Рефлюксная нефропатия у детей: патогенез и прогноз. Часть 1


DOI: https://dx.doi.org/10.18565/urology.2021.3.150-154

О.Л. Морозова, Д.Ю. Лакомова, Н.Б. Захарова, Л.Д. Мальцева, З.Ш. Манасова, Д.А. Морозов

1) ФГАОУ ВО «Первый МГМУ им. И. М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия; 2) ФГБОУ ВО «Саратовский ГМУ им. В. И. Разумовского» Минздрава России, Саратов, Россия
Целью данного обзора стала обработка и систематизация накопленного материала относительно механизмов почечного повреждения и его прогрессирования на фоне пузырно-мочеточникового рефлюкса (ПМР). ПМР – наиболее частый вариант нарушения уродинамики у детей, а рефлюксная нефропатия (РН) как его основное осложнение занимает первое место среди причин хронической болезни почек (ХБП). В первой части обзора подробно представлены факторы риска формирования и прогрессирования РН. В рамках данного вопроса изложены основные методы лечения ПМР и ассоциированной с ним инфекции мочевыводящих путей. Рассмотрены возможности консервативного и хирургического методов устранения рефлюкса в профилактике развития и прогнозирования течения РН. Изложены основные патоморфологические аспекты формирования РН.
Ключевые слова: повреждение почек, рефлюкс-нефропатия, пузырно-мочеточниковый рефлюкс, дети, факторы риска
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Литература

1. Morris A.P., Le T.H., Wu H., et. al. Trans-ethnic kidney function association study reveals putative causal genes and effects on kidney-specific disease aetiologies. Nat. Commun. 2019;10(1):29. Doi: 10.1038/s41467-018-07867-7.


2. Dong S., Wang C., Li X., et. al. Noncoding rare variants of TBX6 in congenital anomalies of the kidney and urinary tract. 2019; 294(2):493–500. Doi: 10.1007/s00438-018-1522-6.


3. Urisarri A., Gil M., Mandiá N., et. al. Retrospective study to identify risk factors for chronic kidney disease in children with congenitalsolitary functioning kidney detected by neonatal renal ultrasound screening. Medicine (Baltimore). 2018;97(32):e11819. Doi: 10.1097/MD.0000000000011819.


4. Chu D.I., Abraham A.G., Tasian G.E., et. al. Urologic Care and Progression to End-Stage Kidney Disease: A Chronic Kidney Disease in Children (CKiD) Nested Case-Control Study. J Pediatr Urol. 2009;15(3), 266.e1–266.e7. Doi: 10.1016/j.jpurol.2019.03.008


5. Nazlı D.G., Meryem B., Şebnem Tekin-Neijmann. Is There Any Relation Between Connective Tissue Growth Factor and Scar Tissue in Vesicoureteral Reflux? Turk J Pediatr. 2019;61(1):71–78. Doi: 10.24953/turkjped.2019.01.011.


6. Hideshi M., Yutaro H., Takahiko M., et. al. Guidelines for the Medical Management of Pediatric Vesicoureteral Reflux. Int J Urol. 2020 Doi: 10.1111/iju.142231689/5000.


7. Tullus K. Vesicoureteric reflux in children. Lancet. 2015;385(9965):371–379. Doi: 10.1016/S0140-6736(14)60383-4.


8. Jakub Zieg. Vesicoureteric Reflux in Children: Many Questions Still Unanswered. Cas Lek Cesk. 2016;155(3):31–34.


9. Thergaonkar R.W., Hari P. Current Management of Urinary Tract Infection and Vesicoureteral Reflux. Indian J Pediatr. 2019. Doi.10.1007/s12098-019-03099-9.


10. Narothama R. Aeddula; Krishna M. Baradhi. Reflux Nephropathy. In: StatPearls


11. Ashlene M.M., Siah K., Sean E.K. Long-term Outcome of Kidney Transplantation in Patients With Congenital Anomalies of the Kidney and Urinary Tract. Pediatr Nephrol. 2019;34(11):2409–2415. Doi: 10.1007/s00467-019-04300-z.


12. Danka P., Irmina S.P., Amela B. Vesicoureteral Reflux and Renal Scarring in Infants After the First Febrile Urinary Tract Infection. Med Arch. 2018;72(4):272–275. Doi: 10.5455/medarh.2018.72.272-275.


