Autonomic status in children with chronic pyelonephritis at the initial stages of chronic kidney disease

Abstract

Background. The determination of vegetative homeostasis in children is one of the components of the assessment of the organism adaptive mechanisms in chronic pathology. The purpose was the evaluation of vegetative homeostasis to estimate the formation and severity of adaptive mechanisms in children and adolescents with chronic pyelonephritis. Materials and methods. One-hundred and fifteen children aged from 6 to 17 years (53 boys, 62 girls) without exacerbation of chronic pyelonephritis were examined. The control group consisted of 60 apparently healthy children at the same age. The state of the autonomic nervous system was assessed by the parameters of the initial vegetative tone, vegetative reactivity, vegetative control of the activity ­using cardiointervalography and orthostatic test. Results. The patients with chronic pyelonephritis presented enhanced activity of sympathetic nervous system and depressed parasympathetic tone in the initial vegetative tone. Furthermore, tension index, reflecting the degree of stress regulating mechanisms, statistically significantly exceeded the normal values in patients with II–III stage chronic kidney di­sease in all age groups. With the chronic kidney disease progres­sing, the hypersympathicotonic variant of vegetative reactivity changed to asympathicotonic. Thus, the pathological variants predominate in autonomic control of the cardiac acti­vity in patients with chronic pyelonephritis. This testifies the progressive deficiency and depletion of adaptive resources of an organism. Conclusions. Changes in vegetative homeostasis in patients with chronic pyelonephritis show tension of the adaptive mechanisms of the cardiovascular system and a significant reduction of adaptive capacity.

Keywords

• children
• chronic pyelonephritis
• chronic kidney disease
• vegetative homeostasis
• sympathetic hyperactivity