RU2634042C1 - Method for rehabilitation of children with chronic secondary pyelonephritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: at the second stage of rehabilitation, interference therapy is performed with a rhythmically varying frequency of 1-200 Hz, current intensity of 15 mA by the cross-over method to the segmentary-reflex area L2-S1 and the upper third of the front surface of hips. The duration of exposure is 10 minutes, for a course of 8 daily procedures. Also, exercise therapy is performed daily for 20-30 minutes in the morning together with manual massage of the lumbosacral area, for a course of 10 procedures every other day. In addition, sapropel is applied to the lumbar region with a temperature of +38°C, duration of 10-12 minutes, for a course of 8 procedures every other day. Low-mineralized chloride-sulfate magnesium-sodium mineral water, heated to 38-40°C, is administered as 5 ml/kg 3 times a day 40 minutes before meals daily for 21-24 days.

EFFECT: normalization of oxidation-reduction processes, correction of immunological disorders, relief of inflammation and improvement of urodynamics and metabolic processes in kidneys, leading to an increase in the terms of remission and prevention of complications.

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Description

The invention relates to medicine, in particular to restorative medicine, balneology, physiotherapy and pediatrics; and concerns methods for the rehabilitation of children with chronic secondary pyelonephritis.

Microbial inflammatory diseases of the urinary system due to its prevalence, severity, tendency to chronicity are one of the urgent problems among childhood diseases [7]. The prevalence of nephropathy in childhood is 29-187: 1000 [8]. In the structure of these diseases, the leading place belongs to pyelonephritis. It has now been shown that chronic pyelonephritis can lead to the development of chronic kidney disease already in childhood. Among the causes of chronic pyelonephritis, the main role is played by organic and functional disorders of urodynamics, including vesicoureteral reflux [9]. The frequency of vesicoureteral reflux is 0.4-1.8% of cases in children [10].

The main objectives of therapy for pyelonephritis in the acute period are the elimination of the microbial inflammatory process, the restoration of urodynamics, the normalization of metabolic disorders and the functional state of the kidneys, and the stimulation of regenerative processes. Some children have been unsuccessfully treated for outpatient conditions for chronic pyelonephritis for years, while long-term antibiotic treatment is not always able to suppress the inflammatory process, but rather leads to a gradual worsening of the situation [3, 11]. The urgent task is the use of not only effective drug and non-drug methods of treatment in children with diseases of the urinary system, but also the development and improvement of integrated approaches to treatment and rehabilitation using the principle of staging.

Known methods of rehabilitation of children using physical factors, such as the intake of mineral water, shared baths from sea, mineral water, paraffin baths, magnetotherapy [1, 2]. However, these methods have drawbacks in that immediately after the exacerbation of chronic pyelonephritis (the first stage of rehabilitation includes antibacterial agents, uroseptics, antihistamines, membrane stabilizers), the second stage of rehabilitation is not carried out and children after another exacerbation of the chronic inflammatory process in the kidneys are discharged home, bypassing second stage of rehabilitation. Not always after relief of acute inflammation in the kidneys, complete remission is achieved. To achieve clinical and laboratory remission, additional rehabilitation measures are often needed, aimed mainly at the final relief of the inflammatory process, improvement of redox processes in the kidneys and normalizing the functioning of the neuromuscular apparatus of the urinary tract, activation of the body's protective mechanisms, which provides for the second stage of rehabilitation measures.

Closest to the proposed is a method of rehabilitation treatment of children with chronic pyelonephritis using interference currents with a frequency of 90-100 Hz paravertebral to the segmented reflexogenic zone L1-L3 and to the projection area of the bladder for 7-10 minutes depending on age. The current strength of 8-10 mA to the sensation of a weak pleasant vibration in the course of 10-12 daily procedures [3]. The disadvantages of this method are the provision of only a painkiller that increases the muscle tone of the ureters and redistribution of blood flow in the kidneys without significant anti-inflammatory effects, activation of the antioxidant system, immunomodulatory effects. Getting used to interference currents in “constant mode” quickly gets used, therefore, it is more efficient to use “rhythmically changing frequencies” in a wider range. A current with rhythmically changing frequencies from 1 to 200 Hz affects all excitable muscle structures (in our case, the ureters). This frequency range helps to improve neuromuscular conduction, accelerate metabolism and normalize tissue tone. In addition, the disadvantage of this method is the impact on the patient without taking into account the stages of rehabilitation measures, which is important when the medical examination of this category of children and limits the use of this technique.

