Exchange or dysmetabolic nephropathy in children and adults: causes of mineral metabolism disorders, types of pathology and effective treatment options. Dysmetabolic nephropathy in children

- Structural and functional changes in the kidneys, developing against the background of metabolic disorders, accompanied by crystalluria. Dysmetabolic nephropathy in children can be clinically manifested by allergies and skin itching, edema, back pain, hypotension, and turbid urine. In children, dysmetabolic nephropathy is usually first diagnosed when examining a general urine test; advanced diagnostics includes ultrasound of the kidneys, biochemical analysis urine. Treatment of dysmetabolic nephropathy in children is carried out taking into account its type and includes diet, drug correction of metabolic disorders and physical and chemical properties urine, phytotherapy.

General information

Dysmetabolic nephropathy in children is a group of metabolic disorders accompanied by increased urinary excretion of various salts (oxalates, urates, phosphates) and, as a result, damage to the renal structures. In pediatric urology, dysmetabolic nephropathies account for about 27-64% of all diseases of the urinary system in children; in the practice of pediatrics, signs of metabolic disorders in the urine are found in almost every third child. Children with dysmetabolic nephropathies belong to the group high risk on the development of interstitial nephritis, pyelonephritis, urolithiasis.

Classification of dysmetabolic nephropathy in children

Depending on the composition of the salts, dysmetabolic nephropathy in children is distinguished, occurring with:

• oxalate-calcium crystalluria (85-90%)
• phosphate crystalluria (3–10%)
• urate crystalluria (5%)
• cystine crystalluria (3%)
• mixed (oxalate / phosphate-urate) crystalluria

Taking into account the causes of occurrence, primary and secondary dysmetabolic nephropathies in children are distinguished. Primary nephropathies are hereditary diseases that have a progressive course and early lead to nephrolitosis and chronic renal failure. The group of secondary nephropathies in children includes various dysmetabolic disorders that occur with crystalluria and develop against the background of damage to other organs.

Causes of dysmetabolic nephropathy in children

Dysmetabolic nephropathy in children is a polyetiological syndrome that occurs with the participation of many factors. Common causes may be poisoning and intoxication, heavy physical exertion, prolonged use medicinal substances, monodeficient diets. The frequent development of dysmetabolic nephropathy was noted in children born from a pregnancy that proceeded with late toxicosis and fetal hypoxia, as well as children with neuro-arthritic diathesis. Primary nephropathy can be caused by metabolic disorders in the child's relatives or by accumulated mutations that cause an imbalance in the regulatory cellular mechanisms in the child.

Except common causes, in the occurrence of one or another type of dysmetabolic nephropathy in children, the impact of particular factors matters.

Oxalate dysmetabolic nephropathy in children (oxaluria) is pathogenetically associated with impaired metabolism of calcium and oxalic acid salts (oxalates). A certain role in its development is played by a deficiency of vitamins A, B6, E, magnesium, potassium; an overdose of vitamin D in the treatment of rickets; increased intake of oxalates from food. Oxalate dysmetabolic nephropathy is common in children with Crohn's disease, enteritis, colitis, chronic pancreatitis, biliary dyskinesia, diabetes mellitus, pyelonephritis.

Urate dysmetabolic nephropathy in children is characterized by excretion in the urine and deposition in the kidneys of urate - sodium salt uric acid. Primary (hereditary) uraturia is most common in children with Lesch-Nyhan syndrome. Secondary nephropathies accompany the course of erythremia, hemolytic anemia in children, multiple myeloma, pyelonephritis. Perhaps the development of urate dysmetabolic nephropathy in children receiving treatment with cytostatics, thiazide diuretics, salicylates, cyclosporine A, etc.

Phosphaturia may be caused by chronic urinary infection, primary and secondary hyperparathyroidism, diseases of the central nervous system. Cystinuria develops with a systemic disorder of cystine metabolism - cystinosis, characterized by intracellular and extracellular accumulation of cystine crystals in the interstitium and tubules of the kidneys, spleen, liver, lymph nodes, blood cells, bone marrow, nervous and muscular tissue. Secondary cystine dysmetabolic nephropathy in children is usually associated with pyelonephritis or tubular interstitial nephritis.

Symptoms of dismetabolic nephropathy in children

Signs of oxalate dysmetabolic nephropathy in a child can manifest already in the neonatal period, but in most cases the disease is latent for a long time. In the pedigree of children with dysmetabolic nephropathy, arthropathies, gout, spondylosis, urolithiasis, cholelithiasis, diabetes mellitus are noted.

Most often, crystalluria is detected in children aged 5-7 years by chance, in the study of a general urine test. Attentive parents may notice that the child's urine looks cloudy, with sediment, often forms a hard-to-wash coating on the walls of the pot.

With dysmetabolic nephropathy in children, there is a tendency to allergic skin reactions, vegetative-vascular dystonia, hypotension, headaches, arthralgia, obesity. Children may experience increased fatigue, stabbing pains in the lower back, frequent and painful urination, enuresis, redness and itching in the vulva, muscular hypotension, subfebrile condition, dyspepsia, bloating.

Exacerbation and progression of the disease is noted in the puberty period due to hormonal changes. Dysmetabolic nephropathy in children is a risk factor for the formation of kidney and bladder stones, the development of chronic pyelonephritis and chronic kidney failure.

Diagnosis of dysmetabolic nephropathy in children

Urinalysis reveals crystalluria, proteinuria, hematuria, abacterial leukocyturia, cylindruria. In a biochemical study of urine, an increased concentration of certain salts (oxalates, phosphates, urates, etc.) is determined. In the complex of laboratory diagnostics, functional tests urine according to Zimnitsky, Addis-Kakovsky, Nechiporenko, determination of urine pH. When layering secondary bacterial infection necessary bacteriological examination urine for microflora.

