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History, Current Advances, Problems, and Pitfalls of Nephrology in Russia

The anatomy and physiology of kidneys as well as kidney diseases have been studied in Russia since the 18th century. However, there was a surge in interest in the 1920s, with numerous researchers and clinicians making substantial advances in the understanding of the pathophysiology, pathology, and diagnostics of kidney diseases. The field of nephrology as clinical practice can be traced back to 1957–1958, when the first beds for patients with kidney diseases became available and the first hemodialysis procedure was performed. Nephrology and hemodialysis units were opened soon after, offering kidney biopsy, corticosteroid and immunosuppressive therapies, and dialysis for acute renal failure and end stage of renal disease. In 1965 kidney transplantation commenced. Between 1970 and 1990, the number of centers providing care for patients with kidney diseases increased; however, they were insufficient to meet the demands of native kidney disorders and renal replacement therapy. To address this, several educational institutions established postgraduate programs in nephrology and dialysis, and professional societies and journals were funded. While economic changes at the end of the 1990s resulted in a rapid increase of dialysis service, kidney transplantation and pathology-based diagnostics of kidney diseases remained underdeveloped. During the last 2 decades cooperation among international professional societies, continuing medical education courses, and the translation and implementation of international guidelines have resulted in substantial improvements in the quality of care provided to patients with kidney diseases.

We describe the history and development of clinical nephrology, dialysis, kidney transplantation, education in nephrology and dialysis, professional societies and journals, and registry of patients on renal replacement therapy in Russia during almost 60 years. We also present the most recent registry data analysis, address current problems and difficulties, and stress the role of incorporation into the international nephrology community.

Key Message

Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and renal replacement therapy are developing fast; implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

Historical Aspects

Russian scientists have been interested in the anatomy and physiology of kidneys as well as kidney diseases since the 18th century. Professor Shumlansky investigated renal anatomy and defended his thesis entitled “De structura renum: Tractatus physiologicoanatomicus” in 1776; the paper was republished in Strasburg in 1788 [ 1 ]. In 1853 Professor Polunin [ 2 ] described acute renal failure in patients with cholera, and Professor Zakharyin [ 3 ] published his paper entitled “Association between protein-containing urine and convulsions in pregnant women,” which was one of the first descriptions of eclampsia. Professor Bogolybov [ 4 ] defended his PhD thesis entitled “Renal pathology of parenchymal inflammation (Bright's disease)” in 1862, and in 1876 Professor Stolnykov [ 5 ] designed the quantitative method to detect protein levels in the urine. He also studied hemoglobinuria [ 6 ], and he published the association between renal ischemia and left ventricular hypertrophy in 1880 [ 7 ]. In 1882, Professor Ivanovsky [ 8 ] published his paper entitled “Bacterial inflammation of kidneys as a consequence of erysipelas.”

The first widely recognized historical case of kidney disease in Russia was the illness of Czar Alexander III, who suffered from severe edema, ascites, itching, dyspnea, and hemoptysis. His urinalysis showed the presence of proteins and casts, and he was diagnosed with “chronic interstitial inflammation of kidneys” and died from pulmonary edema on October 20, 1894. Among the attending doctors of Czar Alexander III during his last fatal illness were Professor Ernst Viktor von Leyden from Germany and Professor Grigory Zakharyin [ 9 ].

The most important achievement in the field of kidney diseases in 19th century Russia was the first model of nephrotoxic nephritis, developed by Professor Lindemann while working in Professor Mechnikov's laboratory. Lindemann [ 10 ] published his research entitled “Sur le mode d'action de certains poisons renaux” in the Annals of Institute Pasteur in 1900, in which he demonstrated the nephrotoxicity of heterologous anti-kidney sera in experimental animals. This model remains the most widely used animal model of crescentic glomerulonephritis.

The next phase of research commenced in the 1920s. In 1921, Professor Zymnitsky [ 11 ] implemented a simple kidney function test, based on the relative density of urine, which was known as the modified Volhard test. In 1929, Professor Tareev [ 12 ] published his book entitled “Anemia in Bright's disease.” He later published several monographs, summarizing his clinical experience, and highlighting the most important issues of pathophysiology, pathology, and clinical presentation of kidney diseases: “Kidneys and the Body” (1932), “Hypoproteinemic syndrome” (1933), “Kidney diseases” (1936), “Nephritis” (1958), “Fundamentals of Nephrology” (1972) [ 13 , 14 , 15 , 16 , 17 ], and many others, all of which became handbooks for several generations of nephrologists. In 1950, Professor Lang [ 18 ] published the monograph “Hypertensive disease,” in which he stressed the role of essential hypertension in kidney damage. In 1963, Professor Gynetsynsky [ 19 ] published “Physiological mechanisms of water-electrolyte balance,” where he described the details of water reabsorption in the distal nephron.

Development of Nephrology in Russia

General nephrology.

Nephrology as a field of medical practice started its development in Russia (which was then the Soviet Union) in 1957. An initiative of Professor Woffsy, one of the most recognized internists, introduced the first beds for patients with kidney diseases in the internal diseases unit of Moscow City Hospital No. 52 [ 20 ]. Professor Ratner, who as a resident studied internal medicine with Professor Lang in the then Leningrad (now known as Saint Petersburg), was invited to manage the patients and played a leading role during the fledging years of nephrology in Russia. Under her direction the nephrology beds transformed into the first nephrology unit in 1964, and in the same year, the first kidney biopsy in the Soviet Union was performed in the unit. Professor Ratner was also the first to successfully use corticosteroids to treat glomerulonephritis at the end of 1950s. The patient was a child with severe nephrotic syndrome. Immunosuppressants were first used by the initiative of Professor Tareev in 1959, and in 1961, Professors Woffsy and Ratner [ 21 ] published a paper entitled “Corticosteroid therapy of glomerulonephritis” in the Annals of Academy of Medical Science.

