What is pyelonephritis in children symptoms. Acute pyelonephritis: how to recognize the disease and help the child. Symptoms of an acute form of the disease

Pyelonephritis is an inflammation of the kidneys of an infectious nature. This disease is common among children, especially preschool age. In terms of incidence, he took second place after respiratory infections and is able to act as their complication. To cope with the disease, it is important to correctly diagnose pyelonephritis in children, not confusing it with clinically similar cystitis or urethritis.

The main causes of pyelonephritis in infection with pathogenic microbes. Bacteria, mainly E. coli, as well as viruses and fungi, can act as the causative agent. In the chronic form of the disease, several pathological microorganisms are usually found simultaneously.

Pathogenic microbes enter the excretory system in various ways:

1. Hematogenous, that is, by blood flow from foci of infection to other organs. This route of infection is common in babies up to a year old. The disease they often develops after pneumonia, otitis media, influenza. In older children, this method is only possible in case of a serious bacterial infection, for example, sepsis.
2. Lymphogenic. The infection enters the kidneys through the common lymphatic system between the organs of the excretory system and the gastrointestinal tract. This is facilitated by stagnation of lymph in gastrointestinal disorders, intestinal infections.
3. Ascending. From the bladder, excretory and genital organs, the infection rises to the kidneys.

The latter route of infection is considered the most common in children older than a year. Girls get sick more often because of the peculiarities of their anatomy.

Who is prone to illness

There are certain factors that contribute to the spread of infection:

• Anomalies of the excretory organs;
• Stones in the urinary system;
• Vesicoureteral reflux;
• Excess vitamin D;
• Hypotrophy;
• Enzyme deficiency;
• Undertreated or urethritis;
• Dysmetabolic nephropathy;
• Chronic infectious diseases (tonsillitis, sinusitis);
• Complications after diseases of an infectious nature - SARS, mumps, others;
• Insufficient personal hygiene;
• Hypothermia.

In babies under one year old, the risk factor may be the transition to artificial nutrition, the appearance of the first teeth, the introduction of complementary foods, and other processes that increase the load on the defense system.

In addition, even a healthy and vigorous child can be affected by an ailment if the pathogen turns out to be aggressive and resistant to the action of immune mechanisms.

What types of pyelonephritis are distinguished by nephrologists

Like most diseases, pyelonephritis in children can occur in acute and chronic forms with different symptoms and duration.

Acute pyelonephritis in children, it heals quite quickly - in a month or two. Treatment of chronic pyelonephritis in children is delayed for at least six months, periodic relapses are possible.

Important! In rare cases chronic pyelonephritis in children it is latent, asymptomatic, but with poor test results.

The disease can be primary, that is, not dependent on the state of the urinary organs, and secondary. Secondary pyelonephritis in children occurs against the background of anomalies of the excretory system and can be obstructive - with functional disorders or non-obstructive - with dysmetabolic disorders. A child is diagnosed with chronic secondary pyelonephritis if there are changes in the structure of the kidneys, other congenital pathologies of the excretory system. Also, the disease is classified by localization, subdivided into unilateral and bilateral.

Pyelonephritis in children symptoms and treatment

Symptoms and treatment of pyelonephritis in children vary depending on the age of the child, the form and severity of the disease, its cause, and comorbidities.

In crumbs up to a year, the disease manifests itself in the form of a sharp rise in temperature to almost 40 degrees, dryness and pallor of the skin with a bluish halo around the mouth. The baby becomes lethargic, refuses to eat, cries. Most babies tense up and grunt when urinating, and the urine turns dark and smells bad.

Often in babies, the disease is accompanied by an upset stomach and vomiting. In conjunction with high temperature this makes it difficult to make a diagnosis due to the similarity of the clinic with intestinal infections.

The main signs of acute pyelonephritis in older children:

• Temperature rise to 38 degrees and above;
• Lethargy or feverish state;
• pale skin and bags under the eyes;
• Lack of appetite, nausea, vomiting;
• Darkening of urine and change in its smell;
• Drawing pains in the peritoneum and lumbar region.

Some children have a violation of urination and slight swelling of the face.

Chronic pyelonephritis in children, if it is not in a latent form, is characterized by a change in periods of remission and exacerbations. The latter are manifested by the same signs as the acute form of the disease. Additionally, children who are chronically ill are more likely to get tired and do worse at school. If the illness torments the baby with early age, a delay in psychomotor and physical development is possible.

What is the diagnosis

Suspecting inflammation of the kidneys, the pediatrician refers the young patient to a pediatric nephrologist. In addition to an external examination, the diagnosis of pyelonephritis in children includes:

• General analysis and biochemistry of urine and blood;
• Quantitative samples according to Zimnitsky, Amburge, Addis-Kakovsky, Nechiporenko;
• The study of diuresis, sediment, enzymes, urine pH;
• Bakposev and antibiogram;
• Test for fungi and viruses;
• Cytological studies to identify atypical cells;
• Ultrasound procedure kidneys and bladder;
• Cystometry;
• Urography, cystography;
• Ultrasound of renal blood flow;
• Computed tomography.

Pyelonephritis characterizes an increase in leukocytes in the urine, as well as the number of microorganisms (bacteriuria) more than 100,000/1 ml. In this case, proteinuria is less than 1 g / l, and the number of neutrophils grows by more than 50 percent. Chronic form with kidney failure leads to an increase in the level of urea and creatinine and a decrease in total protein.

Is it possible to cure pyelonephritis in a child completely

This disease requires long-term therapy, but can be cured completely. How to treat pyelonephritis in children depends on its form, the nature of inflammation and the presence of pathological changes in the kidneys.