A new technical task is to increase the efficiency of the method due to the normalization of redox processes, correction of immunological disorders, reducing the frequency of exacerbations of the chronic inflammatory process in the kidneys and disease progression.

To solve the problem in a method of rehabilitation of children with chronic secondary pyelonephritis, including interference therapy in the second stage of rehabilitation, and interference therapy is carried out with a rhythmically changing frequency of 1-200 Hz, a current of 15 mA according to the transverse-cross-section technique to the reflex-segmental zone L2-S1 and the upper third of the front surface of the thighs, lasting 15 minutes, on a course of 8 daily procedures, also conduct physical therapy daily, for 20-30 minutes, in the morning, manual lumbar massage but-sacral region, No. 10 every other day, sapropel is also applied to the lumbar region with a temperature of + 38 ° C, lasting 10-12 minutes, No. 8 every other day; internal intake of low-mineralized chloride-sulfate magnesium-sodium water inside 5 ml / kg 3 times a day 40 minutes before meals, heated to 38-40 ° C, daily, for 21-24 days, with a continuation of the course of treatment for up to 2 months outpatient.

The method is as follows.

At the second stage of rehabilitation, they carry out interference therapy with a rhythmically changing frequency of 1-200 Hz, a current of 15 mA according to the transverse-cross-section technique to the reflex-segmental zone L2-S1 and the upper third of the anterior thigh surface, lasting 15 minutes, for a course of 8 daily procedures, also physical therapy is carried out daily, for 20-30 minutes, in the morning, manual lumbosacral area massage, No. 10 every other day, sapropel is also applied to the lumbar region at a temperature of + 38 ° C, lasting 10-12 minutes, 8 in a day; internal intake of low-mineralized chloride-sulfate magnesium-sodium water inside 5 ml / kg 3 times a day 40 minutes before meals, heated to 38-40 ° C, daily, for 21-24 days, with a continuation of the course of treatment for up to 2 months outpatient.

The method is based on the analysis of clinical research data, during which physical and balneological factors of exposure were selected, technical parameters of exposure and their sequence were determined.

The method consists in the use of a complex that includes physical therapy at the second stage of rehabilitation daily, 20-30 minutes, in the morning; manual lumbosacral massage, No. 8-10 every other day. Physical therapy is a non-specific stimulating factor, physical therapy exercises improve the renal blood flow, renal function, and also favorably increase adaptation [4, 5].

Also, to increase the speed of microcirculation and oxygenation in the area of influence, massage was chosen. The increase in tissue lymphoperfusion accelerates the release of metabolic products and cell autolysis, which leads to the elimination of stagnant phenomena in the tissues. In addition, tonic, vasoactive, trophic, draining, immunostimulating, sedative, analgesic effects are realized [6].

An undoubted reserve for optimizing the treatment of inflammatory diseases and preventing their frequent relapses is the use of natural and preformed physical factors with the ability to regulate neurohumoral and immune processes, prevent and reduce dystrophic changes, and stimulate the regeneration of cell structures [12]. Among the treatment methods, physiotherapeutic methods, including balneotherapy, occupy an important place. Balneotherapy remains one of the most popular, effective and safe types of restorative sanatorium-resort treatment [13, 14, 15, 16].

The intake of mineral water enhances intraorgan blood flow, glomerular filtration, normalizes urodynamics, increases diuresis [17, 18, 19], promotes more intensive removal of metabolic products from tissues, reduces the inflammatory process in the kidneys and urinary tract, and normalizes the functional state of the kidneys.

