A method of treating acute renal failure in the initial period

 

(57) Abstract:

The invention relates to medicine, namely to Nephrology. Treatment of acute renal failure include infusion therapy. Additionally, in the initial period of acute renal failure have single-needle non-apparatus membrane plazmaferez with intravenous supplementation donor fresh-frozen plasma in a dose of 400-500 ml, 10% solution of albumin at a dose of 200-300 ml and 200000-300000 kontiola rate 2-3 sessions, 1 per day. The method allows to eliminate side effects and shorten the treatment of acute renal failure. table 2.

The invention relates to medicine, namely to Nephrology.

There is a method of treatment of acute renal failure (ARF) in the initial period (A. Y. Nikolaev, Y. S. Milovanov, Medical information Agency, Moscow, 1999, S. 64-66), namely, that in the initial period of the surge arrester is infusion therapy to stabilize hemodynamics, and then assign saluretic (furosemide intravenous 200-400 mg every 3 h) dopamine intravenous dose of 3 mcg/kg/min for a period of 6-24 hours If it is impossible to completely eliminate acute tubular necrosis (window) conduct the test with mannitol: for the lead with another 50 ml for 3 minutes If the urine output greater than 50 ml/h, transferred to the infusion of a 10% aqueous solution of mannitol, maintaining urine output at 100 ml/h

Disadvantages: measures for the stabilization of hemodynamics using infusion therapy therapy aimed at the investigation, but not the cause.

There is no possibility to accurately predict the boxes based on what a load test with mannitol and use of high, super high doses saluretic furosemide are dangerous. Can be side effects in the form of the development of acute pulmonary edema, toxic damage to the auditory nerve.

The technical result of the invention is the elimination of side effects and shorter treatment of ARF.

The technical result is achieved by the fact that in the initial period of ARF on infusion therapy is used needle non-apparatus membrane plasmapheresis with filling donor fresh frozen plasma (FFP) at a dose of 400-500 ml, 10% solution of albumin at a dose of 200-300 ml and 200000-300000 IU kontrikala. Treatment accounts for 23 plasmapheresis, 1 times a day. The above therapy in the initial period of the surge arrester is pathogenetically justified, because in this period of the disease leading powerdays the enable quick and effective pain DIC, in the end, to prevent the development of resources and to achieve a speedy recovery.

As follows from table 1, all patients ARF minute diuresis source was (0,09±0,02) ml/min at 24 h after treatment with plasmapheresis there was a sharp increase of diuresis (minute diuresis (1,04±0.03 in) ml/min). After 48 h after the regular session of plasmapheresis were further increased diuresis (minute diuresis (1,76±0,02) ml/min). After 72 h from the onset of the disease had developed persistent polyuria (minute diuresis (2,09±0.03 in) ml/min).

As follows from table 2, all patients ARF creatinine blood source was a 0.27±0.02 mmol/l at 24 h after treatment with plasmapheresis there was a slight decrease in creatinine blood (0,23±0.03 mmol/l). After 48 h after the regular session of plasmapheresis further decline of creatinine (0,16±0.02 mmol/l). After 72 h from the onset of the disease was ascertained disappearance azotemii (0,07±0.02 mmol/l).

Example. Patient L., 42 years old (case history No. 11457) was in the hospital with a clinical diagnosis of Thromboangiitis obliterans of the lower extremities of the fourth degree. 20.11.91, the patient under General anesthesia was performed preoperatively right sympathectomy is the operation erroneously transferred 500,0 ml inogroupna blood. It was noted a decrease in blood pressure, tachycardia, increased bleeding tissue with darkening blood, which was seen as the result of trauma surgery. In the next few hours after surgery was identified oliguria with the presence of urine color “tar”, what was the reason for consultation in the haemodialysis Department.

When inspecting the condition of the patient corresponds to the severity of the surgery. Sclera and skin jaundice. Peripheral lymph nodes are not even royalty. Vesicular breathing in lungs, 21-23 respiratory movements per minute. The rhythmic heart sounds, tachycardia. The pulse of 98 beats per minute a/D-140/90 mm RT. Art. the Abdomen is soft, painful in the right hypochondrium. The liver stands out from the edge of a costal arch on 3.0 cm, painful. Kidney, spleen not palpable. No edema. Diuresis - 70,0 ml urine dark brown.

Complete blood count: erythrocytes 3,01012/l; hemoglobin 100 g/l; leukocytes 12109/l; hematocrit 0,32; ESR - 35 mm/h

Urinalysis: 70,0 ml, dark-brown; protein - 3,3 g/l; erythrocytes cover all fields of view. Intravascular hemolysis 715 mg/ml Bilirubin total - 35,8 μm/l; free - 25,0 µm/l, associated to 10.8 μm/l Total protein blood is 59.5 g is creatinin blood - 0.2 mmol/l

The patient urgently conducted the session-needle non-apparatus membrane plasmapheresis (C. A. Voinov, doctor. - 1997, S. 99-107) delete 1.0 l of plasma and intravenous supplementation of 500.0 ml of fresh frozen plasma, of 300.0 ml of 10% aqueous solution of albumin and introduction kontrikala dose of 250000 UNITS.

