Журнал "Почки" том 10, №1

Îðèã³íàëüí³ ñòàòò³ / Original Articles
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Отримано/Received 20.12.2020
Рецензовано/Revised 08.01.2021
Прийнято до друку/Accepted 12.01.2021
Information about authors
Nataliia S. Lukyanenko, MD, PhD in Medicine, Senior Researcher, Head of the Department of clinical genetics, State Institution “Institute of hereditary pathology of the National Academy of Medical
Sciences of Ukraine”, Lviv, Ukraine; https://orcid.org/0000-0003-4847-1488
Konstantin A. Kens, PhD in Medicine, Assistant at the Department of Pediatric surgery, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine;
Olha A. Dobryk, PhD in Medicine, Associate Professor at the Department of Pediatrics 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; https://orcid.org/0000-0001-5445-6837
N.S. Lukyanenko 1, 2 , K.A. Kens 2 , O.A. Dobrik 2
1
State Institution “Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine”, Lviv, Ukraine
2
Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
The role of metabolic therapy in the treatment of renal parenchymal hypoxia in children ith pyelonephritis associated
with undifferentiated connective tissue dysplasia
Abstract. Purpose of the work: to substantiate the choice and evaluate
the effectiveness of the use of a metabolic therapeutic complex
(vitamin E and L-carnitine) aimed at reducing tissue hypoxia and
improving metabolic processes in the renal parenchyma du ring the
treatment of acute pyelonephritis against the background of vesicoureteral
reflux (VUR) as visceral manifestation of undifferentiated
connective tissue dysplasia (UCTD) in young children. Materials
and methods. Sixty-seven children aged 3 months to 3 years with
pyelonephritis and VUR associated with UCTD were examined.
The control group consisted of 65 young children with acute pyelonephritis,
who after examination did not reveal VUR and signs of
UCTD. The second control group included 40 somatically healthy
children of the same age. In order to diagnose the presence of
undifferentiated connective tissue dysplasia, all children with remission
of the inflammatory process underwent a hydroxyproline
urine test. Markers of renal parenchymal hypoxia were determined
using a test for anticrystallization function of urine and daily urinary
salt excretion according to the method of Yu.Ye. Veltyshchev
and Ye.O. Yurieva. The markers of the morphofunctional state of
the renal epithelial cytomembranes were studied by means of a test
for calcification — the presence of polar lipids in urine, and a test
for the presence of lipid peroxidation products (LPР) in urine. For
young children with pyelonephritis, VUR and UCTD in whose
urine a high excretion of hydroxyproline was detected, in addition
to protocol treatment in the period of remission of the inflammatory
process, it was recommended to take for a month medications
that have antihypoxant properties and are able to improve metabolic
processes in the renal parenchyma — vitamin E and L-carnitine
in age-related doses. Results. The high frequency of detection of
phenotypic signs of undifferentiated connective tissue dysplasia and
significant urinary excretion of hydroxyproline (86.6 %) in children
with pyelonephritis against the background of vesicoureteral reflux
reliably indicate the presence of undifferentiated connective tissue
dysplasia as a result of fibrillogenesis disorders. In young children
with pyelonephritis against the background of vesicoureteral reflux,
the presence of renal parenchymal hypoxia and nephrothelial
membrane destruction was revealed, as indicated by a decrease in
the anticrystallization function of urine, daily excretion of phosphates
and a high excretion of lipid peroxidation products from
urine and polar lipids. In children in whom the association of the
pathological process with UCTD was detected, these changes were
more significant. This is indicated by a more pronounce decrease,
compared to children in whom no association with UCTD was
found, in the anticrystallization function of urine, an increase in
the oxalate excretion and a decrease in the daily urinary excretion
of phosphates and urates, which was accompanied by a significant
intensification of lipid peroxidation processes and the appearance
of polar lipids in daily urine. After metabolic therapy with antihypoxant
and membrane-protective action, the exa mined children
showed a significant positive dyna mics of the studied markers of
tissue hypoxia and membrane destruction of the renal parenchyma.
Conclusions. A positive effect of a metabolic complex (vitamin E
and L-carnitine) during remission of the inflammatory process in
the kidneys was revealed, which was expressed in a decrease in the
degree of tissue hypoxia and membrane destruction, which confirms
the possibility of reducing tissue hypoxia in children with pyelonephritis
and vesicoureteral reflux associated with undifferentiated
dysplasia connective tissue using vitamin E and L-carnitine
in age-related doses for a month and allows you to recommend
metabolite therapy to these children.
Keywords: young children; vesicoureteral reflux; metabolic therapy;
undifferentiated connective tissue dysplasia
24 Íèðêè, ISSN 2307-1257 (print), ISSN 2307-1265 (online) Òîì 10, ¹ 1, 2021