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Background: In 1998, a survey of the European Society for Paediatric Nephrology (ESPN) revealed substantial disparities in pediatric renal care among European countries. Therefore, ESPN aimed at harmonizing renal care in all European countries in the following 20 years. In 2017, we conducted a survey to evaluate the current status of renal health policies for children in Europe. Methods: A 33-question web-based survey was designed and sent to presidents or representatives of national societies of pediatric nephrology in 44 European countries. Results: Data was reported from 42 (95.5%) countries. The number of pediatric nephrologists per million child population increased from 1998 to 2017 in 70% of countries. Pediatric dialysis facilities for acute kidney injury and end-stage kidney disease were available in 95% of countries. The availability of pediatric kidney transplantation increased from 55 to 93% of countries. Considerable variation was found in the current availability of allied health professionals, including psychosocial and nutritional support, high-tech diagnostic methods, and treatment with expensive drugs for children with kidney diseases between different European countries. Conclusions: The 20-year follow-up analysis of pediatric renal care services in European countries revealed that pediatric nephrology has become a well-established subspecialty in pediatrics and nephrology in 2017. The ESPN will continue its efforts to further improve pediatric renal care for European children by harmonizing remaining disparities of renal care services. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is detected in 8-15% of the world's population. Along with fibrotic changes, it can lead to a complete loss of organ function. Therefore, a better understanding of the onset of the pathological process is required. To address this issue, we examined the interaction between mast cells (MCs) and cells in fibrous and intact regions, focusing on the role of MC proteases such as tryptase, chymase, and carboxypeptidase A3 (CPA3). MCs appear to be involved in the development of inflammatory and fibrotic changes through the targeted secretion of tryptase, chymase, and CPA3 to the vascular endothelium, nephron epithelium, interstitial cells, and components of intercellular substances. Protease-based phenotyping of renal MCs showed that tryptase-positive MCs were the most common phenotype at all anatomic sites. The infiltration of MC in different anatomic sites of the kidney with an associated release of protease content was accompanied by a loss of contact between the epithelium and the basement membrane, indicating the active participation of MCs in the formation and development of fibrogenic niches in the kidney. These findings may contribute to the development of novel strategies for the treatment of tubulointerstitial fibrosis.

Background: Analysis of publication activity in the field of biomedicine shows insignificant input of Russia in the world scientific product. This is largely due to the lack of incentives for researchers. Article describes stimulation of researchers in Russia, compares it with foreign models, formulates main shortcomings of support and stimulation of research in Russia and introduces the concept of effective contract., Aims: Development of personnel motivation and stimulation of employees of scientific and research organizations in the field of health., Materials and Methods: As a successful experience the article describes the implementation of effective contract in Veltishev Research and Clinical Institute for Pediatrics where for years remuneration of researchers depended upon their positions without consideration of research results. Effective contract brought significant changes in the traditional system setting new performance and efficiency criteria. New evaluation system took into account publication activity, presentation activity, implementation of research results, raising scientific personnel, thesis work and income-generating activities., Results: Introduction of effective contract already in the second year led to a rise in the number of foreign publications, publications in journals with impact factor of more than 2, the general increase in the number of articles in peer-reviewed journals with impact factor more than 0.3, the growth of the number of articles by 1 researcher, Hirsch index improving both by individual employees and the entire Institute, increase of grant activity and presentation activity at top-rated professional congresses. The growth of publication and presentation activities has been achieved at the reduction of research staff by 23%. From financial viewpoint effective contract resulted in the redistribution of resources in favour of more efficient researchers., Conclusions: The introduction of effective contract and increase of requirements for scientific output did not cause resistance of staff, although demanded certain time for joint development of criteria by scientific community, as well as the development and implementation of soft for continuous assessment of research activity.

The endogenous intoxication of organism can be a primary cause of changing in content of protein molecules with enhancement of their capacity to adsorb microelements fastening conformation of proteins. Such an alteration add them antigen characteristics conditioning autoimmune damage of tissues, kidneys included. The most frequent syndromes (cases?) ofendogenous intoxication effecting kidneys pathology are presented.

Investigations performed in the region contaminated with heavy metal salts revealed high prevalence of renal diseases in children. The test for blood polymorphic proteins indicated signs of genetic predisposition to renal damage. Greater occurrence in the population with econephropathy of a rare allele of transferrin C3 may be the cause of enhanced oxidative-radical processes in renal cells. Individual sensitivity of children to heavy metal salts assessed by leukocytolysis and high incidence of somatic mutations to determine T-lymphocyte microclones deficient by HGPRT may help in specification of the affections detected in the regions contaminated with heavy metal salts.

The study of the population in the region contaminated with heavy metal salts has revealed high incidence of nephropathies even in preschool children manifesting initially in the majority of cases with hematuria. All the patients had the signs of urinary dysembryogenesis and marked membranopathological process. Long-term exposure to even small doses of heavy metals is supposed to cause nephropathy. Urinary disease arose more frequently in those genetically predisposed to renal and urinary tract affections. Because urolithiasis is a frequent result of dismetabolic nephropathy in endemic regions, it is advisable to perform active monitoring of children with environmental nephropathy using membrane-stabilizing measures. Optimal for these purpose could be xidifon. Further studies are needed to elucidate the problem of rapid elimination of heavy metals with chelating agents.

