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(ISSN
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A
BSTRACT
Throughout the world, in recent years there has been a clear increase in the number of kidney diseases in
both the adult (12.2) and pediatric populations (6.10). The frequency of urinary system infections (UTI)
and their share in the nosological structure of kidney diseases is also increasing to 75.6% (9). The
prevalence of pyelonephritis (PN) itself was 32.1:1000, i.e. 43.4% of the total number of nephrology
patients. Latent forms of PN pyelonephritis, detected during active examination, are 3 times more common
than manifest forms identified by referral. According to V.I. Naumova (1991), 15.3% of chronic renal failure
(CRF) developed in childhood is the outcome of secondary chronic pyelonephritis.
K
EYWORDS
Chronic renal failure, pyelonephritis, children.
I
NTRODUCTION
Journal
Website:
http://sciencebring.co
m/index.php/ijasr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Research Article
ON THERAPEUTIC TACTICS FOR CHRONIC SECONDARY
PYELONEPHRITIS IN CHILDREN
Submission Date:
January 17,
2024,
Accepted Date:
January 22, 2024,
Published Date:
January 27, 2024
Crossref doi:
https://doi.org/10.37547/ijasr-04-01-13
Ishkabulova Gulchexra Djankurazovna
Department Of Pediatrics, Faculty Of Medicine, Candidate Of Medical Sciences Samarkand State Medical
University, Samarkand, Uzbekistan
Kholmuradova Zilola Ergashevna
Department Of Pediatrics, Faculty Of Medicine, Assistant Samarkand State Medical University, Samarkand,
Uzbekistan
Rahmonkulov Shahzod Islamjon
Pediatrics Student Samarkand State Medical University, Samarkand, Uzbekistan
Volume 04 Issue 01-2024
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It was found that in 50-65% of children,
inflammation causes irreparable damage to the
kidney parenchyma, which leads to the
development of chronic kidney failure along with
the replacement of damaged areas with
connective tissue. In addition, 41% of children
without urodynamic disorders develop sclerosis.
The direct cause of kidney damage is bacterial
infection (2.6.2). Since the basis of pyelonephritis
is undoubtedly an acute or chronic microbial
inflammatory process, etiotropic treatment of
pyelonephritis is the use of antibacterial therapy,
including antibiotics, antibacterial chemotherapy
drugs, and antiseptics (4,9,11).
Long-term (months and years) antibacterial
therapy carried out in the last 3-4 decades is not
considered harmless, and it leads to a decrease in
the div's general resistance, causes allergies and
has a toxic effect on parenchymal organs,
including the kidneys. also has a toxic effect. In
addition, there is a risk of developing
dysbacteriosis and resistant forms of bacteria.
Modern antibacterial therapy for PN is successful
only in 50-70% of patients, in 30-50% of patients
it does not lead to complete elimination of the
pathogen and thus leads to the risk of subclinical
development of nephrosclerosis and chronic
kidney failure. . In addition, certain observations
show that long courses of intermittent antibiotic
therapy of 6 months and 2 months after the end
of a course of 4-6 weeks of continuous
antibacterial therapy do not prevent the chronic
development of PN, do not increase the duration
of remission, and do not increase the recurrence
of PN. does not reduce the frequency (13, 2, 4).
The main reason for the failure of the treatment
of PN is the insufficient identification of the
causes that contribute to the development of PN
and provoke its recurrence: dysplasia, metabolic,
immunological, endocrine dysfunctions (3,5,23).
In addition, viruses, cytomegalovirus, and
chlamydia play an important role in the etiology
of PN, which are often neglected and therefore
pose a serious threat to public health (8). Taking
into account the above, it is optimal to correct the
background conditions of the div for 2-3 weeks
before antibacterial therapy. (11,9). Among the
studied nephropathies, much attention was paid
to pyelonephritis as a very common pathology in
children, which turns the problem from a purely
nephrological problem into a general pediatric
problem, because almost every pediatrician has
to deal with the diagnosis and treatment of
pyelonephritis (9).
Nevertheless, children with pyelonephritis
syndrome are often unsuccessfully treated for a
long time by doctors of various specialties. This is
explained by the fact that the disease can be
accurately diagnosed only in a specialized
department, where doctors use all the main
methods of urological examination and evaluate
the metabolic and immunological status of the
patient. Despite the history of studying
pyelonephritis for more than a century, there is
still no unified point of view on the essence of this
disease, and the question is often raised in the
specialized literature today: does such an
independent disease really exist or is this disease
a myth? (23, 19,3). Today, the diagnosis of
pyelonephritis is based only on clinical data and a
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general urine test (even including bacteriological
data), but it should be comprehensive and include
genealogical analysis, obstetric history, X-ray
urological
examination,
metabolic
and
immunological status assessment. should include.
