Доктор ахборотномаси № 4—2019
30
УДК: 616.61
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002.3
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07
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08
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053
IMPROVEMENT OF DIAGNOSTICS AND TREATMENT
OF CHRONIC PYELONEPHRITIS IN CHILDREN
N. I. Akhmedjanova, I. A. Akhmedjanov, A. A. Akhmatov, Yu. A. Akhmatova, H. U.
Makhmudov, F. A. Khusenova
Samarkand state medical institute, Samarkand, Uzbekistan
Key words:
chronic pyelonephritis, regional lymphotropic antibiotic therapy, vitamin A.
Таянч сўзлар:
сурункали пиелонефрит, регионал лимфотроп антибиотикотерапия, витамин A.
Ключевые слова:
хронический пиелонефрит, региональная лимфотропная антибиотикотерапия, витамин А.
The aim of this work was an attempt to evaluate the effect of сomplex treatment on some endogenous intoxica-
tion indicators in chronic pyelonephritis developed on the background of dismetabolic nephropathy (DMN) (СHP).
Patents and methods. A survey of 177 children CHP, aged 4 to 15 years. Patients were divided into 2 groups depend-
ing on treatment method. Results. Comparative assessment of the results of the study of endogenous intoxication con-
ducted after treatment in children with СHP, depending on the method of treatment, demonstrated the effectiveness of
regional lymphotropic antibiotic therapy in combination with vitamin A compared to other methods of therapy. Con-
clusion. The use of complex treatment of regional lymphotropic antibiotic therapy in combination with vitamin A
when CHP is the most appropriate method of therapy. This method leads to the restoration of the TCA (total concen-
tration of albumin) and ECA (effective concentration of albumin) in the blood and kidney function.
БОЛАЛАРДА СУРУНКАЛИ ПИЕЛОНЕФРИТНИ ТАШҲИСЛАШ ВА ДАВОЛАШНИ
ТАКОМИЛЛАШТИРИШ
Н. И. Ахмеджанова, И. А. Ахмеджанов, А. А. Ахматов, Ю. А. Ахматова, Х. У. Махмудов, Ф. А. Хусенова
Самарқанд Давлат тиббиѐт институти, Самарқанд, Ўзбекистон
Болаларда дисметаболик нефропатия (ДН) фонида иккиламчи пиелонефритни шаклланиши педиатрияда ва
нефрологияда актуал муаммолардан бири бўлиб ҳисобланади. Ишнинг мақсади: сурункали пиелонефрит би-
лан касалланган болаларда комплекс даво чораларининг эндоген интоксикация (ЭИ) кўрсаткичларига таъси-
рини аниқлаш. 4 ѐшдан 15 ѐшгача бўлган 177 бола ДН фонида ривожланган сурункали пиелонефритни авж
олиш даври билан бўлган беморлар ва 30 бола соғлом гуруҳни ташкил қилди. Беморлар даволаш усулига кўра
2 гуруҳга бўлинди. Текширувлар натижасида комплекс даво чоралари РЛАТ (регионал лимфотроп антибиоти-
котерапия) ва витамин А ни қўлланилиши дисметаболик сурункали пиелонефритни энг эффектив даволаш
усули эканлиги аниқланди. Бу даволаш усули қонда АУК (альбуминнинг умумий концентрацияси) ва АЭК
(альбуминнинг эффектив концентрацияси) миқдорини ва буйраклар функциясини қайта тикланишига олиб
келади.
СОВЕРШЕНСТВОВАНИЕ ДИАГНОСТИКИ И ЛЕЧЕНИЯ
ХРОНИЧЕСКОГО ПИЕЛОНЕФРИТА У ДЕТЕЙ
Н. И. Ахмеджанова, И. А. Ахмеджанов, А. А. Ахматов, Ю. А. Ахматова, Х. У. Махмудов, Ф. А. Хусенова
Самаркандский Государственный медицинский институт, Самарканд, Узбекистан
Целью работы была попытка оценить влияние комплексного лечения на некоторые показатели эндоген-
ной интоксикации (ЭИ) при хроническом пиелонефрите, развившемся на фоне дизметаболической нефропа-
тии (ДМН). Пациенты и методы. Проведено обследование 177 детей, больных ХП, в возрасте от 4 до 15 лет.
