Факторный анализ клинических и параклинических критериев, определяющих прогноз острого почечного повреждения

Abstract

Aim to identify risk factors and assess their significance in the development and prognosis of acute kidney injury in urological patients. Material and methods The data of 6272 patients treated in the Department of Urology and Intensive care Unit were analyzed retro- and prospectively. Factorial and linear regression analyzes of the primary diagnostic criteria were carried out, which allowed to establish an impact of individual signs and their combination in determining the risk of developing or diagnosing existing renal dysfunction in the absence of clinical manifestations. Results Statistical analysis has demonstrated the high significance of some diagnostic criteria (gender, increased body mass index, duration of the disease, comorbidities, hyperthermia, epitheliuria, proteinuria) influencing the development of acute kidney injury in patients with urolithiasis complicated by renal colic or secondary pyelonephritis. The factor load of each criterion allowed to establish the worst prognosis and the risk of progression of acute kidney injury in patients with frequent recurrences of secondary pyelonephritis, episodes of renal colic over the last 5 years, a combination of arterial hypertension and diabetes mellitus who underwent extracorporeal shock-wave lithotripsy or pyelolithotomy with nephrostomy. These risk factors require for additional pharmacological protective therapy aimed at preventing the progression of acute kidney injury. Conclusions Decreased urine output and serum creatinine levels as criteria for acute kidney injury (according to KDIGO) do not allow to fully assess the risk of renal dysfunction, which requires to consider additional criteria (gender, increased body mass index, duration of the disease, comorbidities, hyperthermia, epitheliuria, proteinuria) when taking history during the initial examination of a patient with upper urinary tract pathology.