Vol 38, No 1 (2021)

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Full Issue

Original studies
N-terminal pro-brain natriuretic peptide as a predictor of hemodynamic significance of functioning ductus arteriosus in premature newborns
Porodikov A.A., Biyanov A.N., Permyakova A.V., Tuktamyshev V.S., Kuchumov A.G., Pospelova N.S., Furman E.G., Onoprienko M.N.

Objective. To study the possibility of using N-terminal pro-BNP fragment as a screening criterion of hemodynamic significant of the functioning arterial duct in extremely premature newborns. Hemodynamically significant functioning arterial duct (HSFAD) is a reason of the development of various complications in extremely premature newborns. The basic method for HSFAD diagnosis is Echo CG. The limited technical abilities of ultrasound devices can prevent from an early diagnosis and timely treatment of this state. The search of additional markers of hemodynamic significance the functioning arterial duct (FAD) is actual.

Materials and methods. A continuous prospective observational study included patients aged 1 to 3 days with FAD, gestation period of 25–32 weeks and birth weight from 500 to 1500 g. Hemodynamic significance of FAD was determined according to generally accepted Eco CG criteria. The level of NT-pro-BNP was identified with IFA on the third day of life. Mathematical modelling was used to calculate a “threshold” value of NT-pro-BNP, corresponding to 6500 pg/ml, at which the probability of hemodynamic significance of the functioning arterial duct exceeds 80 %.

Results. The assessment of NT-pro BNP concentration on the third day of life permitted to establish the following reliable differences: in the main group, the median concentration for NT-pro BNP was 15000 [IQR 2 587; 26 500] pg/ml, in the comparison group – 1920 [IQR 1379; 3467] pg/ml, р = 0.001. Mean force direct correlation, r = 0.52, between Echo CG results and NT-pro-BNP values was stated.

Conclusions. The obtained results make it possible to use NT-pro-BNP as a screening criterion of FAD hemodynamic significance in extremely premature newborns.

Perm Medical Journal. 2021;38(1):5-15
State of cardiovascular system in employees with chronic obstructive pulmonary disease in combination with arterial hypertension in terms of exposure to toxic games
Panacheva L.A., Shpagina L.A.

Objective. Identification of the features of the cardiovascular system damage in chronic obstructive pulmonary disease (COPD) combined with arterial hypertension (AH) in workers exposed to toxic gases (TG).

Materials and methods. 132 house painters and paint production workers of the Novosibirsk aviation enterprise were included in 3 strata and examined: I-COPD and TG; II-COPD in combination with AH when exposed to TG; III – COPD in combination with AH without exposure to TG. Employees of all strata were divided by length of service less than 10 and more than 10 years. The selection of workers in groups was carried out by a continuous method.

Results. The most pronounced changes on the ECG, regardless of the length of service, were observed in workers with COPD in combination with hypertension and contact with TG (levogram and metabolic changes in the myocardium). When exposed to TG for more than 10 years, hypertrophy of the left parts of the heart was also detected. Among workers with COPD in combination with hypertension exposed to TG, the indicators of average pulmonary artery pressure (APAP) and pulmonary vascular resistance (PVR) elevated with increasing work experience; changes in the structure and function of the right and left parts of the heart and signs of remodeling of large vessels were also revealed. The same workers showed more pronounced changes in the daily blood pressure profile (DBPP) of AP with the prevalence of Non-dippers and Night-pickers.

Conclusions. Among workers suffering from comorbid pathology, with increasing duration of TG exposure over 10 years, there were observed the most pronounced ECG changes (deviation of electrical axis to the left, metabolic changes in the myocardium, hypertrophy of the left heart); increased APAP and PVR 1.21 and 1.10 times; changes in the structure and function of the right and left chambers of the heart, remodeling of large vessels; increase in the frequency of variants of the DBPP of Non-dippers and Night-pickers.

Perm Medical Journal. 2021;38(1):16-28
Indicators of dental status in professional sportswomen
Safaraliyev F.R.

Objective. To study the indicators of the dental status in professional athletes.

Materials and methods. The object of the study was 200 professional female athletes representing various kinds of sport and 200 practically healthy female individuals who are not involved in sports. The total sports experience of the subjects was on average 13–15 years. The prevalence of periodontal diseases among female athletes was determined using the CPITN index. The prevalence and intensity of caries was determined by the CPI index. The hygienic state of the oral cavity was determined using the oral hygiene efficiency index (PHP). In the main group, patients were administered applications of a drug based on propolis and vegetable oil for two weeks; in the comparison group, the traditional antiseptic, chlorhexidine bigluconate, was used for the same period.