Thus, the urgency of the problem of urinary tract
infection does not decrease, discussions about the
nature of the disease, determining the number of
layers of the lesion, etc. continue(2). The serious
prognosis of chronic inflammatory conditions of
the urinary system still requires the search for
new effective methods of diagnosis and
optimization of therapy.
The purpose of the study is to evaluate the
importance of metabolic diseases in the
development and progression of secondary
chronic pyelonephritis in children and to
optimize their treatment.
R
ESEARCH MATERIALS AND METHODS
In this article, 163 children diagnosed with
secondary chronic pyelonephritis aged 1 to 14
years were studied. 35 of them (21.4%) are under
3 years old, 59 (36.2%) are 4-7 years old, 69
(42.3%) are 8-14 years old. 68 boys (71.6%) and
95 girls (58.4%). 70 of 163 patients (49%) were
diagnosed with pyelonephritis 2-5 years ago, and
mostly antibacterial treatment had only a
temporary effect, and then repeated relapses
were observed. Among them, the initial stage of
kidney failure (4.9%), 8 had a tendency to
polyuria, hyposthenuria and hyperazotemia. The
latter is undoubtedly due to inadequate
consideration of contributing and precipitating
background conditions. From the total number of
patients, 90 children were X-rayed, 32 of them
were diagnosed with various anomalies of kidney
development and vesicoureteral reflux (35.5%).
Accordingly,
secondary
obstructive
pyelonephritis was diagnosed. Including 24
children, at the same time, hyperoxaluria,
uraturia and their combination were detected, i.e.
In 755 cases, secondary chronic obstructive
pyelonephritis had an obstructive-dysmetabolic
character. The most frequently identified
dysmetabolic variant of secondary chronic
pyelonephritis is SIPN (80.4%). In order to
identify the listed groups, the studies were
conducted in the following order: the metabolic
status of patients was evaluated based on the
results of many studies carried out according to a
multi-stage program, in which a genealogical
analysis was carried out taking into account the
kidney and kidney spectrum: pedigree, clinical
screening and quantitative biochemical studies
include extrarenal pathologies. Daily excretion of
oxalates, uricosuria and uricemia are the main
biochemical signs of metabolic disorders.
Hyperoxaluria is defined as secretion of more
than 0.5 mg/kg per day. Hyperuricemia is defined
as a serum uric acid level of more than 5 mg% or
0.3 mmol/l, and uraturia is defined as excretion of
more than 1 mg/ml of urine per day. Quantitative
determination of oxalates in urine was carried out
according to N.V. Dmitrieva (1966). Uric acid was
determined by the Müller-Seifert method, and
urate salts by the Hopkins method (11).
To estimate glomerular filtration, endogenous
creatinine clearance was calculated using the Van
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Slyke formula and recalculated to adult standard
surface area. Tubular functional status was
assessed by Zimnitsky test, ammonia excretion
rate, titratable acids and water reabsorption. X-
ray urological studies were performed and
evaluated by pediatric surgeons according to
generally accepted principles in nephrourology,
followed by X-ray planometry.
R
ESULTS AND DISCUSSION
The results of the study of the genealogical
history of patients with chronic renal failure
against the background of hyperoxaluria and
uraturia showed that they are closer to the
proband. Thus, in the presence of hyperoxaluria
among first-degree relatives, the frequency of
nephropathy in genealogy with the control group
(3.57%). In patients with chronic kidney failure
due to uraturia, this rate was 15.6%. These data
indicate an unmistakable role of heredity in the
development of DZMN. A retrospective study of
the obstetric history of observed children showed
that every fourth woman (26.7%) had diseases of
the
urinary
system
(mainly
cystitis,
pyelonephritis) before pregnancy or during
pregnancy. 40% of mothers had toxicosis in the
first half of pregnancy, and 31.5% had gestosis
during the entire pregnancy. The overall
frequency of gestosis in pregnant women
exceeded 70%, which is almost ten times higher
than the level observed in the general population.
All this confirms the truth. This indicates that
children of this group are at potential risk for
kidney pathology. The disease is often detected
against the background of bronchopulmonary
diseases (ORVI, pneumonia) and this is not
accidental. Known. Relationship between
pulmonary ventilation and renal hemodynamics.
