In recent years, there has been increasing evidence of the benefits of a plant-based diet for the prevention and treatment of most somatic diseases, including chronic kidney disease (CKD). Improving the nutritional properties of foods by increasing the proportion of plant ingredients while reducing the total amount of animal proteins can reduce the need for nephroprotective drugs, complications of renal diseases and may favorably affect disease progression and patient survival. In this article, we analyze the data available in the world literature on a diet with a predominance of plant products, which has a positive effect on the prevention of renal pathology, the incidence and CKD progression, metabolic acidosis, hyperphosphatemia, arterial hypertension, uremic toxicity, the need for renal replacement therapy and quality of life. Attention is also paid to hyperkalemia and vitamin B12 deficiency, which are often associated with plant-based nutrition, but with the participation of a nutritionist, these risks can be significantly minimized. Therefore, taking into account the risk-benefit ratio, the approach to therapeutic nutrition for CKD is confidently shifting to the plant-based diet.

Background. Sarcopenia is a clinically significant complication of long-term therapy with chronic hemodialysis and is an independent prognostic factor of morbidity and mortality. This explains the need for its timely and accurate diagnosis.

The aim of the study was to study the epidemiological aspects of sarcopenia in patients receiving treatment with programmed hemodialysis.

Methods and material. 317 patients treated with programmed bicarbonate hemodialysis for 8.2 ± 5.1 years were examined, among them 171 women and 146 men, the average age was 57.1±11.3 years. The assessment of the presence of sarcopenia was performed using a technique recommended by the European Working Group on Sarcopenia in Older People.

Results. The prevalence of presarcopenia was 0.7% (2 patients) and sarcopenia 29.6% (93 patients). The presence of skeletal muscle mass deficiency according to the muscle mass index (MMI) was 30.3% (95 patients), a decrease in muscle strength according to dynamometry was noted in 153 patients (48.7%), low skeletal muscle performance according to the results of the 6-minute walking test was determined in 134 patients (42.8%).

Conclusion. The prevalence of sarcopenia in hemodialysis patients is 29.6%. The duration of hemodialysis therapy and the age of the patient are independent risk factors for the development of sarcopenia.

In monoclonal gammopathies the aberrant B-cell clone produces the monoclonal immunoglobulin (MIG) which could present as only one light chain or only one heavy chain or the whole immunoglobulin. Due to somatic mutations in B-cell clone genetic the MIG obtains abnormal features and different types of tissue toxicity. The condition of non-organized granular MIG deposition leading to organ damage and dysfunction is known as monoclonal immunoglobulin deposition disease (MIDD). Most commonly MIDD involves the kidney parenchyma. However, extrarenal MIDD may affect other tissues and present as local or systemic condition. This review summarizes the current knowledge concerning the mechanisms, clinical manifestation, diagnostics and treatment approaches in extrarenal MIDD.

There is a close connection between cholelithiasis (GSD) and non-alcoholic fatty liver disease (NAFLD). It is based on common risk factors, insulin resistance, disorders of carbohydrate and lipid metabolism, hepato-enteric circulation (HEC) of bile acids and the state of intestinal microflora. Chole-cystectomy (CE) is currently considered as an independent risk factor for the development and progres-sion of NAFLD and metabolic disorders in patients with cholelithiasis.

That is why a patient suffering from cholelithiasis and NAFLD needs an individual approach before cholecystectomy. Patients with cholelithiasis and NAFLD are recommended to undergo a dynamic monitoring after cholecystectomy. The monitoring includes a control of general condition, biochemical parameters of the liver, lipid and carbohydrate metabolism, liver fibroelastography parameters. The treatment for this category of patients is aimed at eliminating risk factors, strict adherence to diet, phys-ical activity regimen, in order to correct obesity, dyslipidemia, hyperglycemia, the use of drugs that im-prove the condition of the hepatocytes, lipid and carbohydrate metabolism, the metabolic function of hepatocytes and inhibiting the processes of fibrogenesis in liver. At the same time, the common medi-cines of this category of patients are ursodeoxycholic acid, glycyrrhizic acid, phospholipids, antioxi-dants, and drugs to cure bacterial overgrowth syndrome in the intestines.

Obeticholic acid is the first-in-class selective farnesoid X receptor agonist that is approved in several countries (since August 2024, including Russia) for the treatment of primary biliary cholangitis in patients with inadequate response to monotherapy with ursodeoxycholic acid or intolerance thereof. The present paper reviews the aspects and prospects of the use of obeticholic acid in primary biliary cholangitis as well as other hepatobiliary diseases, including non-alcoholic (metabolic dysfunction-associated) steatohepatitis.