Больные были разделены на 2 группы в зависимости от метода лечения. Результаты. Сравнительная оценка
результатов исследования эндогенной интоксикации проведѐнных после лечения, у детей с ХП в зависимости
от способа лечения, показала большую эффективность комплексного применения РЛАТ (региональной лим-
фотропной терапии) в сочетании с витамином А по сравнению с остальными методами терапии. Заключение.
Применение комплексного лечения РЛАТ в сочетании с витамином А при ХП является наиболее приемлемым
методом терапии. Этот метод приводит к восстановлению ОКА (общая концентрация альбумина) и ЭКА
(эффективная концентрация альбумина) в крови и ренальных функций.
Preventive medicine is topical and in many ways discourteous. In connection with the high
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
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40.0% of all kidney diseases in chil-
dren, and in young children up to 71.6% [4, 11]. In the practice of a pediatrician, signs of metabol-
ic disturbances in the urine are found in every third child [1, 2, 13]. In Uzbekistan, in the structure
Оригинальная статья
Доктор ахборотномаси № 4—2019
31
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)
P
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reliability of the difference between indices of healthy children and in children with chronic pyelone-
phritis. P1
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the reliability of the difference between the indicators before and after treatment. P2
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the reli-
ability of the difference between traditional therapy and the group of children who received RLAT in com-
bination with vitamin A.
Note:
N. I. Akhmedjanova, I. A. Akhmedjanov,...
of dismetabolic nephropathy in children, oxalate crystalluria is the most common, accounting for 68
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71% of all metabolic disorders [5, 6]. Dysmetabolic disorders are one of the leading predisposing fac-
tors 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 meta-
bolic processes of interstitium, 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].
Objective:
to develop the principles of secondary prevention of chronic pyelonephritis in chil-
dren.
The study involved
177 children with chronic pyelonephritis on the background of dysmetabol-
ic 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 of bacteriological study
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antibacterial drug, depending on the sensitivity of the pathogen). Group II consisted of 47 patients who
received antibiotics in a lymphotropic way, that is, regional lymphotropic antibacterial therapy (RLAT)
was performed in combination with vitamin A. 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 de-
termined by the clearance of endogenous creatinine (Van Slayke), osmolarity of urine by cryoscopic
method on OMK apparatus A
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1 C
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01, oxalate by NV. Dmitrieva (1966) method.
Indicators of protein metabolism were determined (total serum protein, protein fractions, total
and effective albumin concentration, albumin binding capacity). The value of the total and effective
albumin concentration was determined using the Albumin
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UTS kit (manufactured by Eiliton LLC by
order of A/o Unimed CJSC) in quartz cuvettes of section 1 per 1 cm. Albumin binding capacity and
toxicity index were calculated using the formulas : CCA = (ECA / OKA) * 100%, where OKA is the
total concentration of albumin in g / l, ECA is the effective concentration of albumin, the equivalent of
―healthy‖ albumin, measured by a fluorescent method with a K
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35 probe, in g / l. [6]. Mathematical
processing of the obtained results was carried out using computer statistical programs Excel. In the
study of indices of endogenous intoxication, depending on the method of treatment of chronic pyelone-
phritis, it was revealed: in children receiving standard therapy (group I), before discharge from hospi-
tal, the level of ТСA, ECA, ВCA in blood plasma remained practically unchanged (P1> 0.1) (Table 1).
Indices
Healthy
(n=30)
Before treatment
(n=177)
After treatment
I группа
(n=48)
II группа
(n=47)
TCА, g/l
47,5±0,55
30,13±0,96
Р<0,001
31,04±1,03
Р
1
>0,1
40,16±0,81
Р
1
<0,001,
Р
2
<0,001
ECА, g/l
40,4±3,7
23,4±0,84
Р<0,001
23,02±0,91
Р
1
>0,1
35,5±0,3 Р
1
<0,001,
Р
2
<0,001
BСА,
(ECА\TCАx100)
%
93±0,9
77±0,3
Р<0,001
73,3±0,8
Р
1
>0,1
87,9±0,3
Р
1
<0,001,
Р
2
<0,001
Доктор ахборотномаси № 4—2019
32
Table 2.
