Information about the authors

Ahmedzhanova Nargiza Ismailovna - PhD, Associate Professor of Pediatrics and 3 Medical Genetics SamGosMI, a doctoral student named department. Uzbekistan, Samarkand, str. Haitova, Building 33A. Mob. T .: (+99898) 573-64-15 E-mail: n_ismailovna @ mail.ru.

Dilmuradova Clara Ravshanovna - MD, associate professor of neonatology course of the Faculty of Postgraduate Medical SamGosMI. 703003, Samarkand, Samarkand, str. Gagarin, d.95 kv.27. T. (8366) 2345285.

Akhmedzhanov Ismail Ahmedzhanovich- MD, professor of pediatric surgery SamGosMI. Samarkand, Samarkand, settlement Taylyak Street. Birlik, d.41.

OPTIMIZATION OF METHODS OF DIAGNOSIS AND TREATMENT OF CHRONIC PYELONEPHRITIS IN CHILDREN

N.I.Ahmedzhanova, K.R.Dilmuradova, I.A. Akhmedzhanov

Samarkand State Medical Institute

The aim is to assess the impact of the regional lymphatic therapy (RLT) + + kanefron electrophoresis aminophylline on some parameters of endogenous intoxication (EI) and renal function (SAF) in chronic pyelonephritis dismetabolic (CDA). The study involved 70 children with CDA, aged 4 to 14 years. Patients were divided into four groups depending on the treatment method. Comparative evaluation of research results and indicators of EI FAK showed high efficiency of complex application RLT + kanefron electrophoresis with aminophylline, which we called "renal tyubazh."

Keywords: endogenous intoxication, renal function, regional lymph antibiotic, kanefron, renal tyubazh.

I.Introduction

Significantly increased the proportion of latent forms and by the reduced flow of renal infection, occurring against the backdrop of dismetabolic nephropathy, which requires an individual approach to the diagnosis and management of these patients. Chronic pyelonephritis dismetabolic (CDA) is a high risk of developing chronic kidney disease (CKD) with the formation of chronic renal failure (CRF) and reduced quality of life in childhood [3, 4]. On average, the prevalence of Russia dismetabolic nephropathy (DMN) is about 27-64% of all diseases of the urinary system in children; in the practice of pediatrics signs of metabolic disorders in the urine found in almost every third child [1, 2, 6]. In Uzbekistan, in the structure of the most common is the DMN oxalate crystalluria, which accounts for 68-71%, 15% is uraturia, 9-10% - phosphaturia and from 5 to 3% cystinuria [7, 8]. According Kuzbekova RS (2008) in a study of 128 patients with CP, they observed, 60 (46.9%) the disease was formed against the background of DMN, 40 (31.2%) - on the background of neurogenic bladder dysfunction, 28 (21.9% ) - against the backdrop of obstructive uropathy (vesicoureteral reflux, hydronephrosis, renal hypoplasia and aplasia, horseshoe kidney, lumbar dystopia kidney et al.) [5, 9]. All this indicates that the CP formed on the background of DMN in children today remains one of the most pressing problems of practical health care, the solution of which has not only medical but also social significance.

II. Statement of the Problem

         The aim is a comprehensive evaluation of clinical, biochemical parameters, partial renal function and endogenous intoxication at the CDA in children after the application of the "kidney of probing."

          Materials and methods. We examined 70 children aged 4 to 14 years. The patients were arbitrarily divided into 4 groups depending on the treatment method. In Group 1 included 18 patients who received standard therapy (in the first three days, usually ampicillin / m, after the results of bacteriological of research is an antibacterial drug, depending on the sensitivity of the pathogen). Group 2 - 15 patients who were administered antibiotics lymphotropic way, the third - of the 17 patients treated with RLT in conjunction with kanefron and 4th group - 20 patients who used RLT + kanefron in conjunction with electrophoresis aminophylline ("renal tyubazh"). Study of EI and FAK were performed in all children before and after treatment.

Glomerular filtration rate of the kidneys was determined by endogenous creatinine clearance (Van Slayke), creatinine, blood and urine - on the total content of chromogens based on Jaffe reaction (E.D.Ponomarёva et al., 1969).

         Urine osmolality was determined by freezing point depression method on the unit OMC-1, C-01. Quantitative determination of oxalate in urine was carried out by NV Dmitrieva (1966). Calculation of daily excretion of oxalate was carried out according to the formula:

(Number of potassium permanganate (KMgO4) × 0,63) - 0,1 × D / 2 = mg of oxalate in the day, where: 0,63 - constant coefficient; D - diuresis.

Determination of average mass molecules by the method II Zhadenova (2002). C-RB- method latex immunonephelometry analyzer BN-ProSpec, total protein levels were determined azotometricheskim: classical Kjeldahl method (1883) and its modifications; total albumin was measured by the fluorescence method (Miller, A., Dobretsov GE, 1992). Mathematical processing of the results was performed using the statistical software Excel.

Given the complex pharmacokinetic effect of the drugs: Novocaine, which is the first part of the RLT, kanefron and aminophylline we called "renal tyubazh."