Results. In the control group, the prevalence of chronic generalized gingivitis was on average two times less than in the main group, in which the value of this indicator varied within 50 %. Among all the studied diseases of the oral cavity in athletes in general, the most essential and significant differences were observed in relation to the prevalence of dental caries and its complications, which were more common in the group of athletes than in the control group – 95.0 ± 1.54 %, versus 89.5 ± 2.17 %, respectively (p < 0.001). The need for treatment of moderate and severe inflammatory periodontal diseases in the main group was approximately 1.5 times higher than in the control group (77.0 ± 2.98 vs. 42.5 ± 3.50 %, p < 0.001), and for gingivitis almost 2 times higher than in the control group (61.5 ± 3.44 vs. 39.0 ± 3.45 %, p < 0.001). The results of the study showed that among the oral diseases in sportswomen, the most essential and significant differences were observed in the prevalence of dental caries and its complications. The intensity of periodontal tissue damage over the entire period of sports career in athletes of the older age group corresponded to moderate and severe periodontitis. The high percentage of cases of major dental diseases detected among female athletes indicates their high need for periodontal care.

Conclusions. Regular use of a biologically neutral propolis-based preparation for preventive purposes leads to a relatively more pronounced improvement in laboratory and clinical indicators of the oral cavity status.

Perm Medical Journal. 2021;38(1):29-37
Role of inflammation and iron exchange disorders in progression of liver cirrosis
Bulatova I.A., Shchekotova A.P., Paducheva S.V.

Objective. To assess the role of the main pathogenetically significant molecules, including tumor necrosis factor alpha (TNF-α) and transferrin, as an inflammatory protein, in the progression of chronic diffuse liver diseases (CDLD).

Material and methods. The study involved 86 patients with cirrhosis of the liver (LC) of viral, alcoholic and mixed etiology. Inflammatory parameters were studied, including tumor necrosis factor alpha (TNF-α), indicators of iron metabolism, α-fetoprotein (AFP), vasculoendothelial growth factor (VEGF), and functional liver biochemical tests. The control group consisted of 70 persons.

Results. It was revealed that the LC severity class is interrelated with the clinical manifestations of the disease, the severity of biochemical syndromes as well as a significant increase in the concentration of γ-globulins, CRP, the amount of TNF-α up to 3.5 (2.6–4.7) pg/ ml (p < 0.001) and ferritin up to 325.8 (209; 401) ng / ml (p < 0.001) compared to the control group. An increase in TNF-α and ferritin as inflammatory protein in LC confirms the growth of the activity of inflammation in the liver and correlates with other parameters involved in the pathogenesis of LC: with VEGF, as a marker of endothelial dysfunction, which is involved in the activation of fibrosis and neoangiogenesis, and AFP, reflecting regeneration processes in the liver.

Conclusions. The progression of liver damage in cirrhosis is based primarily on the secondary inflammation caused by portal hypertension with the entry of intestinal antigens and toxins into the central bloodstream. At the same time, the perverse circle of the development of the disease is closed.

Perm Medical Journal. 2021;38(1):38-45
Features of change of immune status indicators in individuals with active and latent forms of herpes-virus infections
Solomay T.V., Semenenko T.A., Karazhas N.V., Rybalkina T.N., Veselovsky P.A., Pulnova N.L., Gotvyanskaya T.P., Golosova S.A., Ivanova I.V., Boshyan R.E., Kulakov D.Y.

Objective. The aim of the study is to investigate the peculiarities of changes in the immune status of individuals with active and latent forms of herpesvirus infections. Herpesvirus infections are an urgent problem of modern health care.

Materials and methods. The prospective longitudinal cohort study included 92 permanent blood donors who were examined twice at 6-month intervals for the presence of specific IgM and IgG antibodies and antigens of herpes simplex viruses 1, 2, Epstein-Barr, cytomegalovirus, human herpesvirus type 6, as well as humoral immunity indicators.

