RU2423703C1 - Method of estimating human renal function in high pressure gas medium - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: compression water load (pressure chamber immersion at a depth of 60 metres and staying there for 1.5 hours) in dosage 20 ml per one kg of body weight is followed by calculating a renal functional activity index (RFAI) by formula: RFAI=0.1N1+0.4D1+0.2D2+0.1N2-0.1K+0.1Chl, where: N1 is the amount of sodium discharged by kidneys on the 60th minute after the water load (mmol/hour); D1 is the amount of discharged urine on the 60th minute after the water load (ml/min); D2 is the amount of discharged on the 90th minute after the water load (ml/min); N2 is the amount of sodium discharged by kidneys on the 90th minute after the water load (mmol/hour); K is the amount of potassium discharged by kidneys on the 90th minute after the water load (mmol/hour); Chl is the amount of discharged chlorine on the 90th minute after the water load (mmol/hour). If the RFAI value is 5.7 or more, excretory and concentration renal function is considered to be satisfactory, and the RFAI value less than 5.7 shows unsatisfactory function. ^ EFFECT: method can be used in practice of scuba diving physiology and diving medicine for estimation of excretory and concentration renal functions of a person in high pressure gas medium.

Description

The invention relates to medicine, in particular to the field of aviation, space and marine medicine, can be used in the practice of physiology of scuba diving and diving medicine to assess the excretory and concentration functions of human kidneys under conditions of high pressure gas environment, by evaluating clinical data.

Known methods for assessing the excretory and concentration functions of the kidneys (using a sample with a water load) in the study of the capabilities of osmoregulatory systems of the kidneys in a clinical setting (Ryabov S.I. Diagnosis of kidney disease / S.I. Ryabov, Yu.V. Natochin, B. B. . Bondarenko. - L .: Medicine, 1979. - 255 p.), And also with astronauts before and after a space flight (Gazenko OG Water-salt homeostasis and space flight / OG Gazenko. - M .: Science, 1986. - 238 pp.), As well as before and after exposure to high pressure of the gas medium (Kushnirenko N.P. Izm Changes in the functional state of the kidneys during asymptomatic decompression gas formation and decompression sickness (experimental and clinical research): abstract of thesis of candidate of medical sciences / N.P. Kushnirenko. - L., 1980. - 16 p.; Raymond LW In the weight loss of hiperbaric habitation a disorder of osmoregulation? / LW Raymond, NSRaymond, VP Frattali // Aviat. Space. Environ. Med. - 1980. - Vol. 51, No. 4. - P. 397-401). Adequate methods for assessing the excretory and concentration functions of human kidneys under conditions of exposure to high pressure of the gas environment (in the conditions of the pressure chamber) currently do not exist.

A disadvantage of the known methods is the low accuracy of the study, as well as the fact that they were used mainly before and after (and not during) exposure to high pressure gas environment.

The aim of the invention is to improve the accuracy of the study of excretory and concentration functions of the kidneys of specialists working in conditions of altered pressure of the gas and water environment.

The goal is achieved by using a method for assessing the excretory and concentration functions of the kidneys under conditions of increased pressure of the gas environment, by evaluating the clinical data obtained after the water load carried out during compression (immersion in a pressure chamber to a depth of 60 meters and staying there for 1, 5 hours) at a dose of 20 ml per kg body weight, characterized in that they determine the index of functional activity of the kidneys (IFAP) by the formula:

IFAP = 0.1 · N ₁ + 0.4 · D ₁ + 0.2 · D ₂ + 0.1 · N ₂ -0.1 · K + 0.1 · Chl

Where:

H ₁ - the amount of sodium excreted by the kidneys at 60 minutes after water load (mmol / hour);

D ₁ - the amount of urine excreted at 60 minutes after water load (ml / min);

D ₂ - the amount of urine at 90 minutes after water load (ml / min);

N ₂ - the amount of sodium excreted by the kidneys at 90 minutes after water load (mmol / hour);

K is the amount of potassium excreted by the kidneys at 90 minutes after a water load (mmol / hour);

Chl - the amount of chlorine released at 90 minutes after water loading (mmol / hour);

and with its value of 5.7 or more, excretory and concentration function of the kidneys is considered satisfactory, and with its value less than 5.7 - excretory and concentration function of the kidneys is considered unsatisfactory.

