Dysmetabolic nephropathy is a broad collective concept that includes a number of different pathologies with various causes and mechanisms of development, but everything develops against the background of metabolic disorders. The latter are reflected in changes in the functional state of the kidneys.
Why dysmetabolic nephropathy develops in children
The causes of dysmetabolic nephropathy are numerous. In general, we can say that this condition develops due to the influence of unfavorable external factors. In a broad sense, such factors are understood as diseases of the gastrointestinal tract, poisoning, vitamin D overdose, impaired water-salt metabolism, long diets.
How is dysmetabolic nephropathy in children classified?
Dysmetabolic nephropathy is a collective term for metabolic disorders. Therefore, this pathology has another name - metabolic or metabolic nephropathy. The condition can be caused by various mechanisms, depending on the type of substances whose metabolism has been impaired. It is for these specific substances that the modern classification of nephropathies is built.
Uraturia
Uraturia is a violation of urate metabolism and the detection of uric acid in a general urine test.
Oxalaturia
Oxalaturia is a violation of oxalate metabolism and the detection of oxalic acid salts in urine sediment.
Phosphaturia
Phosphaturia is a metabolic disorder and the detection of phosphate-containing substances in the urine.
Mixed
Mixed nephropathy is established when it is difficult to determine which metabolic mechanism is disturbed; salts of different nature are observed in the urine.
Reasons for the development of dysmetabolic nephropathy
Since the general moments of the occurrence of nephropathy have already been discussed above, it is necessary to determine the specific causes of development by classification. In private, you can make out some types of metabolic disorders as part of dysmetabolic nephropathy.
Oxalate nephropathy
Pathology with the identification of oxalates (salts of oxalic acid) develops in connection with a violation of the exchange of the acid itself and calcium salts. Deficiency of certain vitamins and minerals (retinol, alpha-tocopherol, pyridoxine, magnesium, potassium) plays a significant role in the formation of oxalate nephropathy. This condition can be observed during the treatment of rickets, when there is an overdose of vitamin D. Also, oxalate nephropathy is often observed in children with a violation of proper nutrition (excessive intake of oxalates with food).
The highest concentration of oxalates (oxalic acid) is achieved in the following products: cocoa, sorrel, parsley, rhubarb, beets.
It is important to remember that nephropathy can develop not only exogenously, but also endogenously. Oxalic acid metabolism disorders are often combined with other pathologies. Most often these are diseases of the gastrointestinal tract (Crohn's disease, colitis, enteritis, pancreatitis, dysfunction of the biliary system), but there may also be endocrine pathologies (diabetes mellitus).
Urate nephropathy
Another component of dysmetabolic pathology is urate nephropathy. This condition is characterized by the deposition of uric acid in the kidneys, as well as their detection in urine sediment. Urate nephropathy can be both primary (hereditary) and secondary (acquired). An inherited disorder is rare and is considered a genetic disorder.
Acquired nephropathy also occurs with other diseases (hemolytic, multiple myeloma, inflammatory changes in the kidneys). Long-term use of "aggressive" drugs (cytostatics, diuretics) can be an unfavorable factor that triggers the mechanism of uric acid metabolism disorders.
Phosphate nephropathy
Phosphate metabolic nephropathy is the last of the dysmetabolic disorders, which is characterized by the accumulation and excretion of salts (phosphates) in the urine. This condition occurs in the form of a secondary pathology along with kidney diseases (pyelonephritis, urinary tract infection, tubulointerstitial nephritis).
Symptoms of dysmetabolic nephropathy
The clinical manifestations of dysmetabolic nephropathy are not specific. Therefore, a diagnosis cannot be made based on the symptoms of the disease. Pathological changes in urinary sediment are detected by chance during dispensary observation at the age of 3 to 5 years.
Parents may notice a yellow coating on the surface of the pot, which cannot be washed off without effort.
At the same time, some patients may have symptoms of intoxication (headache, weakness, lethargy, loss of appetite). But such manifestations are poorly expressed.
