Method for applying restoration therapy to chronic pyelonephritis patients

FIELD: medicine.

SUBSTANCE: method involves applying dietotherapy of zoosterol as 0.5% of aqueous solution in the amount of 100-200 ml in the morning 30 min before taking meals at a daily dose of 0.5-1.0 g in 21 days long course.

EFFECT: enhanced effectiveness in correcting metabolism disorders.

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The invention relates to medicine, namely to Nephrology, and can be used for rehabilitation treatment of patients with chronic pyelonephritis.

The urgency of the problem of rehabilitation treatment of patients with pyelonephritis due to high growth of this pathology in the overall morbidity. Etiological factors of chronic pyelonephritis are urinary tract infection and disturbance of outflow of urine. To vascular mechanisms of progression of chronic pyelonephritis are increasing systemic BP, hyperfiltration and vnutripolusharnaya hypertension [1, 2]. Metabolic link in the pathogenesis of pyelonephritis are violations of nitrogen, electrolyte, lipid metabolism, influencing the severity of the disease, contributing to the hardening of renal tissue and formation of chronic renal failure (CRF) [3]. The accumulated experimental and clinical data quite convincingly testify to the involvement of lipoproteins in the formation of sclerotic processes in the renal parenchyma. Activation of lipid peroxidation in cell membranes of renal parenchyma entails the loss of their functional activity due to the destabilization of the lipid bilayer and violations of transmembrane ion transport[4, 5, 6, 7]. Patologiagenerale - and hypermagnesemia, hypercalciuria create conditions for violations of reabsorption, the functioning of tubular and glomerular systems kidneys and development membrantechnik processes in the urinary system [8].

At the stage of rehabilitation treatment of patients with chronic pyelonephritis etiological factors, as a rule, do not play a significant role, preference is given to non-specific therapy aimed at eliminating the leading pathogenetic metabolic disorders.

For restorative treatment of patients with chronic pyelonephritis predominantly use non-drug methods, nutritional therapy, natural and preformed medical factors (climate, mineral water, peloids, apparatus physiotherapy). Experimental and clinical studies as a method of rehabilitation treatment of chronic pyelonephritis proven effectiveness of balneotherapy. However, the reduction of pathological hyperquality and hypermagnesemia, hypercalciuria, normalization of renal excretory function, correction of lipid metabolism, stabilize membrantechnik processes the maximum is achieved when the complex balneotherapy, including internal and external use of mineral water. This complete treatment may only be provided in the resort or sanatorium that the current economic conditions is becoming less accessible to a wider group of patients and therefore limits the possibility of complex restorative treatment.

An important element in the rehabilitation of patients with kidney disease is the use of physiotherapeutic methods such as electrophoresis, sinusoidal modulated currents, high-frequency, microwave, and ultrasound therapy. Methods of physiotherapy have predominantly anti-inflammatory effect, helping to improve blood flow in the kidneys, reduce blood pressure, increase diuresis. When exposed to preformed physical factors less amenable to correction crystallization of salts, lipid peroxidation in kidney cells, membraneelectrode renal tissue. However, there are some contraindications that restrict the application of methods of physiotherapy in people with kidney disease. In addition to the procedures required special physiotherapeutic equipment.

As an independent method of treatment in the rehabilitation period is widely used nutritional therapy. Medical-preventive nutrition in chronic pyelonephritis minimize the load on the kidneys, restoration of water-salt metabolism in the body, lowering blood pressure. However, this method is not always effective enough when self-applied. Course of diet therapy in patients with chronic pyelo what AFRICOM should be long-term. In remission when remitting or a lack of strong clinical manifestations of the disease, patients usually do not adhere to the principles of clinical nutrition. For the correction of metabolic disorders, filling contents into the body of micronutrients and fiber can be used a method of enteral correction based on the use of natural chelators, which is the most physiological and promising for practical use. One of the famous natural enterosorbents is, for example, Zosterin derived from sea grass family Zosteraceae. A feature of the chemical structure of Zosterin is the low degree of methoxylation of its molecules (less than 10%)that allows the formation of salts, complexes with food contaminate (pesticides, toxins and other) and endogenous toxic substances. By its physical-chemical properties of Zosterin is natural polyanion. The presence in the molecule of free carboxyl groups leads to its ability to form salt - posterity [9].