A relationship between clinical forms of glomerulonephritis and incidence of viral antigens in renal tissue was revealed: Hepatitis B virus antigens (HBsAg) are more frequently detected in the glomeruli in the patients with nephrotic glomerulonephritis, Herpes simplex antigens are detected in the glomeruli in mixed glomerulonephritis, and cytomegaloviral and Herpes simplex antigens are detected in the epithelium of the proximal canaliculi in patients with hematuric glomerulonephritis. No correlations between the persistence of Herpes simplex type 1, cytomegalovirus, and HBsAg in the renal tissue were detected. HBsAg is detected in the renal tissue mainly in the children without free HBsAg in the blood serum. This may be indicative of an important role of specific immune complexes in the pathogenesis of glomerulonephritis associated with hepatitis B viral infection. The results point to an appreciable contribution of a persistent viral infection to the progress of glomerulonephritis.

A total of 142 children aged 2-15 years with different nephropathies, among them 94 children with glomerulonephritis (GN), 26 children with pyelonephritis and 22 children with oxalate nephropathy, were examined. The diagnosis was histologically confirmed in 36 children. Mesangial proliferative GN was detected in 22 patients and membrane proliferative GN, in 14 children. The presence of the markers of HBV infection (HBsAg, anti-HBs and anti-HBc total immunoglobulins, anti-HBc IgM) was detected in the sera of all patients by the enzyme immunoassay. As the result of this examination, essential changes in the distribution of different markers of HBV infection in children with nephropathies were detected. The combination of HBsAg with anti-HBc IgM proved to be the most characteristic feature of patients with the nephrotic syndrome; this was indicative of active HBV infection, and in patients with the mixed form of GN this combination occurred twice as frequently. The established correlation between the activity of HBV infection and the severity of the course of GN made it possible to suggest the participation of HBV in the pathogenesis of GN. This suggestion was indirectly confirmed by a higher detection rate of HBsAg and anti-HBc IgM in patients with the membrane proliferative form of GN.

The efficacy of therapy with reaferon (recombinant alpha 2-interferon) was studied in children with glomerulonephritis (GN) associated with hepatitis B virus infection as well as its effect on the interferon status (IFN), production of interleukins (IL) 1 and 2 and synthesis of active arachidonic acid (AA) metabolites by the blood cells in the course of treatment. The IFN status, IL-1, IL-2 production, and synthesis of AA active metabolites (LTB 4- and 5-HETE) by the blood cells, as well as markers of HBV-infection (HBsAg, anti-HBs, anti-HBc total and anti-HBc of the IgM class) were examined over time in 60 GN patients treated with reaferon alone and administered immunosuppression therapy (IST), with antioxidants, or IST alone. The employment of reaferon for treatment of GN patients was shown to increase the efficacy of GN treatment, especially in combination with immunosuppressive drugs, to prevent reactivation of hepatitis B virus when prednisolone and/or cytostatic drugs were used, and to reduce hepatitis activity. It way be assumed that the above effects were mainly due to the action of reaferon and antioxidants on the improvement of the condition of immunocompetent cells, primarily monocyte-macrophage system and leukocytes. During reaferon therapy, normalization of alpha-IFN and IL-1 production by the blood cells and inhibition of production of AA active metabolites were observed.

A total of 33 families were surveyed with a view to determine the presence of viral hepatitis B markers in persons with diagnosed renal diseases. In all patients markers of hepatitis B virus infection (HBsAg, anti-HBs antibodies, anti-HBc total and IgM antibodies) were determined in the enzyme immunoassay. Those families in which examinees with renal pathology were found to have markers of hepatitis B virus infection exhibited a high level of contamination with hepatitis B virus. A high proportion of examinees with viral hepatitis B was established in the families where mothers were found to have markers of hepatitis B virus infection. These facts indicate that everyday contacts play an important role in the transmission of the virus. The study points out that in the family foci of hepatitis B virus infection non-manifest or slightly manifest forms of this infection are mainly registered.

To define the clinico-pathogenetic importance of alpha 1-inhibitor of proteinases and alpha 2-macroglobulin of the blood in children with glomerulonephritis, a study was made of the phenotype of alpha 1-inhibitor of proteinases and its concentration in the blood serum of 156 patients with different clinical forms of glomerulonephritis. Overall 1290 practically healthy children were examined as control. The patients suffering from glomerulonephritis did not demonstrate phenotypes responsible for acute deficiency of alpha 1-inhibitor of proteinases (PISS, PISZ). A relationship was established between the amount of alpha 1-inhibitor of proteinases in the blood serum in children with different clinical forms of glomerulonephritis: the patients with the nephrotic form manifested a significant decrease of the inhibitor concentration in the blood serum, whereas in the hematuric form, a significant rise of it was recorded. All the patients suffering from glomerulonephritis showed a significant increase of the content of alpha 2-macroglobulin, particularly in the nephrotic form, which is likely to be determined by the enhanced output of the given protein and its negligible loss with urine in connection with a high molecular weight.