In addition to common childhood diseases, there are also those that are registered in babies quite infrequently. One of these pathologies is dysmetabolic nephropathy... This condition is more common among nephrologists than pediatricians.
What it is?
Dysmetabolic nephropathy is a pathological condition that leads to impaired renal function. This clinical symptom complex is not at all a separate disease. Various diseases can lead to the development of this unfavorable and even dangerous condition in a child.
If the doctor detects dysmetabolic nephropathy in a baby, then this indicates the presence of a whole complex of disorders in the urinary organs and kidneys.
According to statistics, every third baby has clinical signs of this condition. Dysmetabolic nephropathy is not at all a diagnosis or even a sentence. When the reasons that contributed to its development are eliminated, it completely disappears. This requires timely diagnosis and appropriate treatment of the underlying disease.
Usually, signs of dysmetabolic nephropathy occur unscheduled in children. When screening urine, doctors identify changes in it that are clinical signs of functional disorders in the work of the kidneys. This pathological condition can develop at different ages. The long course of dysmetabolic nephropathies leads to the development of nephrotic syndrome in the child.
This condition is manifested by persistent edema, which is mainly located on the face and upper body. Nephrotic syndrome usually occurs in 13-16 out of 100,000 babies. There are population characteristics in the incidence.
To eliminate this pathological condition, the appointment of a complex treatment is required, which is usually compiled by a pediatric nephrologist.
Causes
Dysmetabolic nephropathy in children is, first of all, impaired metabolism. Persistent changes lead to the appearance of various salt crystals in the baby's urine. They can be different in their composition. This is largely determined by the chemical composition of the stones.
Multiple reasons lead to the development of dysmetabolic nephropathy in babies. In some cases, it is difficult to establish them. Often, the pathological state of the kidneys develops as a result of several causal factors at once. The development of a pronounced disturbance in the work of the kidneys is caused by:
- various intoxication with chemicals;
- severe poisoning by various industrial products;
- improper and irrational nutrition;
- anatomical defects that arose immediately after the birth of a child.
Scientists also talk about the presence of congenital forms of the disease. In this case, changes in kidney function are observed already within the first months after the birth of the child. Leads to this condition, as a rule, a complicated course of pregnancy. If, during gestation, the expectant mother develops severe gestosis or toxicosis at a later date, then this significantly increases the risk of functional disorders of the urinary organs in the child.
Also, intrauterine conditions, in which fetal hypoxia occurs, lead to the congenital form of dysmetabolic nephropathy. If oxygen starvation of tissues occurs in the early stages of pregnancy, then this contributes to disruption of organogenesis. In this case, the laying and intrauterine development of the kidneys is disturbed. Subsequently, the child may develop various diseases of the urinary tract: acute glomerulonephritis with nephrotic syndrome, pyelonephritis and others. The nephrotic form of glomerulonephritis in a small child is a rather dangerous disease that requires mandatory consultation with a nephrologist and the appointment of special treatment. In some cases, therapy is lifelong.
Many researchers talk about hereditary predisposition. If parents or close relatives have a tendency to urolithiasis, then the child often has characteristic changes.
Certain genetic mutations can also cause kidney damage. Such cases are rare.
The idiopathic variant of dysmetabolic nephropathy is also registered in pediatric practice. This clinical condition is established by exclusion. Usually, for this, doctors carry out an extended differential diagnosis, excluding all possible alternative causes that could cause impaired renal function in a child. There is idiopathic nephropathy in young children.
Classification
Any dismetabolic nephropathy is based on pronounced metabolic disorders. This is manifested by deviations in the normal chemical composition of urine and the appearance of various salt crystals. Depending on the substances included in their composition, several variants of this state are distinguished.
Taking into account the chemical composition of crystals, the following clinical variants are distinguished:
- Oxalaturia - a condition in which large amounts of oxalates appear in the urine. This pathological process is due to systemic disorders of calcium metabolism in the body. Excessive formation of oxalic acid leads to the appearance of crystals (oxalates) in the urine. This condition can be of varying severity. The smallest signs appear at grade 1 oxalaturia.
- Uraturia. It is characterized by the appearance of urate crystals in the remainder of the urine. This pathology can be primary and secondary. Lesch-Nyhan syndrome is considered the main hereditary cause of the appearance of a large number of urate accumulations in the urine of children. Various types of hemolytic anemia, erythremia, multiple myeloma, pyelonephritis are the most common diseases leading to urate dysmetabolic nephropathy in children.
- Phosphaturia. It is characterized by the appearance in the general analysis of urine of a large number of phosphate crystals. Often this pathological disorder is caused by various infectious diseases that develop in the kidneys. Diseases of the central nervous system, as well as various pathologies of the parathyroid glands, lead to a violation of phosphorus metabolism in the child's body. There are also dosage forms of phosphate dysmetabolic nephropathy caused by prolonged use of anticancer drugs, thiazide diuretics, salicylates, and cyclosporine A.
- Cystine form. It occurs in babies with a violation of cystine metabolism. This substance is the main metabolic product of methionine. Excess cystine crystals begin to be deposited in the renal tubules, interstitial tissue of the kidneys, spleen and liver, lymph nodes, blood cells, and spinal cord. Secondary cystine dysmetabolic nephropathy can develop with some types of pyelonephritis or tubular interstitial nephritis.
