RESUMO
The authors studied biomicroscopic picture of microcirculation in the vessels of bulbar conjunctiva, renal hemodynamics, blood cell metabolism in 50 patients aged 3-12 with renal and ureteral defects. By morphology of the kidneys assessed at aortography, computer renangiography and other tests 2 groups of children were identified: bilateral congenital urological disorder combined with severe advanced dysplasia of the renal tissue and the ureter, low renal function (group 1); light or moderate disorder of renal function, minimal dysplasia of the renal tissue. In children with renal and urinary defects with renal dysfunction there was systemic abnormal microcirculation (group 1) characterized by severe capillarotrophic insufficiency in the form of unusual winding of all the microvessels, formation of vascular loops and balls, narrowing of capillary lumen, etc. in the presence of acute arteriolar spasm and rheological alterations in microvessels. In addition to functional changes in arteriolar tone, mechanisms of microcirculatory disturbances in children with congenital surgical disorders of the kidneys and urinary tracts involve membrane-destructive processes. Changes in phospholipids level and their spectrum in plasma and red cell membranes, a rise in the activity of phospholipase A and C in the serum and red cell membranes exhibit close correlation with microhemodynamic impairment. Instructions are provided for conduction of preoperative preparation and multicomponent anaesthesia with allowances for principal mechanisms of microcirculatory disorders in children with severe congenital renal and urinary affections.