Sometimes you can observe a decrease in blood pressure, as well as an increase in body weight. The typical clinical picture characteristic of kidney disease is absent.
A decrease in the volume of urine excreted per day is possible, while the appearance of edema is never observed. Due to the fact that urine output decreases, the urine becomes more concentrated and cloudy in color.
According to the type of nephropathy, the clinical manifestations may also differ. It is important to know some of the features characteristic of one form or another of metabolic disorders.
Features of scalate nephropathy
With oxalate nephropathy, pain in the abdomen is often observed. Small patients cannot accurately determine the localization of pain. Painful sensations appear when urinating.
Features of urate nephropathy
Urate nephropathies are also characterized by the appearance of abdominal pain that is difficult to localize. And there may also be painful sensations in the lumbar region, resembling renal colic from afar. The volume of urine per day decreases.
Features of phosphate nephropathy
With phosphaturia, abdominal pain is characteristic only for phosphate-calcium crystalluria.
Diagnosis of metabolic nephropathies in children
At the initial stages of the disease, a pediatrician can deal with metabolic nephropathy. If the doctor has doubts or the disease has a severe course, there is a risk of complications, then the pediatrician can refer the child to a pediatric urologist or nephrologist for consultation.
As a rule, the hereditary history is aggravated. Relatives may have diseases of the urinary system, gastrointestinal tract, metabolic disorders, inflammatory diseases of the joints.
Diagnostic search has its own characteristics for various types of nephropathy. When making a diagnosis, it is important to pay attention to the presence of other diseases, the existence of which could provoke the formation of metabolic disorders.
In the case of a diagnosis of oxalate nephropathy, diseases of the gastrointestinal, biliary and genitourinary tracts, endocrine and allergic diseases are important.
Diagnosis of metabolic nephropathies must necessarily include: biochemical study of urine sediment, if necessary, additional research is possible (special tests that determine the functional ability of the kidneys). The instrumental methods include ultrasound examination of the kidneys and urinary tract.
So, let's analyze the diagnostic issues. With oxalate metabolic disorder, changes are observed in the general analysis of urine (an increase in concentration, urine outwardly has a rich color and a cloudy sediment, protein and erythrocytes appear, as well as calcium oxalate crystals).
When oxalates are detected, it is necessary to perform a biochemical analysis of urine, which makes it possible to determine the daily amount. With oxalate nephropathy, the release of oxalates in children reaches more than 20 mg / day. Ultrasound examination of the kidneys and urinary tract may indicate the deposition of salts on the walls of the organs (increased echogenicity of the parenchyma of the kidneys, pelvis, ureters).
Urate nephropathy also has its own characteristics in diagnostics. In the general analysis of urine, you can observe an increased concentration, precipitation, an increase in the amount of protein and red blood cells, as well as uric acid crystals. A biochemical blood test indicates an increase in the concentration of uric acid, albumin.
Phosphate form metabolic disorders are characterized by the following change in the general analysis of urine - a shift in pH to the alkaline side, while the normal environment is acidic. Sediment is also observed, but it has a white tint. The sediment contains a large amount of phosphate crystals (more than 2.5 μg). Also, bacteria with urease activity are detected in the urine.
Treatment of dysmetabolic nephropathy
Treatment of metabolic disorders should be based on several regime activities. Of course, medications take place in nephropathies, but it happens that it is the correction of the child's lifestyle that leads to recovery.
For the correct selection of treatment, you must contact a specialist.
Drinking regime
The first main principle is an adequate drinking regime. There is no need to remind that water is necessary for the body, especially for children. And in the case of existing nephropathy, it is extremely important, since crystals dissolve in water, and their concentration decreases. It is necessary to consume a large amount of liquid: up to 3 years - 1 liter, 3 - 7 years - 1.5 liters,> 7 years - 2 liters.
As a drink, it is better to use water or diluted dried fruit compote.
