Pathogenetic features of functional disorders in the remaining kidney during the early postoperative period of radical nephrectomy

Relevance. Despite the widespread introduction of organ-preserving operations into urological practice, the number of radical nephrectomies has continued to increase. The results of modern research show that the initial stages of diseases of the remaining kidney are already formed at the earliest possible time after radical nephrectomy; therefore, adequate management of the postoperative period is a key factor in the prevention of diseases of the single kidney. However, this approach should be based on a detailed understanding of the mechanisms of adaptive restructuring of the body, which have a key effect on the morphology and function of a single kidney.

Objective. To study the features of adaptive body reactions and the dynamics of the functional state of a single kidney following radical nephrectomy.

Materials and methods. In the early postoperative period, the clinical and laboratory parameters of 85 patients who underwent radical nephrectomy for renal cell carcinoma in the T2-T3N0M0 stage were studied. The control group comprised 25 patients who underwent similar operations for the same indications within a period of 1.5–12 months. The metabolism of adrenaline, histamine, and serotonin, indicators of psychological and emotional states, vegetative-vascular status, and nitrogen excretion and filtration functions of the remaining kidney were studied.

Results. Radical nephrectomy, as well as the period of conscious expectation, is the cause of a stress syndrome that occurs due to an imbalance of the studied biogenic amines, accompanied by disorders of psychological and emotional health and vegetative-vascular disorders observed at least during the 2 weeks of the postoperative period. In addition, the filtration capacity of a single kidney is impaired, and it persists for 14 days at follow-up. Correlation analysis made it possible to establish reliable links between the imbalance of biogenic amine and anxiety levels and the severity of autonomic vascular disorders, which adversely affect kidney filtration.

Conclusions. The results of this study indicate the need for pharmacological subsidies during the postoperative period of radical nephrectomy, which makes it possible to offset the negative impact of stress syndrome on the outcome of surgical treatment.

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