sibmedСибирский научный медицинский журналСибирский научный медицинский журнал2410-25122410-2520ИЦиГ СО РАН10.18699/SSMJ20230308sibmed-1109Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEМожно ли говорить о закономерностях острой почечной дисфункции после реконструктивных вмешательств по поводу периферического атеросклероза?Can the patterns of acute renal dysfunction after reconstructive interventions for peripheral atherosclerosis be considered expectable?https://orcid.org/0000-0001-8146-4728ГлушковН. И.GlushkovN. I.

Глушков Николай Иванович, д.м.н., проф.

195067, г. Санкт-Петербург, Пискаревский пр., 47

Nikolay I. Glushkov, doctor of medical sciences, professor

195067, Saint-Petersburg, Piskarevsky ave., 47

nikolay.glushkov@szgmu.ruhttps://orcid.org/0000-0001-8024-6825КостылевИ. А.KostyleI. A.

Костылев Игорь Александрович

195067, г. Санкт-Петербург, Пискаревский пр., 47

Igor A. Kostylev

195067, Saint-Petersburg, Piskarevsky ave., 47

https://orcid.org/0000-0003-2780-9726НайденовМ. Д.NaidenovaM. D.

Найденова Мария Дмитриевна

195067, г. Санкт-Петербург, Пискаревский пр., 47

Maria D. Naidenova

195067, Saint-Petersburg, Piskarevsky ave., 47

mari.naydenova.96@mail.ruhttps://orcid.org/0000-0003-2055-2446БородичА. А.BorodichA. A.

Бородич Александр Андреевич

195067, г. Санкт-Петербург, Пискаревский пр., 47

Aleksandr A. Borodich

195067, Saint-Petersburg, Piskarevsky ave., 47

aborodich2705@gmail.comhttps://orcid.org/0000-0003-3495-3590ТройноМ. А.TroynoM. A.

Тройно Мария Алексеевна

195067, г. Санкт-Петербург, Пискаревский пр., 47

Maria A. Troyno

195067, Saint-Petersburg, Piskarevsky ave., 47

missmashyla2702@mail.ruhttps://orcid.org/0000-0002-7549-0927НовикА. В.NovikA. V.

Новик Анна Валерьевна

195067, г. Санкт-Петербург, Пискаревский пр., 47

Anna V. Novik

195067, Saint-Petersburg, Piskarevsky ave., 47

novikanya12@gmail.comhttps://orcid.org/0000-0003-0733-759XБахтигарееваЛ. С.BakhtigareevaL. S.

Бахтигареева Лия Салаватовна

195067, г. Санкт-Петербург, Пискаревский пр., 47

Lia S. Bakhtigareeva

195067, Saint-Petersburg, Piskarevsky ave., 47

liya13072205@gmail.comhttps://orcid.org/0000-0002-4756-6488ИвановМ. А.IvanovM. A.

Иванов Михаил Анатольевич, д.м.н., проф.

195067, г. Санкт-Петербург, Пискаревский пр., 47

Mikhael A. Ivanov, doctor of medical sciences, professor

195067, Saint-Petersburg, Piskarevsky ave., 47

iv30407302007@yandex.ruСеверо-Западный государственный медицинский университет имени И.И. Мечникова Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. Mechnikov of Minzdrav of RussiaRussian FederationСеверо-Западный государственный медицинский университет имени И.И. Мечникова Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. Mechnikov of Minzdrav of RussiaRussian Federation2023230620234336974Copyright © Глушков Н.И., Костылев И.А., Найденов М.Д., Бородич А.А., Тройно М.А., Новик А.В., Бахтигареева Л.С., Иванов М.А., 20232023Глушков Н.И., Костылев И.А., Найденов М.Д., Бородич А.А., Тройно М.А., Новик А.В., Бахтигареева Л.С., Иванов М.А.Glushkov N.I., Kostyle I.A., Naidenova M.D., Borodich A.A., Troyno M.A., Novik A.V., Bakhtigareeva L.S., Ivanov M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://sibmed.elpub.ru/jour/article/view/1109

Выполнено оригинальное исследование и выявлены факторы риска, предрасполагающие к развитию острой почечной дисфункции (ОПД), установлены частота и последствия ОПД после реваскуляризирующих операций на нижних конечностях, а также изучены и обобщены данные научных статей по данной тематике. Цель исследования – изучить обстоятельства риска развития ОПД у больных, перенесших реваскуляризацию в связи с периферической артериальной болезнью.Материал и методы. Проспективно изучены признаки развития ОПД у 101 пациента, оперированного на аорто-подвздошном сегменте по поводу периферического атеросклероза, в том числе аневризматической болезни. Проявления ОПД, регистрировавшейся по рекомендациям RIFLE, отмечены у 40 больных. Анализировались показатели гемодинамики, уровень креатинина, диурез, сопутствующие заболевания, течение послеоперационного периода.Результаты и их обсуждение. Достоверно чаще ОПД встречалась у лиц с сахарным диабетом, сердечной патологией и проявлениями генерализованного атеросклероза, а также после выполнения экстренных вмешательств. Особенно высока вероятность ОПД на фоне гемодинамической нестабильности и кровопотери более 1000 мл, в том числе с проявлениями централизации кровообращения.Заключение. Решающее влияние на развитие ОПД после операций на аорто-подвздошном сегменте оказывает массивная кровопотеря с проявлениями нестабильности гемодинамики, а также кардиальные нарушения.