In children with chronic pyelonephritis, the study of the effectiveness of low-mineralized chloride-sulfate magnesium-sodium water of the XIII type, of the Moscow type, with internal use has not been previously conducted. The main ion-salt composition of water is expressed by the formula:

Mineral waters enriched with calcium and magnesium ions have anti-inflammatory, hypoallergenic effects, decreasing membrane permeability, and regulate osmotic cell homeostasis [20]. In addition, magnesium ions are antagonists of calcium oxalate [21].

The presence of bicarbonate in this mineral water will contribute to the dissolution and removal of mucus from the urinary tract, have a diuretic effect, change the reaction of urine, and reduce its acidity.

Silt sulfide mud contributes to the normalization of lipid metabolism, peroxide homeostasis, urodynamics, increased intraorgan blood flow, glomerular filtration, increased diuresis, has anti-inflammatory, antioxidant and stimulating effects [22], can significantly increase the overall treatment efficiency by improving blood circulation to the kidneys, increasing secretory activity of the kidneys reducing swelling of inflammatory tissue.

Interferential currents cause rhythmic contractions of the smooth muscles of blood vessels, renal pelvis and ureters, which leads to increased blood supply, lymph drainage, oxygen supply to the kidney tissue, elimination of tissue hypoxia, increased intensity of tissue respiration and enzymatic reactions, and improved trophism [23]. A rhythmically changing frequency of 0-200 Hz reduces the tone of sympathetic innervation, has a special tropism for neuromuscular tissue, affects the tone of the smooth muscles of the ureters and bladder, improves blood circulation in the kidneys, has an analgesic effect, and helps redistribute blood flow in the kidneys. In clinical practice, the high efficiency of interference therapy in children with chronic pyelonephritis has been proven [24].

The method allows to increase the effectiveness of rehabilitation measures and to increase the body's resistance to damaging factors of the external and internal environment, increase the timing of remission of chronic pyelonephritis in children and prevent the development of complications.

For a better understanding of the essence of the method, we offer specific examples of its implementation:

Example 1

Patient P., 8 years old, was treated in the children's department of the Research Institute from May 7 to May 26, 2014 with a diagnosis of Chronic secondary pyelonephritis (vesicoureteral reflux of the III degree), the period of clinical and laboratory remission. Kidney function saved. From the anamnesis: under the supervision of a nephrologist since 3 years. The frequency of exacerbations is 1 time per year, the last in 2013. Treatment and examination courses are regularly 1 time per year in oil separation.

Upon admission, she complained of lethargy, loss of appetite, headaches, and rare urination. When viewed before treatment, the condition is satisfactory, the skin is pale, periorbital cyanosis. Edema not detected. Turgor tissue preserved.

General clinical blood test: hemoglobin 142 g / l, red blood cells 5.3 × 10 ¹² cells / l, white blood cells 9.93 × 10 ⁹ cells / l, platelets 302 × 10 ⁹ cells / l, ESR 11 mm / h, leukocyte formula: stab neutrophils 1%, segmented neutrophils 52%, lymphocytes 37%, monocytes 8%, eosinophils 2%.

Biochemical analysis of blood: total protein 70.8 g / l, glucose 4.99 mmol / l, urea 3.54 mmol / l, creatine 35 μmol / l, C-reactive protein 1.3 mg / l.

General clinical analysis of urine: yellow, clear slightly turbid, specific gravity 1025, pH 5.5, epithelium 0-2 in the field of view, white blood cells 0-1 in the field of view, oxalates +.

Analysis by A.Z. Nechiporenko leukocytes 1200 cells / ml, red blood cells 200 cells / ml.

Test according to S.S. Zimnitsky:

Daily diuresis 315 ml.

Night diuresis 150 ml.

Daily diuresis 465 ml.

1 serving (6-9 h): specific gravity 1020, volume 50 ml.

