Keywords

rmsj

Российский медико-социальный журнал

Russian Medical and Social Journal

admin

Московский медико-социальный институт имени Ф.П. Гааза

2658-77182658-7726

10.35571/RMSJ.2019.1.006

Review articles

Обзоры

Острое повреждение почек при пневмонии

Acute Kidney Injury in patients with pneumonia

Магомедалиев

Магомедали Омарасхабович

1586 Main Military Clinical Hospital — Resuscitation and Intensive Therapy Unit, Anesthesiology, Resuscitation and Intensive Ther-apy Center, Senior Doctor

ФГКУ «1586 Военный клинический госпиталь» Минобороны России — отделение реанимации и интенсивной терапии центра анестезиологии, реанимации и интенсивной терапии, старший ординатор

Корабельников

Даниил Иванович

Moscow Medical - Social Institute named after Friedrich Haass — Rector

АНО ДПО "Московский медико-социальный институт имени Ф.П. Гааза" — Ректор

Хорошилов

Сергей Евгеньевич

Burdenko Main Military Clinical Hospital — Extracorporeal Dialysis Unit, Head of the Unit

Federal Scientific and Clinical Centre of Critical Care and Reabilitation Medicine, Russian Academy of Sciences — Leading researcher

ФГБУ «Главный военный клинический госпиталь им. академика Н.Н. Бурденко» Минобороны России — отделение гемодиализа, заведующий отделением

ФГБНУ «Федеральный научно-клинический центр реаниматологии и реабилитологии» — ведущий научный сотрудник

ФГКУ «1586 Военный клинический госпиталь» Минобороны России, Подольск, РоссияАНО ДПО "Московский медико-социальный институт имени Ф.П. Гааза", Москва, РоссияФГБУ «Главный военный клинический госпиталь им. академика Н.Н. Бурденко» Минобороны России, Москва, РоссияФГБНУ «Федеральный научно-клинический центр реаниматологии и реабилитологии», Москва, Россия

2019

01072019

5973

Received: 1482026

2026

Российский медико-социальный журнал

<a rel="license" href="https://creativecommons.org/licenses/by-nc-sa/4.0/"><img alt="Лицензия Creative Commons" src="//i.creativecommons.org/l/by-nc-sa/4.0/88x31.png" /></a><p>Это произведение доступно по <a rel="license" href="https://creativecommons.org/licenses/by-nc-sa/4.0/">лицензии Creative Commons «Attribution-NonCommercial-ShareAlike» («Атрибуция — Некоммерческое использование — На тех же условиях») 4.0 Всемирная</a>.</p>

Рассматриваются вопросы взаимоотягощения нарушений функций легких и по-чек при тяжелой пневмонии (ТП), осложненной острым повреждением почек (ОПП). Легкие и почки выполняют некоторые сходные функции, такие как дезинтоксикация и регуляция кислотно – щелочного состояния. Повреждение легких осложняется дис-функцией или недостаточностью функции почек, и, наоборот, ОПП депрессивно влия-ет на функцию легких. Первично от гипоксемической дыхательной недостаточности страдают все органы и ткани, в том числе и почки. ТП характеризуется увеличенной продукцией медиаторов воспаления, в кровеносное русло выбрасываются продукты распада микроорганизмов и их токсины, развивается эндотелиальная сосудистая недо-статочность, диссеминированный тромбоз микрососудов, расстройства центральной гемодинамики, в результате развивается полиорганная недостаточность. С развитием ОПП нарушается элиминация уремических токсинов и воды, формируется гипергид-ратация с увеличением объёма внесосудистой воды в легких на фоне уже имеющегося нарушенного аэрогематического барьера, а уремические токсины депрессивно влияют на сердечную мышцу на фоне острого легочного сердца. Существуют свидетельства об отрицательном влиянии искусственной вентиляции легких (ИВЛ) на функцию почек, и, наоборот, о неблагоприятном влиянии ОПП на необходимость и продолжительность вентиляции. Прогрессирование ТП и ОПП нарушает кислотно – щелочное состояние из-за избытка СО2, нарушения выделения ионов H+, нарушений в синтезе НСО3-. Па-тофизиологические механизмы, лежащие в основе этих взаимоотношений сложные, а их влияние на течение заболевания - существенно.

Mutual complications of impaired lung and kidney function in severe pneumonia (SP) complicated by acute kidney damage (AKP) are considered. The lungs and kidneys perform some similar functions, such as detoxification and regulation of acid-base balance. Lung damage is complicated by dysfunction or impaired renal function, and vice versa, AKI depressively affects lung function. Initially, all organs and tissues, including the kidneys, suffer from hypoxemic respiratory failure. SP is characterized by increased production of inflammatory mediators, decay products of microorganisms and their toxins and ejection them into the bloodstream. Endothelial vascular insufficiency, disseminated microvascular thrombosis, central hemodynamic disorders develop, and as a result, multiple organ failure develops. With the development of AKI, the elimination of uremic toxins and water is disrupted, hyperhydration is formed with an increase in the volume of extravascular water in the lungs on the background of the already existing broken airborne barrier. Uremic toxins depressively affect the heart muscle on the background of an acute pulmonary heart. There is evidence of a negative effect of mechanical ventilation on kidney function, and, conversely, of an adverse effect of AKI on the need and duration of ventilation. The progression of TP and AKP disrupts the acid - base balance due to excess CO2, impaired H+ ion release, and impaired synthesis of HCO3. The pathophysiological mechanisms underlying these relationships are complex, and their effect on the course of the disease is significant.

KeywordsAKIAcute kidney injuryAcute lung injuryLung and kidney connectionsPneumoniaAcute respiratory distress syndromeSepsisMultiple organ failure

Ключевые словаострое повреждение почеклегочно-почечные взаимоотношенияпневмонияострый респираторный дистресс-синдромсепсисполиорганная недостаточность

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