The way to diagnose the stage of acute pyelonephritis in children
The invention relates to medicine, in particular to clinical diagnosis. The method improves the accuracy of diagnosing the stage of acute pyelonephritis in children. Conduct research in the biological fluid proteins in serum define the content of the plasminogen/plasmin,2-macroglobulin,1-antitrypsin, lactoferrin and at the level of the plasminogen/plasmin 66-76 μg/ml, the level2-macroglobulin 2,5-3.13 g/l1-antitrypsin 2,28-3.0 g/l, the level of lactoferrin to 1 μg/ml diagnosed with serous stage pyelonephritis, at the level of the plasminogen/plasmin 96-169 μg/ml, the level2-macroglobulin 2,28 at 2.59 g/l1-antitrypsin a 2.9-7.2 g/l, the level of lactoferrin 1,10-4,07 µg/ml diagnose purulent stage of pyelonephritis. table 2.
The proposed method relates to medicine, to clinical diagnosis and can be used to adequately assess the severity of patients when determining stages of acute pyelonephritis in children.
Pyelonephritis occupies a special place among kidney disease. He is one of the main reasons for the development of chronic renal failure and nephrogenic hypertension is assintance flow. Pyelonephritis - nonspecific inflammatory process of the renal pelvis, cups, parenchyma with a primary lesion of interstitial tissue. According to A. J. Pytel of and co-authors (1977), in pathology of the kidney and urinary tract pyelonephritis occurs in 33% of cases, with the acute form is 14%, standing at 36%. During the opening of pyelonephritis discover 5.6-22.7% of the cases, diabetes - 22.5-22.7 per cent (W. Bruns, 1969, G. Ditscheriein, 1969), children - in 15-25% of cases (A., Pugachev, 1977). Diagnosis of pyelonephritis complicated and imperfect. Despite the use of complex methods of research, hospital diagnostic errors are often 25-30%, while outpatient study reach 60-75%. (A. C. Lyulko, 1989).
A known method for predicting early postoperative complications in children, based on the study of the peripheral blood in the early postoperative period and determining the relative amount of HLA - DR + lymphocytes, and indices greater than or equal to 12%, predict the development of septic complications in the early postoperative period. (Patent No. 2131610, M CL 7 G 01 N 33/53, BIPM No. 36. 2000. S).
The disadvantage of this method is to estimate only of peripheral blood without taking into account the e in a patient with symptoms of a systemic inflammatory response to the presence of the nidus.
Closest to the claimed is a method of diagnosis stage of acute pyelonephritis, based on the study of biological fluids and the determination in urine of lactate dehydrogenase activity, succinaldehyde and glucose-6-phosphate dehydrogenase. And when the activity value of the first enzyme below 1,62 µmol/l/min, the second lower 1,58 µmol/l/min, the third below 21,10 µmol/l/min diagnosed with serous stage of acute pyelonephritis, and when the value of the first enzyme above 1.7 mmol/l/min, the second above 1.6 µmol/l/min, the third above 22,2 µmol/l/min diagnosed with purulent stage of acute pyelonephritis. (Patent No. 2115124, M CL 7 G 01 N 33/68, BIPM No. 19. 1998. S).
The disadvantage of this method is that the study of biological fluids (urine) makes no assumptions about the severity of the inflammatory process. Do not count and metabolic indexes of volemic body. To judge the future course and outcome of the disease without additional methods of research is not possible.
The present invention is to improve the accuracy of determining the stage of the pathological process to predict the course and outcome of the disease and determine the best tactics of the weave of blood. Define the content of the plasminogen/plasmin,2-macroglobulin, 1-antitrypsin, lactoferrin, and if plasminogen/plasmin 66-76 μg/ml, the level2-macroglobulin 2,5-3.13 g/l1-antitrypsin 2,28-3.0 g/l, the level of lactoferrin to 1 μg/ml diagnosed with serous stage pyelonephritis, if plasma-nogen/plasmin 96-169 μg/ml, the level2-macroglobulin 2,28 at 2.59 g/l1-antitrypsin a 2.9-7.2 g/l, the level of lactoferrin 1,10-4,07 µg/ml diagnose purulent stage of pyelonephritis.
The novelty of the method.
1. Selected as markers of the inflammatory process indicators proteins of acute phase of inflammation: the plasminogen/plasmin,2-macroglobulin,1-antitripsin, lactoferrin, the content of which is determined in the serum.
2. Limits to the changes of these indicators of the severity of the pathological process and its stage.
Changes in the concentration of the plasminogen/plasmin indicates activation of proteolysis. About the state of the inhibiting factors is judged by the degree of changes of level2-macroglobulin and1-antitrypsin, which are natural inhibitors, lactoferrin testifies to Aleksei organism for the presence of inflammation in pediatric practice poorly understood. The syndrome of systemic inflammatory response is a response of the organism to the presence of a pathological lesion and does not give a clear idea of the stage of the pathological process and the degree of destructive changes. Any pathological process, regardless of the location of the hearth, the body responds physiologically reasonable response aimed at limiting process. However, the inflammatory reaction is unified in its manifestation at all levels of damage. When endotoxicosis observed a direct effect of toxins on the vascular wall, which contributes to the activation of cellular proteolysis. Violation of dynamic equilibrium between the activated proteolytic enzymes and their natural inhibitors lead to the development of septic complications. Thus, there are certain difficulties in evaluating the severity of the patient and the nature of the pathological process.