2 servings (9-12 h): specific gravity 1010, volume 55 ml.

3 servings (12-15 hours): specific gravity 1013, volume 75 ml.

4 servings (15-18 h): specific gravity 1015, volume 135 ml

5 servings (18-21 hours): specific gravity 1012, volume 5 ml.

6 servings (21-00 h): specific gravity 1007, volume 40 ml.

7 portion (00-3 h): specific gravity 1015, volume 45 ml.

8 portion (3-6 hours): specific gravity 1025, volume 60 ml.

Volume and rhythm of spontaneous urination (for 1 day):

Drunk 860 ml, allocated 650 ml, the number of urinations 4 times.

Treatment is prescribed in accordance with the claimed method:

- physiotherapy exercises daily, 20 minutes, in the morning;

- manual lumbosacral massage, No. 10 every other day;

- interference therapy from the apparatus "AIT-01" according to the transverse-cross-sectional technique to the reflex-segmental zone (L2-S1) and the upper third of the front surface of the thighs, rhythmically changing with a frequency of 1-200 Hz, the current strength of 15 mA - until you feel a moderate painless vibration, 15 minutes, 8 daily procedures per course;

- applications of sapropel on the lumbar region with a temperature of + 38 ° C, lasting 10 minutes, No. 8 every other day;

- internal intake of low-mineralized chloride-sulfate magnesium-sodium water inside 5 ml / kg (150.0) 3 times a day 40 minutes before meals, heated to 38 ° C daily, for 21 days, with continued intake of water on an outpatient basis 2 months.

By the end of treatment, health, appetite improved, weakness, fatigue decreased, headaches disappeared.

General clinical blood test: hemoglobin 145 g / l, red blood cells 5.2 × 10 ¹² cells / l, white blood cells 6.3 × 10 ⁹ cells / l, platelets 290 × 10 ⁹ cells / l, ESR 7 mm / h, leukocyte formula: stab neutrophils 1%, segmented neutrophils 62%, lymphocytes 28%, monocytes 8%, eosinophils 1%.

General clinical analysis of urine: color yellow, full transparency, specific gravity 1019, pH 5, epithelium 0-1 in the field of view, leukocytes 3-4 in the field of view, no oxalates were detected.

(Oxalaturia disappeared in the general clinical analysis of urine.)

The volume and rhythm of spontaneous urination (for 1 day): 1230 ml were drunk, 1010 ml were excreted, the number of urinations increased up to 7 times a day, the amount of excreted fluid increased in relation to the drunk.

Test according to S.S. Zimnitsky: Daily diuresis 560 ml.

Night diuresis 350 ml.

Daily diuresis 910 ml.

On examination, the pallor of the skin, orbital cyanosis were not detected.

When assessing laboratory parameters: oxaluria of inorganic phosphorus in serum before treatment - 0.92 mmol / l, after treatment - 1.10 mmol / l, in daily urine before treatment 41.73 mmol / day, after treatment 37.52 mmol / day Dynamics of the level of MDA in serum (spontaneous: before treatment - 5.67 μmol / L, after treatment - 5.00 μmol / L, induced: before treatment - 17.33 μmol / L, after treatment - 16.79 μmol / l, accumulation rate before and after treatment 0.39 μmol⋅min / l), in the morning portion of urine (spontaneous MDA: before treatment - 4.33 μmol / l, after treatment - 3.33 μmol / l, induced: before treatment - 8.83 μmol / l, after treatment - 7.13 μmol / l, accumulation rate: before treatment - 0.15 μmol⋅min / l, after treatment - 0.13 μmol⋅min / l). Thus, there was a positive dynamics of laboratory parameters, indicating a decrease in the inflammatory process in the kidneys.

When studying long-term results for 12 months, the child did not have an exacerbation of chronic pyelonephritis.