The first pediatric nephrology unit at the National Medical Research Center of Children's Health (the Research Institute of Pediatrics) was opened in 1965 by the initiative of Professor Studenikin, again headed by Professor Ratner. In 1970, Professor Veltischev started the division of inherited and acquired kidney diseases in the Research Clinical Institute of Pediatrics (which was then the Research Institute of Pediatrics and Children's Surgery), headed by Professor Ignatova till 2006 [ 22 ].

The second nephrology unit opened in Moscow City Hospital No. 52 in 1971, followed soon after with nephrology units opened in Moscow City Hospital No. 24 and the Moscow City Hospital n.a. S.P. Botkin (first headed by Dr. Alexander Lokshin). Other hospitals in Moscow, Saint Petersburg, and most big cities used the Moscow City Hospital No. 52 experience as a model when opening their respective units.

Professor Ratner was active as the leader of the rapidly growing renal service in Moscow until the end of 1980s. Her main interests were glomerulonephritis, transplanted kidney issues, and tubulointerstitial disorders, on which along with Professors Serov and Tomilina, she published a book entitled “Renal dysfunctions” in 1977 [ 23 ]. She also established a school of clinical nephrology, which is currently headed by Professor Tomilina.

In 1993 Professor Tomilina initiated the merging of two nephrology units - one for patients with native kidney diseases and the other for recipients of transplanted kidney - with the dialysis and outpatient units to create the Moscow City Nephrology Center, based in Moscow City Hospital No. 52. In 1998, the first intensive care unit for patients with kidney diseases opened in this center. The Moscow City Nephrology Center provides high-quality care for patients with any type of native and transplanted kidney diseases, not only to Moscow citizens, but also to referred patients. Professor Tomilina [ 24 ] recently summarized her clinical experience and published a monograph entitled “Selected Chapters in Nephrology.” The nephrology unit of the Moscow City Hospital n.a. S.P. Botkin also became a tertiary referral center at the beginning of 2000. The main priority of both centers is kidney biopsy with high-quality pathology diagnostics for a wide range of renal diseases. The nephropathology unit, which performs kidney biopsy readings for a vast majority of the population in Moscow, the surrounding area, and referred patients from other regions, is actually part of the Moscow City Nephrology Center.

Leading the intense development of clinical and research nephrology in Leningrad were Professor Ryabov, Professor Stavskaya, Dr. Jdanova, and Professor Bagrov - the successor of Professor Gynetsynsky, representing the Novosibirsk physiology school. For almost 50 years Professor Bagrov worked in the field of renal physiology and pathophysiology in close association with clinical practice. His monograph entitled “Water-electrolyte balance in Heart Failure” was published in 1984 [ 25 ]. A complex nephrology service, including the first outpatient unit for patients with kidney diseases, was organized in Leningrad in 1977 by Professor Ryabov. In 2003, several outpatient nephrology units in Saint Petersburg were merged under Professor Komandenko, and in 2008, the Saint Petersburg City Nephrology Center was opened. Currently, there are many nephrology units in Moscow, Saint Petersburg, and other big cities actively treating patients with glomerulonephritis, systemic diseases, diabetes, amyloidosis, chronic kidney disease (CKD) complications, and even orphan diseases such as atypical hemolytic uremic syndrome, Fabry disease, and cystinosis.

Unfortunately, the exact disease spectrum for CKD is not known, because general statistics, based on the main diagnosis only, does not represent CKD epidemiology. However, the database of the nephrology unit of the Moscow City Hospital n.a. S.P. Botkin provides some information and gives an impression of the disease spectrum. Table ​ Table1 1 represents unpublished data analysis.

Spectrum of CKD causes

Nephrology unit of Moscow City Hospital n.a. S.P. Botkin, 1994–2017 ( n = 18,368 cases).

The care and management of CKD include (1) CKD diagnostics and stratification; (2) monitoring of proteinuria, eGFR, and blood pressure; (3) treatment of underlying kidney diseases and measures for prevention of CKD progression; and (4) diagnostics, evaluation, and treatment of anemia, metabolic bone disease, cardiovascular complications, etc. Nephroprotection strategies, erythropoiesis-stimulating agents, iron supplementation, and phosphate binders are widely used. Diagnostic approaches and treatment of glomerulonephritis, including use of corticosteroids, immunosuppressants (cyclophosphamide, calcineurin inhibitors, mycophenolates, rituximab), and plasmapheresis are in agreement with international and national guidelines.

Of note, the International KDIGO Clinical Practice Guidelines for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder; for Anemia in Chronic Kidney Disease; for Lipid Management in Chronic Kidney Disease; for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease; and for Glomerulonephritis were translated to Russian and widely implemented [ 26 , 27 , 28 , 29 , 30 ]. The translation of KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease - Mineral and Bone Disorder is currently in progress.

