RU2166757C2 - Method for diagnosing latent secondary pyelonephritis in patients suffering from urolithiasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves taking 19 ml of native patient urine in the morning on the empty stomach state to exclude drug consumption and physical loading influence upon chemoluminescence. The samples under study are placed into thermostatted chemiluminometer cell where + 37 C temperature is maintained. Spontaneous luminescence is recorded during 1 min and then, 50 mM iron sulfate solution as chemoluminescence initiator agent is added in the amount of 1 ml. Urine chemoluminescence intensity is recorded during 1 min. Urine chemoluminescence light photosum being from 10 to 20 conditional units, latent phase of chronic pyelonephritis is to be diagnosed. The value being below 10 units, active form of chronic pyelonephritis is to be diagnosed. EFFECT: high accuracy and actuality of diagnosis.

Description

 The invention relates to medicine, namely to urology. A known method for the diagnosis of latent chronic pyelonephritis using an allergen-renographic provocation test (A.A.Shabad, B.S. Gusev, N.K. Soloviev, V.I. Kuznetsov. Urology and Nephrology, 1987, N 2), consisting in subcutaneous-intradermal administration of various bacterial allergens of microorganisms and registration of the response by radioisotope renography (RIRG). The survey is carried out according to the following method. Bacterial allergens of the most common causative agents of urinary infection and chronic pyelonephritis are injected intradermally-subcutaneously into the middle palmar surface of the forearm in a volume of 0.3-0.4 ml subcutaneously and 0.1 ml intradermally, each allergen separately, aseptically. Skin-allergic reactions are recorded after 20 minutes, 24, 48, 72 hours and recorded according to the scheme. The reaction is evaluated as follows: +++ in the presence of an infiltrate of at least 30 mm, ++ with an infiltrate with a diameter of 20-29 mm, + with an infiltrate with a diameter of 8-19 mm and as dubious (-) with an infiltrate with a diameter of less than 7 mm.

Control radioisotope renography with hippuran - J ¹³¹ was performed 24 and 48 hours after the introduction of bacterial allergens during the period of the maximum kidney reaction to the allergen. Changes in renographic indicators are considered a positive result. The method is time-consuming and lengthy, the result of a skin-allergic reaction is taken into account after 72 hours, the control radioisotope renography is carried out after 24 and 48 hours. This method is invasive, expensive, requiring the use of a hippuran radiopharmaceutical - J ¹³¹ and intradermal administration of allergens.

 The purpose of the invention is to improve the accuracy and timeliness of the diagnosis of the latent phase of chronic pyelonephritis in patients with kidney stones.

A method for the diagnosis of the latent phase of chronic pyelonephritis in patients with kidney stones is as follows. The patient’s urine is taken in the native form in the amount of 19 ml, in the morning on an empty stomach in order to exclude the effect on medication and physical activity on chemiluminescence (CL). The test samples are placed in a temperature-controlled cuvette of the chemiluminometer XL-003, in which the temperature is maintained at +37 ^o C. For 1 min, a spontaneous glow is recorded, and then, with constant stirring, the initiator CL-1 ml of a 50 mM solution of iron sulfate salt is added to the urine.

 A significant difference of the proposed study is that within 5 minutes, the urine chemiluminescence intensity is recorded, the level of which characterizes the production of reactive oxygen species that have a bactericidal effect and reflects the nature of the inflammatory process in the kidneys. With a light sum of CL urine from 10 to 20 conventional units, the latent phase of chronic pyelonephritis is diagnosed, and with a light sum of luminescence of less than 10 conventional units, the active phase of chronic pyelonephritis is diagnosed.

 As examples of the application of the proposed method for the diagnosis of latent chronic pyelonephritis, we present the following clinical observations.

 Example 1. Patient E., 28 years old, was admitted to the urology department of BSMP in a planned manner with complaints of dull constant pain in the left lumbar region. He suffers from urolithiasis for 3 years, and small calculi independently departed.

