Volume 03 Issue 10-2023
47
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(ISSN
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2771-2265)
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ABSTRACT
The urgency of the problem. The development of renal failure depends on secondary hemodynamic metabolic factors
than on the activity of the primary pathological process. Both non-modifiable and potentially modifiable risk factors
for the development of renal failure have been identified (2, 7). Among the potentially reversible risk factors for the
development of renal failure, glomerular hyperfiltration and interglomerular hypertension under the influence of
angiotensin II (ANG II) are of high importance.
KEYWORDS
Renal failure, glomerular hyperfiltration, non-modifiable and potentially modifiable.
INTRODUCTION
The results of research conducted in recent years
allowed to significantly expand the ideas about the
mechanisms of development of kidney damage in
urate dysmetabolism. In the induction of inflammation
and fibrosis of tubulointerstitial structures, the
increase in renin expression by yxtaglomerular cells
under the influence of uric acid is of great importance,
Research Article
CHANGE OF FUNCTIONAL KIDNEY RESERVE IN CHILDREN IN
DYSMETABOLIC NEPHROPATHIES
Submission Date:
October 11, 2023,
Accepted Date:
October 16, 2023,
Published Date:
October 21, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue10-09
Ishkabulova G. Dj
PHD, Samarkand State Medical University, student of the Faculty of Pediatrics, Uzbekistan
Kholmuradova Z.E.
Assistant, Samarkand State Medical University, student of the Faculty of Pediatrics, Uzbekistan
Rahmonkulov Sh. I.
Samarkand State Medical University, student of the Faculty of Pediatrics, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 10-2023
48
International Journal of Medical Sciences And Clinical Research
(ISSN
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2771-2265)
VOLUME
03
ISSUE
10
P
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:
47-54
SJIF
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FACTOR
(2021:
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(2022:
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(2023:
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)
OCLC
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1121105677
Publisher:
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Servi
which leads to the activation of the local renal renin
angiotensin-aldosterone system (RAAS).
RAAS activation leads to an increase in ANG II, causing
systemic spasm of arteries, glomerular hyperfiltration,
and proteinuria (8, 9). Given the above, as well as the
fact that uric acid (UC) is a strong inducer of general
endothelial dysfunction, metabolic correction of UC
should be initiated early if possible. (4). However,
angiotensin-converting enzyme (AAFI) inhibitors are
currently used to reduce the expression of tubulo-
interstitial fibrosis markers.
Thus, suppression of ANGII at the renal level in patients
with urate nephropathy is a very important aspect of
the problem.
The functional criterion of the state of glomerular
hyperfiltration is to determine the functional reserve of
the kidneys (BFZ), the level of which can also evaluate
the effectiveness of measures aimed at its elimination
(1, 6). The maximal rate of glomerular filtration (MF) in
the hyperfiltration state and the difference between
the maximum and basal HF is defined as BFZ.
Objective: To study the clinical significance: Identify the
functional stock of kidneys in drugs in children.
Materials and research methods. 76 children, an optical
nephropathy, were monitored. Including 27 children
and pyelonephritis, including Corridor Nephropathy,
were examined by 49 children. In the groups above,
the condition of the functional reserve in the field of
protein - the degree of water metabolism, the degree
of the degree of endogenine Clients of the endogenine
clearance was further studied.
77.8% of children with urate nephropathy and 86% of
patients with impaired renal function have reduced
functional renal reserve. The functional reserve index
of the kidneys can serve as a measure of the
effectiveness of therapy.
76 children with urate dysmetabolism aged 6 to 14
years were under our control. 38 of them are girls and
38 are boys. The control group consisted of 16 clinically
healthy children with no family history of kidney
pathology. Sick children were divided into 2 groups.
Group I consisted of 27 children (35.5%) with
dysmetabolic nephropathy (DZMN), 17 girls (63%), 10
boys (37%). The diagnosis of DZMN is based on the
nature of the pathology in the family, the level of uric
acid (MC) in the blood and urine, the presence of an
isolated urinary syndrome of microhematuria and/or
proteinuria, tubular dysfunctions, hyperstenuria,
oliguria.
