RU2197292C1 - Method for treating chronic pyelonephritis in children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: a patient is affected with interference currents at rhythmically alternating frequency being 90- 100 Hz, paravertebrally onto segmentary-reflexogenic area L₁-L₃ and onto area of a bladder's projection, for 7-10 min depending upon an age. Current power is about 8- 10 mA till the feeling of a slight pleasant vibration, 10-12 daily procedures/course. EFFECT: higher efficiency of therapy. 2 ex

Description

 The invention relates to medicine, in particular to pediatrics, namely to nephrology, and can be used in medical institutions for the treatment of children with chronic pyelonephritis.

 It is known that currently the treatment of chronic pyelonephritis is complex, primarily aimed at combating inflammation, for which various medications (antibacterial) drugs are used: antibiotics, uroseptics, membrane stabilizers, antihistamines, immunomodulators, etc. ("Kidney diseases in childhood ". Under the editorship of Studenikin M.Ya., M .: 1976," Guides. Nephrology ". Under the editorship of Tareeva I.E. M.: 1995). However, the main disadvantages of this method are: allergization of the body, deterioration of the immunological reactivity and functional state of the kidneys, resistance to therapy and its short-term effect.

 Physiotherapeutic methods are also known for treating chronic pyelonephritis in children, for example, using supratonal frequency currents (“Current of supratonal frequency in the complex treatment of children with chronic inflammatory diseases of the urinary tract.” Diss. Ph.D. Vasilyeva MF, M. : 1983).

 However, currents of a natal frequency have a surface effect, in addition there are certain difficulties in carrying out the procedures.

 Closest to the technical nature of the present invention is a method for the treatment of chronic pyelonephritis in children, based on the combined effects of direct current of low frequency and a drug substance administered with it ("Physiotherapy in Pediatrics" by Kh. T. Umarova, T. V. Karachevtseva, 1993). The treatment is carried out from the apparatus "Stream 1", a bifurcated electrode with pads moistened with 1% r-rm of furadonin is placed on the area of the projection of the kidneys, a positive electrode on the abdomen, current density 0.02 0.03 mA / cm, duration of the procedure 10-15 minutes, up to 15 procedures performed daily or every other day ("Physiotherapy in Pediatrics" by Kh. T. Umarova, T V. Karachevtseva, 1993).

 The disadvantage of this method is that direct currents of a constant direction have a pronounced irritating effect under the electrodes, which causes a child to have a negative attitude to treatment. In addition, this method limits the possibility of a targeted action on organs, does not allow to clearly localize the effect in the depths of tissues due to the involvement of a larger volume of tissues located between the electrodes in the sphere of influence, as well as large energy losses during the passage of the epidermis.

 A significant negative point is the possibility of an allergic reaction to the medication used, moreover, this factor does not affect the smooth muscles of the urinary tract, which is especially important for children with concomitant urinary tract pathology.

 The technical result of the proposed method is the relief of pain, restoration of urodynamics, lengthening the period of remission, the possibility of use with concomitant pathology of the lower urinary tract.

The specified technical result is achieved by exposing the patient to interference currents with a frequency of 90-100 Hz, a current strength of 7-14 mA depending on the age of the child, paravertebral to the segmented reflexogenic zone L ₁ -L ₃ and to the projection area of the bladder for 7-10 minutes until you feel a slight vibration, daily, for a course of 10-12 procedures.

 The interference current therapy in this method is based on the use of a mid-frequency alternating sinusoidal current with low-frequency amplitude modulations (1-100 Hz) from two independent circuits using 4 electrodes. As a result of this effect, a biologically active interference current of low frequency (0-100 Hz) occurs not in the device, but inside the patient’s tissues, which causes 100% absorption of interference currents without energy loss and allows you to limit the area of influence, have a targeted effect, which is especially important for child's body.

 The device "Ait-01" generates rhythmically changing frequencies within 10, 25, 50 and 100 Hz of the carrier frequency. The main operating frequency of the generators is 5000 Hz ± 10%.

 Within each subband, interference frequencies change automatically with a repetition period (10 ± 1) s. The current in the patient circuit is continuously regulated using variable resistors from 0 to 50 mA and is controlled in both circuits with a relative error of 10%.

 In this method of treatment, a rhythmically changing frequency of 90-100 Hz is used, which reduces the tone of the sympathetic innervation, has a special tropism for neuromuscular tissue, has an effect on the tone of the smooth muscles of the ureters and bladder, improves blood circulation in the kidneys.

 A rhythmically changing frequency, in contrast to a constant frequency, is used to prevent addiction. We did not use low frequencies in the range from 0 to 25 Hz due to the fact that they cause strong motor excitement in the form of a separate or tetanic contraction of muscle fibers. These frequencies are selected for muscle atrophy (V.E. Yasnogorodsky, "Electrotherapy", M., 1987, p. 80).