         Novocaine has antispasmodic effect on smooth muscles, which helps to improve microcirculation. The main effect kanefron diuretic, antispasmodic, which promotes the release of oxalate from the renal pelvis. Aminophylline muscle relaxant, vascular resistance decreases and expands them lowers pressure in the renal arteries and increases renal blood flow, has a diuretic (diuretic) activity. Given the complex pharmacokinetic effect of the drugs: Novocaine, which is the first part of the RLT, kanefron and aminophylline we called "renal tyubazh."

         Thus, the combination of novocaine entered regional lymphotropic method kanefron and electrophoresis with aminophylline ("renal tyubazh") increases the excretion of salts from kidney tissue and accelerates the regression of the inflammatory process by improving the microcirculation.

            III. The Results

          Comparative evaluation of endogenous intoxication and renal function (SAF), depending on the method of treatment, showed: children treated with conventional therapy (group 1), before discharge from the hospital level SM, the total concentration of albumin (OKA), C-reactive protein, as well as FAK remained practically unchanged (P1> 0.1). More positive developments endogenous intoxication in patients we identified against the background of the use of RLAT (group 2). There was a significant reduction in the SM, C-reactive protein, increased OKA (P1<0.001) and a significant increase in performance by endogenous creatinine clearance (P1<0.001), urine osmolarity (P1<0.001). Furthermore, there was an increase of the daily urine output (P1<0.001), compared with those before the treatment. In general, the use of RLAT in children with CP on the secondary background DMN had a positive effect on EI and binders, to a greater extent on the level of CM, C-reactive protein and endogenous creatinine clearance on, but to a lesser extent on the level of oxaluria.

Table

Dynamics of partial indicators of kidney function in patients with CDA depending on the method of treatment (X ± m)

Indicators	of Healthy Children	Before treatment	After treatment
			I group (n=18)	II group (n=15)	III group (n=17)	IV group (n=20)
GFR ml / min.m²	98,6±7,8	68,11±1,16 Р<0,05	71,0±2,3 Р1>0,1	78,8±1,6 Р1<0,001 Р2<0,001	85,5±2,8 Р1<0,001, Р2<0,001	89,6±2,5 Р1<0,001 Р2<0,001
Urine osmolality, mmol / L	1000±200	623,46±21,0 Р<0,001	680,8±40,2 Р1>0,1	813±23,8 Р1<0,001 Р2<0,001	975,6±37,6 Р1<0,001, Р2<0,001	983,3±36 Р1<0,001, Р2<0,001
Daily urine output, l / day.	1,7±0,036	1,02±0,028 Р<0,001	1,03±0,05 Р1>0,1	1,41±0,05 Р1<0,001, Р2<0,01	1,4±0,027 Р1<0,001, Р2<0,01	1,6±0,025 Р1<0,001, Р2<0,001
Oxaluria mg / day.	25±2,4	43,8±2,6 Р<0,001	33,3±3,8 Р1>0,1	29,09±1,06 Р1<0,001 Р2>0,1	27,3±0,5 Р1<0,001, Р2<0,05	25,3±0,8 Р1<0,001, Р2<0,001

Note: P-significant differences between the performance of healthy and in children with chronic pyelonephritis. P1 - reliability of differences between the indices before and after treatment. P2 - significant differences between traditional therapy and a group of children who received RLAT.

Patients third group received kanefron addition RLAT. We observed a positive trend of all the studied parameters of EI, but to a lesser extent FAK in this group. Thus, significantly improved performance ee with respect to the relevant parameters prior to treatment and after the standard treatment parameters (P1 <0.001, P2 <0.001). In this group, we have also found positive dynamics of FAK (P2 <0.001), which have improved relative to that of group 2 after combined treatment.

Patients Group 4 received kanefron and electrophoresis with aminophylline RLAT addition, we observed a positive trend of all the studied parameters as EI and FAK in this group. Thus, the performance of CM, OKA and C-reactive protein is not only significantly improved with respect to the relevant indicators before treatment and after the standard treatment parameters (P1 <0.001, P2 <0.001), but reached the level of healthy children (P> 0.1 ). In this group, we have also found significant improvements in all indicators of FAK (P1 <0.001, P2 <0.01) and oxaluria (P1 <0.001, P2 <0.01), which is also close to the standards after the application of "renal tyubazh" (P > 0.1).

All this suggests the high efficiency of the proposed methods of therapy in the secondary CP children (RLAT + kanefron and RLAT kanefron + electrophoresis with aminophylline) on indicators of EI and FAK.

IV. CONCLUSIONS

1. When the CDA violated renal function that requires finding new approaches to treatment aimed at reducing the impact of antibiotic therapy on renal function and with mandatory use kanefron.

2. During an exacerbation CDA significant reduction in total plasma albumin and increased SM and CRP in the blood plasma. The results obtained demonstrate the diagnostic value of the investigated parameters of EI, which allows to recommend them, including procedures for the assessment and detoxification.

3. RLAT is highly effective therapy CDA has a positive impact on the main indicators of renal function and endogenous intoxication: GFR, urine osmolality, the level of the SM, the total albumin and CRP.

4. Application kanefron in conjunction with RLAT at CDA leads to the restoration of indicators of EI and to the relative performance improvement FAK.

5. Application kanefron + electrophoresis in combination with aminophylline RLAT at CDA is the most appropriate method of treatment. This method leads to the restoration of indicators of daily urine output, reducing oxaluria has a positive impact on the GFR, urine osmolality and indices of endogenous intoxication: CM level, total albumin and CRP.

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