Acute kidney disease. Part I

Смирнов, А В; Румянцев, Александр Шаликович

doi:10.36485/1561-6274-2020-24-1-67-95

Cited by 16 publications

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“…(2020) [16]. Вероятно, это может быть связано с тем, что KIM-1 является маркером, отражающим преимущественно повреждение проксимальных канальцев [2].…”

Section: таблица 4 частота и структура ургентных осложнений госпитального периода у пациентов с окс в зависимости от наличия или отсутствunclassified

“…У пациентов с ОПП (n=29), в отличие от больных без ОПП (n=58) был выявлен более высокий уровень KIM-1 (999,2 (480,8;1314,1) и 663,1 (360,5;905,2) пг/мл; р=0,008), что согласуется с данными литературы [2,10,16]. Кроме того, у них была выше альбуминурия (62,0 (11,4; По данным литературы, гиперурикемия, и, как следствие, гиперурикурия может развиваться при прогрессировании ОЗ, проведении химио-и/или лучевой терапии [4,5].…”

“…ОКС часто сопровождается развитием патологии почек (острый кардиоренальный синдром) [2], что приводит к ухудшению ближайшего и отдаленного прогноза основного заболевания [2,3].…”

unclassified

“…Одним из перспективных биомаркеров повреждения почек является KIM-1 (kidney injury molecule, молекула почечного повреждения). В клинических исследованиях KIM-1 показал себя как чувствительный и специфичный биомаркер для диагностики ОПП, индуцированного противоопухолевой терапией, рентгеноконтрастными препаратами (РКП) (констраст-индуцированное ОПП (КИ-ОПП)), а также после кардиохирургических вмешательств [2,10,11]. Имеются данные, что KIM-1 повышается у больных с ХБП и является одним из маркеров почечно-клеточного рака [12].…”

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Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Михайлова¹,

Пивоваров²,

Пивоварова³

2021

Arhivʺ vnutrennej mediciny

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Relevance. The presence of oncological diseases, high polymorbidity in elderly and senile patients can lead to a complicated course of acute coronary syndrome, including the development of acute kidney injury and/or chronic kidney disease, which contributes to a deterioration of the immediate and long-term prognosis and an increase in mortality.The research purposes. To study the course of acute coronary syndrome depending on the presence or absence of oncological diseases in elderly and senile people and to identify clinical and laboratory-instrumental features.Materials and methods. The study included 200 patients (men — n=122 (61 %), women — n=78 (39 %), Me age — 69 (65;77) years). The patients were divided into two groups: 1) the main group — acute coronary syndrome in combination with oncological diseases (n=100) (men — n=61 (61 %), women — n=39 (39 %), Me age — 69 (65;77) years); 2) the comparison group — acute coronary syndrome without oncological diseases (n=100). The groups were formed by the copy-pair method in a ratio of 1:1 by gender and age. All patients were evaluated for anamnesis parameters, the total number of diseases, the Charlson comorbidity index, the main clinical and laboratory-instrumental parameters and the development of complications. We collected an average portion of morning urine on the first day of hospitalization to determine the content of KIM-1 (pg/ml) in 40 patients of the main group and 47 from the comparison group. We collected daily urine on the 2nd day of hospital treatment to determine the level of K+, Na+, Cl-, uric acid and albumin.The results. Patients of the main group, according to the anamnesis, were more often diagnosed with stable angina (p = 0.042), diabetic kidney disease (p = 0.017), chronic kidney disease (p = 0.013) and anemia (p = 0.008). In addition, these patients had a higher Charleson comorbidity index [8 (6; 9) and 5 (4; 6) points; p <0.001] and a total number of diseases [6 (5; 7) and 4 (3; 5); p <0.001]. Patients with oncological diseases with the development of acute coronary syndrome more often complained of shortness of breath (p=0.008) and heart rhythm disturbance (p=0.004). In patients of the main group a lower left ventricular ejection fraction was diagnosed [51.0 (44; 55) and 54 (48; 57), p=0.013]. Acute kidney injury was more frequently diagnosed in the study group than in the comparison group (p <0.001), including acute kidney injury by “basal” creatinine (p=0.005), acute kidney injury by creatinine dynamics (p=0.047), and acute kidney injury by chronic kidney disease (p=0.003). The KIM-1 leel in patients of the main group was higher [921.0 (425.1; 1314.8) and 658.0 (345.6; 921.4) pg/ml; p=0.011]. In patients with acute kidney injury, in contrast to patients without acute kidney injury, a higher level of KIM-1 was detected [999.2 (480.8;1314.1) and 663.1 (360.5;905.2) pg/ml; p=0.008]. Patients with acute coronary syndrome and oncological diseases in the hospital were more likely to develop urgent complications (p=0.005), including death (p=0.024) and acute heart failure (p <0.001). They also had a higher incidence of early post-infarction angina (p=0.018) and anemia (p=0.005).Conclusions. Our study found that patients in the main group had a higher Charlson comorbidity index, a greater number of diseases, including stable angina, diabetic kidney disease, chronic kidney disease, and anemia. These patients with the development of acute coronary syndrome more often complained of shortness of breath and heart rhythm disturbance. Patients with oncological diseases were more often diagnosed with acute kidney damage, including “basal” creatinine, creatinine dynamics, and chronic kidney disease. The level of KIM-1 in the urine was higher in this group of patients. Patients of the main group in the hospital were more likely to develop urgent complications, including acute heart failure and death. There was also a high incidence of early post-infarction angina and anemia.