Any type of illness requires a change in diet, especially during exacerbations. The diet for pyelonephritis in children is aimed at reducing the load on the kidneys and correcting metabolic disorders. Dietstol No. 5 is recommended without salt restriction and an increase in the amount of fluid if the baby does not have kidney dysfunctions. Otherwise, salt and liquid will have to be limited. Useful protein-vegetable dishes. You need to exclude fried, fatty and spicy.

Important! The decision to hospitalize a sick child is made by the attending physician. But in any case, the baby needs a weekly bed rest.

If necessary, the child is placed in the nephrological or urological department of the hospital. Infants under one year old with acute pyelonephritis are also better treated in a hospital.

The easiest way to cure primary acute pyelonephritis. But if the disease returns 2 weeks after recovery, then the pathogen has not been completely eliminated, there is a risk of getting a chronic form of the disease. A more thorough study and a new therapeutic course are required.

What drugs will the doctor prescribe

Treatment of pyelonephritis in children includes:

Other pharmaceuticals are also used in therapeutic courses: antiviral, antipyretic, antispasmodics for pain, to restore microflora.

By agreement with the doctor, phytotherapy is possible. Decoctions from diuretic and anti-inflammatory plants (horsetail, lingonberry leaf, bearberry, nettle, sage) are suitable. In the pharmacy you can buy ready-made kidney teas and herbal remedies "Fitolizin", "Kanefron", "Cyston". All herbal remedies remove fluid from the body, remove swelling, have a disinfecting and anti-inflammatory effect.

Important! After treatment, the child should continue to be observed by a nephrologist so that there are no relapses. Yes, once a month general study urine, once every six months - ultrasound of the kidneys. Removed from the register of a child who had acute pyelonephritis, after 5 years without relapse.

In the chronic form of the disease during exacerbations, a treatment similar to that of acute pyelonephritis is used. During remission, anti-relapse measures are necessary: ​​courses of antibiotics and uroseptics in reduced doses and herbal medicine.

How to prevent the return of the disease?

If pyelonephritis is not treated in time, it can cause serious illness. The acute form is complicated by purulent processes - abscesses, urosepsis and others. Chronic - renal dysfunction.

To avoid dangerous consequences and the transition of the disease into a chronic form, you must follow all the therapeutic recommendations of the doctor. Prevention of pyelonephritis in children is also important:

• Clothing for the season, without overheating and hypothermia;
• strengthening immune system- walks in nature, hardening, sports within reasonable limits;
• Control of the regularity of trips to the toilet "in a small way";

Symptoms of pyelonephritis in children are often absent or erased, and only a doctor will help to make a diagnosis in this situation. But parents still need to know the characteristic signs of manifestation this disease in your child for the early detection of pathology and the appointment of adequate treatment.

What is pyelonephritis

Pyelonephritis is a common disease in children. This is an infectious-inflammatory process and it affects pelvic system kidneys and their tubules.

This disease manifests itself from the earliest age of the child. Doctors put it in second place after acute respiratory infections. But not all parents are aware of the close relationship between these two, at first glance, unrelated diseases.

In most cases, this disease occurs in schoolchildren, in rare cases it can be diagnosed in infants and preschool children.

Usmanov Sh.S., doctor the highest category, urologist, Candidate of Medical Sciences, Clinic "Medical On Group", Kazan

Symptoms of pyelonephritis in children 3 years old may be similar to other diseases.

Pyelonephritis of the kidneys in children often manifests itself after a severe respiratory illness suffered the day before, which can give serious complications.

Doctors-specialists note that it is girls who in most cases are prone to this pathology. This is due characteristic features structure of the female body.

Causes

Inflammatory processes of an infectious nature in the kidneys can be caused by bacteria, viruses or fungal infections.

The cause of pyelonephritis can be, for example, a disease such as.

The main causative agent is E. coli, viruses and bacteria. However, when chronic degree the course of the disease in the human body, there are several such pathogens.

Ways and causes of pathogens entering the kidneys:

1. The hematogenous route is the entry of the pathogen to the lesion (kidneys) through the blood. In most cases, this is observed in infants who have recently suffered pneumonia or otitis media. In schoolchildren, infection by the hematogenous route occurs as a result of sepsis.
2. Lymphogenic infection occurs as a result of infection from the intestines to the urinary organs. This infection is observed in those who suffer from frequent disorders in the digestive system, constipation or diarrhea. As a result, the functions of the intestinal mucosa are disrupted.
3. The most common route of infection is through the urethra. or sexual organs. In these cases, bacteria rise up and attack the kidneys. However, this problem is more prevalent in girls.

Forms of the course of the disease

AT medical practice There are two types of inflammatory process in the kidneys, namely, the acute and chronic form of the course of the disease.

One of the signs of pyelonephritis in children is an increase in body temperature.

Chronic pyelonephritis, the symptoms of which appear for 6 or more months, are recurrent or latent in the course of the disease.

With a relapsing form, the temperature rises, urination is disturbed, weakness appears. In the latent form, there are no signs at all.

Acute pyelonephritis, the symptoms of which are manifested in acute pain and an increase in body temperature, it is easier to determine than chronic.

Acute pyelonephritis in children, the treatment of which is characterized by quick recovery disappears after a few months.

In addition to chronic and acute forms of diseases, pediatricians also distinguish the primary degree of the disease and the secondary one.

The primary form is due to the onset of the inflammatory process in the kidneys, and the secondary develops as a result of a different kind of disease. , at first glance, not related to the work of the kidneys.

Acute pyelonephritis: symptoms and signs

As mentioned earlier, the causes of the disease are often infectious and inflammatory processes, viruses and bacteria that penetrate the kidneys.

