RU2499993C1 - Method of estimating kaliuretic renal function in high pressure gas medium - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: oral load of 10% potassium chloride 0.55 mm per kg of body weight by pressure chamber immersion at a depth of 60 meters and staying there for 1.5 hours is followed by calculating a kaliuretic renal activity index (KRAI) by formula: KRAI=0.2·K₁-0.1·H₁-0.2·D₂-0.2·K₂+0.2·K₃+0.1·X, wherein: K₁ is renal potassium excretion 40 minutes after the water load, mmole/h; H₁ is sodium excretion 60 minutes after the water load, ml/min; D₂ is diuresis 60 minutes after the water load, ml/min; K₃ is renal potassium excretion 60 minutes after the water load, mmole/h; K₃ is renal potassium excretion 90 minutes after the water load, mmole/h; X is chloride excretion 90 minutes after the water load, mmole/h; if the derived value is less than 0, the kaliuretic renal function is considered to be inadequate; the value falling within the range of 0 through 1.0 shows the adequate kaliuretic renal function, while the value of 0.1 and more makes the good function be stated.

EFFECT: more accurate estimation of the human kaliuretic renal function in high pressure gas medium by comparing the clinical findings.

Description

The invention relates to medicine, in particular to the field of aviation, space and marine medicine, can be used in the practice of diving medicine to assess the potassium-urinary function of human kidneys under conditions of exposure to high pressure of the gas environment, by evaluating clinical data.

Known methods for assessing the excretory and concentration functions of human kidneys (using a sample with a load of potassium chloride) in the study of the possibilities 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.), As well as with astronauts before and after space flight (Grigoryev A.I. Functional test with potassium chloride after long space missions / A.I. Grigoryev , VB Noskov // Aerospace and Environmental Engineering dicina. - 1997. - T.31, No. 5. - S.15-19), as well as before and after exposure to increased pressure of the gaseous medium (Kushnirenko N.P. Changes in the functional state of the kidneys with asymptomatic decompression gas formation and decompression sickness (experimental and clinical research): Ph.D. dissertation ... Candidate of Medical Sciences / N.P. Kushnirenko - L., 1980. - 16 pp .; Raymond LW In the weight loss of hiperbaric habitation a disorder of osmoregulation? / L.W. Raymond, N. S. Raymond, V. P. Frattali // Aviat. Space Environ. Med. - 1980. - Vol. 51, No. 4. - P.397-401). In addition, there is a method for evaluating the excretory and concentration functions of human kidneys under conditions of increased pressure of the gas medium (Pat. 2423703 Russian Federation, A. A. Myasnikov, A. Yu. Shitov; 07/10/2011 // Inventions. Utility models: official bulletin - Moscow: FIPS, 2011. - No. 19). At the same time, there are currently no adequate methods for assessing the potassium urethral functions of a person under conditions of exposure to increased pressure of the gaseous medium (in a pressure chamber).

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 the potassium function 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 evaluating the potassium-kidney function of kidneys under conditions of increased pressure of the gas medium by evaluating the clinical data obtained after an oral load of 10% potassium chloride solution, carried out while immersing in a pressure chamber to a depth of 60 meters and staying there for 1 , 5 hours at a dose of 0.55 ml per kg of body weight, characterized in that they determine the index of renal potassium activity (ICAP) by the formula:

ICAP = 0.2 · K ₁ -0.1 · H ₁ -0.2 · D ₂ -0.2 · K ₂ + 0.2 · K ₃ + 0.1 · X,

Where:

K ₁ - the amount of potassium excreted by the kidneys at 40 minutes after water load, mmol / hour;

H ₁ - the amount of sodium released at 60 minutes after water load, ml / min;

D ₂ - the amount of urine excreted at 60 minutes after water load, ml / min;

K ₂ - the amount of potassium excreted by the kidneys at 60 minutes after water load, mmol / hour;

K ₃ - the amount of potassium excreted by the kidneys at 90 minutes after water load, mmol / hour;

X is the amount of chlorine released at 90 minutes after the water load, mmol / hour;

and when its value is less than 0, the potassium urethral function of the kidneys is considered unsatisfactory, with a value from 0 to 1.0 - satisfactory and more than 1.0 - the potassium urethral function of the kidneys is considered good.

