RU2738552C1 - Method of treating oxalate nephropathy in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to pediatrics, and can be used for treating oxalate nephropathy in children. That is ensured by administering Magne B6 in drinking ampoules of 1 ampoule 2 times a day and Hilak forte 30 drops 3 times day for 4 weeks with hypooxalate diet, high-liquid drinking mode.

EFFECT: method provides higher clinical effectiveness in oxalate nephropathy ensured by reducing urinary excretion of oxalates with prolonged remission.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to pediatrics, and can be used in the treatment of patients with oxalate nephropathy.

Oxalate nephropathy is an inflammatory lesion of the kidney tubules associated with the pathology of oxalic acid metabolism and manifested by hyperoxaluria, which is of a secondary nature.

Oxalate nephropathy with secondary hyperoxaluria is quite common in childhood (32 per 1000 children). Alimentary factors (excessive intake of oxalate from food), as well as the destruction of membrane phospholipids of renal tissue due to renal ischemia, exposure to bacterial phospholipases and membrane toxic compounds, contribute to the violation of oxalate metabolism.

The problem of oxalate nephropathy requires solutions taking into account the potential danger to the health of children, since the disease can lead to the development of urolithiasis with a subsequent transition to chronic kidney disease. Considering this fact, it becomes obvious that it is necessary to prevent the progression of oxalate nephropathy in childhood, which makes us look for new approaches to rational and effective therapy of oxalate nephropathy.

Known methods of treating oxalate nephropathy, presented in a practical guide to childhood nephrology (Pediatric nephrology / edited by V.A.Tabolin, S.V. Belmer, I.M. Osmanov. - M .: MEDPRACTICA-M, 2005. - 711 pp. 484-485), consisting in dietary recommendations (exclusion of foods with high oxalate density from the diet (over 1.3 g of oxalic acid / kg of product)), compliance with a highly liquid drinking regime (2 liters per 1.73 m ^{2 of a} standard body surface), the appointment of membranotropic drugs (xidiphon, dimephosphon) and antioxidants (vitamins A, E, pyridoxine, magnesium oxide). However, the presented methods of therapy have the disadvantage of low efficiency of treatment of patients with oxalate nephropathy. When we used these methods of therapy in practice (hypooxalate diet, high-liquid drinking regimen, and Magne B6 as an antioxidant), no statistically significant decrease in the level of urinary excretion of oxalates was obtained (p = 0.109). In addition, a decrease in oxaluria levels to normal values occurred in only 80% of patients. Considering that the efficiency of using this method has not reached the limit, it seems necessary to increase it.

The problem to be solved by the present invention is to increase the effectiveness of the treatment of oxalate nephropathy in children.

The technical result of using the proposed method is to increase the effectiveness of therapy for patients with oxalate nephropathy, a clinically significant decrease in the level of urinary excretion of oxalate, as well as an increase in the period of remission.

The technical result is achieved by the fact that in a method of treatment, including a hypooxalate diet, a high-liquid drinking regimen, drug therapy with Magne B6, the administration of Magne B6 preparations in drinking ampoules, 1 ampoule 2 times a day, and Hilak forte, 30 drops 3 once a day.

The method is carried out as follows:

A child with an established diagnosis of oxalate nephropathy is prescribed a hypooxalate diet for 4 weeks, excluding foods with a high oxalate density from the diet (over 1.3 g of oxalic acid / kg of product) and a highly liquid drinking regime (from 1 to 1.5 liters of pure water per day). If patients follow a hypooxalate diet and a high-liquid drinking regimen, Magne B6 preparation in drinking ampoules (10 ml) in a daily dose of 2 ampoules (200 mg of magnesium and 20 mg of vitamin B6), divided into 2 doses: 1 ampoule 2 times a day. Before taking, the contents of the ampoule are dissolved in Ѕ glass of water. And also the drug Hilak forte 30 drops 3 times a day. The drug Hilak forte is diluted for intake with a small amount of liquid, excluding milk. Additionally, according to indications, membrane stabilizers (xidiphon, dimephosphon) and other antioxidants (vitamins A, E) are used.