To get the disease out acute form has not become chronic, it is important for parents to recognize the symptoms of acute pyelonephritis in time and seek advice from a specialist in this field as soon as possible.

We note the main signs of acute pyelonephritis in children, namely, the symptoms of pyelonephritis in children 2 years of age and older:

1. An increase in body temperature or chills when the thermometer shows above 38 degrees.
2. Intoxication - nausea, less often, darkening in the eyes, dizziness or fainting, drowsiness and lack of appetite.
3. Pain sensations. Children under the age of 3 who do not yet understand the symptoms of pain may complain of pain throughout the abdomen, less often in the area around the navel. A teenager of school age, able to distinguish pain, can feel it in the lumbar region, namely on one side - below.
4. One of the symptoms of pyelonephritis in children, which is less common, is.
5. There may be slight swelling of the face or limbs, but only in the morning. Pronounced puffiness indicates a different type of disease, since this disease is not characterized by severe edema.
6. The color of urine (darkens or becomes cloudy), in rare cases, its smell intensifies.

Parents should know: the younger their child, the more severe the symptoms will be with manifestations of the acute form. Inevitable nausea, vomiting, severe pain and high temperature.

Chronic form

Symptoms of chronic pyelonephritis are not as pronounced as in the acute course of the disease. In most cases, they are characterized by fatigue, nausea and pallor of the skin, so in this case it is very difficult to make a diagnosis.

recurrent chronic view The disease manifests itself in the following symptoms:

• pain in the back or abdomen;
• violation in urination;
• weakness;
• increase in body temperature.

For a latent species, this is not typical and, basically, the disease is always asymptomatic. Therefore, it is important for parents to monitor the health of their child and periodically conduct a comprehensive examination.

Only a general urine test will help to identify the disease, which will show characteristic changes in the content of leukocytes and.

Safronov D.B., urologist, doctor of the highest category, clinic "Mother and Child", Perm

Pyelonephritis is insidious and often has no symptoms, which is why it is so important to have preventive checkups. Delayed treatment disease is less effective.

Symptoms in children under one year old

Babies cannot tell their parents about their pains and worries. That's why symptoms of pyelonephritis in infants are manifested in the form of anxiety, crying, often diarrhea, as a result, children under one year old may be misdiagnosed, interpreting it.

In addition, the symptoms of pyelonephritis in children under one year old are observed in the form of:

• body temperature reaching 39-40 degrees;
• changes in skin color (pallor and dryness of the skin);
• frequent;
• in rare cases of refusal breastfeeding resulting in a decrease in body weight.

Signs of illness in infants can be confused with intestinal diseases , this manifests itself in the form of indigestion (diarrhea)

Diagnostics

Often, the disease is asymptomatic and therefore, in this situation, tests for pyelonephritis are very important, which can both confirm and refute this diagnosis.

When contacting a doctor for the diagnosis of pyelonephritis, it is necessary first of all to report complaints, which include pain in the lateral region below the abdomen or lumbar, fever, disorders in the urinary system.

When palpation of the abdomen, the baby often experiences pain However, an appropriate diagnosis can only be made after passing a complete laboratory examination.

When diagnosing pyelonephritis, ultrasound of the kidneys is mandatory.

Diagnosis of chronic and acute pyelonephritis involves the following laboratory tests:

• General urine analysis;
• Urine according to Zimnitsky and urine according to Nechiporenko;
• with pyelonephritis;
• Renal angiography;
• CT scan of the kidneys;
• Ultrasound procedure;
• Blood chemistry;
• Urodynamic studies.

How to properly collect urine

Urine with pyelonephritis is one of the most important analyzes for history.

However, not all parents know how to properly collect a portion for urinalysis with pyelonephritis.

Urinalysis should be collected in the morning, after washing the baby so that microorganisms do not get into the container, then the first portion must be flushed down the toilet, and the middle one must be collected in a special container.

Accumulative analyzes, for example, such as according to Nechiporenko, are collected during the day, also in an average portion in a common container. You can find out how to collect a urine test according to Nechiporenko

A prerequisite for diagnosing pyelonephritis in a child is to pass urine for analysis and at the same time collect it correctly

The study of urine for sterility is carried out directly in the hospital.

Many parents of babies are wondering: how to collect urine from someone who is still in a diaper?

In recent years, special containers have appeared in pharmacies, with which you can easily collect the required portion.

Below is a table of indicators of the norm.

Indicators	1 day life	1-12 months of life	1-6 years old	7-12 years old
Hemoglobin	180-240	115-135	110-140	110-145
red blood cells	4,3-7,6	3,8-4,9	3,5-4,5	3,5-4,7
color indicator	0,85-1,15	0,85-1,15	0,85-1,15	0,85-1,15
platelets	180-490	180-400	160-390	160-380
ESR	2-4	4-10	4-12	4-12
Leukocytes	8,5-24,5	6-12	5-12	4-9
Eosinophils	0,5-6	0,5-7	0,5-7	0,5-7
Lymphocytes	12-36	40-72	26-60	25-55
Monocytes	2-12	2-12	2-10	2-10

Normal analysis indicators according to Nicheporenko:

• Leukocytes up to 2000;
• Erythrocytes up to 1000;
• Cylinders are normally no more than 20.

Treatment of pyelonephritis in children

After examining the laboratory symptoms, the treatment of pyelonephritis in children should be carried out in a hospital.

Firstly, in the treatment of kidney pyelonephritis, the patient is assigned bed rest for at least a week, or even more.

Treatment of pyelonephritis in children in the early stages is based on a special diet., which excludes all fried, salty, sour, carbonated drinks and teas.

With pyelonephritis, children need to refrain from spicy, salty, fried foods

After a sick baby, a complex medical treatment is prescribed and it consists in taking anti-inflammatory, analgesic, diuretic drugs and antibiotics.