13. Mattoo T.K., Chesney R.W., Greenfield S.P., et. al. RIVUR Trial Investigators. Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. Clin J Am Soc Nephrol. 2016;11(1):54–61. Doi: 10.2215/CJN.05210515.


14. Balakrishna B., Seema P.S., Soma S.K., et. al. Renal scarring following urinary tract infections in children. Sudan J Paediatr. 2019;19(1):25–30. Doi: 10.24911/SJP.106-1554791193.


15. Swerkersson S., Jodal U., Sixt R., et. al. Urinary tract infection in small children: the evolution of renal damage over time. Pediatr Nephrol. 2017;32(10):1907–1913. Doi: 10.1007/s00467-017-3705-5.


16. İsa Y., Harun P., Fatma H.Y., et. al. Association of Vesicoureteral Reflux and Renal Scarring in Urinary Tract Infections.


17. Erman M. V. Reflux-nephropathy in children. Medicine of the XXI century. 2006;4(5);28-33. Russian (Эрман М.В. Рефлюкс-нефропатия у детей. Медицина ХХІ век. 2006;4(5);28–33).


18. Murugapoopathy V., McCusker C., Gupta I.R. The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis. Pediatr Nephrol. 2020;35(3):349–357. Doi: 10.1007/s00467-018-4187-9.


19. Zorin I.V., Vyalkova A.A. Prediction of progression of tubulointerstitial damage in children with reflux nephropathy. Nephrology (Saint-Petersburg). 2015;19(3):65–71.


20. Coulthard M.G., Verber I., Jani J.C., et. al. Can prompt treatment of childhood UTI prevent kidney scarring Pediatr Nephrol. 2009;24(10):2059–2063. Doi: 10.1007/s00467-009-1233-7.


21. Begoña R.A., José M.R., Sonia S.C., et. al. Renal Scarring in Children Under 36 Months Hospitalised for Acute Pyelonephritis. An Pediatr (Barc). 2017;86(2):76–80. Doi: 10.1016/j.anpedi.2016.03.002.


22. Beiraghdar F., Panahi Y., Einollahi B., et. al. Predisposing factors for renal scarring in children with urinary tract infection. Saudi J Kidney Dis Transplant. 2012;23(3):532–537.


23. Pokrajac D., Sefic-Pasic I., Begic A. Vesicoureteral Reflux and Renal Scarring in Infants After the First Febrile Urinary Tract Infection. Med Arch. 2018;72:272–275. Doi: 10.5455/medarh.2018.72.272-275.


24. Ademola B.L., Atanda A.T., Aji S.A., Abdu A. Clinical, morphologic and histological features of chronic pyelonephritis: An 8-year review. Niger Postgrad Med J. 2020;27(1):37–41. Doi: 10.4103/npmj.npmj_109_19.


25. Andrew JK., Angela MA. Evolving Surgical Management of Pediatric Vesicoureteral Reflux: Is Open Ureteral Reimplantation Still the ‘Gold Standard’? Int Braz J Urol. 2020;46(3):314–321 Doi: 10.1590/S1677-5538.IBJU.2020.99.05.


26. Thergaonkar R.W., Hari P. Current Management of Urinary Tract Infection and Vesicoureteral Reflux. Indian J Pediatr. 2019. Doi: 10.1007/s12098-019-03099-9.


27. Sara F., Andrés G.F., Isabel C.A., et. al. Endoscopic Treatment of Vesicoureteral Reflux in Infants. Can We Do It and Should We Do It? Urology. 2017;110:196–200. Doi: 10.1016/j.urology.2017.08.005.


28. Çitamak B., Bozaci A.C., Altan M., et. al. Surgical outcome of patients with vesicoureteral reflux from a single institution in reference to the ESPU guidelines: a retrospective analysis. J Pediatr Urol. 2019;15(1):73.e1–73.e6. Doi: 10.1016/j.jpurol.2018.10.017.


29. Josef Oswald. Surgical Treatment of Vesicoureteral Reflux in the First Year of Life? Aktuelle Urol. 2020;51(2):158–164. Doi: 10.1055/a-1044-5310.


30. Akhmetshin R.Z. Problems of prevention of progression of chronic kidney disease in children with congenital malformations of the urinary system. Medical Bulletin of Bashkortostan. 2017;3(69):6–13. Russian (Ахметшин Р.З. Проблемы профилактики прогрессирования хронической болезни почек у детей с врожденными пороками развития мочевыводящей системы. Медицинский вестник Башкортостана. 2017;3(69):6–13).