Ultrasound of the kidneys and bladder in children with dysmetabolic nephropathy may show crystalline inclusions indicating the presence of sand or calculi. Dysmetabolic nephropathy in children should be distinguished from transient crystalluria associated with SARS, abundant reception some products.

Treatment of dysmetabolic nephropathy in children

The main principles of treatment of dysmetabolic nephropathy in children include: rational diet, normalization metabolic processes, elimination of conditions for crystal formation and increased removal of salts.

With oxalate dysmetabolic nephropathy in children, meat broths, spinach, sorrel, cranberries, carrots, beets, cocoa, chocolate are excluded from the diet; preference is given to the potato-cabbage diet. Drug therapy is carried out with membranotropic drugs (vitamin B6, A,yl) and antioxidants (vitamin E).

The diet for urate dysmetabolic nephropathy in children should not contain foods rich in purine bases (kidneys, liver, meat broths, beans, peas, cocoa, etc.). The basis of the diet is dairy and vegetable products. To reduce the synthesis of uric acid, allopurinol, nicotinamide, herbal teas, etc. are prescribed.

With phosphate dysmetabolic nephropathy in children, it is recommended to limit foods rich in phosphorus (cheeses, liver, legumes, chicken, chocolate). It is necessary to acidify urine through the use of mineral waters and drugs (ascorbic acid, tincture of madder root tincture).

Treatment of cystinosis includes a diet with the exclusion from the child's diet of foods rich in sulfur-containing amino acids and methionine (fish, cottage cheese, eggs, etc.). Important obligatory alkalization of urine with a citrate mixture, sodium bicarbonate solution, alkaline mineral waters. In order to prevent the crystallization of cystine, penicillamine is prescribed.

With any type of dysmetabolic nephropathy in children, sufficient water load is important, which helps to reduce the concentration of salts in the urine, the child's compliance with the regimen of forced urination (every 1.5-2 hours). As an alternative correction of metabolic processes, homeopathic treatment can be carried out under the supervision of a children's homeopath.

Forecast and prevention of dysmetabolic nephropathy in children

Subject to diet and drug therapy, the prognosis of dysmetabolic nephropathy in children is favorable: there is a persistent normalization of biochemical parameters in the urine. In case of non-compliance with the general and therapeutic regimen, the natural outcome of nephropathy is pyelonephritis and urolithiasis. With cystinosis, patients, as a rule, need a kidney transplant, but the prolapse of cystine crystals eventually develops in the graft, leading to the death of children aged 15–19 years.

Dispensary observation of children with dysmetabolic nephropathy is carried out by a pediatrician and a pediatric nephrologist. Prevention of dysmetabolic nephropathy in children requires compliance with the drinking regimen by children, exclusion of predisposing factors, treatment of comorbidities, and examination of children at risk.

Many health problems in adults begin in childhood. It is during this period that the main mechanisms of vital activity are formed. Metabolism is largely hereditary. The prerequisites for the formation of kidney stones are laid from an early age. Urolithiasis is a consequence of dysmetabolic nephropathy developing in childhood.

The formation of salts in the kidneys

The kidneys are the body's main station for cleaning the blood of harmful substances. By nature, this process is thought out at all stages. The kidneys of the child begin their important activity long before birth. Already in the period prenatal development these organs purify the blood from metabolic products.

All the blood in the child's body passes several times during the day through a special filter located in the renal glomeruli. In the second stage, the filtered liquid part of the blood passes through a system of special tubes - tubules. It is here that the separation occurs: everything useful is sent back to the bloodstream, the unnecessary gets into the composition of the urine. Thus, most of the metabolic products of protein, muscle tissue, and excess fluid are removed from the body. This process is strictly controlled endocrine glands and hormones.

Dysmetabolic nephropathy is a metabolic disease in the body, leading to increased excretion of salts in the urine.

Classification

Dysmetabolic nephropathy is divided into several main forms:

• urate nephropathy is associated with a violation of the metabolism of uric acid, which is the final stage in the transformation of most proteins in the human body;
• oxalate nephropathy is a metabolic disorder of oxalic acid. The latter is formed at one of the stages of the breakdown of carbohydrates;
• phosphate nephropathy - excessive excretion in the urine of salts of phosphoric acid, the main component bone tissue;
• cystine nephropathy is associated with a metabolic disorder of the amino acid cystine, an integral component of most proteins in the human body;
• mixed nephropathy is an excessive excretion of all types of salts in the urine.

Types of salts in urine - photo gallery

Uric acid is a metabolic product of proteins Oxalates are a metabolic product of oxalic acid Phosphoric acid is found in large quantities in bone tissue Cystine - one of the amino acids needed by the body

Causes and development factors

Dysmetabolic nephropathy is a metabolic disease. Every second in the body of a child, some chemical compounds are converted into others necessary for this moment. Squirrels - construction material most tissues and organs. Their constituent amino acid components come from food, after which they are combined in various combinations. Glucose is the main source of energy in human body. At one stage, oxalic acid is formed. Phosphoric acid is also found in a large amount of protein. In addition, it is one of the main components of bone tissue.

All chemical transformations occur in the body under the action of specific proteins-enzymes. Their structure and activity are embedded in the genes of the child received from the parents. Any breakdown of enzymes leads to the fact that metabolic processes begin to occur according to a vicious pattern. As a result, substances accumulate, the excess of which is excreted by the kidneys with urine.

Relatives of a child suffering from a certain kind dysmetabolic nephropathy, various diseases are noted.

The very fact increased excretion salts with urine is not a sentence. There are two things that are most dangerous. Excess salt in the urine often leads to the formation of large crystals and stones in the tubules of the kidneys, pelvis and urinary tract. They can interfere with the flow of urine. Salt crystals damage tissue renal tubules, as a result of which foci of inflammation appear and a specific disease develops - interstitial nephritis.

