Drug correction of endothelial dysfunction in children with chronic pyelonephritis
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.
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