Results. In the period from October to April, 68.5 % of blood and its components donors were found to have markers of active herpesvirus infection caused by HSV 1, 2, EBV, CMV, and HHV6. The combination of the detected markers in the absence of clinical manifestations and changes in General and biochemical blood tests indicated asymptomatic reactivation of latent infection. The frequency of reactivations in the autumn and spring months is the same. The absence of IgG production after asymptomatic reactivation of HSV-2 and HHV-6 infections and an increase in IgG concentrations to HSV-1, EBV, and CMV were revealed. EBV infection is the most common among the studied nosologies (98.91 %) and is characterized by statistically significantly higher levels of specific IgG. The effect of asymptomatic reactivation of herpesvirus infections on the levels of total IDA, IgM, IgG, IDE, and CEC was not established.

Conclusions. Asymptomatic reactivation of herpesvirus infections does not significantly affect the changes in immune status indicators, and the absence of clinical manifestations, and significant changes in General and biochemical blood tests cause epidemiological risks associated with difficulties in identifying the sources of infection.

Perm Medical Journal. 2021;38(1):46-63
Features of reproductive function in infertile women with hyperthyroidism
Rzakulieva L.M., Hajizade A.E.


Objective. The aim was to study the characteristics of reproductive function in women of fertile age with infertility and hyperfunction of the thyroid gland.

Materials and methods. The object of the study was 148 women of fertile age. To compare the indicators obtained by special methods, the control group included the indicators of laboratory and instrumental examination of 30 non-pregnant women of reproductive age. Reproductive function was evaluated in 118 women with hyperthyroidism: 58 retrospectively (group I) and 60 prospectively (group II); the control group consisted of 30 healthy women of reproductive age. Hormonal studies were performed by radioimmune and enzyme immunoassay methods using the automatic analyzer "Cobb" ("Hoffmann La Roche", Switzerland), as well as DPS test systems – the analyzer “Immulite” (USA). Ultrasound of the thyroid gland was performed by a linear sensor with a frequency of 7.5 MHz. The volume of the thyroid gland was calculated according to the Bruno formula.

Results. For women of fertile age with hyperthyroidism, a decrease in ovarian reserve is characteristic that is manifested by a significant increase in FSH level (14.1 ± 3.1 IU / L, p < 0.05), and a decrease in inhibin B level (35.9 ± 12,7 pg / ml, p < 0.05). In 47.7 % of women of fertile age with hyperthyroidism, there is a decrease in ovarian volume and a significant reduction in the average number of antral follicles of normal size (4.34 ± 1.56, p < 0.05).

Conclusions. Based on the results obtained, it can be assumed that in diffuse toxic goiter there are not only functional disorders (metabolism of hormones of the reproductive system), but also deep organic changes in the structure of the ovaries that leads to a rapid suppression of their functions. In cases of thyroid diseases, the clinical manifestation of these changes is premature and early menopause.

Perm Medical Journal. 2021;38(1):64-71
Review of literature
Muscular system in maintaining health and preventing chronic non-infectious diseases
Golovskoy B.V., Berg M.D., Bulatova I.A., Voronova E.I., Khovaeva Y.B.

Chronic non-infectious diseases are the leading cause of premature death according to the WHO data. This review considers the evolution of studying and modern views of domestic and foreign authors on the role of skeletal muscles in maintaining health and preventing chronic non-infectious diseases. An idea regarding the nervous and reflex influence from the working muscles on both individual organs and the body as a whole is presented. The role of myokines, specific proteins produced by skeletal muscles, capable of influencing the state of many organs and systems, is described.

Perm Medical Journal. 2021;38(1):72-86
Role of genetic structure of Helicobacter Pylori in formation of chronic inflammatory process in gastric mucosa
Manyakina O.M., Akkuratova-Maksimova I.S., Pukhova T.G., Shitova A.S.

The literature review highlights the questions of the interaction of Helicobacter pylori and the human body. Modern data on the structure of the pathogenicity island in the Helicobacter pylori genome are presented. There is given a detailed description of both well-known virulence and pathogenicity factors of the infection (genes encoding the formation of urease subunits, in particular urel, cytotoxin associated gene A, vacuolating cytotoxin gen A, blood group associated binding adhesion, induced by contact with epithelium) and less studied ones (sialic acid-binding adhesion, adhesion-associated lipoprotein A and B, adhesin gene of Helicobacter pylori, Hp outer membrane protein). The significance of individual genes and proteins encoded by them in the development of chronic inflammatory process in diseases of the upper digestive tract, as well as in ulcer – and carcinogenesis is analyzed. Mechanisms of interaction of bacteria with epithelial cells of the gastric mucosa, adhesive and cytotoxic effects of Helicobacter pylori, factors of biofilm formation are described. The influence of the genetic structure of Infect on cytological composition of the gastric glands in the form of reduction of specialized glandular cells – chief and parietal cells of pyloric glands and the increase of endocrine cells in the pool is assessed. It is shown that colonization of the gastric mucosa by highly pathogenic strains of Helicobacter pylori contributes to the development of widespread pronounced and active inflammation in it, the appearance of morphological signs of atrophy. The role of the genetic characteristics of the infection in the failure of anti-helicobacter therapy is emphasized. Separately, the question of the effect of combined infection of the gastric mucosa with highly pathogenic strains of Helicobacter pylori and Epstein-Barr virus is highlighted.

