Психоэмоциональные, вегетативно-сосудистые и нефрологические детерминанты дезадаптационного стресса у лиц, перенесших нефрэктомию по поводу почечно-клеточного рака

Abstract

to assess the relationship of psycho-emotional and autonomic stress with changes in the functional state of the kidney in patients undergoing nephrectomy for kidney cancer. The clinical study involved 75 patients (mean age 64+/-3 years, stage 1 CKD) who underwent nephrectomy for localized kidney cancer. In patients of the study group (n=45) before surgery and in the early postoperative period on the 1st, 7th and 14th day, somatic and psychoemotional statuses were studied using the Zung scale, Kerdo index, and glomerular reaction rate estimates. Group control (n=30) of patients who underwent nephrectomy 12 months ago, with the results of clinical studies, as a result of which there were no clinical, laboratory and radiological diseases of a single kidney. The results of biochemical, autonomic and functional tests in this group of patients were taken as the conditionally normal rate characteristic of patients undergoing nephrectomy. In the course of the correlation analysis, when comparing the degree of anxiety of patients after nephrectomy (estimated by SBT according to the Tsung Anxiety Scale) with the calculated Kerdo vegetative index (VIC), a statistically significant positive relationship was found between them, especially pronounced during the first 7 days of the early postoperative period. At this time, the vegetative mediated by vasculogenic factors adaptation progressively worsened (VIC increased), while the GFR of a single kidney significantly decreased. Operational stress, together with all other predictors, may be a risk factor for the development of acute renal failure in the early postoperative period and the progression of CKD in the late period after surgery.