The method is implemented as follows:

a method is used to evaluate the potassium-kidney function of the kidneys under conditions of increased pressure of the gaseous medium, by evaluating the clinical data obtained after an oral load of 10% potassium chloride solution carried out while immersing in a pressure chamber to a depth of 60 meters and being there for 1.5 hours in a dose 0.55 ml per kg of body weight, characterized in that they determine the index of potassiumuretic activity of the kidneys (IKAL) according to the formula:

ICAP = 0.2 · K ₁ -0.1 · H ₁ -0.2 · D ₂ -0.2 · K ₂ + 0.2 · K ₃ + 0.1 · X

Where:

To ₁ - the amount of potassium excreted by the kidneys at 40 minutes after water load, mmol / hour;

H ₁ - the amount of sodium released at 60 minutes after water load, ml / min;

D ₂ - the amount of urine excreted at 60 minutes after water load, ml / min;

K ₂ - the amount of potassium excreted by the kidneys at 60 minutes after water load, mmol / hour;

K ₃ - the amount of potassium excreted by the kidneys at 90 minutes after water load, mmol / hour;

X is the amount of chlorine released at 90 minutes after the water load, mmol / hour;

and if its value is less than 0, the potassium urethral function of the kidneys is considered unsatisfactory, with a value from 0 to 1.0 inclusive - satisfactory and more than 1.0 - the potassium urethral function of the kidneys is considered good.

The methodology for carrying out a load of potassium chloride, 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, potassium chloride of room temperature (at a dose of 0.55 ml per kg body weight) is taken for 15-20 minutes. Urine is collected by random urination at 40, 60 and 90 minutes after loading with potassium chloride. 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 potassium-diuretic function of a diver’s kidney under conditions of exposure to increased pressure of the gaseous medium. For this, a diver is placed in a pressure chamber, immersed to a depth of 60 meters and a load of potassium chloride is carried out at a dose of 0.55 ml per kg of body weight. At 40, 60 and 90 minutes after loading with potassium chloride, urine is collected. When evaluating clinical data, the following results were obtained: the amount of potassium excreted by the kidneys at 40 minutes after a water load of 3.26 mmol / hour; the amount of sodium excreted by the kidneys at 60 minutes after a water load of 7.44 mmol / hour; the amount of urine excreted at 60 minutes after a water load of 4.15 ml / min; the amount of potassium excreted by the kidneys at 60 minutes after a water load of 4.32 mmol / hour; the amount of potassium excreted by the kidneys at 90 minutes after a water load of 4.47 mmol / hour; the amount of chlorine released at 90 minutes after a water load of 8.76 mmol / hour. Applying the formula, we calculate the kidney potassium activity index (ICAP):

ICAP = 0.2 · 3.26-0.1 · 7.44-0.2 · 4.15-0.2 · 4.32 + 0.2 · 4.47 + 0.1 · 8.76

ICAP = 0.652-0.744-0.83-0.864 + 0.894 + 0.846

ICAP = -0.046

Consequently, ICAP will be, in this case, less than 0 therefore, the potassium-urethral function of the kidneys of such a diver under conditions of increased pressure of the gaseous medium should be considered unsatisfactory.

For example, it is necessary to evaluate the potassium-diuretic function of a diver’s kidney under conditions of exposure to increased pressure of the gaseous medium. For this, a diver is placed in a pressure chamber, immersed to a depth of 60 meters and a load of potassium chloride is carried out at a dose of 0.55 ml per kg of body weight. At 40, 60 and 90 minutes after loading with potassium chloride, urine is collected. When evaluating clinical data, the following results were obtained: the amount of potassium excreted by the kidneys at 40 minutes after a water load of 4.21 mmol / hour; the amount of sodium excreted by the kidneys at 60 minutes after a water load of 6.92 mmol / hour; the amount of urine excreted at 60 minutes after a water load of 3.86 ml / min; the amount of potassium excreted by the kidneys at 60 minutes after a water load of 3.92 mmol / hour; the amount of potassium excreted by the kidneys at 90 minutes after a water load of 5.23 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 kidney potassium activity index (ICAP):

ICAP = 0.2 · 4.21-0.1 · 6.92-0.2 · 3.86-0.2 · 3.92 + 0.2 · 5.23 + 0.1 · 9.12

ICAP = 0.842-0.692-0.772-0.784 + 1.046 + 0.912

ICAP = 0.552

Therefore, ICAP will, in this case, be more than 0, but less than 1.0 therefore, the potassium urethral function of the kidneys of such a diver under conditions of increased pressure of the gas environment should be considered satisfactory.