On the following day the patient's condition has improved, diuresis recovered to 950,0 ml of urine, platelets - 200109l; fibrinogen - 3,9 g/l; APTT - 45, intravascular hemolysis 150 mg/ml, creatinine blood of 0.16 mmol/l, total blood protein 58 g/L. the Patient repeated the next session of plasmapheresis to remove 1.0 l of plasma and replacement of 500.0 ml of fresh frozen plasma, of 300.0 ml of 10% aqueous solution of albumin and the introduction of 200,000 IU kontrikala. Diuresis bravely recovered to 3,500 ml of urine per day; creatinine - 0.07 mmol/l Recovery occurred after three days from the onset of the disease.

An example of a typical method of treatment of patients with ARF.

Patient K., 25 years old (case history No. 3999/2), entered in the haemodialysis Department of the regional clinical hospital 15.04.96,

From the anamnesis of the disease it is known that, being drunk, 14.04.96, the patient fell asleep on the right side. Was hospitalized in bol is ptx2">

On admission, the patient's condition is moderate. In the minds adequately oriented in the environment. Pale skin. In the lungs breathing hard, no wheezing. The number of respiratory movements 24 - 26 min. The rhythmic heart sounds; the rhythmic pulse is 96 beats per min; a/D 140/80 mm RT.article The abdomen is soft, painful to palpation in the right hypochondrium. The liver stands out from the edge of a costal arch on 2.5 cm, painful. Kidney, spleen not palpable. Swelling on the periphery of the no. Daily diuresis 200.0 ml of urine.

Status localis: on the right upper extremity is defined by a dense swelling of the forearm and hand with the lack of active movement in the right upper limb. The limb is cold to the touch. Ripple on the periphery weakened, but saved.

Complete blood count: erythrocytes 4,31012/l; hemoglobin - 142 g/l; hematocrit - 0,46; leucocytes - 5,610 g9/l, e - 2; p - 8; p - 67; l - 20; m-3; ESR - 28 mm/h

Urinalysis: the number in 100.0 ml, dark color, beats. weight - 1009; protein - 3,3; leucocytes - 15-20 in the field of view; erythrocytes - 10-15 in the field of view. Acid-base state: compensated metabolic acidosis. Potassium plasma - 5.8 mmol/l; plasma Na - 140 mmol/l Triglycerides: the tendency to hypercoagulability.

In combination with the ongoing conservative treatment the patient began treatment with hemodialysis program- 16.04, 18.04, 20.04, 22.04, 23.04, 25.04, 27.04. With 28.04.96 the patient observed a strong recovery of diuresis to 3.5 liters of urine, followed by a gradual disappearance of azotemii. Recovery occurred on the 21st day of the disease.

The use of the proposed method for the treatment of ARF in clinical practice allows us to achieve fast recovery in excess of the usual method of treatment of ARF in 5-6 times.

A method of treating acute renal failure, including infusion therapy, characterized in that in the initial period of acute renal failure undergo additional needle, non-apparatus, membrane plasmapheresis with intravenous supplementation donor fresh-frozen plasma in a dose of 400-500 ml, 10% solution of albumin at a dose of 200-300 ml and 200000-300000 kontrikala rate 2-3 sessions, 1 per day.

 

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FIELD: medicine, cardiology.

SUBSTANCE: the suggested method should be performed at the background of medicinal therapy with preparations out of statins group, tevetene, polyoxidonium and conducting seances of plasmapheresis by removing 800 ml plasma twice weekly with N 5 due to additional intramuscular injection of immunophan 0.005%-1.0 with N 10 and fluimucyl 300 mg intravenously daily with N 5-10, total course of therapy lasts for 2 mo. The method provides modulation of leukocytic functional activity, moreover, due to altered cytokine profile and, thus, through disintegration of protein-lipid complexes participating in the development of atherosclerotic platelets.

EFFECT: higher efficiency of therapy.

3 ex

FIELD: medicine.

SUBSTANCE: method involves using apparatus supporting washed erythrocyte reinfusion as far as the erythrocytes become available. Reinfusion duration is limited with 3-4 h of the nearest postoperative period. The device has valve for preventing excessive rarefaction to occur. The valve is connected to main pipe for taking blood via T-shaped connector. The valve has membrane member which inlet flow nipple is connected to valve nozzle, shutter and upper and lower strap springs connected to each other. Screw for setting zero on the upper strap providing membrane member displacement. Adjusting screw is mounted on the lower strap allowing detaching shutter from the nozzle to make communication to atmosphere.

EFFECT: enhanced effectiveness in compensating postoperative blood losses with full-valued formed blood elements.

2 cl, 2 dwg

FIELD: medicine, endocrinology.

