Frequency and Severity of Acute Kidney Injury in Patients After Replacement of Large Joints With Infectious Complications

Abstract

To identify the incidence and severity of acute kidney injury (AKI) in patients after replacement of large joints with infectious complications. Materials and methods. The object of study: 54 patients with infectious complications after replacement of large joints. The severity of AKI was determined by the RIFLE classification. Three groups of observation were singled out: I-18 patients (33.3%) with AKI in stage R (risk); II-11 patients (20.3%) with AKI in stage I (injury); III-25 patients (46.3%) with AKI in stage F (failure). AKI developed in 0.2% of cases. Results. In most cases, the clinical picture of AKI developed 2-4 days after surgery, and 2-5 days after onset of AKI, the signs of infectious endotoxicosis with the development of various infectious complications were noted. The analysis of the intraoperative period established that most patients in groups II and III had hypotension with MBP [mean blood pressure] 55-70 mm Hg, 87.5% of patients with intraoperative blood loss greater than 20% of blood volume were included in the study groups II and III. The calculation of odds ratios (OR) showed that low MBP levels, intraoperative blood loss greater than 20% of blood volume and sepsis are statistically significant factors of the risk of severe AKI (p˂0.05). Conclusions. Risk factors for the development of AKI and its severity after replacement of large joints were the presence of arterial hypertension, MBP level of less than 75 mm Hg, blood loss greater than 20% of blood volume, and sepsis. Manifestation of the clinical picture of AKI after such operations may be a warning sign of the development of postoperative infection and sepsis.