Shramenko Ekaterina Konstantinovna, Doctor of medical sciences, associate professor, sub-department of anesthesiology, intensive care and emergency medicine, Donetsk National Medical University after M. Gorky (16 Ilyicha avenue, Donetsk, Ukraine),
Kuznetsova Irina Vadimovna, Doctor of medical sciences, professor, sub-department of anesthesiology, intensive care and emergency medicine, Donetsk National Medical University after M. Gorky (16 Ilyicha avenue, Donetsk, Ukraine), firstname.lastname@example.org
Potapov Vladimir Vladimirovich, Resident, sub-department of anesthesiology, intensive care and emergency medicine, Donetsk National Medical University after M. Gorky (16 Ilyicha avenue, Donetsk, Ukraine), email@example.com
Zenin Oleg Konstantinovich, Doctor of medical sciences, professor, sub-department of human anatomy, Penza State University (40 Krasnaya street, Penza, Russia), firstname.lastname@example.org
Background. In recent years, the incidence of acute kidney injury (AKI) has increased, accounting for more than 35 % of patients in intensive care units (ICU). Mortality in this pathology remains high and exceeds 50 %. Reduction of renal blood flow is the main mechanism for the formation of AKI. Peculiarities of intrarenal hemodynamics disorders can determine the individual intensive care and improve the outcomes in AKI patients. The aim of our study was to reveal the peculiarities of disturbed renal blood flow, depending on the underlying cause, variant, stage and severity of AKI.
Materials and methods. A prospective nonrandomized study. Inclusion criteria: patients with prerenal, renal and subrenal AKI in the stage of oligoanuria and restoration of diuresis; Exclusion criteria: AKI patients after cardiac surgery and operations on the large vessels. 250 ICU patients with prerenal (130), renal (81) and subrenal (39) AKI were examined by ultrasound dopplerography.
Results. Comparative data of intrarenal blood flow dopplerographic examination in patients with various variants of AKI are presented. All patients initially, at admission in ICU revealed disorders of renal hemodynamics, the severity of which was different depending on the AKI module. During intensive care, as diuresis was restored, the parameters of renal blood flow improved. The speed and completeness of hemodynamics recovery was determined by both the modulus and severity of AKI. The heterogeneity of the prerenal module of AKI was determined due the data of renal blood flow and the rate of restoration of diuresis. So, we divided prerenal module in 2 groups: 1) verily prerenal AKI and 2) AKI prerenal for reason. It was established that resistive index (RI) in the main trunk of the renal artery is an early criterion of severity of AKI (F), and its dynamics during intensive care makes it possible to diagnose the transformation of AKI in chronic kidney disease. Strong direct correlation RI with the duration of oligoanuria (r = 0.72), which is the main retrospective marker of the severity of AKI, was revealed yet upon admission to the ICU. It was found that the peculiarities of renal hemodynamics disturbance are an important criterion for differential diagnosis of the AKI module: renal dopplerometry data significantly (p < 0.05) differ in prerenal, renal and subrenal AKI.
Conclusions. The revealed peculiarities of intrarenal hemodynamics disorders in AKI patients of different origin can determine the individual intensive care in these patients.
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