Know the use of Zosterin as tools for diseases of the cardiovascular system, the gastrointestinal tract. According to the literature data for the prevention of relapse of chronic gastritis associated with Helicobacter pylori shows the application profile the political courses of pectin-Zosterin 1 g (dry matter) in the gel 200 ml in the morning on an empty stomach, within 5 days, 3 courses with an interval of 2-3 days, every 3 months [10]. It is known the use of pectin-Zosterin of 25 mg per 1 kg of body weight 3 times daily on an empty stomach in the gel for 12-14 days at the gastroenterological diseases [11, 12]. In frequently ill children A.A. Smolnikov proposes to apply the gel pectin-Zosterin 0.5% aqueous solution according to scheme 5 days - ingestion of 50 to 150 ml depending on age, break 3-5 days, 3 cycle [13]. The technique of using Zosterin when dysmetabolic nephropathy in children, including his admission of 0.5% aqueous solution of 100 ml in the morning on an empty stomach 30 minutes before meals, course 15 days [14].

As shown by the analysis of the available scientific and patent information, information about the use of Zosterin in the rehabilitation treatment of patients with chronic pyelonephritis, could not be found.

Thus, the invention staged development of a method of rehabilitation treatment of patients with pyelonephritis, aimed primarily at correcting metabolic disorders, contributing to the formation of sclerotic processes in the renal tissue. To date, the authors are not aware of any source of information, which would be staged and solved a similar problem. The problem is solved by including in the complex rehabilitation treatment natural entero is Orbeta, for example, Zosterin.

The method is as follows.

Powder Zosterin contained in the package (5 g Zosterin) stir in 1 liter of distilled or pranipatena and settled warm (not above 50° (C) water. Used the mixture was kept in refrigerator at +2-4°C for 5 days. Water-soluble pectin Zosterin accepted therapeutic dose of 1 g per day in 0.5% aqueous solution of 200 ml in the morning on an empty stomach 30 minutes before eating. The rate of reception of Zosterin 3 weeks. Developer Zosterin - Pacific Institute of Bioorganic chemistry, far Eastern branch of Russian Academy of Sciences; producer - OOO DINAMA”, Vladivostok. Manufactured form - packaged powder. Distributed in pharmacies. THE 15-01 946-90. Registration certificate №R, Technology and regulatory documentation are protected by RF patent No. 2000064 from 15.06.93. The number in the Federal register BAA 003074. R. 07. 20 tibah, date of registration 09.07.01,

1st group (control) - patients with chronic pyelonephritis without impaired renal function in a stage of partial and complete clinical and laboratory remission treated with diet No. 7 (17 patients), group 2 - patients with chronic pyelonephritis, on the background diet treated Zosterin. This group consisted of 27 patients with chronic pyelonephritis, including 8 men and 19 women aged 27 to 50 years.

Verification of the diagnosis was carried out on the OS the implement clinical and anamnestic data of the results of ultrasound examination of the structural-functional state of the tissue and Cup-pelvis system kidney biochemical examination including determination of indicators of nitrogen, water and electrolyte, lipid, and protein metabolism.

Patients of study groups were in clinical remission, which was characterized by malosimptomnogo clinical manifestations of nephropathy. So, edematous syndrome, manifested moderate pastos face, was detected in 11.5% of patients, mild hypertension to 155/87 mm Hg - 18,3% of patients.

When applying the basic therapy in the 1st group was noted implausible increase in diurnal diuresis, the calcium concentration in serum and decrease in its level in the urine (table). Introduction to rehabilitation complex enterosorbent patients of the 2nd group contributed to increased urine output by 33%, a slight increase in the concentration of calcium ions in serum by reducing the level of calcium in the urine by 26.3% (p<0,05), which is associated with high sorption ability of pectins to form complexes with cations.

The active influence of Zosterin when it is integrated using the indicators of the exchange of magnesium was expressed in significantly significant decrease in the concentration of magnesium in serum by 11.9% (p<0,05), while increasing the level of the electrolyte in the urine by 18.7%. Mechanism of maggiorata in the corresponding group was to increase glomerular filtration rate and decreased reabsorption of magnesium ions pochechnyh bone.

In the examined patients of the 1st and 2nd clinical group showed moderate hypercholesterolemia (GHS) and hypertriglyceridemia (TG) on the background of low levels of HDL cholesterol. Exchange application of Zosterin in complex therapy of patients with chronic pyelonephritis in comparison with a control group of patients not receiving Zosterin, had a positive impact on the dynamics of lipid disorders and was accompanied by a reduction of total cholesterol by 15.7%, triglycerides by 33.6% (p<0,05). There was a trend toward higher levels of HDL cholesterol.

