Early Diagnosing and Predicting the Course of Tubulointerstitial Kidney Disease in Children

Purpose. To determine biomarkers for early diagnosing and prognosing the course of various types of TIBP in children. Materials and methods. A clinical and paraclinical examination and prospective observation of 120 children with TIBP and 30 children in the control group aged from 1 year to 17 years were carried out. Group 1 patients were identified as presenting TIBP without signs of CKD (n=50); group 2 patients were identified as presenting TIBP with CKD formation (n=70). Statistical processing of the material was carried out using Statistica 10.0 program. Results. In progressive course of TIBP in children, clinical and paraclinical as well as structural and functional features are characterized by high frequency of kidney pathology in the family (67.2%) and perinatal pathology (74.3%); clinically by increasing frequency of arterial hypertension (72.9%); frequent relapses of renal infection in the history (80%); impaired intrarenal hemodynamics with decreased systolic and diastolic intrarenal blood flow velocity; decreased GFR and tubular function indicators (100%), allowing their use as informative criteria for assessing TIBP progression in children. Indicators of endothelial function and cytokine status in children with TIBP differ from those in the control group and depend on its course variants with a significantly higher increase in endothelin-1, cystatin C, and homocysteine levels in serum and plasminogen activation inhibitor-1 in plasma, increased urinary lipocalin associated with neutrophil gelatinase level and daily urine IL-1, IL-6, IL-8, TNF-β, and TNF-α levels in progressive course of the disease. Increased levels of endothelial dysfunction indicators combined with urinary excretion of pro-sclerotic and pro-inflammatory cytokines and growth factor, and decreased urinary excretion of anti-inflammatory cytokine are predictors of progressing TIBP course in children. Conclusion. The criteria for predicting the progressive course of TILD with CKD formation were substantiated by assessing the leading pathogenetic factors obtained using multivariate analysis and calculating TILD course index using the Wald test. Prognostic criteria for the progressive course of TIBP are: increased levels of endothelin-1, cystatin C and homocysteine in the blood serum, plasminogen activation inhibitor type 1 in the blood plasma, urinary levels of lipocalin associated with neutrophil gelatinase, 24-hour urine levels of IL-1, IL-6, IL-8, TGF-β, and TNF-α. © 2024, Professionalnye Izdaniya. All rights reserved.