Diagnosis of reflux nephropathy

Biochemical analysis of urine reveals oxaluria, calciuria, uraturia in 80% of cases, glucosuria in 34%, decreased levels of ammonia and titratable acids in 90%, which indicates dysfunction of the tubules and metabolic disorders.

In the ultrasound image of the kidneys in the presence of reflux nephropathy, a decrease in the size of the kidneys, a lag in their growth dynamics, uneven lumpy contours, poorly differentiated, unevenly expressed parenchyma with hyperechoic areas, and an expansion of the renal pelvic echo signal are noted.

When performing Doppler ultrasonography of the kidneys, a decrease in blood flow can be observed against the background of a decrease in the resistance index.

According to the ultrasound and Doppler examination, three groups of children are distinguished. The first group includes children with ultrasound signs of Rn. lag in kidney size, decreased renal blood flow, decrease or increase in the vascular resistance index. The second group includes children with a "small kidney", when, against the background of lag in kidney size, no change in renal hemodynamics is observed (it is possible that in these cases vesicoureteral reflux develops into a hypoplastic kidney). The third group includes children at the stage of "prereflux nephropathy", when, against the background of a slight lag in kidney size, a change in the resistance of the renal vessels is observed.

Intravenous urography can show a decrease in the parenchyma index to 0.48-0.54 with a norm of 0.58, deformation of the contour of the renal pelvis-calyceal system, its hyporamification, coarsening of the fornices, hypotension and deformation of the ureters, and slow excretion of the radiocontrast agent.

Renal scintiography data show a decrease in the size of the kidney, a decrease and slowdown in the accumulation of the radiopharmaceutical, its slow monotonous distribution, a delay in the projection of the middle segment, and a moderate or severe degree of impairment of the accumulative and excretory function of the kidneys.

Based on the severity of nephrosclerosis during intravenous urography and radioisotope scintiography, 4 degrees of reflux nephropathy are distinguished:

• moderate with one or two fields of sclerosis;
• severe with damage to more than two cups with areas of normal parenchyma;
• generalized deformity of the cups with variable reduction of parenchyma;
• shriveled kidney.

Mitochondrial analysis is becoming increasingly widespread in modern pediatric nephrology. There are clinical signs of mitochondrial insufficiency: delayed physical development, decreased tolerance to physical and psychological stress, minor developmental abnormalities, frequent colds, a large number of concomitant somatic diseases, aggravated allergy history, metabolic disorders, muscle hypotonia, myopia, ophthalmoplegia, convulsive syndrome. In the presence of these clinical signs, it is advisable to analyze the mitochondrial state. The most reliable is a histological study of muscle fibers and detection of the phenomenon of "torn red muscle fibers". However, a screening method has been developed that allows determining the presence of mitochondrial dysfunctions by blood analysis. The method is based on R.P. Nartsissov's theory of the relationship between the state of mitochondria in lymphocytes and the entire organism as a whole. Using the cytochemical analysis method, qualitative (optical density, size, degree of cluster formation) and quantitative characteristics of mitochondrial enzymes (succinate dehydrogenase, glycerophosphate dehydrogenase, glutamate dehydrogenase, lactate dehydrogenase) are determined. These characteristics can be used to judge the degree of compensation of intracellular energy processes.

These data clearly correlate with the stages of ROP development according to ultrasound and Doppler data. Thus, in nephrosclerosis, a marked decrease in the activity of mitochondrial enzymes and a change in all their qualitative characteristics is revealed; in "small kidney" - a moderate decrease in the activity of mitochondrial enzymes; in "prereflux nephropathy" - a slight decrease in enzyme activity against the background of a compensatory increase in clast formation.

Thus, taking into account the low symptomatology of the non-infected stage of vesicoureteral reflux of reflux nephropathy, an algorithm for examining children with suspected of these conditions has been developed.

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