У статті наводяться сучасні уявлення про хронічну хворобу нирок у дітей як про стан, що розвивається внаслідок необоротного зниження ниркових гомеостатичних функцій при будь-якому тяжкому прогресуючому захворюванні нирок. Показані епідеміологічні дані про поширеність, етіологічні фактори, методи діагностики, стадії і клінічний перебіг хронічної хвороби нирок у дітей. Крім того, зазначено, що раннє виявлення і своєчасне лікування хронічної хвороби нирок у дітей є важливою передумовою для запобігання або віддалення від її несприятливого результату. Більш того, показані високий ступінь інвалідизації і значне зниження якості життя пацієнтів, складність і висока вартість терапії хворих із термінальною хронічною нирковою недостатністю, що робить дуже актуальним запобігання її розвитку в пацієнтів із нефропатіями. Викладено основні принципи патогенетичної терапії, засновані на аналізі вітчизняних і зарубіжних керівництв із лікування хронічної хвороби нирок у дітей. Наведено схеми лікування білково-енергетичної недостатності, артеріальної гіпертензії, анемії, корекції порушень мінерального обміну. Обговорюються питання про зниження рівня азотемії різними препаратами і розробка нових препаратів із метою раннього початку лікування і запобігання розвитку тяжких форм хронічної хвороби нирок у дітей. Пошук потрібних літературних джерел проводився в базах даних Scopus, MedLine, The Cochrane Library, CyberLeninka, РІНЦ.
The review presents materials on the prevalence of NS in children, variants of its course: steroid-sensitive (SSNS) and steroidresistant (SRNS) steroid-dependent (SSNS). Minimal change nephrotic syndrome minimal changes (NSMC) is the most common glomerular disorder. Although NSMC has an excellent prognosis with a low risk of progression to t-CRF, its recurrent nature requires children to receive frequent courses of steroid therapy and other medications, many of which are known to affect blood pressure (BP). The interrelation of NS in children with arterial hypertension (AH) is shown. Prevalence of hypertension in children with SCNS, SRNS, SZNS is given. The regulation of hypertension in children is mandatory in the treatment of NS, due to the fact that hypertension is not established in a timely manner, is insufficiently controlled and is often masked. Vascular dysregulation, fluid overload, increased cardiac output and peripheral vascular resistance, alone or in combination, can lead to hypertension in CKD. The use of modern methods to monitor and control blood pressure is critical for improving hypertension management and preventing target organ damage in children. 24-hour blood pressure measurements are an important tool in determining the prognosis and treatment of children with HC. Many comorbidities increase the risk of cardiovascular disease, including obesity, left ventricular hypertrophy (LVH), increased arterial stiffness (increased BMI, endothelial dysfunction), impaired glucose metabolism, and hyperlipidemia. The pathophysiological aspects of hypertension in children with NS are considered. The pathophysiology of hypertension in NS is complex, with many renal and extrarenal factors. Renal factors include sodium retention, fibrosis / decreased GFR, and progression of kidney disease, and a direct link between albuminuria and blood pressure has recently been described. Other factors include drug side effects, comorbidities and genetic predisposition. Sodium metabolism plays an important role in the development of edema and blood pressure regulation in NS. There are two main hypotheses for sodium retention in NS, the hypothesis of underfilling and overfilling. The role of the epithelial sodium channel (ENC), atrial natriuretic peptide (ANP), nitric oxide (NO), steroid hormones and other drugs in sodium retention and the pathogenesis of hypertension is also considered. In children with NS, hypertension leads to target organs damage (TOD): left ventricular hypertrophy (LVH), damage to the organ of vision, cognitive impairment and more rapid progression of chronic kidney disease. Salt restriction and RAAS inhibition are considered integral parts of the treatment of children with proteinuria, and both are known to have blood pressure lowering effects. The RAAS blockade has a renoprotective effect in patients with glomerular damage. Studies have found greater reductions in proteinuria with ACE / ARB combination therapy. This renoprotective effect is explained by both a decrease in blood pressure and mechanisms independent of blood pressure. Lifestyle modifications, weight control, healthy eating, reduced sodium intake, supportive exercise, and basic drug therapy using angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), diuretics can slow the progression of NS in children.