- Mixed. It is characterized by the appearance of various types of crystals. It can be congenital and acquired. Secondary forms of mixed dysmetabolic nephropathy are found in various chronic diseases of the kidneys and urinary tract. It is registered in babies of any age.
Symptoms
Many forms of dysmetabolic nephropathy are asymptomatic. The kid may not be bothered by anything. The behavior and well-being of the child does not change in any way. Pathological disorders in the kidneys are detected, as a rule, during the delivery of a general urine test. Various crystals that have appeared in it indicate that the baby has problems with metabolic processes.
In some cases, nephropathy occurs with the appearance of various unfavorable signs. They are usually systemic. So, babies with congenital oxalaturia also have signs of arthropathy, gout, spondylosis, urolithiasis, diabetes mellitus. These are combined pathological conditions. They arise as a result of an initial disturbance in the body's metabolism at different levels.
Metabolic disorders are observed in all clinical variants of dysmetabolic nephropathy.
Babies with metabolic functional disorders of the kidneys also often suffer from obesity, allergic pathologies, hypotension. They have trouble urinating and may experience a slight burning sensation or pain when urinating. The symptoms of dysmetabolic nephropathy are not very specific and largely depend on the underlying disease.
Diagnostics
Finding nephropathy on your own at home is a rather difficult and sometimes simply impossible task. In some cases, crystals can be found when urine is drained from a pot. It becomes rather cloudy and has a pronounced white precipitate. Normal urine is straw-yellow in color and fairly clear. The appearance of turbidity or sediment must necessarily alert parents and motivate them to seek medical advice.
In establishing the diagnosis of dysmetabolic nephropathy, a pediatric urologist or nephrologist is necessarily involved. These specialists have the necessary knowledge, and, most importantly, experience in the treatment of such pathological conditions in children. After a clinical examination and examination, they will recommend several additional tests to help clarify the diagnosis.
The basic diagnosis of dysmetabolic nephropathy includes a mandatory general blood test. This simple and affordable laboratory test allows you to identify various salt crystals in the urinary residue, determine the density and specific gravity of urine, and identify protein. The number of leukocytes and erythrocytes in this analysis establishes the presence in the child of any diseases of the kidneys and urinary tract, which could cause him to develop metabolic nephropathy. In a number of difficult diagnostic cases, doctors resort to prescribing more specific urine tests. Urine analysis according to Nechiporenko helps to identify some latent forms of pyelonephritis and glomerulonephritis, which often lead to the development of metabolic disorders in the kidneys in babies.
If the cause of the kidney disease is a bacterial infection, then it would be appropriate to conduct a bacteriological study of urine with a determination of sensitivity to antibiotics.
Usually, this analysis is performed within a week and gives an accurate description of what pathogenic microflora is in the urine. This test gives doctors more opportunities to prescribe adequate and correct treatment.
To identify kidney stones, as well as to establish various structural pathologies, an ultrasound examination with Doppler mapping is prescribed. Each disease of the urinary tract has its own specific echo symptoms. With the help of a high-precision examination, various kidney pathologies can be detected even at the earliest stages. The method is safe and can be used even in the smallest patients.
For older children, in some cases, an overview urography is used. With the help of the introduction of a special contrast, the work of the kidneys is assessed, and functional disorders associated with pathologies of urine excretion are identified. A photo depicting the result of a survey urography gives specialists a complete picture of the existing pathologies of the kidneys and urinary tract.
Treatment
Therapy for dysmetabolic nephropathy is individual for each child. The variety of clinical variants of the disease determines the use of various tactics to eliminate the adverse consequences of impaired metabolism. The choice of treatment remains with the pediatric urologist or nephrologist.
The doctor sets the duration and intensity of therapy based on the physiological characteristics of the child and the presence of concomitant chronic diseases.
For the treatment of impaired metabolism in the kidneys are used:
- Diet. Nutrition for babies should be high in calories and meet age standards for all necessary nutrients. All rich and strong meat broths, which contain quite a few different extractives, are excluded from the children's menu. With a tendency to the formation of oxalates, the use of cranberries, lingonberries, sorrel, beets, carrots, and fresh herbs should be limited in the diet. Confectionery sweets containing cocoa beans are also subject to restrictions.
- Care. If dysmetabolic nephropathy is of secondary origin and some kind of kidney disease contributed to its appearance in the child, then you should carefully monitor the baby's well-being. When the first signs of an exacerbation of chronic pathology of the urinary tract appear, it is imperative to show the baby to the doctor. The child should stay at home during the entire acute period of the disease. Babies with a high body temperature should be kept in bed.
- Medication therapy. It consists in the appointment of drugs for the treatment of the underlying disease and the symptomatic treatment of various metabolic disorders. To improve kidney function in childhood, various antioxidant agents and multivitamin complexes are used. For urinary disorders, diuretics (diuretics) are prescribed.
The duration and frequency, as well as the dosage of drugs are discussed individually with the attending physician.
- Phytotherapy. It has been successfully used to normalize the chemical composition of urine in babies for many years. It has long been noted that some medicinal herbs have a uroseptic effect and normalize kidney function. They can be used as tea or added to food.
- Sufficient drinking regime. In order for crystals not to stagnate in the kidneys, and urolithiasis does not occur, you should consume a sufficient amount of water per day. On average, a student should drink at least 1-1.5 liters of liquid. Water entering the body ensures normal kidney function and reduces the risk of developing dysmetabolic nephropathy.
For more information on nephropathy, see the next issue of the Medical Bulletin.