Hemodialysis (HD) techniques, invented and developed in western countries, immediately raised great interest in the Soviet Union. The first paper presenting an international experience of “artificial kidney” use was published by Dr. Parin [ 31 ] in 1955. The first Soviet “Artificial Kidney Apparatus” (AKA-60) was invented in 1957 by Yury Kozlov and his colleagues in the Research Institute of Experimental Surgical Technologies; production of the AKA-60 commenced in the Factory of Medical Equipment in Kazan [ 32 ].

In 1958, the first HD procedure using the Moeller dialysis machine was performed by Professors Pytel, Lopatkin, and Djavadzade at the University Clinic of Russian National Research Medical University n.a. N.I. Pyrogov (then the 2nd Moscow Medical Institute), based in Moscow City Hospital No. 1. Professor Pytel, a recognized urologist, was specifically interested in nephrology and had already studied crush syndrome and hepatorenal syndrome. In 1961, he published a monograph entitled “Artificial kidney and its clinical usage”, which was the first Russian monograph in the field [ 33 ].

Between 1958 and 1960 four “Experimental renal laboratories” for the treatment of patients with acute renal failure (ARF) opened: one in the Hematology Research Center (then the Research Institute of Blood Transfusion), one in Moscow Hospital No. 1, one in the Moscow City Hospital n.a. S.P. Botkin, and one in the 1st Moscow Medical University n.a. I.M. Sechenov (then the 1st Moscow Medical Institute). In 1960, the department of HD for patients with ARF, working in cooperation with the “Laboratory of Artificial Kidney” headed by Professor Gert Kulakov, was opened in the Moscow City Hospital n.a. S.P. Botkin. It was headed by Dr. Melikyan, who was one of the pioneers of HD in Russia and worked actively for 4 decades.

The year 1962 saw the first ever procedure not using donor blood with AKA-60 [ 34 ]. In 1964, the modified AKA-140 was invented, with production starting in Leningrad in 1969. HD was primarily used for the treatment of ARF in the setting of obstetric and surgical complications, poisoning, Hanta virus hemorrhagic fever, and crush syndrome. By 1971 more than 50 HD centers, equipped with AKA machines were successfully implemented throughout the Soviet Union. This allowed the expansion of indications for HD to chronic renal failure. The first dialysis unit for patients with end-stage renal disease (ESRD) was started in Moscow City Hospital No. 24 in 1967.

In 1963, the first pediatric patient, a 3-year-old child, was treated with HD. The first pediatric HD unit for the treatment of children with ARF was established in 1976 in the St. Vladimir Children's Hospital (then the Children's Hospital n.a. I.V. Rusakov), headed by Dr. Zverev. It was the only such unit in the country for many years, and later became the first center for children with hemolytic uremic syndrome; in 1991 peritoneal dialysis (PD) was successfully performed for the first time in Russia at this center.

Between 1971 and 1973 Hemodialysis System 6 (SHD-6) was invented by Professor Kulakov and engineer Balabanov. The new model of HD machine enabled HD procedures to be performed on 6 patients simultaneously [ 32 ]. The first two machines were introduced in 1974 in the “Laboratory of Artificial Kidney” in the Moscow City Hospital n.a. S.P. Botkin. Later, the SHD-8 replaced the SHD-6 and was introduced to clinical practice in many cities. In 1976, the first arteriovenous fistula was placed by Dr. Timokhov and Dr. Melikyan at the Moscow City Hospital n.a. S.P. Botkin, with arteriovenous fistula swiftly replacing shunts as the standard dialysis access technique in most HD units for ESRD patients soon after. The nephrology service in Leningrad first included HD units, working in cooperation with clinical nephrology and outpatient units; Professor Shostka coordinated this work.

During the next 2 decades, the number of HD units increased; however, they were insufficient to meet the demands of dialysis care for the ESRD patients. The biggest challenge for the dialysis service was the Spitak (Armenia) earthquake in 1988. At least 400 earthquake victims developed crush syndrome, and many of them with ARF were treated with HD. Most victims were evacuated from Armenia to Moscow and other major cities.

The economic changes following the collapse of the Soviet Union resulted in the substantial growth of dialysis care services. Unfortunately, this growth was not accompanied by the development of dialysis machine production, and now only imported equipment is used in the Russian Federation. While many intensive care units were equipped with dialysis machines that performed HD and continuous hemodiafiltration, the PD program for adult patients was started in 1995 to improve dialysis services; the first three units were opened in the Moscow City Clinical Hospital No. 52, Moscow City Hospital n.a. S.P. Botkin, and Moscow City Clinical Hospital No. 7, followed by Mariinskaya City Hospital, Saint Petersburg, and later in the other big cities. The PD unit of Moscow City Clinical Hospital No. 52 is actually the biggest in the Russian Federation.

In 2002, the Ministry of Health issued an order regarding “Excellence of Organization of Dialysis Care,” whereby public-private partnership implementation resulted in a rapid increase in the HD outpatient units. The International KDIGO and ERBP Guidelines concerning CKD and acute kidney injury were translated to Russian and widely implemented [ 30 , 35 , 36 ].

Evaluation of the disease spectrum of ESRD is based on the data from the Registry of patients on renal replacement therapy (RRT), started by the Russian Dialysis Society in 1998. The available individual data analysis is shown in Table ​ Table2 2 [ 37 ].

Causes of ESRD in patients on hemodialysis and peritoneal dialysis

Russian Dialysis Society Registry, 2011–2013 ( n = 15,880 patients).

