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32CHANGE OF THE STATE OF THE FUNCTIONAL RESERVE OF KIDNEYS IN DYSMETABOLIC NEPHROPATHIES (URATURIA) IN CHILDREN
Gulchekhra Dzhonhurozovna Ishkabulova Zilola Ergashevna Kholmuradova
Department of Pediatrics, Faculty of General Medicine, Samarkand State Medical
Institute
ABSTRACT
A total of 97 children with urate dysmetabolic nephropathy were examined. It was revealed that in children with a complicated course of the disease, heredity was more often aggravated, the disease was accompanied by concomitant pathology, in patients with uraturia there was a decrease in glomerular filtration rate against the background of a high degree of hyperuremia and hyperuricosuria.
Key words: dysmetabolic nephropathy, hyperuricosuria and hyperuricemia
RELEVANCE
The results of recent studies have made it possible to significantly expand the understanding of the mechanisms of development of kidney damage in urate dysmetabolism [1,8,9]. It turned out that an increase in the expression of renin by juxtaglomerular cells under the influence of uric acid, which leads to the activation of the local renal renin-angiotensin-aldosterone system (RASS), is of great importance in the induction of the processes of inflammation and fibrosis of the structures of tubolointerstitium. Activation of RASC leads to an increase in ANH II production, causes systemic arterial spasm, glomerular hyperfiltration, and proteinuria. Taking into account this fact, and also considering that uric acid (uric acid) is a powerful inducer of generalized endothelial dysfunction, there is a need for early correction of uric acid metabolic disorders. Along with this, angiotensin-converting enzyme (ACE) inhibitors are currently used to reduce the severity of fibrosis [2,5,6].
Damage to the urinary system (OMS) in hyperuricemia (GU) and hyperuricosuria (GUU) in children usually manifests in the form of uric acid diathesis, interstitial nephritis (IN), secondary pyelonephritis (UPN), uric acid lithiasis. Obstructive secondary chronic PN occurs mainly against the background of metabolic disorders. Changes in the nosological structure of kidney diseases in children, an increase in the incidence of OMS diseases with latent, atypical according to the traditional concepts of diseases led to a seemingly paradoxical phenomenon, a worsening of their diagnosis, difficulty in their differential diagnosis contributed to the increase in cases of inadequate, sometimes excessive therapy. Difficulties in the clinical diagnosis of urate nephropathy contribute to the fact that often such patients are supervised as
glomerulonephritis and pyelonephritis, respectively, inadequate, often excessive antibacterial, hormonal therapy is carried out [3,4,5]. Meanwhile, at present, there are real opportunities to control the level of uricemia and uraruria, thereby conducting etiotropic and preventive prevention of urate nephropathy starting from childhood.
Purpose of the study: to study the functional reserve of the kidneys in children with urate nephropathy.
MATERIALS AND RESEARCH METHODS
We observed 97 children diagnosed with DMD. The diagnosis of DZMN was substantiated by the nature of the pathology in the pedigree, the level of uric acid (MC) in the blood and urine, isolated urinary syndrome - microhematuria and proteinuria, the presence of tubular dysfunctions. Sick children were divided into 2 groups depending on the presence of renal pathology activity. Group 1 consisted of 32 children with dysmetabolic nephropathy (DMN) without complications.
Group 2 included 65 children in whom hyperuricemia and uraturia were complicated by chronic pyelonephritis, hematuria, and 21 children were diagnosed with uraturia and isolated urinary syndrome. The control group consisted of 27 clinically healthy children without a family history of renal pathology.
RESEARCH RESULTS
If kidney disease is suspected, in order to avoid diagnostic errors, a multifaceted examination of patients is necessary, which is currently possible when examining all patients with newly diagnosed pathology in a specialized hospital, or a one-day specialized hospital based on large multidisciplinary hospitals. This is all the more important because in order to choose the correct therapeutic tactics, it is necessary to establish the stages of development of urate nephropathy, an assessment of renal function.
Thus, diagnostic errors are most often caused by, on the one hand, the absence of nephrological alertness in local doctors when detecting urinary microsymptoms, and, secondly, by improper treatment of patients at home. A correctly collected anamnesis is of fundamental importance for the diagnosis of DMD in general, in particular of urate nephropathy. We analyzed the pedigrees of 60 probands with urate nephropathy. The proportion of nephropathies among them was 20.5%. It should be noted in the pedigree of patients with urate nephropathy, the exceptional frequency of cardiovascular diseases including hypertension (43.3%), gastroduodenal pathology (19.7%), hepatobiliary system (39.6%) diseases associated with salt deposition (26.7%) ). Such a spectrum of extrarenal pathology in the pedigree should certainly direct the diagnostic search to study the metabolic status and, above all, to exclude dyspurinosis. When the microbial-
inflammatory process is layered, symptoms of intoxication, an increase in body temperature, an increase in pain, dysuria and other signs appear. In the absence of secondary pyelonephritis, a predominance of hematuria over leukocyturia is possible (Table 1). It is characteristic that urate nephropathy essentially does not occur in isolation, as a rule it is combined with a number of visceropathies, which are often perceived as an independent pathology and patients are observed by different specialists: neurologists, allergists, helminthologists, gastroenterologists. One of the most common causes of this phenomenon is insufficient examination of the patient.