The main drugs for treatment are: Tavirid, Urogram, Glamurin, Zanocin, Kanefron, in addition, antifungal drugs and vitamin complexes are prescribed.

Treatment of pyelonephritis at home is carried out only after consulting a doctor. Alternative methods of treatment can be auxiliary, and they should be used only in parallel with the main drug course of treatment, after consulting with your doctor.

Sokolov A.M., urologist, clinic "Miracle Doctor", Moscow


Treatment of the acute form must be agreed with the doctor without fail.

Parents categorically should not self-medicate, so as not to aggravate the situation, since in this case the disease can take a chronic form, after which it will take much more time for treatment and rehabilitation.

Prevention measures

The main measures for the prevention of pyelonephritis in children are:

The best prevention pyelonephritis - protect your child from all sorts of infections, adherence to sleep, food and drink regimen
• compliance with the drinking regime according to age;
• timely emptying of the bladder and intestines;
• treatment of inflammatory processes in other organs;
• preventive examinations of the body.

This ailment in the younger generation is often asymptomatic, so scheduled visits to your pediatrician should not be postponed.

And if the symptoms of pyelonephritis in children still appear, then in this case, parents should visit a specialist as soon as possible. As a result of laboratory research The doctor is able to make an appropriate diagnosis with full confidence.

Pyelonephritis is a nonspecific infectious and inflammatory disease of the kidneys with a primary lesion of the pelvicalyceal system (PCS), tubules and interstitium. According to the classification of the World Health Organization (WHO), pyelonephritis belongs to the group of tubulointerstitial nephritis and is actually tubulointerstitial nephritis of infectious origin.

To date, the question of the primary and secondary nature of pyelonephritis, especially chronic, as well as the role of urinary tract obstruction in the development of one or another of its variants, remains relevant. These signs form the basis for the classification of pyelonephritis.

There is no generally accepted classification of pyelonephritis today. The most commonly used classification proposed by M. Ya. Studenikin and co-authors in 1980 ( ), which determines the form (primary, secondary), the nature of the course (acute, chronic), disease activity and kidney function. V. G. Maydannik et al. (2002) also suggested indicating the stage of the pyelonephritic process (infiltrative, sclerotic) and the degree of disease activity.

Pyelonephritis is called primary, in which during the examination it is not possible to identify any factors that contribute to the fixation of microorganisms in the kidney tissue, that is, when the microbial-inflammatory process develops in an initially healthy organ. Secondary pyelonephritis is due to specific factors.

In turn, secondary pyelonephritis is divided into obstructive and non-obstructive. Secondary obstructive develops against the background of organic (congenital, hereditary and acquired) or functional disorders of urodynamics; secondary non-obstructive - against the background of dysmetabolic disorders (secondary dysmetabolic pyelonephritis), hemodynamic disorders, immunodeficiency states, endocrine disorders, etc.

The concept of primary or secondary disease undergoes significant changes over time. Clinical and experimental data convincingly indicate that without a preliminary violation of urodynamics, the pyelonephritic process practically does not develop. Obstruction of the urinary tract implies not only the presence of a mechanical obstruction to the flow of urine, but also functional disorders of activity, such as hyper- or hypokinesia, dystonia. From this point of view, primary pyelonephritis no longer implies any absence of a violation of the passage of urine, since dynamic changes in urinary excretion are not excluded.

Primary pyelonephritis is quite rare - no more than 10% of all cases, and its share in the structure of the disease decreases as the methods of examining the patient improve.

It is also very conditional to classify secondary dysmetabolic pyelonephritis as non-obstructive, since in this variant obstruction of the renal tubules and collecting ducts by salt crystals is always observed.

Acute and chronic pyelonephritis is distinguished depending on the duration of the pathological process and features. clinical manifestations.

The acute or cyclic course of pyelonephritis is characterized by the transition of the active stage of the disease (fever, leukocyturia, bacteriuria) into the period of regression of symptoms with the development of complete clinical and laboratory remission with the duration of the inflammatory process in the kidneys less than 6 months. The chronic course of pyelonephritis is characterized by the persistence of symptoms of the disease for more than 6 months from its onset or the presence of at least two relapses during this period and, as a rule, is observed in secondary pyelonephritis. According to the nature of the course, latent or recurrent chronic pyelonephritis is distinguished. The recurrent course is characterized by periods of exacerbation that occur with the clinic of acute pyelonephritis (urinary and pain syndromes, symptoms of general intoxication), and remissions. The latent course of the chronic form is characterized only by urinary syndrome of varying severity.

As the experience gained in the Department of Nephrology of the Russian Children's Clinical Hospital shows, chronic pyelonephritis is always secondary and develops most often as an obstructive-dysmetabolic type against the background of dysmetabolic nephropathy, neurogenic bladder dysfunction, obstructive uropathy, etc. Among 128 patients with chronic pyelonephritis observed by us during 2004 in 60 (46.9%) the disease was formed against the background of dysmetabolic nephropathy, in 40 (31.2%) - against the background of neurogenic dysfunction of the bladder, in 28 (21.9%) - against the background of obstructive uropathy (vesico- ureteral reflux, hydronephrosis, hypoplasia and aplasia of the kidney, horseshoe kidney, lumbar kidney dystopia, etc.).

Depending on the severity of the signs of the disease, it is possible to distinguish the active stage of chronic pyelonephritis, partial clinical and laboratory remission and complete clinical and laboratory remission.

The activity of chronic pyelonephritis is determined by the totality of clinical symptoms and changes in urine and blood tests.

To clinical symptoms relate:

• fever, chills;
• pain syndrome;
• dysuric phenomena (when combined with cystitis).

