[Renal distress syndrome in surgery and uronephrology: concept, pathogenesis, basics of prevention and correction]. / Renal'nyi distress-sindrom v khirurgii i uronefrologii: ponyatie, patogenez, osnovy profilaktiki i korrektsii.

OBJECTIVE: Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction. MATERIAL AND METHODS: Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup). RESULTS: In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology. CONCLUSION: Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.

[Intensification of the organism detoxification ability under surgical endogenous intoxication]. / Povyshenie detoksikatsionnoi sposobnosti organizma pri khirurgicheskom éndotoksikoze.

The purpose of the study is to establish the effectiveness of remaxol in the correction of endogenous intoxication in patients with acute peritonitis. MATERIAL AND METHODS: The work is based on the results of clinical and laboratory studies. The clinic examined 55 patients with acute moderate peritonitis as complication of various diseases (acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis). Before surgical operation and in the early postoperative period we evaluated the severity of endogenous intoxication by the level of hydrophilic and hydrophobic toxic products. The content of molecular products of lipids peroxidation - oxidative stress, phospholipase activity were determined in the blood plasma. In the study group (n = 28) in the postoperative therapy additionally included remaxol (400 ml intravenous fluids). RESULTS: Research established that the occurrence of endogenous intoxication syndrome in patients with acute peritonitis associated with the activation of oxidative stress and phospholipases, high intensity of which is maintained even after elimination of the source of peritonitis with manifestation on the 1st day after surgery. Remaxol include leads to a significant reduction in the severity of intoxication syndrome in patients with acute peritonitis. Positive effect of the drug on the correction of endogenous intoxication is largely determined by its ability to significantly reduce oxidative stress and the activity of phospholipases, as the most important membrane destabilizing agents. The greatest detoxication effect of the drug is recorded when it is applied already at the preoperative stage of patients when its ability to reduce the activity of trigger agents of catabolic processes implemented to the greatest extent. CONCLUSION: In acute moderate peritonitis, remaxol use before surgery or in the early postoperative period in complex therapy leads to a significant correction of factors contributing to the development and preservation of the intensification of catabolic processes - one of the sources of endogenous intoxication.