Научная статья на тему 'New methods of diagnosis and treatment of chronic pyelonephritis in children'

New methods of diagnosis and treatment of chronic pyelonephritis in children Текст научной статьи по специальности «Клиническая медицина»

CC BY
163
31
i Надоели баннеры? Вы всегда можете отключить рекламу.
Ключевые слова
CHRONIC PYELONEPHRITIS / REGIONAL LYMPHOTROPIC ANTIBIOTIC THERAPY / VITAMIN A

Аннотация научной статьи по клинической медицине, автор научной работы — Akhmedjanova Nargiza Ismailovna, Akhmatov Ablakul Akhmatovich, Abdurasulov Fozil Pardaevich, Makhmudov Hushnud Ulugbekovich, Khusenova Feruza Azizovna

The aim of this work was an attempt to evaluate the effect of сomplex treatment on some endogenous intoxication 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 depending on treatment method. Results. Comparative assessment of the results of the study of endogenous intoxication conducted 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. Conclusion. 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 concentration of albumin) and ECA (effective concentration of albumin) in the blood and kidney function.

i Надоели баннеры? Вы всегда можете отключить рекламу.
iНе можете найти то, что вам нужно? Попробуйте сервис подбора литературы.
i Надоели баннеры? Вы всегда можете отключить рекламу.

Текст научной работы на тему «New methods of diagnosis and treatment of chronic pyelonephritis in children»

NEW METHODS OF DIAGNOSIS AND TREATMENT OF CHRONIC PYELONEPHRITIS IN CHILDREN

12 3

Akhmedjanova N.I. , Akhmatov A.A. , Abdurasulov F.P. , Makhmudov H.U.4, Khusenova F.A.5

JAkhmedjanova Nargiza Ismailovna - Docent;

2Akhmatov Ablakul Akhmatovich - Docent;

3Abdurasulov Fozil Pardaevich - Assistant; 4Makhmudov Hushnud Ulugbekovich - Graduate Student; 5Khusenova Feruza Azizovna - Graduate Student, DEPARTMENT OF PEDIATRICS № 2, NEONATOLOGY AND PROPAEDEUTIC OF CHILDHOOD DISEASES, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN

Abstract: the aim of this work was an attempt to evaluate the effect of complex treatment on some endogenous intoxication indicators in chronic pyelonephritis developed on the background of dismetabolic nephropathy (DMN) (CHP). Patents and methods. A survey of 177 children CHP, aged 4 to 15 years. Patients were divided into 2 groups depending on treatment method. Results. Comparative assessment of the results of the study of endogenous intoxication conducted after treatment in children with CHP, 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. Conclusion. 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 concentration of albumin) and ECA (effective concentration of albumin) in the blood and kidney function. Keywords: chronic pyelonephritis, regional lymphotropic antibiotic therapy, vitamin A.

Relevance. 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, 11, 14]. 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, 12, 13]. In the practice of a pediatrician, signs of metabolic disturbances in the urine are found in every third child [1, 2, 15]. 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, 20]. Dysmetabolic disorders are one of the leading predisposing factors to the recurrence and progression of chronic pyelonephritis in children [8, 16]. At the basis of the pathogenesis of dismetabolic nephropathies, especially those caused by genetic factors, there are metabolic processes of interstitium, glomerulus and renal tubules [2, 7, 21]. 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 [9, 17]. 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 [10, 18, 19].

Purpose of the study: to develop the principles of secondary prevention of chronic pyelonephritis in children.

Materials and methods. The study involved 177 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 of bacteriological study -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 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.

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-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-35 probe, in g / l. [6]. Mathematical processing of the obtained results was carried out using computer statistical programs Excel.

Results and discussion. In the study of indices of endogenous intoxication, depending on the method of treatment of chronic pyelonephritis, it was revealed: in children receiving standard therapy (group I), before discharge from hospital, the level of TCA, ECA, BCA in blood plasma remained practically unchanged (P1> 0.1) (Table 1).

Table 1. Dynamics of indices of endogenous intoxication of the kidneys in blood plasma in patients with CCP, depending on the

method of treatment

Indices Healthy (n=30) Before treatment (n=177) After treatment

I gr (n=48) II gr (n=47)

TCÂ, g/l 47,5±0,55 30,13±0,96 Р<0,001 31,04±1,03 Рl>0,1 40,16±0,81 Рl<0,001, Р2<0,001

ECÂ, g/l 40,4±3,7 23,4±0,84 Р<0,001 23,02±0,91 Рl>0,1 35,5±0,3 Рl<0,001, Р2<0,001

BСА, (ECÂ\TCÂx100) % 93±0,9 77±0,3 Р<0,001 73,3±0,8 Рl>0,1 87,9±0,3 Рl<0,001, Р2<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 vitamin A.

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 treatment, 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 compared 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).

Table 2. Dynamics of renal partial function indicators in patients with CCP, depending on the treatment method (M ± m)

Indices Healthy (n=30) Before treatment (n=177) After treatment

Iгруппа (n=48) II группа (n=47)

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

Ammonia, mmol/24h. 46,8±1,2 30,3±0,55 P<0,001 33,6±0,57 P1>0,1 44,0±0,39 P1<0,001, P2<0,001

Urine acidity titration mmol /24h. 51,0±2,8 23,8±0,48 P<0,001 27,9±0,68 P1>0,1 48,0±0,34 P1<0,001, P2<0,001

AK 0,478 0,560 P<0,001 0,547 P1>0,1 0,468 P1<0,001, P2<0,05

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 vitamin A.

