Pediatrics. Consilium Medicum

The history of urine testing is deeply rooted in ancient times. Ancient civilizations mastered the art of urine testing by its appearance, and later, this test was deeply seated as an integral diagnostic method, as evidenced by numerous historical documents. Ancient knowledge, systematized and communicated through written sources, remains the basis for diagnosis and medical practice. Uroscopy, initially a visual-descriptive method, has been improved using modern technologies. To date, new opportunities for urine testing have become available, which has drastically changed clinical practice. The article presents the key takeaways of the history of studying the composition and properties of urine and also prospects for this diagnostic method.

Vesicoureteral reflux (VUR) is the main precipitating factor of urinary tract infection (UTI) in children and one of the most debatable and common diseases in pediatric urology and nephrology. The article analyzes foreign publications on the urinary microbiome in children with VUR. Despite disagreements over non-surgical treatment of VUR, continuous antibiotic prophylaxis, which is prescribed for a long time at a prophylactic dosage, is currently considered the standard of care for young children with VUR of varying grades. The urinary microbiome research is at its early stage. Like the gut microbiome, the UT microbiome (urobiome) is formed from the first days of life. One of the most significant factors that can disrupt the development of a healthy microbiome is the use of antibiotics prescribed to children during the first years of life in various dosages for a long time. The study of their effect on the microbial architecture of the gut and the overall microbiome is becoming a key priority of modern research. The primary source of the microbiome is the environment and the intestine. Studies of the change in the composition of the microbiome in young children with VUR who received non-surgical treatment with continuous antibiotic prophylaxis have demonstrated that this group of children is prone to a high concentration of enterobacteria, such as Klebsiella spp. and Escherichia coli, which increases the risk of exacerbation of UT inflammatory diseases.

Renal Fanconi syndrome is a generalized disorder of the proximal convoluted tubule, characterized by non-selective aminoaciduria, glucosuria, low molecular weight proteinuria, phosphaturia, loss of bicarbonates, electrolytes and many other substances. Autosomal dominant Fanconi renotubular syndromes due to a GATM missense-variant, encodes mitochondrial enzyme arginine-glycine amidinotransferase. In total, 36 cases of genetically confirmed Fanconi renotubular syndrome, type 1 have been reported to date from 10 families. In this article, we present the first Russian cases of two unrelated patients with previously undescribed variants c.1076C>T (p.Ser359Phe) and c.1079T>A (p.Met360Lys) in the GATM gene. The first clinical features of the disease with complete Fanconi syndrome were diagnosed in both cases in early childhood. A decrease of renal function was detected in each of cases already during the first examinations, but the rate of progression was different. The patient 1 had a rate of eGFR decline of 0.6 ml/min/1.73 m² per year, whereas patient 2 demonstrated a higher rate of eGFR decline (-2.1 ml/min/1.73 m²/year). Symptomatic therapy resulted in normalization of growth rates and a decrease in the activity of rickets in patient 1. In patient 2, despite the therapy, signs of osteomalacia persisted, and rachitic deformities of the limbs required orthopedic correction.

Progressive loss of kidney function is associated with significant morbidity and mortality and is an important global health concern, given the high prevalence of chronic kidney disease (CKD). Recently, there has been an increased interest in finding new therapeutic strategies that may slow the progression of renal dysfunction. Numerous studies using various experimental models have proven that treatment with active metabolites of vitamin D can have a renoprotective effect, preventing fibrosis, apoptosis, and inflammation. In addition, vitamin D deficiency and insufficiency are common conditions in CKD patients in the pre-dialysis stages. It has been established that the vitamin D serum level is directly proportional to kidney function. Recent clinical studies have shown that reducing proteinuria and mortality in CKD patients receiving active vitamin D goes beyond the classical role of vitamin D in maintaining bone and mineral metabolism. Therefore, vitamin D analogs have the potential to become components of CKD treatment to achieve better clinical outcomes in patients with advanced kidney disease and those on hemodialysis. Current guidelines recommend treatment with vitamin D only in patients with moderate CKD with secondary hyperparathyroidism and vitamin D deficiency. This review presents the results of numerous studies demonstrating the prevalence of vitamin D deficiency among patients with various kidney diseases, the effect of vitamin D in reducing the rate of CKD progression, as well as the clinical outcomes of vitamin D use in patients with infectious and non-infectious kidney diseases.