The evaluation and management of patients receiving RRT include monitoring of dialysis dose and key quality indicators, blood pressure, body mass index, serum albumin, hemoglobin, total cholesterol, total calcium, serum phosphates, and parathyroid hormone. Comorbidities, treatment patterns, mortality, and survival are also evaluated on a regular basis. Patients on RRT receive antihypertensive medications, iron supplementation, erythropoiesis-stimulating agents, phosphate binders, and calcimimetics.

Transplantation

The first kidney transplantation from a deceased donor was performed by Dr. Voronoy in 1933 in Kherson (now a territory of Ukraine). While the procedure was not successful, the first ever attempt, published in 1936, enabled further developments [ 38 ]. The first successful kidney transplantation from a living donor, in this case a relative, was performed by Professor Petrovsky at the Russian Research Center of Surgery in 1965. In 1967, the National Medical Research Center of Transplantology and Artificial Organs n.a. V.I. Shumakov (then the Research Institute of Organ and Tissue Transplantation, first headed by Professor Solovyov) was created by Professor Petrovsky. Professor Petrovsky, along with Professor Solovyov and his group, published a book entitled “Kidney transplantation” in 1969 [ 39 ], when the program of kidney transplantation from deceased donors was initiated and widely implemented by Professor Shumakov, who headed the Research Institute of Organ and Tissue Transplantation for more than 30 years since 1974. The number of centers performing kidney transplantation exclusively from deceased donors increased over the next 2 decades. Professor Phyliptsev played a leading role in the implementation of kidney transplantation for almost 3 decades. In 1990, the first center for pediatric kidney transplantation was opened in the Russian Children's Clinical Hospital.

In 1992, the federal legislation regarding “transplantation of organs and/or tissues” was introduced, whereby only direct relatives are allowed to donate kidneys for transplantation. Several regulatory documents have been released since the order addressing “regalement of brain death diagnostics” (2014). The program of kidney transplantation from living donors commenced in 1999 in the National Medical Research Center of Transplantology and Artificial Organs, headed by Professor Moysuk, who summarized the experience of the first 2 years in the article “Kidney transplantation from living relative donor” [ 40 ].

The first Department of Nephrology came from the Department of Internal and Occupational Diseases of the 1st Moscow Medical University n.a. I.M Sechenov (formerly known as the Faculty of Medicine of Imperator's Moscow University, created in 1755), which started in 1930 and was headed by Professor Tareev from 1950. Under his leadership, nephrology became one of the main priorities, and in 1966 the Clinic of Nephrology, Internal and Occupational Diseases opened, merging the Department of Nephrology, the Department of Internal and Occupational Diseases, and the Nephrology and HD units. Between 1986 and 2017, the head of the Clinic of Nephrology was Professor Mukhin. In 1972, Professor Tareev initiated the Laboratory of Nephrology Problems, which was headed by his daughter, Professor Tareeva, from 1975 [ 41 ].

An educational course on hemodialysis at the Russian Medical Academy of Continuous Postgraduate Education (formerly the Central Institute of Medical Qualification, created in 1930) was initiated by Professor Kulakov in 1965, based at the “Laboratory of Artificial Kidney”. In 1982, this educational course developed into the first Department of Nephrology and Hemodialysis, headed by Professor Kulakov [ 32 ]. The Department was, and still is, based in the Moscow City Hospital n.a. S.P. Botkin; the close relationships between academia and clinical practice ensured the development of the field. Currently the Department is headed by Professor Ermolenko, one of the opinion leaders in the field, whose monograph entitled “Chronic Hemodialysis” was published in 1982 [ 42 ].

In 1996, the Research Institute of Nephrology was created at the 1st Saint Petersburg Medical University n.a. I.P. Pavlov (formerly the Women's Medical Institute, and later the 1st Leningrad Medical Institute), with Professor Ryabov as the first director. The Institute of Nephrology merged the Course of Nephrology and Dialysis (later the Department of Nephrology and Dialysis, headed by Professor Eacayan), the Department of Internal Medicine (formerly the Department of Internal Diseases, created in 1914 and headed by Professor Lang from 1919 to 1921), and several laboratories with the clinical nephrology unit.

A course of “efferent therapy” was started in 1994 at the Saint Petersburg Medical Academy of Postgraduate Education (formerly the Imperator's Clinical Institute, created in 1896). The course was later changed to the Department of Nephrology and Efferent Therapy and existed until 2011, when the Saint Petersburg Medical Academy of Postgraduate Education merged with the Saint Petersburg Medical Academy n.a. I.M. Mechnikov (formerly the Institute of Psychoneurology, created in 1907) under the name North-Western State Medical University n.a. I.M. Mechnikov.

In 2004, the Department of Nephrology, headed by Professor Tomilina, opened in the Moscow State University of Medicine and Dentistry (formerly the Moscow Institute of Medicine and Dentistry, created from the Moscow State Institute of Dentistry in 1949). This is a unique institution, providing postgraduate education in the fields of clinical nephrology, nephropathology, dialysis, and transplantation.

All of the abovementioned institutions provide professional education for residents and PhD students as well as certification courses and short-term continuing medical education (CME) courses.

The Society of Nephrology and Immunopathology, as part of the Moscow Scientific Society of Therapeutics created in 1895, started its work in 1958 and is currently active, conducts monthly meetings, and is devoted to selected issues of clinical nephrology, immunonephrology, and nephropathology.

