Chronic kidney disease resulting from acute morphofunctional changes in the kidneys in patients with abdominal surgical conditions

The prevalence of chronic kidney disease (CKD) has not decreased over the past 50 years and is now comparable to that of major conditions as hypertension and diabetes mellitus. It is now well established that CKD may develop as a consequence of acute kidney injury (AKI). Recent studies indicate that AKI is among the most common complications following emergency abdominal surgery. However, this problem remains insufficiently represented in general surgical literature, partly due to limited scientific interaction between surgeons and nephrologists.

In general surgical hospitals, the diagnosis of AKI is currently based mainly increases in serum creatinine and/or decreases in urine output. However, serum creatinine, as a marker of glomerular filtration rate, is relatively insensitive to acute changes in renal function. This limitation may contribute to delayed clinical diagnosis and underestimation of the severity tubular and glomerular injury.

Circulatory collapse is a prominent clinical sign of the early stage of AKI, but in some cases it is so transient that it remains unnoticed. A detailed understanding of the dynamics of morphological and functional changes at the level of the renal microcirculation, renal corpuscles, and parenchymal microcirculation during endotoxicosis is essential, as these processes form the pathogenetic basis of AKI and the subsequent development of CKD even after apparent recovery. Without such knowledge, meaningful improvements in pathogenetically targeted therapy for complications of urgent abdominal surgical diseases and in the prevention of dependence on renal replacement therapy, both in the early and late postoperative periods, are unlikely.

One objective criterion for assessing the severity of AKI and the effectiveness of its prevention and treatment in abdominal surgical diseases of the is the time factor. Its significance should be validated experimentally through models of acute strangulatory small intestinal obstruction and through the study of associated morphological and functional changes in the renal corpuscles.

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