The application of technologies of Extracorporal hemocorrection in the complex therapy of Cystitis and Pyelonephritis, is allowed:
- in short periods to restore the activity of immune system
- to deliver antibacterial preparations directly into the center of infectious inflammation
- 6 - 8 times to reduce the course doses of antibacterial preparations, and means to decrease the negative action of antibiotics on the organism of patient
- to assuredly choke the activity of infectious process
- 2 - 3 times to reduce the periods of the treatment
Among the diseases of kidneys us first of all interest such illnesses, as glomerulonephritis and pyelonephritis.
The problem of glomerulonephritis occupies central place in neprology. To this illness in the medical literature is devoted more attention, than to all remaining defeats of kidneys. The urgency of this illness is determined by its prevalence - glomerulonephritis is diagnosed in 1/3 all nefrologicheskikh patients, by gravity of forecast - in the substantial part of the patients disease is accompanied by the development of the progressive chronic renal insufficiency (CRI), and also by the insufficient effectiveness of drug therapy.
In the etiology of disease, until now, is much obscure, nevertheless, according to the contemporary ideas glomerulonephritis - this is the disease, in development of which determining be the processes of the immune inflammation, which damage the basic structural elements of kidneys - renal glomerules.
The Pathogenesis of glomerulonephritis is composed of three stages: the stage of immune component, hypercoagulation and inflammation. Traditionally disease is developed according to the following diagram. There is an antigen, which can be either exogenous or endogenous. In the role of antigens can come out the antigenic structures of microorganisms, some medicines, salts of heavy metals. By antigens also can be the tissular elements of their own kidneys, which changed their structure as a result of damage previously chemical or toxic factors.
To the appearance within the limits of the organism of foreign antigen immune system reacts by the production of the factors, directed toward their neutralization. First of all the antibodies (AB) are such factors. Subsequently the disease can be developed according to the following variants:
- Antibodies, interactive with the antigens, are formed unique structures - the immune complexes, which circulate in the blood stream.
- Kidneys are filter, passing during 4 minutes through themselves practically entire blood, in this case immune complexes formed deposits in the glomerular filter, causing subsequently the damage of the renal glomerules and other elements of nephritic tissue.
- Antibodies can directly interact with the structural elements of renal glomerules, causing the process of immune inflammation and their damage.
The activity of immune inflammation leads to the hypercoagulation and the microcirculatory disturbances. The fibrinoid necrosis of nephritic capillaries is the consequence of this. Subsequently reactive inflammation is joined.
Finally all these processes lead to the damage of the structural elements of renal tissue and the disturbance of the function of kidneys, what clinically can be manifested by the development of the specific syndromes - urinary, nephrotic, hypertensive, or by their combination.
With the treatment of patient by glomerulonephritis for the action on each of it is sectional pathologic process they are used different methods of drug therapy.
For the action on the immune component are used the cytostatics and corticosteroids, to the hypercoagulation - anticoagulants and antiaggregants, to the component of inflammation - nonsteroid antiinflammatory preparations. If necessary is conducted hypotensive, anti-edematous, hemostatic therapy.
In this case, one should say that the problem of the treatment of glomerulonephritis - remains one of the sharp in nephrology. Numerous studies confirm the very indeterminate results of different it is specific therapy. Moreover, many indices attest to the fact that the untreated patients live so many, how much and treated. All this bears out the fact that it is necessary to search for new directions in the treatment of this illness.
One of the ways capable of considerably improving the outcome of treatment and of optimizing forecast with this illness is the application of methods of extracorporeal hemocorrection.
It is necessary to say that application in the treatment of glomerulonephritis of this method of extracorporeal hemocorrection, as plasmapheresis - it is not new. At present by different clinical schools the method of plasmapheresis , not frequently, but it adapts.
The basic purposes of the application of plasmapheresis are:
- reduction in the activity of immune inflammation,
- the decrease of the manifestation of endogenous intoxication,
- the correction of side effects with conducting of therapy by cytostatics.
Some positive effect in this case certainly is achieved. However, from our point of view the isolated application of plasmapheresis in the treatment of this group of diseases unjustifiably - too prohibitive a luxury is the nonselective removal of all protein fractions in patients with initially existing hypoproteinemia.
Such nonselective methods of extracorporeal hemocorrection as plasmapheresis, hemosorption - separately by us in practice is not used for this reason. For us these methods are purely official. Included as the initial in the developed comprehensive programs of extracorporeal hemocorrection, these methods they make it possible to obtain the initial components of the blood for their further modification.
With the treatment of patients with glomerulonephritis we is oriented to the stage of disease, the predominance in the clinical picture of various manifestations of it, the laboratory indices, the specific features of this patient. In accordance with obtained initial data, by us is compiled the individual program of the methods of extracorporeal hemocorrection, which consists of the separate modules, each of which is directed toward the correction of those determined it is sectional pathologic process. Into the composition of such modules enter the methods of extracorporeal hemocorrection, that has the strictly defined specific character.
