nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2014-18-2-50-68nefr-16Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES CLINICAL STUDIESОстрое повреждение почек у больных с инсультомAcute kidney injury in patients with acute strokeМензоровМ. В.MenzorovM. V.noemail@neicon.ruШутовА. М.ShutovA. M.amshu@mail.ruЛукьяноваВ. А.LukyanovaV. A.noemail@neicon.ruГердтА. М.GerdtA. M.noemail@neicon.ruГришенькинИ. Ю.GrishenkinI. Y.noemail@neicon.ruУльяновский государственный университетРоссияГУЗ «Центральная городская клиническая больница, г. Ульяновска»Россия2014010320141825560Copyright © Мензоров М.В., Шутов А.М., Лукьянова В.А., Гердт А.М., Гришенькин И.Ю., 20142014Мензоров М.В., Шутов А.М., Лукьянова В.А., Гердт А.М., Гришенькин И.Ю.Menzorov M.V., Shutov A.M., Lukyanova V.A., Gerdt A.M., Grishenkin I.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/16

ЦЕЛЬ ИССЛЕДОВАНИЯ. Оценка частоты и тяжести острого повреждения почек (ОПП) у больных с инсультом, а также уточнение связи ОПП с внутригоспитальной летальностью. ПАЦИЕНТЫ И МЕТОДЫ. Обследовано 98 больных инсультом. Мужчин было 54 (55%), женщин - 44 (45%), средний возраст пациентов составил 63±11 лет. У всех больных диагноз инсульта верифицирован при компьютерной томографии. У 66 (67%) пациентов диагностирован ишемический инсульт, у 32 (33%) - геморрагический. ОПП диагностировали и классифицировали согласно Рекомендациям KDIGO (2012). РЕЗУЛЬТАТЫ. ОПП выявлено у 30 (31%) больных, причем у 19 (20%) - 1 стадия, у 6 (6%) - 2 стадия и у 5 (5%) - 3 стадия. Острое повреждение почек достоверно чаще наблюдалось у пациентов с геморрагическим инсультом, чем с ишемическим: 16 (50%) и 14 (21%), соответственно, p=0,004. Больные с ОПП имели при поступлении более низкий индекс мобильности по шкале Ривермид (p=0,0007) и более выраженную тяжесть неврологической симптоматики по шкале NIHSS (p=0,001). Наличие в анамнезе хронической сердечной недостаточности (ХСН) было фактором риска развития острого повреждения почек (ОР 6,7; 95% ДИ: 1,8-20,0; p=0,003). В период госпитализации умерли 18 (18%) больных. Внутригоспитальная летальность была выше у пациентов с ОПП, чем без ОПП (ОР 5,4; 95% ДИ: 1,5-19,3). ЗАКЛЮЧЕНИЕ. Одна треть больных с инсультом имеют острое повреждение почек. Частота ОПП при геморрагическом инсульте в два раза выше, чем при ишемическом. Хроническая сердечная недостаточность является фактором риска развития ОПП. Среди больных с инсультом с ОПП внутригоспитальная летальность выше, чем у пациентов без ОПП.

AIM. The aim of this study was to assess the incidence and severity of the acute kidney injury (AKI) in patients with stroke and investigate the relationship between AKI and in-hospital mortality. PATIENTS AND METHODS. 98 patients (54 (55%) men and 44 (45%) women, mean age was 63±11 years) with acute stroke were studied. Diagnosis was confirmed by tomography. 66 (67%) patients had ischemic stroke and 32 (33%) - hemorrhagic stroke . AKI was defined according to KDIGO Guidelines (2012). RESULTS. AKI was revealed in 30 patients (31%): 19 (20%) with first stage, 6 (6%) with stage 2 and 5 (5%) with stage 3. The incidence of AKI was significantly higher in patients with hemorrhagic stroke, than with ischemic stroke (50% and 21%, respectively, p=0,004). The AKI patients had a higher NIHSS (National Institutes of Health Stroke Scale) severity scores (p=0,001) and lower Rivermed mobility index (p=0,0007) compared with patients without AKI. Previous chronic heart failure was the independent predictor of AKI (relative risk 6.7, 95% confidence intervals 1.8 to 20.0). The in-hospital mortality rate was 18%. AKI was independent predictor of in-hospital mortality (relative risk 5.4, 95% confidence intervals 1.5 to 19.3). CONCLUSIONS. Our results show that the incidence of AKI in patients with acute stroke is 31%. The ischemic stroke patients had a twice higher rate of AKI compared with hemorrhagic stroke patients. Previous chronic heart failure was the predictor of AKI. AKI was significantly associated with in-hospital mortality.