Dynamics of renal partial function indicators in patients with CCP,
depending on the treatment method (M ± m)
P
-
reliability of the difference between indices of healthy children and in children with chronic pyelo-
nephritis. P1
-
the reliability of the difference between the indicators before and after treatment. P2
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the reliability of the difference between traditional therapy and the group of children who received
RLAT in combination with vitamin A.
Note:
Оригинальная статья
More marked changes in the indices of endogenous intoxication in patients were revealed on the
background of the use of RLAT in combination with vitamin A (group II). Thus, the parameters of
TCA, ECA and BCA in blood plasma did not 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 treat-
ment, there was an improvement in the indices, but the difference was statistically unreliable (P1>0.1).
In patients 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). It should
be noted that when studying the excretion of ammonia and antibodies in the urine in the compared
groups after treatment, there was noted a more significant increase of 32% and 51% in group 2 com-
pared with group 1, where these indicators were increased only by 10% and 15% (P1>0.1), i.e. due
thanks to the use of RLAT in combination with viferon and vitamin A, the function of acido
-
ammoniogenesis has recovered, having a steady tendency to increase (Table 2).
Healthy
(n=30)
Before treatment
(n=177)
After treatment
Indices
I группа
(n=48)
II группа
(n=47)
RGF, ml/min.м²
98,6±7,8
72,0±0,25
Р<0,001
72,5 ±1,59
Р
1
>0,1
96,8±1,61
Р
1
<0,001,
Р
2
<0,001
Osmolarity of
urine,
mmol/24hours
1000±200
646,7±9,9
Р<0,001
712,7±24,73
Р
1
<0,001
935,7±24,0
Р
1
<0,001,
Р
2
<0,001
Ammonia,
mmоl/24h.
46,8±1,2
30,3±0,55
Р<0,001
33,6±0,57
Р
1
>0,1
44,0±0,39
Р
1
<0,001,
Р
2
<0,001
Urine acidity
titration
mmоl /24h.
51,0±2,8
23,8±0,48
Р<0,001
27,9±0,68
Р
1
>0,1
48,0±0,34
Р
1
<0,001,
Р
2
<0,001
АК
0,478
0,560
Р<0,001
0,547
Р
1
>0,1
0,468
Р
1
<0,001, Р
2
<0,05
24hours diuresis,
l/24h.
1,7±0,036
1,06±0,015
Р<0,05
1,08±0,027
Р
1
>0,1
1,22±0,046
Р
1
<0,05, Р
2
<0,05
Oxaluria,
mg/24hours.
25±2,4
46,8±1,14
Р<0,001
45,2±1,66
Р
1
>0,1
26,4±0,29
Р
1
<0,001,
Р
2
<0,001
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 as a
method of renoprophylaxis.
Сonclusions.
In the period of exacerbation of chronic pyelonephritis processes of endotoxicosis:
a significant reduction in the total albumin concentration, effective albumin concentration, the binding
capacity of albumin in the blood plasma.
In the acute period, the functional state of kidneys decreases due to impaired concentration, am-
monio
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acidogenetic function. In recurrent pyelonephritis, the decrease in tubular function during exac-
Доктор ахборотномаси № 4—2019
33
erbation is more marked and is not compensated in the period of remission. In a latent course of the
disease, a similar trend persists.
The inclusion of RLAT and vitamin A with viferon in the complex therapy of patients with CP
leads to the elimination of membranopathy, acceleration of the restoration of filtration
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reabsorption,
ammonioacidogenetic and osmoregulatory functions of the kidneys, which helps to reduce the length
of hospital stay by 5 days and prolong the period of remission.
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N. I. Akhmedjanova, I. A. Akhmedjanov,...
