Русский
The hemostasis system in patients with acute renal injury
DOI: https://dx.doi.org/10.18565/nephrology.2022.2.59-63
V.E. Ryazantsev, A.P. Vlasov, N.Yu. Stepanov
Department of Faculty Surgery with courses in topographic anatomy and operative surgery, urology and pediatric surgery, National Research Mordovia State Universityst, Saransk, Russia
The aim of the study was to evaluate the data of thromboelastography - indicators of coagulation hemostasis in urological patients against the background of acute renal injury. A detailed assessment of hemostatic parameters makes it possible to adjust therapy in intensive care units and reduce the mortality rate.
Material and methods. We examined 47 patients who had a serious condition and were treated in the intensive care unit of the GBUZ RM “Republican Clinical Hospital named after S. V. Katkov “, Saransk. Pain was investigated in 2 groups of patients: group 1 was diagnosed with Acute purulent pyelonephritis of a solitary kidney and anuria due to blockage of the ureter; group 2 had a diagnosis of Acute purulent pyelonephritis and infectious toxic shock. On the first day of observation, all patients underwent urine and blood analysis, thermometry, electrocardiography, the concentration of biochemical parameters in the venous blood was determined, the glomerular filtration rate, blood gas composition, and acid-base state were calculated. The patients underwent an ultrasound examination of the kidneys, urinary bladder, liver and gallbladder, pancreas, spleen and, if necessary, underwent survey, excretory, retrograde urography, computed tomography of the abdominal and retroperitoneal organs. Coagulation hemostasis was studied using the apparatus Thromboelastograph TEG 5000 Thrombelastograph (USA). We determined the main parameters of the coagulation, anticoagulation and fibrinolytic systems. The analysis of hemostasis components included: “LY 30,%” - the percentage of clot dissolution at 30 minutes from the start of the study; “CL 30,%” is a derived coagulation index (in percent) of several parameters, reflecting the coagulation potential of the patient’s blood as a whole; “R, min” - a time indicator (in minutes), reflecting the duration of the formation of the first fibrin fibers; “Α-angle, ̊” - the angle (in degrees), demonstrating the deviation of the beam from the 0X axis with the point of clot formation, characterizes the dynamics of fibrin formation and the level of fibrinogen; “MA, mm” is an indicator of the maximum amplitude, which is recorded before dissolution of the clot during fibrinolysis, reflecting the functional ability of platelets, the amount and quality of fibrinogen. Statistical processing of the obtained results was performed using the SPSS Statistica 16.0 program, the results were formatted in Microsoft Excel 2003 (Microsoft Corporation, USA) and Microsoft Word 2003 (Microsoft Corporation, USA).
Results. The results of the analyzes were evaluated separately and in combination with other analyzes. Significant changes were revealed in the 1st group of patients. The severity of the patients’ condition was aggravated by long-term difficult-to-correct gross hematuria after unblocking of the urinary tract, which was based on secondary fibrinolysis in 5 (10.6%) patients. In group 2, versatile changes were found, so in 16 (34%) cases, hypocoagulable changes due to primary and secondary fibrinolysis, as well as a low concentration of platelets. Hypercoagulable changes in this group were observed in 18 (38.3%) patients, of which 6 (12.7%) cases did not reveal any changes in the hemostatic system.
Discussion. Acute renal injury is a consequence of an underlying urological disorder. Significant functional and morphological changes in the kidneys are complicated by disorders in the hemostasis system. Detection and early correction of a variety of coagulation changes allows minimizing the severity of pathological disorders.
Conclusion. The use of a thromboelastograph in the assessment of hemostatic parameters (LY 30, CL 30, R, α-angle, MA) allows increasing the accuracy and information content, determining the prognosis and stating the severity of coagulation changes in patients. This is especially important in patients with an extremely serious condition caused by urological pathology, where the prognosis and mortality rate are explained not only by general changes, but also by damage to the renal tissue caused by urological pathology. A detailed analysis of the obtained thromboelastographic data allows for early correction of the revealed changes.
