Endothelium is the unique «endocrine tree» lining absolutely all cardiovascular system organs of the body. Endothelial cells form a barrier between the blood and tissues, perform a number of important regulatory functions, synthesizing and releasing a wide range of biologically active substances. The strategic location of the endothelium allows it to be sensitive to haemodynamic changes as well as to the signals carried by the blood and signals of underlying tissues. Balanced release of biologically active substances contributes to homeostasis maintenance. The data concerning the multiple mechanisms of endothelium participation in the origin and development of various pathological conditions is accumulated so far. This is not only due to its participation in vascular tone regulation, but also due to the direct influence on atherogenesis, thrombus formation, and protection of the vascular wall integrity. Endothelial dysfunction is considered as a pathological condition of the endothelium based on impaired synthesis of endothelial factors. As a result, endothelium is unable to provide the haemorheological balance of the blood, resulting in disorders of different organs and systems functions. Endothelial dysfunction is a key link in pathogenesis of many diseases and their complications. The role of endothelial dysfunction in the development of chronic diseases such as atherosclerosis, arterial hypertension, chronic heart failure, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, inflammatory bowel disease, and others has been proven recently. The review provides data on the functions of vascular endothelium and its dysfunction. Types of endothelial dysfunction are described. Modern concept of endothelial dysfunction as the key link of pathogenesis of many chronic diseases is presented. Endothelial dysfunction precedes the development of clinical manifestations of diseases, so the study of the endothelium condition at early stages of the diseases is promising and could be of great diagnostic and prognostic value.
Цель: оценка маркеров эндотелиальной дисфункции (эндотелин-1 и оксид азота) и элементного статуса (цинк, железо, магний) у детей на разных стадиях хронической болезни почек. Обследованы 104 пациента в возрасте от 2 до 17 лет с различными стадиями хронической болезни почек: 63 ребенка с I стадией болезни, 26 -с III стадией и 15 -с V стадией болезни. Результаты: у пациентов с хронической болезнью почек выявлено повышение уровня эндотелина-1 в крови с одновременным снижением продукции оксида азота по мере прогрессирования заболевания от I до V стадии. Увеличение в 2,5 раза содержания эндотелина-1, установленное у больных с V стадией хронической болезни почек, сопровождалось снижением в 5,5 раза отношения оксид азота/эндотелин-1. У больных детей выявлены нарушения элементного статуса, проявляющиеся снижением содержания в сыворотке крови цинка, железа, магния уже на I стадии, с максимальной реализацией при III стадии болезни. У 68,3% пациентов с хронической болезнью почек наблюдалась артериальная гипертензия. Определены прямые корреляции между содержанием сывороточного железа и магния в крови с уровнем артериального давления у пациентов при I стадии хронической болезни почек. При III и V стадии болезни установлена прямая корреляция показателя сывороточного магния с уровнем артериального давления и концентрацией оксида азота. Выводы: у детей с хронической болезнью почек наблюдается эндотелиальная дисфункция и нарушения элементного статуса начиная с I стадии развития заболевания, что может рассматриваться как факторы, определяющие прогрессирование патологического процесса в почках.
Multisystem inflammatory syndrome in children associated with COVID-19 is a new disease, information first appeared in April 2020. There were reported cases of hospitalized children with unusual symptoms, manifested primarily by fever and multisystem inflammation from the pediatricians in the UK and other countries during the coronavirus infection pandemic (COVID-19). Some of these children were in critical condition with symptoms of shock and multiple organ failure, and some children had manifestations similar to Kawasaki disease. Despite the fact that COVID-19 in children is relatively easy, some of the «convalescents» after 2–6 weeks develop symptoms largely identical to the manifestations of severe forms of new coronavirus infection in adults. The report presents own clinical cases of multisystem inflammatory syndrome that developed in children after acute form of a new coronavirus infection. The authors discuss the possible clinical variants of the syndrome, its origin and outcomes.
CAKUT-syndrome includes combined congenital abnormalities of the kidneys and urinary tract and is a complex problem in pediatrics, requiring an interdisciplinary approach of doctors of various specialties. One of the most severe manifestations of CAKUT-syndrome is vesicoureteral reflux, which is often the main manifestation of a congenital abnormality of the kidneys and urinary tract. Structural and urodynamic disorders in the organs of the urinary system in vesicoureteral reflux can lead to the formation of reflux nephropathy and chronic kidney disease. Low-symptom clinical manifestations of reflux nephropathy make it difficult to diagnose it early. Vesicoureteral reflux leads to intrarenal reflux, repeated attacks of pyelonephritis and sclerosis of the renal tissue, which in 25-60 % of cases causes end-stage chronic renal failure due to vesicoureteral reflux. Given the absence of specific pathognomonic clinical manifestations of reflux nephropathy, laboratory indicators are of fundamental importance in the diagnosis-levels of albuminuria, leukocyturia, urinary sediment fermenturia, urine osmolarity, daily urinary excretion of β2 – microglobulin and a wide arsenal of methods for diagnosing reflux nephropathy and scarring of the renal parenchyma: ultrasound with dopplerography of the renal blood flow, magnetic resonance imaging and computed tomography, radioisotope scanning. The imperfection of instrumental methods for visualizing the initial stages of kidney fibrosis dictates the need to develop alternative, more sensitive methods for early diagnosis of reflux nephropathy. One of the directions of this search is molecular diagnostics, which allows you to detect possible damage to the renal tissue at the subcellular level long before the clinical manifestations of pathology, personify nephroprotective therapy and prevention of reflux nephropathy. The article presents clinical observations from our own practice of late diagnosis of reflux nephropathy, in which renal pathology was first detected at stages 5 and 3 of chronic kidney disease in two boys aged 10 and 16 years, respectively, who were on inpatient treatment in the Nephrology Department of the Children's Republican clinical hospital.
Objective. To describe clinical and laboratory features of COVID-19 in children admitted to the hospital.Children characteristics and research methods. The authors carried out a retrospective observational study, which included 204 children admitted to the Kazan hospital with a diagnosis of “new coronavirus infection” in the period from May 1 to October 30, 2020.Results. It was revealed that all hospitalized children had RNA of the SARS-CoV-2 virus (100%) in a smear from the nasopharynx and oropharynx detected by PCR and only 50% of patients were diagnosed with lung tissue lesions by computed tomography. The clinical picture of COVID-19 in children most often corresponds to the classic manifestations of a respiratory viral infection. Risk factors for the development of severe forms, described in adults, were recorded only in isolated cases in our study.Conclusion. The clinical picture of COVID-19 in children most often corresponds to the classic manifestations of a respiratory viral infection. Risk factors for the development of severe forms, described in adults, were recorded in isolated cases in our study.
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