- so for the suppression of the activity of the process of immune inflammation by us they are used the complexes of the methods of extracorporeal hemocorrection, which include: the incubation of cellular mass with the immunomodulators, the cryomodification of autoplasma, the methods of restoring the receptor activity of the cells of the immune system, which make it possible to clean the receptors of the cell-regulators of immune system and to restore their normal exchange of data carriers.
- for the correction of hypercoagulation and disturbances of microcirculation by us adapt the methods of extracorporeal hemocorrection, which can restore a rheological properties of blood - thermomodification of autoplasma, the the wave working of the blood
- for the purpose of the preventive maintenance of the infectious diseases, which provoke the aggravation of chronic glomerulonephritis, and for treating the already developed infectious diseases we use the methods of the extracorporal antibacterial therapy, developed by us and previously already shown their high efficiency
In the process studies are located the modules of extracorporeal hemocorrection, which make it possible differentially to act on the activity of separate it is sectional immunity - cellular and humoral. The use of these modules will make it possible purposeful to suppress the processes of immune inflammation, without decreasing the immunological protection of organism as a whole.
Pyelonephritis - disease, which is encountered in all age classes; however, more than 70% patients with pyelonephritis relate to the age class from 20 to 40 years, i.e., this illness strikes people at the working age.
At the basis of the development of pyelonephritis lie the disturbance of urodynamics and the loss of the resistance of the tissue of kidneys to the infection with the subsequent development of the inflammatory process, which consecutively all structures of renal tissue.
Is schematic the development of pyelonephritis it is possible to represent as follows.
As a result of any reasons the normal urine outflow is disrupted. The disturbance of urodinamics leads to the stagnation of urine in renal pelvis and an increase in the pressure in it this. It, in turn, leads to the development of reflux, i.e., to the throw of urine back into the renal tissue. The urine being stood too long in the wash-tub very rapidly is infected, i.e., occurs the reflux not of the sterile, but infected urine, which creates prerequisites for the infection of most nephritic tissue. Subsequently the process of infectious inflammation applies to all structures of renal tissue. In the kidney as a result of the prolonged inflammatory process the processes of sclerotization and progressive disturbance of functions begin.
For the clinical picture of pyelonephritis the development of the following syndromes is characteristic:
The treatment of pyelonephritis includes the measures, directed toward the elimination of the factors, which facilitate the development of disease and measures, directed toward the correction of the developed pathologic processes.
The elimination of the factors, which lead to the disturbance of urodinamiki, more frequently relates to the scope of urologists, i.e. - it requires some surgical intervention.
The disturbance of the resistance of mucosa the urinary tracts and tissue of kidney to the infection - is the consequence of many reasons, among which on one of the first places is located the inadequacy of immunological protection. This is confirmed by the fact that among the microorganisms, which cause the development of infectious process, the majority relates to the microorganisms, which under normal conditions wonderfully it lives together with the man, without causing to it harm. These microorganisms are capable of being activated only with the presence of immune insufficiency. The corrections of this component of pathologic process do not usually pay a sufficient attention.
Thus, in the first place in the treatment of pyelonephritis usually find antibacterial therapy. In the mild cases conducting usual antibacterial therapy makes it possible to sufficiently rapidly choke the activity of infectious process. With the disease, which takes place with the high activity of infectious process, the possibilities of traditional antibacterial therapy prove to be very limited. This is connected with the fact that the antibacterial therapy with pyelonephritis is conducted against the background of the initially disrupted function of kidneys.
Our experience shows that competent application of methods of extracorporeal hemocorrection in the treatment of pyelonephritis, gives the possibility to considerably improve its results.
The programs of extracorporeal hemocorrection, which we use with the treatment of pyelonephritis, include first of all the methods of the extracorporeal immunocorrection, which make it possible to restore the disrupted resistance of nephritic tissue to the infection. We already spoke about considerably higher efficiency of these methods in the comparison with the methods of usual drug therapy.
In parallel we use the methods of the extracorporal antibacterial therapy, whose application with the treatment of this illness is especially shown, since the possibility to considerably reduce summary medicinal load on the organism of patient gives, and it means to decrease the risk of the second medicinal damage of kidneys.
In the cases of the manifestation of intoxication we use the metods of extracorporeal hemocorrection, which have predominantly detoxification directivity, for example, such as plasmasorption.
The results of the complex therapy of pyelonephritis, which include the application of methods of extracorporeal hemocorrection, demonstrate them considerably higher efficiency. The application of programs of extracorporeal hemocorrection allows 2 - 3 times to reduce the periods of treatment, to improve its outcomes. The methods of extracorporeal immunopharmacotherapy, used by us, make it possible not only more rapidly to manage the infection, but to treat preventively the subsequent relapses of disease.
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