Diseases traced in the pedigree of a child with dysmetabolic nephropathy - table

Risk factors

The development of dysmetabolic nephropathy contributes to a number of related problems in the child's body.

Predisposing factors for the development of dysmetabolic nephropathy in a child - table

Factors in the development of dysmetabolic nephropathy - photo gallery

Infection of the kidneys contributes to the excretion of salts Violation of the outflow of urine negatively affects the functioning of the kidneys Carious teeth are the source of infection in the body Parathyroid glands regulate metabolism in bone tissue Changes in metabolism also affect the composition of bile

Symptoms and signs of dysmetabolic nephropathies

Symptoms of dysmetabolic nephropathy in a child are often non-specific and do not always indicate a serious problem. In addition, negative signs can be scattered throughout the body, which creates additional difficulties.

Symptoms of dysmetabolic nephropathy - table

Symptoms of dysmetabolic nephropathy - photo gallery

Abdominal pain is a common symptom of nephropathy A large amount of oxalates in the blood leads to their deposition in the lungs Rickets may be a consequence of nephropathy Salt deposition in the joint is a consequence of nephropathy Fever is a sign of inflammation in the kidneys due to nephropathy

Diagnostic methods

Diagnosis of dysmetabolic nephropathy is carried out under the supervision of a specialist and includes a number of activities:

• a general examination reveals changes in skin color, the presence of edema and impaired joint mobility;
• a complete blood count is used to assess the number of white cells, leukocytes, red erythrocytes, hemoglobin oxygen carrier protein;
• biochemical analysis of blood is allowed to evaluate functional ability kidneys by the level of urea and creatinine. In addition, this laboratory method will help to identify an increase in the amount of uric, oxalic, phosphate, cystic acids;
• a blood test for the level of hormones and calcium reveals a violation of the activity of the thyroid and parathyroid glands;
• a general urine test is used to detect salts in the sediment and determine their type (urates, oxalates, phosphates), as well as leukocytes and erythrocytes;
• the Nechiporenko test is used to accurately assess the number of leukocytes and erythrocytes in the urine;
• ultrasonography kidney allows you to assess the size of organs and the adequacy of blood circulation. In addition, the method helps to identify structural anomalies, cysts, stones and tumors.

Diagnosis of dysmetabolic nephropathy - photo gallery

Blood analysis - mandatory step diagnosis of nephropathy A large number of leukocytes in the urine is a sign of an inflammatory process Parathyroid hormone regulates calcium metabolism in the body Adequate blood flow - important factor normal operation kidney

Dr. Komarovsky about urine analysis - video

Differential Diagnosis

Differential diagnosis of dysmetabolic nephropathy occurs with the following diseases:

Treatment methods for dysmetabolic nephropathy

Dysmetabolic nephropathy in a child requires long-term treatment under the supervision of a specialist. In most cases, it can be done on an outpatient basis. The principles of therapy are similar for children of all ages.

Diet

Diet is the fundamental treatment for dysmetabolic nephropathy. Compliance with the doctor's recommendations for correcting the child's diet in some cases can eliminate the need to prescribe medications.

The diet of children with various types of dysmetabolic nephropathy - table

Medical treatment

For the treatment of each type of dysmetabolic nephropathy in a child, various drugs are used. The main goals are to reduce the release of salts, to reduce the likelihood of the formation of crystals and stones.

Drugs for the treatment of nephropathy - table

Preparations for the treatment of nephropathy in children - photo gallery

Urodan is used to treat urate nephropathy Allopurinol normalizes uric acid metabolism Xidifon is used for nephropathies Dimephosphone has a beneficial effect on kidney tissue Retinol contains vitamin A Tocopherol - a preparation of vitamin E Potassium orotate reduces the excretion of salts in the urine

Physiotherapy

Physiotherapy is used for concomitant inflammation in the kidneys - pyelonephritis, interstitial nephritis:

• ultrasound therapy improves blood flow in the kidneys;
• magnetotherapy helps to eliminate inflammation;
• Mud therapy enhances blood circulation in the tissues of the kidney.

Treatment with folk remedies

With the permission of the doctor, traditional medicine recipes can be used to treat dysmetabolic nephropathy in a child.

Plants used to treat dysmetabolic nephropathy - table

Plants in the treatment of nephropathy - photo gallery

Sage effectively fights microbes Lingonberry contains many useful substances Dill seeds are useful for kidney diseases
Strawberries contain a large amount of vitamins St. John's wort has an antiseptic effect

Prognosis and complications

The prognosis for the treatment of dysmetabolic nephropathy in a child, subject to all recommendations, is favorable. The long course of the disease can lead to the development of the following complications:

Prevention

Prevention of the development of dysmetabolic nephropathy in a child includes the following activities:

Dysmetabolic nephropathy in a child is a risk factor for the development of many diseases in more late age: gout, kidney stones, chronic pyelonephritis, renal failure. Treatment of pathology requires systematic adherence to the doctor's recommendations for diet correction and taking medications.

Dysmetabolic nephropathy is a kidney disease that develops as a result of a metabolic disorder. The peculiarity of this pathology lies in the fact that it is not always associated with kidney diseases, it often develops against the background of other diseases.

What is dysmetabolic nephropathy? This question is asked by every patient, having heard a similar diagnosis. Dysmetabolic nephropathy is a collective name that includes many metabolic disorders that ultimately lead to serious disorders in the functioning of the kidneys.

Dysmetabolic nephropathy in children is more often a hereditary disease. It is dangerous, as it leads to serious complications in a short period of time. In adults, nephropathy associated with impaired metabolic processes in the body occurs as a result of negative impact internal and external factors.

Depending on the content of substances in urine, nephropathy in a child and an adult can be:

• Oxalate - characterized increased concentration oxalate in urine is the most commonly diagnosed species.
• Urate - with an increased level of uric acid.
• Phosphate - in the course clinical research an increase in phosphate is found.
• Cystine - develops as a result of a violation of methionine metabolism, which leads to an increase in cystine.
• Mixed - in the urine, the level of oxalates, urates, phosphates and cystine simultaneously increases.

