PERINATOLOGIYA AND PEDIATRIYA.2019.2(78):32-37; doi 10.15574/PP.2019.78.32

Abaturov О. Ye., Vakulenko L. I.
SI «Dnipropetrovsk medical academy of Ministry of Health of Ukraine», Dnipro

Introduction. Defining factors which promote development and progressing of chronic pyelonephritis (CPN) in children is provided by timely taking preventive and adequate treatment measures, which will improve the prognosis of the disease and reduce the progression of chronic kidney disease.

Purpose — defining predictive factors for development of CPN in children for carrying out early diagnostics and timely treatment.

Patients and methods. The analysis of 176 chronic pyelonephritis cases in children aged from 1 to 18 years has been made. Group of comparison included 74 children with acute pyelonephritis resulted in recovery. To reveal leading predictive risk factors for development of CPN in children and to define the most informative indices, Bayes theorem and sequential Wald analysis with the assessment of informative value of signs, calculated by Kullback's measure were used (І). The sign with the coefficient 1 and more than 0.5 was considered to be informative.

Results. Of high predictive informative value for the development of chronic pyelonephritis in children were 11 clinical-laboratory risk factors: abnormalities of urinary system, urodynamic disorders (vesico-urinary reflux), lingering course of the first episode of pyelonephritis or relapse during 3 months; presence of more than 5 dysembryogenic stigmas; urogenital mycoplasmosis in girls; arterial hypertension; normochromal anemia in the disease onset; neurogenic cyst / enuresis; oxalate dysmetabolic nephrоpathy with excretion of calcium oxalate more than 1,5 mg/kg/daily; hydronephrosis; concomitant chronic foci of infection. For more informative predictive signs of chronic pyelonephritis there were calculated diagnostic coefficients in their summing-up, diagnostic information can be accumulated. Inserting diagnostic symptoms obtained on patient's examination in the table, one can calculate the total of corresponding diagnostic coefficients. In the total of diagnostic coefficients equal to (+13), a probable development of chronic pyelonephritis with probability of error <5% (p<0.05) is predicted; in the total of diagnostic coefficients equal to (+20) the probability of prognosis is 99% (p<0.01). If the total of diagnostic coefficients is less than (+13) and more than (-13), the conclusion is drawn about insufficient amount of information to make a decision about a probable development of chronic pyelonephritis with the set level of error (negative response).

Conclusions. Predictive table can be used for defining probability of chronic pyelonephritis development in children aged from 1 to 18 years.

Key words: children, chronic pyelonephritis, chronic kidney disease, risk factors, prognosis.

REFERENCES

1. Borisova TP,  Bagdasarova IV. (2012). Infections of the urinary system in children. Pyelonephritis. Diagnostic approaches and therapeutic tactics at the level of primary health care. Child health. 4(39): 9–13.

2. Vakulenko LI. (2018). Dismetabolic nephropathy as a risk factor for the development of pyelonephritis in children. Child health. 1 (13): 85–89. https://doi.org/10.22141/2224-0551.13.1.2018.127063

3. Ivanov DD. (2009). Arterial hypertension in children and adolescents: nephrological aspect. Children's doctor. 2 (2): 22–25.

4. Lukyanenko NS, Petritsa NA, Kens KA. (2015). Place of undifferentiated connective tissue dysplasia in childhood pathology (literature review). Child health. 2 (61): 80–85.

5. Makyeyeva NI, Morozova OO (2018). Level of biological markers of fibrogenesis and angiogenesis in urine of children with vesicourethral reflex. Child health. 13 (5). URL: http://www.mif-ua.com/archive/article_print/46422. https://doi.org/10.22141/2224-0551.13.5.2018.141560

6. Maltsev SV, Mansurova GSH. (2012). An innovative approach to assessing the risk factors for kidney disease in children. International Journal of Pediatrics, Obstetrics and Gynecology. 2 (3): 5–11.

7. Prosova YeYe, Goremykin VI. (2018). Forecasting of exacerbations of chronic pyelonephritis in children. Modern problems of science and education. 6. ISSN 2070-7428. URL: http://www.science-education.ru/ru/article/view?id=28318.

8. Savenkova ND. (2017). Renal arterial hypertension in children and adolescents: causes, classification, diagnosis. Rossiyskiy Vestnik Perinatologii i Pediatrii. 62 (4): 43–48. https://doi.org/10.21508/1027-4065-2017-62-4-43-48.

9. Amancio L, Fedrizzi M, Bresolin NL, Penido MG. (2016). Pediatric urolithiasis: experience at a tertiary care pediatric hospital. J Bras Nefrol. 38 (1): 90–98. https://doi.org/10.5935/0101-2800.20160014; PMid:27049370.

10. Arena S, Iacona R, Impellizzeri P, Russo T, Marseglia L, Gitto E, Romeo C. (2016). Physiopathology of vesico-ureteral reflux. Ital J Pediatr. 42: 103. https://doi.org/10.1186/s13052-016-0316-x; PMid:27899160 PMCid:PMC5129198.

