OPTIMIZATION OF REHABILITATION OF PATIENTS WITH ACUTE RENAL FAILURE OF OBSTETRICAL ETIOLOGY IN THE SOUTHERN ARAL RIVER

Acute renal failure of obstetric etiology (ARF) remains one of the main causes of maternal mortality and morbidity in developing countries. The unfavorable environmental conditions of the South Aral Sea region aggravate the severity of renal damage and slow down the recovery process. This study included 108 patients with ARF on the background of obstetric pathology (hemorrhage, preeclampsia/eclampsia, sepsis). It was found that environmental factors (pollution of soil and water with heavy metals) play an important role in the development and progression of nephropathy. Patients were randomized into two groups: the main group (n=54) received a two-stage rehabilitation program: 1) nephroprotective therapy (acetylsalicylic acid, pentoxifylline, L-arginine); 2) individualized hydration and diet regimen; 3) endothelial dysfunction control and psychocognitive program. The control group (n=54) received standard recommendations. The optimized program increased the rate of complete or partial recovery of renal function by 25% (p<0.01) at 3 months, improved quality of life indicators (SF-36) by 42% (p<0.001), and reduced the risk of developing chronic kidney disease (CKD) by 30%. Incomplete functional recovery, proteinuria, arterial hypertension, and climatic and geographical unfavorable conditions were found to be independent prognostic factors for the development of CKD. A systematic rehabilitation algorithm adapted to the South Island region was proposed.

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