Material and methods. We examined 47 patients who had a serious condition and were treated in the intensive care unit of the GBUZ RM “Republican Clinical Hospital named after S. V. Katkov “, Saransk. Pain was investigated in 2 groups of patients: group 1 was diagnosed with Acute purulent pyelonephritis of a solitary kidney and anuria due to blockage of the ureter; group 2 had a diagnosis of Acute purulent pyelonephritis and infectious toxic shock. On the first day of observation, all patients underwent urine and blood analysis, thermometry, electrocardiography, the concentration of biochemical parameters in the venous blood was determined, the glomerular filtration rate, blood gas composition, and acid-base state were calculated. The patients underwent an ultrasound examination of the kidneys, urinary bladder, liver and gallbladder, pancreas, spleen and, if necessary, underwent survey, excretory, retrograde urography, computed tomography of the abdominal and retroperitoneal organs. Coagulation hemostasis was studied using the apparatus Thromboelastograph TEG 5000 Thrombelastograph (USA). We determined the main parameters of the coagulation, anticoagulation and fibrinolytic systems. The analysis of hemostasis components included: “LY 30,%” - the percentage of clot dissolution at 30 minutes from the start of the study; “CL 30,%” is a derived coagulation index (in percent) of several parameters, reflecting the coagulation potential of the patient’s blood as a whole; “R, min” - a time indicator (in minutes), reflecting the duration of the formation of the first fibrin fibers; “Α-angle, ̊” - the angle (in degrees), demonstrating the deviation of the beam from the 0X axis with the point of clot formation, characterizes the dynamics of fibrin formation and the level of fibrinogen; “MA, mm” is an indicator of the maximum amplitude, which is recorded before dissolution of the clot during fibrinolysis, reflecting the functional ability of platelets, the amount and quality of fibrinogen. Statistical processing of the obtained results was performed using the SPSS Statistica 16.0 program, the results were formatted in Microsoft Excel 2003 (Microsoft Corporation, USA) and Microsoft Word 2003 (Microsoft Corporation, USA).
Results. The results of the analyzes were evaluated separately and in combination with other analyzes. Significant changes were revealed in the 1st group of patients. The severity of the patients’ condition was aggravated by long-term difficult-to-correct gross hematuria after unblocking of the urinary tract, which was based on secondary fibrinolysis in 5 (10.6%) patients. In group 2, versatile changes were found, so in 16 (34%) cases, hypocoagulable changes due to primary and secondary fibrinolysis, as well as a low concentration of platelets. Hypercoagulable changes in this group were observed in 18 (38.3%) patients, of which 6 (12.7%) cases did not reveal any changes in the hemostatic system.
Discussion. Acute renal injury is a consequence of an underlying urological disorder. Significant functional and morphological changes in the kidneys are complicated by disorders in the hemostasis system. Detection and early correction of a variety of coagulation changes allows minimizing the severity of pathological disorders.
Conclusion. The use of a thromboelastograph in the assessment of hemostatic parameters (LY 30, CL 30, R, α-angle, MA) allows increasing the accuracy and information content, determining the prognosis and stating the severity of coagulation changes in patients. This is especially important in patients with an extremely serious condition caused by urological pathology, where the prognosis and mortality rate are explained not only by general changes, but also by damage to the renal tissue caused by urological pathology. A detailed analysis of the obtained thromboelastographic data allows for early correction of the revealed changes.
About the Autors
Vladimir E. Ryazantsev– candidate of medical sciences, associate professor of the department of faculty surgery, National Research Mordovia State University, Saransk, Russia; e-mail: bobsonj@mail.ru.
ORCID: http://orcid.org/0000-0003-1431-0854.
Aleksey P. Vlasov– doctor of medical sciences, head of the department of faculty surgery, National Research Mordovia State University, Saransk, Russia; e-mail: vap61@mail.ru. ORCID: http://orcid.org/0000-0003-4731-2952., Russia.
Nikita Yu. Stepanov– postgraduate student of the department of faculty surgery, National Research Mordovia State University, Saransk, Russia; e-mail: jedi777jedi@mail.ru. ORCID: https://orcid.org/0000-0002-8293-9753.
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