Drug correction of endothelial dysfunction in children with chronic pyelonephritis

L.I. Vakulenko


Background. Timely and sufficient drug correction of endothelial dysfunction in children with chronic pyelonephritis determines the effectiveness of preventing its progression, improves cardiovascular and renal prognosis. The purpose of the study was to examine the effectiveness of various regimens of drug correction for endothelial dysfunction in children with chronic pyelonephritis. Materials and methods. Thirty seven children aged 11–17 years with non-acute chronic pyelonephritis were examined. Thus, the first group of 17 patients received baseline therapy of chronic pyelonephritis, including angiotensin-converting enzyme (ACE) inhibitor enalapril; the second group of 20 patients in addition to standard therapy with ACE inhibitor received the intravenous infusion of L-arginine and then took its oral solution. Results. Patients in the first group had a tendency to increase in the diameter of the brachial artery at rest (2.4 ± 0.1 mm), in the phase of maximal vasodilation (2.9 ± 0.1 mm), without a significant difference from the state before the treatment. An increment of the brachial artery diameter after the treatment had significantly increased in comparison with the level before the treatment (12.00 ± 0.39 mm). Moreover, the reduction of linear blood flow velocity at rest was not statistically significant (146.90 ± 1.13 cm/s). In the second group, there was a significant increase in the brachial artery diameter at rest (2.80 ± 0.13 mm) and in the phase of maximal vasodilation (3.40 ± 0.14 mm) as compared to the baseline. Meanwhile, an increase in the brachial artery diameter after treatment was not significantly different from the physiological norm (17.20 ± 0.41 mm). The linear blood flow velocity at rest was close to the value in the control group, with no significant difference (141.20 ± 1.16 cm/s). In general, the manifestations of endothelial dysfunction decreased by 26.9 and 47.8 % in the first and second groups, respectively. Conclusions. In patients with chronic pyelonephritis without manifestations of chronic renal failure, monotherapy with ACE inhibitor enalapril is effective. In patients with manifestations of chronic renal failure degree I–II, it is advisable to use combined therapy with L-arginine.


endothelial dysfunction; chronic pyelonephritis; children; angiotensin-converting enzyme inhibitors; L-arginine


Abaturov AE, Volosovets AP, Borisova TP. The antioxidant system of the respiratory tract. the intracellular antioxidant protection in the respiratory tract (part 4). Zdorov'ye rebenka. 2016;(76):94-100. doi: 10.22141/2224-0551.8.76.2016.90832. (in Russian).

Babushkina AV. L-arginine in terms of evidence-based medicine. Ukrainian medical journal. 2009;(6)74:43-48. (in Russian).

Berezhniy VV, Romankevych IV. The study of the functional state of the endothelium via a complex of markers with reactive hyperemia. Sovremennaya pediatriya. 2016;(74):112-116. (in Ukrainian).

Volosovets AP, Kryvopustov SP, Moroz TS, Dosenko VJe. Endothelial dysfunction as a systemic pathology in children. Zdorov’ja Ukrai'ny. Pediatrija. 2011;(17):48-49. (in Ukrainian).

Dzugkoev SG, Mozhayeva IV, Takoeva EA, Dzugkoeva FS, Marghieva OI. Mechanisms of development of endothelial dysfunction and prospects of correction. Fundamental research. 2014;(4-1):198-204. (in Russian).

Zharinova VYu. Endothelial dysfunction as a multidisciplinary problem. Krovoobig i gomeostaz. 2015;(1-2):9-14. (in Russian).

Zahorodnyi MІ, Svintsitskyi ІА. Endothelial dysfunction in hypertension: current views on the causes and pathogenetic mechanisms, diagnosis and therapeutic strategies. Praktykujuchyj likar. 2013;(6):17-27. (in Ukrainian).

Kvashnina LV, Ignatova TB. Prophylaxis of disturbances of endothelial function within the children during transition from health to a syndrome of vegetative dysfunction. Sovremennaya pediatriya. 2016;(77):16-24. doi: 10.15574/SP.2016.77.16. (in Ukrainian).

Kuryata OV, Frolova JeO. Application of the infusion form of L-arginine in the complex treatment of patients with chronic kidney disease II and III degrees in combination with ischemic heart disease. Klinichni ta eksperymental'ni doslidzhennja. 2012;(3):235-238. (in Ukrainian).

Oksenyuk OS, Kalmykova YuA, Smirnova OB, Pasechnik DG. The role of oxidative stress in the development of chronic kidney disease and methods for its evaluation. Zurnal fundamentalʹnoj mediciny i biologii. 2016;(1):15-24. (in Russian).

Pertseva NO. Dynamics of endothelial dysfunction, nephropathic and dyslipidemic disorders in patients with insufficient glycemic compensation of type 2 diabetes mellitus during 1 year of application of angiotensin II receptor antagonists for hypertension correction. Medicni perspektivi. 2014;19(4):89-97. (in Ukrainian).

