Zakharchenko N. Factors of chronicization and prognosis of the course of inflammatory diseases of the urinary system in children

Inflammatory diseases of the urinary system in children rank second in the structure of childhood diseases, second only to acute respiratory diseases. The aim of this study was to stratify chronicity factors and predict the course of inflammatory diseases of the urinary system in children based on the determination of the peculiarities of antimicrobial peptides, proinflammatory cytokines and NO synthase activity. The dissertation is based on the results of our own observations, clinical, laboratory, biochemical and special methods of studying patients. 88 children (mean age 9.9 ± 0.5 years) were examined. The criteria for inclusion of patients in the study group were: children aged 3-18 years; informed consent of parents; confirmed diagnosis of urinary tract infection (UTI). The main study group included 68 patients (mean age 9.7±0.6 years) with primary urinary tract infections. The main group was divided into 4 subgroups. The first subgroup included children with acute pyelonephritis, the second - patients with chronic pyelonephritis, the third - patients with acute cystitis, and the fourth - patients with 3022371231370471 9 urinary tract infection with unspecified localization. The control group consisted of 20 conditionally healthy children (mean age 10.6 ± 0.9 years) with no signs of inflammation, including urinary system organs. The anamnestic data of all patients under observation were studied. Laboratory tests were performed during the first day after hospitalization. The analysis of statistical data showed that the prevalence of urinary tract infections in the structure of urinary system diseases among the children's population of Zaporizhzhia region is 15.1±0.3‰, including chronic pyelonephritis - 4.33±0.12‰. The annual increase rate of children with newly diagnosed chronic pyelonephritis is 11.9±1.5%. It was established that the peculiarity of the course of inflammatory diseases of the urinary system in children under observation was the predominance of female patients (76.5%), a simple course of the disease was noted in 77.9% of patients, and 14.7% of patients were diagnosed with UTIs with unspecified localization. Scientific novelty of the results. The scientific data on the etiological factors of inflammatory diseases of the urinary system in children living in the city of Zaporizhzhia and Zaporizhzhia region have been supplemented; the growth of gram-positive microflora as a leading pathogen has been shown. The pathogenetic role of IL-6 and IL-15, inducible NO synthase and cystatin C in the development of acute and chronic inflammatory diseases of the urinary system in children was specified. For the first time, it was noted that the level of antimicrobial peptides varies with the leading etiologic factor. It has been proved that each nosological form of urinary tract infection has its own configuration of antimicrobial peptides. It has been shown that in children, the development of the inflammatory process in the urinary tract occurs against the background of a statistically significant decrease in the level of 1,25(OH)2D3 in the blood serum in combination with high levels of vitamin D binding protein. Practical significance of the results The complex of measures aimed at preventing the development of chronic inflammatory diseases of the urinary system in children, which includes constant local bacterial monitoring to improve the effectiveness of antibiotic therapy and prevent antibiotic resistance, determination of serum levels of vitamin D3 in the debut of acute inflammatory bacterial disease of the urinary system for the purpose of early diagnosis of its deficiency, has been theoretically substantiated. A mathematical model has been developed to predict the possibility of developing chronic inflammatory diseases of the urinary system in children. The use of the presented mathematical model, taking into account the defined prognostic criteria, allows predicting the occurrence of chronic urinary system infections, which has favorable prognostic features for preventing the development of this condition.