CC BY
3
Ahmedjanova Nargiza, Samarkand State Medical Institute, PhD in medicine, department of pediatrics № 3 and medical genetics E-mail: [email protected]
RENOPROPHYLAXIS IN SECONDARY CHRONIC PYELONEPHRITIS IN CHILDREN
Abstract: The study involved 85 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 4 groups depending on the method of treatment. In the period of exacerbation of chronic dismetabolic (oxalate) pyelonephritis, disturbances of partial kidney functions were noted in patients: a decrease in the glomerular filtration rate, osmolarity of urine, daily diuresis; processes of endotoxicosis: a significant reduction in the total albumin concentration, effective albumin concentration, the binding capacity of albumin in the blood plasma, and an increase in the total albumin concentration, of medium-molecular peptides in the urine.
Keywords: chronic pyelonephritis, children, lymphotropic.
Introduction. Preventive medicine is topical and in Objective: to develop the principles of secondary pre-
many ways discourteous. In connection with the high vention ofchronic dysmetabolic pyelonephritis in children.
frequency of chronic kidney disease in children, the prevention of their exacerbations is gaining increasing recognition [3, 12]. The most prevalent in the structure of nephropathy now are kidney lesions of metabolic origin, which constitute the majority - 40.0% of all kidney diseases in children, and in young children up to 71.6% [4, 11]. In the practice of a pediatrician, signs of metabolic disturbances in the urine are found in every third child [1; 2; 13]. In Uzbekistan, in the structure of dismetabolic nephropathy in children, oxalate crystalluria is the most common, accounting for 68-71% of all metabolic disorders [5; 6]. Dysmetabolic disorders are one of the leading predisposing factors to the recurrence and progression of chronic pyelonephritis in children [8; 14]. At the basis of the pathogenesis of dismetabolic nephropathies, especially those caused by genetic factors, there are metabolic processes ofinterstitium, glomerulus and renal tubules [2; 7]. And therefore, the consequence of renoprophylaxis should be the prevention of marked glomerular sclerosis and tubulointerstitial fibrosis, which is the basis of chronic renal failure [3, 9, 15]. In the case of dismetabolic chronic pyelonephritis, the measures should be directed to reduce the concentration of nephrotoxic salts leading to ischemia, edema and sclerosing of the kidney [5; 10; 16].
The study involved 85 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 4 groups depending on the method of treatment. Group I included 48 children who received conventional therapy (in the first three days, it is usually i\m cefotaxime, after the results ofbacteriological study - antibacterial drug, depending on the sensitivity of the pathogen). Group II consisted of 37 patients who received antibiotics in a lymphotropic way, that is, regional lymphotropic antibacterial therapy (RLAT) was performed in combination with 0.5% euphylln electro-phoresis. The patients of all studied groups received a copious drink and followed a diet used for oxaluria. The control group consisted of 30 practically healthy peers.
All examined patients under went genealogical pedigree analysis in order to establish the fact of hereditary burden. Studies of indices of endogenous intoxication and functional state of the kidneys were performed in all children before and after treatment. Glomerular filtration of the kidneys was determined by the clearance of endogenous creatinine (Van Slayke), osmolarity of urine by cryoscopic method on OMK apparatus A - 1 C - 01, oxalate by NV. Dmitrieva (1966) method.
The severity of endotoxicosis was assessed by the total concentration of albumin (TCA) and the effective concentration of albumin (ECA) in the blood plasma, and also TCA in the urine taking into account the binding capacity of albumin (BCA) in the description of P. E. Kiseleva [6]. The determination of the level of the average molecular peptides (AMP) was carried out according to the method of I. I. Zhadenova and co-authors
was carried out using computer statistical programs Excel. In the study of indices of endogenous intoxication, depending on the method of treatment of chronic dys-metabolic pyelonephritis, it was revealed: in children receiving standard therapy (group I), before discharge from hospital, the level of TCA, ECA, BCA in blood plasma, as well as TAC and AMP in urine remained practically unchanged (Pi > 0.1) (Table 1, 2).
