[Cardiorenal syndrome in urological practice].

A lecture on the pathogenesis and treatment of cardiorenal syndrome, which is a combination of various variants of renal and heart failure, is presented in the article. Currently, there are five types of this syndrome. All of them are discussed in detail from the view of relevance for urological practice. In patients of the urological profile, II type, to a lesser extent III and V types of cardiorenal syndrome are most common. Moreover, type II, which is the simultaneous coexistence of chronic heart failure and chronic renal failure due to different (unrelated causal relationships) conditions, can significantly influence on the choice of surgical tactics. This question requires further research. Type III of cardiorenal syndrome, which is a cardiac complication of a prolonged acute phase of acute renal failure, in most cases can be prevented through drug treatment and timely renal replacement therapy. Type V cardiorenal syndrome, which represents a combined damage to the heart and kidneys within the same condition, apparently, occurs in urological practice in the most severe patients with metabolic syndrome, which allows to combine uric acid stones and other variants of gouty nephropathy into one nosology, naturally leading to progressive renal failure, ischemic heart disease and chronic heart failure. In the section on treatment tactics, it is mentioned that there are no standard approaches to the treatment of cardiorenal syndrome in the literature. The restrictions in the choice and dosing regimen of cardiotropic drugs due to renal failure are considered in detail. The importance of timely hemodialysis is especially emphasized. In conclusion, the authors suggest that the development of cardiorenal syndrome is due to the effect of potentiation with a significantly higher rate of progression of both renal and heart failure compared to isolated forms of both conditions.

[Characteristics of pathogenesis and manifestations of nephrolithiasis in patients with chronic cardiovascular diseases].

AIM: To study the pathogenetic and clinical features of nephrolithiasis in patients with concomitant chronic cardiovascular diseases (CVD), particularly the chemical composition of renal stones, the frequency of relapses, as well as the daily dynamics of the urine specific gravity and acidity level as the main factors of stone formation. MATERIALS AND METHODS: A total of 270 patients were treated in the Department of the urology No. 1 of the "Main Military Clinical Hospital named after N. N. Burdenko" of the Ministry of Defense of the Russian Federation during the period from 2008 to 2018. The main group included 184 patients suffering from nephrolithiasis, of which 72 had hypertension in combination with coronary heart disease, and in other 112 patients chronic heart failure (CHF of stage I, IIA and IIB in 55, 37 and 20 patients, respectively) was previously diagnosed. Data on the CVD were obtained from medical records; if necessary, patients were referred to an internist and/or cardiologist. The CHF was staged in accordance with the Strazhesco-Vasilenko (1935) classification. In the control group there were 86 patients with urolithiasis without any cardiovascular disorders. A retrospective analysis of the stone composition was performed using a NICOLET iS10 spectral analyzer. The urine specific gravity and acidity (pH) was determined using a semi-automatic analyzer CLINITEK Status Plus three times a day (both during hospital stay and 3 months after discharge). Statistical analysis was done using the SPSS program v.19. The absolute values (M+/-m) were calculated, as well as Min, ME, Mo, Max. Relative values, including Fischer criterion, were evaluated, taking into account the Bonferroni correction. Differences were significant if p-value was < 0.05. RESULTS: There was no difference between groups in age (32; 64; 83). In both groups men were predominated (~ 75-78%). According to chemical analysis, stone composition in the control group was as following: oxalates (76.6%), uric acid (9.3%), phosphates (8.1%); mixed stones (6.7%). Independent of stage of CHF, respective figures were 51.4, 23.6, 8.3 and 16%, respectively. The follow-up of patients for 5 years showed that patients were admitted to the urological hospital with a stone recurrence on average 1.8 times, compared to 3 and 3.8 times with concomitant CVD and CHF, respectively. The most concentrated (specific gravity of 1035) and the most acidic (pH =5.5-5) urine in patients with CHF was found in the evening. CONCLUSION: Chronic CVD has a significant impact on the clinical manifestations of urinary stone disease. The most pronounced changes are associated with CHF. Features of nephrolithiasis in patients with a CVD include the predominance of uric acid and urate stones, more frequent recurrences, shift in the peak of acidity and urine specific gravity from morning to evening hours.