Effectiveness of nephroprotective therapy in children with chronic pyelonephritis in the follow-up observation
Keywords:children, chronic pyelonephritis, renal hemodynamics, daily blood pressure monitoring, hypertension, nephroprotection, angiotensin-converting enzyme inhibitors
Background. Timely correction of hemodynamic disorders in children with chronic pyelonephritis is a component of nephroprotection. Аngiotensin-converting enzyme inhibitors (ACEI) are the basis of renoprotective therapy. The purpose of the study was to evaluate the efficiency of nephroprotective therapy in children with chronic pyelonephritis during follow-up observation. Materials and methods. Ninety three children aged 4 to 17 years with chronic pyelonephritis (disease duration from 3 to 7 years) were examined. The control group consisted of 30 healthy children of the same age. Daily blood pressure monitoring and Doppler sonography of the renal blood vessels were performed. Furthermore, ACEI enalapril was administered in the maximum allowed and tolerated doses, for 2–3 years. Results. During the follow-up examination, there was a significant reduction in the incidence and severity of hypertension syndrome according to the data of daily blood pressure monitoring on the background of ACEI administration (vs baseline from 28.5 to 7 % in general; p < 0.05). Moreover, there were reliable changes of renal hemodynamic parameters at the level of segmental and stem arteries in the form of reduced peripheral resistance parameters and rate indices that indicated the processes of vessel remodeling in the kidneys. In the prospective analysis, there has been determined an improvement of intrarenal hemodynamics on the background of ACEI administration. Conclusions. Chronic pyelonephritis in children is associated with gradual disorders of the central and peripheral blood flow, ischemic and hemodynamic changes in parenchyma that require proper correction. ACEI enalapril is a drug of choice. Moreover, enalapril inclusion in the treatment leads to positive dynamics in majority of patients (75.2 %).
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