The state system of the specialized pediatric nephrological care is created and fruitfully works in Russia.

Modern data about prevalence, etiology and pathogenesis of nocturnal enuresis are presented. The nocturnal enuresis meets at children till 5 years in 15 % of cases. It is a heterogeneous disorder with a whole variety of etiologic factors (genetic, endocrinological, neurobiological), particularly a dysfunction of the lower urinary tract. This is polietiologic disease in which development various factors (genetic, endocrine, neurogenetic), being accompanied dysfunction of the bottom urinary ways can take part. Despite the prevalence of enuresis many questions regarding its pathophysiological mechanisms remain disputable. There are three pathogenetic mechanisms that have sufficient scientific support: nocturnal polyuria, nocturnal detrusor overactivity and high arousal thresholds. Nocturnal polyuria is often explained by a nocturnal lack of the antidiuretic pituitary hormone vasopressin. At primary nocturnal enuresis the urine incontience is noted at night from the moment of the birth. At secondary nocturnal enuresis arises in 6 months after the birth. Primary night enuresis associates with a night polyuriya, increased renal sodium excretion, higher secretion of prostaglandins. Desmopressin markedly reduced nocturnal urine output in patients with enuresis, minimizing sodium, urea and overall solute excretion.

This review is a generalisation of modern conceptions about Bartter Syndrome – autosomal-recessive tubulopathy with impairment of K, Na, Cl transport system in distal tubule in the thick ascending limb of Henle’s loop. Data about K, Na, Cl transport regulation mechanisms, pathogenic and clinical features are generalized. The diagnostic algorithms and approachs to the treatment of Bartter Syndrom in children are presented.

The review of literature summarizes data on features of development and of a current, data on outcomes of the hereditary, congenital and acquired cystic diseases of kidneys at children. The algorithm of diagnostics and the modern directions in treatment of cystic diseases are presented.

AIM OF RESEARCH. To estimate concentrations of serum amyloid precursor protein (serum amyloid A protein – SAA) in blood of children with juvenile rheumatoid arthritis (JRA), to compare SAA concentration with pathology of urine analyses. PATIENTS AND METHODS. 60 children with JRA were examined. Сoncentration SAA in blood of patients was measured by an enzyme linked immunoelectrodiffusion essay. Dynamics of clinical urine analyses, daily proteinuria, total protein value, serum albumin value, glomerular filtration rate (GFR) were estimated by endogenous creatinine clearance. RESULTS. 31 of 60 patients (51,7%) had normal urine analyses. 29 patients (48,3%) had proteinuria, 28 from them had daily proteinuria value less than 1g/m2/24h. One patient with rheumatoid renal amyloidosis because of long-standing systemic JRA had proteinuria up to 33g/m2/24h, GFR - 40 ml/min, maximal SAA concentration 828 mg/l. 59 of 60 patients with JRA had normal GFR according to endogenous creatinine clearance. Increased blood SAA concentration (292,3±30,9 mg/l) was revealed in 56 of 60 children (93,3%). In 31 patients with JRA without proteinuria in 28 (90,3%) was observed increased SAA concentration (205,7±44,3 mg/l). In 28 of 29 patients with proteinuria (96,6%) was determined increased blood SAA concentration (378,8±36,7 mg/l). SAA concentration in 28 patients with proteinuria (378,8±36,7 mg/l) was authentically higher than SAA (205,7±44,3 mg/l) in blood of 28 patients without proteinuria. CONCLUSION. In 93,3% patients with JRA increased blood SAA concentration was determined. The results revealed that blood SAA concentration in patients with JRA and proteinuria was higher than in patients without proteinuria.

AIM OF RESEARCH – to examine the prevalence, dynamics, and regional causes of urinary tract diseases in children in the Primorye. MATERIAL AND METHODS. We used epidemiological, hygienic, clinical and statistical methods. In estimating of long-term morbidity rate dynamics average annual growth rate was calculated. Mapping was performed on the basis of ranked epidemiological factors of risk of disease. Selection of the children for the medical examination was carried out using the sampling method with elements of randomization and the use of computer software random number generator. Indigenous inhabitants of areas were examined. RESULTS. It has prtesented child population urinary system morbidity analysis results in Primorye 1998-2010 are. Increase of kidney diseases in children. Poor prognosis is counted: in the next five years 3 times increase of frequency of urinary tract infections in children, 2 times for adolescents, increase of chronic kidney disease – 2.5 times. The reasons for the development of kidney diseases: high frequency of urinary system congenital malformations, antropotehnogenic situation and climatic conditions in some areas, inadequate and/or poor nutrition, mild low-mineralized water in water supply systems with deficiency of many nutrients. CONCLUSION. Knowing of morbidity objective data provided to make reasonable management decisions regarding the implementation of the scientific program for the risk group formation and early detection of urinary system diseases in Primorsky Krai with prognostic evaluation tables for neonatal screening.