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.

Conclusions. 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.

1. In the acute period, the functional state of kidneys decreases due to impaired concentration, ammonio-acidogenetic function. In recurrent pyelonephritis, the decrease in tubular function during exacerbation is more marked and is not compensated in the period of remission. In a latent course of the disease, a similar trend persists.

2. 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-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.

References

1. Abdurasulov F.P., Yuldashev B.A., Ergashev A.H., Ruzikulov N.E. Multi-stage comprehensive screening program in diagnostics and prevention of dismetabolic nephropathy in children // Health, demography, ecology of Finno-Ugric peoples, 2017. P. 75-77.

2. Akhmedzhanova N.I., Akhmedzhanov I.A., Melieva G.A., Mamatkulova D., Bakhranov Sh. Optimization of methods of diagnostics and treatment of secondary chronic pyelonephritis in children // European Science Review Austria. № 9-10. Vienna, 2018. Р. 26-29.

3. Akhmedzhanova N.I. Renoprophylaxis in secondary chronic pyelonephritis in children // European Science Review Austria. № 9-10. Vienna, 2017. Р. 27-31.

81

4. Akhmedzhanova N.I. Effect of complex treatment on indicators of endogenous intoxication in dismetabolic chronic pyelonephritis in children // European Science Review Austria. Vienna, 2018. № 1-2. Р.91-96.

5. Aminov Z., Haase R. & Carpenter D., 2011. The Effects of Polychlorinated Biphenyls on Lipid Synthesis. Epidemiology. 22 (1). S. 298-S. 299.

6. Davlatov S.S., Kasimov S.Z. Extracorporal technologies in the treatment of cholemic intoxication in patients with suppurative cholangitis //The First European Conference on Biology and Medical Sciences, 2014. С. 175-179.

7. Garifulina L.M., Kudratova G.N., Goyibova N.S. The degree of metabolic disorders in children and adolescents with obesity and hypertension // Actual problems of modern science, 2016. № 4.

8. Muhamadiev N.Q., Ibatova S.M., Ergashev I.M. BIOL 249-Study fatty-acid composition of blood serum in children at vitamin D-deficient rachitis by the method of gas-liquid chromatography // Abstracts of papers of the American chemical society. P. 234.

9. Indiaminov S.I. Morphological features of the human brain in different variants of fatal blood loss on the background of alcohol intoxication // Herald of Russian State Medical University. Moscow, 2011. № 5. С. 63-66.

10. Jamshid S., Ravshan S. Accompanying defects of development in children with congenital cleft of lip and palate //European science review, 2017. № 1-2.

11. Malik A. et al. Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in Samarkand, Uzbekistan //Nagoya journal of medical science, 2014. Т. 76. № 3-4. С. 255.

12.Minaev S.V. et al. Laparoscopic treatment in children with hydatid cyst of the liver //World journal of surgery, 2017. Т. 41. № 12. С. 3218-3223.

13. Nazyrov F.G. et al. Пути улучшения результатов хирургического лечения эхинококкоз печени // Неонатология, хирургия и перинатальная медицина, 2018. Т. 8. № 3 (29). С. 39-43.

14.Kasimov S. et al. Haemosorption in complex management of hepatargia //The International Journal of Artificial Organs, 2013. Т. 36. № 8.

15. Kasymov S.Z., Davlatov S.S. Hemoperfusion as a method of homeostasis protection in multiple organ failure syndrome // Akademicheskiy zhurnal Zapadnoy Sibiri, 2013. Т. 9. № 1. С. 31-32.

16.Slepov V.P. et al. Use of ethonium in the combined treatment of suppurative and inflammatory diseases in children //Klinicheskaia khirurgiia, 1981. № 6. С. 78.

17.Sayit I. Damages to hypothalamus vessels in various types of blood loss on the background of acute alcohol intoxication //European science review, 2016. № 7-8.

18.Zayniev S.S. Ultrastructure of the Bone Tissue in Chronic Recurrent Hematogenous Osteomyelitis in Children //Journal of Experimental and Clinical Surgery, 2016. Т. 9. № 1. С. 53.

19. Shamsiyev A.M., Khusinova S.A. The Influence of Environmental Factors on Human Health in Uzbekistan //The Socio-Economic Causes and Consequences of Desertification in Central Asia. Springer, Dordrecht, 2008. С. 249-252.

20.Shamsiev А.М., Zayniev S.S. Комп'ютерно-томографiчна семютика хрошчного рецидивного гематогенного ocTeoMÍCTÍTy // Вюник наукових дослщжень, 2017. № 4.

21.Shamsiyev A., Davlatov S. A differentiated approach to the treatment of patients with acute cholangitis //International Journal of Medical and Health Research, 2017. С. 80-83.

22.Shamsiev A.M., Yusupov S.A., Shahriev A.K. Ефектившсть ультразвуково! сонографп при апендикулярних перитоштах у дгтей //Здобутки кишчно! i експериментально! медицини, 2016. Т. 26. № 2.

23.Soliman A. et al. Serological evidence of rickettsial infection among acute febrile illness patients in Uzbekistan //American journal of tropical medicine and hygiene. 8000 Westpark dr, ste 130, Mclean, va 22101 usa: amer soc trop med & hygiene, 2005. Т. 73. № 6. С. 79-80.

i Надоели баннеры? Вы всегда можете отключить рекламу.