CC BY
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УДК 616.61-002.8-036.65-053.2
Noraliev I.
Department of Pediatrics Andijan State Medical Institute
EVALUATION OF CLINICAL AND IMMUNOLOGICAL CRITERIA OF CHRONIC PYELONEPHRITIS IN CHILDREN
Resume: In recent decades, there has been an unfavorable growth trend in the pediatric population of recurrent pyelonephritis, formed against the background of obstructive uropathy and dysmetabolic diseases. Patients with chronic pyelonephritis (CP) are still at high risk of developing chronic renal failure and a decrease in the quality of life in childhood, which attracts the attention of many researchers to this problem.
This article provides information on the separation of two variants of the course in the clinical form of chronic pyelonephritis: the presence of latent and recurrent forms, the absence of clinical manifestations with atypical symptoms of chronic pyelonephritis, as well as the fact that the presence of the disease can only be detected by laboratory and instrumental examination methods, the recurrence of chronic pyelonephritis
Key words: pyelonephritis, remission, quality of life ofpatients, children's
age.
Relevance. In recent years, new data have been obtained indicating the pathogenetic role of endotoxins, the adhesion of microorganisms, the structural and functional state of cytomembranes, as well as some immunological and immunogenetic mechanisms of the formation of microbial-inflammatory process in the urinary system [2,4].
At the same time, despite a large number of studies devoted to various aspects of the etiology and immunopathogenesis of urinary system infection (IMS), there are still many unresolved issues in this problem [1,5].
Thus, to date, such issues as the intensity of phagocytosis, differentiation of T-lymphocyte subpopulations, the nature of the cytokine response, as well as allelic polymorphism of HLA-system genes that influence the formation, course, prognosis and outcome of the inflammatory process in the kidneys remain insufficiently studied and debatable [3].
Thus, the study of poorly understood pathogenetic mechanisms of the primary response of the immune system to urinary tract infection, the identification of individual, genetically determined features of the immune response in the dynamics of the pathological process in the kidneys, will allow us to study new aspects of the etiopathogenesis of PN, which are far from being resolved [6].
The purpose of the study. Identification of clinical, immunological and immunogenetic criteria for the activity and chronization of various forms of PN in children in order to early diagnose, predict the course of the disease and optimize pathogenetic treatment.
Material and methods of research. To solve the tasks, a clinical, laboratory, instrumental and immunogenetic examination of 104 children diagnosed with PN aged 3 to 16 years living in the city of Andijan was carried out. The comparison group consisted of 28 children of the same age who belonged to health groups I-II, in whose anamnesis during the last two months there were no indications of previous illnesses and preventive vaccinations.
The results of the study. The clinical and paraclinical characteristics of PN in children of both age groups at the present stage are manifested by various degrees of activity of the inflammatory process, has a predominantly chronic course, secondary character due to the presence of combined kidney damage at the level of tubulointerstitial tissue, obstructive uropathies that contribute to urohemodynamic disorders and chronization of the disease. Intoxication, abdominal and dysuric syndromes were most often detected in children of the younger age group, while dysuric and pain syndromes prevailed in the older age group. Urinary syndrome was registered with the same frequency in different variants of the course of the disease in children of both age groups.
The immune status in children with PN is characterized by a violation of the main links of immunogenesis - the processes of activation, proliferation and effective functions of the immune system. The revealed divergence of these changes depends on the initial state of the immune system, against which the pathological process in the kidneys develops.
A feature of the immune status in the acute course of PN is its more pronounced violations in the primary form of PN, which confirms the leading role of immune system dysfunction in its genesis. In the chronic course of the disease, the degree of severity of changes in the immune system is more clearly traced in the secondary form of PN against the background of morphofunctional changes in the MVS, contributing to the chronization of the disease.
The minimal degree of activity of the inflammatory process in combination with changes in the immune status of children with PN in the form of impaired stages of maturation, processes of differentiation and activation of immunocompetent cells, increased readiness of lymphocytes for apoptosis, as well as violations of effector and elimination functions of the immune system are an unfavorable prognostic sign predisposing to a prolonged, recurrent course of the disease.
Conclusion. Conducting a comprehensive assessment of the immune status in children with PN, regardless of the clinical variant of its course, will allow a differentiated approach to the appointment of immunocorrecting drugs that increase the effectiveness of basic therapy in order to prevent further progression of the disease and improve the quality of life of children with PN.
The presented differences in immunogenetic changes depending on the age of patients, the clinical variant of PN, the nature of its course and the morphofunctional state of the kidneys can be used to clarify the diagnosis, prognosis of the disease and the appointment of pathogenetic treatment.
Determination of the specificity of the NA system can be used both at the level of population studies, in groups at increased risk of developing PN, as well as at the stages of early diagnosis of the disease and to determine the individual prognosis of the disease.
References:
1. Ignatova M.S. Pediatric nephrology: A guide for doctors. 3rd ed., reprint. and additional M.: LLC "Medical Information Agency", 2011. 696 p.
2. Kozlovsky A.A. Pyelonephritis in children (literature review) // Problems of health and ecology. 2009. pp. 60-66.
3. Nesterenko O.V., Goremykin V.I., Meshcheryakova E.E., Elizarova S.Yu., Sidorovich O.V. Violation of urodynamics in children with secondary chronic pyelonephritis // Modern problems of science and education. 2013. No. 2.
4. Papayan A.B., Savenkova N.D. Clinical nephrology of childhood. St. Petersburg, 2008. 600 p.
5. Pekareva N.A. Pathogenetic features of the inflammatory process in remission and exacerbation of secondary chronic pyelonephritis in children: abstract. dis.... doctor of medical Sciences. Novosibirsk, 2011. 53 p.
6. Erman M.V. Nephrology of childhood. St. Petersburg. 2nd ed., 2010. 683 p.