Group II included 49 children (64.5%) with
hyperuricemia and uraturia: 32 children had
pyelonephritis (PN), 17 children had interstitial
nephritis (IN), of which 27 (55.1%) were girls, and 27
(55.1%) were boys. children made up 22 (44.9%).
Volume 03 Issue 10-2023
49
International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
03
ISSUE
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47-54
SJIF
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(2021:
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1121105677
Publisher:
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A complete clinical and genealogical analysis was
performed. Glomerular function was assessed by
endogenous creatinine clearance, uric acid was
determined by the Müller-Seifert method. The
functional state of the tubes was assessed by the level
of excretion of calcium, phosphorus, ammonia, and
titrated acids.
BFZ was defined as the rate of increase in basal CF ( %
CF) after stimulation with increased protein and water
intake: basal and stimulated CF were calculated from
endogenous creatinine (Ccr) clearance. For this, 1 g/kg
div weight of meat protein should be given orally.
The study was carried out on an empty stomach after a
night's sleep, and in the morning, medication was
canceled. Between 8:30 AM and 8:30 AM, the patient
drank 10 mL/kg of water, and then collected urine by
voiding for one hour from 8:30 AM to 9:30 AM.
Thus, KF was determined. To determine the child's
stimulated CF, the child was offered boiled meat at the
rate of 1.0 g protein/kg div weight and drank another
10 ml/kg water for 30 minutes, from 9 hours to 30
minutes to 10 hours. then I collected urine for an hour,
from 10 to 11 hours. Creatinine in blood and
accumulated parts of urine were determined by the
generally accepted Yaffe method, and clearance was
calculated by Van Slick (E. A. Yuryeva, 2002)
Research and discussion results:
In the comparative analysis of the functional state of
the kidneys and the composition of urine, a number of
characteristics were revealed in the studied groups
(Table 1).
Table 1.
Comparative characteristics of the functional status of kidneys and the composition of urine in children with urate
nephropathy (m±m)
Indicators
Control group (n=16)
Children with DZMN
Children
with
urate
nephropathy
with
isolated urine syndrome
(n=27)
Kidney
function
activity (n=49)
Diuresis (ml/min.)
Urates (mmol/day)
0.72±0,04
2.41±0,20
0,56±0,03 P<0,001
5,74±0,26 P<0,001
0,64±0,05 P<0,05
5,94±0,15 P<0,001
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Oxalates (mmol/milk)
Calcium (mmol/milk)
Inorganic phosphorus
(mmol/milk)
Creatinine
clearance
(ml/min. 1.73m²)
Calcium
Phosphorus
Ammonia (mmol/milk)
Titrated acid
(mmol/milk)
0.332±0.05
1,42±0,18
10,4±1,24
115,8±7,1
0.78±0,1
9.4±2.0
91,9±12,6
28,4±2,7
0,62±0,03 P<0,001
1,66±0,09 P<0.05
16,2±1,3 P<0,001
81,9±13,9 P<0,001
1,26±0,24 P<0,05
12,6±0,94 P<0,05
101,6±21,4 P<0.05
22,4±4,5 P<0,05
0,51±0,03 P<0,001
1,52±0,09 P<0,05
18,6±0,86 P<0,001
61,4±3,9 P<0,001
1,32±0,24 P<0.05
16,4±10,94 P<0,05
127,7±14,8 P<0,001
22,4±5,4 P<0,05
Note: p-relative to control group
The table shows that the minute diuresis in patients
with uratic nephropathy (0.72±0.04 ml/min) is
significantly reduced (0.56±0.03 ml/min) compared to
the control group (p<0.05). min). The daily excretion of
urates is 2.4 times higher than both groups (5.74±0.26
and 5.94±0.15 mmol/day, respectively) compared to
the control group (2.41±0.20 per day). mmol.).
It should be noted that 1/2 of patients with urate
nephropathy had increased excretion of oxalates in the
urine, so the daily excretion of oxalates in the urine was
2 times higher (0.332±0.05 mmol/day) compared to the
control group ( 0.62±0.03 and 0.51±0.03 mmol/day).).