Background. The study of the effect of drugs at the molecular genetic level in the recurrent course of bronchial obstruction (RBО) in children improved the understanding of the pathogenesis of the disease and made it possible to better characterize the reliability of use in therapy. The aim of the study was to assess the clinical significance of the polymorphism of the Arg16Gly loci of the ADRB2 gene with a therapeutic response to β2-agonists in children with RBО of Uzbek ethnicity. Materials and methods. Tested 88 patients aged 6 to 15 years with recurrent bronchial obstruction and bronchial asthma with the polymorphism of the ADRB2 gene loci and determined the effectiveness of salbutamol in these groups of patients. Results. Results of the study of the significance of the polymorphism of the Arg16Gly locus of the ADRB2 gene with a therapeutic response to β2-agonists in children with RBO showed high efficacy of salbutamol in 72.9 % of children, among whom representatives of the A/G and A/A genotypes were found in the largest number. At the same time, the low efficacy of salbutamol was found in the greatest amount in carriers of the mutational genotype G/G of the Arg16Gly locus of the ADRB2 gene. Conclusions. The predictor role of the polymorphic locus rs1042713 (Arg16Gly) was determined in carriers of the unfavorable 46G allele of the G/G genotype of the ADRB2 gene, which was a genetic marker of children’s predisposition to RBO and BA in children. Children with the G/G genotype of the Arg16Gly locus of the ADRB2 gene are at risk for severe RBO and BA in children. Children with RBO carriers (Arg16Gly) of the homozygous G/G genotype have a high incidence of RBO recurrence against the background of ARVI and are at risk of developing BA.
Bolalar orasida kasallanish ko‘rsatkichi va asoratlari bo‘yicha nafas olish tizimi kasalliklari pediatriyada dolzarb muammolardan biri sifatida qolmoqda. Tadqiqot maqsadi - bolalarda kasalxonadan tashqari pnevmoniya tashxisini retrospektiv tahlil qilish. Material va uslublar. Kasalxonadan tashqari pnevmoniya tashxisi bilan TTA ko`p tarmoqli klinikasi bolalar pulmonologiyasi bo`limida 2019-2022yy. davolagan 3-18 yoshdagi bolalarning kasallik tarixini retrospektiv tahlil qilindi. Natijalar.Ma`lum bo`ldiki, bugungi kunda klinik amaliyot uchun kasalxonadan tashqari bacterial pnevmoniyani virusli turidan farqlashda quyidagi o`z echimini talab etuvchi qiyinchiliklar mavjud: ya`ni antibiotiklarni bacterial ekmadan oldin qo'llash; kichik yoshdagi bolalarda nafas olish yollaridan balgamning ishonchli namunasini olishning qiyinligi; molekulyar tashxis usulining tor doirada qo`llanilishi. Bemor bolalarda pnevmoniya etiologiyasini aniqlashda yuqori darajada o'ziga xoslik va sezuvchanlikka ega bo'lgan tashxis testlarini ishlab chiqish tibbiy yordam muassasalari faoliyati uchun yuqori samara bo`lib hisoblanadi.
Bolalardagi me'yoriy va patologik jarayonlarda, xususan surunkali buyrak kasalligi immunpatogenetik rivojlanishida sitokin profili boshqaruvi ahamiyatini aniqlash. Xulosa: sitokin mediatorlarining turli xil xususiyatlari organizmni yuqumli agentlardan himoya qilish va to‘qimalarni tiklashga xizmat qiladi. Birinchi navbatda, sitokinlar mahalliy himoya jarayonlarining rivojlanishini tartibga soladi, yallig‘lanish reaksiyasining shakllanishini sodir etadi. Shuning uchun ham yallig‘lanishni qo‘llovchi va yallig‘lanishga qarshi sitokinlarning tarkibi va ularning nisbatini yallig‘lanish jarayoni va fibrozning kuchayishini eng ob'ektiv ko‘rsatkichlari deb hisoblash mumkin. Sitokin tizimidagi nomutanosiblikni bashorat qilish, surunkali buyrak kasalligining biomarkeri sifatida, kasallikni kechishi va davolash samaradorligini baholashda qo‘llanilishi mumkin. Adabiyot ma'lumotlarini tahlil qilish surunkali buyrak kasalliklarida sitokin holatini o‘rganishning ilmiy va amaliy ahamiyatini yoritib berdi.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.