Ostapenko V. Immuno-genetic criteria for prognosis and optimizing treatment of chronic pyelonephritis in children.

The thesis is devoted to improving the quality of life of children with pyelonephritis, by preventing of chronic relapsing forms of the disease and optimization of health care measures. By means of clinical observation of 60 children suffering from chronic pyelonephritis (CP) who were hospitalized, 70 out-patients with the same diagnosis, 10 pediatric patients with other diagnoses and 39 healthy children of the control group as well as by retrospective study of 561 case histories it was established basic predictors of CP and shown the role of family history in this process. It is proved that the mutant allele Arg753 of TLR2 gene and 299Gly of TLR4 gene are significantly more spread in children with CP as compared with population control. Presence of mutant genotype is a marker of high risk of recurrent disease, its early manifestation and certain infectious agents. Polymorphism of TLR2 and TLR4 gene is associated with the activity of the total body inflammatory response, severity of bladder syndrome during acute phase of CP and changes of interleukin-6 level. It causes different patients reaction to immune-modulative therapy with Ribomunil that is more effective in patients with "wild" genotype. Based on the statistical treatment of catamnestic, anamnestic, clinical data, laboratory tests and results of genetic screening it is proposed the algorithm for prognosis of CP realization in children with differentiated preventive treatment using ribosomal proteoglycan complex Ribomunil as an immunomodulator.