An original study was conducted and risk factors predisposing to the development of acute renal dysfunction (ARD) were identified, the frequency and consequences of ARD after revascularization operations on the lower extremities were established, and data from scientific articles on this topic were studied and summarized. The aim of the study was to investigate the circumstances of the risk of ARD in patients who underwent revascularization due to peripheral arterial disease.Material and methods. The signs of ARD development were prospectively studied in 101 patients operated on the aorto-iliac segment for peripheral atherosclerosis, including aneurysmal disease. Manifestations of ARD registered according to RIFLE recommendations were observed in 40 patients. Hemodynamic parameters, creatinine levels, diuresis, concomitant diseases, and the course of the postoperative period were analyzed.Results. The incidence of ARD was significantly higher in persons with diabetes mellitus, cardiac pathology and manifestations of generalized atherosclerosis, as well as after emergency interventions. The probability of ARD is especially high against the background of hemodynamic instability and blood loss of more than 1000 ml, including with manifestations of centralization of blood circulation.Conclusions. Massive blood loss with manifestations of hemodynamic instability, as well as cardiac disorders, has a decisive influence on the development of ARD after operations on the aorto-iliac segment.

острая почечная дисфункцияреваскуляризация нижних конечностейпочечная недостаточностьacute renal dysfunctionrevascularization of the lower extremitiesrenal failureReferencesHobson C., Lysak N., Huber M., Scali S., Bihorac A. Epidemiology, outcomes, and management of acute kidney injury in the vascular surgery patient. J. Vasc. Surg. 2018;68(3):916–928. doi: 10.1016/j.jvs.2018.05.017Hobson C., Lysak N., Huber M., Scali S., Bihorac A. Epidemiology, outcomes, and management of acute kidney injury in the vascular surgery patient. J. Vasc. Surg. 2018;68(3):916–928. doi: 10.1016/j.jvs.2018.05.017Ivanov M.A., Kasimova A.M., Chizhova K.A. Prevention of kidney damage during operations for peripheral atherosclerosis. Preventive medicine-2020: proc. conf., Saint-Petersburg, November 18–19, 2020. Part 1. Saint-Petersburg: Publishing House of I.I. Mechnikov NWSMU, 2020. P. 163–168. [In Russian].Ivanov M.A., Kasimova A.M., Chizhova K.A. Prevention of kidney damage during operations for peripheral atherosclerosis. Preventive medicine-2020: proc. conf., Saint-Petersburg, November 18–19, 2020. Part 1. Saint-Petersburg: Publishing House of I.I. Mechnikov NWSMU, 2020. P. 163–168. [In Russian].Safley D.M., Salisbury A.C., Tsai T.T., Secemsky E.A., Kennedy K.F., Rogers R.K., Latif F., Shammas N.W., Garcia L., Cavender M.A., … Spertus J.A. Acute kidney injury following in-patient lower extremity vascular intervention: from the National Cardiovascular Data Registry. JACC Cardiovasc. Interv. 2021;14(3): 333–341. doi: 10.1016/j.jcin.2020.10.028Safley D.M., Salisbury A.C., Tsai T.T., Secemsky E.A., Kennedy K.F., Rogers R.K., Latif F., Shammas N.W., Garcia L., Cavender M.A., … Spertus J.A. Acute kidney injury following in-patient lower extremity vascular intervention: from the National Cardiovascular Data Registry. JACC Cardiovasc. Interv. 2021;14(3): 333–341. doi: 10.1016/j.jcin.2020.10.028Lieberthal W., Nigam S.K. Acute renal failure. II. Experimental models of acute renal failure: imperfect but indispensable. Am. J. Physiol. Renal. Physiol. 2018;278(1):F1-F12. doi: 10.1152/ajprenal.2000.278.1.F1Lieberthal W., Nigam S.K. Acute renal failure. II. Experimental models of acute renal failure: imperfect but indispensable. Am. J. Physiol. Renal. Physiol. 2018;278(1):F1-F12. doi: 10.1152/ajprenal.2000.278.1.F1Pathak S., Olivieri G., Mohamed W., Abbasciano R., Roman M., Tomassini S., Lai F., Wozniak M., Murphy G.J. Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis. Br. J. Anaesth. 2021;126(1):131–138. doi: 10.1016/j.bja.2020.06.064Pathak S., Olivieri G., Mohamed W., Abbasciano R., Roman M., Tomassini S., Lai F., Wozniak M., Murphy G.J. Pharmacological interventions for the prevention of renal injury in surgical patients: a systematic literature review and meta-analysis. Br. J. Anaesth. 