Acute renal injury induced by septic processes

Abstract

Introduction. AKI is a common complication of sepsis and carries an ominous prognosis. Mortality was reported higher in patients with septic AKI (74.5%) than in those whose renal failure did not result from sepsis (45.2%). AKI risk factors include age, severity of the disease, the presence of other chronic pathologies. Aim of the study. Analysis of cases of acute kidney damage caused by septic processes during 2016 in the following sections: septic surgery, general surgery, general therapy, urology, haemodialysis of the Republican Clinical Hospital. Materials and methods. 147 patients were included in the study, fulfilling the following inclusion criteria: indicators of the presence of septic and AKI processes. Results. The study group included 81 (55.1%) men, and 66 (44.9%) women, their average age being 60.1 ± 13.2 years. The average values of AKI indicators were the following: urea - 23.5 ± 12.5 mmol/l, creatinine - 343.9 ± 371.2 mmol/l. Deregulation of diuresis: anuria - 10.8%, oliguria - 6.1%, polyuria - 14.2%, lack of data or norm - 68.7%. In 24.48% of deceased patients during the morphopathological examination acute renal tubular necrosis was found, although some of them had creatinine volumes ranging from 86-147 mmol/l, these still being increased compared to the previous values. Localization of the primary septic outbreak was the following: 38.77% of the gastrointestinal system (pancreonerosis, thin and thick intestine necrosis, intraabdominal abscesses, purulent angiocolitis, cholecystitis, liver abscesses, massive liver necrosis, suppressed hydatid cyst, acute gangrenous appendicitis), urogenital system - 31.97% (pioneer, acute pyelonephritis, renal abscesses, acute purulent nephritis, cystitis, urethritis, prostatitis), skin and soft tissue damage - 12.24% (phlegm, abscess), respiratory system - 7.4% (bronchopneumonia), osteoarticular system - 6.8% (gangrene with bone and soft tissue damage, purulent coxarthrosis, osteomyelitis), cardiovascular system - 2.72% (pericarditis, endocarditis), septic pneumonia - 54.42% of the studied group. The respiratory system was affected as a secondary stage in sepsis. CID syndrome was present in 23.8% of the studied group, development and severity of CID correlating with mortality rates and MODS development in sepsis. Methods of treatment (detoxification): plasmapheresis - 11.56%, haemodialysis - 14.28%, haemofiltration - 3.4%, conservative treatment - 70.74%. Lethality rates were of 46%. Conclusions. Despite progress in pathophysiology, diagnostic procedures, and appropriate therapeutic interventions, sepsis-induced AKI still registers high mortality rates, the lethality being 46% of the patients included in the study. Creatinine is not capable of detecting precocious AKI induced by sepsis. A major obstacle for the effective treatment of sepsis-induced AKI is lack of early and effective diagnostic tools.