The method is implemented as follows:

A method is used to assess the excretory and concentration functions of the kidneys under conditions of increased pressure of the gaseous medium by evaluating the clinical data obtained after the water load carried out during compression (immersion in a pressure chamber to a depth of 60 meters and staying there for 1.5 hours) in a dose 20 ml per kg of body weight, characterized in that they determine the index of functional activity of the kidneys (IFAP) according to the formula:

IFAP = 0.1 · N ₁ + 0.4 · D ₁ + 0.2 · D ₂ + 0.1 · N ₂ -0.1 · K + 0.1 · Chl

Where:

H ₁ - the amount of sodium excreted by the kidneys at 60 minutes after water load (mmol / hour);

D ₁ - the amount of urine excreted at 60 minutes after water load (ml / min);

D ₂ - the amount of urine at 90 minutes after water load (ml / min);

N ₂ - the amount of sodium excreted by the kidneys at 90 minutes after water load (mmol / hour);

K is the amount of potassium excreted by the kidneys at 90 minutes after a water load (mmol / hour);

Chl - the amount of chlorine released at 90 minutes after water loading (mmol / hour);

and with its value of 5.7 or more, excretory and concentration function of the kidneys is considered satisfactory, and with its value less than 5.7 - excretory and concentration function of the kidneys is considered unsatisfactory.

The methodology for conducting the water load, collecting and analyzing the excreted urine should be as follows: before the test, the subjects do not take water and food from 20 hours on the previous day. While immersing in a pressure chamber to a depth of 60 meters and staying there for 1.5 hours, water (GOST "Drinking Water") at room temperature (20 ml per kg body weight) is taken for 15-20 minutes. Urine is collected by voluntary urination 60 and 90 minutes after a water load. In this case, the amount of urine excreted, as well as the concentration of electrolytes in it (sodium, potassium, chloride), is determined.

For example, it is necessary to evaluate the concentration and excretory functions of the diver's kidneys under conditions of exposure to high pressure of the gas environment. For this, a diver is placed in a pressure chamber, immersed to a depth of 60 meters and a water load of 20 ml per kg of body weight is carried out. At 60 and 90 minutes after the water load, urine is collected. When evaluating clinical data, the following results were obtained: the amount of sodium excreted by the kidneys at 60 minutes after a water load of 7.55 mmol / hour; the amount of urine excreted at 60 minutes after a water load of 5.63 ml / min; the amount of urine released at 90 minutes after a water load of 9.81 ml / min; the amount of sodium excreted by the kidneys at 90 minutes after a water load of 7.26 mmol / hour; the amount of potassium excreted by the kidneys at 90 minutes after a water load of 4.22 mmol / hour; the amount of chlorine released at 90 minutes after a water load of 9.92 mmol / hour. Applying the formula, we calculate the index of functional activity of the kidneys (IFAP):

IFAP = 0.1 · 7.55 + 0.4 · 5.63 + 0.2 · 9.81 + 0.1 · 7.26-0.1 · 4.22 + 0.1 · 9.92

IFAP = 0.755 + 2.25 + 1.962 + 0.726-0.422 + 0.992

IFAP = 6,263

Therefore, IFAP will, in this case, be greater than 5.7, therefore, the excretory and concentration function of the kidneys of such a diver under the influence of increased pressure of the gas medium should be considered satisfactory.

For example, it is necessary to evaluate the concentration and excretory functions of the diver's kidneys under conditions of exposure to high pressure of the gas environment. For this, a diver is placed in a pressure chamber, immersed to a depth of 60 meters and a water load of 20 ml per kg of body weight is carried out. At 60 and 90 minutes after the water load, urine is collected. When evaluating clinical data, the following results were obtained: the amount of sodium excreted by the kidneys at 60 minutes after a water load of 6.82 mmol / hour; the amount of urine excreted at 60 minutes after a water load of 5.04 ml / min; the amount of urine released at 90 minutes after a water load of 8.43 ml / min; the amount of sodium excreted by the kidneys at 90 minutes after a water load of 7.11 mmol / hour; the amount of potassium excreted by the kidneys at 90 minutes after a water load of 4.29 mmol / hour; the amount of chlorine released at 90 minutes after a water load of 9.12 mmol / hour. Applying the formula, we calculate the index of functional activity of the kidneys (IFAP):

IFAP = 0.1 · 6.82 + 0.4 · 5.04 + 0.2 · 8.43 + 0.1 · 7.11-0.1 · 4.29 + 0.1 · 9.12

IFAP = 0.682 + 2.016 + 1.666 + 0.711-0.429 + 0.912

IFAP = 5.578

Therefore, IFAP will, in this case, be less than 5.7, therefore, the excretory and concentration function of the kidneys of such a diver under conditions of increased pressure of the gaseous medium should be considered unsatisfactory.