2021;126(1):131–138. doi: 10.1016/j.bja.2020.06.064Er R.E., Okyay G.U., Kmaz G.A.B., Lu M.T., Erten Y. Comparison between RIFLE, AKIN, and KDIGO: acute kidney injury definition criteria for prediction of in-hospital mortality in critically ill patients. Iran. J. Kidney Dis. 2020;14(5):365–372.Er R.E., Okyay G.U., Kmaz G.A.B., Lu M.T., Erten Y. Comparison between RIFLE, AKIN, and KDIGO: acute kidney injury definition criteria for prediction of in-hospital mortality in critically ill patients. Iran. J. Kidney Dis. 2020;14(5):365–372.Sarnak M.J., Amann K., Bangalore S., Cavalcante J.L., Charytan D.M., Craig J.C., Gill J.S., Hlatky M.A., Jardine A.G., Landmesser U., … Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2019;74(14):1823–1838. doi: 10.1016/j.jacc.2019.08.1017Sarnak M.J., Amann K., Bangalore S., Cavalcante J.L., Charytan D.M., Craig J.C., Gill J.S., Hlatky M.A., Jardine A.G., Landmesser U., … Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 2019;74(14):1823–1838. doi: 10.1016/j.jacc.2019.08.1017Glushkov N.I., Ivanov M.A., Samko K.V., Puzdriak P.D., Bondarenko P.B., Zhdanovich K.V., Petrova K.A., Kolchinsky I.A., Ponikarova N.Yu. Abdominal aorta surgical intervention and acute renal injury. Vestnik khirurgii imeni Ivana Ivanovicha Grekova = Grekov’s Bulletin of Surgery. 2020;179(2):20–25. [In Russian]. doi: 10.24884/0042-4625-2020-179-2-20-25Glushkov N.I., Ivanov M.A., Samko K.V., Puzdriak P.D., Bondarenko P.B., Zhdanovich K.V., Petrova K.A., Kolchinsky I.A., Ponikarova N.Yu. Abdominal aorta surgical intervention and acute renal injury. Vestnik khirurgii imeni Ivana Ivanovicha Grekova = Grekov’s Bulletin of Surgery. 2020;179(2):20–25. [In Russian]. doi: 10.24884/0042-4625-2020-179-2-20-25Gameiro J., Fonseca J.A., Outerelo C., Lopes J.A. Acute kidney injury: from diagnosis to prevention and treatment strategies. J. Clin. Med. 2020;9(6):1704. doi: 10.3390/jcm9061704Gameiro J., Fonseca J.A., Outerelo C., Lopes J.A. Acute kidney injury: from diagnosis to prevention and treatment strategies. J. Clin. Med. 2020;9(6):1704. doi: 10.3390/jcm9061704Romagnoli S., Ricci Z., Ronco C. Perioperative acute kidney injury: prevention, early recognition, and supportive measures. Nephron. 2018;140(2):105–110. doi: 10.1159/000490500Romagnoli S., Ricci Z., Ronco C. Perioperative acute kidney injury: prevention, early recognition, and supportive measures. Nephron. 2018;140(2):105–110. doi: 10.1159/000490500Nonaka T., Kimura N., Hori D., Sasabuchi Y., Nakano M., Yuri K., Sanui M., Matsumoto H., Yamaguchi A. Predictors of acute kidney injury following elective open and endovascular aortic repair for abdominal aortic aneurysm. Ann. Vasc. Dis. 2018;11(3):298–305. doi: 10.3400/avd.oa.18-00029Nonaka T., Kimura N., Hori D., Sasabuchi Y., Nakano M., Yuri K., Sanui M., Matsumoto H., Yamaguchi A. Predictors of acute kidney injury following elective open and endovascular aortic repair for abdominal aortic aneurysm. Ann. Vasc. Dis. 2018;11(3):298–305. doi: 10.3400/avd.oa.18-00029Tsilimigras D.I., Sigala F., Karaolanis G., Ntanasis-Stathopoulos I., Spartalis E., Spartalis M., Patelis N., Papalampros A., Long C., Moris D. Cytokines as biomarkers of inflammatory response after open versus endovascular repair of abdominal aortic aneurysms: a systematic review. Acta Pharmacol. Sin. 2018;39(7):1164–1175. doi: 10.1038/aps.2017.212Tsilimigras D.I., Sigala F., Karaolanis G., Ntanasis-Stathopoulos I., Spartalis E., Spartalis M., Patelis N., Papalampros A., Long C., Moris D. Cytokines as biomarkers of inflammatory response after open versus endovascular repair of abdominal aortic aneurysms: a systematic review. Acta Pharmacol. Sin. 2018;39(7):1164–1175. doi: 10.1038/aps.2017.212Smidfelt K., Nordanstig J., Wingren U., Bergström G., Langenskiöld M. Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score-matched study. SAGE Open Med. 2019;7:2050312119833501. doi: 10.1177/2050312119833501Smidfelt K., Nordanstig J., Wingren U., Bergström G., Langenskiöld M. Routine open abdomen treatment compared with on-demand open abdomen or direct closure following open repair of ruptured abdominal aortic aneurysms: A propensity score-matched study. SAGE Open Med. 2019;7:2050312119833501. doi: 10.1177/2050312119833501

The authors declare that there are no conflicts of interest present.