• Visceral markers of violation of fibrillogenesis in children with different variants of pyelonephritis

Visceral markers of violation of fibrillogenesis in children with different variants of pyelonephritis

SOVREMENNAYA PEDIATRIYA.2018.3(91):27-32; doi 10.15574/SP.2018.91.27

Lukyanenko N. S., Iskiv M. Yu., Kens K. A.
SI «Institute of Hereditary Pathology, NAMS of Ukraine», Lviv, Ukraine
Danylo Halytsky Lviv National Medical University, Ukraine

Among the diseases of urinary system, one of the most important factors is pyelonephritis (PN), since in 86.0% children the episodes of its exacerbations are observed. In recent years, there is 2–2.5:fold increase in the incidence rate of its latent forms. Congenital defects of collagen formation can become the basis for different pathological changes of the kidneys.

Objective: incidence rate analysis of congenital defects of the urinary system (CDoUS), as visceral markers of fibrillogenesis violation, in children with various course variants of PN.

Material and methods. In total 148 children aged from 3 to 18 years were examined. The first group included 92 children with chronic pyelonephritis, in which three or more episodes of PN relapse during two years (I:CPN) were diagnosed in a catamnesis, and the second group consisted of 56 children with acute PN, in whom there were non:relapsive disease within two years (II:APN). The control group comprised 65 apparently healthy children. All children underwent clinico:laboratory and nephrourologic examinations and markers of fibrillogenesis disorder were detected that are as follows: phenotypic signs of undifferen: tiated connective tissue dysplasia (UCTD) and urinary excretion of oxyproline.

Results. Only the I:CPN children had phenotypic characteristics of UCTD, such as joint hypermobility, visual impairment, chest deformation, scoliotic posture and arachnodactylia. They were also registered a high rate of increased oxyproline urinary excretion, which was 9.7 times higher than in II:APN children, which confirmed the presence of UCTD in I:CPN patients. CDoUS were diagnosed in 90.52% of I:CPN children, whereas in II:APN group — only in 8.93% of cases. Among CDoUS, vesicorenal reflux with pyelectasia (in 52.17% of I:CPN children) and kidney duplication (in 11.96% of cases) were mostly detected.

Conclusions. Phenotypic signs of UCTD in children with CPN were statistically significant as compared with children with APN. The high urinary excretion of oxyproline in almost all children with CPN indicates an increased disintegration and excretion of collagen by:products, which denote a severe violation of collagen catabolism in children prone to relapses of PN and confirms the presence of UCTD. Laboratory evidence of UCTD in children with CPN makes it possible to consider diagnosing CDoMS as visceral markers of UCTD.

Key words: children, pyelonephritis, connective tissue dysplasia, oxyproline, collagen.


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