Table 1.
Frequency of various diseases and syndromes in children with urate nephropathy (n = 86)
Nosology Feature frequency
abs %
Allergic conditions 26 30,2
Chronic tonsillitis 27 31,4
Deep multiple dental caries 12 13,9
Purulent otitis media 8 9,3
Gastro-dudenal pathology 36 41,8
Dysfunction of the biliary system on ultrasound 74 86,0
Chronic nonspecific diseases of the lungs and bronchi 7 8,1
Kidney and urinary tract stones 4 4,6
Tub. bronchoadenitis 8 9,3
Anomaly of the urinary system 7 8,1
External stigmas of dysembryogenesis 36 41,8
Deposits in the renal parenchyma with ultrasound 84 97,6
Neurosthenic Syndrome 80 93,0
Acetonemic vomiting 17 19,7
Hypotension 16 18,6
Other mechanisms may include immunocompromising in these children, as well as oxidative stress. Noteworthy is the high frequency of external stigmas of connective tissue dysembryogenesis (83%), and 41% of them had more than 7 stigmas.
Clear information can be obtained by examining the partial functions of the kidneys and the composition of urine. For completeness of the characteristics of the formation of partial functions of the kidneys in the early neonatal period in newborns from mothers with OPH-gestosis, we present data on the state of filtration-reabsorption processes and the level of excretion of a number of substances under physiological
conditions, usually homeostasized by the kidneys. Glomerular filtration in newborns from mothers with pure preeclampsia on day 2 of life is significantly lower than in the healthy group (16.4 ± 0.78 ml / min / 1.73 m2, P<0.001), and in the group of newborns from mothers with combined preeclampsia remain significantly decreased Ccr and CNa in comparison with the first group (Р<0.001). The concentration of uric acid in both blood and urine is clearly increased (respectively 0.221 ± 0.06, 7.46 ± 0.57 mmol / l, P<0.001). By the 7th day of life, all the studied parameters of blood and urine differed little from those in healthy newborns, with the exception of the level of uric acid (P<0.005). Urine in the group of newborns from mothers with pyelonephritis is always more hyperosmolar in relation to the blood: during pregnancy in women with chronic pyelonephritis, the level of uric acid was 1.141 ± 0.06 (in healthy people 1.060 ± 0.07, in the presence of OPG-gestosis of the 1st degree 1.062 ± 0 , 07, and at II and III degrees 1.314 ± 0.012), which apparently indicates an earlier activation of the concentrating mechanism of the kidneys in conditions of chronic fetal hypoxia. Low rates of ammonio-acidogenesis in newborns, whose gestation proceeded against the background of pregnancy gestosis combined with chronic pyelonephritis, coincide with a high incidence of complications of the early neonatal period (metabolic acidosis, edema syndrome, late recovery of body weight). Filtration and reabsorption processes in the kidney tubules, as well as osmoregulation and ammonio acidogenesis, are largely determined by the structural and functional state of cell membranes.
The lipid spectrum of blood during the early neonatal period is dynamic: by the 5th day of life, the level of total lipids significantly increases in comparison with the indices at birth, and the content of monodiglycerides and non-esterified fatty acids did not change significantly.
Improving the primary prevention of DMD from the standpoint of hereditary predisposition (diathesis) provides for the differentiation of the stages of nosology formation: the threatened period as a compensated stage (elimination of all possible risk factors - dietary overload, climate, oxidative stress, etc.), the development of borderline states at the cellular and subcellular levels without the onset of symptoms and syndromes characteristic of nosology.
CONCLUSIONS
The priority of primary prevention of dysmetabolic nephropathies in children focuses on the need for significant strengthening of primary health care by specialized pediatricians, as well as laboratory services to identify pathogenetic markers of predisposition.
Differentiated preventive preventive programs for monitoring children, taking into account the nature of the factors for the development of nephropathy, need special
development: the nature of diathesis, children born from a mother with kidney diseases who have undergone critical conditions in the peri- and neonatal period. Since hyperuricemia and hyperuricosuria are constantly acting causal factors of development and progression, this contingent needs constant monitoring in childhood, followed by transmission by stage.
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