zdorПроблемы здоровья и экологииHealth and Ecology Issues2220-09672708-6011Gomel State Medical University10.51523/2708-6011.2023-20-4-09zdor-2649Research ArticleКЛИНИЧЕСКАЯ МЕДИЦИНАCLINICAL MEDICINEПатология почек при циррозе печениKidney pathology in liver cirrhosishttps://orcid.org/0000-0003-1051-0787МалаеваЕ. Г.MalaevaE. G.

Малаева Екатерина Геннадьевна, к.м.н., доцент, заве- дующий кафедрой внутренних болезней № 1 с курсами эндокринологии и гематологии

Гомель

Ekaterina G. Malaeva, Candidate of Medical Sciences, Associate Professor, Head of the Department of Internal Diseases No.1 with the Courses of Endocrinology and Hematology

Gomel

Гомельский государственный медицинский университетGomel State Medical University20230501202420470–77Copyright © Малаева Е.Г., 20242024Малаева Е.Г.Malaeva E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.gsmu.by/jour/article/view/2649

Цель исследования. Провести анализ структуры и частоты патологии почек при циррозе печени по данным секционного анализа и изучить взаимосвязь между острым почечным повреждением и инфекцией мочевыводящих путей.Материалы и методы. Дизайн исследования смешанный: описательный и аналитический, который включал проведение ретроспективного исследования «случай – контроль» патологии почек по результатам протоколов патологоанатомических вскрытий на базе государственного учреждения здравоохранения «Гомельское областное клиническое патологоанатомическое бюро» за январь 2022 – июль 2023 гг. и клинических, лабораторных, инструментальных, цитологических, микробиологических данных пациентов с циррозом печени. В исследование включено 98 умерших пациентов, из них 70 (71,4 %) мужчин, 28 (28,6 %) женщин. Средний возраст составил 53,9 года, большинство пациентов являлись лицами трудоспособного возраста — 72,9 % мужчин и 60,7 % женщин, 21,4 % — лицами молодого возраста.Результаты. Наиболее распространенной патологией почек при циррозе печени по данным секционного анализа является острое почечное повреждение (57,1 %). Реже диагностированы абсцессы почек (3 %), тубулоинтерстициальный нефрит (2 %) и пиелонефрит (4 %). Несмотря на отсутствие у большинства пациентов с циррозом печени анамнеза заболеваний почек, классических клинических, лабораторно-инструментальных признаков поражения почечной ткани, на аутопсии выявлены макроскопические и микроскопические изменения почек в 100 % случаев. В 84,7 % случаев морфологически диагностирован острый тубулярный некроз от очагового (51 %) до тотального (19,4 %), который не всегда сопровождался повышением уровня сывороточного креатинина. Установлена связь умеренной силы между острым почечным повреждением и инфекцией мочевыводящих путей (OR = 14; 95 % CI 11,13–16,61).Заключение. Наиболее частым осложнением цирроза печени, ассоциированным с неблагоприятным прогнозом, является острое почечное повреждение, которое связано с наличием инфекции мочевыводящих путей.

Objective. To analyze the structure and frequency of kidney pathology in liver cirrhosis according to sectional analysis and to study the relationship between acute renal injury and urinary tract infection.Materials and methods. The design of the study is mixed: descriptive and analytical, which included conducting a retrospective case–control study of kidney pathology based on the results of the protocols of pathoanatomical autopsies on the basis of the state healthcare institution “Gomel Regional Clinical Pathoanatomical Bureau” for the period of January 2022 – July 2023 and clinical, laboratory, instrumental, cytological, microbiological data of patients with liver cirrhosis. The study included 98 deceased patients, including 70 (71.4%) men, 28 (28.6%) women. The average age was 53.9 years, the majority of patients were persons of working age — 72.9% of men and 60.7% of women, 21.4% were young people.Results. The most common kidney pathology in liver cirrhosis according to sectional analysis is acute renal injury (57.1%). Kidney abscesses (3%), tubulointerstitial nephritis (2%) and pyelonephritis (4%) were less frequently diagnosed. Despite the absence of a history of kidney diseases in most patients with cirrhosis, classical clinical, laboratory and instrumental signs of renal tissue damage, macroscopic and microscopic changes of the kidneys were revealed in 100% of cases at autopsy. In 84.7% of cases, acute tubular necrosis was morphologically diagnosed from focal (51%) to total (19.4%), which was not always accompanied by an increase in serum creatinine levels. A moderate relationship was established between acute kidney injury and urinary tract infection (OR = 14; 95 % CI 11.13–16.61).Conclusion. The most common complication of liver cirrhosis associated with an unfavorable prognosis is acute renal injury, which is associated with the presence of urinary tract infection.

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The authors declare that there are no conflicts of interest present.