Perm Medical Journal. 2021;38(1):87-99
Methods of diagnosis and technologies
Minimally invasive Ozaki procedure for aortic valve disease, preliminary results
Kadyraliev B.K., Arutyunyan V.B., Chragyan V.A., Askadinov M.N., Enginoev S.T., Kucherenko S.V.

Objective. To assess the efficiency and realizability of the surgical technique of aortic valve reconstruction using autologous pericardium treated by glutaraldehyde in different aortic valve diseases such as aortic stenosis, aortic regurgitation, rheumatic and degenerative diseases of aortic valve. In 2014, Ozaki presented the technique described.

Materials and methods. In this work we analysed 10 cases of ministernomy combined with Ozaki procedure in patients operated at “Sukhanov Federal Center for Cardiovascular Surgery”.

Results. No hospital mortality was registered in our study. Intraoperatively, transition to a full sternotomy was not required. A mean time of aortic cross-clamping was 84.6 (± 14.4) minutes, a mean value of artificial circulation was 103.1 (± 17.7) minutes, a mean time of ventilation was 8.4 hours, and a mean time of staying in intensive care unit room was 1.6 days.

Conclusions. Minimally invasive approach combined with Ozaki procedure is realizable; it is an alternative to conventional sternotomy and should be used for patients in grave condition having concomitant diseases.

Perm Medical Journal. 2021;38(1):100-107
Prediction of persistence of hemodynamically significant open arterial duct in profoundlypreterm infants
Klimachev A.M., Nikolaeva T.N., Klimacheva O.V.

Objective. To develop a method for predicting the persistence of hemodynamically significant ductus arteriosus in profoundly premature newborns based on the evaluation of clinical data and the results of additional studies.

Material and methods. Sixty-nine profoundly preterm newborns were examined including 37 with very low and 32 with extremely low body weight. Clinical and anamnestic data, the results of laboratory radiographic and instrumental examinations were evaluated. The state of the arterial duct, as well as the parameters of central and intracardiac hemodynamics were determined by echocardiography. The criteria for hemodynamically significant open arterial duct (OAD) were the following: duct size greater than 1.5 mm, left-right blood bypass, the presence of retrograde blood flow in the aorta greater than 50 % of the antegrade value. There were 2 groups: comparison (n = 41) – children with hemodynamically insignificant ductus arteriosus, main (n = 28) – children with hemodynamically significant ductus arteriosus after 72 hours of postnatal life.

Results. After 72 hours of the postnatal life, a hemodynamically significant ductus arteriosus is detected in 40.6 % of profoundly premature newborns. The factors of a long-term persistence of ductus arteriosus are as follows: birth at term of gestation less than 27 weeks with a low Apgar score within the first minute of life (≤ 4 points), a patient has a sharp weakening or absence of reflexes of the newborn, severe muscular hypotonia, signs of peripheral circulation, moist fine wheezing and crepitation in the lungs, strengthening of their images on the radiograph due to the interstitial and vascular components, dilation of the left and right ventricles and the left atrium. The method for predicting the dynamics of the open ductus arteriosus in profoundly premature newborns has been developed.

Conclusion. The use of the developed prognostic table makes it possible to identify with an accuracy of 85.7 % profoundly premature newborns with a high risk of persistence of a hemodynamically significant ductus arteriosus after 72 hours of postnatal life.

Perm Medical Journal. 2021;38(1):108-114
Preventive and social medicine
Sanitary and parasitologic state of environmental objects. Analysis of work of the center for hy-giene and epidemiology in astrakhan region for 2015–2019
Arakelyan R.S., Shendo G.L., Irdeeva V.A., Deeva T.M., Galkina E.V.

Objective. To study the sanitary and parasitologic state of environmental objects in Astrakhan Region for 2015–2019 at the example of studying the samples of soil, water and solid surface washes.