Causes of metabolic disorders

The main cause of nephropathy is a violation of metabolic processes in the body due to congenital and acquired pathologies of the urinary organs. Urolithiasis, inflammatory processes in the genitourinary organs, an abnormal structure and location of the organs of the urinary system, due to which there is a reverse reflux of urine and its stagnation, lead to metabolic disorders.

Failures in the processes of synthesis, transportation and assimilation of phosphates, calcium, uric acid, oxalic acid and cystine lead to metabolic disorders. Also, dysmetabolic nephropathy in children can be the result of hormonal disruptions, disruption endocrine system or organ diseases digestive tract.

Long-term treatment has a negative effect on the metabolism in adults and children. hormonal drugs and some other types of drugs, radiation and radiation exposure, poisoning with toxic compounds.

Symptoms

Dysmetabolic nephropathy, regardless of the type, is accompanied by a violation of the cleansing function, urolithiasis and pyelonephritis. Kidney diseases are characterized by urination disorder, which is accompanied by pain, cutting and burning in the urinary canal, a decrease in urine volume.

With kidney dysfunction, the work of the cardiovascular system is disrupted, which is manifested by an increase / decrease blood pressure, tachycardia. On the part of the digestive tract, there is a deterioration in appetite, flatulence, constipation.

Due to the deterioration of urine output, swelling and thirst increase. The patient complains of regular headaches and excessive sweating. As a result of impaired metabolism, a child may develop a tendency to allergies, overweight. Exacerbation of symptoms is transitional age, which is associated with hormonal changes in the child's body.

Oxalate nephropathy

Oxaluria is the most common type of nephropathy that develops as a result of metabolic disorders. It is divided into 2 subspecies: oxalate-calcium nephropathy and oxalaturia. The first develops in violation of the process of transportation and absorption of calcium, phosphorus and oxalic acid. Oxalaturia is a type of nephropathy that occurs when there is a violation of the metabolism of oxalic acid in the body. This type Nephropathy can develop at any age, even in newborns.

Causes and symptoms

In more than half of the cases, oxalate nephropathy is a congenital pathology and develops with a hereditary deficiency of certain enzymes, which negatively affects the metabolism. Contribute to the increase in the amount of oxalates inflammatory pathologies digestive tract, ulcers, Crohn's disease.

Another reason is malnutrition with a high content of oxalic and ascorbic acid and insufficient intake of vitamin B6. Also, a lack of fluid in the body leads to an increase in the level of oxalic acid.

It is extremely difficult to suspect the development of the disease, since oxalaturia rarely has bad influence on the state of health. It is discovered incidentally on the results of a routine urinalysis. With oxalaturia in urine, the content of oxalates, the level of protein, leukocytes and erythrocytes increase. There is also an increase in the density of urine.

Diagnosis and treatment

If oxalate nephropathy is suspected, the child must pass daily urine to determine the concentration of salts. important place in the diagnosis, ultrasound of the organs of the urinary system plays, which helps to determine the location, size and properties of oxalates.

Based on the obtained diagnostic data, oxalate dysmetabolic nephropathy in children is treated with dietary changes and medications. The diet will help reduce the burden on the kidneys and reduce the intake of oxalic and ascorbic acids in the body along with food. All meat and fish products and their dishes. You should also exclude greens, sour berries and fruits, beets, carrots and products containing cocoa. The diet should include dried fruits, pears, apples, watermelons, melons, potatoes and cabbage. It is important to follow the drinking regimen recommended by the doctor - water contributes to leaching excess salts from the body.

During treatment, it is important to ensure sufficient intake of vitamins B, A, E and magnesium, which can be obtained from food or drugs.

Sufficient intake of B vitamins helps to improve the metabolism of fats and antioxidants. Vitamin A normalizes the process of splitting and assimilation of protein and sugar. Vitamin E improves the relationship between protein and sugars in cells. To reduce the concentration of oxalates, it is recommended to take magnesium oxide.

Urate nephropathy

Urate nephropathy in children is less common than oxalate nephropathy. This type of disease is characterized by an increase in the concentration of uric acid. The latter, settling on the walls of organs, leads to blockage and a decrease in their performance, as a result, inflammatory processes develop.

Causes and symptoms

The disease can be congenital or acquired. In the first case, the disease develops against the background genetic predisposition is more common in newborns. In the second, the causes of the development of pathology may be Rustitzky-Kahler disease, hemolytic anemia, inflammation of the kidneys, malnutrition and long-term use of hormonal and diuretic drugs.

Urate nephropathy in newborns is latent for a long time. The first symptoms occur with a significant accumulation of salts in the child's body. The child becomes capricious and whiny, appears skin rash and itching, possible attacks of suffocation. With an excess of urates in the body, urine becomes dark red.

Diagnosis and treatment

To put accurate diagnosis, it is necessary to take a blood test for the level of uric acid and acidity. After confirming urate-derived nephropathy, the doctor recommends diet and medication.

A diet with a complete rejection of purine-rich foods (veal, pork, offal, products containing cocoa, fatty fish, legumes and nuts). Sweets are also subject to the restriction. bakery products, fried and smoked dishes. Add dairy products to your diet lean varieties meat and fish (available in morning hours), cereals, fruits and vegetables.

It is important to drink enough water, which promotes excretion salt deposits. From mineral waters, give preference to slightly alkaline ones. It is recommended to drink diuretic decoctions and teas, which include dill, lingonberry and currant leaves, knotweed, horsetail and others.

For the treatment of urate dysmetabolic nephropathy in children, a course of medications is prescribed, the action of which is aimed at normalizing the content of uric acid and improving urination. For this purpose, Milurit, Tsilorik, Fitolizin, Urolesan and others are prescribed.