Teething is an important stage in every child's life. It can be accompanied by a deterioration in the general well-being of children, leading to increased irritability, sleep disturbance, local signs of inflammation, swelling, redness, and soreness of the gums. The article presents the authors' data on the use of dental gel Cholisal® in varying degrees of inflammation in the teething area and changes in the general well-being of children. The method of using Cholisal® gel in a child aged 9 months with severe mucous membrane inflammation due to tooth eruption is described in a clinical case.

Background. The smell is the most important "signaling" function, and its deterioration significantly reduces the quality of life. Available methods of subjective olfactory assessment, which do not require special expensive equipment, allow for primary "screening" in outpatient settings and at home. Considering the causes of impairment and especially the lack of smell, it is crucial to be aware of congenital anosmia (isolated and familial, requiring examination of the child's blood relatives) in pediatric practice.

Aim. To evaluate the results of "family" subjective olfactometry.

Materials and methods. Subjective olfactometry was performed in patients who visited an otorhinolaryngologist and their parents/legal representatives after history taking and a routine ENT examination/endoscopy of ENT organs (in all children and adults, in case of acute or exacerbation of chronic ENT condition at the time of examination), using a professional kit consisting of 12 odorants and cards with four response options for each of the proposed odors. The obtained results were recorded in Excel spreadsheets for further statistical processing.

Results. We examined 64 families: 132 subjects (64 children and 68 adults), including 31 girls and 33 boys aged 6 to 17 years and 64 women and 4 men aged 32 to 47 years. The reason for visiting an otorhinolaryngologist was symptoms related to the ENT organs in children and smell impairment in 1 (1.6%) case. Olfactory disorders were detected only in children: hyposmia (59.4%) and a single (1.6%) case of anosmia. When identifying odors in "child-parent" pairs, the match of "misidentified" odorants was noted only in 19 (29.65%) families; in 34 (53.1%) pairs, children performed better than their parents. The list of difficult-to-perceive odorants almost matched in children and adults, but there were differences in the frequency of "recognition" of a particular smell.

Conclusion. "Family" subjective olfactometry is necessary to confirm/exclude congenital familial/hereditary olfactory impairment, while only data obtained from the consanguineous relatives of the child should be considered. The presence and involvement of parents/legal representatives in the examination process increase the child's compliance and contribute to greater psychological comfort, which improves the test performance. Repeated/multiple use of odorants unfamiliar to the subject (olfactory training) may improve the re-examination results. The data obtained (the match of "misidentified odorants" and a child and a parent in 29.65% of cases and the correct choice of an odorant by a child with an incorrect parent's answer in 53.1%) do not support the hypothesis of family "ignorance" of a particular odorant.

Phytotherapy is one of the oldest, but not outdated methods of treatment, it is based on centuries-old traditions of different peoples, when people empirically, by trial and error, looked for ways of healing in nature. Today, a wealth of knowledge has been accumulated on the use of plants. The article shows the influence of various historical periods on the development of phytotherapy. Human health is influenced by various factors – hereditary, lifestyle, environmental factors, and recently there has been an increase in demand for herbal preparations. Progressive doctors in search of effective drugs are increasingly turning to plants for help, however, modern phytotherapy should be based exclusively on scientifically recognized facts and operate with standardized drugs used for therapeutic or prophylactic purposes. Particular attention is paid to the features of the use of phytotherapy in pediatric practice: dosing depending on the age and body weight of the child, the adequacy of the method of administration of the drug using children's dosage forms, taking into account the physiological and pathological characteristics of the child's body, etc. Phytotherapy is gaining serious positions, and a pediatrician needs deep knowledge in one of the most promising areas of medical science in the future for effective clinical practice.

Inflammatory bowel diseases (IBD) include two main entities: ulcerative colitis (UC) and Crohn's disease (CD). Despite the awareness of specialists, the knowledge of pathogenesis, and advances in diagnostics, there are still patients in whom the clinical, endoscopic, and histological presentation does not fully correspond to one of the diseases, which is defined as undifferentiated colitis. Subsequently, some of these cases are verified as UC or CD; however, other patients are followed up for a long time with an uncertain diagnosis. Nevertheless, differential diagnosis is crucial for the choice of therapeutic tactics, risk assessment of surgical treatment, and prognosis of colorectal cancer. The article aims to demonstrate the challenges of differential diagnosis of UC and CD in a child with rectal stenosis. In the described case, low compliance in a girl with UC led to significant errors in traditional therapy regimens, the development of complications that irreversibly change the anatomical structure of the colon and complicate the examination, mimicking the course of stenosing CD. The clinical case emphasizes the need for more detailed criteria for differential diagnosis and additional therapeutic algorithms, with an earlier use of genetically engineered biological agents as disease-modifying therapy.