 To affect the internal organs, it is sufficient to use high frequencies of 90-100 Hz, which have analgesic effects, reduce the tone of the sympathetic nervous system, and improve blood circulation.

 In our method, a rhythmically changing frequency of 90-100 Hz is used, which is most acceptable for affecting the kidney area in children with chronic pyelonephritis. It is preferable to use this frequency, since it is not addictive, has a mild effect, has no discomfort in children, increases the tone of the muscles of the ureters, and helps redistribute the blood flow in the kidneys.

DESCRIPTION OF THE METHOD OF TREATMENT
The patient is laid on a wooden couch. Previously turn on the device for 5 minutes in order to prepare it for the procedure. On the patient’s body, 2 electrodes are placed paravertebrally onto the segmented reflexogenic zone L ₁ -L ₃ and 2 electrodes are placed on the projection area of the bladder with a size of 4 • 4 cm from 2 independent circuits with thin hydrophilic pads moistened with warm tap water, providing the best electrode contact with the body and performing hygienic functions. The electrodes are positioned so that the currents flowing in one circuit cross in the area of the kidney gate with the currents flowing in another circuit, i.e. so that the imaginary lines connecting both pairs of electrodes are as perpendicular to each other as possible. The electrodes are fixed using a sand bag or rubber bandages. The impact is carried out by a rhythmically changing frequency of 90-100 Hz. The total duration of the procedure is set from 7 to 10 minutes, depending on age, current strength of 7-14 mA, to the sensations of weak pleasant vibration, on a course of 10-12 daily procedures.

EXAMPLES OF IMPLEMENTATION OF THE METHOD
EXAMPLE 1

 Laskovaya Anna, 9 years old, was admitted to the neurological department of the RCHD RAMP with a diagnosis of chronic pyelonephritis, partial clinical and laboratory remission, decreased renal function by osmotic concentration, neurogenic bladder dysfunction.

 A girl from the 1st pregnancy, proceeding with the threat of interruption. Heredity due to kidney disease is burdened by the mother. An allergic history is calm. Early development by age. Urine tests up to 5 years - without features. The debut of the disease from daytime enuresis, frequent urination, peremptory urges, periodic leukocyturia. Treatment with physical factors (atropine-electrophoresis of the bladder), uroseptics - with a temporary effect.

Disease progression was noted from the age of 7. For the first time, against the background of dysuric phenomena, intoxication phenomena were noted in the form of pallor of the skin and nausea, severe leukocyturia up to 50-70 s / s, febrile temperature, pain, bacteriuria, leukocytosis in the general blood test up to 10x10 ⁹ / l. It was treated for 2 months with antibacterial drugs in a therapeutic dose (ampicillin, furagin).

 Repeated relapse at age 9 with febrile fever, pain in the lumbar region, expressed by leukocyturia, dysuric phenomena. The child was hospitalized in the neurological department of the Research Institute of Pediatrics.

 Upon admission to the clinic, the condition of a child of moderate severity. On examination: asthenic physique, skin is clean, pale, eye shadow, respiratory and cardiovascular systems without features. The abdomen is soft, painless in all departments, the filled sigmoid colon is palpated. The chair is irregular, prone to constipation. Liver on the edge of the costal arch. Bubble symptoms are negative, a positive symptom was noted on both sides, frequent urination. Daytime urinary incontinence.

The following examinations were carried out in the department:
An. blood wedge: L 9.6, Er 4.2, HB 128 g / l, 0, P 0, C 52, L 39, M 9, ESR 8, Tr 242.

 Biochemical an. blood: AST-24, ALT-23, cholesterol 4.3 mmol / L, Ca 2.08 mmol / L, K 4.5 mmol / L, Na 150 mmol / L, chlorides 100 mmol / L, urea 45 mg% , creatinine 1.2 mg%, sugar 70 mg%.

Proteinogram: commonly. protein 70 g / l, albumin 49.8%, globulins: α ₁ 1.1%, α ₂ 12.2%, β 13.9%, γ 22.6%.

 An. urine commonly. : acid reaction, beats. weight 1006, protein 0.150%, white blood cells 50-52 in n / a, red blood cells 2-3 in n / a.

 An. urine according to Addis: diuresis 650 ml, protein 0.15%, white blood cells 20 million, red blood cells 300,000.

 An.m. according to Zimnitsky: diuresis 700 ml, beats. weight 1006-1017.

 Daily excretion of salts with urine: diuresis 720 ml, urates 261 mg / day, oxalates 7.15 mg / day.

