[New data on the pathophysiology of ischemic stroke: epigenetic mechanisms in focus]. / Novye dannye o patofiziologii ishemicheskogo insul'ta: v fokuse epigeneticheskie mekhanizmy.

Epigenetics is a branch of molecular biology that studies modifications able to change gene expression without changing the DNA sequence. Epigenetic modulations include DNA methylation, histone modifications, and noncoding RNAs. These heritable and modifiable gene changes can be caused by lifestyle and dietary factors. In recent years, epigenetic changes have been associated with the pathogenesis of a number of diseases, such as diabetes mellitus, obesity, renal pathology and various types of cancer. They were also associated with the pathogenesis of cardiovascular diseases, including ischemic stroke. In this regard, it is important to note that since epigenetic modifications are reversible processes, they can help in the development of new therapeutic approaches to treat human diseases. This mini-review presents the latest data on the influence of epigenetic modifications on the pathogenesis of ischemic stroke obtained both in animal models and in patients.

[Urolithiasis in HIV-positive patients: prevalence and risk factors].

Today, the total number of people living with the human immunodeficiency virus (HIV) is 43.8 million. From the moment of infection to the terminal stage of the disease, the risk of stone formation progressively increases. A prevalence and role of individual risk factors for urolithiasis in patients with HIV are reviewed in the article. It is shown that in HIV-positive individuals, urolithiasis takes a leading position among renal diseases, with a prevalence ranging from 8 to 27%. The main risk factors for urolithiasis in HIV are: dietary factors, age, comorbid pathologies, use of protease inhibitors, changes in the ionic composition of urine, etc.

[Vascular endothelial growth factor in elderly and senile age: clinical and pathogenetic relationships.]

The aim of the study was to study the role of serum vascular endothelial growth factor and to determine its clinical significance in elderly and senile patients. The study included 124 people (40 men and 84 women) aged 60 to 89 years, the average age was 68,8±7,4 years. Serum levels of vascular endothelial growth factor (VEGF) were studied in the work; blood lipid spectrum parameters, indicators of acute phase blood proteins: C-reactive protein (C-RP), fibrinogen; glomerular filtration rate (GFR) according to the CKD-EPI formula based on serum creatinine and according to the F. Hoek method using cystatin C. In general, 15,3% of the examined individuals had elevated serum levels of VEGF, more often in elderly patients. It was found that serum levels of VEGF are positively associated with the concentration of CRP (r=0,411), the number of platelets in peripheral blood (r=0,358) and positive with the concentration of serum cystatin C (r=0,211). In the subgroup of patients with an elevated serum VEGF level, the platelet count, the concentration of C-RP, fibrinogen, and cystatin C were significantly higher, and the calculated GFR according to F.Hoek was significantly lower. Patients with an elevated serum VEGF level, as a pro-inflammatory and prothrombogenic potential, especially if it is associated with the development of kidney dysfunction in the elderly and senile, should be considered as a risk group for atherothrombotic cardiovascular events.

[Chronic cerebral ischemia in therapeutic hospital patients]. / Khronicheskaya ishemiya mozga u patsientov terapevticheskogo statsionara.

