Stoieva T. Dysmetabolic nephropathy and crystalluria in children: clinical-pathogenetic grounding of therapy and prevention

The thesis is devoted to the problem of medical actions optimization and preventive maintenance of pathological process progressing in dysmetabolic nephropathies in children on the basis of working out and introducing the pathogenetically grounded program of the integrated conducting of patients. On prospective stage the complex inspection of 470 patients with dysmetabolic nephropathy by means of general clinical and special (biochemical, laser correlation spectroscopy, crystallomorphometry, urofloumetry) methods of examination was made and their diagnostic significance was estimated. The prevalence (p<0.05) in the structure of dysmetabolic nephropathy and crystalluria disturbances of oxalic acid metabolism were shown. The pathogenetic role of membrane-destructive processes (p<0.001) and macroelement shifts behind a magnesium metabolism (p<0.001) was established. The role of intestinal microecological disturbances (disorders of the intestinal biocenosis, absence of oxalate-transforming bacteria Oxalobacter formigenes p <0.0001) was defined. Features of metabolic function of lungs with hyperexpiration of oxalate were proved in dysmetabolic nephropathies in children. Differentiated pathogenetically directed medical complexes and the program of conducting patients, which included algorithms of stage-by-stage diagnosing (screening, generally clinical, specialized nephrological stages), definitions of the course prognosis, differentiated management of treatment and preventive maintenance were offered, the effectiveness of the introduced program according to the immediate and distant results was shown: RR - 0.46, RRR - 0.53, NNT - 3.1.