SEPSIS AND CARDIO-RENAL SYNDROME: ETIOPATHOGENESIS, DIAGNOSIS AND TREATMENT

Dejan S Petrovic; Željko Mijailović; Biljana Popovska; Vladimir Miloradović; predrag đurđević

doi:10.5937/sjecr14-4363

Dejan S Petrovic Clinic for urology and nephrology
Željko Mijailović clinic for Infectology
Biljana Popovska clinic for Infectology
Vladimir Miloradović clinic for cardiology
predrag đurđević clinic for hematology

DOI: https://doi.org/10.5937/sjecr14-4363

Abstract

Introduction: Sepsis is the most common cause of acute renal failure in intensive care units. Aim: The work aimed to analyze the etiopathogenesis of sepsis and clinical significance of early detection and timely treatment of sepsis in intensive care units. Method: We analyzed the papers and clinical studies dealing with the pathogenesis, diagnosis and treatment of sepsis syndrome. Results: One-year rate of increase in the number of patients with sepsis is 1.5%. Severe sepsis is defined as sepsis with hypotension, hypoperfusion and organ dysfunctiona. Sepsis is characterized by activation of the patient^,s immune system and enhancing the creation of mediators play an important role in the development of multiple system organ failure in patients with sepsis. Strategy for the prevention of acute renal failure in patients with sepsis includes early targeted therapy (in the first 6 hours), which consists of an early increase of blood volume circulating fluids (at least 20 ml/kg crystalloid in the first hour). Initial therapy should be achieved by central venous pressure of 8-12 mmHg, mean arterial blood pressure greater than 65 mmHg, urine output greater than 0.5 ml/kg/h and mixed venous blood saturation of oxygen greater than 70%. Ventilation strategy to protect the lungs and kidneys in patients on a mechanical respirator include tidal volume of 6 ml/kg and end-inspiratory pressure plateau than 30 cmH₂O. To remove a mediator from the serum of patients a high-volume haemofiltration and continuous haemodiafiltration with PMMA are used. Conclusion: Early follow-up and early implementation of targeted therapies play a key role in preventing the development of acute heart and kidney damage.

Author Biographies

Dejan S Petrovic, Clinic for urology and nephrology

KC Kragujevac

Klinika za urologiju i nefrologiju

Centar za nefrologiju i dijalizu

Željko Mijailović, clinic for Infectology

Klinika za infektivne bolesti

direktor klinike

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