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Ahmedjanova Nargiza, PhD., in medicine, department of pediatrics № 3 and medical genetics Samarkand State Medical Institute, E-mail: [email protected] Akhmedzhanov Ismail Аhmedjanovich, professor, department of pediatrics surgery, Samarkand State Medical Institute Melievа Gulsara, PhD., in medicine, department of pediatrics № 3 and medical genetics, Samarkand State Medical Institute Mamatkulova Dilrabo, PhD., in medicine, department of pediatrics № 3 and medical genetics, Samarkand State Medical Institute Bakhranov Sherzod, assistant, department of pediatrics № 3 and medical genetics, Samarkand State Medical Institute
OPTIMIZATION OF METHODS OF DIAGNOSTICS AND TREATMENT OF SECONDARY CHRONIC PYELONEPHRITIS IN CHILDREN
Abstract: The point finger of intersection of the XII rib and the outer edge of the long back muscle (m. Sacro-spinalis), was determined by the index finger of the left arm and that place was pre-treated with alcohol or iodine. The use of complex treatment: regional lymphotropic antibacterial therapy + vitamin A in chronic pyelonephritis is an effective method of therapy, which leads to the restoration of daily diuresis, has a positive effect on the level of oxaluria, the functional state of the kidneys and cytokine urine profile: IL-10, IL -1, IL-6, IL-8.
Keywords: chronic pyelonephritis, children, diagnostics, lymphotropic.
Among kidney diseases, pyelonephritis ranks first. The always defines or determines a positive result of treatment. spread of pyelonephritis in the children's population, accord- It is necessary to use new means of normalizing the stability ing to different authors, ranges from 7.3% to 37.5-46.3% with of membranes of kidney tissue of the child's organism, which clarification of diagnoses in nephrological hospitals [2; 3; 7]. directly stimulate and correct the defects of the metabolic According to several authors, it has now been established that system [8; 9; 11].
instability of cytomebranes of renal epithelium is an important According to several studies, vitamin A deficiency causes
component ofthe pathogenesis ofchronic pyelonephritis [4; 5]. an increase in the incidence of urinary infections, while the
In the development of HP, virulent and sufficiently mas- introduction of vitamin A leads to a decrease in the incidence sive infection is significant its biological property is persis- of UTI. It is known that lymphotropic administration gives tence, which determines the process of prolonged bacterial completely new properties to low-molecular drugs, due to experience in the host organism. This phenomenon causes a which they penetrate through the biological barriers into the disturbance of urodynamic. scar-modified and inflamed kidney tissue, that makes it pos-
However, observations of leading nephrologists indicate sible a sufficient therapeutic concentration there [1]. that recurrent course is defined in 30-50% of patients, with Damage to proximal tubular cells demonstrated in a
90% of them having their first relapse within the next three number of studies as a key event in the formation of tubu-months after the first episode [6]. Probably, the uniform lointerstitial changes, which causes the release by means of scheme or plan of treatment, despite of all advantages, not these cells of cytokines (interleukins 1, 6, 8, 10), promoting
the involvement of macrophages and T-lymphocytes in the interstitial kidneys, which in their turn secrete mediators, stimulating the further involvement of cells in the intersti-tium, indicates the important role of indicated cytokines in the pathogenesis of tubulointerstitial damage as local mediators, formed directly in the renal tissue [10].
Objective: to evaluate the complex treatment of chronic pyelonephritis in children.
The study involved 177 children with chronic pyelonephritis on the background of dysmetabolic disorders of the oxaluria type at the age of 4 to 15 years. Patients were conditionally divided into 2 groups depending on the method of treatment. Group I included 48 children who received conventional therapy (in the first three days, usually cefotaxime i/m, after the results of bacteriological study - antibacterial drug, depending on the sensitivity of the pathogen). Group II consisted of 37 patients who received antibiotics in a lym-photropic way, that is, RLAT method (regional lymphotropic antibacterial therapy) in combination with vitamin A.
Method: The point finger of intersection of the XII rib and the outer edge of the long back muscle (m. Sacrospinalis), was determined by the index finger of the left arm and that place was pre-treated with alcohol or iodine. Then, at this place, a thin needle puncture was performed and 0.25% solution of novocaine was administered as a lymphostimulator at the rate: 3-5 ml to children with a body weight of up to 16 kg, and 5-10 ml to ones with more than 16 kg, after 5-10 min an antibiotic (cefotaxime) was administered in an amount of1/3 of the daily age dose (ie, from the calculation of 50 mg / kg of body weight) [1].
Patients of both groups received a profuse drinking and were on a diet used for oxaluria. The control group consisted of 25 practically healthy children of the same age.
Genealogical analysis of pedigree was carried out to establish the fact of hereditary burden of all examined children. The indices of the urinary cytokine profile and the functional state of the kidneys were studied in all children before and after treatment. Glomerular filtration of the kidneys was determined by the clearance of endogenous creatinine (Van Slayke) and osmolarity of urine by cryoscopic method on OMK apparatus A - 1 C - 01, oxalate by NV. Dmitrieva (1966).
