In addition to the traditional "childhood" diseases, so familiar to every practicing pediatrician, the child sometimes develops serious changes in the work of important organs and systems. In recent years, children of an early age often have malfunctions in the functioning of the urinary system, called dismetabolic nephropathy.
Dismetabolic nephropathy in the practice of physicians occurs quite often, according to statistics, every third small patient suffers from a similar disorder today. Nephropathy is not a final disease and does not stand out as a separate diagnosis in the international classification of diseases. If a doctor speaks of a dismetabolic nephropathy in a child, then, as a rule, involves a number of metabolic disorders, the end result of which are serious changes in the kidneys.
Parents should not be intimidated by a complex medical term: nephropathy caused by metabolic failures is not a sentence at all, with a change in lifestyle and a proper approach
to treatment, the child does not have any restrictions to the usual way of life. And vice versa - the lack of adequate therapy and diet can eventually lead to the development of severe complications.
Distinguish primary and secondary form of the disease. The primary form is found in children quite early, in infancy, and, as a rule, is hereditary. This is considered quite a rare phenomenon and quickly leads to the development of serious complications - kidney failure or urolithiasis.
More often, secondary dysmetabolic kidney nephropathy associated with various endogenous and exogenous factors - nutrition, medication, a violation of the exchange of certain substances in the child's body.
Physicians share dismetabolic nephropathies into several species, depending on which crystals of what salts are present in the urine of a small patient.
In children, the most common types of disease, such as:
- Oxaluria, associated with the presence in the urine analysis of a high content of oxalates. This type of nephropathy is 85-90% of all cases encountered in practice.
- Uraturia, or a high urate content in urine - salts of uric acid.
- Phosphaturia, characterized by the appearance in the analysis of a small patient of phosphate.
- Cystine nephropathy occurs with a high concentration in the urine of cystine, the methionine metabolite.
- Mixed form of the disease - oxalate / phosphate-urate.
None of the above forms is not able to manifest itself in newborns. The most observant parents may notice that the urine of the child has become cloudy, and the walls of the pot are covered with sediment, but it is usually rare which adults connect these signs with the presence of the disease.
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All types of dysmetabolic nephropathy have their own causes, signs and treatment plan. Let us consider them in more detail.
Most of the dismetabolic nephropathy is associated with the increased content of oxalate salts in the child's body. This type of pathology can be divided into oxalate-calcium nephropathy and oxaluria.
Oxalate-calcium nephropathy is mainly caused by a violation in the body of a child calcium metabolism or exchange of oxalates. The reasons for this may be several:
- is a genetic predisposition to disease. Quite often, one of the parents of a suffering child has a disease associated with a metabolic disorder, for example, diabetes mellitus;
- pathological processes in the intestine. Impaired absorption of food, as a rule, leads to changes in metabolic processes, and, as a result, to kidney diseases. And if the child already suffers from Crohn's disease or ulcerative lesions of the intestine, this becomes an additional provoking factor in the development of oxalate nephropathy;
- infringements of a drinking mode by the child, connected with small use of water;
- vitamin deficiency, in particular, insufficient intake of B vitamins into the body;
- excess amount of ascorbic acid supplied with food.
It is almost impossible to detect oxaluria in a child, especially since the first manifestations of pathology can be detected even in the period of newborn. At an older age, the disease manifests itself as general fatigue, increased urine output, headaches, allergies. There are no specific symptoms characteristic of the development of nephropathy.
For the final diagnosis, the child must first pass a urinalysis test for the daily excretion of oxalates, then conduct an ultrasound examination of the urinary system to detect oxalate inclusions( small crystals in the form of sand or large stones in the kidneys).
Diet is the fundamental principle of treatment. Complete recovery is impossible without adherence to a special diet, whose goal is to reduce the intake of oxalic acid with food. In the daily diet of the child, there must be no products containing oxalic acid: cocoa, sorrel, citrus fruits, chocolate and its derivatives, broths and canned products.
The child is allowed to eat liquid dairy products( yogurt, kefir, milk), cereals, legumes, neutral vegetables and fruits( zucchini, cabbage, turnips, sweet apples and pears, apricots and peaches), watermelons and melons, pasta.
Treatment of dismetabolic nephropathy involves a diet for 2 weeks, during which the metabolism should be adjusted, after which a break is made for the same time:
- The reception of wheat bran and oats decoction helps to remove excess salts from the child's body and normalizes the stool.
- Compliance with the drinking regime. The more ordinary or mineral non-carbonated in the water consumes a child during the day, the greater the volume of urine is released from him during the day. Thus there is a significant decrease in salts in the body. It is recommended to give plenty to drink in the evening hours.
- Medication therapy. Treatment with drugs always gives positive results, only if the diet is observed. The usual scheme of treatment of oxaluria includes the intake of vitamins, in particular group B, vitamins A and E, magnesium preparations( magnesium B6, magnesium, magnesium oxide), membrane stabilizing substances( xidiphon and dimephosphon), phytotherapy.
Good results in the treatment of oxalate-calcium nephropathy showed the drug xidiphon. It regulates the exchange of calcium in the body, preventing the deposition of its salts in the tissues.
Membrane-Protector Dimephosphon deserves special attention in the therapy of oxaluria. Dimephosphon normalizes the acid-base balance in the blood of a small patient, the acidity of the blood decreases. Treatment can take a long time, so parents should be patient.
The prognosis in curing such patients is favorable, after a full course of drug therapy in combination with a diet, recovery comes very quickly. However, for the future, it should be remembered that a child with a diagnosis of oxaluria should constantly consume large amounts of fluid, monitor his diet, and treat intestinal diseases in a timely manner.