Urinalysis indicators are as follows:

• bacteriuria >100,000 microbial bodies in 1 ml;
• leukocyturia> 4000 in the analysis of urine according to Nechiporenko.

Blood test indicators:

• leukocytosis with a stab-nuclear shift;
• anemia;
• increased erythrocyte sedimentation rate (ESR).

Partial clinical and laboratory remission is characterized by the absence of clinical manifestations with persistent urinary syndrome. At the stage of complete clinical and laboratory remission, neither clinical nor laboratory signs of the disease are detected.

With an exacerbation of recurrent pyelonephritis, an acute form is observed, although the general clinical symptoms are usually less pronounced. During periods of remission, the disease often does not manifest itself at all or only urinary syndrome occurs.

Often, in the chronic form, infectious asthenia is expressed in children: irritability, fatigue, poor school performance, etc.

Leukocyturia in pyelonephritis is neutrophilic in nature (more than 50% of neutrophils). Proteinuria, if present, is negligible, less than 1 g/l, and correlates with the severity of leukocyturia. Quite often at children with pyelonephritis the erythrocyturia, usually single not changed erythrocytes is noted.

In the chronic dysmetabolic variant, crystalluria is detected in the general urine test, elevated levels of oxalates, phosphates, urates, cystine, etc. are detected in the biochemical analysis of the urine, and a decrease in the ability to dissolve the corresponding salts is detected in the urine test for the anti-crystal-forming ability of urine, positive tests for calcification and the presence of peroxides.

Diagnosis of chronic pyelonephritis is based on the protracted course of the disease (more than 6 months), repeated exacerbations, identification of signs of damage to the tubulointerstitium and CHLS due to bacterial infection.

In any course of the disease, the patient needs to conduct a full range of studies aimed at establishing the activity of the microbial-inflammatory process, the functional state of the kidneys, the presence of signs of obstruction and metabolic disorders, the state of the renal parenchyma. We offer the following set of studies in chronic pyelonephritis, which allows you to get answers to the questions posed.

1. Studies to identify the activity of the microbial-inflammatory process.

• Clinical blood test.
• Biochemical blood test (total protein, protein fractions, urea, fibrinogen, C-reactive protein(SRB)).
• General urine analysis.
• Quantitative urine tests (according to Nechiporenko, Amburge, Addis-Kakovsky).
• Morphology of urine sediment.
• Urine culture for flora quantification degree of bacteriuria.
• urine antibioticogram.
• Biochemical study of urine (daily excretion of protein, oxalates, urates, cystine, calcium salts, indicators of membrane instability - peroxides, lipids, anti-crystal-forming ability of urine).
• Urinalysis for chlamydia, mycoplasma, ureaplasma (polymerase chain reaction, cultural, cytological, serological methods), fungi, viruses, mycobacterium tuberculosis (urine culture, express diagnostics).
• Study of the immunological status (secretory immunoglobulin A (sIgA), the state of phagocytosis).

2. Studies to assess the functional state of the kidneys and tubular apparatus.

Mandatory laboratory tests:

• The level of creatinine, urea in the blood.
• Zimnitsky test.
• Clearance of endogenous creatinine.
• Investigation of pH, titratable acidity, ammonia excretion.
• diuresis control.
• Rhythm and volume of spontaneous urination.

Additional laboratory tests:

• Urinary excretion of β 2 -microglobulin (mg).
• Osmolarity of urine.
• urine enzymes.
• Ammonium chloride test.
• Zimnitsky's test with dry food.

3. Instrumental research.

Mandatory:

• Measurement of blood pressure.
• Ultrasound examination (ultrasound) of the urinary system.
• X-ray contrast studies (micting cystography, excretory urography).
• Functional methods for studying the bladder (uroflowmetry, cystometry, profilometry).

Additional:

• Doppler ultrasound of the renal blood flow.
• Excretory urography with furosemide test.
• Cystourethroscopy.
• Radionuclide studies (scintigraphy).
• Electroencephalography.
• echoencephalography.
• CT scan
• Nuclear magnetic resonance.

Thus, the diagnosis of pyelonephritis in children is established based on a combination of the following criteria.

• Symptoms of intoxication.
• Pain syndrome.
• Changes in the urinary sediment: leukocyturia of the neutrophilic type (more than 50% of neutrophils), bacteriuria (more than 100 thousand microbial bodies in 1 ml of urine), proteinuria (less than 1 g / l of protein).
• Violation of the functional state of the kidneys of the tubulointerstitial type: a decrease in urine osmolarity less than 800 mosmol / l with a blood osmolarity of less than 275 mosmol / l, a decrease in the relative density of urine and indicators of acido- and amoniogenesis, an increase in the level of β 2 -microglobulin in blood plasma more than 2.5 mg / l l and in the urine - above 0.2 mg / l.
• Asymmetry of CHLS contrasting, coarsening and deformation of the vaults of the cups, pyelectasis.
• Elongation of the secretory and excretory segments of renograms, their asymmetry.

Additional criteria may include:

• Increased ESR (more than 15 mm / h).
• Leukocytosis (more than 9Ё109/l) with a shift to the left.
• An increase in antibacterial antibody titers (1:160 or more), dysimmunoglobulinemia, an increase in the number of circulating immune complexes.
• An increase in the level of CRP (above 20 μg / ml), hyper-γ- and hyper-α 2 -globulinemia.

Complications of pyelonephritis are associated with the development of purulent processes and progressive dysfunction of the tubules, leading to the development of chronic renal failure with chronic course pyelonephritis.

Complications of pyelonephritis:

• nephrogenic arterial hypertension;
• hydronephrotic transformation;
• pyelonephritis shriveled kidney, uremia;
• purulent complications (apostematous nephritis, abscesses, paranephritis, urosepsis);
• bacteremia shock.