Sowing urine on the flora: gram + cocci 100,000,
Examination:
ECHO of the abdominal organs: The abdominal organs without features. Kidneys - on the left 83 • 33 mm, on the right 79 • 32 mm The parenchyma is not changed, the walls of the CSF and blood vessels are sealed. The bladder is without features.

 Cystoscopy is the norm.

Cystography - a double contour, different wall thickness, no reflux, hypoplasia of 12 pairs of ribs, absence of fusion of the spinous processes S ₁ .

 Gynecologist consultation. Conclusion: moderate vulvitis.

On the 8th day after admission to the clinic, the child is prescribed therapy with interference currents. The patient was laid on a wooden couch. On the patient’s body, 2 electrodes were placed paravertebrally onto the segmented reflexogenic zone L ₁ -L ₃ and 2 electrodes onto the projection area of the bladder measuring 4 • 4 cm with thin hydrophilic pads moistened with warm tap water, providing the best electrode contact with the body and performing hygienic functions . The electrodes were positioned so that the currents flowing in one circuit cross in the area of the kidney gate with currents flowing in another circuit. The electrodes are fixed using a sand bag. The impact is carried out by a rhythmically changing frequency of 90-100 Hz. The total duration of the procedure is set up to 10 min, the current strength is 10 mA, until the sensations of a weak pleasant vibration, in the course of 10 daily procedures. I transferred the first procedure well. In the course of treatment, by the middle of the course (in the 4th-5th procedure), the patient's condition improved significantly, the pain syndrome stopped, urinary incontinence became less frequent, and stool returned to normal. The girl has become more active. When examining after a course of treatment:
An. urine total: acid reaction, ud.weight 1006, protein traces, leukocytes 1-2 in s / sp, red blood cells 0-1 in s / sp.

 An. urine according to Addis: diuresis 650 ml, protein traces, white blood cells 60 thousand, red blood cells 400.

 Sowing urine on the flora: no growth.

 As a result of treatment with the proposed method, along with improving the clinical picture of the underlying disease, a favorable effect of interference currents on the course of concomitant pathology was established: the rhythm and volume of urination were normalized, and constipation was stopped.

 A favorable effect of interference currents on the indices of cellular and humoral immunity was established, which was manifested in an increase in the absolute number of lymphocytes and their activity by the blast transformation reaction from 66% to 70% and a decrease in IgG from 1,024 mg% to 981 mg%, and IgM from 354 mg% up to 193 mg%.

EXAMPLE 2
Igor Lukyanov, 8 years old, was admitted to the neurological department of the SCCH RAMS with a diagnosis of chronic pyelonephritis, recurrent course, partial clinical and laboratory remission, restriction of renal function by osmotic concentration. Bronchial asthma, atopic form, moderate course, period of remission. Food allergy. Violation of tolerance to carbohydrates.

 From the anamnesis: this disease has been observed since January 1996, when the decrease in beats was first detected. weight up to 1014 in the sample with dry eating, severe polydipsia without polyuria, transient hyperglycemia. Consulted at the Research Institute of Endocrinology. Diagnosis: prediabetes. An examination at the Pediatric Research Institute showed urinary sediment without any particularities, however, upon repeated hospitalization in 1998, there was a slight leukocyturia of up to 8 PS, transient hematuria, proteinuria of up to 0.03 g / l, ESR of 10 mm / h. A course of treatment with uroseptics 6 months. In the subsequent exacerbation 2-3 times a year, treatment with antibiotics, uroseptics with a positive effect, in 1999, according to excretory urography, hydronephrotic transformation of the left kidney was revealed.

 At admission: a state of moderate severity for the underlying disease, well-being is satisfactory. In the lungs, vesicular breathing, single dry rales. Palpation of the left kidney is moderately painful, the rest of the internal organs without features.

Analysis data
An. blood wedge: L 9.2, Er 3.97, HB 132 g / l, E 0, P 0, C 47, L 44, M 9, ESR 2. Tr 281. B / X blood AST 26, ALT 33 , cholesterol 5.0 mmol / L, Ca 2.24 mmol / L, K 4.5 mmol / L, Na 148 mmol / L, chlorides 100 mmol / L, urea 33.2 mg%, sugar 79 mg%.

 Proteinogram: total protein 69 g / l, albumin 50.2%.

 An.m. of urine total: acid reaction, ud.weight 1006, protein 0, leukocytes 3-5.

 An.m. according to Addis: diuresis 650 ml, protein 0.15%, white blood cells 4200000.

 An.m. according to Zimnitsky: diuresis 740 ml, ud.weight 1006-1016.

 KHS: pH 7.42, BE -1.1, CB 23.5. Blood gases and CBS are normal.

 Daily excretion of salts with urine: diuresis 800 ml, urate 380 mg / day, oxalates 10.4 mg / day.

