THERAPEUTIC

APHERESIS OF ACUTE
RENAL FAILURE
V.A.Voinov

I.P.Pavlov First Saint-Petersburg State

Medical University
Saint-Petersburg, Russia
 The acute renal failure quite often
accompanies acute inflammatory
diseases of chest and belly cavities
organs, severe injuries and burns,
an eclampsia and septic shock.

Is the main reason for multiple organ

insufficiency
and a lethality to 80%.
Acute renal failure

Is followed :

Respiratory distress syndrome

Acute liver failure

Toxic encephalopathy

Toxic myocardiopathy
 PATHOGENESIS
OF THE ACUTE RENAL FAILURE

ENDOTOXICOSIS
with toxic damage of a kidney parenchyma.

Permeability violations of a vessels endothelium

result to perivascular hypostasis
with decrease in a kidney blood-circulation,
glomerular filtration, to a canaliculus necrosis,
oligo-anury.
 Pathogenesis of an endotoxicosis

1. Bacterial endo- and exotoxins.

2. Mediators of an inflammation, tissue hypoxia and
destructions
3. Excitement of a proteolysis.
4. Initiation of reactions of lipids peroxidation
5. Depression of an antioxidant protection system .
6. Middle molecular oligopeptides.
7. Lysosomal enzymes.
 Endotoxicosis consequences

• 1. Violation of permeability of vessels endothelium

membranes.

• 2. Hypoproteinemia, hypovolemia, tissue hypoxia.

• 3. Toxic interstitium edema

• 4. DIC-syndrome
• 5. Multiple organ failure.
 Severity of an acute renal failure
(Bellomo R. et al., 2004)

Degree Criterion Level of

average
ARF ARF molecules

Group of risk Less than 0,5

350,0
ml/kg in 6 hours 22,5
Damage of kidneys Less than 0,5 ml/kg
in 12 hours 644,2
45,3
Failure Less than 0,3 ml/kg
in 24 hours or 880,1
52,6
anury in 12 hours
 Risk of a deadly outcome

• In group of "risk"– 13%

• In group of «damage» – 40%
• In group of «failure» – 80%

(Stainvall I. et al., 2008)

 Therapeutic apheresis
of acute renal failure
Operation Effects
1 1. Removal of toxic products
Plasma
exchange 2. Restoration ("prosthetics") of system
of immune protection
(immunoglobulins, complement,
opsonins of donor plasma)

3. Restoration of the coagulation system

at the DIC-syndrome (fibrinogen and
other coagulation factors )

4. Fuller restoration of "a biochemical

homeostasis" and blood rheology
 Therapeutic apheresis
of acute renal failure
2
Hemosorption 1. Detoxification

2. Binding and removal of microbs (both

live, and killed)

3. Removal of the leukocytes overloaded

with microbes and detritus (prevention of a
syndrome of "regional standing of
leukocytes")

4. Removal of the excited platelets and their

microaggregats (prevention
of the DIC syndrome)
Treatment methods at varying severity of ARF
(Number of patients)

Degree Traditional Hemosorption ECMO Total

treatment or Plasma
of ARF exchange + HS

Risk 52 47 99
group

Damage 15 39 54
of kidneys
Failure 11 11
 Treatment duration
at different methods of therapy of ARF
(bed-dais)

Degree Traditional Detoxificatio

only

40,3 ± 3.3 28,0 ± 1.5

Risk group
 Lethality levels
at different severity of ARF
depending on therapy methods
ARF Traditiona Detoxification ECMO
l only
degree
Risk 0 0
group
Damage 73,33% 31,03%
of kidneys
Failure 36,3%
 ADVANTAGES OF THE
MEMBRANE PLASMA
EXCHANGE ON THE DEVICE
“HEMOFENIX"
• The small filling volume (to 70 ml)

• Portability

• Possibility of carrying out a membrane plasma

exchange even at unstable haemo dynamics

• Possibility of carrying out a membrane plasma

exchange against the DIC-syndrome

•
 HEMO FILTRATION
It is necessary not to delete excessive
water from an organism and to
eliminate the reasons its delays.
It is necessary not symptomatic,
and pathogenetic treatment.
Removal of a toxic press from kidneys at
hemosorption or a plasma exchange
promotes faster restoration of their
own function.
Acute lymphoid leukosis, stem cells transplantation,
sepsis,
multiple organ insufficiency
On the way to recovery
 Conclusion
• 1.Endotoxicosis
is the leading reason of ARF

• 2.Detoxification
is necessary in a complex of medical measures

• 3. Plasma exchange
is the most effective method of a detoxification
 Thank you
for your attention