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Risc factors in children pyelonephratis chronization, diagnosis and treatment


Author: Natalia Zaicova
Degree:doctor of medicine
Speciality: 14.00.09 - Pediatrics
Year:2005
Scientific adviser: Tudor Rusnac
doctor habilitat
Scientific consultant: Valentin Gudumac
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 20 September, 2005
Approved by NCAA on the 22 December, 2005

Abstract

Adobe PDF document0.81 Mb / in romanian

Thesis

CZU 616.61–002.3–053.2–07-08

Adobe PDF document 3.45 Mb / in russian
153 pages


Summary

This paper includes the retrospective analysis of 340 patients with different types of pyelonephritis who are under medical supervision at family medicine centres (FMC) No.1, 2, 4, 9,10, Chishinau.

The direct connection between development of inflammatory process in kidneys and investigated hereditary-constitutional as well as social risk factors has been revealed.

At the same time the delineate high risk group of early stage children with nephrologic disorders and medical supervision evaluation of relative and atributive risk allow to determine the prognostic value of each criteria in primary process as well as in progression and chronization, which lead the prophylactic strategy development.

Additionaly to the adapted methods of diagnosing value of special biochemical tests has been determined. The indexes of collagen metabolism (total, free and peptide-bounded hidroxyproline), activity of some lysosomal enzymes (N-acetyl-β-D-glucosaminidase, arilsulfatasis), elastasis, pseudocholinesterasis and γ-glutamiltranspherasis in the evaluation of inflammatory process in kidneys and onset of sclerosis were investigated and analyzed. For the determining of the nephrosclerosis process in kidneys the method of static DMSA-scintigraphy has been used.

The high direct correlation between increased level of free (rxy=0,79) and peptide-bounded hidroxyproline (rxy=0,83), elastasis (rxy=0,92) and γ-glutamiltranspherasis activity (rxy=0,82) and the level of sclerotic changes resulting in DMSA-scintigraphy has been revealed. The increased level of excretion of free and peptide-bounded oxyproline and increased level of activity elastasis and γ-glutamiltranspherasis which can be used as a markers of nephrosclerosis has been evidenced. At same time, the level of N-acetyl-β-D-glucosaminidasis activity can suggests the disorder of tubular functions in children with pyelonephritis.

The efficiency of long-term complex anti-relapsing treatment of non-obstructive forms of pyelonephritis in children has been revealed.

Based on statistic-mathematics analysis the early diagnosing criteria in latent pyelonephritis, early stage chronization of pyelonephritis in children, algorhythm of early diagnosing and treatment level of children with pyelonephritis has been eloborated. ranspherasis in the evaluation of inflammatory process in kidneys and onset of sclerosis were investigated and analyzed. For the determining of the nephrosclerosis process in kidneys the method of static DMSA-scintigraphy has been used. The high direct correlation between increased level of free (rxy=0,79) and peptide-bounded hidroxyproline (rxy=0,83), elastasis (rxy=0,92) and γ-glutamiltranspherasis activity (rxy=0,82) and the level of sclerotic changes resulting in DMSA-scintigraphy has been revealed. The increased level of excretion of free and peptide-bounded oxyproline and increased level of activity elastasis and γ-glutamiltranspherasis which can be used as a markers of nephrosclerosis has been evidenced. At same time, the level of N-acetyl-β-D-glucosaminidasis activity can suggests the disorder of tubular functions in children with pyelonephritis. The efficiency of long-term complex anti-relapsing treatment of non-obstructive forms of pyelonephritis in children has been revealed. Based on statistic-mathematics analysis the early diagnosing criteria in latent pyelonephritis, early stage chronization of pyelonephritis in children, algorhythm of early diagnosing and treatment level of children with pyelonephritis has been eloborated.