Studies conducted with 44 volunteer test subjects confirm the effectiveness and validity of the method used (Myasnikov A.A. Use of a sample with a water load to evaluate kidney activity during intravascular decompression gas formation of various intensities / A.A. Myasnikov, A.Yu. Shitov, Yu. N. Sogrin // Nephrology and dialysis. - 2010.V. 12, No. 1. - S.49-53). In addition, the obtained data are confirmed by the data of earlier studies (Shitov A.Yu. Physiological substantiation of a rational drinking regimen for the prevention of decompression sickness during descents to medium depths: dis. Candidate of medical science / A.Yu.Shitov - St. Petersburg: VMedA , 2007. - 216 p.), In which similar specific results are presented.

Thus, when examining 44 volunteer subjects in this way, data were obtained indicating that 13.6% of the examined (6 people) showed unsatisfactory excretory and concentration function of the kidneys, and 86.4% of the examined (38 people) showed satisfactory excretory and the concentration function of the kidneys under conditions of increased pressure of the gas environment.

Moreover, if we compare the results of the examination with the data presented in the work of N.P. Kushnirenko (Kushnirenko N.P. Changes in the functional state of the kidneys during asymptomatic decompression gas formation and decompression sickness (experimental and clinical research): abstract of diss. sciences / N.P. Kushnirenko - L., VMedA, 1980. - 16 p.), it turns out that in this work only excretory function of the kidneys was determined (only the amount of urine excreted, but not its electrolyte composition) was determined, but vodilos before and after (not during) the impact of high pressure gas environment, which reduces the accuracy of the study. Nevertheless, the author obtained results similar to ours when examining 27 divers (test subjects), which showed that 3 of them (11.1%) showed impaired renal excretory function, and the remaining 24 people (88.9 %) such violations were not detected.

From this it follows that when using the proposed method, the accuracy of determining the functions of the kidneys is increased, namely, the number of persons with detectable unsatisfactory renal function (excretory and concentration function) increases. In the studies of N.P. Kushnirenko of such individuals - 11.1%, and in the studies of such subjects - 13.6%. This suggests a more accurate identification of such persons using the proposed method.

Thus, by evaluating the clinical data obtained after water loading during compression (immersion in a pressure chamber), a person providing medical support for diving descents can accurately determine the excretory and concentration function of a person’s kidneys under conditions of increased pressure of the gas environment, which determines industrial applicability of this method in healthcare.

Claims (1)

A method for assessing the excretory and concentration functions of the kidneys under conditions of increased pressure of the gas medium by evaluating the clinical data obtained after the water load carried out during compression (immersion in a pressure chamber to a depth of 60 m and being there for 1.5 hours) at a dose of 20 ml per kg of body weight, characterized in that they determine the index of functional activity of the kidneys (IFAP) by the formula:
IFAP = 0.1 N ₁ + 0.4 D ₁ + 0.2 D ₂ + 0.1 N ₂ -0.1 K + 0.1 Chl,
where H ₁ - the amount of sodium excreted by the kidneys at 60 minutes after water load (mmol / h);
D ₁ - the amount of urine excreted at 60 minutes after water load (ml / min);
D ₂ - the amount of urine at 90 minutes after water load (ml / min);
N ₂ - the amount of sodium excreted by the kidneys at 90 minutes after water load (mmol / h);
K is the amount of potassium excreted by the kidneys at 90 minutes after water load (mmol / h);
Chl - the amount of chlorine released at 90 minutes after water load (mmol / h);
and with its value of 5.7 or more, the excretory and concentration function of the kidneys is considered satisfactory, and with its value less than 5.7
excretory and concentration function of the kidneys is considered unsatisfactory.