Example 2

Patient Maria Z., 11 years old, was treated at the children's department of the TNIIKiF from May 30 to June 17, 2014 with a diagnosis of Chronic secondary pyelonephritis, a period of clinical and laboratory remission. Kidney function saved. Concomitant diseases: chronic cystitis, art. remission. Dystopia of the external opening of the urethra. From the anamnesis: it has been under the supervision of a nephrologist since 2007. The frequency of exacerbations is 1 time per year, the last in 2012. Treatment and examination courses are regularly 1 time per year in nephrotomy.

Upon admission, she complained of lethargy, weakness, selective appetite, frequent urination (with exacerbation). When viewed before treatment, the condition is satisfactory, the skin is pale, periorbital cyanosis. Edema not detected. Turgor tissue preserved. Urination is rare (~ 4 times a day), uncomplicated, painless. The kidneys are not palpable, the projection above them is painless.

General clinical blood test: hemoglobin 137 g / l, red blood cells 4.8 × 10 ¹² cells / l, white blood cells 5.2 × 10 ⁹ cells / l, platelets 212 × 10 ⁹ cells / l, ESR 6 mm / h, leukocyte formula: stab neutrophils 2%, segmented neutrophils 43%, lymphocytes 48%, monocytes 5%, eosinophils 2%.

Biochemical analysis of blood: total protein 71 g / l, glucose 4.94 mmol / l, urea 3.28 mmol / l, creatine 32.4 μmol / l, C-reactive protein was not detected.

General clinical analysis of urine: color yellow, full transparency, specific gravity 1020, pH 5.5, epithelium 0 in the field of view, white blood cells 0-1 in the field of view, oxalates +.

Analysis by A.Z. Nechiporenko: white blood cells 400 cells / ml, red blood cells 0 cells / ml.

Test according to S.S. Zimnitsky:

Daily diuresis 155 ml.

Night diuresis 275 ml.

Daily diuresis 430 ml.

1 serving (6-9 h): -

2 servings (9-12 h): specific gravity 1010, volume 70 ml.

3 servings (12-15 h): -

4 servings (15-18 h): specific gravity 1005, volume 85 ml

5 servings (18-21 hours): specific gravity 1012, volume 90 ml.

6 servings (21-00 h): specific gravity 1015, volume 80 ml.

7 portion (00-3 h): specific gravity 1018, volume 10 ml.

8 portion (3-6 hours): specific gravity 1030, volume 95 ml.

Volume and rhythm of spontaneous urination (for 1 day):

Drunk 1350 ml, allocated 800 ml, the number of urinations 4 times.

Thus, pathological changes in general clinical and biochemical blood tests, in the analysis according to Nechiporenko, were not detected. In the sample according to Zimnitsky - nocturia. In a general clinical analysis of urine, oxalaturia was detected.

Treatment is prescribed in accordance with the claimed method:

- physiotherapy exercises daily, 30 minutes, in the morning;

- manual lumbosacral massage, No. 10 every other day;

- interference therapy from the AIT-01 apparatus according to the transverse-cross-section technique to the reflex-segmental zone (L2-S1) and the upper third of the front surface of the thighs, rhythmically changing at a frequency of 1-200 Hz, current strength of 15 mA - until a moderate painless vibration lasts for a duration 15 minutes, 8 daily procedures per course;

- applications of sapropel on the lumbar region with a temperature of + 38 ° C, lasting 12 minutes, No. 8 every other day;

- internal intake of low-mineralized chloride-sulfate magnesium-sodium water inside 5 ml / kg (180.0), 3 times a day, 40 minutes before meals, heated to 38-40 ° C, daily, for 24 days, s continued intake of water on an outpatient basis for up to 2 months.

By the end of treatment, the state of health improved, weakness, fatigue decreased, headaches disappeared, and the frequency of urination returned to normal. On examination, the pallor of the skin, orbital cyanosis are less pronounced.

