Modulation of the Surgical Stress Response in the Early Postoperative Period After Radical Nephrectomy as the Core of the Nephroprotective Strategy

Background: One of the most important problems in medicine today is prevention of chronic kidney disease development and progression in patients who underwent radical nephrectomy. Surgical removal of one kidney initiates adaptive functional and morphological restructuring in the other one. Changes in the condition of the remaining kidney have been sufficiently detailed, whereas systemic metabolic disorders induced by surgical stress, which occur during remodeling of the kidney parenchyma and functional restructuring of the kidney, remain overlooked. Both local processes of recovery, adaptation, and compensation in the remaining kidney and the endocrine and metabolic response as a whole should be examined. Only adequate pharmacological modulation of the endocrine-metabolic stress response to surgery will contribute to providing optimal conditions for proper anatomical and functional adaptation of the remaining kidney and preventing kidney diseases. Objective: To justify an algorithm for patient management in the early postoperative period after radical nephrectomy that minimizes risks of dysfunction of the remaining kidney. Materials and methods : We examined 2 groups of patients who underwent radical nephrectomy, one of which additionally received a synthetic adaptogen, Selank, for 2 weeks after the surgery. Results: The patients additionally receiving Selank had significantly better results in terms of the dynamics of recovery initiated by surgery: disorders of biogenic amine metabolism, psycho-emotional disorders, vegetative-vascular disorders, and glomerular filtration rates. Conclusions: The surgery is a strong stressor that disrupts adaptive mechanisms both at systemic and organ levels. The combination of these pathological processes ultimately results in an overload of the compensatory capabilities of the remaining kidney, which requires pharmacological support from day 1 after surgery. Given the mechanism of disrupted adaptive reactivity due to neuro-endocrine regulation disorders, synthetic adaptogens based on regulatory peptides may be the best solution.