[Adenoma of the parathyroid gland in a young woman with chronic kidney disease: primary or tertiary hyperparathyroidism?]

Clinical observation of a young woman with chronic kidney disease IV stage and hyperparathyroidism is presented. Ultrasound and99mTc-sestamibi scintigraphy of the anterior surface of the neck visualized a tumor of the left upper parathyroid gland. In a histological examination of distant education was diagnosed a solid parathyroid adenoma. The difficulty of differential diagnosis between primary and secondary/tertiary hyperparathyroidism in chronic kidney disease is discussed.

[The clinical course and treatment of fungal infections in the early period after kidney transplantation].

The article discusses the critical issues of clinical manifestations and treatment of fungal infections in patients after kidney transplantation. In fungal infection, which is usually detected in the composition of microbial associations, lungs are more often affected. In this case, mortality reaches 60%. Affecting the renal transplant by Candida spp. or Aspergillus spp. can lead to the loss of function of transplanted kidneys. At the current stage, lipid formulations of amphotericin B are drugs of choice for antimycotic therapy in posttransplant period. Nephrotoxic effect of amphotericin B is reversible and does not represent a serious threat to the function of the transplantate. Administration of lipid formulations of amphotericin B is the most justified, since it does not affect the concentration ofimmunosuppressive drugs in the blood serum of patients after transplantation.

[A case of complication of system scleroderma with AL-amyloidosis].

The article describes a case of systemic scleroderma complicated by a severe nephrotic syndrome after seven years in a 46-year-old patient. Rectal mucosal biopsy and right renal biopsy were performed to clarify the origin of the nephrotic syndrome and because amyloidosis was suspected. Massive amyloid deposits were found in biopsy material, colored with Congo red and studied in normal and polarized light. After processing with guanidine and coloring with Congo red, the material was studied in normal and polarized light; amyloid deposits preserved their congophilia and double refraction during two hours of incubation, which is typical of AL-amyloidosis. The patient was directed to a specialized nephrological department for the treatment of AL-amyloidosis.

[Fast detection of DNA of hepatitis B virus by real time PCR].

90 blood plasma samples from patients with suspected chronic viral hepatitis B (CVHB) were analyzed by real-time polymerized chain reaction (PCR). The findings were compared with the results obtained by 2 PCR electrophoresis-based test-systems; the sensitivity limit for the quantification of DNA of hepatitis B virus (HBV) was determined; in the present case, the limit corresponded to 30 replications of HBV DNA to reaction (600 GE/ml). The positive result of real-time PCR was registered in 53.3% of cases. The quantity of HBV DNA replications in blood plasma samples varied from 30 to 3.9 x 10(6) per reaction (600-7.8 x 10(7) GE/ml). Serological profiles were analyzed in 18 patients with the verified diagnosis of CVHB. HBV DNA was detected in blood of 65% of HBsAg(+)-patients. The markers of HBeAg replication were noted in 35.5% of patients; it is noteworthy, that HBeAg(+)-samples were characterized by a higher level of viral loads (> or = 10(6) GE/ml) versus HBeAg(-)-samples (> or = 6 x 10(3) GE/ml). An analysis of blood-plasma samples dynamically obtained from one patient with chronic renal insufficiency and CVHB showed a decreased level of viral load from 1.7 x 10(7) GE/ml to a negative finding of real-time PCR registered after a therapy course by zeffix. Hence, the automated and standardized real-time PCR, when used at a multi-field patient-care facility, ensures a better diagnosis of viral hepatitis B.

[Infectious complications in using mofetil micofenolate in patients with renal allotransplant].

AIM: To study infectious complications in renal transplant recipients receiving mycophenolate mofetil (MMF) for prevention of acute transplant rejection or treatment of chronic allograft nephropathy (CAN). MATERIAL AND METHODS: A group of renal transplant recipients (n=47) receiving 1.0-2.0 g/day MMF with cyclosporine A (CsA) and steroids as maintaining immunosuppression was compared to a group (n=47) taking triple immunosuppressive therapy which included azathioprine (Aza). Separate group of patients (n=9) received MMF for treatment of CAN. In all groups etiology and incidence of infections were evaluated. RESULTS: During 2 years various posttransplant infections developed in 72.3% patients on MMF and 93.6% on Aza. The incidence of viral infections was 53.2% in MMF and 59.6% in Aza group, the incidence of bacterial infection--55.3 and 70.2%, respectively. Among 9 recipients with CAN the infections occurred in five. There were two cases of active tuberculosis in Aza group, one--in MMF group and one in patients with CAN. CONCLUSION: We suggest that MMF in the dose 1-2 g/day does not increase infection rates in renal transplant recipients comparing Aza.

[Malignant tumors in patients with kidney transplants ]. / Zlokachestvennye opukholi u bol'nykh s peresazhennoi pochkoi..

In this retrospective study we evaluated incidence of malignancies observed among 718 renal transplant recipients with at least 6 months of follow-up. A total of 461 men and 257 women (mean age at transplantation 36.3 +/- 8.3 years) were included. Thirty three out of 718 recipients (4.6%) developed malignant neoplasia: 45.4% of these were Kaposi's sarcomas, 12.1%--cancers of the uterine cervix, 12.1% cancers of the stomach, 12.1%--basal cell carcinomas, 6.06%--posttransplant lymphoproliferative disorder. There was no significant effect of either cyclosporin A doses or OKT3/ATG on the incidence of the tumors. Mean age of transplant recipients with malignancies was statistically higher as compared to those without malignancies (45.5 +/- 8.2 years versus 36.1 +/- 8.4 years, p < 0.00001). The median time from onset of end-stage renal failure (dialysis start) and from the transplantation to the diagnosis of the tumor make up 32 (16-161) and 23 (5-158) months, respectively. One renal transplant patient suffered from multiple myeloma with aggressive course.

[Generalized tuberculosis after kidney transplantation]. / Generalizovannyi tuberkulez posle transplantatsii pochki.

Tuberculosis is one of severe infectious complications in patients on hemodialysis and after kidney transplantation. Incidence of disseminated and generalized forms is high, whereas clinical symptoms are weak and nonspecific. An aggressive generalized form of tuberculosis was observed in a kidney transplant recipient. M. tuberculosis, the antigen and DNA were registered only a few days before death. Disseminated foci in the lungs were seen on CT image only in the agonal period in spite of multiple x-ray investigations. Thus, our experience and experience of other investigators evidence that if recipients of renal transplant have fever of unknown genesis and do not respond to standard antibiotic therapy, tuberculosis should be suspected and a course of specific antituberculosis therapy should be started as early as possible.

[Use of plasmapheresis in intensive therapy of acute steroid-resistant rejection reaction in renal transplants]. / Primenenie plazmafereza v intensivnoi terapii ostroi steroidrezistentnoi reaktsii ottorzheniia renal'nykh transplantatov.

For many years the treatment of steroid-resistant rejection (SSR) remains a common problem od renal transplantation. We used plasmapheresis (PPH) in the treatment of SRR in 29 renal transplant recipients. All patients had progressive deterioration of renal function and compatible biopsy histology. The first group (15 patients) was administered PPH with methylprednisolone (MP). The second group (14 patients) was treated by intravenous MP. There was no significant difference in the time of beginning and severity of rejection. In the PPH group the results were better: a significant increase in SSR reversion was attained (73.3%) in comparison with the control (42.8%), the number of grafts lost during the first year was less (26.7 versus 57.2%). Better results were observed in patients with high levels of serum anti-HLA antibodies. Their transplants functioned well during 12 months after SSR. Hence, PPH can be used in patients with SSR with high levels of anti-HLA antibodies.