rospedРоссийский педиатрический журнал имени М.Я. СтуденикинаM.Ya. Studenikin Russian Pediatric JournalФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/1560-9561-2021-24-2-130-135hhdndbrosped-1214Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR PRACTITIONERSОсновные пути коррекции идиопатической гиперкальциурии у детейThe main ways of correcting idiopathic hypercalciuria in childrenМихееваНаталия МихайловнаMikheevaNatalia M.

Канд. мед. наук, доцент каф. пропедевтики детских болезней ФГБОУ ВО «Алтайский государственный медицинский университет»

e-mail: micheeva.1974@mail.ru

MD, Ph.D., Associate Professor of the Department of Propaedeutics of Children Diseases of the Altai State Medical University, Barnaul, 656038, Russian Federation

e-mail: micheeva.1974@mail.ru

micheeva.1974@mail.ruЗверевЯков ФедоровичZverevYakov F.

Доктор мед. наук, проф., каф. фармакологии ФГБОУ ВО «Алтайский государственный медицинский университет» Минздрава России

e-mail: zver@agmu.ru

zver@agmu.ruhttps://orcid.org/0000-0002-8586-1330СтрозенкоЛюдмила АнатольевнаStrozenkoLyudmila A.

Доктор мед. наук, проф. каф. пропедевтики детских болезней ФГБОУ ВО «Алтайский государственный медицинский университет» Минздрава России

e-mail: strozen@mail.ru

strozen@mail.ruhttps://orcid.org/0000-0001-6284-1604ЛобановЮрий ФедоровичLobanovYuri F.

Доктор мед. наук, проф., зав. каф. пропедевтики детских болезней ФГБОУ ВО «Алтайский государственный медицинский университет» Минздрава России

e-mail: ped2@agmu.ru

ped2@agmu.ruФГБОУ ВО «Алтайский государственный медицинский университет»Altai State Medical University202110012025242130135Copyright © Михеева Н.М., Зверев Я.Ф., Строзенко Л.А., Лобанов Ю.Ф., 20252025Михеева Н.М., Зверев Я.Ф., Строзенко Л.А., Лобанов Ю.Ф.Mikheeva N.M., Zverev Y.F., Strozenko L.A., Lobanov Y.F.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/1214Введение

Введение. Идиопатическая гиперкальциурия (ИГ) — распространённое метаболическое нарушение, одна из основных причин развития кальциевого уролитиаза и остеопороза у детей. Целью лечения ИГ является снижение экскреции кальция с мочой.

Материалы и методы

Материалы и методы. Обследовано 93 ребёнка в возрасте 3–14 лет с ИГ. На первом этапе лечения детям с ИГ назначали низконатриевую и высококалиевую диету с повышенным потреблением жидкости в течение 3 мес без медикаментозной терапии. На втором этапе детям с сохраняющейся ИГ к диете добавляли лечение препаратом детского рыбьего жира в суточной дозе 1000–1500 мг в зависимости от возраста в течение 3 мес. Детям с сохраняющейся ИГ на третьем этапе терапии назначали гидрохлортиазид в дозе 1 мг/кг на протяжении 3 мес. После каждого этапа лечения проводили анализ проявлений ИГ в динамике и контроль экскреции кальция с мочой по кальций/креатининовому коэффициенту (ККК).

Результаты

Результаты. Оценка клинико-лабораторных проявлений ИГ после первого этапа лечения показала эффективность диеты у 59,1% пациентов. Среди 38 пациентов, включённых во второй этап терапии, нормализация экскреции кальция с мочой была отмечена в 52,6% наблюдений. Третий этап терапии проводился 18 пациентам (19% от первоначальной группы детей с ИГ). Нормализация ККК была достигнута у 16 (88,9%) детей.

Заключение

Заключение. Для коррекции ИГ у детей следует рекомендовать поэтапный подход, начиная с рекомендаций по питьевому режиму и питанию, затем назначая препараты рыбьего жира и прибегая к применению тиазидных диуретиков при отсутствии эффекта от первых этапов лечения.

Участие авторов

Участие авторов: Михеева Н.М., Зверев Я.Ф., Строзенко Л.А. — концепция и дизайн исследования; Михеева Н.М., Зверев Я.Ф. — сбор и обработка материала; Строзенко Л.А. — статистическая обработка; Михеева Н.М., Зверев Я.Ф. — написание текста; Зверев Я.Ф., Строзенко Л.А., Лобанов Ю.Ф. — редактирование. Все соавторы — утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи.

Протокол исследования был одобрен локальным этическим комитетом. От родителей пациентов получено письменное добровольное информированное согласие на участие в исследовании.

Финансирование

Финансирование. Исследование не имело финансовой поддержки.

Конфликт интересов

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

Поступила 29

Поступила 29.03.2021Принята к печати 22.04.2021Опубликована 14.05.2021

Introduction

Introduction. Idiopathic hypercalciuria (IH) is one of the most common metabolic disorders in children and is one of the leading causes of calcium urolithiasis and osteoporosis. The strategic goal of treatment for IH is to reduce urinary calcium excretion.

Materials and methods

Materials and methods. The study included 93 IH children aged from 3 to 14 years with identified IH. At the first stage, IH children have been prescribed low sodium and high potassium diet with increased fluid intake for three months without additional drug therapy. For children with persistent IH at the second stage, the diet was supplemented daily with 1000–1500 mg of fish oil for children for 3 months. At the third stage of treatment, persistent IH patients were prescribed hydrochlorothiazide at a dose of 1 mg/kg for 3 months. After each stage of treatment, we analyzed IH’s manifestations in dynamics and monitored urinary calcium excretion by calcium/creatinine ratio (CCR).

Results

Results. Evaluation of clinical and laboratory manifestations of IH after the first stage of treatment showed the effectiveness of the diet in 59.1% of patients. Among 38 patients included in the second stage of therapy, the normalization of urinary calcium excretion was noted in 52.6% of cases. The third stage of therapy was performed in 18 patients (19% of the initial group of IH children patients). The normalization of CCR was achieved in 16 (88.9%) children.

Conclusion

Conclusion. For the correction of IH in children, a step-by-step approach should be recommended, starting with recommendations on the drinking regimen and nutrition, then prescribing fish oil preparations and resorting to thiazide diuretics in the lack of an effect from the first stages of treatment.

Contribution

Contribution. Mikheeva N.M., Zverev Ya.F., Strozenko L.A. — research concept and design of the study;Mikheeva N.M., Zverev Ya.F. — collection and processing of material;Strozenko L.A. — statistical processing; Mikheeva N.M., Zverev Ya.F. — text writing; Zverev Ya.F., Strozenko L.A., Lobanov Yu.F. — editing.All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

The study protocol was approved by the local ethics committee. The patients’ parents gave written voluntary informed consent to participate in the study.

Acknowledgment

Acknowledgment. The study had no sponsorship.

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.