u. compared to 25.4+/-5.9 pf.u. in the second group. At the same time, the value recorded on the skin was 13.08+/-1.2 pf.u. in the first group compared to 13.1+/-0.77 pf.u. in the second group (p>0.05). During the initial registration, the PM immediately after stone fragmentation was 19.5 +/- 1.2 pf.u, while on the overlying skin it was 11.2 +/- 0.9 pf.u. In the contralateral kidney area, IM was 10.2+/-0.9 pf.u. In the case of an intraoperative increase in intrapelvic pressure, IM was 22.3+/-1.6 pf.u. compared to 12.1+/-0.7 pf.u on the skin. The dynamics of IM on the skin tended to further decrease and returned to normal values of 10.3 +/- 0.7 pf.u on the 3rd day. When intraoperative intrapelvic pressure exceeded the normal value, IM by the 5th day was 10.1+/-0.4 pf.u. When determining the correlation of IM with RI of the ipsilateral kidney, a direct moderate correlation was revealed (r=+0.516). CONCLUSION: The measurement of microcirculation in the intra- and postoperative period allows to assess changes in the intrarenal microcirculation both directly and indirectly. This method can be used as an additional tool for assessing obstructive changes and the activity of pyelonephritis. A significant correlation between IM and RI indicates that functional changes in the renal and skin microcirculation tend to develop simultaneously.

[Molecular genetic predictors of the development of urolithiasis].

Urolithiasis is one of the most urgent problems of clinical urology. Currently, there is no consensus on the causes of stone formation, as well as the role of various factors in the development of urolithiasis, however, increasingly, according to various studies, the leading role is given to genetic causes. The article presents a modern review of data on genetic polymorphisms associated with ICD: rs1801197 and rs6776158 of the CASR gene; TaqI of the VDR gene; rs1801197 of the CALCR gene, rs3752472, rs650439, rs2853744 of the Klotho gene.

[Acute kidney injury in the pathogenesis of coronavirus infection].

COVID-19 is an acute respiratory viral disease that primarily affects the lungs, but can also affect other organs, including the kidneys. Damage to the kidneys can be caused by direct effects arising from the invasion of the virus into kidney cells, or it occurs secondarily due to immunological, hemocoagulation and ischemic disorders. Given the importance of preserving kidney function during illness and after recovery, this review aims to investigate the impact of novel coronavirus infection on the kidney and its role in the development of acute kidney injury.

[Frequency of occurrence and risk factors for acute kidney injury after radical cystectomy].

INTRODUCTION: Various studies have revealed the negative impact of surgery or related factors on the risk of acute kidney injury (AKI). The risk factors and 6-months outcomes in patients with clinical or subclinical manifestations of AKI after radical cystectomy were analyzed. MATERIALS AND METHODS: This prospective study included patients with normal renal function who underwent radical cystectomy. Urine and serum samples were collected to measure the level of neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 186 patients, 43 (23.1%) had AKI in the postoperative period. The most reliable predictor was the concentration of NGAL in the urine 12 hours after surgery (threshold value of 156.87 ng/ml). In 53 (28.5%) patients with NGAL higher than this value, subclinical AKI was diagnosed. Patients with clinical AKI and patients with subclinical AKI were allocated to the AKI group. Independent risk factors for postoperative AKI were age and obesity. After 6 months the glomerular filtration rate (GFR) in the group with AKI was significantly lower than in the control group, although the baseline GFR was similar. CONCLUSION: Determination of NGAL concentration in urine is recommended for early diagnosis of postoperative AKI, as well as for predicting the functional state of the kidneys 6 months after oncourological procedures. A significant proportion of patients developed subclinical AKI; in this group there was a worse renal outcome in comparison with the group without AKI.

[Nephroprotective effect of calcium channel blocker lercanidipine in treatment of patients with urolithiasis and urinary tract obstruction and monitoring of the serum cytokine profile].

OBJECTIVE: to evaluate the nephroprotective effect of lercanidipine, its effect on the dynamics of creatinine clearance and blood cytokine levels in patients with nephrolithiasis with obstructive uropathy during renal drainage. MATERIAL AND METHODS: 66 patients were included in the study with concretions of the pelvic segment and the presence of obstruction according to instrumental methods of examination. In order to prevent the occurrence of infectious complications before lithotripsy patients the first stage was performed installation of nephrostomic drainage, followed by antibacterial, anti-inflammatory therapy. Patients were divided into 2 groups: the first (33 patients) received standard therapy, the second (33 people) additionally received lercanidipine at a dose of 10 mg per day for 1 month. Determined the concentration of IL-8, VEGF, MCP-1, G-CSF and GM-CSF in the blood serum by the method of solid-phase ELISA. The glomerular filtration rate was calculated using the CKD-EPI formula. All studies were performed at the preoperative stage, on 7, 14, 21 and 28 days after renal drainage. RESULTS: In the appointment of lercanidipine, there was a more rapid decrease in levels of IL-8, VEGF, MS-1, GM-CSF in serum (21 days), and an improvement in renal function, compared with the group that did not receive nephroprotective therapy. CONCLUSION: The administration of lercanidipine may contribute to a more rapid recovery of renal function and normalization of blood cytokine levels. This drug can be used in the complex treatment of patients with nephrolithiasis with obstructive uropathy.

[Mechanisms of kidney damage].

The results of recent studies on the mechanisms of kidney damage are presented in the review of literature. The role of the immune system in the occurrence, development and outcome of damage to the epithelium of the renal tubules, as well as molecular, genetic and metabolic changes which determine the extent and consequences of renal trauma are described in details. The mechanisms of restoration of the renal parenchyma and the development of fibrosis following the cessation of injury are given.

[Biomarkers of renal injury in contact ureteral lithotripsy].

AIM: To optimize the transurethral endoscopic management of patients with ureterolithiasis by measuring biomarkers of renal parenchymal damage. MATERIALS AND METHODS: One hundred fifty-one patients with solitary ureteral stones were tested for levels of cystatin C, neutrophil gelatinase-associated lipocalin, 2-microglobulin and interleukin 18. RESULTS: An increase in the levels of markers of renal injury was observed both in the preoperative period and after CULT. Differences in the values of these indices depended on the timing of the CULT, the size and location of the stone and the type of lithotripter. CONCLUSIONS: All patients were found to have damage to the renal tubular system. The established critical values of the markers of renal injury in ureterolithiasis may be used as diagnostic criteria for renal injury.

[The role of urinary tract infection in the development of recurrent nephrolithiasis].

This is a literature review on the role of microbial flora in the development of recurrent urolithiasis. The authors outline pathogenetic aspects of recurrent stone formation associated bacterial flora. A number of studies reported that standard urine culture has limited sensitivity in detecting urinary tract infection.

[A look at the problem of surgical treatment of renal cel carcinoma in the aspect of biomolecular diagnosis and assessment of renal function].

The article reviews the domestic and international literature on the issues of biomolecular diagnosis of acute renal injury in the perioperative period in patients with renal cell carcinoma (RCC). Emerging opportunities for early detection of tumors make even more relevant the use of minimally invasive interventions. Of equal importance is the assessment of renal function in patients with diagnosed RCC and the prediction of acute renal injury and progression of chronic kidney disease in the postoperative period. The authors performed a systematic search for preclinical and clinical studies to identify the main trends and achievements in the field of biomolecular diagnosis of RCC and renal injury allowing the individual approach to choosing surgical treatment, improve the survival and quality of life of the patient and improve the functional state of the renal parenchyma.