With the help of drugs and nutrition, it is necessary to ensure sufficient intake in children's body vitamins of groups B and C, which help improve metabolism.

Phosphate nephropathy

This disease accounts for about 3% of cases of nephropathy. It is characterized by an increase in the concentration of phosphates in urine, which is caused by failures in the process of formation, transportation and absorption of phosphorus and calcium.

Causes and symptoms

Phosphate nephropathy develops as a result of proper nutrition with a high proportion herbal products and fish. Violation of phosphate-calcium metabolism leads to the development of rickets. The accumulation of a large amount of phosphorus and calcium in the body leads to infectious diseases of the kidneys and chronic diseases digestive organs. Some endocrine disorders, such as diabetes, also cause phosphate nephropathy.

It is difficult to determine the disease: the patient describes the symptoms of diseases that led to a violation of phosphate-calcium metabolism. The patient's urine becomes cloudy, with a white precipitate. The level of phosphate concentration is determined using a special analysis - the daily excretion of phosphates.

Treatment

An important place in the treatment is a diet with a limited intake of foods containing phosphorus in large quantities (cheeses, liver, dietary meat, legumes and cocoa products). The diet should include protein products(meat, fish), but not more than 1 g of protein per 1 kg of weight per day. Do not fall under the restriction of cereals, sour vegetables, fruits and berries. It is necessary to exclude salty, smoked, fried and sweet.

It is important to ensure adequate intake of vitamin A and ascorbic acid through food and drugs. Of the medicines, Canephron, Cystenal and Methionine are used.

cystine nephropathy

Cystinuria develops when the process of absorption of the amino acid methionine is disturbed and its excessive accumulation in the kidneys. More often the result hereditary disease- cystinosis. It can also be a consequence of inflammatory processes in the kidneys. Cystine tends to accumulate in other organs (liver, bone marrow, muscles, blood, and others). Clinical signs similar to urolithiasis and pyelonephritis.

Diagnosis and treatment

Determine the concentration of cystine in the urine using biochemical laboratory tests urine and ultrasound examination of the urinary system.

During treatment, it is necessary to exclude products with high content methionine: eggs, cottage cheese, fish and meat. Later, the gradual introduction of meat products is allowed. It is important to drink a lot clean water and alkaline mineral waters, including evening time, which will help reduce the concentration of cystine in the urine.

For the same purpose, penicillinamine is also prescribed, the dosage of which is gradually increased, and vitamins B6, E and A are also introduced with it to improve the condition of the membranes. To monitor the implementation of the recommendations and their effectiveness, it is necessary to regularly test for the content of cystine in leukocytes and cyanide nitroprusside.

When an infection is attached, a course is prescribed antibiotic therapy. With the development of complications due to the critical concentration of cystine in the kidneys, doctors resort to an organ transplant operation. But in most cases, the accumulation of cystine is also noted in the transplanted organ.

Oxalic acid salts, oxalates (calcium oxalate) and uric acid salts (urates) are deposited mainly. Depending on the qualitative composition of salts, oxalate nephropathy and urate nephropathy are divided.

Oxalate nephropathy (oxaluria)

The leading symptom of oxalate nephropathy is the excretion of oxalates in the urine (oxaluria).

Causes of oxaluria:

Hereditary oxaluria. Passed down from generation to generation from parent to child.
Secondary oxaluria. It develops against the background of any disease. In its development, heredity also plays a certain role, a tendency to stone formation. The starting point for its development can be:

• Hypovitaminosis. Deficiency of vitamins B6, A, E.
• Hypervitaminosis D. Often occurs with an overdose of vitamin D during the treatment of rickets.
• Deficiency of magnesium and potassium.
• Excess intake of calcium in the body.
• Nervous-arthritic diathesis.
• Increased absorption of oxalates in the intestine in diseases of the digestive system:
• Inflammation of the intestines (enteritis, colitis).
• Chronic pancreatitis.
• Diseases of the liver.
• Biliary dyskinesia. A constant companion of dysmetabolic nephropathies. JVP is present in all children suffering from oxaluria and uraturia.
• Operations on the intestines.
• Bacterial infection (pyelonephritis).
• Diabetes.
• Hypoxia.
• Acute infectious diseases.

Clinical manifestations

Secondary oxaluria is usually detected incidentally: oxalates are constantly found in urine tests. A one-time appearance of oxalates in the anatise does not mean anything, since they can enter the urine after eating a large amount of vegetables and fruits the day before.
Complaints are usually made by children suffering from diathesis, atopic dermatitis, biliary dyskinesia, vegetative-vascular dystonia. Typical complaints: abdominal pain and low blood pressure. Initially healthy children, as a rule, do not complain about anything.
In the analysis of urine in patients with oxaluria, in addition to oxalates, an increase in leukocytes, erythrocytes is found, there may be bacteria and protein. The result of oxaluria can be urolithiasis. In addition, the presence of dysmetabolic nephropathy in a child is fertile ground for infection in the kidney and the development of pyelonephritis.
In patients with hereditary form oxaluria disease is much more severe. From the first years of life, children are worried about periodic pain in the joints and their swelling, pain in the abdomen. This is due to the deposition of oxalate salts in the kidneys and joints. For such children, the outcome of the disease is always urolithiasis.

Treatment of oxaluria in children

Liquid. With a tendency to salt deposits in the kidneys, the child needs to “wash” them: drink a lot. During the day, the child should drink liquid at the rate of 50-60 ml per 1 kg of weight. For example, a child of 30 kg should drink about 1.5 - 1.8 liters of fluid per day. It is especially useful to give 1-2 glasses of mineral water to drink at night. From drinks are preferred:

• Dining room mineral water: Slavyanovskaya, Smirnovskaya, etc.
• Diluted cranberry and lingonberry fruit drinks.
• Dried fruits compote.
• Herb tea.
• Diluted freshly squeezed juices: apple, pumpkin-apple.

