ОЦЕНКА ФАКТОРОВ РИСКА ПРОГРЕССИРОВАНИЯ ВТОРИЧНЫХ ГЛОМЕРУЛОПАТИЙ У ДЕТЕЙ

Abstract

The problem of glomerular kidney damage remains relevant in pediatric nephrology due to the variety of reasons for its development and tendency to progression. According to the data of the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy, glomerulopathies (GP) occupy 2nd place in the structure of the causes of end-stage chronic kidney disease (CKD). The peculiarities of the course of GP dictate the need to search for informative predictors of the risk of adverse events, which will predict and prevent renal damage with a high degree of probability. Purpose of the study: to determine the rate of progression of secondary GP in children and to establish the main risk factors for its development. Materials and methods. 118 patients who were under observation and treatment at the Belarusian Center for Pediatric Nephrology and Renal Replacement Therapy of the "2nd Children's City Clinical Hospital" in Minsk, aged 3 to 17 years, were included in the study. We used the method of continuous targeted selection of patients with morphologically verified kidney damage due to the systemic disease. The analysis of the data of 4 study groups was carried out: 1) children with SLE, lupus nephritis (LN), retrospective group, n = 30; 2) children with SLE, LN, prospective group, n = 35; 3) patients with nephritis due to IgA vasculitis Schoenlein- Henoch (IgAV), n = 33; 4) patients with nephritis due to systemic vasculitis (SV), including ANCA-associated (AAV), n = 20. The duration of the period from the onset of the disease to reaching the 3rd stage of CKD and predictors that determine the rate of progression of GP using Kaplan-Meier method was studied. Results. Anamnestic, clinical, laboratory, immunological (blood concentration of markers of T and B lymphocyte activation RANTES and BAFF), proinflammatory (caspase 1, IL1e and TNFa), vascular (VEGF) and tissue (TGF1fi) growth factors), metabolic status (adiponectin, leptin, obestatin, vitamin D 25 (OH) D), instrumental, morphological changes were analyzed. Each of the variables was considered as a likely risk factor for the progression of GP. Conclusion. A mathematical model has been developed for predicting the risk of progression of secondary GP in children, including risk factors as predictors: anamnestic factors of kidney damage, non-compliance with therapy, persistent nephrotic proteinuria, increased serum creatinine over 200 umol/l. The predictive accuracy of the model was 93,6 % (95 % CI 84,8-100 %).