(2002). Mathematical processing of the obtained results
Table 1. - Dynamics of indices of endogenous intoxication of the kidneys in blood plasma in patients with CCP, depending on the method of treatment (M ± m)
Indices Healthy (n = 30) Before treatment (n = 85) After treatment
I ^^^ (n = 48) II группа (n = 37)
TCA, g/l 47.5 ± 0.55 30.13 ± 0.96 P < 0.001 31.04 ± 1.03 P1>0.1 40.16 ± 0.81 P1 < 0.001. P2 < 0.001
ECA, g/l 40.4 ± 3.7 23.4 ± 0.84 P < 0.001 23.02 ± 0.91 P1 > 0.1 35.5 ± 0.3 P1 < 0.001. P2 < 0.001
BCA, (ECA\TCAx100)% 93 ± 0.9 77 ± 0.3 P < 0.001 73.3 ± 0.8 P1 >0.1 87.9 ± 0.3 P1 < 0.001. P2 < 0.001
Note: P-reliability of the difference between indices of healthy children and in children with 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 electrophoresis with about 5% of euphyllin.
Table 2. - Dynamics of endogenous kidney toxicity indicators in the urine of patients with CCP according to the method of treatment (M ± m)
Indices Healthy (n = 30) Before treatment (n = 85) After treatment
I ^^^ (n = 48) II группа (n = 37)
AMP, units 0.136 ± 0.021 2.23 ± 0.08 P < 0.001 0.754 ± 0.047 P1 > 0.1 0.287 ± 0.012 P1 < 0.001. P2 > 0.1
TCA, g/l 0.02 ± 0.01 2.34 ± 0.09 P < 0.001 1.66 ± 0.05 P1 > 0.1 0.028 ± 0.02 P1 < 0.001. P2 < 0.05
Note: P-reliability of the difference between indices of healthy children and in children with 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 electrophoresis with about 5% of euphyllin.
More marked changes in the indices of endog- euphyllin electrophoresis (group II). Thus, the param-enous intoxication in patients were revealed on the eters of TCA, ECA and BCA in blood plasma did not background of the use of RLAT in combination with only significantly improve with respect to the relevant
parameters before treatment and after the standard treatment (P1 < 0.001, P2 < 0.001), but also reached the level of healthy children (P > 0.1).
Analyzing the state of kidney function in the examined patients who received traditional treatment, there was an improvement in the indices, but the differ-
of group II, a significant increase in the clearance of endogenous creatinine (P1 < 0.001), urine osmolality (P1 < 0.001), daily diuresis (P1 < 0.001), oxaluria (P1 < 0.001) was noted compared with similar indications before treatment and indicators after conventional treatment (P2 < 0.001) (table 3).
ence was statistically unreliable (P1 > 0.1). In patients
Table 3. - Dynamics of renal partial function indicators in patients with CCP, depending on the treatment method (M ± m)
Indices Healthy (n = 30) Before treatment (n = 85) After treatment
I ^^^ (n = 48) IIгруппа (n = 37)
RGF, ml/min.M2 98.6 ± 7.8 72.0 ± 0.25 P < 0.001 72.5 ± 1.59 P1 > 0.1 96.8 ± 1.61 P1 < 0.001. P2 < 0.001
Osmolarity of urine, mmol/24hours 1000 ± 200 646.7 ± 9.9 P < 0.001 712.7 ± 24.73 P1 < 0.001 935.7 ± 24.0 P1 < 0.001. P2 < 0.001
24hours diuresis, l/24h. 1.7 ± 0.036 1.06 ± 0.015 P < 0.05 1.08 ± 0.027 P1 > 0.1 1.22 ± 0.046 P1 < 0.05. P2 < 0.05
Oxaluria, mg/24hours. 25 ± 2.4 46.8 ± 1.14 P < 0.001 45.2 ± 1.66 P1 > 0.1 26.4 ± 0.29 P1 < 0.001. P2 < 0.001
Note: P-reliability of the difference between indices of healthy children and in children with 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 electrophoresis with about 5% of euphyllin.
The obtained results allowed to recommend complex treatment (RLAT + electrophoresis with 0.5% of euphyllin) of chronic dismetabolic pyelonephritis for the prevention of frequent relapses, development of renal failure, that is, to use as a method of renoprophylaxis.