OBJECTIVE: To study the features of clinical and functional manifestations of the syndrome of chronic cerebral ischemia (CCI) in therapeutic patients. MATERIAL AND METHODS: Patients (n=577) in therapeutic departments were selected by random sampling. Of these, 277 patients had verified CCI. RESULTS: Patients with CCI, compared with the control group, were older (61.7±9.6 years and 43.3±12.2 years, p<0.05), had a significant increase in body mass index (28.5±5.1 and 26.9±5.7 kg/m2, p<0.05), systolic level (140±20 and 127±17 mmHg, p<0.05) and diastolic blood pressure (87±10 and 82±11 mm Hg, p<0.05), platelet count in peripheral blood (278.0±70.7·109/l and 259.1±80.8·109/l, p<0.05), venous blood glucose (7.11±3.8 and 5.31±1.7 mmol/l, p<0.05), triglycerides (1.37 (1.01; 1.97) mmol/l and 1.34 (0.96; 1.96) mmol/l, p<0.05), uric acid (0.425±0.12 and 0.374±0.14 mmol/l, p<0.05), creatinine (82.7 (68.0; 114.0) µmol/l and 72.3 (61.8; 93.0) µmol/l, p<0.05) and cystatin C (1.24 (1.08;1.62) mg/l and 1.01 (0.87; 1.32) mg/l, p<0.05). Statistically significant decrease in the concentration of high-density lipoprotein cholesterol (1.0±0.28 mmol/l and 1.2±0.32 mmol/l, p<0.05), serum magnesium (0.90±0.15 and 0.94±0.13 mmol/l, p<0.05) and estimated GFR (57.9±24 and 72.6±26.8 ml/min, p<0.05) were characteristic of patients with CCI. Elevated levels of C-reactive protein and anemia were significantly more common in these patients. A close correlation was found between the concentrations of uric acid (r=0.786; p<0.001) and cystatin C (r=0.587; p<0.005) in blood serum and the thickness of the intima-media complex of the carotid arteries. CONCLUSION: In patients of a therapeutic hospital, CCI is associated with older age, weight gain, arterial hypertension, dyslipidemia, anemia, inflammation, hypomagnesemia, hyperuricemia, thickening of the intima-media complex of the carotid arteries, and a decrease in the functional state of the kidneys.

[Functional state of kidneys and cardiovascular risk in patients with urolithiasis in an outpatient setting].

AIM: To analyze the functional state of the kidneys and vascular stiffness in patients with urinary stone disease in an outpatient setting. MATERIAL AND METHODS: A total of 110 patients with urinary stone disease aged 17-72 years were included in the study. The stone size was 2,67 (1,90-3,49) mm. A clinical examination included evaluation of vascular stiffness, serum level of creatinine, cystatin C, calcium, phosphorus, sodium, magnesium, uric acid and total cholesterol. The glomerular filtration rate (eGFR) was calculated based on the formulas CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) and MDRD (Modification of Diet in Renal Disease) and Hoek's equations using creatinine and cystatin C, respectively. RESULTS: Most often, urinary stone disease was associated with arterial hypertension (75%), a sedentary lifestyle (66.3%), hypercholesterolemia (53.6%), obesity (47.2%), hyperuricemia (44.5%) and smoking (40.9%). The median and interquartile range of eGFR according to CKD-EPI, MDRD and Hoek's equations was 100.00 (78.00;113.00) ml/min, 96.00 (71.00;106.00) ml/min and 77.65 (61.50; 93.60) ml/min, respectively. The normal GFR was significantly more often detected by the formula CKD-EPI (66.3%) in comparison with the Hoek's equations (52.7%), p<0.05. A decrease in mild GFR was found in 21 (19.0%) patients according to CKD-EPI and 33 (30.0%) according to Hoek's equations (p<0.05). In the subgroup of patients with a mild to moderate decrease in GFR according to the Hoek's equations, stiffness index and resistive index were significantly higher than in the similar subgroup of patients with decrease of GFR measured using the CKD-EPI formula (p<0.05). A negative correlation between GFR calculated using three formulas and Augmentation Index was established. CONCLUSIONS: In patients with urinary stone disease, potential cardiovascular risk factors are very common. The study of serum cystatin C level with calculation of GFR according to Hoek's equations in individuals with urolithiasis allows to evaluate total renal nitrogen excretion, as well as the level of the cardiovascular risk in the early stages of the disease.

[Inflammatory markers, lipid metabolism and renal functional state in young, middle, elderly and senior patients with high cardiovascular risk.]