General clinical blood test: hemoglobin 129 g / l, red blood cells 4.8 × 10 ¹² cells / l, white blood cells 6.1 × 10 ⁹ cells / l, platelets 161 × 10 ⁹ cells / l, ESR 7 mm / h, leukocyte formula: stab neutrophils 2%, segmented neutrophils 52%, lymphocytes 39%, monocytes 4%, eosinophils 3%.

Biochemical analysis of blood: total protein 73.7 g / l, glucose 5.09 mmol / l, urea 4.92 mmol / l, creatine 29.8 μmol / l, C-reactive protein was not detected.

General clinical analysis of urine: yellow, transparency slightly cloudy, specific gravity 1016, pH 5, epithelium 2-4-6 in the field of view, leukocytes 4-6 in the field of view, no oxalates were detected.

(Oxalaturia disappeared in the general clinical analysis of urine.)

Test according to S.S. Zimnitsky:

Daily diuresis 500 ml.

Night diuresis 250 ml.

Daily diuresis 750 ml.

(No nocturia was found in the sample according to S. S. Zimnitsky.) Volume and rhythm of spontaneous urination (for 1 day):

Drunk 850 ml, allocated 800 ml, the number of urinations increased up to 5 times, the amount of allocated fluid increased in relation to the drunk.

In laboratory studies: the content of inorganic phosphorus in the blood serum: before treatment - 0.92 mmol / l, after treatment -1.10 mmol / l, in daily urine: before treatment 41.73 mmol / day, after treatment 37.52 mmol / day Dynamics of the level of MDA in serum (spontaneous: before treatment - 5.67 μmol / L, after treatment - 5.00 μmol / L, induced: before treatment - 17.33 μmol / L, after treatment - 16.79 μmol / l, MDA accumulation rate before and after treatment 0.39 μmol⋅min / l), in the morning urine (spontaneous: before treatment - 4.33 μmol / l, after treatment - 3.33 μmol / l, induced: before treatment , - 8.83 μmol / l, after treatment - 7.13 μmol / l, MDA accumulation rate: before treatment - 0.15 μmol⋅min / l, after treatment - 0.13 μmol⋅min / l), which indicates on anti-inflammatory action desired medical complex.

During the observation period for 12 months, there was no exacerbation of chronic pyelonephritis and cystitis in the child.

The mode of the proposed method is based on the results of the analysis of clinical observations, laboratory studies of blood serum and urine.

To achieve this goal, at stage I of the study, 44 children from 7 to 14 years old were examined and treated in the nephrology department of a multidisciplinary hospital for chronic secondary pyelonephritis. At the II stage of the study, the same children were examined and treated in the rehabilitation department of the Research Institute of Balneology and Physiotherapy (children entered the II stage of rehabilitation immediately after discharge from the nephrological hospital after stopping the exacerbation of inflammation in the kidneys). At the III stage of the study, an analysis of outpatient cards of children in outpatient settings.

The diagnosis was verified on the basis of anamnesis and examination data in accordance with the classification proposed by M.Ya. Studenikin (1982). Laboratory and instrumental methods of research in children with chronic pyelonephritis included examination of the child according to the order of the Ministry of Health of the Russian Federation dated 07.05.1998 N 151.

A complex has been developed for the 2nd stage of rehabilitation measures using natural and preformed factors aimed at preventing exacerbation of the disease, increasing the duration of remission, reducing the frequency of relapses and preventing the development of complications in children with chronic pyelonephritis.

The control group consisted of 20 healthy children of the same age who did not have chronic and acute diseases in the last three months before the examination.

Analysis of existing concomitant diseases during the observation of children with chronic pyelonephritis showed the following:

- the pathology of ENT organs is widespread in the main group: adenoiditis in 6 children (15%), chronic rhinitis in 9 (20%), chronic tonsillitis in 31 (70%), chronic sinusitis 2 (4.5%). It was noted that a large number of children (30 people (70%)) with diseases of the musculoskeletal system, mainly represented by a violation of posture. With a diagnosis of chronic gastroduodenitis, 12 patients (26%) were out of exacerbation at the time of the examination. Vulvitis, vulvovaginitis was found in 3 (10% of girls), pathology of the endocrine system in 4 (10%), central nervous system in 11 (25%).