AIM OF RESEARCH – to estimate physical fitness of children with vesicoureteral reflux (VUR) with usage of international standards and local guides. PATIENTS AND METHODS. Performed comparison of z-values of length, weight and body-weight index of children in two groups – with VUR 1-3 stage and VUR 4 stage and over and reflux nephropathy. RESULTS. It was established growth impairment which depends on disease severity and progresses with age with high grade of reflux and reflux nephropathy in children with VUR. At high grade intensity of VUR prevailed quantity of children with low body-weight index with wide scatter of values. In children with VUR body-weight index was usually lower than in healthy children. CONCLUSION. Suggested z-values of physical fitness increase analysis effectiveness because of parametric methods high sensitivity to potential inhomogeneity in sampling.

AIM OF THE STUDY - to optimize early diagnostics of pyelonephritis at children with congenital malformation of urinary system. PATIENTS AND METHODS. In article results of complex studying of risk factors and clinico-paraclinical features of pyelonephritis at 240 children with congenital malformation of urinary system, and also new data on level of organospecific enzymes neutral α-glucosidase and L-alaninaminopeptidase in urine at children with congenital malformation of urinary system and patients with pyelonephritis are presented. RESULTS. In this group of patients changes of a structurally functional condition of proximal and distal tubules of kidneys and indicators of intrarenal haemodynamics to a stage of demonstration of pyelonephritis are shown at children with congenital malformation of urinary system. CONCLUSION. Application of advanced diagnostics of pyelonephritis on a complex of parameters of a structurally functional condition of kidneys and a fermenturiya gives the chance to predict pyelonephritis development, to carry out its early diagnostics and timely prevention at congenital malformation of urinary system at children.

AIM OF RESEARCH. To assess the role of hemogram and immunogram parameters for predicting the course of acute kidney injury (AKI) in children. PATIENTS AND METHODS. 272 children (boys/girls, 155/117, aged 35,3±2,6 months) were included in the study. 252 patients (92,65%) received conservative treatment and renal replacement therapy by intermittent hemodialysis (HD). The number of HD session averaged to 5,4±0 per 1 patient (1-21). 20 children (7,35%) received only conservative treatment. Proportion of patients with hemolytic-uremic syndrome amounted to 73,1%, those with glomerulonephritis – 6,2%, acute interstitial nephritis – 5,5%; other causes (acute intestinal infections, acute exogenous poisonings, abdominal surgical pathology, tumor lysis syndrome, meningococcal infection, etc.) made up 15,2%. Depending on the outcome of the disease, 2 groups of patients were formed: the 1st group included those who survived (65,5%), the 2nd group comprised those who died (34,5%). Morphologic structure of formed blood elements was investigated in all the examined children with the help of standard testing sets and automatic analyzers. Erythrocyte and leukocyte indices were determined, such as mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red deviation wide (RDW), mean platelet volume (MPV). Leukocyte reactivity indices were measured, such as nuclear shift and lymphocyte indices. The levels of immune complexes in blood serum and the amount of serum immunoglobulins A, G and M were determined. The data obtained in children from both the groups were compared depending on the AKI period: oligoanuria, initial diuresis, polyuria and clinical recovery, which corresponded to the 1st, 2nd, 3d and 4th weeks of the disease. RESULTS. Significant decrease in MCV (71,47±4,23 and 79,03±0,78, accordingly, р=0,0118057) and in lymphocyte index (0,52±0,02 and 0,71±0,03, accordingly, р=0,000002), as well as more pronounced leukocytosis (13,43±0,75 and 10,54±0,33·109 accordingly, р=0,000089) were observed in children of the 2nd group as compared with the 1st one. In all cases of the unfavorable ARF outcome, leukogram dynamics had no signs of the inflammatory process termination and was characterized by monocyto-, lymphocyto- and eosinopenia. CONCLUSION. Dynamic analysis of the hemogram findings with the determination of erythrocyte and leukocyte indices, as well as IgА, G and М levels allows predicting the ARF course and outcome. Prolonged microcytosis (more than 2 weeks), decreased lymphocyte index (less than 0,31) with no increase in dynamics, decreased IgA and IgG levels in blood serum by 50% and more from normal values are considered to be prognostically unfavorable factors of the ARF course and outcome.

Infection of the urinary system (UTI) is the most common abnormality of childhood. A key sign of urinary tract infection is bacteriuria. The main laboratory method of examination of patients with suspected UTI is the microbiological analysis of urine. Microbiological features of UTI in children of the Orenburg region are determined and proposed methods for estimating the etiologic significance urological flora.

The case of antiphospholipid syndrome and congenital thrombophilia development in patient with lupus nephritis is described. The diagnostic significance of detailed assessment of hemostasis system and allelic polymorphism of some genes, associated with dysfunction of blood coagulation system, immunological and morphological analysis of kidney biopsy material in lupus nephritis is shown.