Protopopov AA, Nesterenko OV, Borodulin VB, Shevchenko OV. Hyperhomocysteinemia as a predictor of chronic pyelonephritis progression. Klinicheskaya nefrologiya. 2013;(6):33-36. (in Russian).

Topchii ІІ, Kiriyenko AN, Bondar TN. Lesovaja AV, Schenyavskaya EN. Lipid peroxidation and nitric oxide metabolism at patients with chronic kidney disease in the dynamics of treatment. Ukrainian Journal of Nephrology and Dialysis. 2012;(1):3-8. (in Russian).

Chernyavskaya TK. Modern approaches to the diagnosis and treatment of endothelial dysfunction in patients with arterial hypertension. Lechebnoe delo. 2013;(2):118-130. (in Russian).

Aldámiz-Echevarría L, Andrade F. Asymmetric dimethylarginine, endothelial dysfunction and renal diseas. Int J Mol Sci. 2012;13(9):11288-311. doi: 10.3390/ijms130911288.

Chen J, Hamm LL, Mohler ER, et al. Interrelationship of Multiple Endothelial Dysfunction Biomarkers with Chronic Kidney Diseeas. PLoS One. 2015 Jul 1;10(7):e0132047. doi: 10.1371/journal.pone.0132047.

Drożdż D, Łątka M, Drożdż T, Sztefko K, Kwinta P. Thrombomodulin as a New Marker of Endothelial Dysfunction in Chronic Kidney Disease in Children. Oxid Med Cell Longev. 2018 Feb 28;2018:1619293. doi: 10.1155/2018/1619293.

El-Sadek AE, Behery EG, Azab AA, et al. Arginine dimethylation products in pediatric patients with chronic kidney disease. Ann Med Surg (Lond). 2016 Jun 2;9:22-7. doi: 10.1016/j.amsu.2016.05.017.

Fliser D, Wiecek A, Suleymanlar G, et al. The dysfunctional endothelium in CKD and in cardiovascular disease: mapping the origin(s) of cardiovascular problems in CKD and of kidney disease in cardiovascular conditions for a research agenda.  Kidney Int Suppl (2011). 2011 Jun;1(1):6-9.

Goligorsky MS. Pathogenesis of endothelial cell dysfunction in chronic kidney disease: a retrospective and what the future may hold. Kidney Res Clin Pract. 2015 Jun;34(2):76-82. doi: 10.1016/j.krcp.2015.05.003.

Higashi Y. Assessment of endothelial function. History, methodological aspects, and clinical perspectives. Int Heart J. 2015;56(2):125-34. doi: 10.1536/ihj.14-385.

Martens CR, Kirkman DL, Edwards DG. The Vascular Endothelium in Chronic Kidney Disease: A Novel Target for Aerobic Exercise. Exerc Sport Sci Rev. 2016 Jan;44(1):12-9. doi: 10.1249/JES.0000000000000065.

Popolo A, Adesso S, Pinto A, Autore G, Marzocco S. L-Arginine and its metabolites in kidney and cardiovascular disease. Amino Acids. 2014 Oct;46(10):2271-86. doi: 10.1007/s00726-014-1825-9.

Reddy YS, Kiranmayi VS, Bitla AR, Krishna GS, Rao PV, Sivakumar V. Nitric oxide status in patients with chronic kidney disease. Indian J Nephrol. 2015 Sep-Oct;25(5):287-91. doi: 10.4103/0971-4065.147376.

Si D, Ni L, Wang Y, Liu J, Yang J, Yang P. A new method for the assessment of endothelial function with peripheral arterial volume. BMC Cardiovasc Disord. 2018 May 4;18(1):81. doi: 10.1186/s12872-018-0821-5.

Shahin Y, Khan JA, Samuel N, Chetter I. Angiotensin converting enzyme inhibitors effect on endothelial dysfunction: a meta-analysis of randomised controlled trials. Atherosclerosis. 2011; 216(1):7-16. doi: 10.1016/j.atherosclerosis.2011.02.044.

Tomasoni L, Sitia S, Borghi C, et al. Effects of treatment strategy on endothelial function. Autoimmun Rev. 2010 Oct;9(12):840-4. doi: 10.1016/j.autrev.2010.07.017.

Tian J, Niu L, An X. Cardiovascular risks in chronic kidney disease pediatric patients. Exp Ther Med. 2017 Nov;14(5):4615-4619. doi: 10.3892/etm.2017.5117.

Turner JM, Bauer C, Abramowitz MK, Melamed ML, Hostetter TH. Treatment of chronic kidney disease. Kidney Int. 2012 Feb;81(4):351-62. doi: 10.1038/ki.2011.380.

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