rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2021-24-2-122-129whvugvrosped-1213Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR PRACTITIONERSХроническая болезнь почек у детей: принципы ведения в условиях первичного звена здравоохраненияСhronic kidney disease in children: principles of ambulatory managementhttps://orcid.org/0000-0002-6608-7888ВялковаАльбина АлександровнаVyalkovaAlbina A.

Доктор мед. наук, проф., зав. каф. факультетской педиатрии ФГБОУ ВО «Оренбургский государственный медицинский университет» Минздрава России

e-mail: k_pediatry@orgma.ru

k_pediatry@orgma.ruhttps://orcid.org/0000-0003-0807-6133ЧесноковаСветлана АлександровнаChesnokovaSvetlana A.

Ассистент каф. факультетской педиатрии ФГБОУ ВО «Оренбургский государственный медицинский университет» Минздрава России

e-mail: d.s.a.dk@mail.ru

Assistant of the Department of Faculty Pediatrics, Orenburg State Medical University, Orenburg, 460018, Russian Federation

e-mail: d.s.a.dk@mail.ru

d.s.a.dk@mail.ruУстиноваОксана ОлеговнаUstinovaOksana O.

Канд. мед. наук, ассистент каф. факультетской педиатрии ФГБОУ ВО «Оренбургский государственный медицинский университет» Минздрава России

e-mail: oksanau78@yandex.ru

oksanau78@yandex.ruГайковаЛариса АнатольевнаGaikovaLarisa A.

И.о. зав. нефрологического отделения ГАУЗ ГКБ № 6 г. Оренбурга

e-mail: k_pediatry@orgma.ru

k_pediatry@orgma.ruФГБОУ ВО «Оренбургский государственный медицинский университет»Orenburg State Medical UniversityГАУЗ «Городская клиническая больница № 6»City Clinical Hospital No. 6202110012025242122129Copyright © Вялкова А.А., Чеснокова С.А., Устинова О.О., Гайкова Л.А., 20252025Вялкова А.А., Чеснокова С.А., Устинова О.О., Гайкова Л.А.Vyalkova A.A., Chesnokova S.A., Ustinova O.O., Gaikova L.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rosped.ru/jour/article/view/1213

Термином «хроническая болезнь почек» (ХБП) определяют исход различных форм хронической прогрессирующей патологии почек, характеризующийся повреждением почек, либо снижение их функции в течение 3 мес и более вне зависимости от нозологического диагноза.

Цель работы — определить частоту, структуру и клинико-параклинические особенности ХБП у детей для обоснования принципов её ведения в условиях первичного звена здравоохранения.

Материалы и методы

Материалы и методы. Представлена частота и структура ХБП у детей Оренбургской области за 10-летний период (2009–2019 гг.).

Результаты

Результаты. Установлено, что среди пациентов с ХБП преобладают тубулоинтерстициальные поражения почек (80%), ассоциированные с врождёнными пороками развития органов мочевой системы, рефлюкс-уропатией, уролитиазом, в 98% случаев осложнённые ренальной инфекцией. У 8,9% детей ХБП сформировалась как исход гломерулопатий; у 6,7% — при врождённых и наследственных нефропатиях; у 4,4% — как исход гемолитико-уремического синдрома. У детей преобладали I–II (74,3%), реже III и IV (25,7%) стадии ХБП. Представлены выявленные клинико-параклинические особенности ХБП у детей.

Обоснованы современные принципы ранней диагностики ХБП у детей и выявления факторов риска прогрессирования нефропатий. Создан алгоритм диагностики ХБП в детском возрасте, в том числе на амбулаторном этапе; предложен комплекс мероприятий по профилактике нефропатий.

Заключение

Заключение. Разработан алгоритм ранней диагностики ХБП в детском возрасте на основе анализа комплекса клинико-параклинических, структурных и функциональных показателей почек в сочетании с параметрами функции эндотелия и цитокинового статуса.

Участие авторов

Участие авторов: Вялкова А.А. — концепция и дизайн исследования, редактирование; Чеснокова С.А., Гайкова Л.А. — сбор и статистическая обработка материала; Чеснокова С.А., Устинова О.О. — написание текста. Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех её частей.

Информированное согласие

Информированное согласие. От родителей пациентов получено письменное добровольное информированное согласие на участие в исследовании.

Финансирование

Финансирование. Работа выполнена в рамках грантовой поддержки ФГБОУ ВО «Оренбургский государственный медицинский университет», Университетский научный грант «Предикторы и персонифицированная профилактика хронической болезни почек у детей» (соглашение № 2019 РХД/2019/04-02-2-Гр/М/1 от 14.01.2019 г.).

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 29

Поступила 29.03.2021Принята к печати 22.04.20211Опубликована 14.05.2021

Introduction

Introduction. The term «chronic kidney disease» (CKD) is used to define the outcomes of various forms of chronic progressive kidney disease, characterized by kidney damage, or a decrease in their function for three months or more, regardless of the nosological diagnosis.

The aim of the work was to determine the frequency, structure, and clinical and paraclinical features of CKD in children to substantiate the principles of its management in primary health care.

Results

Results. In CKD patients, tubulointerstitial renal lesions were established to prevail (80%). Associated with congenital malformations of the urinary system, reflux uropathy, and urolithiasis in 98% of cases tubulointerstitial renal lesions are complicated by renal infection. In 8.9% of children, CKD was formed as an outcome of glomerulopathies; in 6.7% of children — with congenital and hereditary nephropathies; in 4.4% of children an outcome of a hemolytic uremic syndrome. The observed children dominated by I–II (74.3%), less often III and IV (25.7%) stages of CKD. The revealed clinical and paraclinical features of CKD in children are presented.

The modern principles of early diagnosis of CKD in children and the identification of risk factors for the progression of nephropathy have been substantiated. For the diagnosis of CKD in childhood there has been created a. n algorithm, including at the outpatient stage. Authors suggested a set of measures for the prevention of nephropathy.

Conclusion

Conclusion. For early diagnosis of CKD in childhood there was developed an algorithm based on the analysis of a complex of clinical and paraclinical, structural and functional parameters of the kidneys in combination with the parameters of endothelial function and cytokine status.

Contribution

Contribution: Vyalkova A.A. — research concept and design of the study, editing; Chesnokova S.A., Gaikova L.A. — collection and processing of material; Chesnokova S.A., Ustinova O.O. — text writing. All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Informed consent

Informed consent. Written voluntary informed consent was obtained from the patients’ parents to participate in the study.

Acknowledgement

Acknowledgement. The study was carried out within the framework of the grant support of the Orenburg State Medical University. University Research Grant «Predictors and personalized prevention of chronic kidney disease in children» (Agreement No. 2019 RCD/2019/04-02-2-Gr/M/1 of 14.01.2019).

Conflict of interest

Conflict of interest. The authors declare no conflict of interest.

Received

Received: March 29, 2021Accepted: April 22, 2021Published: May 14, 2021

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The authors declare that there are no conflicts of interest present.