Assessment of dynamic changes in the concentration of proteins of the acute phase of inflammation allows you to more accurately determine the stage of the pathological process, the nature of its flow and to predict the outcome of the disease. Conducted a comprehensive assessment of the severity of the patient, including assessment of funkcionalnog is employed to evaluate the body's response to the presence of the pathological focus. The assessment takes into account the degree of activation of proteolytic systems and natural inhibitors of this process.
The method consists in the following
At admission the patient to the hospital examined the protein level of the acute phase of inflammation in serum: the plasminogen/plasmin,2-macroglobulin,1-antitrypsin, lactoferrin (low voltage rocket immunoelectrophoresis). In combination with clinical data (HR, BH, BP, body temperature, assessment of urine output), data from laboratory tests (complete blood count, biochemical complex, KHS, hemostasis), the estimated indicators of the degree of endotoxemia (LII, RON) evaluated the severity of the patients predicted the course and outcome of the disease.
Assessment, determination of the stage of the pathological process was carried out for the following data.
1. When the level of the plasminogen/plasmin 66-76 μg/ml, the level2-macroglobulin 2,5-3.13 g/l1-antitrypsin 2,28-3.0 g/l, the level of lactoferrin to 1 μg/ml diagnosed with serous stage of pyelonephritis.
2. When the level of the plasminogen/plasmin 96-169 μg/ml, the level2-macroglobulin 2,28 at 2.59 g/l1-antitrypsin is whether 1,3,5,10 day and at discharge from the hospital for monitoring.
The definition of early activation of proteolysis and state inhibiting factors allows early to step up and correct therapy. Depending on the stage of the process are also corrected antibacterial therapy, infusion-transfusion therapy, defined indications for surgical rehabilitation of the hearth.
When serous stage pyelonephritis conducting a course of conservative treatment. When purulent stage of pyelonephritis patients surgical treatment.
Patient O., 4 years (East. disease No. 3664).
Admitted to the hospital with a diagnosis of urinary tract Infection. Acute pyelonephritis”. State upon receipt of moderate severity through mild endotoxemia: HR 120-130 min, BH 24-26 min, body temperature of 38.2°C, a slight decrease of diuresis. Laboratory leukocytosis with 14,5 p/I shift in the formula blood up to 10%, LII - 4,78. RON -37,3. Level ostrofsky proteins were measured in the dynamics. The patient was treated conservatively. The indicators are listed in the table.1
Conclusion: With a slight decrease in the level of the plasminogen/plasmin in the blood serum level of inhibitory factors2-macroglobulin and1-antitrypsin otoxic mild severity. Classied by us as the development of systemic inflammatory response to inflammation. The patient has been standard therapy aimed at correction of water-electrolyte metabolism, antibiotic therapy with 2 drugs. The patient is conservative. The normalization parameters to 5 days. The patient was discharged with recovery.
Patient M., age 14 (East. disease No. 8363).
Admitted to the hospital with a diagnosis of “Carbuncle upper pole of the left kidney”. The state of admission heavy: tachycardia 128-140 min, shortness of breath up to 32 min, T-38,4 With severe pallor of the skin, breathing hard, laboratory leukocytosis with 11,5 p/I shift 11-17%, LEAH 4,0-6,1, RON-41-71,18, which corresponds to heavy endotoxicosis. After preoperative preparation of the patient was operated. The postoperative period of severe, signs of multiple organ dysfunction. The concentration of acute phase proteins are given in table.2.
Conclusion: The patient was noted severe postoperative period. With a sharp increase in the level of the plasminogen/plasmin, reducing2-macroglobulin more than 50% from age norms, a sharp increase in the level1-entities the process of proteolysis. Sick for a long time was treated in the intensive care unit. Conducted ABT 3 drugs, correction of all hemodynamic parameters, water-electrolyte metabolism, hemostasis, CSR. For a long time preserved signs of multiple organ failure with slow regression process. In this situation, the patient noted a generalization of infection, the patient threaten in the development of septic complications.
In these patients, even with adequate therapy, a high percentage of severe sepsis and prolonged course of the disease.
Thus, the proposed method allows us to objectively and more accurately determine the stage of the pathological process, to assess the effectiveness of the treatment and to make timely adjustments in tactics of treatment.
The proposed method is used in MDCB No. 7. , Novokuznetsk. For the period 2001-2002, studied 28 patients with varying degrees of kidney damage. Based on a survey on the proposed method was recommended to use only 30% of patients, the remaining 70% of patients were treated conservatively. If this were achieved good results.
The way to diagnose acute stage of PIAL blood define the content of the plasminogen/plasmin,2-macroglobulin, 1-antitrypsin, lactoferrin and at the level of the plasminogen/plasmin 66-76 μg/ml, the level2-macroglobulin 2,5-3.13 g/l1-antitrypsin 2,28-3.0 g/l, the level of lactoferrin to 1 μg/ml diagnosed with serous stage pyelonephritis, at the level of the plasminogen/plasmin 96-169 μg/ml, the level2-macroglobulin 2,28 at 2.59 g/l1-antitrypsin a 2.9-7.2 g/l, the level of lactoferrin 1,10-4,07 µg/ml - diagnose purulent stage of pyelonephritis.
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.