Журнал нефрологии и терапии

Introduction: The AKI appears in 5-25% of patients in ICU, of which 6% will require RRT. If the AKI is associated with MODS mortality will be 50% and if RRT is required this will be 80%. Sepsis and Acute tubular perfusion are causes of AKI. The CRRT is an option for hemodynamically unstable patients and those who cannot handle the volume or metabolic disorders. The hemodialysis (HD) in critical patients is a common practice; however, the use of continuous therapy with hemodiafiltration modality requires special characteristics. Objective: To describe the experience using PRISMA monitor in our center. Material & Methods: Retrospective, descriptive, observational study. All patients were given CRRT with PRISMA at our center from March 2013 to November 2014. Data analysis was performed using Excel and SPSS programs. There is no conflict of interest and was conducted according to the ethics committee of our hospital. Results: CRRT was applied in an active way to 18 patients, 15 males (83%) and 3 females (17%), the average age was 43.9 years (Min. 17 Max. 78). 14 presented AKIN III, 4 where known with CKD. The most common cause of AKI was septic shock (83.3%). The oliguric AKI was the most common form of presentation in 86% of the patients. The average days of stay in ICU was 17.5 (SD 16.5). The average days of arrival and development of AKI is 2.6 days (SD 2.9). APACHE II and SOFA admission average was 30.5 (SD 6.5) and 13.6 (of 3.9) respectively. It was possible to stop CRRT in 5 of 18 patients (27.7 %), 2 patients continued with HD. There was a patient with combined therapy PRISMAMARS. Only 3 out of 18 patients (20%) survived the hospital stay. In the comparative analysis of the groups: Survivors versus non survivors, there were no statistically significant differences in the SOFA and APACHE II scores or in the days of stay in the ICU with IC of 95%. As for the prescription, blood flow measured in ml/min, extraction measured in ml/hr, the dialysate, the reinjection and total UF, showed no statistically significant differences with IC of 95%. Discussion & Conclusions: According to the results, our experience is similar to that reported in the literature with high mortality in patients with AKI and MODS, despite improvement in renal function. With the methodology used and the present number of patients, it´s not possible to point out a good or bad prediction factor on the clinical characteristics of the patients or the therapeutic prescription.

? ????????? ??????????????? ????????????????? ??????? (????) ??????? ???-???????? ?????????, ? ?????????????? ????? (??) ? ???-????????????? ????????? ????? ?????????. ?? ??????? ???????????????, ???????????, ???????????? ? ??????????????? ?????? ???? ???-?????????????? ?????????, ??????? ????? ???? ????????? ?? ? ?????? ? 2009 ???? (?????? ?? ? ?????????? ? ???-??????????????? ????????) ?? ??? 2014 ????. ?????????? ??????? ??????????? ?? ???? ????????????? ??????? ??, ??? ??????????? ?? ? ???-?????????????? ?????????. ???????? ???? ????????????????? ? ???????????? ? ????????????? ? ?????????? ??????????????, ??????? ???????? ??????????? ????, ?????????????? ????? ??? ??? ? ?????? ? ?????????? ?????????? CD4 ≥200 ??????/??? ?? ????????? 6 ???????. ???????????? ?? ???? ????????? ? ??????, 3 ?? ? ??????. ??????? ??????? ????????? ?? ?????? ?????????????? ???????? 49,9±11,7 ???. ???-?????? ??? ???????? ? ??????? 12±5 ???. ?????? ????????? ????? ???? ? ???????, ? ??? ???????? ???????? ????????????? ?? ??????? ???????. ?????????? ????????? (64,7%) ???????? ???????????? ??????? ??????????????, ? ? ???? ????????? ???? ?????? ?????? ?????????????. ? 2 ????????? ???? ??????????????? ??????????? ??????????, ? ? 3 ????????? — ????????? ??????????. ???? ????????? ??????, ? ??? ? ?????? ???????? ???? ?????? ?????? ?????????????. KT ???????? ?????????, ?? ???????, ?????????????? ???????? ???????? ? ????????? ????????? ? ???. ???? ? ???, ? ???? ? ??????? ???? ???????? ?????, ????? ??????????? ?????????????? ? ????? ?????????????? ???????? ??????? ? ??????? cART, KT ????? ???? ?????????. ??? ?? ?????, ?????????? ????????? ??????????? ????? ? ?????? ??? ??????? ????????.

