[Plasmapheresis in the complex therapy of patients with acute pyelonephritis and urologic infection].

In 19 urological patients with pyointoxication and urosepsis 49 plasmaphereses for the purpose of detoxication were performed in the complex with other therapeutic measures. The causes for the pyoseptic complications were as follows: urolithiasis in connection with acute pyelonephritis, acute pyelonephritis (among others in pregnancy, cystic renal dysplasia, carcinoma of the urinary bladder), renal insufficiency in the terminal stage. The treatment of these diseases with haemodialysis and haemoperfusion was complicated by a pyosepsis. Two methods of the plasmapheresis were used: the intermitting plasmapheresis with use of a refrigeration centrifuge K-70 (GDR) and the permanent membrane plasma separation with the device A2008 RG of the firm "Fresenius" (FRG). The plasma perfusion was experimentally proved and in 5 cases used on 5 columns with activated charcoal. The efficacy of the plasmapheresis and the plasma perfusion was apart from the clinical condition judged according to the values of the middle molecules in the blood, or urea, creatinine and the normalisation of the hypoproteinaemia as well as of the humoral immunity. To this are added the increase of diuresis, the normalisation of the haematological parameters and the bacteriological findings of blood and urine. Furthermore, several pathogenetic mechanisms of the positive effect of the plasmapheresis were analysed (mechanic removal of bacteria and their toxins, effect of "deplasmation" with tissue dehydration, improvement of the functional state of the kidneys within the first 3-4 days: reduction of the azotaemic intoxication, the DWS-syndrome, improvement of the rheological properties of the blood and of the microcirculation, increase of the antitoxic function of the liver).(ABSTRACT TRUNCATED AT 250 WORDS)