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Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Михайлова¹,

Пивоваров²,

Пивоварова³

2021

Arhivʺ vnutrennej mediciny

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“…Предложенные критерии KDIGO широко используются врачами различных специальностей: реаниматологами, нефрологами, сердечнососудистыми хирургами и другими. Медицинская общественность рассматривает внедрение концепции ОПП в практическую работу системы национального здравоохранения как важный стратегический междисциплинарный подход к снижению общей смертности и заболеваемости хронической болезнью почек (ХБП) и сердечно-сосудистой патологией, а также увеличению продолжительности жизни населения и уменьшению расходов на госпитальное лечение осложнений острого нарушения функции почек [19].…”

Section: определение острого повреждения почек группой экспертов Kdigounclassified

Acute kidney injury in cardiac surgery: definition, epidemiology, outcomes and socio-economic significance

Каменщиков¹,

Podoksenov²,

Diakova³

et al. 2020

PKiK

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Surgical intervention on an ‘open’ heart during cardio-pulmonary bypass is the method of choice for patients with valvular defects, complicated forms of coronary heart disease and combined pathology. The level of perioperative mortality in these interventions range from 2 % to 10 %. Acute kidney injury associated with cardiac surgery is a common and serious complication which dramatically worsens operative prognoses and results. According to several major studies, the incidence of acute renal injury in cardiac surgery is comparable with the incidence of myocardial infarction, with corresponding unsatisfactory outcomes. The introduction of the term ‘acute kidney injury’ into clinical practise, replacing the concept of acute renal failure, occurred relatively recently. This facilitated a universal definition for this condition, and unified the criteria for diagnosis and stratification of acute renal dysfunction severity. The article defines acute kidney injury using RIFLE, AKIN and KDIGO criteria. Acute kidney injury in cardiac surgery dramatically worsens short-term results and long-term outcomes, and thus increases the economic cost of treating patients. According to some reports, in industrialised countries, the health costs associated with acute kidney injury are estimated at $ 1 billion. Acute kidney injury is associated with approximately 300,000 deaths per annum, as well as approximately 300,000 new cases of chronic kidney disease. Cumulative expenses associated with acute renal injury in cardiac surgery are not directly limited to the hospitalisation period, but are often prolonged and/or deferred. These patients require additional financial expenses after discharge from hospital, which once again exemplifies this problem in cardiac surgery. Manifest acute kidney injury in the postoperative period of cardiac surgery leads to an increased number of extrarenal complications, reduced short-and long-term survival rates, increased economic costs in hospitals and prolonged treatment effects in the long-term. The introduction of a single definition of cardiac acute renal injury according to KDIGO criteria into clinical practise will identify patient groups with a high risk of developing this pathology. Similarly, it will also facilitate timely measures to prevent the development of complications in postoperative periods, which will reduce the risk of complications in cardiac patients.Received 10 July 2020. Revised 2 September 2020. Accepted 9 September 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova Data collection and analysis: N.O. Kamenshchikov, A.M. Boyko, M.L. Diakova Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko Critical revision of the article: M.L. Diakova, Y.K. Podoksenov Final approval of the version to be published: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov

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Perioperative acute kidney injury in surgical treatment of renal cancer: pathogenesis, therapy of early and late complications

Popov,

Guseynov,

Pomeshkin

et al. 2023

Issled. prakt. med. (Print)

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The development of acute renal injury is due to a number of factors both on the part of the patient (age, concomitant pathology, objective status) and the oncological process (stage of the disease, localization, volume of surgical intervention, access, etc.). Acute renal injury in patients with kidney cancer after surgical treatment may be accompanied by the development of early (hyperhydration, electrolyte balance disorders, hyperkalemia, acid‑base condition disorders, uremic intoxication) and late chronic kidney disease complications. The incidence of these complications increases with an increase in the volume of kidney resection, as a result of which it is important to take into account risk factors, timely diagnosis of the degree of kidney damage and medical measures aimed at restoring kidney function. Currently, the possibility of using various molecules as early markers of kidney damage, which help not only assess the presence of kidney damage, but also localize it, is being studied. For example, albumin, serum cystatin C, alpha 1‑microglobulin, P2‑microglobulin – markers of glomerular damage, NGAL, KIM‑1; L‑FABP, urine cystatin‑C, IL‑18 – reflect damage to the proximal tubule, GST, NGAL – distal tubule, calibindin D28 ‑ characterizes damage to the collecting duct, osteopontin, NHE‑3 – are associated with damage to the loop of Henle. Measures of a curative and preventive nature (infusion therapy, anti‑ischemic protection, modulation of ferroptosis, renal replacement therapy), as well as dynamic monitoring of the main biomarkers of renal damage are aimed at preventing the persistence of the pathological process with a possible outcome into chronic kidney disease, which is especially undesirable in patients with single kidney cancer. The main directions of medical and preventive measures in patients with acute kidney injury should be considered: 1) the fastest possible elimination or minimization of the effect of tumor tissue; 2) control and correction of life‑threatening complications of renal dysfunction (hyperhydration, electrolyte balance disorders (hyperkalemia), acid‑base state, uremic intoxication). Methods of anti‑ischemic protection include a number of surgical techniques aimed at 1) minimizing ischemia time, 2) reducing the intensity of volatile metabolic processes in the kidney, 3) training renal parenchyma for hypoxic conditions (receiving ischemic preconditioning).Duration of renal ischemia represents an important modifiable factor affecting early and distant renal function in surgically exposed patients. The article analyzes modern scientific data on the problem of postoperative acute kidney injury in renal cancer surgery.

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Acute kidney disease. Part I

Abstract: (Project, 2019)

Cited by 16 publications

References 0 publications

Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

Acute kidney injury in cardiac surgery: definition, epidemiology, outcomes and socio-economic significance

Perioperative acute kidney injury in surgical treatment of renal cancer: pathogenesis, therapy of early and late complications

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