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Diagnosis of reflux-nephropathy
Last reviewed: 23.04.2024
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In the biochemical analysis of urine, oxaluria, calciumuria, uraturia are observed in 80% of cases, glucosuria in 34%, a decrease in the level of ammonia and titrated acids in 90%, which indicates tubal dysfunction and metabolic disorders.
On the ultrasound picture of the kidneys in the presence of reflux-nephropathy there is a decrease in the size of the kidneys, a lag in their growth in dynamics, uneven knobby contours, poorly differentiated unevenly expressed with hyperechogenic parenchyma patches, an expansion of the pelvic echo signal.
When performing dopplerography of the kidneys, one can observe a decrease in blood flow against the background of a decrease in the resistance index.
According to ultrasound and dopplerography, three groups of children are identified. The first group includes children with ultrasound signs of the Rn. Lag of kidney size, decreased renal blood flow, a decrease or increase in the index of vascular resistance. In the second - children with a "small kidney", when against the backdrop of the size of the kidneys there is no change in renal hemodynamics (it is possible that in these cases the vesicoureteral reflux develops already into the hypoplastic kidney). In the third - children at the stage of "pre-reflux-nephropathy", when against the background of a small lag in the size of the kidneys there is a change in the resistance of renal vessels.
On intravenous urography, one can see a decrease in the parenchyma index to 0.48-0.54 at a rate of 0.58, a deformation of the contouring of the calyceal system, its hypomapping, coarsening of the forties, hypotension and deformation of the ureters, delayed removal of the X-ray contrast medium.
Rensocintiography has been shown to reduce the size of the kidney, reduce and slow the accumulation of radiopharmaceutical, delayed monotonous distribution, delay in the projection of the middle segment, moderate or severe degree of impairment of the memory-excretory function of the kidneys.
Based on the severity of nephrosclerosis in the course of intravenous urography and radioisotope scintigraphy, 4 degrees of reflux-nephropathy are distinguished:
- moderate with one or two fields of sclerosis;
- heavy with damage more than two cups with areas of normal parenchyma;
- generalized deformity of calyx with variable decrease in parenchyma;
- shriveled kidney.
An increasing distribution in modern pediatric nephrology acquires an analysis of the state of mitochondria. There are clinical signs of mitochondrial insufficiency: lag in physical development, reduced tolerance to physical and psychological stress, small developmental anomalies, frequent catarrhal diseases, a large number of concomitant somatic diseases, allergic anamnesis, metabolic disorders, muscle hypotension, myopia, ophthalmoplegia, convulsive syndrome. In the presence of these clinical signs, it is advisable to analyze the state of mitochondria. The most reliable is the histological examination of muscle fibers and the detection of the phenomenon of "torn red muscle fibers." However, a screening method has been developed that allows one to determine the presence of mitochondrial dysfunctions by blood analysis. The method was based on the theory of RP Narcissova on the relationship between the state of mitochondria in lymphocytes and the whole organism as a whole. Using the method of cytochemical analysis, qualitative (optical density, size, degree of clast formation) and quantitative characteristics of mitochondrial enzymes (succinate dehydrogenase, glycerophosphate dehydrogenase, glutamate dehydrogenase, lactate dehydrogenase) are determined. By these characteristics, it is possible to judge the degree of compensation of intracellular energy processes.
These data clearly correlate with the stages of development of RN according to ultrasound and dopplerography. Thus, in nephrosclerosis, a pronounced decrease in the activity of mitochondrial enzymes is revealed, a change in all their qualitative characteristics; with a "small kidney" - a moderate decrease in the activity of mitochondrial enzymes; with "pre-reflux-nephropathy" - a slight decrease in the activity of enzymes against a background of compensatory increase in clast formation.
Thus, taking into account the low-symptomateness of the uninfected stage of vesicoureteral reflux reflux-nephropathy, an algorithm for examining children with suspicion of these conditions has been developed.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14],