Currently, the use of the drug Hilak forte, as well as the proposed dosage, frequency and duration of admission in the treatment of oxalate nephropathy, is new and not obvious for a specialist working in this field, allows you to solve the problem and increase the effectiveness of treatment of this category of patients.

The method is applied in 25 patients aged 2 to 7 years, with an established diagnosis of oxalate nephropathy (ICD-10: N16.3), who are hospitalized. The comparison group also included 25 children. The inclusion of patients in the groups was carried out on the basis of randomization, from the number of children in whom all signs of inclusion were found and all signs of exclusion were absent. Patients of the main group were treated according to the proposed method, and in the patients of the comparison group, the drug Hilak forte was excluded. The initial values of indicators after division into groups were comparable.

The baseline level of oxaluria in the main group of patients was 20.3 [15.6; 26.1] mg / day (hereinafter, the median is given, in square brackets - the first and third quartiles), the level of oxaluria after therapeutic correction is 11.2 [9.6; 13.3] mg / day. The decrease in the daily urinary oxalate excretion when comparing the parameters before and after the therapy was significant (p = 0.012). In all patients of the main group, after the treatment, the urinary excretion of oxalates decreased to normal values. The obtained positive result of the treatment remained in dynamics, for 6 months after the end of the course of therapy.

In the comparison group, the following results were obtained: the level of oxaluria before the start of treatment was 23.1 [19.8; 28.6] mg / day, the level of oxaluria after therapeutic correction was 14.3 [13.1; 17.6] mg / day. ... However, there was no statistically significant decrease in urinary oxalate levels (p = 0.109). In addition, a decrease in the level of oxaluria to normal values occurred only in 80% (n = 20) of patients in this group.

When comparing oxaluria indicators among two groups of patients, it was found that in the main group the intensity of oxaluria reduction was higher than in the comparison group. There was a clinically significant reduction in oxaluria of 6.7% compared to baseline.

Clinical example No. 1.

Patient V., 4 years old, from the 2nd pregnancy, proceeding without pathology, from 2 independent deliveries on time. At birth: weight 3340 g, height 54 cm. Development by age. Preventive vaccination by age. Allergic history is not burdened. There is no drug intolerance. Heredity is not burdened. Past diseases: ARVI.

She was admitted to the pediatric department due to changes in outpatient urine tests (microhematuria 7-10 per day, abacterial leukocyturia up to 15 per day, hyperoxaluria 28 mg / day).

Objectively: at the time of examination - a state of moderate severity. Active. The appetite is saved. Neuropsychic development is age appropriate. Physical development is average, harmonious (weight 14.5 kg, height 103 cm). Musculoskeletal system without visible pathology. The subcutaneous fat layer is moderately developed. The skin is pale pink, clean. The oropharynx without inflammatory changes, no plaque. No edema. The lymph nodes are small, painless. Percussion in the lungs clear pulmonary sound. Auscultatory breathing is puerile, carried out in all departments, no wheezing. BH 20 in 1 min. The boundaries of the heart are within the age norm. Rhythmic heart sounds, systolic murmur. Heart rate 110 in 1 min. The abdomen is soft and painless on palpation. The liver is not enlarged. The spleen is not palpable. Pasternatsky's symptom is negative on both sides. Urination is free, painless. The genitals are of the female type. The chair is regular, decorated.

Data of laboratory and instrumental examination of patient V. upon admission to the hospital:

Complete blood count: hemoglobin - 110 g / l, erythrocyte count - 3.87 x ^{10 12} / l, leukocyte count - 9.49 x ^{10 9} / l, platelet count - 342 x ^{10 9} / l, ESR - 12 mm / h.

Biochemical blood test: AsAt - 0.91 μkat / L, AlAt - 0.32 μkat / L, glucose - 5.03 mmol / L, calcium - 2.29 mmol / L, phosphorus - 1.62 mmol / L, creatinine - 59 μmol / l, urea - 3.6 mmol / l, potassium - 3.3 mmol / l, sodium - 129 mmol / l, chlorine - 104 mmol / l, calcium - 2.29 mmol / l, phosphorus - 1, 62 mmol / l, total bilirubin - 16.3 μmol / l, total protein - 62.5 g / l, albumin - 40.2 g / l.

