Issledovaniâ i Praktika v Medicine (Dec 2021)
Urolithiasis complicated by chronic obstructive pyelonephritis in patients with concomitant diseases of the cardiovascular system
Abstract
Purpose of the study. To study the features of chronic obstructive pyelonephritis in patients with recurrent nephrolithiasis and concomitant diseases of the cardiovascular system.Materials and methods. The study included a total of 618 patients suffering from recurrent nephrolithiasis complicated by ChOP. The 3 groups were formed: the first (I) of them included 42 patients with ChOP and uncomplicated coronary heart disease (CHD); the second (II)- 38 patients with CHD complicated by chronic heart failure (CHF); III (control) group consisted of 24 respondents with recurrent urolithiasis.Results. The sample was dominated by men (78 %). In total, there were 474 (76.7 %) patients with intact cardiovascular system. Cardiovascular disease (CVD) suffered from 144 (23.3 %) patients, 38 (26.4 %) of whom had CHF of varying severity. Exacerbations of ChOP in patients of group I developed 1.5 times more often (once in 2.8-3 years) than in patients from the control group (on average after 18 months versus 28), and in group II almost annually (1 time in 13 months). In the entire cohort (n = 618), pyelonephritis was transformed into purulent-destructive in 19 (3.1 %) cases; with concomitant CVD, this complication developed in 7 (4.9 % of 144) cases, the remaining 12 (2.5 % of 474) respondents did not suffer from CVD. In group II, the purulent-destructive form occurred in 4 (10.5 %) patients; their share in the general group of patients with CVD was 2.8 % (the differences were significant - p < 0.05). Of the 19 patients with purulent-destructive pyelonephritis on the background of nephrolithiasis, more than a third (7 people - 36.8 %) had concomitant CHD, and of the 7 patients with this terrible complication that developed on the background of concomitant CHD, more than half (4 people - 57.1 %) had CHF of varying severity. The chemical composition of the urine samples was determined using a NICOLET iS10 spectral analyzer (Thermo scientific, USA). The stages of CHF were determined in accordance with the Strazhesco-Vasilenko classification [N. D. Strazhesco, V. H. Vasilenko, 1935]. Statistical data processing was carried out using the SPSS program 19. Absolute and relative indicators were calculated, as well as the exact Fisher criterion, taking into account the Bonferroni correction; the differences were considered reliable at p < 0.05.Conclusion. in patients with recurrent nephrolithiasis and concomitant CVD (especially with complicated CHF), exacerbations of obstructive pyelonephritis develop more often, the inflammatory process often turns into a purulent-destructive form.
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