Ways to improve the results of treatment of patients with end-stage chronic renal failure in the outcome of urological diseases and acute pyelonephritis
Introduction. Patients in the outcome of urological diseases after the beginning of treatment with hemodialysis in the presence of permanent drainage in the kidneys, or with recurrent pyelonephritis have high risks of urosepsis and death. In order to improve the results of diagnosis and treatment of this category of patients, we analyzed our own results. Materials and methods. The study included 58 patients with end-stage chronic renal failure (ESRD) who were treated with hemodialysis and had a nephrectomy for active pyelonephritis in the period from 2013 to 2020. Results. The most informative method in the diagnosis of pyelonephritis was magnetic resonance imaging using diffuse-weighted image protocols (MR1-DWI), the diagnostic efficiency was 94%. There were no differences in the frequency of intraoperative complications in laparoscopic and open nephrectomy. The mortality rate after nephrectomy was 25.9% (n=15). With a preoperative C-reactive protein (CRP) level of more than 95 mg/l (p=0.011) and a Charlson comorbidity index of more than 5 (p=0.003), a high probability of death was predicted. Long-term (more than 14 days) antibacterial preoperative therapy was significantly associated with sepsis before surgery, postoperative antibiotic-associated colitis, and infectious-inflammatory complications from the postoperative wound. Discussion. Our work, as well as many other publications, demonstrates a high incidence of septic complications in patients with ESRD. Patients with permanent drainage in the upper urinary tract are most at risk. this study convincingly showed that the results of nephrectomy are significantly worse in the presence of a systemic inflammatory reaction (SIRS), and therefore it is advisable to perform a nephrectomy before the development of SIRS. Our opinion on the possibility and safety of laparoscopic nephrectomy in chronic pyelonephritis in patients with ESRD who have undergone repeated renal interventions is consistent with a number of other studies in recent years. Conclusion. Diagnosis of pyelonephritis in patients with ESRD is advisable to start with MRI-DWI. The results of nephrectomy are better in the absence of a systemic inflammatory response. It is necessary to minimize antibacterial therapy before surgery. Laparoscopic nephrectomy is a safe procedure for inflammatory kidney diseases.