The effect of the combined therapy on the lipid metabolism was characterized by a decrease in the concentration of phospholipids in the urine by 27.5% (p<0,05), indicating stabilization membrantechnik processes in the renal tubules. Use only basic treatment did not cause significant changes in the concentration of creatinine, total protein and phospholipids.

Improvement of clinical symptoms in patients with complex use of pectin Zosterin manifested in the normalization of HELL. It should be noted that the 4 patients who Zosterin, on the 5th day from the start of treatment appeared dyspeptic disorders in the form of rumbling in the stomach, frequent bowel movements up to 3 times per day. These were patients with concomitant diseases of the hepatobiliary system and gastrointestinal tract. After SN is the supply of a 0.5% aqueous solution of Zosterin to 100 ml, amounting to 0.5 g per day, further reception was well tolerated. By the end of treatment in this subgroup of patients showed improvement of clinical symptoms of the underlying disease. Revealed less intense decrease in the level of calcium in the urine. The dynamics of the rest of the studied biochemical parameters in serum and urine was not significantly different from that in patients of the 2nd group. This fact indicates the possibility of reducing the dose of Zosterin to 100 ml in patients with chronic pyelonephritis with concomitant pathology of the hepatobiliary system and gastrointestinal tract.

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Table
Dynamics of biochemical parameters in serum and urine of patients with chronic pyelonephritis treated Zosterin, M±m
Indicators1st group (control)2nd group
before the treatmentafter the treatmentbefore the treatmentafter the treatment
Total protein, g/l74,4±0,9670,5±1,4969,2±0,5871,4±equal to 4.97
Creatinine, mmol/l87,5±12,27to 91.6±20,1688,7±of 10.05109,2±10,38
Calcium, mmol/l
Magnesium, mmol/l
OXC, mmol/l5,94±0,075,62±0,096,06±0,985,11±0,02
TG, mmol/l2,75±0,062,55±0,132,8±0,111,86±0,15*
HDL, mmol/l0,74±0,080,76±0,030,71±0,020,78±0,06
Phospholipids,% OL26,7±6,0222,4±3,3228,4±1,8520,6±4,06*
Diuresis, ml985,8±and 19.41109,3±29,31075,5±30,11430,5±22,7*
Note: in the numerator parameters in serum, the denominator in the urine of patients; reliability calculated in comparison with the data before the correction, (*) p<0,05.

Thus, clinical, laboratory and functional and is a research proven, inclusion in recreation complex natural enterosorbent, for example, Zosterin without additional non-pharmacological therapy helps reduce hypermagnesemia, hypercalciuria, reduces cholesterol, triglycerides, as determined by high sorption properties of the enteric and ensures the effectiveness of non-pharmacological therapy Nephrology patients. The results of the effectiveness of natural chelators in patients with chronic pyelonephritis no doubt the inclusion of biologically active substances of this group in therapeutic and prophylactic complexes. For the practitioner it is especially important to have alternative means of non-drug therapy, providing kristallingeologie and hypolipidemic effect. Therefore, it is necessary to engage in recreation complex natural chelators, particularly Zosterin that will allow for early non-pharmacological correction of electrolyte and lipid disorders in patients with chronic pyelonephritis and to prevent the development of chronic kidney disease, hardening of the kidney tissue.

Example. Patient D., 38 years old, was admitted after inpatient treatment in the clinic of the Institute of medical climatology and rehabilitation treatment WITH the RAMS with a diagnosis of ismetabolites nefro the Atia, oxalate-calcium crystalluria; secondary chronic pyelonephritis, stage partial clinical and laboratory remission without renal dysfunction. At admission she complained of pain in the lumbar region, which arose after exercise. The study of blood serum: total protein - 72.5 g/l, creatinine - a 94.6 mmol/l, calcium - 2.58 mmol/l, magnesium - 1.44 mmol/l, cholesterol - x 6.15 mmol/l, TG is 2.37 mmol/l, HDL - 0.7 mmol/l urine: urine output 940 ml, specific gravity of urine - 1027, pH is 5.5, the leukocyte - 10-12 P.Z., calcium - 8.17 mmol/l, magnesium - 2.57 mmol/l, oxalates - 810 mg/day, phospholipids - 33,0%. The patient received the following treatment - diet No. 7, as enterosorbent appointed water-soluble pectin Zosterin in therapeutic dose of 1 g per day in 0.5% aqueous solution of 200 ml in the morning on an empty stomach 30 minutes before eating. The rate of reception of Zosterin amounted to 3 weeks. All treatments the patient was well tolerated. At the end of treatment there was no pain in the lumbar region. At check-in serum: total protein is 74.5 g/l, creatinine - of 83.6 mmol/l, calcium - 2.48 mmol/l, magnesium - 1,45 mmol/l, cholesterol - 5,31 mmol/l, TG - 2,17 mmol/l, HDL - 0.8 mmol/l urine Output increased to 1420 ml, urine pH to 5.8, the number of leukocytes in the urine decreased to 3 in P.Z., urinary specific gravity - up to 1018, oxalates - 452 mg/day, phospholipids and 15.3%, calcium - of 5.75 mmol/l, magnesium - 3.0 mmol/L. Observation of the patient within 3 months which was characterized by the stability of the studied parameters the lack of aggravation.