Materials and methods. Over the period from 2015 to 2019, at the laboratory departments of “The Center for Hygiene and Epidemiology in Astrakhan Region”, 15253 samples from different environmental objects were taken, 21850 studies were carried out. The number of samples, which did not satisfy the hygienic norms, was 2.5 % (383 samples).

Results. For the analyzed period, 4002 samples (26.2 %) of soil from the territory of Astrakhan and Astrakhan Region were taken and studied; 8004 investigations were performed. The number of samples, which did not satisfy the hygienic standards, was 7.5 % (300 samples). The number of samples of the washes from the solid surfaces was 56.7 % (8656 samples). Unsatisfactory samples made up 0.01 % (1 sample) – in this sample, teniid oncospheres were detected (2019). The study of water samples taken from different water objects formed 17.0 % (2595 samples) out of the number of all sanitary and parasitologic studies carried out in 2015–2019. Water was taken from different sources of water supply including centralized water supply, water from swimming pools, water from open reservoirs and wastewater.

Conclusions. The presence of moving larvae of palisade worms and toxocar eggs in the soil confirms the infested animal fecal contamination of this object, and the presence of ascarid, opisthorchis, Hymenolepis nana, teniid oncospheres eggs and dysentery amoeba cysts in the soil – the infested human fecal contamination. The presence of teniid oncospheres in the solid indoor washes demonstrates the contact of the infested person with this object. The presence of helminth eggs and larvae, typical for animals and human being in the samples taken from the open reservoirs indicates, first of all, contamination of these objects by feces of infested human beings and/or animals as well as the supposed version of water contamination by wastewater. The presence of eggs and larvae of helminths in the wastewater, dangerous for animals and human beings, testifies to a low-quality work of treatment facilities.

Perm Medical Journal. 2021;38(1):115-122
Sudden death from common diseases at workplace and preventive measures (on the example of the Republic of Bashkortostan)
Karimova L.K., Gimaeva Z.F., Bakirov A.B., Muldasheva N.A., Kaptsov V.A.

Objective. To study the causes of death from common diseases at the workplace and to develop the scientifically grounded programs aimed at their prevention and decrease. A sudden death of a person at workplace is a global issue of occupational medicine in all the countries. About 85 % of sudden deaths occur due to health status of workers, first of all, circulatory system diseases and only 15 % are caused by occupational accidents.

Materials and methods. To reach the aim, there were investigated the materials of investigation of the cases of death form common diseases at the workplace for 5 years (2014–2018) presented by the State Labor Inspection in the Republic of Bashkortostan.

Results. According to the analyzed data of medicolegal report of accidents with lethal outcome resulting from common diseases it was established that men aged 56–60 years, workers, mostly of manufacturing industry, died more often (92.5 %). Program of preventive measures was worked out on the basis of the obtained results.

Conclusions. High death rate from circulatory system diseases at workplace needs a complex of treatment and preventive measures to be developed, which will decrease the risk of a sudden cardiac death among workers of industrial enterprises.

Perm Medical Journal. 2021;38(1):123-134
Food safety by parasitological indicators
Irdeeva V.A., Arakelyan R.S., Shendo G.L., Aleksashina D.S., Sosnina A.M., Bolonina A.V.

Objective. To study the sanitary and parasitological state of food products in Astrakhan Region for their contamination with eggs and larvae of helminths, as well as cysts of pathogenic intestinal protozoa.

Materials and methods. The work was carried out on the basis of the Laboratory of Bacteriological and Parasitological Research of the Center for Hygiene and Epidemiology in the Astrakhan Region in 2015–2019. A total of 1.430 food samples were examined and 2207 studies were performed during the analyzed period. The number of unsatisfactory samples was 4.6 % (n = 66) – the following was found: larvae of Strongyloides stercoralis – 84.8 % (n = 56), eggs and metacercariae of Opisthorchis felineus – 4.5 % (n = 3), cysts of Entamoeba histolytica, larvae of Strongyloides stercoralis + Ascaris lumbricoides – 3.0 % (n = 2), eggs of Ascaris lumbricoides and Enterobius vermicularis – 1.5 % (n = 1) and larvae of Strongyloides stercoralis + Toxocara Canis – 1.5 % (n = 1).