 Excretion of Ca and P with urine: diuresis 500 ml, Ca 0.51 mM / day, P 0.24 g / day. Daily urine for sugar: diuresis 650 ml, sugar 0.

 Sugar profile: on an empty stomach 87 mg%, after 60 minutes 62 mg%, after 120 minutes 113 mg%, after 180 minutes 65 mg%.

Examination:
ATS FVC 134%, 115% _FEV1, IT 88%, PSV 104% MOC _50% 85% 87% ISO.

 MOS 72%. Conclusion: the norm.

 ECHO of the abdominal organs: The abdominal organs without features. Kidneys on the left 81 36 mm, on the right 70 31 mm, structure without features.

 Allergist consultation. Conclusion: the child has bronchial asthma, atopic form, moderate course. Food and drug allergies.

ECG: EOS deviation to the right. Severe arrhythmia, moderate bradycardia on the background of atrial pacemaker migration. Some disorders of the metabolic processes in the myocardium of the ventricles. X-ray of the spinal column. The shape and size of the vertebral bodies correspond to age, no bone changes. Lumbar lordosis. X-ray of brushes. Bone age is 6 years. There is no distal epiphysis of the ulna with the styloid process. On the 7th day after admission to the clinic, the child was prescribed therapy with interference currents: the patient was placed on a wooden couch. Four electrodes were placed on the patient’s body paravertebrally onto a segmented reflexogenic zone L ₁ -L ₃ measuring 4 • 4 cm with thin hydrophilic pads moistened with warm tap water, providing the best electrode contact with the body and performing hygienic functions. The electrodes are fixed using a sand bag.

The impact is carried out by a rhythmically changing frequency of 90-100 Hz. The total duration of the procedure was set to 7 min, the current strength of 8 mA to the sensations of weak pleasant vibration, in the course of 12 daily procedures. He transferred the first procedure well. In the course of treatment, by the middle of the course (in the 4-5th procedure), the patient’s condition improved, the boy’s pain became more active. When examining after a course of treatment:
An. urine commonly. : acid reaction, specific weight 1006, protein 0, leukocytes 1-2 in s / sp.

 An. urine according to Addis: diuresis 650 ml, protein traces, white blood cells 200 thousand, red blood cells 400 thousand

 Sowing urine on the flora - no growth.

 The impact of interference currents was characterized by the normalization of the level of malondialdehyde-1 (MDA-1) from 2, 7 to 1.5 nmol / L * 10 er and MDL-2 from 2.75 to 1.5 nmol / L * 10 er, which testified to the restoration of the ability of cells to utilize secondary peroxidation products.

 The proposed method of treatment was used in 65 children with chronic pyelonephritis who had concomitant diseases: cystitis, neurogenic bladder dysfunction, functional constipation, bronchial asthma, allergic rhinitis. Among the examined children predominated with a moderate course of the disease (40 people), the rest had a mild severity of chronic pyelonephritis. All children tolerated treatment with the proposed method, no adverse reactions were noted. By the end of the course of treatment, all patients felt better, their sleep was normal, and their irritability decreased. In all patients with concomitant neurogenic bladder dysfunction, the rhythm and volume of urination returned to normal. In chronic constipation, stool returned to normal in most patients. All patients showed a positive dynamics of clinical symptoms: pain and dysuric phenomena by the end of the course of treatment, IT was not observed in any child.

 The anti-inflammatory effect was manifested in a significant decrease in leukocyturia: in an. urine according to Addis from 6.240 million ± 0.330 to 1.210 million ± 0.105, p <0.05, as well as in the elimination of pathologically significant bacteriuria in 100% of children.

 The beneficial effect of the method on the indicators of cellular and humoral immunity was established, which manifested itself in an increase in the absolute number of lymphocytes and their activity in response to blastotransformation and a decrease in IgG and IgM.

 The impact of interference currents was characterized by the normalization of lipid peroxidation.

 As a result of treatment, improvement and significant improvement were observed in 82.0% of patients.

 Follow-up observation revealed a beneficial effect of IT for 6 months, which was characterized by persistent clinical and laboratory remission.

 As a result of treatment with this method, it was found that children with chronic pyelonephritis can be treated with interference currents to relieve pain, restore urodynamics, lengthen the period of remission, and provide corrective effects on the lower urinary tract.

Claims (1)

A method of treating chronic pyelonephritis in children by exposure to pulsed currents, characterized in that the patient is affected by interference currents with a rhythmically changing frequency of 90-100 Hz paravertebrally on the segmented reflexogenic zone L ₁ -L ₃ and on the projection area of the bladder for 7-10 min, depending on age, current strength of 8-10 mA, until a weak pleasant vibration is felt, for a course of 10-12 daily procedures.