Thus, the results of clinical studies have proved the high effectiveness of rehabilitation treatment using natural enteric Zosterin aimed at regulating metabolic processes in patients with chronic pyelonephritis. The use of this technique allows additional appointments physiotherapy and balneotherapy, a correction of electrolyte disorders, nitrogen and lipid metabolism in individuals with chronic pyelonephritis. Inclusion in the medical complex of Zosterin reduces pathological hyperquality - and hypermagnesemia, hypercalciuria, lowers cholesterol and triglyceride levels, normalizes diuresis, renal excretory function and creates the conditions for stabilization membrantechnik processes in the urinary system in chronic pyelonephritis, which generally prevents the development and progression of chronic renal failure, hardening of the kidney tissue.

Advantages of the proposed method are the availability, Malostranske (cost), the use in the outpatient setting, no need for additional hardware.

Literature

1. Comandanta MS, Shostka HD the Basic mechanisms of development tubulointerstitial damage in diseases of p is check//Nephrology. - 2000. -V. 4, No. 4. - P.10-17.

2. Sutula BV Chronic pyelonephritis - open questions//the Doctor. -1996. No. 5. - P.30-31.

3. Ignatov M.S., Kharina, E.A., Yaroshevsky I. Modern ideas about oxalate nefropatia (clinical and population studies)//Tep.apx. - 1994. No. 6. - P.45-51.

4. Gozhenko A.I., Fedoruk A.S. Influence of Preductal on the development and course of experimental acute renal failure//Nephrology. - 2000. - V. 4, No. 4. - P.67-72.

5. Kulikov P.I., O. Mitrofanov, Kozlov V.V., Baranov S.V. Changes in fractional composition of phospholipids of erythrocytes and blood plasma in patients with chronic glomerulonephritis//Nephrology. - 1998. - Vol.2, No. 1. - P.37-41.

6. MANOVA D.A. Dyslipidemia in patients with kidney disease/Nephrology, dialysis and transplantation. - 1998. - V.3, №3-4. - P.12-22.

7. Ryabov, S. Nephrotic syndrome. - SPb: DOE, 1998. - 405 S.

8. Simons T.J. Lead-calcium interactions in cellular lead toxicity //Nenrotoxicology/ - 1993. - Vol.14, No. 2-3. - P.77-85.

9. Loanco YU.N., Artukov A.A., Kozlovskaya AP Zosterin, 1997. - 211 S.

10. Smirnov PV Characteristic of dyslipoproteinemia in patients with glomerulonephritis//Nephrology. - 1998. - Vol.2, No. 3. - P.76-83.

11. Miroshnichenko, VA, Papernov POSTGRADUATE, Horseflies US, Ovodova RG and other Method of treating gastrointestinal diseases//Patent for the invention №1782601 A1. - Publ. 23.12.92. Bull. No. 47.

12. Jansons THE Treatment and rehabilitation of children with gastritis with the application of the biologically active substances of marine life in the conditions of policlinic: Autoreplies....candlenut. - Vladivostok, 1998. - 24 S.

13. A.A. Smolnikov risk Factors, treatment and prevention of common diseases in children with biologically active substances of marine life: Autoreplies....candlenut. - Vladivostok, 1998. - 25 S.

14. Gvozdenko T.A., Skladchikova S.N., ANCOVA VI Method of correction of metabolic disorders in children with dysmetabolic nefropatia//Patent for the invention №2190413 C2. - Publ. 10.10.2002. Bull. No. 28.

The method of rehabilitation treatment of patients with chronic pyelonephritis, including diet therapy, characterized in that it further designate a 0.5%aqueous solution of Zosterin 100-200 ml in the morning 30 minutes before eating a daily dose of 0.5-1 g 21 days course.



 

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