Morozova O. Improvement of diagnosis of the progression of chronic kidney disease in children with vesicoureteral reflux and chronic pyelonephritis. - The manuscript.

The dissertation is devoted to issues the early diagnostics of the formation and progression of chronic kidney disease in children with VUR and chronic pyelonephritis by assessing the cytokine profile, metabolic rate, structural and hemodynamic changes in the kidneys. Patients with VUR and chronic pyelonephritis in the stage of remission without renal scarring in high degrees of VUR had a significant increase in the levels of urinary excretion of IL-6 and IL-8, which marks persisting inflammation in tubulointerstitial kidney tissue in confirmed clinical and laboratory remission. Children with VUR and chronic pyelonephritis with renal scarring showed a significantly lower incidence of urinary excretion of IL-6 and IL-8, which signifies the development and progression of nephrosclerosis - a natural outcome of inflammation. Assessment of the results of the study of pro-fibrotic cytokines revealed a statistically significant increase in urinary excretion of TGF-β1 and VEGF in children with VUR and chronic pyelonephritis, regardless of the degree of reflux and the presence of signs of renal scarring, indicating remodeling processes in parenchyma and renal vessels. The level of urinary excretion of TGF-β1, as the main factor for the development of fibrosis in children with renal scarring was significantly higher than that of patients without renal scarring. VEGF urinary excretion values in children with renal scarring were significantly lower than those of patients without renal scarring, but were higher than those of control group children signifying further confirmed existing of nephrosclerosis. Deep disorders of connective tissue metabolism have been detected in the examined children. Assessment of findings obtained by kidneys ultrasound showed that the risk factors of renal scarring were reduced kidney size, reduced thickness of the renal parenchyma, deformation and unevenness in the renal margins, diffuse echogenicity increase of the renal parenchyma. Additional diagnostic and prognostic markers of the formation of renal scarring with a high level of sensitivity and specificity are suggested.