CLINICO-MORPHOLOGICAL CHARACTERIZATION OF LESIONS OF THE KIDNEYS CAUSED BY COMBINED THERMO-CHEMICAL TRAUMA

THE AIM of the investigation was to assess effects of a combination of thermal and toxic factors of the fire environment on dynamics of kidney lesions. MATERIAL AND METHODS. Pieces of the kidneys from 47 corpses of humans dead due to action of fire factors, and corresponding medical case histories of stationary patients were used as objects of the investigation. For modeling a combined thermo-chemical injury 48 outbred white rats were used. Sections of the renal tissue were stained with hematoxylin-eosin after Van-Gieson. RESULTS. In victims of the combined thermo-chemical injury the concentration of urea after the first day was 9.1± 0.78, on the second day – 10.9 ±1.06 mmol·l -1, amounting to 14.6 ± 2.51 mmol·l -1 by the 6th day. A correlation analysis has shown that during the first 3 days the urea concentration depended both on severity of trauma and the content of COHb at the moment of admission to hospital. Later the connection with these features of injury became weaker. Histological investigations of cases of combined effects of high temperature and CO have found more pronounced alterations as compared with an isolated thermal trauma, that possessed a malignant course and were characterized by necrosis of the epithelium of not only convoluted tubules, but also of the straight tubules; in the peritubular spaces there was sharp plethora of the capillaries and diapedesic hemorrhages. In the glomerular apparatus there was plethora of capillary loops and an extension of the area was also accompanied by protein exudates into the urinary space of the glomeruli. The detected changes at the early posttraumatic period can be accounted for by effects of hypoxia and biologically active substances excreted in great amounts in burns. CONCLUSION. Combined thermochemical injuries resulting from action of fire factors are characterized by a marked nephrotoxic effect with morphological manifestations typical of glomerulonephritis. Clinicolaboratory findings, dynamics of lethality during the posttraumatic period and morphological alterations in the kidneys suggest that lesions of the kidneys are a substantial factor influencing the outcome of the combined trauma.

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