Pyelonephritis must be differentiated from chronic cystitis, interstitial nephritis, acute glomerulonephritis with isolated urinary syndrome, chronic glomerulonephritis, kidney tuberculosis, etc. Often in pediatric practice, pyelonephritis is diagnosed as " acute abdomen", intestinal and respiratory infections, pneumonia, sepsis.

Treatment of pyelonephritis

Treatment of pyelonephritis involves not only antibacterial, pathogenetic and symptomatic therapy, but also the organization of the correct regimen and nutrition of a sick child.

The issue of hospitalization is decided depending on the severity of the child's condition, the risk of complications and the social conditions of the family. In the active stage of the disease in the presence of fever and pain syndrome bed rest is prescribed for 5-7 days.

Dietary restrictions aim to reduce the load on the transport systems of the tubules and correct metabolic disorders. In the active stage, table No. 5 according to Pevzner is used without salt restriction, but with an increased drinking regimen, 50% more than the age norm. The amount of salt and fluid is limited only if the kidney function is impaired. It is recommended to alternate protein and plant foods. Exclude products containing extractives and essential oils, fried, spicy, fatty foods. Detected metabolic disorders require special corrective diets.

The basis of drug treatment of pyelonephritis is antibiotic therapy which is based on the following principles:

• urine culture should be performed prior to starting treatment later treatment change based on the results of sowing);
• exclude and, if possible, eliminate factors that contribute to infection;
• improvement does not mean the disappearance of bacteriuria;
• the results of treatment are regarded as a failure in the absence of improvement and / or persistence of bacteriuria;
• primary lower urinary tract infections usually respond to short courses of antimicrobial therapy; upper urinary tract - require long-term therapy;
• early relapses (up to 2 weeks) represent a recurrent infection and are due either to the survival of the pathogen in the upper urinary tract or to continued colonization from the intestine. Late relapses are almost always re-infection;
• causative agents of community-acquired urinary tract infections are usually susceptible to antibiotics;
• frequent relapses, instrumental interventions on the urinary tract, recent hospitalization make us suspect an infection caused by resistant pathogens.

Therapy of pyelonephritis includes several stages: 1) suppression of the active microbial-inflammatory process using an etiological approach; 2) pathogenetic treatment against the background of the subsidence of the process using antioxidant protection and immunocorrection; 3) anti-relapse treatment. Therapy of acute pyelonephritis, as a rule, is limited to the first two stages, in chronic cases all three stages of treatment are necessary.

The stage of suppression of the activity of the microbial-inflammatory process. Conventionally, this stage can be divided into two periods.

The first is aimed at eliminating the pathogen before obtaining the results of urine culture and includes the appointment of starting (empirical) antibiotic therapy, diuretic therapy (with a non-obstructive variant), infusion-corrective therapy for severe endogenous intoxication syndrome and hemodynamic disorders.

The second (etiotropic) period consists in the correction of antibiotic therapy, taking into account the results of urine culture and determining the sensitivity of the microorganism to antibiotics.

When choosing antibacterial drugs it must be taken into account that:

The duration of antibiotic therapy should be optimal, ensuring complete suppression of the activity of the pathogen. Thus, its duration is usually about 4 weeks in a hospital with a change of antibiotic every 7-10 days (or replacement with a uroseptic).

Starting antibiotic therapy is prescribed empirically, based on the most likely pathogens. In the absence of a clinical and laboratory effect, it is necessary to change the antibiotic after 2-3 days.

In case of manifest severe and moderate pyelonephritis, drugs are administered mainly parenterally (intravenously or intramuscularly) in a hospital setting.

We list some antibiotics used in the initial therapy of pyelonephritis:

• semi-synthetic penicillins in combination with β-lactomase inhibitors - amoxicillin and clavulanic acid: augmentin - 25-50 mg / kg / day, inside - 10-14 days; amoxiclav - 20-40 microns / kg / day, inside - 10-14 days;
• 2nd generation cephalosporins: cefuroxime (zinacef, ketocef, cefurabol), cefamandol (mandol, cefamabol) - 80-160 mg / kg / day, intravenously, intramuscularly - 4 times a day - 7-10 days;
• 3rd generation cephalosporins: cefotaxime (claforan, clafobrin), ceftazidime (fortum, vicef), ceftizoxime (epocelin) - 75-200 mg / kg / day, intravenously, intramuscularly - 3-4 times a day - 7-10 days; cefoperazone (cefobid, cefoperabol), ceftriaxone (rocefin, ceftriabol) - 50-100 mg / kg / day, intravenously, intramuscularly - 2 times a day - 7-10 days;
• aminoglycosides: gentamicin (gentamycin sulfate) - 3.0-7.5 mg / kg / day, intravenously, intramuscularly - 3 times a day - 5-7 days; amikacin (amicin, lykacin) - 15-30 mg / kg / day, intravenously, intramuscularly - 2 times a day - 5-7 days.

During the period of subsiding activity, antibacterial drugs are administered mainly orally, while “step therapy” is possible, when the same drug is given orally as was administered parenterally, or a drug of the same group. The most commonly used during this period are:

• semi-synthetic penicillins in combination with β-lactomase inhibitors: amoxicillin and clavulanic acid (augmentin, amoxiclav);
• cephalosporins of the 2nd generation: cefaclor (ceclor, vercef) - 20-40 mg / kg / day;
• 3rd generation cephalosporins: ceftibuten (Cedex) - 9 mg / kg / day, once;
• nitrofuran derivatives: nitrofurantoin (furadonin) - 5-7 mg / kg / day;
• quinolone derivatives (non-fluorinated): nalidixic acid (negram, nevigramon) - 60 mg / kg / day; pipemidic acid (palin, pimidel) - 0.4-0.8 g / day; nitroxoline (5-NOC, 5-nitrox) — 10 mg/kg/day;
• sulfamethoxazole and trimethoprim (cotrimoxazole, biseptol) - 4-6 mg / kg / day for trimethoprim.