A less common type of nephropathy, like oxaluria, but still the second most common among children. Uraturia is characterized by an increased content and loss of uric acid salts in urine. Urturia can be hereditary in nature or accompany some diseases - hemolytic anemia, pyelonephritis.
In addition to heredity, the causes of uraturia are:
- errors in nutrition, excess in the diet of baby purine products - strong broths, meat, chocolate, canned food;
- long-term use of certain types of drugs - diuretics, cytostatics.
If the uraturia is not treated, then a surplus of uric acid may soon lead to a formidable disease - gouty arthritis.
Symptoms of uraturia are rather blurred, with a small amount of salts in the urine, their presence is by no means felt by the baby. In a later period, with a serious overabundance of urates, a child can become easily excitable, capricious, tearfulness prevails. Further, deposits of salts in the joints are formed, itchy skin rashes, and sometimes complications from the breath in the form of asthma attacks.
It is possible to suspect uraturia in a child by changing the color of its urine, with an excess of uric acid, the urine becomes reddish-brown in color. However, the main method of investigation is an ordinary blood test. In addition, the doctor can recommend taking a blood test for uric acid and acidity. The course of urate nephropathy
In the treatment of urate nephropathy, the following principles should be adhered to:
- Diet. Sometimes only changes in the diet are enough to improve the analysis and complete disposal of excess uric acid salts. When treating uraturia from a child's diet, veal, young pork, lamb and broths of meat, all by-products, tea, coffee and cocoa, chocolate, fatty fish and soy products should be excluded. Do not give muffin rolls, sweets, fried and smoked.
In the morning hours it is allowed to give the baby low-fat boiled fish and low-fat boiled meat, but not more often than a couple of times a week.
Dairy products are allowed, melons( watermelon and melon), cereals, sweet berries, dried rye bread, vegetarian soups, a large number of vegetables.
A drinking regimen similar to that of oxaluria. As a rule, urates appear in concentrated urine, so the child must consume at least 1.5 liters of simple and alkaline minerals without gas.
For faster recovery, doctors recommend taking course medication with drugs that help reduce uric acid levels. These include Allopurinol, Ciloric, Milurit.
To enhance the outflow of urine in therapy, Phytolysin, Kanefron and Urolesan are used.
Equally, as in the previous case, vitamin-mineral complexes with a high content of vitamins B and C are used in the therapy of uraturia. This greatly improves metabolism and helps to alleviate the condition of the sick child.
Control of baby nutrition and timely treatment will allow you to quickly adjust the condition of the baby and keep him healthy for many years.
Phosphaturia occurs in 3-10 cases of 100 and is associated with the loss of phosphate in the urine.
Phosphate nephropathy is always associated with a violation of calcium phosphate metabolism and it happens for the following reasons:
Causes and Diagnosis of Phosphate Nephropathy
- disorders in feeding a baby or a nursing mother - the predominance of plant foods and fish in the diet, excessive use of soda;
- kidney pathology;
- inflammatory kidney disease.
It should be noted that the diagnosis of a small amount of phosphate in the baby's urine should not be considered a serious deviation from the norm, this condition is normal and does not require treatment. Sometimes it is enough to adjust the nutrition, and the tests immediately come back to normal.
It is the correction of the diet in most cases helps to correct the situation and allows you to do without medication support. Meal and fish dishes should be present in the child's nutrition at the rate of 1 gram of protein per 1 kg of weight, porridge, sour vegetables and berries. It is necessary to limit dairy products, salted, smoked and fried, sweets and buns.
A young child diagnosed with phosphate nephropathy should consume more acidic juices, use of a tea fungus or apple cider vinegar, as recommended by a doctor. This is due to the alkaline reaction of urine, in which phosphates are formed. In a more acidic environment, the phosphate precipitate does not fall out.
In addition, it is recommended to drink at least 1.5 liters of normal water per day in order to dilute the concentration of urine.
It is not superfluous to receive vitamin A at the age dosage and the drug Kanefron for removing excess salts from the baby's body.
Cystine nephropathy is caused by excessive accumulation of cystine in the kidneys. The causes of this condition are mostly hereditary pathologies of the kidneys. Sometimes cystinuria occurs due to the defeat of the kidneys after the transferred infectious diseases.
The precipitation of cystine salts in the urine unequivocally indicates a pathological process and requires additional examinations - biochemical analysis of urine, ultrasound examination of the kidneys and bladder.
In cystinuria, as well as with another form of dysmetabolic nephropathy, the child is shown a therapeutic diet. In this case, the child should be limited in the diet of protein products - cottage cheese, eggs, fish and meat. The duration of the therapeutic diet is 1 month, after which the diet is slightly expanded and gradually introduce meat dishes.
Drinking regimen should be observed: the child is shown to drink at least 2 liters of liquid per day, the bulk of the liquid should be in the evening.
Drug treatment provides a course of nephroprotectors - Kuprenil, Blemaren, Penicillamine, supporting kidney work in a normal state. The reception of citrate mixture and vitamin complexes is shown.
More than half of the cases of development of dysmetabolic nephropathies with adequate therapy and following the recommendations of doctors end in complete recovery of the child. In order to prevent a recurring form of the disease, it is necessary to carefully monitor the child's health, to treat inflammatory diseases in time, to monitor the baby's nutrition and to comply with the drinking regime even outside the period of exacerbation.
As a preventive measure, even during periods of persistent remission, try to follow the prescribed diet and periodically take urine analysis for salt content.