 An objective examination of the condition is satisfactory. The organs of the cardiovascular, respiratory, digestive systems during a physical examination without pathological changes. The abdomen is not swollen, palpation is soft, painful in the left hypochondrium. The lumbar region is not changed, the kidneys are not palpated, with striking, pain in the left lumbar region.

Complete blood count: red blood cell count 4.2 • 10 ¹² / l, hemoglobin content 131 g / l, color indicator 0.9. The number of leukocytes 5.8 • 10 ⁹ / l, eosinophils 1%, segmented nuclei 71%, lymphocytes 25%, monocytes 3%, ESR 12 mm / hour. Urinalysis is general: color - straw yellow, reaction - acidic, relative density 1010, protein - 0.085 g / l, white blood cells 4-6 in the field of view, red blood cells 20-25 in the field of view. In the sample according to Nechiporenko, leukocytes 5000 in 1 ml, red blood cells 4000 in 1 ml. No bacterial growth was found in bacteriological culture of urine.

 Biochemical blood test: urea 4.0 mmol / L, creatinine 49 μmol / L, total protein 76 g / L, glucose 6.0 mmol / L, total bilirubin 9.0 mmol / L, direct 1.0 μmol / L, indirect 8.0 μmol / L.

 Survey and excretory urography - in the projection of the left kidney there is a shadow of the calculus 1.5x1.5 cm, the function of both kidneys is preserved, the stone is located in the pelvis of the left kidney, the pyelocaliceal system on the left is expanded, on the right without features, the passage of the contrast drug through the ureters is not broken.

 When registering urine chemiluminescence, the luminosity of the luminescence was 18 arbitrary units. Diagnosed with urolithiasis. Stone of the left kidney. Chronic pyelonephritis latent phase.

The patient performed a DOLE. The operation went well. After lithotripsy, during the first day there was an attack of renal colic, single vomiting, hematuria, an increase in body temperature up to 38 ^o C, due to the transition of the latent phase of chronic pyelonephritis to the active. Prescribed antibacterial treatment. Urine chemiluminescence was recorded; the light sum was 8 arbitrary units. Complete blood count: erythrocyte count 4.3 • 10 ¹² / l, hemoglobin content 126 g / l, color indicator 0.8. The number of leukocytes 9.0 • 10 ⁹ / l, eosinophils 1%, stab 4%, segmented 62%, lymphocytes 24%, monocytes 7%, ESR 28 mm / hour.

After the drug treatment, fragments of stone independently moved away, and clinical recovery began. On the control review urogram of stones in the projection of the kidneys and ureters is not determined. A chemiluminescent urine test was performed, the light sum was 21 arbitrary units. Complete blood count: erythrocyte count 4.1 • 10 ¹² / l, hemoglobin content 135 g / l, color indicator 0.9. The number of leukocytes is 8.5 • 10 ⁹ / l, eosinophils 1%, stab 2%, segmented 66%, lymphocytes 26%, monocytes 5%. ESR 12 mm per hour. Urinalysis: color - straw yellow, clear, acidic reaction, protein 0.66%, relative density 1005, leukocytes 1-3 in the field of view, red blood cells 4-5 in the field of view.

 Example No. 2. Patient S., 41 years old, was admitted with complaints of dull aching pain in the left lumbar region. Was examined on an outpatient basis, a stone was found in the left kidney, sent for ESWL. An objective examination of the condition is satisfactory, the organs of the cardiovascular, respiratory and digestive systems without pathology. Soreness in the left lumbar region during palpation and stumping.

Blood test: red blood cell count 3.8 • 10 ¹² / l, hemoglobin content 123 g / l, color indicator 0.9. The number of leukocytes 6.5 • 10 ⁹ l, eosinophils 2%, stab 1%, segmented 71%, lymphocytes 24%, monocytes 2%. ESR 8 mm hour. Urinalysis: the color is straw yellow, the reaction is acidic, the relative density of 1012, protein 0.033 g / l, white blood cells 2-4 in the field of view, red blood cells 8-10 in the field of view. Test according to Nechiporenko: the number of leukocytes 4000 in 1 ml, the number of red blood cells 5000 in 1 ml. No bacterial growth was found in bacteriological culture of urine. In the biochemical analysis of blood, the glucose content is 5.0 mmol / L, urea 4.0 mmol / L, creatinine 91 μmol / L, total protein 74 g / L, total bilirubin 10 μmol / L.