Maladaptive
vascular
reactions
in
bronchopulmonary diseases lead to a decrease in
glomerular filtration, that is, conditions are
created for the appearance and recurrence of
pyelonephritis.
Urinary excretion of nephrotoxic metabolites in
various
forms
of
chronic
secondary
pyelonephritis in children (М±м)
СhSP patients
Excretion with urine (mmol/day) Coefficients
oxalates urates calcium oxalates/creatinine urates/creatinine
Obstructive 0,462±0,043 2,93±0,39 1,81±0,2 0,48±0,014 0,87±0,09
(n=32)
Р˃
0,05
Р˃
0,5
Р˂
0,01
Р˃
0,5
Р˃
0,05
Obstructive
Dysmetabolism 1,082±0,091 3,94±0,46 2,24±0,18 0,249±0,04 1,38±0,14
(n=24)
Р˂
0,001
Р
=0,05
Р˂
0,01
Р˂
0,001
Р˂
0,01
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Dysmetabolism 0,72±0,051 5,63±0,24 2,53±0,18 0,206±0,04 1,96±0,16
(n=131)
Р˂
0,001
Р˂
0,001
Р˂
0,001
Р˂
0,001
Р˂
0,001
Healthy (n=47) 0,413± 0,059 2,94±0,31 1,46±0,12 0,053±0,005 0,83±0,08
P - significance of the difference compared to the
control group
As can be seen from the table, in contrast to the
pure obstructive form of chronic renal failure, the
obstructive-dysmetabolic
form
significantly
increased the daily excretion of oxalates, urates
and their ratio to creatinine (P˂0.01).
In patients with oxalate nephropathy, the
concentration of oxalates is 0.106±0.011 mmol/l,
the daily excretion rate is 97.4 mg/day (more
than 1.6 mg/kg), which is 3 times higher than in
healthy people (co not 'p) more than 0.5
mg/kg/day). The ratio of oxalates to creatinine
per day is 1.38±0.14, the norm is 0.053±0.83
(P˂0.001). In the group of patients with urate
nephropathy complicated by chronic kidney
disease, oxaluria was 63.2±4.6 mg/24 hours.
creatinine ratio is 1.96±0, 16 is 0.83±0.08
(R˂0.001) in norm. In cases of chronic renal
failure associated with uraturia, a clear decrease
in renal function was observed (Table 3). In the
observed patients, the parameters of tubular
reabsorption of water and glomerular filtration
are not significantly different from the norm. We
regularly observed a tendency to oliguria and a
decrease in GFT (glomerular filtration rate) with
the development of chronic renal failure against
the background of uraturia. All groups of
observed patients were characterized by a
decrease in the relative density of urine and
ammonia acidogenesis (P˂0.05).
Treatment of patients with an obstructive form of
chronic renal failure was carried out together
with pediatric surgeons, and in some cases, with
surgical correction of urinary bladder reflux
(SQR).
Indicators Healthy O
СhSP
ChSP
Creatinine clearance 98,6±4,8 97,8±6,4 75,5±4,2
С
cr
(ml/min,1,73
м
2
)
Ammonia (g/d) 0,91±0,02 0,56±0,07 0,63±0,04
Titrated acids 45,4±2,8 29,0±3,0 27,2±1,4
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Tubular reabsorption of water 98,6±0,06 98,2±0,3 98,3±0,3
(%)
Antibacterial therapy was carried out for 2-3
weeks under the control of the sensitivity of
isolated microbes to them. Repeated courses of
antibacterial therapy were carried out only in the
presence of significant bacteriuria. In cases where
dysmetabolism of oxalates and urates was
detected, a diet was prescribed, which included
the restriction or complete elimination of food
products that are a source of oxalates and urates.
Diet therapy is prescribed for a long period (6-12
months or more). Drug correction of
dysmetabolism has also been used. Taking into
account that the lack of pyridoxal-5-phosphate is
one of the causes of hyperoxaluria, B6 was
prescribed 20-60 mg per day on an empty
stomach, sodium benzoate 0.05-0.3 g/day to limit
the synthesis of oxalate in the div; magnesium
oxide 100-200 mg per day to improve solubility.
Long-term use of this therapy complex (2-6
months) made it possible to normalize the
excretion of oxalate with urine.