31. Alvarez N., Alvira R.D., Ruiz Y.G., et. al. Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center. Cent European J Urol. 2018;71(1):142–147. Doi: 10.5173/ceju.2018.1513.


32. Josefin N., Sofia S., Ulla S.,et. al. The Swedish Infant High-Grade Reflux Trial: UTI and Renal Damage. J Pediatr Urol. 2017;13(2):146–154. Doi: 10.1016/j.jpurol.2016.12.023.


33. Caleb PN., Katherine C.H., Paul J.K., et. al. Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux. J Pediatr Urol. 2013;9:92–98. Doi: 10.1016/j.jpurol.2011.12.009.


34. Daniel H., Paul M., Leslie Q. Continuous Antibiotic Prophylaxis Reduces the Risk of Febrile UTI in Children With Asymptomatic Antenatal Hydronephrosis With Either Ureteral Dilation, High-Grade Vesicoureteral Reflux, or Ureterovesical Junction Obstruction. PMID: 25155409. J Pediatr Urol. 2014;10(4):650–654. Doi: 10.1016/j.jpurol.2014.06.009.


35. William M., Claudio L.S., Irene A., Giovanni M. Acute Pyelonephritis in Children. Pediatr Nephrol. 2016;31(8):1253–1265. Doi: 10.1007/s00467-015-3168-5.


36. Schröder A. Vesicoureteral Reflux: Watchful Waiting, Surgery or Antibiotic Prophylaxis? Urologe A. 2017;56(9):1158–1163. Doi: 10.1007/s00120-017-0453-x.


37. Anraku T., Obara K., Tasaki M., Tomita Y. Retrospective Analysis to Determine the Optimal Timing to Discontinue Continuous Antibiotic Prophylaxis in Patients with Primary Vesicoureteral Reflux. Urol Int. 2019;102(4):462–467. Doi: 10.1159/000497312.


38. Ian K.H., Marco P., William M., et. al. Prophylaxis for Urinary Tract Infection–Related Renal Scarring: A Systematic Review. Pediatrics May 2017;139(5):e20163145. Doi: 10.1542/peds.2016–3145.


39. Wang H.H., Kurtz M., Logvinenko T., Nelson C. Why Does Prevention of Recurrent Urinary Tract Infection not Result in Less Renal Scarring? A Deeper Dive into the RIVUR Trial. J Urol. 2019;202(2):400–405. Doi: 10.1097/JU.0000000000000292.


40. Patrick D.O., Lisa K.L., Alic L., et. al. Renal Scar Formation and Kidney Function Following Antibiotic-Treated Murine Pyelonephritis. Dis Model Mech. 2017;10(11):1371–1379. Doi: 10.1242/dmm.030130.


41. Nastaran S., Shabnam S., Mohammad J.M., et. al. Prevention of Renal Scarring in Acute Pyelonephritis by Probiotic Therapy: An Experimental Study. Probiotics Antimicrob Proteins. 2019;11(1):158–164. Doi: 10.1007/s12602-017-9363-x.


42. Ted L., John M.P. Vesicoureteral Reflux and Continuous Prophylactic Antibiotics. Investig Clin Urol. 2017;58 (Suppl 1):S32–S37. Doi: 10.4111/icu.2017.58.S1.S32.


43. Beetz R. Is there still no alternative to long-term antibacterial prophylaxis? Urologe A. 2020;59(3):255–260. Doi: 10.1007/s00120-020-01139-3.


44. Klinkhammer B.M., Goldschmeding R., Floege J., Boor P. Treatment of renal fibrosis turning challenges into opportunities. Adv. Chronic Kidney Dis. 2017;24:117–129. Doi: 10.1053/j.ackd.2016.11.002.


45. Pottier N., Cauffiez C., Perrais M., et. al. Translating molecular discoveries into new anti-fibrotic drugs. Trends Pharmacol. Sci. 2014;35:119–126. Doi: 10.1016/j.tips.2014.01.003.


46. Simona G., Claudia B., Giovanni G., et. al. Kidney Allograft Fibrosis: What We Learned From Latest Translational Research Studies. J Nephrol. 2020. Doi: 10.1007/s40620-020-00726-z.


47. Lu P., Takai K., Weaver V.M., Werb Z. Extracellular matrix degradation and remodeling in development and disease. Cold Spring Harb. Perspect. Biol. 2011;3:a005058. Doi: 10.1101/cshperspect.a005058.


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