Pulmonary hypertension (PH) – is a pathophysiological condition, which characterized by pressure elevation in pulmonary vascular bed without regard to its causes. Despite the great progress in understanding of etiology, pathophysiology and molecular mechanisms of PH, clinical diagnosis is still a great challenge for the medical practitioner. Lack of specific symptoms, demand of wide range of knowledge, necessity of well-equipped hospital – all these reasons lead to late diagnosis and treatment. In this article we provide brief information of clinical evaluation in case of PH and transthoracic echocardiography as a first step of instrumental examination towards precise diagnosis. .

In spite of obvious role of IL-17 in the pathogenesis of IBD and axial spondyloarthritis, recently, in combination of these pathologies, usage of targeted drugs aimed at IL-17 and IL-23 requires special caution. Thus, using an IL-17A inhibitor in patients with axial spondyloarthritis associated with IBD, it is possible to prevent the progression of spondyloarthritis, but cause exacerbation of IBD. In turn, using an IL-23 inhibitor in such patients, can expect remission of IBD, but progression of spondyloarthritis. The purpose of our literature review is to identify and explain the cause of such observations. In IBD, IL-23 promotes the formation of "pathogenic" Th17, and inhibition of this cytokine appears to be somewhat effective, since IL-17A production by "nonpathogenic" Th17 in the intestinal mucosa remains unchanged. At the same time, in axial spondyloarthritis, IL-23 plays an important role only in the initiation of the pathological process, rather than in maintaining joint damage in an already established disease, which may explain the ineffectiveness of targeted drugs aimed at this cytokine. Exacerbation of IBD with IL-17A inhibition may be explained by disruption of IL-17-induced intercellular epithelial contacts. However, IL-17A inhibitors are quite effective in the treatment of axial spondyloarthritis, since they prevent IL-17-induced inflammation and bone destruction. We also suggest that IL-17A in axial spondyloarthritis is secreted predominantly by myeloid cells rather than Th17. Thus, in the pathogenesis of axial spondyloarthritis associated with inflammatory bowel diseases, the IL-23/ IL-17 axis plays a central role. However, modulation of the IL-17 signaling cascade in this situation remains ambiguous and requires further study.

Currently, there is an increase in the incidence and prevalence of inflammatory bowel diseases. A feature of this group of diseases, in addition to damage to the gastrointestinal tract, is the high frequency of extra-intestinal manifestations, among which thrombotic complications, life-threatening, multifactorial, with little studied pathogenesis, affecting  the therapy, are of particular interest. The practitioner is faced with the  issue  of  prescribing  antiplatelet  or  anticoagulant therapy to a specific patient with both a high risk of intestinal bleeding and a high risk of thrombosis and thromboembolic complications. The article presents the literature data and own observations on this topic. Modern recommendations for the management of patients are given. A clinical case demonstrating the peculiarities of managing a patient with Crohn's disease and thrombotic complications is presented.

In the article the data is about the pathogenesis of endothelial dysfunction in metabolic syndrome. The clinical picture and pathogenic particularities are described. According to recent studies the role of gut microbiota in the development of metabolic syndrome is not in doubt. Specific bacteria species can be considered as predictors of the metabolic syndrome presence.

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system. Despite significant advances in treatment, MS remains a serious health problem requiring the development of new therapeutic approaches. High-dose immunosuppressive therapy (HIST) and autologous hematopoietic stem cell transplantation (auto-HSCT) is one of the promising methods of treating MS, showing a long-term effect. However, the implementation of HIST-auto-HSCT is accompanied by a risk of cardiotoxicity, which significantly limits its use and requires close attention. This article presents a successfully resolved case of toxic cardiomyopathy, caused by HIST-auto-HSCT in a woman without a history of cardiovascular pathology.

The purpose of the article is to draw attention to the problem of cardiotoxicity of HIST-auto-HSCT in the treatment of MS, to emphasize the need to develop new strategies to reduce this risk and improve the safety of the method. The article will consider the mechanisms of cardiotoxicity caused by the components of HIST, as well as risk factors, clinical manifestations and diagnostic methods of cardiac complications.

To the 125^th Anniversary of the Department of Propaedeutics of Internal Medicine of the First St. Petersburg Pavlov State Medical University

The article is devoted to Mikhail Dmitrievich Tushinsky, Academician of the Russian Academy of Sciences, one of the most prominent heads of the Internal Diseases Propaedeutic Department of the Pavlov First Saint Petersburg State Medical University. In addition to the interesting facts of the biography, the memoirs of M.D. Tushinsky himself and the reviews of his contemporaries are given. Mikhail Dmitrievich's contribution to science, teaching and medical practice is considered. Special attention is paid to the unique qualities of his personality.