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[The treatment of the disseminated intravascular coagulation syndrome in urosepsis patients].

The hemostasis system has been assessed in 42 patients in the age range of 18 to 60 years with secondary urosepsis. All patients had been operated for upper urinary tract obstruction or suppurative destructive renal and retroperitoneal lesions. Hemostasis was examined before and after the operation using coagulation screen. Middle-molecular peptides were assayed in the patients before and after plasmapheresis. Revealed hemostatic disorders were treated with heparin, antibacterial agents and infusion of fresh frozen plasma. Plasmapheresis is indicated in patients who are unresponsive to antibacterial therapy and surgical drainage of suppurative lesions. Postoperative hemostatic disorders presented as both hypo- and hypercoagulation, with thrombinemia in most cases. The patients with urosepsis showed latent hypercoagulation phase of DIC. By removing acute phase proteins, plasmapheresis prevented fibrinolytic failure. Exfusion of small volumes of plasma did not affect antithrombin III levels and produced a coagulation-anticoagulation balance. Declining levels of middle-molecular peptides after plasmapheresis were indicative of detoxication, presenting as better clinical status and improvement of laboratory findings.