SUBSTANCE: one should introduce heparin into plasma separated during plasmapheresis at 9000-11000 U/l plasma to incubate it at 4-6 C for 12 h, not less, separate precipitate due to plasma centrifuging at 7-9 C for 15-25 min and introduce the rest plasma into patient's blood. Such procedures should be carried out every other day 5-7 times. The present innovation enables to decrease glomerulosclerosis progressing, avoid excessive heparinization and heparinization-associated complications and, also, those associated with introduction of donor's plasma.

EFFECT: higher efficiency of therapy.

2 ex

FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.

SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

FIELD: medicine, obstetrics.

SUBSTANCE: at the first stage of pregravidic training one should introduce leukinferon per 10000 IU intramuscularly every other day 10 times, at the second stage it is necessary to perform 3 seances of discrete plasmapheresis. The present innovation enables to decrease the frequency in developing gestosis and the risk for abortion due to normalized activity of female immune system, that in its turn, enables to stop virusemia and virusuria, prevent fetoplacental failure and intrauterine fetal infectioning.

EFFECT: higher efficiency of training.

3 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves administering combined sanatorium-and-spa treatment after patient acclimatization on low altitude mountain resort takes place. The treatment comprises mineral carbonic acid water baths physical training exercises on terraincour according to generally applied methods and plasmapheresis procedures. Hypercholesterolemia of 5,0-6.5 mmole/l being the case or cholesterol level being higher than target value of 3.6 mmole/l, it is enough to give 3-4 procedures with exfusion to 1-1.5 times circulating plasma volume. Total cholesterol level being from 6.5 to 7.8 mmole/l, plasma exfusion volume is equal to 1.5-2 times circulating plasma volume. Hypercholesterolemia being higher than 7.8 mmole/l, plasma exfusion volume is equal to 2-2.5 times circulating plasma volume.

EFFECT: enhanced effectiveness of treatment.

1 dwg, 3 tbl

FIELD: medicine.

SUBSTANCE: the present innovation deals with ways for purifying blood plasma in burnt patients followed by applying the plasma obtained either while carrying out the next plasmapheresis or as independent transfusion medium. For this purpose, it is necessary to carry out plasmapheresis in burnt patients. Heparin should be added into plasma removed during plasmapheresis and, additionally, hemodesis, followed by incubation at +4° C for about 5-18 h, then it should be centrifuged for depositing cryoprecipitate. The innovation suggested enables to alter conditions of cryoprecipitation so, that it is possible to increase precipitation of fibrinogen and fibrin-monomeric complexes, the quantity of which is sharply observed in burnt patients.

EFFECT: higher efficiency of purification.

1 tbl

FIELD: medical equipment.

SUBSTANCE: device can be used for medicinal and donor blood separation to erythromass and plasma, for removal of plasma, return of erythromass to patient and introduction of plasma-substituting solutions and anticoagulant. Device has blood taking conduct provided with accumulating container, erythromass returning conduct with air trap, anticoagulant and hemodilution agent supplying conduct and plasma collecting conduct provided with removable containers and clamps. Blood taking conduct has injection unit for additional introduction of medicines, which unit is disposed close to needle for blood taking. Blood taking conduct is joined permanently with accumulating container which is made of film material. Accumulating container has additional tube provided with clamp. One end of tube is joined permanently with accumulating container and the other end is connected with connector and plug. Dropping bottles with polymeric two-channeled needles are mounted at hemodilutant agent and anticoagulant supply conducts. Plasma collecting conduct has container for collection plasma which container is made of film material. Polymeric needles at conducts for supplying hemodilution agent and anticoagulant are made with two channels. Extracorporal close circuit is made to provide higher sterility of plasmapheresis.

EFFECT: better comfort at operation; higher degree of sterility.

2 cl, 1 dwg

FIELD: medicine, oncology.

SUBSTANCE: method involves autoblood sample taking off in the amount 200-250 ml into a sterile flask with hemopreserving agent "Glugitsir" followed by centrifugation at 1500 rev/min for 30 min. Then supernatant plasma is placed into another sterile flask with a hemopreserving agent and cellular precipitate is reinfused. A single dose of a cytostatic agent is mixed with 10-100 ml of autoplasma, incubated at temperature 37°C for 1 h and administrated through catheter in abdominal cavity by puncture in lower quadrant of abdomen. Procedure is repeated if necessary. Method provides decreasing toxicity of chemotherapy, simple method and uniform distribution of volume of injected preparation for all abdomen cavity. Invention can be used in carrying out chemotherapy of abdomen cavity tumors with ascites.

EFFECT: improved method for treatment.

1 ex

FIELD: medicine.

SUBSTANCE: method involves administering 1-2 interrupted plasmapheresis sessions before performing radical operation. Next to it, seven low intensity intravasal blood laser radiation sessions and 1-2 interrupted plasmapheresis sessions are given in postoperative period.

EFFECT: reduced risk of periuterine stump inflammation, rise in temperature and adaptation syndrome occurrence.

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