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[...]. The aim of the study To evaluate the frequency, causes and outcomes of severe acute kidney injury and to establish the predictive factors of the mortality of the patients. The objectives of the study 1. To analyse the frequency of severe acute kidney injury requiring renal replacement therapy and the demographic and clinical data of the examined patients and their change during the period of 5 years. 2. To analyse the causes of severe acute kidney injury and their change during the period of 5 years 3. To evaluate the frequency of the methods of renal replacement therapy applied for the treatment of severe acute kidney injury and its change during the period of 5 years and to establish the treatment of renal replacement therapy expenses. 4. To analyse the outcomes of the patients of the investigated group and their change during the period of 5 years. 5. To establish the significant predictive factors related with higher risk of mortality of the patients. 6. To evaluate the volemia of the patients treated in intensive care unit due to severe acute kidney injury according to the central venous pressure and the state of hydration by the method of bioimpedance and to establish the frequency of hypervolemia and hyperhydration and their connection with the outcomes of severe acute kidney injury. [...].

Background and objective: Acute kidney injury (AKI) is a common and potentially serious postoperative complication after cardiac surgery, and it remains a cause of major morbidity and mortality. The aim of our study was to assess the prognostic illness severity score and to estimate the significant risk factors for poor outcome of patients with AKI requiring renal replacement therapy (RRT) after cardiac surgery. Materials and methods: We retrospectively analyzed data of adult (&gt, 18 years) patients (n = 111) who underwent open heart surgery and had developed AKI with need for RRT. Prognostic illness severity scores were calculated and perioperative risk factors of lethal outcome were assessed at the RRT initiation time. We defined three illness severity scores: Acute Physiology and Chronic Health Evaluation (APACHE II) as a general score, Sequential Organ Failure Assessment (SOFA) as an organ failure score, and Liano score as a kidney-specific disease severity score. Logistic regression was also used for the multivariate analysis of mortality risk factors. Results: Hospital mortality was 76.5%. More than 7% of patients remained dialysis-dependent after their discharge from the hospital. The prognostic abilities of the scores were assessed for their discriminatory power. The area under the receiver-operating characteristic (ROC) curve of SOFA score was 0.719 (95% CI, 0.598–0.841), of Liano was 0.661 (95% CI, 0.535–0.787) and 0.668 (95% CI, 0.550–0.785) of APACHE II scores. From 16 variables analyzed for model selection, we reached a final logistic regression model, which demonstrated four variables significantly associated with patients' mortality. Glasgow coma score &lt, 14 points (OR = 3.304, 95% CI, 1.130–9.662, P = 0.003), mean arterial blood pressure (MAP) &lt, 63.5 mmHg (OR = 3.872, 95% CI, 1.011–13.616, P = 0.035), serum creatinine &gt, 108.5 µmol/L (OR = 0.347, 95% CI, 0.123–0.998, P = 0.046) and platelet count &lt, 115 × 109/L (OR = 3.731, 95% CI, 1.259–11.054, P = 0.018) were independent risk factors for poor patient outcome.Conclusions: Our study demonstrated that SOFA score estimation is the most accurate to predict the fatal outcome in patients with AKI requiring RRT after cardiac surgery. Lethal patient outcome is related to Glasgow coma score, mean arterial blood pressure, preoperative serum creatinine and postoperative platelet count.

Renal tubular acidosis (RTA) more frequently develops in case of chronic diseases of inflammatory-immunological origin. RTA is well known to be associated with chronic liver disease (CLD), with nephrolithiasis, common cases of RTA occur among cancer patients. Abnormalities in the expression or function of band 3 in cell membrane may play a role in the pathogenesis of RTA. Cl-/HCO3- anion exchanger (AE2) is an isoform of band 3 protein, which is expressed in cell membranes of organs such as liver cells and kidney endothelium. There are reports on downregulated AE2 immunoreactivity in the liver of patients with chronic liver diseases and in the kidney tubular tissue of patients with RTA. The proteolytic damage of cell membrane band 3 in tissues could be related to inflammatory-immunological processes. Another important factor able to disturb the band 3 function is medicinal products used in the treatment of certain pathologies. The active substance of a drug itself may have a direct effect on this protein or trigger a pathological process. In such cases ADR can take place and may be evaluated as such. Acid-base disturbances, notably metabolic acidosis, are a serious complication of drug treatment. Reduced AE2 expression or its changed activity (congenital or acquired) could be related with alterations of intracellular pH. This could lead to antigenic changes and autoimmunity. The derangement of band 3 function in organ cell membrane could act as a factor which creates an “acidotic environment” for organ cells. Such circumstances could be the reason for unsuccessful treatment or determine resistance of tumor treatment. The understanding of the mechanisms of RTA development, early diagnostics, and knowledge of the drugs that can cause RTA, are of particular practical significance.