General urine analysis: light yellow color, transparent incomplete, specific gravity - 1020, protein - neg .; glucose - neg .; erythrocytes - 6-7 in the field of vision, leukocytes - 10-12 in the field of vision; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: daily diuresis - 850 ml, pH 7.0, oxalates - 30.5 mg / day, urates - 1.49 mmol / day, calcium - 0.48 mmol / day, phosphorus - 15.3 mmol / day , creatinine - 2.0 mmol / day.

Ultrasound of the abdominal organs, kidneys, urinary bladder - echographically an increase in the size of the liver and spleen, cholestasis, deformation of the hypotonic gallbladder, small lymph nodes in the mesenteric region, hypotension of the pelvis of both kidneys, thickening of the cortical layer of both kidneys.

Examination by a gynecologist - no gynecological pathology was revealed.

Conclusion. Based on complaints, examination and clinical and laboratory data, patient V. has the main diagnosis: Oxalate nephropathy. Concomitant diseases: Syndrome of biliary dysfunction with intrahepatic cholestasis on the background of deformation of the gallbladder.

For 4 weeks, the patient received therapy with Magne B6 in a daily dose of 200 mg of magnesium and 20 mg of vitamin B6: 1 ampoule 2 times a day with meals, dissolving the contents of the ampoule in Ѕ glass of water. For 4 weeks, she followed a hypooxalate diet and a high-liquid drinking regimen (from 1 to 1.5 liters of pure water per day).

Patient V.'s objective condition after the treatment: satisfactory condition. Active. The appetite is saved. The skin is pale pink, clean. No inflammatory changes in the pharynx. The lymph nodes are small, painless. Percussion in the lungs clear pulmonary sound. Auscultatory breathing is puerile, carried out in all departments, no wheezing, BH 22 in 1 min. The boundaries of the heart are within the age norm. Rhythmic heart sounds, systolic murmur. Heart rate 108 in 1 min. The abdomen is soft and painless on palpation. The liver is not enlarged. The spleen is not palpable. Pasternatsky's symptom is negative on both sides. Urination is free, painless. The chair is regular, decorated.

Laboratory examination data of patient V. after treatment:

Complete blood count: hemoglobin - 112 g / l, erythrocyte count - 3.7 x ^{10 12} / l, leukocyte count - 8.5 x ^{10 9} / l, platelet count - 340 x ^{10 9} / l, ESR - 10 mm / h.

Biochemical blood test: AsAt - 0.90 μkat / L, AlAt - 0.31 μkat / L, glucose - 4.05 mmol / L, calcium - 2.20 mmol / L, phosphorus - 1.58 mmol / L, creatinine - 60 μmol / l, urea - 3.5 mmol / l, potassium - 3.2 mmol / l, sodium - 130 mmol / l, chlorine - 105 mmol / l, calcium - 2.30 mmol / l, phosphorus - 1, 63 mmol / L, total bilirubin - 17.0 μmol / L, total protein - 65.3 g / L, albumin - 41.4 g / L.

General urine analysis: color light yellow, transparent full, specific gravity - 1018, protein - neg; glucose - neg .; erythrocytes - 4-5 in the field of vision, leukocytes - 5-7 in the field of vision; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: daily diuresis - 900 ml, pH 7.0, oxalates - 18.5 mg / day, urates - 1.48 mmol / day, calcium - 0.3 mmol / day, phosphorus - 13.3 mmol / day , creatinine - 1.8 mmol / day.

During treatment, there was an improvement in laboratory parameters in the form of a decrease in the level of oxaluria according to biochemical urine analysis.

However, six months later, the child was again admitted to the clinic with the same changes in urine tests (microhematuria 7-9 in f.zr, abacterial leukocyturia up to 20 in f.zr, hyperoxaluria 34 mg / day).