Сonclusions. 1. In the period of exacerbation of chronic dismetabolic (oxalate) pyelonephritis, disturbances of partial kidney functions were noted in patients: a decrease in the glomerular filtration rate, osmolarity of urine, daily diuresis; processes of en-dotoxicosis: a significant reduction in the total albu-
min concentration, effective albumin concentration, the binding capacity of albumin in the blood plasma, and an increase in the total albumin concentration, of medium-molecular peptides in the urine. 2. The use of complex treatment: RLAT + electrophoresis with 0.5% of eufillin in CCP is the most acceptable method of therapy, which leads to recovery of daily diuresis, has a positive effect on the level of oxaluria, the functional state of the kidneys and the indices of endogenous intoxication: the level of TCA, ECA, BCA in blood plasma and TCA, AMP in urine.
References:
1. Dlin V. V. Dysmetabolic nephropathy in children. The Russian herald of perinatology and pediatrics. - 2012. -(5). - P. 36-45.
2. Ignatova M. S. Questions of prevention of development and progression of chronic kidney diseases in children. The Russian herald of perinatology and pediatrics. - 2009. - (5). - P. 6-12.
3. Ishkabulov D. I. Organization of medical care for children with nephropathies on a family basis. Herald of the doctor. - 2015. - (4). - P. 32-37.
4. Mikheeva N. M., Zverev Ya. F., Vykhodtseva G. I., Lobanov Yu. F. Hypercalciuria in children with urinary tract infection. Nephrology. - 2014. - (1). - P. 74-79.
5. Nazarov A. V., Zhdanova T. V., Sadykova Yu. R. The prevalence of chronic kidney disease according to the register of the center of kidney disease and dialysis of the city clinical hospital № 40 in Yekaterinburg. Nephrology. -2012. - 16 (3). - P. 88-92.
6. Neimark A. I., Nozdrachev N. A., Skopa A. P. Complex treatment ofpatients with nephrolithiasis complicated by secondary pyelonephritis. Urology. - 2011. - (3). - P. 9-13.
7. Nuritdinova G. M., Chernyshova L. P., Galimova E. S. Complex treatment of patients with chronic pyelonephritis with the use of magnetic-laser therapy. Questions of balneology, physiotherapy and therapeutic physical training. - 2011. - (3). - P. 24-27.
8. Oskolkov S. A., Zhmurov V. A., Dizer S. A. et al. Clinico-laboratory manifestations of chronic pyelonephritis on the background of nephrolithiasis combined with arterial hypertension. Nephrology. - 2013. - (2). - P. 81-86.
9. Petrosyan E. K. Treatment and prevention ofrecurrent urinary tract infection in children. - 2010. - (1). - P. 85-88.
10. Pleshkova E. M., Yailenko A. A., Khimova Yu. A. Features of the course of oxidative stress in exacerbation of chronic pyelonephritis in children. Russian Pediatric Journal. - 2012. - (2). - P. 30-32.
11. Terentyeva A. A., Kondratieva E. I. Evaluation of the effectiveness of the use of anaferon in children for the prevention of acute respiratory infections in children with chronic pyelonephritis. Pediatrics (Journal of the name of GN Speranskii). - 2011. - (1). - P. 107-111.
12. Tretyakov A. A., Kaysinova A. S., Mishchenko M. M. Rehabilitation of patients with chronic calculous pyelonephritis at the resort. Questions of balneology, physiotherapy and therapeutic physical training. - 2012. - (3). -P. 19-22.
13. Khalmatova B. T., Kasymova M. B., Tadzhieva Z. Dismetabolic nephropathy and asymptomatic uraturia in children. Medical Journal of Uzbekistan. - 2012. - (2). - P. 96-99.
14. Khan M. A., Novikova E. V. Restorative treatment of children with chronic pyelonephritis. Pediatrics (Journal under the name of GN Speransky, - 2011. - (3). - P. 128-131.
15. Chetvertok V. A., Zhmurov V. A., Oskolkov S. A., Oborotova N. V. Clinical and laboratory features of chronic pyelonephritis among residents of the Far North of the Tyumen region. Nephrology. - 2011. - (2). - P. 43-48.
16. Yarov S. K., Shimanovsky N. L., Kareva E. N. Empirical therapy of pyelonephritis. Urology. - 2011. - (2). -P. 67-73.