With increasing age in the human body, various pathophysiological changes are observed in response to the effects of various factors, taking into account the genetic predisposition. Among the possible factors causing an increase in cardiovascular risk in the general population are the level of blood pressure, changes in lipid metabolism and inflammation markers, as well as the magnitude of the filtration function of the kidneys. This publication examined inflammatory markers, lipid metabolism, and renal function in 269 (136 males and 133 females) young, middle, elderly, and senile patients at high cardiovascular risk. It was shown that among the elderly, the frequency of overweight was 31%. The prevalence of obesity of the 1st degree was relatively higher in patients of middle (25,4%) and elderly (28,7%) age. In senile (62,5%) and young (48,3%) people, the most frequently recorded increase in heart rate was ≥80 beats per minute. The prevalence of arterial hypertension was 31,6% in young people and 59,4% in middle-aged people. The number of patients with hypertension increased among the elderly and senile participants, 68,9 and 62,5% respectively. Systolic blood pressure levels were higher in the elderly compared to young and old people. The diastolic blood pressure and hemoglobin levels were significantly lower among elderly patients. Levels of total cholesterol, cholesterol of low density lipoproteins and triglycerides were significantly higher in middle-aged people. Serum levels of tumor necrosis factor-alpha (TNF-α), as well as C-reactive protein, were significantly higher among elderly patients. A significant decrease in the filtration function of the kidneys was observed among elderly and senile patients.

[Modern biomarkers of renal dysfunction in the elderly and senile age: clinical and prognostic significance.]

In the presented work, the role of modern biomarkers of kidney dysfunction in elderly (n=97) and senile (n=18) patients was investigated. A clinical and laboratory examination was performed with an assessment of the glomerular filtration rate (GFR) using the CKD-EPI formula. Serum levels of cystatin C and metabolism of beta-2-microglobulin (ß2-MG) were assessed. In the presented sample, the prevalence of a decrease in GFR <60 ml/min was 30,4% of cases. The frequency of individuals with elevated serum cystatin C, depending on the GFR category (CKD-EPI), was as follows: C1 - in 79,9%; C2 - in 77,6%; C3A - in 74%; C3B - in 80,6%; C4 - in 100%; C5 - in 100%. An increase in the serum level of ß2-MG was observed in 51,8 and 58,4% of patients, respectively, on C1 and C2 gradations of renal function. An increase in urinary ß2-MG excretion was found in 40,7% of patients at C1 and 41,5% at C2 gradations of renal function. The number of patients who had elevated levels of ß2-MG excretion in the urine at C3B and C4 gradations of GFR reduction was 75 and 88,6%, respectively. At the terminal stage of CKD, almost every patient showed an increase in ß2-MG excretion in the urine. A statistically significant relationship between the metabolism of ß2-MG and the nitrogen excretion function of the kidneys was established. In elderly and senile people, the determination of serum levels of cystatin C and ß2-MG makes it possible to detect a decrease in the filtration function of the kidneys at an earlier stage compared with the assessment of GFR calculated from the level of blood creatinine. Elevated levels of cystatin C and ß2-MG are additional risk factors for cardiovascular complications.

[Bidirectionality of cardiovascular risk factors in patients with urolithiasis: current state of the problem].

The most common risk factors for cardiovascular disease and urolithiasis are presented in the article. Data on the prevalence of urolithiasis are discussed, as well as the pathogenetic mechanisms of stone formation in patients with metabolic syndrome, dyslipidemia, and arterial hypertension. The bi-directional relationship of cardiovascular risk factors and urolithiasis is generalized. The role of calcium, uric acid, citrate, changes in urine pH and an increase in body weight in the formation of kidney stones is shown.

[Cerebrovascular complications in patients with malignant neoplasms]. / Tserebrovaskulyarnye oslozhneniya u bol'nykh so zlokachestvennymi novoobrazovaniyami.

Patients with malignant neoplasms have an increased risk of cerebrovascular complications (intratumoral hemorrhage, invasion of arterial and venous sinus by tumor mass or leptomeningeal infiltrates, and tumor embolism). The review discusses the role and importance of cisplatin and radiation therapy in the occurrence of cerebrovascular complications in patients with malignant neoplasms that may occur before, during or years after treatment. Descriptions of individual clinical observations of the lesions of the central nervous system in the treatment of cancer are provided. The type and mechanism of stroke, as well as the stage and pathology of the neoplasm, dictate the use of a multidisciplinary approach, which ensures proper management and helps to outline the prognosis in this category of patients.

[Correlations between parameters of central hemodynamics and cytokine profile in chronic kidney disease in combination with cerebrovascular diseases]. / Vzaimosviaz' parametrov tsentral'noi gemodinamiki i tsitokinovogo profilia pri khronicheskoi bolezni pochek v sochetanii s tserebrovaskuliarnymi zabolevaniiami.

