[Acute kidney injury in the pathogenesis of coronavirus infection].

COVID-19 is an acute respiratory viral disease that primarily affects the lungs, but can also affect other organs, including the kidneys. Damage to the kidneys can be caused by direct effects arising from the invasion of the virus into kidney cells, or it occurs secondarily due to immunological, hemocoagulation and ischemic disorders. Given the importance of preserving kidney function during illness and after recovery, this review aims to investigate the impact of novel coronavirus infection on the kidney and its role in the development of acute kidney injury.

[Frequency of occurrence and risk factors for acute kidney injury after radical cystectomy].

INTRODUCTION: Various studies have revealed the negative impact of surgery or related factors on the risk of acute kidney injury (AKI). The risk factors and 6-months outcomes in patients with clinical or subclinical manifestations of AKI after radical cystectomy were analyzed. MATERIALS AND METHODS: This prospective study included patients with normal renal function who underwent radical cystectomy. Urine and serum samples were collected to measure the level of neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 186 patients, 43 (23.1%) had AKI in the postoperative period. The most reliable predictor was the concentration of NGAL in the urine 12 hours after surgery (threshold value of 156.87 ng/ml). In 53 (28.5%) patients with NGAL higher than this value, subclinical AKI was diagnosed. Patients with clinical AKI and patients with subclinical AKI were allocated to the AKI group. Independent risk factors for postoperative AKI were age and obesity. After 6 months the glomerular filtration rate (GFR) in the group with AKI was significantly lower than in the control group, although the baseline GFR was similar. CONCLUSION: Determination of NGAL concentration in urine is recommended for early diagnosis of postoperative AKI, as well as for predicting the functional state of the kidneys 6 months after oncourological procedures. A significant proportion of patients developed subclinical AKI; in this group there was a worse renal outcome in comparison with the group without AKI.

[PELVIC FLOOR RECONSTRUCTION AFTER PELVIC EVISCERATION USING GRACILIS MUSCULOCUTANEOUS FLAP].

Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss--595 mL and the average length of hospital stay--19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap's distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.