Diet with the restriction of products that promote the formation of salts of oxalic acid oxalates.

Medical treatment:

• Vitamin B6, vitamin A, vitamin E (Aevit drug), beta-carotene (Vetaron).
• Potassium and magnesium preparations: burnt magnesia, Magne B 6, asparkam, panangin.

Physiotherapy.

Physiotherapy.
Drinking mineral water. Alkaline mineral water of low mineralization (Slavyanovskaya, Smirnovskaya) is prescribed. Treatment courses are 1-3 months 2 times a year, in winter (December, January) and in summer.

Urate nephropathy (Uraturia) in children

Urate nephropathy is characterized by the deposition in the kidneys of the sodium salt of uric acid (sodium urate) and their excretion in the urine. A sure sign of the disease will be the constant determination of urates in the analysis of urine (uraturia). Urate nephropathy, unlike oxalate, relatively rarely ends with urolithiasis. However, the development of pyelonephritis against the background of uraturia is not uncommon.

Causes and clinic of uraturia

1. In children, it most often occurs as one of the manifestations of the neuro-arthritic type of diathesis. This is a special constitutional type of children with birth defect uric acid metabolism and predisposition to gout. Details about neuro-arthritic diathesis can be found in the chapter "Vomiting" (subheading "Acetonemic vomiting").
2. Hereditary uraturia (Lesch-Nyhan syndrome). It occurs in boys, manifests itself from the first months of a child's life. severe disease, accompanied by severe developmental delay, mental retardation and serious mental disorders.
3. Urate nephropathy with massive cell breakdown, which happens during treatment with cytostatics (used to treat leukemia and tumors), poisoning with certain drugs, and other conditions.

Treatment of uraturia in children

Liquid.
Diet with the exception of foods that contribute to the formation of uric acid.

Medical treatment:

• Drugs that inhibit the formation of urates and reduce the level of uric acid in the body: allopurinol, probenecid, nitrate mixture, ethamide. They are taken in long courses, prescribed by a doctor.
• Vitamins and minerals. Potassium and magnesium preparations (panangin, as-parkam), B vitamins, vitamin C, bioflavonoids (quercetin, rutin), selenium, germanium.

Physiotherapy.
Drinking mineral water. As in oxaluria.

Phytotherapy and folk remedies in the treatment of dysmetabolic nephropathy

Herbs are very widely used in the treatment of dysmetabolic nephropathy. If the treatment is carried out for a long time, the composition of the phyto-collection herbs must be changed every 2-3 weeks so that there is no addiction, otherwise the effectiveness of herbal medicine will decrease. Every 2 months in treatment take a break for 2 weeks. The duration of the course of treatment is individual, with this question it is better to consult a doctor. Doses of phytopreparations for an adult are indicated. To calculate the pediatric dose, use the application "Peculiarities of taking medications in children."
Oat decoction. Pour 1 cup of dry oats with husks into 2 liters of water. Boil over low heat, evaporating water to 1 liter. Cool, strain. Drink 1/3-1/2-1 glass 2 times a day. The shelf life of the decoction is 2 days in the refrigerator.
Brewer's yeast. Pour 15 g yeast into 1 cup warm water, wait a while until they "fit" and drink. The course of treatment is 2-4 weeks.
watermelons. In August and September, it is very useful to eat watermelons, they perfectly “wash” the kidneys.

Dispensary observation of children with dysmetabolic nephropathy

• The child is observed by a nephrologist and a pediatrician until the transfer of the child to an adult clinic.
• A control urine test is taken once a month.
• Daily analysis of urine for salt is taken 1 time in 3 months.
• Shown sanatorium treatment.
• Lifelong dieting.

Dysmetabolic nephropathy is a whole complex of renal abnormalities caused by a violation of metabolic processes in the body. This type of pathology is also commonly called metabolic nephropathy, it can occur in both adults and children, depending on the etiology.

Among all known types of nephropathy, metabolic is the most common, according to statistics, metabolic disorders and the associated development of renal abnormalities are observed in every third child. However, this type of pathology, like nephropathy in general, cannot be considered as an independent disease that has its own symptoms.

Thus, dysmetabolic nephropathy refers to a number of various disorders in metabolic processes, which entail significant changes in the structure and functioning of the kidneys.

But do not be afraid of frightening medical terminology, metabolic nephropathy can be treated if certain therapeutic measures are observed. Absence adequate treatment may, on the contrary, lead to rather severe nephrotic conditions.

Reasons for the development of the disease

It is customary to distinguish primary and secondary forms of development of metabolic nephropathy in children and adults. Primary is a deviation of a hereditary nature and is quite rare, as a rule, in infants. The disease progresses very quickly, against its background, chronic renal failure and urolithiasis develop (the formation of stones of various etiologies).

Secondary dysmetabolic nephropathy is more common, develops under the influence of various factors, both endogenous (internal) and exogenous (external) nature. The bulk of these nephropathies are disorders of calcium metabolism. Normal Analysis urine implies the presence of dissolved salts in it. In case of deviations, the salts crystallize, forming a characteristic precipitate.

Predisposing exogenous factors:

Predisposing endogenous factors:

All of the above factors contribute to crystallization with further deposition of salts in the renal structures, which provokes the development of inflammatory processes.

Salts accumulating in the tissues further lead to the formation of kidney stones.

The main symptoms of dysmetabolic nephropathy

Metabolic nephropathy is divided into several types, each of which has its own characteristic symptoms, however, along with them, one can single out the general symptoms inherent in nephropathic abnormalities in general.

It is worth paying attention if:

Dysmetabolic nephropathy in children is much more common. Adults are less susceptible to the development of this disease. So, along with the above symptoms, children may develop concomitant deviations in the form of:

• reduced pressure;
• allergic reactions;
• overweight;
• progression of VVD symptoms (vegetovascular dystonia).

