Possibilities of renoprotection in the syndrome of endogenous intoxication of purulent-septic genesis in the period of development of secondary toxic autoagression
DOI:
https://doi.org/10.14739/2310-1210.2018.4.135785Keywords:
endogenous intoxication syndrome, water-electrolyte balance, volumoregulation, kidneysAbstract
The purpose of the work is to investigate the range of renoprotection, in particular osmotic and volumoregulatory functions, with combined application of sorbitol and L-arginine in patients with endogenous intoxication syndrome of purulent-septic genesis in the period of development of secondary toxic autoagression.
Materials and methods. The indices of volumо-, and osmoregulatory functions of the kidneys in three groups of patients were investigated. The first group (control) included 31 patients with systemic inflammatory response syndrome (SIRS). The second group consisted of 27 patients with endogenous intoxication syndrome (EIS) who received standard therapy. The third group consisted of 29 patients with EIS, which on the basis of standard therapy were administered sorbilact. The fourth group included 30 patients with EIS, which on the basis of standard treatment were administered a combination of sorbilact and L-arginine. Infusion of sorbilact for patients of Groups III and IV was carried out at a rate of 6-7 ml/kg bodyweight intravenously at a rate of 7-8 ml/min. After the end of infusion of sorbilact, patients in group IV were infused with 4.2% solution of L-arginine (Tivortin® intravenously according to the instructions). The results of application of the drug in the period of development of secondary toxic autoaggression are presented.
Results A decrease in the velocity of glomerular filtration (GFR) was established as 66 ± 2.1 ml/min in patients of group II. The use of sorbitol on the first day of the study in patients with EIS (Group III) increased the GFR and caused increased diuresis. This study establishes that the filtration fraction of sodium and cation excretion increase under the influence of sorbilact. Clearance of osmotically active substances (OAS) in patients with EIS is reduced by 30-35% of the control level (SIRS). Infusion of sorbilact in patients with EIS during the development of early toxic autoaggression while undergoing standard treatment was accompanied by a statistically significant increase in plasma osmolarity, and the filtration fraction of OAS (in relation to the second group). The combined use of sorbilact and L-arginine resulted in statistically significant increases in GFR and sodium clearance.
Conclusion. Under conditions of medium-severe EIS, sorbilact corrects the integrity of lost osmotic and volumiregulatory functions of the kidneys, but does not restore them to the control level, in particular the degree of oppression is determined respectively at the level of 37% and 22% (p˂0.05). The combination of sorbilact with L-arginine according to the corresponding indicators of clearance after the first session reduces the deficit of compensating volumuminescence (up to 28%, p˂0.05) and osmoregulatory (up to 15%, p˂0.05) renal functions. The obtained results are the basis for the introduction of the sorbilact-L-arginine complex into the program of intensive therapy for the purpose of renoprotection.
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