внутригоспитальная летальностьинсультострое повреждение почекрекомендации KDIGOacute kidney injuryin-hospital mortalityGuidelines KDIGOstrokeReferencesКадыков АС, Шахпаронова НВ. Профилактика повторного ишемического инсульта. Consilium medicum Ukraina Неврология 2006; (8): 30-32Кадыков АС, Шахпаронова НВ. Профилактика повторного ишемического инсульта. Consilium medicum Ukraina Неврология 2006; (8): 30-32Суслина ЗА, Варакин ЮЯ. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы клинической и экспериментальной неврологии 2007; (1): 22-28Суслина ЗА, Варакин ЮЯ. Эпидемиологические аспекты изучения инсульта. Время подводить итоги. Анналы клинической и экспериментальной неврологии 2007; (1): 22-28Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ. Эпидемиология инсульта в России. Журн неврол и психиатр (приложение «Инсульт») 2003; 8: 4-9Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ. Эпидемиология инсульта в России. Журн неврол и психиатр (приложение «Инсульт») 2003; 8: 4-9Пирадов МА, Гулевская ТС, Гнедовская ЕВ и др. Синдром полиорганной недостаточности при тяжелых формах инсульта (клинико-морфологическое исследование). Неврологический журнал 2006; 11(5): 9-13Пирадов МА, Гулевская ТС, Гнедовская ЕВ и др. Синдром полиорганной недостаточности при тяжелых формах инсульта (клинико-морфологическое исследование). Неврологический журнал 2006; 11(5): 9-13Loh Y, McArthur DL, Vespa P et al. The risk of acute radiocontrast-mediated kidney injury following endovascular therapy for acute ischemic stroke is low. AJNR Am J Neuroradiol 2010; 31(9): 1584-1587Loh Y, McArthur DL, Vespa P et al. The risk of acute radiocontrast-mediated kidney injury following endovascular therapy for acute ischemic stroke is low. AJNR Am J Neuroradiol 2010; 31(9): 1584-1587Khatri M, Himmelfarb J, Adams D et al. Acute Kidney Injury is Associated with Increased Hospital Mortality after Stroke. J Stroke Cerebrovasc Dis 2014; 23(1): 25-30Khatri M, Himmelfarb J, Adams D et al. Acute Kidney Injury is Associated with Increased Hospital Mortality after Stroke. J Stroke Cerebrovasc Dis 2014; 23(1): 25-30Cerda J, Lameire N, Eggers P et al. Epidemiology of Acute Kidney Injury. Clin J Am Soc Nephrol 2008; 3: 881-886Cerda J, Lameire N, Eggers P et al. Epidemiology of Acute Kidney Injury. Clin J Am Soc Nephrol 2008; 3: 881-886KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Kidney International Supplements 2012; (2): 5-138KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Kidney International Supplements 2012; (2): 5-138Bellomo R, Ronco C, Kellum JA et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8(4): R204-212Bellomo R, Ronco C, Kellum JA et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8(4): R204-212Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23(5): 1569-1574Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23(5): 1569-1574Englberger L, Suri RM, Li Z et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 2011; 15(1): R16Englberger L, Suri RM, Li Z et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 2011; 15(1): R16Joannidis M, Metnitz B, Bauer P et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009; 35(10): 1692-1702Joannidis M, Metnitz B, Bauer P et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 2009; 35(10): 1692-1702Covic A, Schiller A, Mardare NG et al. The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant 2008; 23(7): 2228-2234Covic A, Schiller A, Mardare NG et al. The impact of acute kidney injury on short-term survival in an Eastern European population with stroke. Nephrol Dial Transplant 2008; 23(7): 2228-2234Chawla LS. Acute kidney injury leading to chronic kidney disease and long-term outcomes of acute kidney injury: the best opportunity to mitigate acute kidney injury? Contrib Nephrol 2011; 174: 182-190Chawla LS. Acute kidney injury leading to chronic kidney disease and long-term outcomes of acute kidney injury: the best opportunity to mitigate acute kidney injury? Contrib Nephrol 2011; 174: 182-190Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull WHO 1976; 54: 541-553Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull WHO 1976; 54: 541-553Collen, FM, Wade DT, Robb GF et al. The Rivermead mobility index: a further development of the Rivermead motor assessment. Disability & Rehabilitation 1991; 13(2): 50-54Collen, FM, Wade DT, Robb GF et al. The Rivermead mobility index: a further development of the Rivermead motor assessment. Disability & Rehabilitation 1991; 13(2): 50-54Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; (46): 660-662Goldstein LB, Bertels C, Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; (46): 660-662Hsu RK, McCulloch CE, Dudley RA et al. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2013; 24(1): 37-42Hsu RK, McCulloch CE, Dudley RA et al. Temporal Changes in Incidence of Dialysis-Requiring AKI. J Am Soc Nephrol 2013; 24(1): 37-42Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012; 81(9): 819-825Singbartl K, Kellum JA. AKI in the ICU: definition, epidemiology, risk stratification, and outcomes. Kidney Int 2012; 81(9): 819-825Ronco C, Haapio M, House AA et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527-1539Ronco C, Haapio M, House AA et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527-1539Vanmassenhove J, Vanholder R, Nagler E et al. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2013; 28(2): 254-273Vanmassenhove J, Vanholder R, Nagler E et al. Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2013; 28(2): 254-273Ostermann M, Chang RWS Challenges of defining acute kidney injury. Q J Med 2011; 104: 237-243Ostermann M, Chang RWS Challenges of defining acute kidney injury. Q J Med 2011; 104: 237-243Joannidis M. Classification of acute kidney injury: are we there yet? Intensive Care Med 2007; 33: 572-574Joannidis M. Classification of acute kidney injury: are we there yet? Intensive Care Med 2007; 33: 572-574Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда и эффективность тромболитической терапии. Кардиология 2012; 5: 8-12Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда и эффективность тромболитической терапии. Кардиология 2012; 5: 8-12Fliser D, Laville M, Covic A et al. European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO)clinical practice guidelines on acute kidney injury: part 1: definitions,conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27(12): 4263-4272Fliser D, Laville M, Covic A et al. European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO)clinical practice guidelines on acute kidney injury: part 1: definitions,conservative management and contrast-induced nephropathy. Nephrol Dial Transplant 2012; 27(12): 4263-4272Tsagalis G, Akrivos T, Alevizaki M et al. Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol 2009; 4(3): 616-622Tsagalis G, Akrivos T, Alevizaki M et al. Long-term prognosis of acute kidney injury after first acute stroke. Clin J Am Soc Nephrol 2009; 4(3): 616-622Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда с подъемом сегмента ST. Нефрология 2012; (1): 40-44Мензоров МВ, Шутов АМ, Серов ВА и др. Острое повреждение почек у больных инфарктом миокарда с подъемом сегмента ST. Нефрология 2012; (1): 40-44Шутов АМ, Курзина ЕВ, Серов ВА и др. Митральная регургитация у больных с хронической сердечной недостаточностью ассоциирована со снижением функционального состояния почек. Нефрология 2008; 12(1): 19-23Шутов АМ, Курзина ЕВ, Серов ВА и др. Митральная регургитация у больных с хронической сердечной недостаточностью ассоциирована со снижением функционального состояния почек. Нефрология 2008; 12(1): 19-23Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-936Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-936Смирнов АВ, Каюков ИГ, Добронравов ВА, Кучер АГ. Острое повреждение почек и острая почечная недостаточность: некоторые уроки международных инициатив. Нефрология 2008;12 (3): 7-12Смирнов АВ, Каюков ИГ, Добронравов ВА, Кучер АГ. Острое повреждение почек и острая почечная недостаточность: некоторые уроки международных инициатив. Нефрология 2008;12 (3): 7-12Macedo E, Bouchard J, Soroko SH et al. Fluid accumulation, recognition and staging of acute kidney injury in critically ill patients. Crit Care 2010; 14: R82Macedo E, Bouchard J, Soroko SH et al. Fluid accumulation, recognition and staging of acute kidney injury in critically ill patients. Crit Care 2010; 14: R82Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20: 672-679Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 2009; 20: 672-679Self WH, Barrett TW. Novel biomarkers: help or hindrance to patient care in the emergency department? Ann Emerg Med 2010; 56: 60-61Self WH, Barrett TW. Novel biomarkers: help or hindrance to patient care in the emergency department? Ann Emerg Med 2010; 56: 60-61Shavit L, Dolgoker I, Ivgi H et al. Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery. Kidney Blood Press Res 2011; 34(2): 116-124Shavit L, Dolgoker I, Ivgi H et al. Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery. Kidney Blood Press Res 2011; 34(2): 116-124

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