 Survey and excretory urography: in the projection of the left kidney there is a calculus shadow of 1.0 • 1.0 cm. The function of both kidneys is satisfactory, the stone is located in the pelvis of the left kidney, the pyelocaliceal system is not expanded, the passage through the ureters of the contrast agent is not broken.

 When registering urine chemiluminescence, the luminosum of the luminescence was 16 arbitrary units. Diagnosed with urolithiasis. Stone of the left kidney. Chronic pyelonephritis, latent phase.

The patient performed a DOLE. The operation went well. A day after ESWL, urine CL was recorded, and clinical blood and urine tests were performed. The sum of the glow of urine was 14 arbitrary units. Complete blood count: erythrocyte count 3.8 • 10 ¹² / l, hemoglobin content 122 g / l, color indicator 1.0. The number of leukocytes 9.0 • 10 ⁹ / l, ESR 16 mm / hour. General analysis of urine: color - yellow, reaction - acid, protein 0.066%, relative density 1010, white blood cells 2-4 in the field of view, red blood cells - a large number.

5 days after the first session of ESWL, the patient experienced an increase in body temperature to 38 ^o C and attacks of left-sided renal colic. Catheterization of the left kidney was performed and antibiotic therapy was prescribed. When registering the chemiluminescence of urine, which was obtained by the ureteric catheter from the left kidney, the luminosity of light was 9 arbitrary units. General blood test: red blood cell count 3.6 • 10 ¹² / l, hemoglobin content 120 g / l, color indicator 0.9. The number of leukocytes 10.0 • 10 ⁹ / l, ESR 36 mm / hour. General urine analysis: color - yellow, reaction - acid, relative density 1016, protein 0.066%, white blood cells 30-40 in the field of view, red blood cells - a large number. The transition of the latent phase of chronic pyelonephritis to the active was diagnosed.

 A repeated session of the stone wall pathway in the lower third of the ureter was performed with a positive result. Within 6 days after the second session of ESWL on the background of conservative therapy, calculus fragments independently moved away. On the control review urogram, stones in the projection of the kidneys and ureters were not detected. A urine CL test was performed 7 days after the second session of ESWL. The total sum of the urine glow was 19 conventional units.

The results of clinical tests 7 days after ESWL. Complete blood count: erythrocyte count 3.8 • 10 ¹² / l, hemoglobin content 122 g / l, color indicator 0.9. The number of leukocytes 6.0 • 10 ⁹ / l, eosinophils 1%, stab 2%, segmented 66%, lymphocytes 26%, monocytes 5%. ESR 22 mm per hour. Urinalysis: color - straw yellow, reaction - acid, specific gravity 1010, protein 0.066%, white blood cells 20-25 in the field of view, red blood cells 4-5 in the field of view.

 The application of the proposed method for assessing the phase of pyelonephritis in patients with urolithiasis during treatment with ESWL allows to increase the accuracy of diagnosis, timely detect the transition of the latent phase of chronic pyelonephritis into the active phase. Using the proposed method, 72 patients with urolithiasis were examined before and after ESWL. In 63% of patients, it was possible to diagnose the latent phase of chronic pyelonephritis, and in 37% - the active phase of chronic pyelonephritis, which is a contraindication for remote shock wave lithotripsy of kidney stones. The proposed research method can be used in urological hospitals equipped with equipment for remote shock wave lithotripsy.

Claims (1)

 A method for the diagnosis of latent secondary chronic pyelonephritis in patients with kidney stones by examination of urine, characterized in that they record the intensity of chemiluminescence of urine induced by the addition of ferrous salt, and with a light sum of glow from 10 to 20 at. e. they diagnose the latent phase of secondary chronic pyelonephritis, and less than 10 cu evaluated as an active phase.