Data of laboratory and instrumental examination of patient V. during re-admission to the hospital:

Complete blood count: hemoglobin - 112 g / l, erythrocyte count - 4.0 x ^{10 12} / l, leukocyte count - 10.9 x ^{10 9} / l, platelet count - 350 x ^{10 9} / l, ESR - 10 mm / h.

Biochemical blood test: AsAt - 0.9 μkat / L, AlAt - 0.28 μkat / L, glucose - 4.3 mmol / L, calcium - 2.2 mmol / L, phosphorus - 1.53 mmol / L, creatinine - 61 mmol / l, urea - 3.7 mmol / l, potassium - 3.5 mmol / l, sodium - 131 mmol / l, chlorine - 105 mmol / l, calcium - 2.3 mmol / l, phosphorus - 1 , 5 mmol / l, total bilirubin - 15.0 μmol / l, total protein - 60.7 g / l, albumin - 40.5 g / l.

General urine analysis: light yellow color, transparent incomplete, specific gravity - 1020, protein - neg .; glucose - neg .; erythrocytes - 7-9 in the field of vision, leukocytes - 18-20 in the field of vision; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: daily diuresis - 900 ml, pH 7.0, oxalates - 34 mg / day, urates - 1.5 mmol / day, calcium - 0.3 mmol / day, phosphorus - 12.4 mmol / day, creatinine - 1.8 mmol / day.

Ultrasound of the abdominal organs, kidneys, bladder - echographically deformation of the gallbladder, compaction of the cortex of both kidneys

Examination by a gynecologist - no gynecological pathology was revealed.

Conclusion. Based on complaints, examination and clinical and laboratory data, patient V. has the main diagnosis: Oxalate nephropathy. Concomitant diseases: Deformation of the gallbladder.

Patient V. was again prescribed treatment in the form of a hypooxalate diet, a high-liquid drinking regimen (from 1 to 1.5 liters of pure water per day), Magne B6 drug in a daily dose of 200 mg of magnesium and 20 mg of vitamin B6: 1 ampoule 2 times per day during meals, dissolving the contents of the ampoule in Ѕ glass of water and, in addition, the drug Hilak forte was prescribed 30 drops 3 times a day during meals, diluting with a small amount of liquid, excluding milk. The girl received this therapy for 4 weeks.

The objective condition of patient V., after treatment according to the proposed method: satisfactory condition. Active. The appetite is saved. The skin is pale pink, clean. No inflammatory changes in the pharynx. The lymph nodes are small, painless. Percussion in the lungs clear pulmonary sound. Auscultatory puerile breathing is carried out in all departments, no wheezing, BH 24 in 1 min. The boundaries of the heart are within the age norm. Rhythmic heart sounds, systolic murmur. Heart rate 110 in 1 min. The abdomen is soft and painless on palpation. The liver is not enlarged. The spleen is not palpable. Pasternatsky's symptom is negative on both sides. Urination is free, painless. The chair is regular, decorated.

Laboratory examination data of patient V. after treatment:

Complete blood count: hemoglobin - 114 g / l, erythrocyte count - 3.8 x ^{10 12} / l, leukocyte count - 8.3 x ^{10 9} / l, platelet count - 340 x ^{10 9} / l, ESR - 8 mm / hour.

Biochemical blood test: AsAt - 0.87 μkat / L, AlAt - 0.3 μkat / L, glucose - 4.6 mmol / L, calcium - 2.31 mmol / L, phosphorus - 1.62 mmol / L, creatinine - 54.3 μmol / l, urea - 3.8 mmol / l, potassium - 3.4 mmol / l, sodium - 128 mmol / l, chlorine - 101 mmol / l, calcium - 2.4 mmol / l, phosphorus - 1.67 mmol / L, total bilirubin - 19.1 μmol / L, total protein - 68.4 g / L, albumin - 40.3 g / L.

General urine analysis: color light yellow, transparent full, specific gravity - 1020, protein - neg; glucose - neg .; erythrocytes - 0-1 v.p., leukocytes - 2-3 v.p .; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: daily urine output - 900 ml, pH 7.0, oxalates - 9.8 mg / day, urates - 1.58 mmol / day, calcium - 0.42 mmol / day, phosphorus - 10.2 mmol / day , creatinine - 1.7 mmol / day.

