Progress of diagnostics and therapy in paediatric nephrology

Urinary tract infections (UTI) in paediatric practice are the second, after infections of the respiratory tract, in terms of frequency in location of bacterial infections. According to epidemiological data, UTI account for 10-20% of community-acquired infections and for 40-50% of hospital infections. Recurrent infections of the urinary system may to lead to renal parenchyma lesions. In the event of damage of renal tubular epithelial cells, lipopolysaccharide-induced renal failure in the course of infection caused by Gram-negative bacteria toll-like receptors (TLR), especially TLR4, plays a fundamental role. Among causes of recurrent urinary tract infection may be cystitis cystica or squamous metaplasia of the urinary bladder. Cystitis cystica is inflammation of the mucous and submucous membrane of the urinary bladder. Vesicoureteral reflux is the most common urological problem in children, and has been reported in 30-50% of children who present with urinary tract infection. Vesicoureteral reflux with urinary tract infection can lead to renal scarring. Children with scarred kidneys are predisposed to hypertension and chronic renal failure. Reflux nephropathy is recognized as a major cause of chronic kidney disease (CKD) in children and young adults, due to congenital anomalies of the kidney and urinary tract. Early chronic kidney disease is now known to be a relatively common problem. Indirect evidence suggest there are high rates of CKD due to immune-mediated glomerular disease, especially focal glomerulosclerosis in children. In the presence of significant proteinuria, hypertension is a cardinal factor in generating progressive renal impairment. It seems sensible to use drugs which reduce proteinuria and systemic blood pressure for renoprotective effect. These include angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Reduction in proteinuria on antihypertensive therapy is a good prognostic sign for children with chronic kidney disease.