In severe septic course, microbial associations, multi-resistance of microflora to antibiotics, when exposed to intracellular microorganisms, as well as to expand the spectrum of antimicrobial action in the absence of culture results, combined antibacterial therapy is used. In this case, bactericidal antibiotics are combined with bactericidal, bacteriostatic with bacteriostatic antibiotics. Some antibiotics are bactericidal for some microorganisms and bacteriostatic for others.

Bactericidal include: penicillins, cephalosporins, aminoglycosides, polymyxins, etc.

Bacteriostatic include: macrolides, tetracyclines, chloramphenicol, lincomycin, etc.

Potentiate each other's action (synergists): penicillins and aminoglycosides; cephalosporins and penicillins; cephalosporins and aminoglycosides.

Antagonists are: penicillins and chloramphenicol; penicillins and tetracyclines; macrolides and chloramphenicol.

From the point of view of nephrotoxicity, erythromycin, drugs of the penicillin group and cephalosporins are non-toxic or low-toxic; moderately toxic - gentamicin, tetracycline, etc.; kanamycin, monomycin, polymyxin, etc. have pronounced nephrotoxicity.

Risk factors for nephrotoxicity of aminoglycosides are: duration of use for more than 11 days, maximum concentration above 10 μg / ml, combination with cephalosporins, liver disease, high levels creatinine.

After a course of antibiotic therapy, treatment should be continued with uroantiseptics.

Nalidixic acid preparations (nevigramon, blacks) are prescribed for children older than 2 years. These agents are bacteriostatics or bactericides depending on the dose in relation to gram-negative flora. They can not be administered simultaneously with nitrofurans, which have an antagonistic effect. The course of treatment is 7-10 days.

Gramurin, a derivative of oxolinic acid, has a wide spectrum of activity against gram-negative and gram-positive microorganisms. It is used in children aged 2 years and over in a course of 7-10 days.

Pipemidic acid (palin, pimidel) affects most gram-negative bacteria and staphylococci. It is prescribed for a short course (3-7 days).

Nitroxoline (5-NOC) and nitrofurans are broad bactericidal preparations.

The reserve drug is ofloxacin (tarivid, zanotsin). It has a wide spectrum of action, including the intracellular flora. Children are prescribed only in case of ineffectiveness of other uroseptics.

The use of biseptol is possible only as an anti-relapse agent in the latent course of pyelonephritis and in the absence of obstruction in the urinary tract.

In the first days of the disease, against the background of increased water load, fast-acting diuretics (furosemide, veroshpiron) are used, which increase renal blood flow, ensure the elimination of microorganisms and inflammation products, and reduce swelling of the interstitial tissue of the kidneys. The composition and volume of infusion therapy depend on the severity of the intoxication syndrome, the patient's condition, indicators of hemostasis, diuresis and other kidney functions.

The stage of pathogenetic therapy begins when the microbial-inflammatory process subsides against the background of antibacterial drugs. On average, this occurs on the 5-7th day from the onset of the disease. Pathogenetic therapy includes anti-inflammatory, antioxidant, immunocorrective and anti-sclerotic therapy.

The combination with anti-inflammatory drugs is used to suppress the activity of inflammation and enhance the effect of antibiotic therapy. It is recommended to take non-steroidal anti-inflammatory drugs - ortofen, voltaren, surgam. The course of treatment is 10-14 days. The use of indomethacin in pediatric practice is not recommended due to a possible deterioration in the blood supply to the kidneys, a decrease in glomerular filtration, water and electrolyte retention, and necrosis of the renal papillae.

Desensitizing agents (tavegil, suprastin, claritin, etc.) are prescribed for acute or chronic pyelonephritis in order to stop the allergic component of the infectious process, as well as with the development of the patient's sensitization to bacterial antigens.

The complex of pyelonephritis therapy includes drugs with antioxidant and antiradical activity: tocopherol acetate (1-2 mg/kg/day for 4 weeks), unithiol (0.1 mg/kg/day intramuscularly once, for 7-10 days), b-carotene (1 drop per year of life 1 time per day for 4 weeks), etc. Of the drugs that improve the microcirculation of the kidneys, trental, cinnarizine, aminofillin are prescribed.

Immunocorrective therapy for pyelonephritis is prescribed strictly according to indications:

• infancy;
• severe variants of kidney damage (purulent lesions; aggravated by the syndrome of multiple organ failure; obstructive pyelonephritis against the background of reflux, hydronephrosis, megaureter, etc.);
• long-term (more than 1 month) or recurrent course;
• intolerance to antibiotics;
• features of the microflora (mixed flora; flora multi-resistant to antibiotics; unusual nature of the flora - Proteus, Pseudomonas, Enterobacter, etc.).

The appointment of immunocorrective therapy is made only after agreement with the immunologist and should include immunological monitoring, relative "selectivity" of the appointment, a short or intermittent course, and strict adherence to the dosages and regimen of drug administration.

Immunal, sodium nucleate, t-activin, levamisole hydrochloride, lycopid, immunofan, reaferon, leukinferon, viferon, cycloferon, myelopid, lysozyme are used as immunotropic agents for pyelonephritis and urinary system infections in children.

If patients have signs of sclerosis of the kidney parenchyma, it is necessary to include drugs with an anti-sclerotic effect (delagil) in the treatment complex for a course of 4-6 weeks.