The Scientific Society of Nephrology (SSN) was founded in 1969 by Professor Tareev, who was the President of the Society for almost 15 years. The congresses of the SSN have been conducted every 6 years since 1974, and during the intervening years Nephrology Summer Schools, initiated by Professor Natochin, the successor of Professor Gynetsynsky, were the most important events.

First contacts with ISN leadership were established by Professor Tomilina in 1994, when she invited Professor Brenner and Professor Dirks to attend the SSN meeting in Moscow. In 1995, the first CME course under the aegis of the ISN, ERA-EDTA, and IPNA was conducted in Moscow. The formal organizer was the SSN, but Professor Tomilina was the driving force. Among the invited international speakers were Professor Cameron and Professor Lameire. Unfortunately, due to formal official regulations the SSN was unable to continue its work for several years. The Scientific Society of Russian Nephrologists, the successor of the SSN, was started in 2005, conducting congresses and plenary assemblies and creating national guidelines and protocols.

In 1997, the Union of Pediatric Nephrologists was funded by an initiative of Professor Papayan [ 22 ]. In 1998, the Russian Dialysis Society (RDS) was established, with Professor Tomilina as the first president. This society is currently the most active professional society of nephrologists in Russia. It is affiliated with the ISN, ERA-EDTA, and EKHA, and cooperates with KDIGO, ERBP, and WKD leadership. The RDS is specifically dedicated to the education of nephrologists throughout the Russian Federation, and conducts up to five CME conferences each year in Moscow, Saint Petersburg, and the big cities in Siberia, Volga, Far East, North West, North, and South Regions. Numerous international leaders of nephrology deliver talks at these meetings as invited speakers, as well as conducting ISN Educational Ambassadors Courses. The RDS also supports the registry and the journal Nephrology and Dialysis (see below). Translations of most KDIGO and ERBP Guidelines and World Kidney Day Editorials were undertaken and published by RDS initiatives [ 26 , 27 , 28 , 29 , 30 , 35 , 36 , 43 , 44 ].

The first journal to publish papers with nephrology articles in Russian was Urology and Nephrology , which was started in 1968 on the basis of the Urology journal, issued since 1965. The journal Nephrology was started by Professor Smirnov in Saint Petersburg in 1997 and was the first journal to publish a wide range of articles in the field.

In 1998, the journal Nephrology and Dialysis (an official journal of the RDS) was initiated by Professor Tomilina. This journal is the most influential nephrology journal in Russia with one of the highest impact factors among all medical journals in Russia. The journal Clinical Nephrology was started in 2009, and was edited by Professor Mukhin till 2017.

In 1998, Professor Tomilina initiated the registry of patients on RRT. The registry data is published every other year in the journal Nephrology and Dialysis , providing detailed information about many aspects of RRT in Russia. These include information not only about the number of centers and patients, but also on issues of anemia, hypertension, CKD-MBD management, viral hepatitis diagnostics and treatment, and many other aspects. The registry is affiliated with the ERA-EDTA Registry, providing data for international publications.

The most recent analysis, which includes published data till the end of 2015 [ 45 ] and unpublished data up to the end of 2016, shows that the total number of centers providing RRT is 506 (including 466 providing HD, 111 for PD, and 37 for kidney transplantation), with many centers providing two or three modalities. Of note, only centers providing care to both adult and pediatric patients with ESRD were included, while centers providing care specifically to patients with acute kidney injury were not registered. The number of patients with ESRD on HD + PD by the end of 2016 was 44,771 (33,876 on HD, 8,537 on PD, and 2,358 living with transplanted kidney); the mean ratio was 305 per million inhabitants. Furthermore, the number of patients on HD in 2016 was 78% greater than that in 2010, mainly due to the development of public-private partnership.

Current Problems

• Absence of nephrology courses for students in Medical schools
• Relatively short-term professional postgraduate education (2-year residency, absence of fellowship programs)
• Lack of certified nephrologists
• Under-recognition of CKD burden by health authorities and policy makers
• Under-diagnostics of CKD in the adult population
• Lack of cooperation among nephrologists and general practitioners, endocrinologists, cardiologists, and other specialists
• Under-diagnostics of CKD and ESRD in the pediatric population
• Lack of nephrology units, disproportionate to the number of dialysis units, especially outside big industrial areas
• Lack of renal pathologists and unavailability of kidney biopsy in many regions
• Under-development of PD
• Uneven distribution of dialysis service throughout the territory of the country, with several remote regions still poorly covered by RRT
• Lack of transplantation and insufficient organ har vesting
• Insufficient funds for research

Conclusions

Nephrology in Russia, despite currently experiencing many difficulties, made great advances during the 60 years of its development. General nephrology, nephropathology, and RRT are developing fast. Implementation of international guidelines, access to modern educational tools, and cooperation with international professional societies are improving the quality of care of renal patients and ensuring further progress.

Statement of Ethics

No ethic approval is required for this type of study.

Disclosure Statement

The author declares no conflict of interest.

Acknowledgments

The author thanks Dr. Anton Andrusev, Dr. Sergey Lashutin, and Prof. Natalia Tomilina for their valuable help.

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34 Best Medical schools in Moscow, Russia

Updated: February 29, 2024

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April 10, 2024

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Living near green space associated with fewer emotional problems in preschool-age kids, study finds

by Environmental influences on Child Health Outcomes

Children who live in areas with natural spaces (e.g., forests, parks, backyards) from birth may experience fewer emotional issues between the ages of 2 and 5, according to a study published in JAMA Network Open .