During treatment, there was a decrease to normal values in the level of oxaluria according to the biochemical analysis of urine, as well as an improvement in the indicators of the general analysis of urine.

When this child was examined 6 months after the repeated treatment of oxalate nephropathy, which included the appointment of the drug Hilak forte in addition to the generally accepted treatment regimen for the disease, the girl's general condition did not deteriorate. The level of oxaluria, according to the biochemical analysis of urine, was kept within normal limits.

Biochemical analysis of urine: daily diuresis - 850 ml, pH 7.0, oxalates - 10.3 mg / day, urates - 0.86 mmol / day, calcium - 0.94 mmol / day, phosphorus - 8.6 mmol / day , creatinine - 1.58 mmol / day.

General urine analysis: color light yellow, transparent full, specific gravity - 1018, protein - neg; glucose - neg .; erythrocytes - 0-1 in p.zr, leukocytes - 0-2 in p.zr; the epithelium is flat in a small amount; bacteria - negative.

Clinical example No. 2.

Patient M., 5 years old, from the 2nd pregnancy, proceeding with the threat of termination in the 2nd trimester, from 2 urgent births. Birth weight 3200 g, height 52 cm. Breastfeeding up to 2 years. Preventive vaccination by age.

She was admitted to the pediatric department due to changes in outpatient urine tests - periodically leukocyturia (10-15-20 per view), microhematuria (up to 10 per view).

Allergic history is calm. Heredity for diseases of the urinary system is not burdened. Past diseases: ARVI, umbilical hernia, viral conjunctivitis, pneumonia at the age of two years, chickenpox, urinary tract infection - July 2018

Objectively: at the time of examination - a state of moderate severity. Neuropsychic development is age appropriate. Physical development is average, harmonious (weight 16.4 kg, height 110 cm). The skin is pale. No inflammatory changes in the pharynx. Vesicular breathing in the lungs, no wheezing. BH 23 at 1 min. Heart sounds are clear, rhythmic. Heart rate 98 in 1 min. The abdomen is soft and painless. Pasternatsky's symptom is negative on both sides. The liver and spleen are not enlarged. Urination is painless, free. The chair is regular, decorated.

Data of laboratory and instrumental examination of the patient M .:

Complete blood count: hemoglobin - 132 g / l, erythrocyte count - 5.05 x ^{10 12} / l, leukocyte count - 7.3 x ^{10 9} / l, platelet count - 320 x ^{10 9} / l, ESR - 4 mm / hour.

Biochemical blood test: AsAt - 0.63 μkat / L, AlAt - 0.26 μkat / L, total bilirubin - 27.0 μmol / L, direct bilirubin - 12.0 μmol / L, calcium - 2.57 mmol / L , creatinine - 59 μmol / l, urea - 4.4 mmol / l, phosphorus - 1.58 mmol / l, glucose - 4.65 mmol / l, potassium - 3.6 mmol / l, sodium –139 mmol / l , chlorides - 106 mmol / l.

General urine analysis: color light yellow, transparent, specific gravity - 1030, protein - neg; glucose - neg .; erythrocytes - 3-5 in the visual field, leukocytes - 6-8 in the visual field; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: diuresis - 210 ml, pH 5.0, oxalates - 20.9 mg / day, urates - 1.4 mmol / day, calcium - 0.5 mmol / day, phosphates - 17.4 mmol / day, creatinine - 2.6 mmol / day.

Ultrasound of the abdominal organs, kidneys, urinary bladder - echographically unsharp deformation of the gallbladder, small lymph nodes of the liver gates, dysmetabolic changes in the kidneys.

Gynecologist's consultation - no pathology.

Conclusion: on the basis of complaints, examination, and clinical and laboratory data, patient M. has the main diagnosis: Oxalate nephropathy. Concomitant diseases: Syndrome of biliary dysfunction with cholestasis on the background of deformation of the gallbladder.