In the treatment of chronic kidney failure in
patients with uricopathy, we use a diet with the
maximum exclusion of food products rich in
purine bases from the diet. Fruits, fruit juices,
lemons, and a high fluid regimen are common to
alkalinize the urine. To limit the synthesis of uric
acid in the div, we used allopurinol 0.05x 1 time
a day for children under 7 years old, 0.1x 1 time a
day for children over 7 years old for 1 month.
Potassium orotate helps to improve the excretion
of uric acid in the urine. In all cases herbal
medicines in various forms are widely
recommended. In recent years, we have widely
used Kanefron-N complex drug, which has anti-
inflammatory, antibacterial, spasmolytic and
diuretic effects (1,15,16). The drug was
prescribed to babies 10 drops 3 times a day. 15
drops for preschool children, 25 drops 3 times a
day for school-aged children. If necessary,
repeated courses of treatment were conducted.
Immunomodulating drugs (Viferon 1.2, Reaferon,
lysostim, Immunal) were prescribed to all
children with a slow, recurrent course of the
disease. Immunomodulators were used in all
patients with the development of chronic renal
failure against the background of uraturia,
because dysnucleotidosis is characterized by a
violation of molecular processes that ensure the
proliferation
and
maturation
of
immunocompetent cells (7,14). In addition, all
patients received concomitant antioxidant
therapy (vitamins A, E, and C) due to the
stimulation of lipid peroxidation and deficiency of
antioxidant protection, which are common
factors in chronic renal failure, which are factors
that aggravate depression of immunological
homeostasis. absence, preparations containing
selenium - triovit, vitrum, centrum) for 2-3 weeks.
If there are symptoms of mitochondrial
insufficiency, Kudesan or Elkar is recommended.
Such complex therapy (and not limited to
prescribing antibacterial therapy) helped to
significantly increase the effectiveness of
treatment. Against the background of 2-3 weeks
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of complex therapy, a significant decrease in
oxaluria, uraturia and, in parallel, proteinuria,
leukocyturia and bacteriuria was observed.
We have seen that in the dysmetabolic variant of
chronic renal failure, the initial acceptance of
clinical and even clinical laboratory remission is
not a guarantee against further relapses of the
disease. Therefore, patients with dysmetabolic
chronic renal failure require continuous targeted
monitoring and corrective dietary therapy. In this
regard, a certain psychological "mood" is
necessary not only for the child, but also for his
parents, because they often stop treatment on
their own, considering that the child is cured, and
often ignore the importance of dietary measures.
they ignore.
C
ONCLUSIONS
The most common source of diagnostic and
treatment-tactical errors is the management of
outdated concepts of pyelonephritis by general
practitioners as an independent disease with
microbial-inflammatory properties, which helps
to implement only antibacterial therapy. The
diagnosis of pyelonephritis should be established
after a comprehensive clinical, genealogical, X-ray
and urological examination, assessment of the
metabolic, immunological and endocrine status of
patients. Without this, it is impossible in relation
to SIPN, the main deontological principle of
clinical medicine should be observed "to treat the
patient, not the disease". Obstructive chronic
secondary pyelonephritis is often combined with
metabolic diseases (hyperoxaluria, uraturia,
hypercalciuria, etc.), which requires surgical
correction of the malformation, as well as
correction of metabolism with diet and drugs, and
targeted antibacterial therapy.
Non-obstructive
chronic
secondary
pyelonephritis is mainly caused by the
accumulation of nephrotoxic metabolites against
the
background
of
metabolic
diseases,
antibacterial therapy is also insufficiently
effective without appropriate correction of the
metabolic background.
Isolated antibacterial therapy for chronic
secondary pyelonephritis is often not effective
enough, it should be comprehensive and, in
addition to surgical and metabolic correction,
should include immunomodulatory therapy and
antioxidant protection of the organism.
R
EFERENCES
1.
Alchinbaev M. K., Sultonova B. G., Karabaeva A.
J. Surunkali pielonefrit bilan og'rigan
bemorlarda funktsional buyrak zaxirasi. //
Nefrologiya. - 2001. 5-jild, 2-son. 71-74 betlar.
2.
Yesayan A.M., Buyrakning to'qima renin-
angiotensin tizimi. nefroproteksiyaning yangi
strategiyasi / / nefrologiya.- 2002. 6-jild, 3-
son.10-14 betlar
3.