Thus, in the observed group of 44 children with chronic pyelonephritis, 41 children had concomitant pathology. On average, 2.25 concomitant diseases were associated with one child, which indicates a high incidence of children with chronic kidney disease.

Analysis of the clinical status showed that before treatment, all had lethargy in 37 people. (84.1%), weakness in 37 people. (84.1%), headaches in 7 people. (15.9%), a decrease in appetite in 42 people. (94.5%), pallor of the skin in 35 people. (79.5%), orbital cyanosis in 32 people. (72.7%), abdominal pain in 8 people. (18.1%), in the lower back in 5 people. (11.4%), rare urination in 2 people. (4.5%), turbid urine in 7 people. (15.9%). After treatment, a significant reduction in complaints occurred, lethargy, weakness, headaches, abdominal pain, lower back urination, rare urination disappeared, appetite increased in all patients, only pale skin in 7 children (15.9%) remained, and orbital cyanosis also in 7 children (15.9%), turbid urine in 2 (4.5%).

After the treatment by the claimed method in laboratory indicators, the dynamics:

- in general urinalysis: there is a disappearance of leukocyturia (before treatment in 2 children (4.5%)), microerythrocyturia (before treatment in 4 people (9%)), phosphaturia (before treatment in 2 children (4.5%) ), reduction in cases of oxalaturia (before treatment in 11 children (25%), after - in 2 (4.5%));

- in samples according to S.S. Zimnitsky experienced a decrease in the number of cases of nocturia (before treatment in 37 people (84%), after - in 30 (68%)) and the disappearance of hyperisostenuria (before treatment in 4 people (9%));

- when interpreting the daily indicators of the volume and rhythm of spontaneous urination, one should also note a decrease in nocturia (before treatment in 33 people (75%), after - in 27 (61.4%)), an increase in the number of urinations from 5.6 times to 6 , 6 times a day, an increase in the average single amount of urine by 12% (from 119 ml to 134 ml) and the average daily amount by 25% (from 670 ml to 891 ml);

- the ratio of drunk and excreted fluid has changed: before treatment: drunk fluid: urine = 9: 5,

after treatment: drunk fluid: urine = 9: 7;

- in samples according to A.Z. Nechiporenko disappeared leukocyturia and microerythrocyturia (before treatment were observed in 7 children (15.9%)).

Since free radical lipid peroxidation (lipid peroxidation) plays a leading role in the pathogenesis of a number of diseases, including kidney diseases, and antioxidants that reduce the content of lipid peroxidation products are essential therapeutic factors, the study of the content of MDA as the final product of lipid peroxidation is necessary to study mechanisms of kidney damage in chronic renal failure at the cellular level. Given that the content of MDA in the blood is quite small [Mecocci P., Polidori C., Troiano L., Cherubini A., Ceccheti R., Pini G., Straatman M., Monti D., Stahl W., Sies K., Franceschi C., Senin U., (2000). Free Radic. Biol. Med., 28, 1243-1248 [25]], recently began to apply the definition of the potential ability of lipids for peroxidation in vitro, the so-called oxidizability or oxidative stability. The initiator of the LPO process is usually metal salts of variable valency.

The results of a study of the activity of LPO in serum in children with chronic pyelonephritis are presented in table 1.

In the acute blood serum of children with chronic renal failure, a statistically significant increase in spontaneous and induced MDA levels was observed in 1.6 and 1.8 times, respectively, compared with the control group. After the treatment, a significant decrease in these indicators in blood serum was recorded: spontaneous MDA content decreased by 34%, induced MDA content by 30%. In children with chronic renal failure, during the period of remission, significant changes in the studied parameters in the blood serum compared with the control group were not observed.

For a more complete understanding of the mechanism of lipid peroxidation in chronic renal failure, these parameters were also studied in the morning urine dose.

