С.of m.s. Akhmedzhanova N.I., d.of m.s. Dilmuradova K.R., d.of m.s. Akhmedzhanov I.A., с.of m.s. Mamatkulova D.H.

Samarkand State Medical Institute

PARTIAL RENAL FUNCTION IN CHRONIC PYELONEPHRITIS IN CHILDREN AFTER FOR NEW TREATMENTS

In the structure of renal pathology in children the frequency ranks first pyelonephritis. More than 15% of developing chronic renal failure (CRF) in children is caused by CP. In patients with secondary pyelonephritis is a high risk of developing CRF and reduced quality of life in childhood. The aim of the study was to assess the impact of regional lymph antibiotic (RLAT) and fitouroantiseptika kanefron some partial indicators of renal function in chronic obstructive pyelonephritis secondary (COPS) in children.

The material for the study of renal function served as peripheral blood taken from the cubital vein and urine taken from patients in the morning on the background of an exacerbation of chronic recurrent process and in remission. Kidney function was assessed by endogenous creatinine clearance, urine osmolality, daily excretion of oxalate.

To assess the state of glomerular filtration used method for calculating the clearance of endogenous creatinine formula Van Slayke. Creatinine is determined by the total content of chromogens based on Jaffe reaction (E.D.Ponomarёva et al., 1969).

At the same time determined by the freezing point depression method of osmolality of urine on the unit OMC 01 1 c, which has significant advantages over the breakdown Zimnitsky. Mathematical processing of the results was performed using a parametric Student's t-test and non-parametric Mann-Whitney test using statistical computer programs.

RLAT carried out aiming to focus the inflammatory process in the perirenal fat.

Technique of RLAT. The patient - sitting, straighten your lumbar region. The index finger of his left hand was determined by the point of intersection XII rib and the outer edge of the long back muscles (m. Sacrospinalis), which was pre-treated skin with alcohol or iodine. Then, at this point the puncture needle made pyatigrammovogo syringe and injected into a lymph-stimulators of 0,25% novocaine solution calculation: for children weighing up to 16 kg – 3,5 ml, and more than 16 kg - 5.10 ml, 5-10 min administered antibiotic. The needle is directed perpendicular to the skin surface or with a small inclination of its pointed end to the body midline. The depth of needle insertion is usually no more than 2-3 sm (depending on the age and condition of the child). The correct position of the needle, we removed the syringe was determined by the absence of the reverse leakage of the injected solution and traces of blood in it, as well as small fluctuations of the needle, respectively, the breath of the patient. After removing the needle puncture site was treated with alcohol and alcohol-imposed furatsillinovy compress. Injection was performed 1 time per day. The course of treatment was on average 5-9 days at regional lymphotropic injection of an antibiotic (at least 10-14 days, injected with conventional antibiotics).

In patients with unilateral COPS when performing RLAT 1/3 administered daily dose of an antibiotic age on the side of the localization of the inflammatory process, which is determined on the basis of clinical disease (aching pain, heaviness palpation, muscle strain lumbar region and positive symptom pokalachivaniya in the projection of the affected side) and the results of instrumental studies. With bilateral COPS 1/2 administered daily doses of age at the same time on both sides, dividing it into two equal parts.

       The study involved 40 children with COPS in age from 4 to 14 years. The patients were arbitrarily divided into 3 groups depending on the treatment. In Group 1 included 14 patients who received standard therapy (the first three days, usually cefotaxime / m, after receiving the results of bacteriological study antibacterial drug, depending on the sensitivity of the pathogen). Group 2 - 11 patients who were administered antibiotics lymphotropic way, and the third - out of 15 patients treated in combination with RLAT kanefron. The material for the study of renal function served as peripheral blood taken from the cubital vein and urine taken from patients in the morning on the background of an exacerbation of chronic recurrent process and in remission. Kidney function was assessed by endogenous creatinine clearance, urine osmolality, daily excretion of oxalate. Comparative evaluation indicators SAF conducted after treatment in children with COPS depending on the method of treatment showed different changes in the indices of partial kidney function. Thus, children with COPS treated with conventional therapy (group 1), before hospital discharge rate of endogenous creatinine clearance was not changed practically (P1> 0,1). Accordingly, there was an increase in urine osmolality (P1 <0,1). Traditional therapy had no effect on the content of oksalaturii (P1> 0,1). More positive changes in FAK patients we have identified on the background of the use RLAT (group 2). There was a significant increase in the rates of endogenous creatinine clearance (P1 <0,001), urine osmolality (P1 <0,001). Patients of group 3 received kanefron addition RLAT. We observed positive dynamics of the studied parameters FAK in this group. Thus, the performance of the endogenous creatinine clearance, urine osmolality is not only significantly improved in relation 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). This group also showed a significant improvement in performance oxaluria (P1<0,001, P2 <0,05), which is also close to the standards after combined treatment (P>0,1). Results: after the conventional treatment were noted positive dynamics of the studied parameters FSP. Using RLAT, we detected a significant improvement in all the studied parameters FSP, a significant reduction in oxaluria level. Finally, using complex and RLAT kanefron managed to achieve the best results: the restoration of a number of the studied parameters (oxaluria) and a significant improvement in the basic rate (GFR, urine osmolality). All this suggests a high effectiveness of the proposed treatment methods for children COPS (RLAT and RLAT kanefron +) in respect of FAK.

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