• Natalia Maksymchuk Department of Anesthesiology and Reanimatology, Higher State Educational Institution of Ukraine «Bukovinian State Medical University»
  • Victor Konovchuk Department of Anesthesiology and Reanimatology, Higher State Educational Institution of Ukraine «Bukovinian State Medical University»
Keywords: endogenous intoxication, L-arginine, kidneys


INTRODUCTION: Kidney injuries in the endogenous intoxication syndrome of septic genesis necessitates nephroprotective therapy.

OBJECTIVES: The purpose of the work was to determine the effect of the combined use of sorbilact and L-arginine on the detoxification function of kidneys and the levels of separate indicators of endogenous intoxication syndrome.

METHODS: Detoxication function of kidneys have been studied in patients of the following groups.

The first group (І, control) consisted of 31 patients with systemic inflammatory response syndrome (SIRS, ICD-10: R-65.2).

The second group (ІІ) consisted of 22 patients with endogenous intoxication syndrome who were treated according to Surviving Sepsis Campaign 2016 (standard therapy) [9].

The third group (IІІ) consisted of 24 patients with endogenous intoxication syndrome, who received sorbilact in addition to standard therapy.

The fourth group (IV) consisted of 21 patients with endogenous intoxication syndrome who received sorbilact and L-arginine in addition to standard therapy.

Sorbilact infusion to patients of the III and IV groups was performed at a rate of 6-7 ml/kg body weight, intravenously dripping at a rate of 7-8 ml/min. After the end of the infusion of sorbilact, patients of the IV group were infused with 4.2% solution of L-arginine (“Tivortin” intravenous drip according to the instructions). Data was obtained and results gathered on the application of drugs in the period of stabilization (according to the state of regulation of water and ion balance by kidneys) of endogenous intoxication syndrome (fourth day of drugs’ application).

As a single-celled receptor-effector system, a Paramecium caudatum culture was used. Low Molecular Weight Protein (LMWP) concentrations in blood and urine were determined using a modified method.

RESULTS: Endogenous intoxication syndrome in patients of II-IV groups was characterized by the following indicators: total blood plasma toxicity (Pt) in the II group was 151 ± 6.4 toxicity units / ml, in group ІІ -147 ± 6.2 toxicity units / ml and 130 ± 6.6 toxicity units / ml in group IV. LMWP concentration in group ІІ was 0.61 ± 0.03 conditional units / ml, in ІІІ group - 0.52 ± 0.029 conditional units / ml and 0.43 ± 0.037 conditional units / ml in group IV.

The following clearance detoxification function characteristics are established, which are integral indicators of its kidneys performance. Clearance of toxic substances (Ct) in the I group was 2.7 ± 0.06 ml / min, in the II group 2.1 ± 0.09 ml / min, in the III group - 2.9 ± 0.07 ml / min and 3.8 ± 0.08 ml / min in the IV group. Clearness of LMWP (C LMWP) in the 1st group was 15.91 ± 0.69, ml / min, in the II group 14.65 ± 0.79 ml / min, in group ІІІ - 25.61 ± 0.71 ml / min and 37.31 ± 0.7 ml / min in group IV.

CONCLUSION: Under conditions of septic endotoxemia in the period of stabilization of endogenous intoxication syndrome optimization of standard therapy with the use of sorbilact and L-arginine is accompanied by the activation of the kidneys’detoxication function according to their clearance characteristics.


Ershov, I., Pleteneva, T.V., Siniuk, T.F., & Dolgopolova, V.A. (1999). Determination of growth parameters of the Paramecium caudatum test-system during standardization of studies of biological activity of chemicals. Biulleten' eksperimental'noi biologii i meditsiny [Bulletin of Experimental Biology and Medicine], 127(6), 717.

Ferguson, M.A., & Waikar, S.S. (2012). Established and emerging markers of kidney function. Clinical chemistry, 58(4), 680-689.

Kamyshnikov, V.S. (2009). Spravochnik po kliniko-biokhimicheskim issledovaniyam i laboratornoy diagnostike [Reference book on clinical and biochemical research and laboratory diagnostics]. MEDpress-inform, 568-663.

Konovchuk, V.M., Andruschak, A.V. & Maksimchuk, N.O. (2016). Pat. 112508 Ukrayina, MPK G01N 33/48. Sposib otsinki perebigu endogennoyi intoksikatsiyi [Pat. 112508 Ukraine, MPK G01N 33/48. Method of evaluation of the course of endogenous intoxication] Patent UA, n. u201604697, 1-2.

Mayr, F.B., Yende, S., & Angus, D.C. (2014). Epidemiology of severe sepsis. Virulence, 5(1), 4 11.

Neirynck, N., Eloot, S., Glorieux, G., Barreto, D.V., Barreto, F.C., Liabeuf, S., & Vanholder, R. (2012). Estimated glomerular filtration rate is a poor predictor of the concentration of middle molecular weight uremic solutes in chronic kidney disease. PloS one, 7(8), e44201.

Nichitailo, M.E. (2011). Application of Sorbilact in the treatment and prophylaxis of postoperative intestinal paresis after reconstructive operations on the biliary ducts. Klinichna khirurhiia [Clinical surgery], 6: 30–31.

Pavliak, A. (2011). Predictive value of test with procalcitonin in diagnostics of endogenous intoxication severity in extended purulent peritonitis. Clinical surgery, (4), 31-34.

Rhodes, A., Evans, L.E., Alhazzani, W., Levy, M.M., Antonelli, M., Ferrer, R., & Rochwerg, B. et al. (2017). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive care medicine, 43(3), 304-377.

Senbel, A.M., Omar, A.G., Abdel-Moneim, L.M., Mohamed, H.F. & Daabees, T.T. (2014). Evaluation of l-arginine on kidney function and vascular reactivity following ischemic injury in rats: protective effects and potential interactions. Pharmacological Reports, 66(6): 976–983.

Yurieva, E.A., Sukhorukov, V.S., Vozdvijenskaia, E.S., Novikova, N.N., & Dlin, V.V. (2015). The endogenous intoxication in pathogenesis of nephropathies. Klinicheskaia laboratornaia diagnostika [Clinical laboratory diagnostics], 60(3), 22-25.

Zarbock, A, John S, Jorres A, & Kindgen-Milles D. (2014). Neue KDIGO-Leitlinien zur akuten Nierenschädigung [New KDIGO guidelines on acute kidney damage]. Anaesthesist, 63(7): 578–588.