Commercial sets were used to measure interleukin lev-els-1, 6, 8, 10 in serum and urine in children with chronic pyelonephritis: CYTELISA-IL-1b, CYTELISA-IL-1, CY-TELISA-IL-6, CYTELISA-IL-8, CYTELISA - IL-10 (CY-TIMMUNE, USA). Their application is based on the "sandwich" method of solid state enzyme-linked immunosorbent analysis (ELISA-enzyme-linked immunosorbent assay), the principle ofwhich is the qualitative and quantitative determination of the antigen under study by its layer-by-layer binding to antibodies specific for it. Mathematical processing of the obtained results was carried out using computer statistical programs Excel.
When studying the parameters of the cytokine profile of urine, depending on the method of treatment of chronic pyelonephritis, it was revealed: in children receiving standard therapy (group I), before discharge from hospital, the level of IL-1, IL-6, IL-8, IL-10 in urine was almost not changed (Pj > 0.1) (Table 1).
Table 1. - Dynamics of cytokine urine profile in patients with chronic pyelonephritis, depending on the treatment method (M ± m)
Indices Healthy (n = 25) Before (n = 177) After treatment
A group I (n = 48) A group II (n = 37)
IL-1 3.7 ± 0.73 39.76 ± 0.74; P < 0.001 39.9 ± 0.69; P1 > 0.1 12.2 ± 0.69; P1 < 0.001. P2 < 0.001
IL-6 2.4 ± 0.25 105.8 ± 2.13; P < 0.001 105.3 ± 1.68; Px > 0.1 10.45 ± 0.79; Pl < 0.001. P2 < 0.001
IL-8 6.1 ± 0.32 466.5 ± 6.14; P < 0.001 458.2 ± 6.8; Px > 0.1 36.0 ± 3.34; Px < 0.001. P2 < 0.001
IL-10 6.4 ± 0.91 1.71 ± 0.19; P < 0.001 2.8 ± 0.19; Pl > 0.1 6.8 ± 1.13; Px < 0.001; P2 < 0.05
Note: P - reliability of the difference between healthy children and in those chronic pyelonephritis; P1 - the reliability of the difference between the indicators before and after treatment; P2 - the reliability of the difference between traditional therapy and the group of children who received RLAT in combination with vitamin A
More pronounced changes in the cytokine urine profile in patients were revealed on the background of the use of RLAT in combination with vitamin A (group II). Our study showed that the "average" concentration of IL-1, IL-6, IL-8 in urine in children of the 2nd group after treatment with 4th scheme had a more positive downward trend, compared to group 1 (Table 1).
After treatment of group II of patients, the level of IL-10 had a relatively high tendency toward normalization (Px < 0.01, P2 > 0.01), compared to group 1 (Px > 0.1) (Table 1).
After the therapy in both groups, we recorded a relatively high tendency to normalize the concentration of cytokines: IL-1, IL-6, IL-8, IL-10 in urine in children of group 2, which indicates the advantage of the 4th scheme of treatment.
Analyzing the state of kidney function in the examined patients who received traditional treatment, there was an improvement in the indices, but the difference was statistically unreliable (Px > 0.1). In Group II patients, after the treatment, there was a significant increase in the clearance of
endogenous creatinine (Px < 0.001), urine osmolality (Px < < 0.001), daily diuresis (Px < 0.001), oxaluria (Px < 0.001) compared with pre-treatment and post-treatment using conventional treatment of children of clinical group I (P2 < 0.001) (Table 2).
Table 2.- Dynamics of renal partial function in patients with chronic pyelonephritis, depending on the treatment method (M ± m)
Indices Healthy(n = 25) Before(n = 177) After treatment
A group I(n = 48) A group II(n = 37)
GFR. ma/mhh.m2 98.6 ± 7.8 72.0 ± 0.25; P < 0.001 72.5 ± 1.59; p > 0.1 96.8 ± 1.61; Px < 0.001, P2 < 0.001
Urine osmolarity. mmol\24h 1000±200 646.7 ± 9.9; P < 0.001 712.7 ± 24.73; Px < 0.001 935.7 ± 24.0 P, < 0.001, P2 < 0.001
Daily dieresis. l\24h 1.7 ± 0.036 1.06 ± 0.015; P < 0.05 1.08 ± 0.027; Pl > 0.1 1.22 ± 0.046 P. < 0.05, P2 < 0.05
Oxaluria. mg\24h 25 ± 2.4 46.8 ± 1.14; P < 0.001 45.2 ± 1.66; p > 0.1 26.4 ± 0.29 Pl < 0.001, P2 < 0.001
Note: P-reliability of the difference between healthy children and in those with chronic pyelonephritis; P - the reliability of the difference between the indicators before and after treatment; P2 - the reliability of the difference between traditional therapy and the group of children who received RLAT in combination with vitamin A.
The obtained results allowed to recommend complex treatment (RLAT + vitamin A) of chronic pyelonephritis for the prevention of frequent relapses, development of renal failure, that is, to use at as a method of renoprophylaxis.
Conclusions. 1. In the period of exacerbation of chronic (oxalate) pyelonephritis, damages to partial functions of the kidneys were noted in patients: a decrease in the glomerular filtration rate, osmolarity of urine, daily diuresis; immune dis-
orders: a significant decrease in IL-10 and an increase in IL-1, IL-6, IL-8 in urine. 2. The use of complex treatment: regional lymphotropic antibacterial therapy + vitamin A in chronic pyelonephritis is an effective method of therapy, which leads to the restoration of daily diuresis, has a positive effect on the level of oxaluria, the functional state of the kidneys and cytokine urine profile: IL-10, IL-1, IL-6, IL-8.
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