Acute kidney injury in acute small intestinal obstruction, state of the problem

Le résumé fourni par la source

Along with an increase in the number and volume of surgical interventions, the frequency of adhesions and acute adhesive small intestinal obstruction (ACST) is increasing, in which the strangulation component of the lesion of the small intestine is a characteristic element of the pathogenesis. Primary ventral hernia is also a common disease that affects up to 5 % of the world’s population. At the same time, among acute surgical nosological forms, pinched hernias of the anterior abdominal wall consistently occupy the 3rd-4th place in terms of frequency, giving way to acute appendicitis, pancreatitis and cholecystitis. Pinched ventral hernias, when the loop of the small intestine and its mesentery are pinched in the hernial sac, represent a typical variant of acute intestinal strangulation obstruction. That is why the clinical symptoms of a pinched hernia are later joined by the symptoms of obstruction, peritonitis and endotoxicosis. According to the literature, it is known that acute kidney injury (AKI) af ter surgical inter ventions in urgent surgery can occur in more than 40 % of adults, while it becomes obvious that currently there are no absolutely reliable clinical and laboratory parameters that allow an objective assessment of the presence and degree of AKI. Currently, the diagnosis of AKI is based solely on an increase in serum creatinine and / or a decrease in diuresis. However, serum creatinine, being a marker of glomerular filtration rate, is insensitive to acute changes in renal function, and this fact may be one of the reasons for delayed clinical diagnosis, as well as underestimation of the severity of damage to tubules and glomeruli. The morphological method remains the most informative. However, when correlating morphological changes and temporal parameters of pathology development, it is the time factor that can become a criterion for a non-invasive method of determining the level of AKI development and the basis for the formation of preventive and therapeutic tactics in this category of patients.

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