While research has suggested that time in nature is important for mental health , studies examining the effects on young children are limited. ECHO investigators addressed this research gap by analyzing information from parents about the behavior of their children from ages 2 to 11. They combined this data with the family's residential address when the child was born and satellite data on live vegetation density around their homes.

What researchers found in their analysis was that higher levels of green spaces up to three-fourths of a mile from a child's home were linked with lower anxiety and depression symptoms from ages 2 to 5 years. The association persisted even after researchers factored in the child's sex, parent education, age at birth, and neighborhood socioeconomic vulnerability.

Researchers did not find a significant association between green space around the home and mental health symptoms in later childhood years from ages 6 to 11, when children spend more time at school.

"Our research supports existing evidence that being in nature is good for kids," said Nissa Towe-Goodman, Ph.D., an ECHO researcher from the Frank Porter Graham Child Development Institute at the University of North Carolina, Chapel Hill. "It also suggests that the early childhood years are a crucial time for exposure to green spaces."

Most research so far has been limited to studying one or a few cities at a time, and focused on adult health. Because the ECHO Program collects data nationwide, researchers were able to examine data from children in 199 counties across 41 U.S. states, exploring the connection between exposure to green spaces from birth and anxiety, depression, aggression, and other symptoms during early or middle childhood.

The study included children born between 2007 and 2013 and whose parents completed the Child Behavior Checklist, a common survey to rate a child's emotional and behavioral symptoms. The 2,103 children included in the study ranged in age from 2 to 11, spanning early and middle childhood.

Green space exposure was measured using the Normalized Difference Vegetation Index (NDVI), a widely used metric for quantifying vegetation density using sensor data . NDVI values range from -1 to 1. High NDVI values (approximately 0.6 to 0.9) represent dense vegetation, such as forests; values close to zero represent areas without live vegetation.

"In the future, researchers could look into what kinds of experiences in nature are connected to kids' early mental health," said Dr. Towe-Goodman. "Also, we should study how creating or preserving natural areas around homes and schools might make a difference in a child's mental health."

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April 4, 2024

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New research traces the fates of stars living near the Milky Way's central black hole

by Northwestern University

Despite their ancient ages, some stars orbiting the Milky Way's central supermassive black hole appear deceptively youthful. But unlike humans, who might appear rejuvenated from a fresh round of collagen injections, these stars look young for a much darker reason.

They ate their neighbors.

This is just one of the more peculiar findings from new Northwestern University research. Using a new model, astrophysicists traced the violent journeys of 1,000 simulated stars orbiting our galaxy's central supermassive black hole , Sagittarius A* (Sgr A*).

So densely packed with stars, the region commonly experiences brutal stellar collisions. By simulating the effects of these intense collisions, the new work finds that collision survivors can lose mass to become stripped down, low-mass stars or can merge with other stars to become massive and rejuvenated in appearance.

"The region around the central black hole is dense with stars moving at extremely high speeds," said Northwestern's Sanaea C. Rose, who led the research.

"It's a bit like running through an incredibly crowded subway station in New York City during rush hour. If you aren't colliding into other people, then you are passing very closely by them. For stars, these near collisions still cause them to interact gravitationally. We wanted to explore what these collisions and interactions mean for the stellar population and characterize their outcomes."

Rose presents this research at the American Physical Society's (APS) April meeting in Sacramento, California. "Stellar Collisions in the Galactic Center" takes place Thursday (April 4) as part of the session " Particle Astrophysics and the Galactic Center ."

Rose is the Lindheimer Postdoctoral Fellow at Northwestern's Center for Interdisciplinary Exploration and Research in Astrophysics (CIERA). She began this work as a Ph.D. candidate at UCLA.

Destined to collide

The center of our Milky Way is a strange and wild place. The gravitational pull of Sgr A* accelerates stars to whip around their orbits at terrifying speeds. And the sheer number of stars packed into the galaxy's center is upwards of a million. The densely packed cluster plus the lightning-fast speeds equal a high-speed demolition derby. In the innermost region—within 0.1 parsecs of the black hole—few stars escape unscathed.

"The closest star to our sun is about four light-years away," Rose explained. "Within that same distance near the supermassive black hole, there are more than a million stars. It's an incredibly crowded neighborhood. On top of that, the supermassive black hole has a really strong gravitational pull. As they orbit the black hole, stars can move at thousands of kilometers per second."

Within this tight, hectic neighborhood, stars can collide with other stars. And the closer stars live to the supermassive black hole, the likelihood of collision increases. Curious of the outcomes of these collisions, Rose and her collaborators developed a simulation to trace the fates of stellar populations in the galactic center . The simulation takes several factors into account: density of the stellar cluster, mass of the stars, orbit speed, gravity and distances from the Sgr A*.

From 'violent high fives' to total mergers

In her research, Rose pinpointed one factor that is most likely to determine a star's fate: its distance from the supermassive black hole.

Within 0.01 parsecs from the black hole, stars—moving at speeds reaching thousands of kilometers per second—constantly bump into one another. It's rarely a head-on collision and more like a "violent high five," as Rose describes it. The impacts are not strong enough to smash the stars completely. Instead, they shed their outer layers and continue speeding along the collision course.

"They whack into each other and keep going," Rose said. "They just graze each other as though they are exchanging a very violent high five. This causes the stars to eject some material and lose their outer layers. Depending on how fast they are moving and how much they overlap when they collide, they might lose quite a bit of their outer layers. These destructive collisions result in a population of strange, stripped down, low-mass stars."

