Odarchuk I. Clinico-pathogenetic peculiarities of pyelonephritis on the background of vesicoureteral reflux in young children.

The dissertation is devoted to the investigation of the clinical peculiarities and paraclinical activity indicators of the inflammatory process, markers of fibro formation, polymorphic variant of the TGFB1 gene in the at positions -509 CT and + 869 CT in case of pyelonephritison the background of vesicoureteral reflux in young children. The conducted research has identified the main risk factors for the development of pyelonephritis in young children. So, a retrospective analysis showed that in most (64,68 ± 5,83%) of hospitalized children, pyelonephritis arose on the background of congenital malformations of the urinary system, among which the vesicoureteral reflux was significantly more commonly observed (76,32 ± 5,27% of cases).The analysis of intercorrelation between the laboratory indicators of the inflammatory process activity (CRP, PCT, MCP-1) and the indicators of fibrosis formation (TGF-B1 and galectin 3) in young children with pyelonephritis in the background of vesicoureteral reflux proves the high degree of integration of all indicators that are included in the correlation structure. This, in turn, explains the need for the determination of PKT and MCP-1 as markers of the inflammatory process activity, and TGF-B1 and galectin 3 as markers of fibrosis formation in case of pyelonephritis on the background of vesicoureteral reflux in young children. Determination of the polymorphism of the TGFB1 gene at positions -509 CT and + 869 CT was undertaken in the dissertation. It has been established that young children who are carriers of the genotype С-509С (34-68 ± 4.86%) and Т + 869Т (29-58 ± 4.46) are more likely to suffer from pyelonephritis on the background of vesicoureteral reflux than heterozygotes C-509T (7-14 ± 1.13%) and T + 869T (13-26 ± 1.92%), as well as homozygotes T-509T (9-18 ± 1.89%) and C + 869C ( 8-16 ± 1.86%), p <0.01, which indicates the genetic determinism of the reflux nephropathy. In addition, the analysis of the interconnection between polymorphic variants of the gene TGF-B1 and the serum level of the prophylactic factor indicated a high transforming growth factor (11,15 ± 2,24%, 95% CI: 5,32-14,98) in homozygotes C-509C and T + 869T, indicating the possibility of formation of irreversible changes in kidney parenchyma of children that are carriers of these genotypes. The conducted research substantiated the addition to the scheme of pathogenesis and algorithm of diagnostic measures aimed at revealing the development of fibrotic changes in pyelonephritis on the background of vesicoureteral reflux in children.