For example, it is necessary to evaluate the potassium-diuretic function of a diver’s kidney under conditions of exposure to increased pressure of the gaseous medium. For this, a diver is placed in a pressure chamber, immersed to a depth of 60 meters and a load of potassium chloride is carried out at a dose of 0.55 ml per kg of body weight. At 40, 60 and 90 minutes after loading with potassium chloride, urine is collected. When evaluating clinical data, the following results were obtained: the amount of potassium excreted by the kidneys at 40 minutes after a water load of 5.36 mmol / hour; the amount of sodium excreted by the kidneys at 60 minutes after a water load of 6.17 mmol / hour; the amount of urine excreted at 60 minutes after a water load of 3.81 ml / min; the amount of potassium excreted by the kidneys at 60 minutes after a water load of 3.81 mmol / hour; the amount of potassium excreted by the kidneys at 90 minutes after a water load of 5.89 mmol / hour; the amount of chlorine released at 90 minutes after a water load of 10.07 mmol / hour. Applying the formula, we calculate the kidney potassium activity index (ICAP):

ICAP = 0.2 · 5.36-0.1 · 6.17-0.2 · 3.81-0.2 · 3.81 + 0.2 · 5.89 + 0.1 · 10.07

ICAP = 1.072-0.617-0.762-0.762 + 1.178 + 1.007

ICAP = 1,116

Therefore, ICAP will, in this case, be more than 1.0, therefore, the potassium-diuretic function of the kidneys of such a diver under conditions of increased pressure of the gaseous medium should be considered good.

Our studies with the participation of 45 test volunteers confirm the effectiveness and validity of the method we use. The results of these studies provide detailed specific results.

So, when examining 45 volunteer test subjects in this way, we obtained data indicating that 8.9% of the examined (4 people) showed unsatisfactory potassium-kidney function of the kidneys, and 71.1% of the examined (32 people) showed satisfactory, and 20% (9 people) have good excretory and concentration function of the kidneys under conditions of exposure to high pressure of the gas environment.

Moreover, if we compare our survey results 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. ... cand. medical sciences / N.P. Kushnirenko - L., VMedA, 1980. - 16 pp.), 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 research The study was carried out before and after (and not during) exposure to increased pressure of the gaseous medium, which reduces the accuracy of the study. Nevertheless, the author obtained results similar to ours when examining 27 divers (subjects), which showed that 2 of them (7.4%) showed impaired renal potassium function, and the rest 25 (92.6 %) such violations were not detected.

From this it follows that when using the method we offer, the accuracy of determining the functions of the kidneys is increased, namely, the number of people with detectable potassium kidney function is increased. In the studies of N.P. Kushnirenko of such individuals - 7.4%, and in our studies of such subjects - 8.9%. In addition, in our studies, 71.1% of the examined (32 people) showed satisfactory potassium function of the kidneys, which is a transition between good and poor potassium function of the kidneys. This suggests a more accurate identification of individuals with different potassium-kidney function using our proposed method.

Thus, by evaluating the clinical data obtained after the load carried out during compression (immersion in the pressure chamber), the person providing medical support for diving descents can accurately determine the potassium urethral function of a person’s kidneys under conditions of increased pressure of the gas environment, which determines the industrial applicability of this method to health care.

Claims (1)

A method for evaluating the potassium-urinary function of the kidneys under conditions of increased pressure of the gaseous medium by evaluating the clinical data obtained after an oral load of a 10% solution of potassium chloride, carried out during immersion in a pressure chamber to a depth of 60 m and being there for 1.5 hours in a dose 0.55 ml per kg of body weight, characterized in that they determine the index of renal potassium activity (ICAP) by the formula:
ICAP = 0.2 · K ₁ -0.1 · H ₁ -0.2 · D ₂ -0.2 · K ₂ + 0.2 · K ₃ + 0.1 · X,
Where
To ₁ - the amount of potassium excreted by the kidneys for 40 min after water load, mmol / h;
H ₁ - the amount of sodium released for 60 min after water load, ml / min;
D ₂ - the amount of urine excreted for 60 min after water load, ml / min;
K ₂ - the amount of potassium excreted by the kidneys at the 60th minute after the water load, mmol / h;
K ₃ - the amount of potassium excreted by the kidneys at the 90th minute after the water load, mmol / h;
X is the amount of chlorine released at the 90th minute after the water load, mmol / h;
and with its value less than 0, the potassium urethral function of the kidneys is considered unsatisfactory, with a value from 0 to 1.0 inclusive - satisfactory, and more than 1.0, the potassium urethic function of the kidneys is considered good.