Comparative evaluation of the results of conservative and surgical methods of treatment of children with destructive forms of pyelonephritis
- Authors: Kuzovleva G.I.1,2, Grushitskaya E.V.1, Staroverov O.V.1, Rostovskaya V.V.2, Shmyrov O.S.3, Zakharov A.I.4
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Affiliations:
- Speransky Children’s Hospital No. 9
- Sechenov First Moscow State Medical University
- Morozovskaya Children’s Hospital
- N.F. Filatov Children’s Hospital
- Issue: Vol 11, No 3 (2021)
- Pages: 339-350
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/123580
- DOI: https://doi.org/10.17816/psaic975
- ID: 123580
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Abstract
BACKGROUND: The relevance of destructive pyelonephritis in pediatric practice is determined by frequency of various complications of the disease associated with a high risk of irreversible morphofunctional changes in parenchyma of affected kidney, the lack of tactical consensus in the professional community and regulatory documents regulating the procedure for diagnostic and therapeutic support of this contingent of patients.
AIM: Substantiation of the tactics of effective treatment children with destructive pyelonephritis, based on the results of a multifactorial retrospective analysis of the course and outcomes of the disease.
MATERIALS AND METHODS: The results of the analysis of medical documentation of 38 patients with destructive pyelonephritis aged 3–204 months (median 93.5) who received inpatient treatment in 2015–2019 in three specialized clinics in Moscow are presented.
RESULTS: More than half of the patients (28 children) in the acute period of the disease received conservative therapy, including infusion and antibacterial, the escalation of which was carried out with the preservation or increase of manifestations of the systemic inflammatory response syndrome, as well as negative dynamics according to ultrasound or CT data. In the group of patients (n = 10), indications for surgical treatment were formulated – decapsulation of the kidney, opening of apostemas and abscessed foci, drainage of the paranephral space. During the examination in catamnesis, realized in 50%. It was found that in the majority (91%) of children treated conservatively, a statistically significant decrease in the volume of the kidney on the affected side was registered. These complications were not detected among the operated patients.
CONCLUSION: The pharmacy of choice for starting antibacterial therapy should be inhibitor-protected beta-lactams, carbapenems, if the etiological significance of staphylococcus is suspected, it is advisable to connect linezolid. In case of laboratory signs of hypercoagulation, it is necessary to connect anticoagulants. Surgical tactics can minimize the risk of complications associated with the purulent-destructive process, contributing to regenerative processes in the kidney parenchyma. The objectification of the results of the catamnestic examination is due to the performance of nephroscintigraphy.
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##article.viewOnOriginalSite##About the authors
Galina I. Kuzovleva
Speransky Children’s Hospital No. 9; Sechenov First Moscow State Medical University
Author for correspondence.
Email: dr.gala@mail.ru
ORCID iD: 0000-0002-5957-7037
SPIN-code: 7990-4317
Cand. Sci. (Med.), paediatric urologist
Russian Federation, 8, b. 2, Trubetskaya str., 119991, Moscow; MoscowElena V. Grushitskaya
Speransky Children’s Hospital No. 9
Email: alenagk@bk.ru
ORCID iD: 0000-0002-8399-2687
SPIN-code: 6660-0890
Clinical pharmacologist
Russian Federation, 8, b. 2, Trubetskaya str., 119991, MoscowOleg V. Staroverov
Speransky Children’s Hospital No. 9
Email: staroverov2002@mail.ru
ORCID iD: 0000-0001-9528-7056
SPIN-code: 5517-1191
Cand. Sci. (Med.)
Russian Federation, 8, b. 2, Trubetskaya str., 119991, MoscowVera V. Rostovskaya
Sechenov First Moscow State Medical University
Email: rostovskaya_vera@mail.ru
ORCID iD: 0000-0002-3718-8911
SPIN-code: 6989-5041
Dr. Sci. (Med.)
Russian Federation, 8, b. 2, Trubetskaya str., 119991, MoscowOleg S. Shmyrov
Morozovskaya Children’s Hospital
Email: moroz-uro@mail.ru
ORCID iD: 0000-0002-0785-0222
SPIN-code: 1228-5484
Cand. Sci. (Med.)
Russian Federation, 8, b. 2, Trubetskaya str., 119991, MoscowAndrey I. Zakharov
N.F. Filatov Children’s Hospital
Email: zaharov@pedurology.ru
ORCID iD: 0000-0001-5872-6267
SPIN-code: 8774-5827
Cand. Sci. (Med.)
Russian Federation, 8, b. 2, Trubetskaya str., 119991, MoscowReferences
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