Outside of 0.01 parsecs, stars move at a more relaxed pace—hundreds of kilometers per second as opposed to thousands. Because of the slower speeds, these stars collide with one another but then don't have enough energy to escape. Instead, they merge to become more massive. In some cases, they might even merge multiple times to become 10 times more massive than our sun.

"A few stars win the collision lottery," Rose said. "Through collisions and mergers, these stars collect more hydrogen. Although they were formed from an older population, they masquerade as rejuvenated, young-looking stars. They are like zombie stars; they eat their neighbors."

But the youthful appearance comes at the cost of a shorter life expectancy.

"They die very quickly," Rose said. "Massive stars are sort of like giant, gas-guzzling cars. They start with a lot of hydrogen, but they burn through it very, very fast."

Extreme environment 'unlike any other'

Although Rose finds simple joy in studying the bizarre, extreme region near our galactic center, her work also can reveal information about the history of the Milky Way. And because the central cluster is extremely difficult to observe, her team's simulations can illuminate otherwise hidden processes.

"It's an environment unlike any other," Rose said. "Stars, which are under the influence of a supermassive black hole in a very crowded region, are unlike anything we will ever see in our own solar neighborhood. But if we can learn about these stellar populations, then we might be able to learn something new about how the galactic center was assembled. At the very least, it certainly provides a point of contrast for the neighborhood where we live."

Rose's APS presentation will include research published by The Astrophysical Journal Letters in March 2024 and by The Astrophysical Journal in September 2023.

Sanaea C. Rose et al, Stellar Collisions in the Galactic Center: Massive Stars, Collision Remnants, and Missing Red Giants, The Astrophysical Journal (2023). DOI: 10.3847/1538-4357/acee75

Journal information: Astrophysical Journal , Astrophysical Journal Letters , arXiv

Provided by Northwestern University

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Why is looking at a solar eclipse dangerous without special glasses? Eye doctors explain.

By Sara Moniuszko

Edited By Allison Elyse Gualtieri

Updated on: April 8, 2024 / 8:54 AM EDT / CBS News

The solar eclipse will be visible for millions of Americans on April 8, 2024, making many excited to see it — but how you watch it matters, since it can be dangerous for your eyes. 

A  solar eclipse occurs when the moon passes between the sun and Earth, blocking the sun's light . When the moon blocks some of the sun, it's a partial solar eclipse, but when moon lines up with the sun, blocking all of its light, a total solar eclipse occurs,  NASA explains . Either way, you need eye protection when viewing.

"The solar eclipse will be beautiful, so I hope that everyone experiences it — but they need to experience it in the right way," said Dr. Jason P. Brinton, an ophthalmologist and medical director at Brinton Vision in St. Louis.

Here's what to know to stay safe.

Why is looking at a solar eclipse dangerous?

Looking at the sun — even when it's partially covered like during an eclipse — can cause eye damage.

There is no safe dose of solar ultraviolet rays or infrared radiation, said  Dr. Yehia Hashad , an ophthalmologist, retinal specialist and the chief medical officer at eye health company Bausch + Lomb.

"A very small dose could cause harm to some people," he said. "That's why we say the partial eclipse could also be damaging. And that's why we protect our eyes with the partial as well as with the full sun."

Some say that during a total eclipse, it's safe to view the brief period time when the moon completely blocks the sun without eye protection. But experts warn against it. 

"Totality of the eclipse lasts only about 1 to 3 minutes based on geographic location, and bright sunlight suddenly can appear as the moon continues to move," notes an eclipse viewing guide published in JAMA , adding, "even a few seconds of viewing the sun during an eclipse" can temporarily or permanently damage your vision. 

Do I need special glasses for eclipse viewing?

Yes.  Eclipse glasses are needed to protect your eyes if you want to look at the eclipse.

Regular sunglasses aren't protective enough for eclipse viewing — even if you stack more than one. 

"There's no amount of sunglasses that people can put on that will make up for the filtering that the ISO standard filters and the eclipse glasses provide," Brinton said.

You also shouldn't look at the eclipse through a camera lens, phone, binoculars or telescope, according to NASA, even while wearing eclipse glasses. The solar rays can burn through the lens and cause serious eye injury.

Eclipse glasses must comply with the  ISO 12312-2 international safety standard , according to NASA, and should have an "ISO" label printed on them to show they comply. The American Astronomical Society  has a list  of approved solar viewers.

Can't find these, or they're sold out near you? You can also  make homemade viewers ,   which allow you to observe the eclipse indirectly — just don't accidentally look at the sun while using one.

How to keep kids safe during the solar eclipse

Since this eclipse is expected to occur around the time of dismissal for many schools across the country, it may be tempting for students to view it without the proper safety precautions while getting to and from their buses. That's why some school districts are  canceling classes early so kids can enjoy the event safely with their families.

Dr. Avnish Deobhakta, vitreoretinal surgeon at New York Eye and Ear Infirmary at Mount Sinai, said parents should also be careful because it can be difficult for children to listen or keep solar eclipse glasses on. 

"You want to actually, in my opinion, kind of avoid them even looking at the eclipse, if possible," he said. "Never look directly at the sun, always wear the right eclipse sunglasses if you are going to look at the sun and make sure that those are coming from a reliable source."