AIM: To study the relationship between central hemodynamics and arterial stiffness indicators with cystatin C, tumor necrosis factor-alpha (TNF-alpha) and interleukin-(IL)-10 in patients with chronic kidney disease (CKD) in combination with cerebrovascular diseases (CEV). MATERIAL AND METHODS: One hundred and twenty patients, aged from 19 to 81 years, with signs of chronic renal dysfunction, including 73 with CKD (1st group) and 47 with CKD in combination with CEH (group 2), were examined. 'AngioScan' (Russia) was used to study indices of arterial rigidity. Blood plasma concentrations of TNF-alpha, IL-10 and cystatin C were determined by the enzyme immunoassay. RESULTS: There is a significant increase (p<0.05) in the systolic, diastolic, central levels of arterial pressure, augmentation index, the index of increase at a pulse rate of 75 per min, the age index, the age of the vascular system and cystatin C content in the patients with CKD in combination with CEV compared to the patients with CKD without accompanying CEH. In the group of patients with CKD in combination with CEV, a correlation was found between the level of TNF-alpha and arterial stiffness index on one side (r=0.318; p<0.05) and the augmentation index on the other (r=0.299; p<0.05). CONCLUSION: The results confirm the fact that there is a significant increase in the level of plasma cystatin C and a decrease in GFR in patients with CKD in combination with CEV. Correlations were found between the level of TNF-alpha, augmentation index and deterioration of parameters of central hemodynamics and arterial stiffness in CKD in combination with CEH.

[Bilateral impact of cardiorenal relationships in the nephrotic syndrome.]

To study and analyze the cardiorenal relationships in nephrotic syndrome, taking into account sex differences. A total of 272 patients with nephrotic syndrome (NS) aged 16 to 65 years were examined. All patients underwent general clinical examination, electro-and echocardiography, assessment of peripheral and biochemical blood counts. NS was determined with daily proteinuria of more than 3.5 g/1.73 m2 per day, hypoalbuminemia (albumin less than 30 g/l) and hyperlipidemia (total cholesterol more than 5.1 mmol/l). The duration of the National Assembly ranged from 3 months or more. Depending on the gender, the total sample (n=272) was divided into two subgroups: the 1st subgroup - patients with female NS (n=88), the 2nd subgroup - males with NS (n=184). The mean systolic, diastolic, pulse and mean arterial pressure (BP) were significantly higher in male NS patients (p<0.05). Supraventricular and ventricular ectopic activity was significantly more common in males. In the subgroup of women with NA, sinus tachycardia was significantly more frequently detected, a slowing down of the impulse conduction along the bundle of His, a violation of the processes of repolarization of the LV (p<0.05). The final systolic and diastolic sizes of the left ventricle (LV), the thickness of the interventricular septum and the posterior wall of the left ventricle, the diameter of the aorta, the longitudinal size of the left atrium and the right ventricle were significantly larger in the group of males with NA. Significantly lower concentrations of hemoglobin, hematocrit, erythrocyte counts were observed in the subgroup of females with NS compared with men (p<0.05). In the cohort of men with HC, there was a significant decrease in the content of total serum protein (44.8±11.0 g/l versus 49.2±11.2 g/l; p=0.003) as compared with females. In the male subgroup of HC, serum creatinine concentration [97 (81;143) mmol/l versus 86 (68;123) mmol/l; p=0.005] and the degree of daily protein excretion [6,490 (4,865;9,661) g versus 5,585 (4,168;7,625) g; p=0.034] with urine were significantly higher compared with the female subgroup (Table 2). At the same time, in the cohort of men with HC, there was a significant decrease in the calculated GFR [62.3 (46.2; 114.9) ml/min versus 87.0 (67.7;127.5) ml/min; p=0.002]. In case of NS in females, factors of deterioration of cardiorenal interrelations are anemia, sinus tachycardia, slowing down of impulse conduction along the bundle of His. Whereas in the NA subgroup of men, negative factors of cardiorenal interrelations are hypoproteinemia, increased systolic, diastolic, pulse and mean blood pressure, creatinine concentration and daily proteinuria, which was accompanied by a decrease in glomerular filtration rate and an increase in the linear dimensions of the heart.

