nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-967Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESГенерализованные отеки. Патогенез и лечение (Лекция)Generalised oedema. Pathogenesis and treatmentБагровЯ. Ю.BagrovYa. Yu.noemail@neicon.ruМанусоваН. Б.ManusovaN. B.nmanus@rambler.ruИнститут эволюционной физиологи и биохимии им. И.М. Сеченова РАН, Санкт-ПетербургРоссияI.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Science, St. Petersburg, RussiaRussian Federation201117062025134388395Copyright © Багров Я.Ю., Манусова Н.Б., 20252025Багров Я.Ю., Манусова Н.Б.Bagrov Y.Y., Manusova N.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/967

В лекции описаны и проанализированы механизмы развития отеков при заболеваниях почек, сердечной недостаточности и различных формах патологии печени. Кроме того, рассмотрены условия возникновения медикаментозных и идиопатических отеков. В лекции сформулированы также основные принципы медикаментозного лечения отеков, проанализирован механизм действия отдельных диуретиков, причина рефрактерности к ним и пути ее устранения. Делается вывод о стойком преобладании антинатриуретических механизмов над натриуретическими как конечном звене отеков различного генеза. Задержка натрия даже при тяжелой патологии почек носит активный характер.

The lecture concentrates on the analysis of mechanisms of development of oedema in cardiac failure, in renal and hepatic diseases. Additionally, the mechanisms of the development of the drug-induced and idiopathic oedema are reviewed. General approaches to the treatment of oedema are introduced including the management of diuretic-refractory oedema. It is concluded that in the chain of events underlying pathogenesis of oedema of varying genesis, antinatriuretic mechanisms strongly prevail upon diuretic ones. Despite different ways of kidney involvement, enhanced renal sodium reabsorption is a common link in the formation of oedema of various origins, and even in advanced stages of renal disease kidney is capable to actively retain sodium.

отекиантинатриурезнефротический синдромнедостаточность кровообращенияцирроз печенимедикаментозные и идиопатические отекидиуретикиoedemaantinatriuretic mechanismsnephrotic syndromecardiac failuredrug-induced and idiopathic oedemaand diureticsReferencesDi Sole F. Adenosine and renal tubular function // Curr. Opin Nephrol. Hypertens. 2008. Vol. 17 (4). P. 399.Di Sole F. Adenosine and renal tubular function // Curr. Opin Nephrol. Hypertens. 2008. Vol. 17 (4). P. 399.Dhir V., Arya V., Malav I.C., Suryanarayanan B.S., Gupta R., Dey A.B. Idiopathic systemic capillary leak syndrome (SCLS): case report and systematic review of cases reported in the last 16 years // Intern Med. 2007. Vol. 46 (12). P. 899.Dhir V., Arya V., Malav I.C., Suryanarayanan B.S., Gupta R., Dey A.B. Idiopathic systemic capillary leak syndrome (SCLS): case report and systematic review of cases reported in the last 16 years // Intern Med. 2007. Vol. 46 (12). P. 899.Dohadwala M.M., Givertz M.M. Role of adenosine antagonism in the cardiorenal syndrome // Cardiovasc. Ther. 2008. Vol. 26 (4). P. 276.Dohadwala M.M., Givertz M.M. Role of adenosine antagonism in the cardiorenal syndrome // Cardiovasc. Ther. 2008. Vol. 26 (4). P. 276.Ernst M.E., Gordon J.A. Diuretic therapy: key aspects in hypertension and renal disease // J Nephrol. 2010. Vol. 23 (5). P. 487.Ernst M.E., Gordon J.A. Diuretic therapy: key aspects in hypertension and renal disease // J Nephrol. 2010. Vol. 23 (5). P. 487.Gildea J.J. Dopamine and angiotensin as renal counterregulatory systems controlling sodium balance // Curr. Opin. Nephrol. Hypertens. 2009. Vol. 18 (1). P. 28.Gildea J.J. Dopamine and angiotensin as renal counterregulatory systems controlling sodium balance // Curr. Opin. Nephrol. Hypertens. 2009. Vol. 18 (1). P. 28.Kaname S., Fujita T. Angiotensin II and the kidney // Nippon Rinsho. 1999. Vol. 57 (5). P. 1103.Kaname S., Fujita T. Angiotensin II and the kidney // Nippon Rinsho. 1999. Vol. 57 (5). P. 1103.Kisner T., Müller R.U., Benzing T. Treating the symptoms in nephrotic syndrome: which therapeutic strategies are evidence based in the treatment of proteinuria? // Dtsch Med Wochenschr. 2011. Vol. 136 (7). P. 325.Kisner T., Müller R.U., Benzing T. Treating the symptoms in nephrotic syndrome: which therapeutic strategies are evidence based in the treatment of proteinuria? // Dtsch Med Wochenschr. 2011. Vol. 136 (7). P. 325.Markowitz G.S., Perazella M.A. Drug-induced renal failure: a focus on tubulointerstitial disease // Clin Chim Acta. 2005. Vol. 351 (1–2). P. 31.Markowitz G.S., Perazella M.A. Drug-induced renal failure: a focus on tubulointerstitial disease // Clin Chim Acta. 2005. Vol. 351 (1–2). P. 31.Mirzoyev Z., Anavekar N.S., Chen H.H. Renal and humoral pathophysiological actions of angiotensin II in congestive heart failure // Drugs Today (Barc). 2005. Vol. 41 (2). P. 129.Mirzoyev Z., Anavekar N.S., Chen H.H. Renal and humoral pathophysiological actions of angiotensin II in congestive heart failure // Drugs Today (Barc). 2005. Vol. 41 (2). P. 129.Sarafidis P.A., Georgianos P.I., Lasaridis A.N. Diuretics in clinical practice. Part I: mechanisms of action, pharmacological effects and clinical indications of diuretic compounds // Expert Opin Drug Saf. 2010. Vol. 9 (2). P. 243.Sarafidis P.A., Georgianos P.I., Lasaridis A.N. Diuretics in clinical practice. Part I: mechanisms of action, pharmacological effects and clinical indications of diuretic compounds // Expert Opin Drug Saf. 2010. Vol. 9 (2). P. 243.Schrier R.W., Masoumi A., Elhassan E. Aldosterone: role in edematous disorders, hypertension, chronic renal failure, and metabolic syndrome // Clin J Am Soc Nephrol. 2010. Vol. 5 (6). P. 1132.Schrier R.W., Masoumi A., Elhassan E. Aldosterone: role in edematous disorders, hypertension, chronic renal failure, and metabolic syndrome // Clin J Am Soc Nephrol. 2010. Vol. 5 (6). P. 1132.Silverberg D.S., Wexler D., Iaina A. et al. Аnemia, chronic renal disease and congestive heart failure – the cardio-renal anemia syndrome: the need for cooperation between cardiologists and nephrologists // Int. Urol. Nephrol. 2006. Vol. 38 (2). P. 295.Silverberg D.S., Wexler D., Iaina A. et al. Аnemia, chronic renal disease and congestive heart failure – the cardio-renal anemia syndrome: the need for cooperation between cardiologists and nephrologists // Int. Urol. Nephrol. 2006. Vol. 38 (2). P. 295.Smilde T.D., Damman K., van der Harst P. et al. Differential associations between renal function and «modifiable» risk factors in patients with chronic heart failure // Clin Res Cardiol. 2009. Vol. 98 (2). P. 121.Smilde T.D., Damman K., van der Harst P. et al. Differential associations between renal function and «modifiable» risk factors in patients with chronic heart failure // Clin Res Cardiol. 2009. Vol. 98 (2). P. 121.

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