Brinton recommends everyone starts their eclipse "viewing" early, by looking at professional photos and videos of an eclipse online or visiting a local planetarium. 

That way, you "have an idea of what to expect," he said. 

He also recommends the foundation  Prevent Blindness , which has resources for families about eclipse safety.

What happens if you look at a solar eclipse without eclipse glasses?

While your eyes likely won't hurt in the moment if you look at the eclipse without protection, due to lowered brightness and where damage occurs in the eye, beware: The rays can still cause damage .

The harm may not be apparent immediately. Sometimes trouble starts to appear one to a few days following the event. It could affect just one or both eyes.

And while some will regain normal visual function, sometimes the damage is permanent. 

"Often there will be some recovery of the vision in the first few months after it, but sometimes there is no recovery and sometimes there's a degree to which it is permanent," Brinton said. 

How long do you have to look at the eclipse to damage your eyes?

Any amount of time looking at the eclipse without protection is too long, experts say. 

"If someone briefly looks at the eclipse, if it's extremely brief, in some cases there won't be damage. But damage can happen even within a fraction of a second in some cases," Brinton said. He said he's had patients who have suffered from solar retinopathy, the official name for the condition.

Deobhakta treated a patient who watched the 2017 solar eclipse for 20 seconds without proper eye protection. She now has permanent damage in the shape of a crescent that interferes with her vision. 

"The crescent that is burned into the retina, the patient sees as black in her visual field," he said. "The visual deficit that she has will never go away."

How to know if you've damaged your eyes from looking at the eclipse

Signs and symptoms of eye damage following an eclipse viewing include headaches, blurred vision, dark spots, changes to how you see color, lines and shapes. 

Unfortunately, there isn't a treatment for solar retinopathy.

"Seeing an eye care professional to solidify the diagnosis and for education I think is reasonable," Brinton said, but added, "right now there is nothing that we do for this. Just wait and give it time and the body does tend to heal up a measure of it."

Sara Moniuszko is a health and lifestyle reporter at CBSNews.com. Previously, she wrote for USA Today, where she was selected to help launch the newspaper's wellness vertical. She now covers breaking and trending news for CBS News' HealthWatch.

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Association of breastfeeding with mental disorders in mother and child: a systematic review and meta-analysis

Affiliations.

• 1 Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences, Berlin, Germany.
• 2 V. Serbsky Federal Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia.
• 3 Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia.
• 4 Moscow City Clinical Hospital After V.M. Buyanov, Moscow, Russia.
• 5 Department of Brain Sciences, Faculty of Medicine, Dementia Research Institute UK, Imperial College London, London, UK.
• 6 Endocrinology Research Centre, Moscow, Russia.
• 7 Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy.
• 8 Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada.
• 9 Department of Pediatrics, Pediatric Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany.
• 10 German Center for Child and Youth Health, Leipzig, Germany.
• 11 Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik Der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany.
• 12 Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria.
• 13 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
• 14 Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia.
• 15 National Heart and Lung Institute, Imperial College London, London, UK. [email protected].
• 16 National Heart and Lung Institute, Imperial College London, London, UK. [email protected].
• 17 Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK. [email protected].
• 18 I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia. [email protected].
• 19 Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom. [email protected].
• PMID: 37840122
• PMCID: PMC10577970
• DOI: 10.1186/s12916-023-03071-7

Background: Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in mothers and children, a systematic review of the available evidence is lacking. The purpose of this study is to systematically evaluate the association between breastfeeding and mental health disorders in mothers and children.

Methods: We systematically searched MEDLINE and EMBASE from inception to June 2, 2023. The inclusion criteria consisted of all studies evaluating links between breastfeeding and development of mental health disorders in children and mothers. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) while grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. A random-effects meta-analysis was used if possible, to estimate the odds ratio for the association between breastfeeding and mental health outcomes. The Mantel-Haenszel method was utilised for pooling ORs across studies. Study heterogeneity was assessed using the I 2 statistic.

Results: Our review identified twenty-one original study. Of these, 18 focused on the association between breastfeeding and child health, assessing depressive disorders, schizophrenia, anxiety disorders, eating disorders and borderline personality disorder. Three studies evaluated the associations between breastfeeding and maternal mental health disorders. Three studies looking at outcomes in children showed no significant association between breastfeeding and occurrence of schizophrenia later in life (OR 0.98; 95% CI 0.57-1.71; I 2 = 29%). For depressive disorders (5 studies) and anxiety disorders (3 studies), we found conflicting evidence with some studies showing a small protective effect while others found no effect. The GRADE certainty for all these findings was very low due to multiple limitations. Three studies looking at association between breastfeeding and maternal mental health, were too heterogeneous to draw any firm conclusions.

Conclusions: We found limited evidence to support a protective association between breastfeeding and the development of mental health disorders in children later in life. The data regarding the association between breastfeeding and maternal mental health beyond the postnatal period is also limited. The methodological limitations of the published literature prevent definitive conclusions, and further research is needed to better understand the relationship between breastfeeding and mental health in mothers and children.

Keywords: Anxiety disorders; Breastfeeding; Child health; Depressive disorders; Maternal health; Mental health; Schizophrenia; Systematic review.

© 2023. BioMed Central Ltd., part of Springer Nature.

Publication types

• Meta-Analysis
• Systematic Review
• Anxiety Disorders
• Breast Feeding*
• Feeding and Eating Disorders*
• Mental Health
• Mothers / psychology