?????????????? ?????? ???????? ??? ???????????? ?????? ??????????? ??????, ????? ??? ??????????? ????????????? ??????? ??????, ?????????????? ???????? ??????, ????????????, ???????? ??????????? ? ?????????, ??????? ????????? ???????????? ??????? ?? ???????? ?????????? ??????? ? ????? ?????? ?? ??????? ??????? ????????? ? ????????? ??????. ??????????????, ??????????, ??? ????????? ? ??????? ??????? ????????? ?, ??????????????, ?????? ????????? ?????????? ????? ?????????????? ??????. ?????? ????????? ?????????? ???????, ??????????????? ? ?????? ????????-?????????? ?????????? ?? ???????? ????????????? ???????????? ???????? ????????. ??????? ????? ?????, ????? ????, ???????????? ????? ???????? ??????????? ??????????????? ??????. ????? ????????? ?????? ?????????? ????? ?????????????? ??????, ???????? ???????? ? ?????? ?????????????? ?????????. ??????, ???? ??????????? ??????????? ?????, ?????? ?? ?????? ???????? ????????? ????????? ???????, ? ?????? ????? ????????-?????????? ??????? ????? ???? ????????? ???????? ?? ????????? ? ??????????? ?????. ?????????? ? ??????? ??????????? ?????????????? ??????? ? ???????????? ????????????? ????? ????? ?????????????? ??????; ? ?????? ??????????????? ????? ?????? ???????? ??????????????? ?? ??????? ???? ???????? ??????????? ???????? ??????????????? ??? ???????????? ??????????. ???? ???????? ??????????????? ????? ?????????????? ?????? ??????? ?? ?????? ???????? ?????, ??????? ???????? ????????? ????? ???????? ? ??????? ???????????????, ???????? ??????? ???????????? ?????????????, ?????????? ????????? ?????????????? ????????? ??-?? ???????????? ??????????????? ??????????? ? ???????? ?????-????????? ????? ???????????????? ?? ???????????? ???????, ??????? ???????? ? ??????????? ????? ? ?????? ???????, ?????????? ?/??? ???????????????. ????? ????, ???????? ????????????????? ????????, ????????? ? ??????????????? ??????, ????? ???????? ?? ???????????? ????? ???????????????. ?????????????, ??????????? EVLP ????? ? ????????? ??????? ???????? ?? ???? ?????? ? ??????????? ??????????? ????? ????? ?????????????? ??????. ???????? ?? ???????? ??? ?????????, ?????? ?? ??????? ??????? ???????? ? ??????????????????? ??????????????? ????????????, ? ??????? ???????????? 52 ??????????? ?????????????? ?????? ? 13 ???????????????? EVLP ???????????? ??????? ????????????? ?????? ???????? ??????????????? ????? ??????????????. ?????????? ?? ???????? ???????????? ????????.

Objective: Pre-exposure of rats to normobaric hyperoxia (O2 ≥95%) may induce late pre-conditioning against renal ischemiareperfusion (IR) injury. In this study we investigated probable mechanisms of IR injury such as the role of reactive oxygen species (ROS), renal antioxidant agents, and heat shock proteins (HSP) 32 and 70 during delayed hyperoxia-pre-conditioning (HO). Methods: Fifty-two rats were divided into 7 groups: (A) IR, (B) HO + IR, (C) mercaptopropionyl glycine (MPG) + HO + IR, (D) MPG + IR, (E) HO + sham, (F) MPG + sham, and (G) sham. Rats in the following study groups (group B, C and E) were kept in a normobaric hyperoxic environment for 4 h/day for 6 consecutive days, after which they were subjected to 40 minutes of ischemia; animals in the control group (group A, D, F, and G) were kept in a normoxic cage. At the end of the preconditioning period, 24 hours of reperfusion was performed. Renal function was assessed by measuring serum creatinine (Cr), blood urea nitrogen (BUN), and creatinine clearance (CLCr). Induction of the antioxidant system was evaluated by measuring renal catalase (CAT) and superoxide dismutase (SOD) activities and glutathione (GSH) and malondialdehyde (MDA) content. The role of ROS was investigated by use of MPG (a ROS scavenger). HSP32 & 70 mRNA and protein also were determined. Results: The hyperoxia-preconditioned IR group (B) had a lower plasma Cr and BUN and greater CLCr compared with the IR group (A) (P≤0.016). Administration of MPG led to an increase in plasma Cr and BUN and a decrease in CLCr in group C compared with the hyperoxia-preconditioned group B (P≤0.004). The hyperoxia-preconditioned IR group had a greater CAT activity and GSH level compared with the IR group A (P≤0.007), whereas the administration of MPG did not change the GSH level but led to a decrease in CAT activity in group D compared with group B (P<0.001). SOD activity did not change in hyperoxia-preconditioned ischemic rats compared with ischemic rats. Hyperoxia preconditioning and MPG administration in ischemic animals did not result in any considerable change in MDA level compared with the IR group A. Also, there were no clinically relevant differences in HSP32 & 70 mRNA and protein between all groups. Conclusion: The present study demonstrates that repeated pre-exposure to hyperoxia can decrease subsequent renal IR damage in this rat model of renal ischemia. Free radical production after hyperoxia appears to play a pivotal role in the hyperoxia-induced renal protection independent of HSP level. Antioxidant enzyme activities and especially catalase seem to be implicated in this renal protective mechanism