11. Atkinson MA, Xiao R, Kottgen A, Wuhl E, Wong CS, Wuttke M et al. (2019). Furth Genetic Associations of Hemoglobin in Children with Chronic Kidney Disease in the PediGFR Consortium. Pediatr Res. 85 (3): 324–328. https://doi.org/10.1038/s41390-018-0148-z; PMid:30140068 PMCid:PMC6377354.

12. Becherucci F, Roperto RM, Materassi M, Romagnani P. (2016). Chronic kidney disease in children. Clin Kidney J. 9 (4): 583–591. https://doi.org/10.1093/ckj/sfw047; PMid:27478602 PMCid:PMC4957724.

13. Cheung KK, Montgomery D, Benjamins LJ. (2015). Prevalence of Sexually Transmitted Infections Among Adolescents Entering Child Protective Services. J Pediatr Adolesc Gynecol. 28 (5): 324–326. https://doi.org/10.1016/j.jpag.2014.09.011; PMid:26094906 PMCid:PMC4478275

14. Frej-Madrzak M, Teryks-Wolyniec D, Jama-Kmiecik A, Sarowska J et al. (2015). Diagnosing Chlamydia Trachomatis Urinary Tract Infections-Preliminary Report. Adv Clin Exp Med. 24 (3): 441–445. https://doi.org/10.17219/acem/43719; PMid:26467132

15. Haid B, Tekgul S. (2017). Primary and secondary enuresis: Pathophysiology, diagnosis, and treatment. Eur Urol Focus. 3: 198–206. https://doi.org/10.1016/j.euf.2017.08.010; PMid:28888814.

16. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. (2012). Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 27 (3): 363–373. https://doi.org/10.1007/s00467-011-1939-1; PMid:21713524 PMCid:PMC3264851.

17. Hewitt IK, Montini G. (2011). Pediatric febrile urinary tract infections: the current state of play. Ital J Pediatr. 30: 37–57. https://doi.org/10.1186/1824-7288-37-57; PMid:22128870 PMCid:PMC3269370

18. Jiang R, Kelly MS, Routh JC. (2018). Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature. J Pediatr Urol. 14 (6): 494–501. https://doi.org/10.1016/j.jpurol.2018.08.010; PMid:30297226.

19. Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group. (2012). KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl. 2 (4): 331–335.

20. Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group. (2013). KDIGO 2012 Сlinical practice Guideline for the Еvaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 3 (1): 1–150.

21. Mikhail A, Brown C, Williams JA, Mathrani V, Shrivastava R, Evans J, Isaac H, Bhandari S. (2017). Renal association clinical practice guideline on Anaemia of Chronic Kidney Disease. BMC Nephrol. 18 (1): 345. https://doi.org/10.1186/s12882-017-0688-1; PMid:29191165 PMCid:PMC5709852.

22. Morin F, Akhavizadegan H, Kavanagh A, Moore K. (2018, Apr.). Dysfunctional voiding: Challenges of disease transition from childhood to adulthood.Can Urol Assoc J. 12; 4; Suppl. 1: S42–S47. https://doi.org/10.5489/cuaj.5230; PMid:29681274 PMCid:PMC5926919.

23. Мorozova О. (2018). Features of formation and progression of chronic kidney disease in children with pyelonephritis and vesicoureteral reflux. Inter Collegas. 3 (5): 132–136. https://doi.org/10.35339/ic.5.3.132-136

24. Park YS. (2012). Renal scar formation after urinary tract infection in children. Korean J Pediatr. 55 (10): 367–370. https://doi.org/10.3345/kjp.2012.55.10.367; PMid:23133482 PMCid:PMC3488611

25. Radmayr C, Bogaert G, Dogan HS, Koc`vara R, Nijman M, Stein R et al. (2018). EAU Guidelines on Paediatric Urology: 159. ISBN 978-94-92671-01-1.

26. Sousa AS, Veiga ML, Braga AA Carvalho MC, Barroso UJr. (2016). Enuresis and overactive bladder in children: what is the relationship between these two conditions? Int Braz J Urol. 42 (4):798–802. https://doi.org/10.1590/S1677-5538.IBJU.2015.0579; PMid:27564293 PMCid:PMC5006778.

27. Y1lmaz I, Peru H, Y1lmaz FH, Sekmenli T, Ciftci I, Kara F. (2018). Association of vesicoureteral reflux and renal scarring in urinary tract infections. Arch Argent Meredith. 116 (4): e542-e547. https://doi.org/10.5546/aap.2018.eng.e542.

28. Zee RS, Herbst KW, Kim C, McKenna PH, Bentley T, Cooper CS, Herndon CD. (2016). Urinary tract infections in children with prenatal hydronephrosis: A risk assessment from the Society for Fetal Urology Hydronephrosis Registry. J Pediatr Urol. 2 (4): 261. e1-7. https://doi.org/10.1016/j.jpurol.2016.04.024; PMid:27290614

Article received: Jan 18, 2019. Accepted for publication: Jun 11, 2019.