[MicroRNA in ischemic stroke]. / MikroRNK pri ishemicheskom insul'te.

Today, stroke is the third most common pathology after cardiovascular disease and cancer, as well as the leading cause of disability in the world. Although some progress has been made in the field of primary and secondary stroke prevention over the past few decades, a deeper knowledge of the pathophysiology of the disease is needed to significantly improve diagnosis and therapy. MicroRNA (miRNA) is an important, recently identified class of posttranscriptional regulators of gene expression. MiRNA can be used as a tool for therapeutic interventions. This review considers a role of miRNAs in the regulation of experimental stroke and in the development of carotid artery stroke. A potential role of miRNAs as promising biomarkers of stroke is discussed.

[Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis].

PURPOSE: to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. MATERIALS AND METHODS: We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. RESULTS: Atherosclerotic changes of CA were found in 79 patients (29.3 %). Four patients (1.4 %) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75 %; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25 % vs. 62.16 %; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. CONCLUSION: We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[Renal dysfunction and indicators of arterial hormity in persons of elderly and senile age.]

In the presented paper had been examined parameters of arterial stiffness (stiffness index, SI m/s; reflection index, RI%; augmentation index, Alp; biological age of the vascular system, VA years; age index, AGI; alternative stiffness index, aSI; index of increase in HP=75, Aiр 75%), central arterial pressure and cystatin C content in serum. A totally were examined 98 persons (women, n=45 and men, n=53) elderly and older. A comparative analysis of arterial stiffness and its relationship with blood cystatin C in the examined groups with gender differences taken into account. In the elderly and older women, the augmentation index and its increase at a pulse rate of 75, atherogenic lipids (total cholesterol, low-density lipoprotein cholesterol and serum triglycerides) were significantly higher, and the indicators of the alternative stiffness index were significantly lower compared to men elderly and older. The greatest number of correlation interrelations was found between the indices of arterial stiffness and the level of cystatin C in the group of women of elderly and senile age.

Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis.

PURPOSE: to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. MATERIALS AND METHODS: We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. RESULTS: Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. CONCLUSION: We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[The gender features of disorders of composition of lipids of blood serum in patients with chronic pathology of kidneys.]

