[Renal distress syndrome in surgery and uronephrology: concept, pathogenesis, basics of prevention and correction]. / Renal'nyi distress-sindrom v khirurgii i uronefrologii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction. MATERIAL AND METHODS: Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup). RESULTS: In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology. CONCLUSION: Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.

[Systemic inflammatory response syndrome in pancreatic necrosis: triggers and organ damage]. / Sindrom sistemnogo vospalitel'nogo otveta pri pankreonekroze: triggernye agenty, organnye povrezhdeniya.

OBJECTIVE: To determine the main trigger mechanisms of multiple organ failure in acute severe pancreatitis. MATERIAL AND METHODS: An experimental study included 26 dogs with pancreatic necrosis. We assessed homeostasis disorders and functional changes in the pancreas, bowel, liver, kidneys, lungs and heart. Forty-six patients with severe acute pancreatitis were examined. We studied homeostasis disorders and functional state of the organs, endotoxemia, lipid peroxidation, phospholipase activity, coagulation system and hypoxia. RESULTS: Injury of various organs and systems due to systemic inflammatory response at the early stage of disease is an important aspect in progression of acute pancreatitis. Membrane destabilizing phenomena and disturbances in tissue component of coagulation system are the most significant factors. Patients with severe acute pancreatitis had significant changes in homeostasis. We distinguished two subgroups of patients. The course of disease was different. In the first subgroup, changes in homeostatic parameters were 15.4-24.2% less than in the second subgroup. This largely determined treatment outcomes as a whole. In the first subgroup, therapy was effective in most cases, in the second one - less effective that required surgical interventions. In the first subgroup, mortality and hospital-stay were less compared to the second subgroup. CONCLUSION: Oxidative stress, hypoxia, activation of phospholipases, and coagulation abnormalities are important in the development of systemic inflammatory response syndrome following acute pancreatitis. These factors are triggers for a cascade of the same kind of pathophysiological phenomena contributing to multiple organ failure and pancreatitis. In the tissues of various organs, proportional growth of these markers is observed until the 6th day, while in the blood - until the 4th day.

[Factor analysis of clinical and paraclinical criteria determining the prognosis of acute renal damage].

AIM: to identify risk factors and assess their significance in the development and prognosis of acute kidney injury in urological patients. MATERIAL AND METHODS: The data of 6272 patients treated in the Department of Urology and Intensive care Unit were analyzed retro- and prospectively. Factorial and linear regression analyzes of the primary diagnostic criteria were carried out, which allowed to establish an impact of individual signs and their combination in determining the risk of developing or diagnosing existing renal dysfunction in the absence of clinical manifestations. RESULTS: Statistical analysis has demonstrated the high significance of some diagnostic criteria (gender, increased body mass index, duration of the disease, comorbidities, hyperthermia, epitheliuria, proteinuria) influencing the development of acute kidney injury in patients with urolithiasis complicated by renal colic or secondary pyelonephritis. The factor load of each criterion allowed to establish the worst prognosis and the risk of progression of acute kidney injury in patients with frequent recurrences of secondary pyelonephritis, episodes of renal colic over the last 5 years, a combination of arterial hypertension and diabetes mellitus who underwent extracorporeal shock-wave lithotripsy or pyelolithotomy with nephrostomy. These risk factors require for additional pharmacological protective therapy aimed at preventing the progression of acute kidney injury. CONCLUSIONS: Decreased urine output and serum creatinine levels as criteria for acute kidney injury (according to KDIGO) do not allow to fully assess the risk of renal dysfunction, which requires to consider additional criteria (gender, increased body mass index, duration of the disease, comorbidities, hyperthermia, epitheliuria, proteinuria) when taking history during the initial examination of a patient with upper urinary tract pathology.