Diet
Diet is also an important principle in the treatment of dysmetabolic nephropathy, because sometimes it is errors in nutrition that lead to metabolic disorders. The diet should be made individually for a particular patient, depending on the type of nephropathy.
So, for example, sorrel, rhubarb, cocoa, spinach are excluded in the diet for oxalate nephropathy. With caution and in small quantities: beets, carrots, onions, liver, beef, black currants, green apples. The child's nutrition should consist of cereals, potatoes, all types of cabbage. Fruits you can use are those that contain a lot of water.
The diet for urate nephropathy should exclude the following types of products: coffee, cocoa, fatty fish and meat, broths. Legumes, dietary meat are introduced into the diet with restriction. It is allowed to use various cereals, potatoes, cabbage, fruits, bread, lean fish, turkey.
Treatment of phosphate nephropathy, as a rule, is reduced only to correct and strict adherence to the diet. Products are excluded from the diet: chocolate, oats, cheese, chicken fillet, buckwheat and pearl barley, liver. Limit sausages, milk, sour cream, eggs. Allowed to eat oil, pasta, rice, legumes, cabbage, most vegetables, fruits and berries.
The main groups of drugs used to treat dysmetabolic nephropathy in children
The most important goal of the treatment of nephropathy is to prevent the formation of crystals, their deposition, as well as their removal. These tasks are performed by a properly selected diet and adherence to the drinking regime. But in order to stabilize the membranes, such measures are not enough. Then the specialist prescribes drugs with antioxidant and membrane stabilizing effects (dimesfon, xidiphon).
Also, the herbal preparation Kanefron, which has proven itself well in the pharmaceutical market, has such an effect. It can be used by both children and adults. This drug is widely used in the treatment of urological and neurological pathology. And also Kanephron is good because it has a moderate diuretic effect and has antiseptic properties.
Since the deficiency of certain vitamins plays an important role in the formation of metabolic disorders, they must be replenished. Prescribe courses of taking vitamins: pyridoxine, alpha-tocopherol, retinol. The course is usually 3 - 4 weeks, repeat the treatment after 3 months.
Correction of metabolic disorders should be carried out along with the treatment of the underlying disease.
It must be remembered that metabolic nephropathy in children often develops against the background of the underlying disease. If the latter is not treated, then it makes no sense to correct the internal imbalance.
To remove urates, the drug Allopurinol is used, but this drug has a large number of complications. Therefore, its use should be strictly according to indications and after assessing the benefits and risks to the health of the child.
With phosphate nephropathy, as mentioned above, diet and drinking regimen is often enough. But there are times when this is not enough. Then decoctions of herbs, ascorbic acid, mineral waters are prescribed. These drugs are important for acidifying urine.
In the case of the addition of bacterial flora, antibacterial therapy is indicated, followed by the appointment of uroantiseptics. Together with them, herbal preparations Fitolizin, Kanefron can be prescribed.
It is important not to forget about further observation of the child after recovery. Regular examination by a pediatrician and a nephrologist or urologist will significantly improve the quality of previous therapy. The control of urine analysis should be carried out within a specific time frame established by a specialist.
Also, the child should be referred for consultation to a dentist and an otorhinolaryngologist for the rehabilitation of foci of chronic infection. Regime measures should remain the same even after recovery.
Forecast and preventive measures
The prognosis for early detection of pathology and timely treatment started is favorable. But in the absence of proper therapy, metabolic nephropathy can turn into serious diseases (pyelonephritis, urolithiasis), then the prognosis worsens significantly and the recovery period increases. The main preventive measure is the treatment of the underlying disease, against which metabolic disorders may appear.
Conclusion
Dysmetabolic nephropathy is a fairly common condition among the child population. There are a great many reasons for the occurrence of metabolic disorders. This disease has a favorable prognosis only when the correct therapeutic measures are taken.
The danger of metabolic nephropathy lies in the fact that this pathology can be transformed into dangerous diseases. You should never forget about the drinking regime and diet, even for healthy people. It would seem that these are elementary principles, but they can prevent the development of serious diseases.