As a rule, complications associated with the period of pregnancy, such as late preeclampsia or prolonged fetal hypoxia, lead to the birth of children with this pathology.

Types of pathology associated with metabolic disorders

It is customary to distinguish several types of dysmetabolic nephropathies, based on which salts predominantly crystallize in urine. So, there is an oxalate, urate, phosphate, cystine variety of metabolic pathology.

In addition, it may occur mixed form when salts can be present in the urine test at the same time various etiologies, be it oxalates, urates or phosphates.

Oxalate nephropathy (oxaluria)

Represents about 80-90% of all cases. This type of nephropathy is most often hereditary and mainly occurs in children, even newborns.

However, as a rule, for a long time, the pathology can be asymptomatic and manifest itself closer to 5 years, when oxalate crystals, slight proteinuria (protein), erythrocytes and leukocytes in a small amount are found in the urine test. The density of urine also increases significantly.

The course of the disease as a whole does not affect the full development of the child, however, some VVD symptoms and allergic reactions.

Oxalate dysmetabolic nephropathy in children may worsen in puberty(10-14 years old) due to significant changes in the hormonal background of a teenager.

Absence timely therapy can cause all kinds of kidney inflammation and the progression of urolithiasis.

Along with oxalate, oxalate-calcium nephropathy is also common - its variety. It occurs due to a violation of the metabolism of calcium and oxalic acid.

The etiology of the appearance of oxalates in addition to genetics:

• Diseases gastrointestinal tract(ulcerative colitis, intestinal anastomosis, Crohn's disease);
• Stress and other disorders of the nervous system;
• Excessive presence of salts of oxalic acid in food;
• Pathological production of excessive amounts of oxalates inside the body;
• Negative environmental factors.

Urate nephropathy (uraturia)

It is a rare pathology (no more than 5% of all cases) associated with impaired uric acid metabolism, as a result of which urates appear in the urine. This type of nephropathy can be both primary and secondary. The primary is associated with a genetic predisposition, the secondary - occurs:

• as a consequence of other ailments (multiple myeloma, hemolytic anemia, erythremia);
• after taking some medicines(cytostatics, diuretics, salicylates, etc.);
• due to functional disorders of the renal tubules or changes in the composition of urine according to physicochemical characteristics (inflammatory processes in the kidneys).

Diagnose the disease early stages quite difficult, because it is characteristic long course V latent form However, the prerequisites for the further progression of the disease can be identified even in children at an early age.

In the initial stages, insignificant uraturia, protein and red blood cells will be observed in the urine. In the later ones, the amount of urates increases, the urine acquires the color of a red brick.

Phosphate nephropathy (phosphaturia)

This variety is a violation of metabolic processes involving phosphorus and calcium. Infections of the urinary system form the basis of this type of nephropathy. Less often - complications of hyperparathyroidism, pathology of the central nervous system, rickets, unbalanced nutrition.

Often, the formation of calcium phosphate nephropathy occurs against the background of calcium oxalate, manifesting itself not so pronounced.

A small presence of phosphates in the urine will not be considered an abnormality and does not require treatment. Phosphate levels can be corrected with proper nutrition, compliance water balance and taking vitamin A and Kanefron. The latter, in turn, are responsible for removing excess salt from the body.

Cystine nephropathy (cystinosis)

It is characterized by an excess of cystine in urine. Cystine, in turn, is the result of the metabolic processes of methionine (an aliphatic amino acid).

This pathology mainly occurs for two reasons:

• cystine, accumulated in the renal tissues, is there in excess;
• functions reverse suction amino acids in the kidneys are impaired.

An excess of cystine in the cells of the organ, as well as the impossibility of its reabsorption, is a consequence of genetic abnormalities. However, it accumulates not only in the kidneys, but also affects The lymph nodes, liver, spleen, muscle tissue, nerve cells, blood system, bone marrow.

Prolonged cystinosis can lead to all sorts of inflammatory processes in the kidneys, as well as to the formation of stones and the further progression of urolithiasis.

Diagnostic measures

Diagnosis of pathology is reduced to a thorough study of the physicochemical processes in urine, since in the early stages nephropathy does not manifest itself in any way, but is detected by chance, for example, during a planned medical examination in patients of any age category.

Uric and oxalic acids have the ability to stick together, resulting in the formation of "glued" compounds in the form of crystals. In the urine collected for analysis, they form a kind of visible sediment.

Thus, in order to diagnose dysmetabolic nephropathy in children and adults, it is necessary:

• pass a general urine test (detection of crystallized salts);
• conduct a biochemical analysis of urine (degree of salt concentration);
• pass tests that detect calcification and the presence of peroxides in urine;
• conduct an analysis that determines the anti-crystal-forming abilities of urine (AKOSM, AKS);
• undergo an ultrasound examination of the kidneys (ultrasound), which allows you to identify possible inflammation, tissue hardening or stones.

If salt crystals were found exclusively in general analysis, this is not a cause for concern. So, crystallization of urine can be a sign of temporary metabolic failures. Such manifestations are especially characteristic of a constantly growing child's body.

Treatment of dysmetabolic nephropathies

The advanced form of the disease, leading to chronic renal failure, nephrosis and nephritis, is a rarity. It mainly takes place in mild form amenable to home therapy.

There are three main components on which the recovery process should be based:

• normalization of nutrition;
• conducting healthy lifestyle life;
• adequate fluid intake.

In addition, it is also used drug therapy and other therapeutic measures (depending on the type of metabolic nephropathy).

Diet and drinking regimen

The formation of the correct drinking regimen is one of the essential conditions for recovery. IN medicinal purposes the necessary water load is assigned depending on age. So, daily rate fluid intake for children aged 2 years and younger is approximately one and a half liters. By the age of 5, the daily rate increases to 2 liters of liquid, and by 10 years and older - up to 2.5 liters.

