[The treatment of infectious-inflammatory urologic diseases and their complications by efferent detoxication methods]. / Lechenie infektsionno-vospalitel'nykh urologicheskikh zabolevanii i ikh oslozhnenii éfferentnymi metodami detoksikatsii.

This is an account of experience with extracorporeal detoxication techniques in 238 patients with urologic conditions who underwent 305 hemosorption (HS), 30 plasma sorption (PS) and 171 plasmapheresis (PA) sessions. Clinical and laboratory criteria are presented for employing an extracorporeal detoxication technique depending on predominance of suppurative septic or azotemic intoxication, and contraindications for HS, PS and PA. Absolute indications for these techniques were suppurative septic intoxication secondary to acute and chronic urologic inflammatory diseases, including septic shock, and acute renal failure. An emphasis is placed on the need for utilization of this therapy after urine flow recovery and drainage of all suppurative foci. An overview of mechanisms of different extracorporeal detoxication techniques showed them to share detoxifying and immunostimulating effects and improvement of blood rheology, renal and hepatic function. Application of the extracorporeal techniques reversed 84.4% of acute pyelonephritis, 61% of acute renal failure (without resorting to hemodialysis) and 65.4% of septic shock. This therapy was less efficient in patients with multiple organ failure. Good efficacy of xenogenic-spleen or splenocyte-suspension hemoperfusion was shown in patients with urosepsis.

[Plasmapheresis in the combined therapy of the acute rejection reaction and of suppurative-septic complications in the pretransplantation period]. / Plazmaferezv kompleksnoi terapii ostroi reaktsii ottorzheniia i gnoino-sepicheskikh oslozhnenii predtransplantatsionnogo perioda.

To define the efficacy of plasmapheresis performed as part of combined treatment for steroid-resistant patterns of acute rejection of a renal transplant, the results of the treatment were analysed in 11 patients. The analysis also involved the results of plasmapheresis treatment of 3 patients with terminal renal failure complicated with septic conditions and 1 patient with stenosed artery of the transplanted kidney and irreversible arterial hypertension. Plasmapheresis was used in various terms of rejection after a 3-4-day prednisolone pulsatile therapy. The effect of the procedure was recorded in 7 out of 13 patients, i. e. in 50 per cent of those treated. The necessity of applying early plasmapheresis (immediately after methylprednisolone pulsatile therapy in case of its failure) was demonstrated as were the methods of intensive plasmapheresis performance (daily within 4-5 days). The technique permitted to eliminate septic conditions before and after the period of transplantation, to decrease blood pressure in the patients with stenosed arteries of transplanted kidney. The authors considered the mechanism of the curative effect of plasmapheresis in the patients with acute rejection and the criteria for its efficiency.