The purpose of the study was to investigate gender features of abnormalities of blood serum lipid composition and their relationship with clinical and functional manifestations in patients with chronic kidney disease (CKD). The study covered patients with CKD at pre-dialysis stage of disease, aged 17 - 71 years (average age 37.3±13.0 years). All patients underwent complex clinical and laboratory examination. Depending on gender, the sample (n = 417) was divided into 2 groups: group I - males (n = 277) and group II - females (n = 140). Blood sampling was implemented using venipuncture of ulnar vein after 12-14 hours of fasting in morning time. The lipid analysis of blood serum was performed using the auto-analyzer "Respons 920" (Germany), including detection of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The atherogenic index (AI) was calculated according formula: AI = (TC - HDL-C)/HDL-C. At analysis of the results of lipidogram, the levels of TC (hypercholesterolemia), LDL-C (hyper-beta-cholesterolemia) and TG (hypertriglyceridemia) were considered as increased when their values were ≥5.0 mmol/L, ≥3.0 mmol/L and > 1.7 mmol/L respectively. The level of HDL cholesterol (hypo-alpha-cholesterolemia) was considered as decreased when its concentration was ≤1.0 mmol/L in males and ≤1.2 mmol/L in females. In the group of male patients, hypo-alpha-cholesterolemia was detected in 135 patients (48.7%), hypertriglyceridemia - in 162 (58.4%), and average value of atherogenic index was significantly higher - 3.49 (2.43-5.08) as compared with 3.12 (2.12-3.74) in female patients (p=0.001). The laboratory signs of anemia were significantly more frequent in group of females - 53 (37.8%) as compared with 63 (22.7%) than in males (p = 0.001). In males, average values of HDL cholesterol and total serum protein were significantly lower (1.07 ± 0.44 mmol/L vs. 1.23 ± 0.42, p = 0.000 and 53.3 ± 14.6 g/L vs. 57.4 ± 11.9 g/L, p = 0.007, respectively. The levels of TG - 1.92 (1.23-2.74) mmol/L vs. 1.85 (1.04-2.37); p = 0.034], sodium (140.3 ± 6.20 mmol/L vs. 138.3 ± 6.01 mmol/L, p = 0.010) and uric acid in blood serum were significantly higher (0.38 ± 0,09 mmol/L vs. 0.34 ± 0.01 mmol/L, p = 0.003) as compared with females. In the group II (females), a noticeable slowing of the glomerular filtration rate (GFR) - 68,4 (43,6-98,1) ml/min vs. 87,6 (55,0 - 117,6) ml/min; (p = 0.001) was detected as compared with group I (males). Among male patients, a reliably significant positive relationship was established between TC and BMI, level of diastolic blood pressure and proteinuria; LDL cholesterol level and proteinuria; concentration of TG - and BMI, level of diastolic blood pressure and level of proteinuria. No correlation was established between the concentration of HDL-cholesterol and aforementioned laboratory markers of CKD. In contrast with males, in females, TC demonstrated an inverse relationship with the concentration of Hb, values of GFR and proteinuria, and level of HDL cholesterol - with indices of BMI, thrombocytes and uric acid of blood serum. In females a positive relationship was established between LDL cholesterol and level of diastolic blood pressure, GFR and daily proteinuria, and also between concentration of serum TG and volume of daily proteinuria and BMI. In general group, a reliable positive relationship was detected between TC and BMI and proteinuria, between LDL-C level and proteinuria, and between TG concentration and BMI, level of diastolic blood pressure, sodium content and proteinuria. The negative relationship was established between concentration of HDL cholesterol and BMI and uric acid in blood plasma, and TG level with Hb concentration. In male patients with CKD at pre-dialysis stage of disease, decreasing of level of HDL cholesterol was established as an increased concentration of TG and increasing atherogenic index. The content of triglyceride of blood serum is closely related to body mass index, level of diastolic blood pressure and proteinuria. In females, slowing of glomerular filtration rate is accompanied by development of anemia and atherogenic dyslipidemia.

[Endothelial dysfunction and arterial wall stiffness: New targets in diabetic nephropathy]. / Disfunktsiia éndoteliia i zhestkost' arterial'noi stenki: novye misheni pri diabeticheskoi nefropatii.

In recent years, one of the promising areas in clinical medicine is the study of impaired ments in endothelial function and arterial wall stiffness, which can be referred to as one of the important predictors of cardiovascular events in patients with chronic kidney disease, including that of diabetic etiology. There is strong evidence that endothelial function and great artery stiffness may be used as reliable clinical and instrumental indicators to evaluate the efficiency of therapeutic measures and the rate of progression of cardiovascular disorders in type 2 diabetes mellitus. The article presents data on the role of endothelial dysfunction and arterial wall stiffness in the progression of chronic kidney disease in type 2 diabetes mellitus and discusses the possibility of their correction with pharmacological agents.

[The nephrogenic anemia: progression in comprehension of pathophysiology and a potential of the new approaches to safe therapy.]

The normocytic normochromic anemia is one of signs of progressing chronic kidney diseases mainly related to absolute or relative decreasing of production of erythropoietin and iron deficiency. The last decade discovery of hepcidin (regulator of iron homeostasis) and also various factors and signaling pathways regulating its metabolism the pathophysiology of anemia under chronic kidney diseases is understood significantly better. As a result, dramatically increased research concerning development of potentially new pharmaceuticals that can be used for treatment of kidney anemia with more or less efficiency and safety. The review words actual conceptions of physiological and pathological role of iron and also about main mechanisms of regulation its metabolism in human organism. The particular attention is given to hepcidin playing a key role in regulation of extra-cellular content of iron. Furthermore, the issues are covered related to risk profile of actual approaches to therapy of anemia under chronic kidney diseases and also certain potentially dangerous methods of treatment that can become available in nearest perspective.