During conflicts, people with kidney disease, either those remaining in the affected zones or those who are displaced, may be exposed to additional threats because of medical and logistical challenges. Acute kidney injury developing on the battlefield, in field hospitals or in higher-level hospital settings is characterized by poor outcomes. People with chronic kidney disease may experience treatment interruptions, contributing to worsening kidney function. Patients living on dialysis or with a functioning graft may experience limitations of dialysis possibilities or availability of immunosuppressive medications, increasing the risk of severe complications including death. When patients must flee, these threats are compounded by unhealthy and insecure conditions both during displacement and/or at destination. Measures to attenuate these risks may only be partially effective. Local preparedness for overall and medical/kidney-related disaster response is essential. Due to limitations in supply, adjustments in dialysis frequency or dose, switching between hemodialysis and peritoneal dialysis and changes in immunosuppressive regimens may be required. Telemedicine (if possible) may be useful to support inexperienced local physicians in managing medical and logistical challenges. Limited treatment possibilities during warfare may necessitate referral of patients to distant higher-level hospitals, once urgent care has been initiated. Preparation for disasters should occur ahead of time. Inclusion of disaster nephrology in medical and nursing curricula and training of patients, families and others on self-care and medical practice in austere settings may enhance awareness and preparedness, support best practices adapted to the demanding circumstances, and prepare non-professionals to lend support.

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BACKGROUND. The presence and drug correction of arterial hypertension (AH) with inhibitors of the renin-angiotensin system (RAS), as well as chronic kidney disease (CKD) and its role in the regulation of RAS, can significantly affect the condition of a person with COVID-19. OBJECTIVE: to study the features of the functional state of the kidneys in patients with grade 1-2 hypertension who have fallen ill with COVID-19. PATIENTS AND METHODS. A subanalysis of patients with CKD, participants in the BIRCOV study (ARB, ACEi, DRi in COVID-19) is presented: 112 outpatient patients with grade 1-2 hypertension, 83 of whom had CKD. The participants were divided into groups receiving ACE inhibitors (group 1 – 39 %), ARBs (group 2 – 32 %), or a direct renin inhibitor (PIR) (group 3 – 29 %) as the main therapy of hypertension. The value of blood pressure, eGFR, albuminuria level were analyzed at the debut of COVID-19 and at 2, 4, 12, 24 weeks from the onset of the disease. RESULTS. In the first two weeks of COVID-19, there was a decrease in blood pressure with a gradual return to baseline values in patients of group 1 and group 3 (to a lesser extent). The use of ACE inhibitors in the treatment of hypertension increased the risk of withdrawal compared to PIR and ARBs due to COVID-19. In patients with CKD, higher values of mean blood pressure were obtained with similar dynamics. A synchronous decrease in eGFR and systolic blood pressure has been documented, more pronounced in patients with CKD, especially when taking aCEI. The decrease in eGFR correlated with the stage of CKD. With stable renal function in patients with CKD during the first 12 weeks of COVID-19, the urine albumin/creatinine ratio (UAC) increased without further normalization. By the second week of the disease, eGFR decreased with a reciprocal increase in the level of uric acid in the blood. The use of dexamethasone was accompanied by a decrease in eGFR in CKD stages 3b-4. CONCLUSION. When taking ACE inhibitors, the effect of lowering blood pressure was comparable to a double block of RAS: ACE inhibitors + ARBs.

БРИМОНЕЛ -БР(А)И(АПФ)МО(ксонидин)НЕ(биволол) Л(еркани ди пин) меняется на МНЕЛД -М(оксонидин) НЕ(биволол)Л(ерканидипин)Д(иуретик),

Тема номеру Cover StoryThe main function of kidneys is urinary excretion. A sudden arrest of diuresis indicates that the organ is severely injured. Conversely, a constant moderate decrease in urinary excretion is a characteristic of chronic kidney disease (CKD). Overhydration that occurs in CKD manifests as high blood pressure and congestive heart failure (CHF) (Fig. 1) [1].The Fig. 1 shows that diuretics are rarely used for acute kidney injury unless there is severe overhydration. Conversely, the primary treatment for edema syndrome and/or over-hydration in CKD is the use of diuretics; however, their clinical effec-