arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2019-25-6-674-681arthyper-1774Research ArticleОБЗОРREVIEWРенальная дисфункция как осложнение острого повреждения головного мозгаRenal dysfunction as a complication of acute brain damagehttps://orcid.org/0000-0002-2957-410XБасанцоваН. Ю.BasantsovaN. Yu.

Басанцова Наталия Юрьевна — ассистент кафедры факультетской терапии, младший научный сотрудник лаборатории мозаики Аутоиммунитета

Университетская наб., д. 7–9, Санкт-Петербург, 199034

Natalia Yu. Basantsova, MD, Assistant, Department of Internal Diseases, Junior Researcher, Mosaic Laboratory of Autoimmunity

7–9 Universitetskaya embankment, St Petersburg, 199034 

fromrussiawithlove_nb@mail.ruШишкинА. Н.ShishkinA. N.

Шишкин Александр Николаевич — доктор медицинских наук, профессор, заведующий кафедрой факультетской терапии

Санкт-Петербург

Aleksandr N. Shishkin, MD, PhD, DSc, Professor, Head, Department of Internal Diseases

St Petersburg

alexshishkin@bk.ruТибекинаЛ. М.TibekinaL. M.

Тибекина Людмила Михайловна — доктор медицинских наук, профессор кафедры нейрохирургии и неврологии

Санкт-Петербург

Lyudmila M. Tibekina, MD, PhD, DSc, Professor, Department of Neurosurgery and Neurology

St Petersburg

lmtibekina@mail.ruЭрманМ. В.ErmanM. V.

Эрман Михаил Владимирович — доктор медицинских наук, профессор, заведующий кафедрой

Санкт-Петербург

Mikhail V. Erman, MD, PhD, DSc, Professor, Head, Department of Pediatrics

St Petersburg

erman_mv@hotbox.ruВоловниковаВ. А.VolovnikovaV. A.

Воловникова Виктория Александровна — кандидат медицинских наук, доцент кафедры факультетской терапии

Санкт-Петербург

Viktoriya A. Volovnikova, MD, PhD, Associate Professor, Department of Internal Diseases

St Petersburg

victoriaav@mail.ruСеменоваО. И.SemenovaO. I.

Семенова Ольга Ивановна — кандидат медицинских наук, заведующая отделением эндокринологии

Санкт-Петербург

Olga I. Semenova, MD, PhD, Head, Endocrinology Department

St Petersburg

olgasemenova17@gmail.comТяпкинаВ. С.TyapkinaV. S.

Тяпкина Виктория Сергеевна — врач функциональной диагностики

Санкт-Петербург

Viktoriya S. Tyapkina, MD, Functional Diagnostics Physician

St Petersburg

vikatyapkina3@rambler.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Санкт-Петербургский государственный университет»РоссияSaint-Petersburg State UniversityRussian FederationСанкт-Петербургское государственное бюджетное учреждение здравоохранения «Городская Александровская больница»РоссияAlexandrovskaya City HospitalRussian Federation201904072019256674681Copyright © Басанцова Н.Ю., Шишкин А.Н., Тибекина Л.М., Эрман М.В., Воловникова В.А., Семенова О.И., Тяпкина В.С., 20202020Басанцова Н.Ю., Шишкин А.Н., Тибекина Л.М., Эрман М.В., Воловникова В.А., Семенова О.И., Тяпкина В.С.Basantsova N.Y., Shishkin A.N., Tibekina L.M., Erman M.V., Volovnikova V.A., Semenova O.I., Tyapkina V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/1774

Возможность развития заболеваний внутренних органов в результате повреждения головного мозга впервые описана более ста лет назад, однако роль острого нарушения мозгового кровообращения и черепно-мозговой травмы (ЧМТ) в развитии ренальной дисфункции изучена недостаточно. До 25 % больных с субарахноидальным кровоизлиянием и ЧМТ в течение первых 7 дней от начала заболевания страдают от развития острого повреждения почек (ОПП). К другим важным проявлениям цереброренальных нарушений можно отнести формирование центрального сольтеряющего синдрома и синдрома неадекватной секреции вазопрессина, проявляющихся гипонатриемией, но различными в патогенетических аспектах и клинической тактике. Помимо этого, пациенты с обширными поражениями головного мозга характеризуются гиперсимпатикотонией с высвобождением провоспалительных цитокинов, таких как фактор некроза опухоли α (ФНОα), интерлейкин-6 (ИЛ-6) и интерферон γ (ИФНγ), что также вносит свой вклад в развитие ОПП. Изучение особенностей проявления церебро-ренального синдрома на фоне остро развившейся церебральной патологии способствует своевременной диагностике данного осложнения, определению лечебно-диагностической тактики (осторожное и ограниченное использование нефротоксических антимикробных препаратов, осмотических диуретиков и внутривенного контрастирования при нейровизуализации) и прогноза заболевания.

The development of internal disease as a result of the brain damage was first described more than one hundred years ago, but the role of acute stroke and traumatic brain injury (TBI) in the progression of renal dysfunction has not been studied enough. Within the first 7 days after onset of subarachnoid hemorrhage or TBI, up to 25 % patients develop acute kidney injury (AKI). Other important manifestations of cerebro-renal disorders include central salt-wasting syndrome and syndrome of inappropriate antidiuretic hormone secretion, that both manifest by hyponatremia, but differ in pathogenesis and clinical tactics. In addition, patients with extensive brain lesions are characterized by excessive sympathetic activation with the release of proinflammatory cytokines, such as tumor necrosis factor α (TNFα), interleukin-6 (IL-6) and interferon γ (IFNγ), which also contributes to the development of AKI. Investigation of the main features of cerebro-renal syndrome will contribute to the early diagnostics, choice of the appropriate management strategy (careful and limited use of nephrotoxic antimicrobial drugs, osmotic diuretics and intravenous contrasting in neuroimaging) and to the improvement of the prognosis.

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The authors declare that there are no conflicts of interest present.