Ishkabulova G. Dj, Kholmuradova Z.E., &
Rahmonkulov Sh. I. (2023). CHANGE OF
FUNCTIONAL
KIDNEY
RESERVE
IN
CHILDREN
IN
DYSMETABOLIC
NEPHROPATHIES. International Journal of
Medical Sciences And Clinical Research, 3(10),
47
–
54.
Volume 04 Issue 01-2024
85
International Journal of Advance Scientific Research
(ISSN
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2750-1396)
VOLUME
04
ISSUE
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SJIF
I
MPACT
FACTOR
(2021:
5.478
)
(2022:
5.636
)
(2023:
6.741
)
OCLC
–
1368736135
4.
Kartamisheva N. N., Chumakova O. V.,
Kucherenko A. G. Surunkali pielonefrit va
surunkali interstitsial nefritning rivojlanish
omillari / / pediatriya. G. N. Speranskiy 2004
Yil. №5.50
-53 betlar.
5.
Gulchekhra Dzhonhurozovna Ishkabulova,
Zilola Ergashevna Kholmuradova CHANGE OF
THE STATE OF THE FUNCTIONAL RESERVE
OF
KIDNEYS
IN
DYSMETABOLIC
NEPHROPATHIES (URATURIA) IN CHILDREN
// Scientific progress. 2021. №6.
6.
Muhin N. A., Balkarov I. M., Moiseev S. V. va
boshqalar.
Surunkali
progressiv
nefropatiyalar va zamonaviy insonning
turmush tarzi / / ter. arx. --2004.-
№9.5 10
sahifa.
7.
Ni A. N., Luchaninova V. N., Popova V. V.,
Simeshina O. V. Bolalardagi dismetabolik bilan
nefropatiyalarning
gomeostatik
buyrak
funktsiyalarining tuzilishi / / nefrologiya.-
2004.8-jild, 2-son.-C. 68-72.
8.
Rogov V. A., Kutirina I. M., Tareyeva I. E. va
boshqalar. Nefrotik sindromda buyraklarning
funktsional zaxirasi / / ter. arx. - qaniydi?
1996.-No6.-C. 55-58.
9.
Smirnov A. V., Yesayan A. M., Kayukov I. G.
Surunkali buyrak kasalligi: yakdillik birligi
yo'lida //nefrologiya.-2002.6-jild, 4-son.11-
17 betlar.
10.
Ishkabulova G. D. et al. MODERN METHODS
FOR ASSESSING THE COURSE, TREATMENT,
AND PROGNOSIS OF CHRONIC RENAL
FAILURE IN CHILDREN //British Medical
Journal.
–
2023.
–
Т. 3. –
№. 1.
11.
Epstein M. Aldosterone as a mediator of
progressive renal disease: Pathogenetic and
clinical implications ||Am, J. Kidney Dis.-2001;
237:677-688.
12.
Mazzali M., Hyghes J.; Kin Y. et. al. Elevated
uric-acid increases blood pressure in the rat
by a novel crystalindependent mechanism
Hypertension.- 2001; 38: 1101-1106.
13.
Ишкабулова
Г.Д.,
Холмурадова
З.Э.
Фосфолипидная структура и состояние
перекисного
окисления
липидов
эритроцитарных
мембран
у
новорожденных от матерей с гестозом,
сочетанным хроническим пиелонефритом.
//Журнал Биомедицины и практики
.2022.-
№3 –С71
-77.
14.
Yuryeva E. A., Dlin V. V. “Nefrologiya
diagnostik qo'llanmasi,".-2002.-95c.
15.
Ishkabulova
G.D.,Kholmuradova
Z.E.
Homiladorlik surunkali pielonefrit va gestoz
bilan
kechgan
onalardan
tug'ilgan
chaqaloqlarda fosfolipid tuzilishi va eritrotsit
membranalarining lipid peroksidlanish holati
//Журнал Биомедицины и Практики. –
2022.
–
Т. 7. –
№. 3.
16.
Ishkabulova Gulchexra Djankurazovna, &
Kholmuradova Zilola Ergashevna. (2022).
FUNCTIONAL STATE OF THE KIDNEYS IN
NEWBORN BORN FROM MOTHERS WITH
PRE-ECLAMPSIA. World Bulletin of Public
Health, 14, 75-78.
17.
Ishkabulova G. J. et al. Сomparative
assessment on the effect of different methods
of corrective therapy on lipid metabolismand
homeostatic renal function //European
Journal of Molecular and Clinical Medicine.
–
2020.
–
Т. 7. –
№. 3. –
С. 2794
-2800.