In both groups, the daily excretion of calcium and
phosphorus exceeds the values in the control group,
and their clearance also increases compared to the
norm (p<0.001). Creatinine clearance decreased in all
groups (p<0.001). An increase in ammonium urea and a
decrease in acidogenesis were observed in both
groups,
especially
in
the
group
with
PN
(pyelonephritis) and IN (interstitial nephritis) layers.
Thus, layering the active pathological renal process in
the Nephropean nephropathy strengthens the
disorders of uratinene, phosphaturia, phosphaturia,
dysfunction, which is likely to bring to tubulo-intensive
disorders.
When the protein-water content, the RFR identified in
healthy children. The Basal KF (DKF) growth rate was
13.7 ± 2.2% in healthy children. In patients with Uritic
Nephropathy, RFR (renal fundal reserve) is based on
DKF control values, the following scderable values,
remain 9% of the score dkf \ u003e 9%; DKF-4.5 - 9% -
reduced bfz; DKF <4.5% - no RFR.
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Information on the distribution of studied patients
according to %KF is presented (Table 2).
Table 2
Distribution of patients according to RFR (Renal Functional Reserve) status
RFR
Patients with urate nephropathy
With
isolated
urine
syndrome (n=27)
Kidney function activity (n=49)
RFR saved
RFR decreased
RFR no
6 (0,22)
12 (0,45)
9 (0.33)
7 (0,14)
22 (0,45)
20 (0.41)
Note: the frequency of occurrence of the symbol in parentheses.
Table 2 shows that RFR urinary syndrome with isolated
uratic nephropathy is preserved in 22.2%, and 77.8% of
them are reduced or absent. The latter indicates the
presence of glomerular hyperfiltration and the risk of
developing glomerulosclerosis at this stage of the
disease. Therefore, at this stage of urate nephropathy,
measures aimed at eliminating hyperuricemia
(correction of diet and drugs) and hyperfiltration
(angiotensin-converting
enzyme
inhibitors)
are
necessary.
The addition of PN and IN sharply worsens the
situation, increases the risk of developing progressive
renal failure. Thus, the preservation of RFR in this
group was determined in 14.3%, its decrease in 44.9%
was not possible in 40.8%. Patients with slightly
elevated creatinine (above 125 μmol/L) also had no
BFZ. The decrease in RFR is associated with the loss of
working parenchyma with the development of
compensatory hyperfiltration. This is confirmed by the
dependence of RFR loss on the severity of the disease
(Table 3).
Table 3
Distribution of patients by RFR status depending on the duration of nephropathy
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Duration of nephropathy
Number of patients
With
isolated
urine
syndrome
Kidney function activity
RFR saved
(n-6)
RFR decreased
or
not
maintained
(n=21)
RFR saved
(n-7)
RFR decreased
or
not
maintained (n-
42)
4 to 1 year
1-3 years
3 years
3
2
1
2
5
14
6
1
0
3
8
31
Table 3 shows that as the duration of the disease increases, the number of patients with preserved BFZ decreases
and the number of patients with reduced or absent RFR increases dramatically).
After diet-drug therapy of urate nephropathy with
isolated urine syndrome and after one month of PN
and targeted therapy including angiotensin-converting
enzyme inhibitors, RFR in all DZMN patients with
isolated urine syndrome From 4.5 to 9% and increased
in 36 of 42 patients (85.7%) in the group of patients with
renal function.
Therefore, the decrease or absence of RFR does not
exclude the possibility of its rebellion with successful
treatment and means a decrease in the rate of
development of kidney disease.
CONCLUSIONS
1.
In patients with urate nephropathy, the partial
functions of the kidney are disturbed in the early
stages of the disease and increase with the
addition of kidney diseases (pyelonephritis,
interstitial nephritis).
2.
The functional reserve of the kidneys decreases in
the early stages of the development of urate
nephropathy and increases when the active renal
process is added.
3.
A decrease in the functional reserve of the kidneys
and the appearance of previously absent urate
nephropathy during successful therapy indicate
the prognostic value of this indicator.
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ISHKABULOVA
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