Results. The largest number of selected and investigated food samples was accounted for fruit and vegetable samples – 54.3 % (n = 777), of which 8.4 % (n = 65) of the samples were unsatisfactory. In these samples, larvae of Strongyloides stercoralis were found – 86.2 % (n = 56) of all positive findings of fruit and vegetable products, eggs of Opisthorchis felineus and cysts of Entamoeba histolytica – 3.1 % (n = 2 each), as well as unfertilized eggs of Ascaris lumbricoides and eggs of Enterobius vermicularis – 1.5 % (n = 1 each). In addition to isolated findings, there were noted cases of mixed invasion: larvae of Strongyloides stercoralis + unfertilized eggs of Ascaris lumbricoides-3.1 % (n = 2) and larvae of Strongyloides stercoralis + eggs of Toxocara canis – 1.5 % (n = 1).

Conclusions. The presence of Toxocara eggs and strongylid larvae on the samples of fruit and vegetable products indicates soil contamination with feces of invasive animals. The presence of ascarid eggs on food indicates contamination of the soil with the feces of infested persons. The presence of opisthorchis eggs on the samples of cucumbers and tomatoes, and cysts of dysentery amoeba on the samples of cucumbers and cabbage indicates contamination of water used for watering these products with eggs and cysts of pathogenic intestinal protozoa. The presence of pinworm eggs on cucumbers indicates contact of an infected person with this product. Contamination may have occurred when the product was transported to the laboratory.

Perm Medical Journal. 2021;38(1):135-143
Clinical case
Clinical case of surgical treatment of giant central anastomosis aneurysm after autovenous femoropopliteal bypass
Samartsev V.A., Vaganov D.S., Oparin A.Y., Karasov I.A., Kruglov E.V., Goryunov S.N.

Ahterosclerosis of vessels of the lower extremities is widely distributed in the population. Open surgical revascularization is an efficient method for treatment of this pathology. One of the rare postoperative complications is an anastomosis aneurysm development. We report about a clinical case of a 74-year-old male with a giant (25 cm in diameter) aneurysm of the proximal anastomosis after femoropopliteal bypass. Open aneurysmectomy was performed, and the postoperative period was uneventful.

Perm Medical Journal. 2021;38(1):144-150
A case of new coronavirus infection course in a child with severe secondary immunodeficiency associated with hematopoietic stem cell transplantation
Grymova N., Khuzina E.A., Furman E.G., Nikonova O.E.

Numerous articles have been published on COVID-19 cases in the child population now. Children become infected and get sick with a new infection much less often and more easily than adults. The supposed relative resistance of children to SARS-CoV-2 can be explained by a number of reasons, one of which is the immaturity of the ACE2 receptor, or by the fact that children have certain features of innate immunity that disappear in ontogenesis. On the contrary, the maturity of the immune system may explain the unfavorable type of triggered immune response associated with the development of acute respiratory distress syndrome in adult patients.

The article describes a case of a new coronavirus infection in a 5-year-old child with a severe secondary immunodeficiency condition associated with hematopoietic stem cell transplantation. By describing this clinical case, we wanted to draw attention to a mild course of COVID-19 infection in a child with a burdened premorbid history in the form of severe secondary immunodeficiency associated with hematopoietic stem cell transplantation in the treatment of acute promyelocytic leukemia.

Perm Medical Journal. 2021;38(1):151-160
Problems in differential diagnosis of secondary hyperparathyroidism
Shulkina S.G., Sirin D.O., Smirnova E.N., Zhelobov V.G., Kolomeets N.Y., Loran E.A., Perevoschikov A.N., Koryagin V.S.

Hyperparathyroidism is an endocrine disease characterized by excessive production of parathyroid hormone in the main cells of the parathyroid glands. Depending on the cause of this disease, there are primary, secondary (SHPT) and tertiary hyperparathyroidism. The most common causes of SHPT are vitamin D deficiency and chronic kidney disease (CKD). Vitamin D is converted to its active form by hydroxylation in the renal tubules. Developmental abnormalities and chronic kidney diseases lead to atrophy of the tubular epithelial cells that causes a violation of vitamin D metabolism and the development of SHPT, which in turn are accompanied by a violation of calcium-phosphorus metabolism and a syndrome of musculoskeletal disorders. This article presents an analysis of a clinical case of a patient diagnosed secondary hyperparathyroidism against the background of vitamin D deficiency combined with polycystic kidney disease. This clinical case reflects the complexity of the differential diagnosis of the disease and the tactics of patient's management.

Perm Medical Journal. 2021;38(1):161-167

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