???????????? PHAII ??????? ? ????????? ?????????? ?????? ?? ?????????? ????????????? ?????????? ???????? ?????????, ??????? ???????????? ??????????? ???????? ?????? ????. ??? ???????????, ????????????? ? ???????????? ?? ??????? ???????? ?????, ??????????????? ?????????????? ? ??????????? K+ ? ?????? ?? 9 ?????/?, ???????? ?? ?????????? ???????? ??????????? ??????????. ????????????? ???????? ? ???????, ?????? ?????????? ??????????, ????? ?????????? ????. ????? ?????????? ??????????????? ? ???????? ?????. ?????????? ??????????? ? 75% ?????????. ??????? ?????? ?????? ??????, ? ??????? ???????????? ?????? ?????? ?? ????????? ? ??????. ???? ???? ??? ??????????? ??????? ??????????????, ?????????? ?????? ??????????? ? ??????? ???????? 30 ???. ?????????? ??????? ? ?????????? ???????????? Na+ ? Cl- ????? Na+-Cl-????????????? (NCC) ? ?????????? ??????? ???????? (DCT). ???? PHAII ????? ???????? ????????, 36% ??????? ????????? de novo. ????????????? ? ????? ????????????? (a) ?????????? ???????? ???????? ???????? ???????? K+ (ROMK), ??? (b) ?????????? ??????????? ??????? (Cl-) (???? Cl-), ??? ??????? ??????? ???????????? ? ????? ???????? K+ ? ????? ?? Na+ ? ????????????? ??????? Na+ (ENaC), ??? (c) ?????????? ???????? Na+ ? ENaC ? ??????? ?????????? ???????, ??? ??????? ???????? K= ? ???? ?????. ? 2000 ???? ???????? ??????? ?????-??????????? ?????? ? ????, ??????? ??? ??????? WNK1, ?????? ??? ? ??? ???????????? ????? ? ??????? ?????????????? ????? (??? ?????? (=K)), ? ?????? ???? ?????????? WNK 2,3 ? 4. ? ???????? ??????? WNK 1 ? 4 (WNK 1 ? 4) ???????????? ? ?????????? ?????? ??????? ? ??????????? ????? ?????????????? ?????????? ?, ??? ???? ??????????, ???????? PHAII, ?? ??????? ?????????? NCC, ??? ???????? ???????? ?????????? WNK. ? ???????? ????? ???? ??????????, ??? ??????? WNK1 ? WNK4 ???????? 13% PHAII. ??????? ???? ?????????? ??? ???? ???????, ???????????? ?????????? ????????? ????????????, ?????????? cullin 3 ? kelch-like3, ? ????????? ?????? ????????????????? E3 ? ?????????? ?????? ???????, ? ?? ??????? (CUL3 ? KLHL3) ???????? 79% PHAII. ??????????? ??????? PHAII ? ??????? ????????: CUL3, ??????????? KLHL3, ??????????? KLHL3, WNK4 ? WNK1. CUL3 ? KLHL3 ????????? ????????????????? (???????? ??? ??????????) WNK4, ?????????? ???????? ???????? ?????????? ROMK ?, ????? ???????, ????? ??????? ?????????????, ??? ? ????????? (a) ????. ????????? WNK4 ????? ??????????? ??????????? Cl- ??????????????? ?????, ??? ???????????? (b) ????. ???? ?????????? ?????????? NCC ????? ?????????? ??????? ???????? Na+ ? ENaC, ??? ? (c) ????, ? ?????????? ????????? ???????? Na+ ? ENaC ????? ??????????, ? ???????????? ??????? ???????? ?????? ? ??????????? ?????? ? ??????????? ????????? Na+ ? ENaC ?? ?????? ?????????? ???? ????????????? ?????????? ???????????????? ?????, ??? ????????? ???????? ? ?????? (c) ????. ??????? ???????? ???????? ??????????? ????????? ??????? PHAII, ????????? ??? ?????????? NCC. ??? ???????? ?????? ??????????? ??? ?????????? ?????????????, ??? ????? ??????? ????????????? ?????????????????? ???????, ? ??? ?????? ?????????? ???????? K+. ????? ???????,dDAVP ?????? ????????? ????????????? PHAII, ? ??? ??????? ??????????? ??? ??????? ????? ?????????. ??????????? Na+ ??????? ????????? ? ?????????????, ????????? ? ????????? ????????????? ???? ????????, ??? ??? ??????????? ??????? K+ ? ??????, ? ?? ????? ??? ? ?????? ????????????? ??? ??? ??????? ??? ?? ????????? ???????? ???????. ???? ??? ??? ??????????, ??????????? K+ ? ????? ????? ???? ???????????.