In the case of nephropathy, it is necessary to increase this volume by another 500-1000 milliliters. At the same time, not only the use of water in pure form, but also other liquids (juices, broths, teas, etc.) If in the case of a baby who is, for example, on breastfeeding, these norms are not so difficult to comply with, children adolescence often not accustomed to drink this amount of liquid.

Thus, children and adults may receive less on average from half a liter to a liter of fluid, which can provoke a number of metabolic disorders in the body.

Drinking plenty of water helps to reduce the concentration of salt crystals in the urine. In this case, it is preferable to take as much liquid as possible before going to bed in order to increase nocturnal diuresis.

In general, in order to approximately determine the required volume, you need to count 50-70 milliliters of liquid per 1 kilogram of weight.

In addition to the drinking regimen, it is necessary to pay close attention to the diet and adjust the list of foods eaten. It is necessary to include in the diet only those in which there is no oxalic acid. The diet can significantly reduce the load of salt on the kidney tissue.

For patients with oxaluria, a potato-cabbage diet is indicated. These two products help to reduce the oxalate load on the body and the kidneys in general. However, it is not recommended to eat them for a long time in patients suffering from gastritis or peptic ulcer stomach. It is preferable to eat potatoes in a boiled or baked form, but there are no special claims for cabbage, any variety and method of preparation will do.

Despite the fact that the diet consists of only 2 ingredients, you can cook a lot of different dishes:

Also, about 2 times a year, in courses lasting a month, mineral water is taken one teaspoon per day (Smirnovskaya, Slavyanskaya, etc.).

Excluded from the diet are: cranberries, carrots, beets, spinach, rich broths, jelly, chocolate and its derivatives.

Dietary nutrition for urate nephropathy

With urate nephropathy, a dietary table No. 6 is prescribed. Its task is to limit the intake of oxalic and uric acid into the body, as well as to exclude further alkalization of urine. So, it is necessary to prevent the intake of purines, which in large quantities found in meat, as well as offal (liver, stomachs, kidneys, heart, brains, etc.).

In addition, it is also forbidden to eat:

• any rich broths (from meat, fish, mushrooms);
• animal fats (lard, butter, margarine);
• bakery products and pastries;
• alcohol and sweets;
• smoked meats, pickles, fried;
• foods rich in organic acids (spinach, sorrel, currants, green apples, etc.).

Sour-milk products (sour cream, low-fat cottage cheese) are allowed for consumption; some vegetables (zucchini, cabbage, carrots, cucumbers, peppers, pumpkins, etc.); some berries (strawberries, strawberries, raspberries); vegetable soups.

Decoctions are allowed from drinks medicinal herbs(dill, birch, lingonberry, clover, horsetail, etc.), as well as slightly carbonated and slightly alkaline mineral waters.

Features of nutrition in phosphaturia

The diet for phosphate nephropathy should be aimed at limiting foods rich in phosphorus (liver, chicken, chocolate, legumes, etc.). In its treatment, as a rule, dietary table No. 14 is used.

In addition, the following features must be kept in mind:

• admissible energy value per day should not be higher than 2000-2500 kcal;
• use table salt per day - within 5 grams;
• the content of fat in food per day should not exceed 100 grams;
• intake of proteins of plant and animal origin - no more than 100 grams per day;
• simple and complex carbohydrates- in the amount of 400-500 grams per day.

List of allowed products:

• all green vegetables (white cabbage and broccoli, green onions, cucumbers, etc.);
• berries and fruits (pears, apples, pomegranates, raspberries, strawberries, lingonberries, etc.);
• egg white;
• vegetable oils;
• legumes and grains;
• lean meats and fish;
• sweets of natural origin (honey, dried fruits, marshmallows, marshmallows, etc.);
• mineral water with hyperacidity(for example, "Narzan") and other drinks (fruit drinks, compotes, jelly, teas, decoctions).

Diet for cystinosis

Dietary nutrition in cystinuria and cystinosis comes down to the fact that foods with sulfur-containing acids, in particular methionine, must be excluded from the diet. This amino acid is found in excess in meat, cottage cheese, eggs, fish, hard cheeses, mushrooms and other foods.

Other protein food allowed for use, but it should be taken only in the morning. This is due to the fact that the accumulation of cystine in the body, as a rule, occurs in the afternoon. For lunch and dinner, lighter foods in the form of fruits, vegetables and cereals are suitable.

So, by the time the diet is completed, the diet gradually expands to the usual one, with the exception of cheeses, fish, eggs, and cottage cheese.

Medical therapy

Treatment with drugs is prescribed based on the degree of development of the pathology, as well as its variety, as in the case of nutrition.

Drug treatment with the appointment of dosages of drugs should be carried out strictly according to the doctor's prescription, self-medication can be very dangerous.

Folk methods

Treatment folk remedies can only be considered as an adjuvant therapy that does not replace the main one, and only after consultation with the attending physician.

all sorts of herbal preparations quite effective in the fight against metabolic nephropathies. However, in order to avoid addiction, the composition of herbs must be changed every two weeks.

The duration of taking medications is prescribed individually with short breaks between courses.

Here are just a few of the more common recipes:

Forecast and preventive measures

In general, if all the doctor's prescriptions are followed, dysmetabolic nephropathy in children and adults is curable, the prognosis is very favorable. Biochemical indicators urine gradually improves, pronounced symptoms recede, and then there is a complete cure of patients. However, the lack of proper treatment can lead to quite serious complications in the form of urolithiasis, pyelonephritis, and in especially advanced cases, chronic renal failure.

In the case of cystinosis, if therapy has not yielded tangible results, a donor kidney transplant may be indicated. But even taking into account this fact, the disease can develop again and lead to death.

In order to prevent the development severe complications, it is necessary to undergo scheduled examinations at least once a year even during periods of remission, to treat concomitant ailments in a timely manner, and to exclude risk factors for the progression of pathology.