Biochemický monitoring a diagnostika poruch renálních funkcí u kriticky nemocných pacientů

Abstract

Ovod: Systematick9 pristup k monitoringu renalnich funkci s vyu2itim funkenich renalnich testO vypooitavan9ch ze serov9ch a m000v9ch parametru nebyl dosud pine zpracovan. Anal9za natriuretick9ch peptide.' oi nizkomolekularnich proteinO v diagnoze pokroeileho renalniho selhani vy2adujiciho nahradu funkce Iedvin nebyla u kriticky nemocn9ch vyu2ita. Provadeni kontinualnich eliminaonich metod zahrnuje i adekvatni antikoagulaci extrakorporalniho okruhu. Prostacyklinova antikoagulace jako jedna z novej§ich postupu nebyla porovnana s citratem, kter9 je standartni metodikou na mnoha jednotkach intenzivni peoe. Zmeny distribueniho objemu antibiotik jsou predmetem diskuze ve smyslu alterace davkovani ale nebyly dosud klinicky stanovovany u 162ka pacienta jinak ne2 s pomoci farmakokinetickeho modelu. Metody: Zavedeni pooitaeoveho programu vypoeitavajiciho spektrum funkenich renalnich parametrO umo2nilo monitorovat efekty diuretik, posuny v osmolalite, poruchy acidifikace mooi a progresi renalni insufficience smerem k renalnimu selhani. Sestaveni funkoniho modelu akutniho renalniho selhani slou21 jako nastroj pro dal§i studie pacientu vy2adujicich nahradu fukce ledvin. Vztah mezi rezidualni diurezou a hladinami natriuretick9ch peptidu a cystatinem C byl studovan pred a behem prvnich 48 h kontinualni...

Aims: A systematic approach to renal function monitoring using information taken by means of renal function tests calculated from serum and urine specimen has not been comprehensively explored. The application of analysis of natriuretic peptides and low molecular weight proteins in diagnosis of advanced renal failure has not been tested in critical ill patients. The performance of continuous renal replacement therapy depends on adequate anticoagulation of the extracorporeal circuit. Prostacyclin as one of the newer agents has not been compared to citrate which may be considered a standart agent in many intensive care units. Changes of distribution volume of antibiotics have been a matter of debate in terms of dosage alteration but have not been assessed clinically at the bedside using other tools than a pharmacokinetic model. Methods: Establishing computer programme calculating various renal function tests allowed us to monitor the effects of diuretics, osmolality shifts, disorders of urine acidification and progression of renal insufficiency towards acute renal failure. Creating a functional model of acute renal failure serves as a tool for further studies on renal replacement therapy. A relationship between residual diuresis and levels of natriuretic peptides and cystatin C were studied before and...