For 4 weeks, the patient received therapy according to the proposed method: adherence to a hypooxalate diet and a high-liquid drinking regime (from 1 to 1.5 liters of pure water per day), Magne B6 preparation in a daily dose of 200 mg of magnesium and 20 mg of vitamin B6: 1 drinking ampoule 2 times a day during meals, dissolving the contents of the ampoule in Ѕ glass of water and the drug Hilak forte 30 drops 3 times a day during meals, diluting with a small amount of liquid, excluding milk.

The objective condition of patient M., a month after the treatment:

The condition is satisfactory. Active. The appetite is saved. The skin is pale pink, clean. No inflammatory changes in the pharynx. The lymph nodes are small, painless. Auscultatory vesicular breathing is carried out in all departments, no wheezing. BH 21 in 1 min. Rhythmic heart sounds, systolic murmur. Heart rate 100 in 1 min. The abdomen is soft and painless on palpation. The liver is not enlarged. The spleen is not palpable. Pasternatsky's symptom is negative on both sides. Urination is free, painless. The chair is regular, decorated.

Laboratory examination data of patient M. a month after treatment:

Complete blood count: hemoglobin - 128 g / l, erythrocyte count - 4.95 x ^{10 12} / l, leukocyte count - 8.8 x ^{10 9} / l, platelet count - 324 x ^{10 9} / l, ESR - 6 mm / hour.

Biochemical blood test: AsAt - 0.60 μkat / L, AlAt - 0.28 μkat / L, total bilirubin - 22.0 μmol / L, direct bilirubin - 10.0 μmol / L, calcium - 2.5 mmol / L , creatinine - 60 μmol / l, urea - 4.1 mmol / l, phosphorus - 1.57 mmol / l, glucose - 5.01 mmol / l, potassium - 3.5 mmol / l, sodium –132 mmol / l , chlorides - 105 mmol / l.

General urine analysis: light yellow color, transparent, specific gravity - 1020, protein - neg; glucose - neg .; erythrocytes - neg., leukocytes - 1-2 in the field of view; the epithelium is flat in a small amount; bacteria - negative.

Daily urine for protein and sugar - protein is negative, glucose is negative.

Biochemical analysis of urine: diuresis - 800 ml, pH 5.0, oxalates - 5.9 mg / day, urates - 1.5 mmol / day, calcium - 0.6 mmol / day, phosphates - 15.7 mmol / day, creatinine - 3.1 mmol / day.

During treatment, there was a decrease in the level of urinary excretion of oxalates to normal values according to the biochemical analysis of urine, as well as normalization of the general analysis of urine.

When examining patient M. in dynamics 6 months after the therapy of oxalate nephropathy, which includes, in addition to the conventional scheme, the drug Hilak forte, there was no deterioration in the child's general condition. The level of oxaluria, according to the biochemical analysis of urine, was kept within normal limits.

Biochemical analysis of urine: daily urine output - 850 ml, pH 7.0, oxalates - 8.42 mg / day, urates - 1.57 mmol / day, calcium - 0.37 mmol / day, phosphorus - 14.2 mmol / day , creatinine - 2.8 mmol / day.

General urine analysis: light yellow color, transparent, specific gravity - 1020, protein - neg; glucose - neg .; erythrocytes - neg., leukocytes - 2-3 in the field of view; the epithelium is flat in a small amount; bacteria - negative.

Thus, the claimed method of treating oxalate nephropathy increases the effectiveness of treating pediatric patients due to the additional use of the drug Hilak forte in the treatment of oxalate nephropathy, 30 drops 3 times a day, during meals, diluting with a small amount of liquid, excluding milk, for 4 weeks. This method allows to improve laboratory parameters in patients with oxalate nephropathy, expressed in a persistent decrease in the level of urinary excretion of oxalates.

Claims (1)

A method of treating oxalate nephropathy in children, including a hypooxalate diet, a high-liquid drinking regimen, drug therapy with Magne B6, characterized in that Magne B6 is prescribed for 4 weeks in drinking ampoules, 1 ampoule 2 times a day and Hilak forte, 30 drops 3 times a day.