The results of the study of LPO activity in the morning urine in children with chronic pyelonephritis are presented in table 2.

In the morning portion of the urine of children with chronic renal failure, in the acute period there was also a significant increase in the spontaneous and induced levels of MDA by 2.3 and 1.8 times, respectively, compared with practically healthy children. After the prescribed therapy, the spontaneous MDA content decreased by 41%, and the induced MDA content decreased by 34%. Significant differences in the parameters determined in the morning urine in children with chronic renal failure during remission compared with the control group were not observed.

The results of the study of the rate of accumulation of MDA in children with chronic pyelonephritis are presented in table 3.

In children with chronic renal failure, in the acute phase in the blood serum there was a statistically significant increase in the accumulation rate of MDA by 1.4 times, while in the morning urine, this indicator increased by 1.5 times compared with the control group. After the course of treatment, the studied indicator in the blood serum decreased by 33%, while this indicator in the morning portion of urine did not significantly change. In the blood serum of children with chronic renal failure, during the period of remission, significant changes in this parameter compared with practically healthy children were not observed.

The content of inorganic phosphorus in the blood serum reflects the state of phosphorus-calcium metabolism and acid-base balance. A study of its concentration in the blood serum is prescribed for symptoms of kidney pathology. Moreover, normal phosphorus concentration is higher in children than in adults, which is associated with increased secretion of growth hormone up to the puberty period. An analysis of phosphorus in the urine is performed in the differential diagnosis of hypophosphatemia. At the same time, increased excretion of phosphorus indicates the renal causes of the disease and excludes nutritional deficiency of this trace element and redistribution of phosphorus in the tissues. Diagnosis of phosphaturia is extremely important for understanding the mechanisms of kidney damage and the localization of the pathological process.

The results of the study of inorganic phosphorus in children with chronic pyelonephritis are presented in table 4.

In the blood serum and daily urine of children with chronic renal failure, in the acute phase there was a significant decrease in the content of inorganic phosphorus by 1.5 times in comparison with the control group. After the prescribed therapy, a 39% increase in inorganic phosphorus was recorded in the blood serum, however, a significant decrease in phosphaturia was not observed in this group of children. The phosphorus content in the daily urine of children with chronic renal failure, during remission increased 1.5 times compared with the control group, and after a course of therapy a significant decrease in this indicator was not observed.

When observing children for 12 months, exacerbation of chronic pyelonephritis was not observed in any of the 44 patients. All children throughout the year (observation period) continued clinical and laboratory remission.

The presented research results indicate the advantage of the proposed method of staged treatment in the comprehensive rehabilitation of children with chronic pyelonephritis.

Thus, the claimed complex for the 2nd stage of rehabilitation measures using natural and preformed factors aimed at stopping inflammation and improving metabolic processes in the kidneys, preventing exacerbation of the disease, increasing the duration of remission and preventing the development of complications in children with chronic pyelonephritis, has an anti-inflammatory effect , improves urodynamics, metabolic processes in the kidneys and can be used to optimize the treatment of children with chronic pyelonephritis.

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Claims (1)

A method for the rehabilitation of children with chronic secondary pyelonephritis, including at the second stage of rehabilitation, interference therapy, characterized in that the interference therapy is performed with a rhythmically changing frequency of 1-200 Hz, a current of 15 mA according to the transverse-cross-section technique to the reflex-segmental zone L2-S1 and the upper third the front surface of the thighs lasting 10 minutes, a course of 8 daily procedures, physical therapy is also carried out daily for 20-30 minutes in the first half of the day, manual lumbosacral massage No. 10 every other day, sapropel is also applied to the lumbar region with a temperature of + 38 ° C for 10-12 minutes; No. 8 every other day; internal intake of low-mineralized chloride-sulfate magnesium-sodium mineral water 5 ml / kg 3 times a day 40 minutes before meals, heated to 38-40 ° C, daily for 21-24 days, with the continuation of the course of treatment for up to 2 months on an outpatient basis .