During the period of remission necessary continuation treatment is phytotherapy (st.

Anti-relapse therapy for pyelonephritis involves long-term treatment antibacterial drugs in small doses and is carried out, as a rule, on an outpatient basis.

For this purpose, use: biseptol at the rate of 2 mg / kg for trimethoprim and 10 mg / kg for sulfamethoxazole 1 time per day for 4 weeks (use with caution in obstructive pyelonephritis); furagin at the rate of 6-8 mg/kg for 2 weeks, then normal tests urine transition to 1 / 2-1 / 3 doses for 4-8 weeks; the appointment of one of the drugs pipemidic acid, nalidixic acid or 8-hydroxyquinoline every month for 10 days at usual dosages for 3-4 months.

For the treatment of frequently recurrent pyelonephritis, a "duplicate" scheme can be used: nitroxoline at a dose of 2 mg/kg in the morning and biseptol at a dose of 2-10 mg/kg in the evening.

At any stage of treatment of secondary pyelonephritis, it is necessary to take into account its nature and functional state kidneys. Treatment of obstructive pyelonephritis should be carried out in conjunction with a urologist and a pediatric surgeon. In this case, the decision to prescribe diuretics and increase the water load should be made taking into account the nature of the obstruction. The issue of surgical treatment, since in the presence of obstruction of the urine flow at any level of the urinary system, the prerequisites for the development of a relapse of the disease remain.

The therapy of dysmetabolic pyelonephritis should include an appropriate dietary regimen and pharmacological treatment.

With the development of renal failure, it is necessary to adjust the dose medicines according to the degree of decrease in glomerular filtration.

Dynamic observation of children suffering from pyelonephritis suggests the following.

• The frequency of examination by a nephrologist: during exacerbation - 1 time in 10 days; during the period of remission against the background of treatment - 1 time per month; remission after the end of treatment for the first 3 years - 1 time in 3 months; remissions in subsequent years until the age of 15 years - 1-2 times a year, then the observation is transferred to therapists.
• Clinical and laboratory studies: general urinalysis - at least 1 time in 1 month and against the background of acute respiratory viral infections; biochemical analysis urine - 1 time in 3-6 months; Ultrasound of the kidneys - 1 time in 6 months. According to the indications, cystoscopy, cystography and intravenous urography are performed.

Removal from the dispensary registration of a child who has had acute pyelonephritis is possible while maintaining clinical and laboratory remission without therapeutic measures (antibiotics and uroseptics) for more than 5 years after a complete clinical and laboratory examination. Patients with chronic pyelonephritis are observed before transfer to the adult network.

Literature

1. Borisov I. A. Pyelonephritis//In the book. "Nephrology" / ed. I. E. Tareeva. M.: Medicine, 2000. S. 383-399.
2. Vozianov A. F., Maidannik V. G., Bidny V. G., Bagdasarova I. V. Fundamentals of Nephrology childhood. Kyiv: Book plus, 2002. S. 22-100.
3. Ignatova M.S., Veltishchev Yu.E. Pediatric nephrology. L.: Medicine, 1989. 432 p.
4. Kirillov V.I. Immunocorrective therapy of urinary tract infections in children//In the book. "Nephrology" / ed. M. S. Ignatova: a guide to pharmacotherapy in pediatrics and pediatric surgery (ed. A. D. Tsaregorodtsev, V. A. Tabolin). M.: Medpraktika-M, 2003. T. 3. S. 171-179.
5. Korovina N. A., Zakharova I. N., Mumladze E. B., Zaplatnikov A. L. Rational choice of antimicrobial therapy for urinary tract infections in children//In the book. "Nephrology" / ed. M. S. Ignatova: a guide to pharmacotherapy in pediatrics and pediatric surgery (ed. A. D. Tsaregorodtsev, V. A. Tabolin). M.: Medpraktika-M, 2003. T. 3. S. 119-170.
6. Malkoch A.V., Kovalenko A.A. Pyelonephritis//In the book. "Nephrology of childhood" / ed. V. A. Tabolina and others: a practical guide to childhood diseases (under the editorship of V. F. Kokolina, A. G. Rumyantsev). M.: Medpraktika, 2005. T. 6. S. 250-282.
7. Papayan A. V., Savenkova N. D. Clinical pediatric nephrology: a guide for physicians. SPb., 1997. S. 450-501.
8. Tebloeva L. T., Kirillov V. I., Diagnosis of infections urinary tract in children: materials of the 1st Congress " Modern methods diagnosis and treatment of nephro-urological diseases in children. M., 1998. S. 57-60.
9. Erman M. V. Nephrology of childhood in schemes and tables. St. Petersburg: Special Literature, 1997. S. 216-253.

A. V. Malkoch, Candidate of Medical Sciences
V. A. Gavrilova, Doctor of Medical Sciences
Yu. B. Yurasova, Candidate of Medical Sciences
RSMU, RCCH, Moscow

Acute pyelonephritis in children is a common disease of the renal pelvis. The pathogenic mechanism is based on infection of the urinary tract by various types of bacterial flora. Most commonly excreted during urine culture Staphylococcus aureus, Streptococcus and Escherichia coli. The peak incidence occurs at an early age of up to 5 years. In girls, acute pyelonephritis is diagnosed 3 times more often than in boys. This is due to the peculiarity of the anatomical structure of the descending urinary tract. According to the frequency of cases of diagnosed diseases in the Russian Federation, acute pyelonephritis in children under 7 years of age is in second place. More often, children suffer only from acute respiratory diseases of the upper respiratory tract. But even here there is a certain relationship.

According to statistics, every 4th case of SARS in young children gives complications in the form of inflammation of the renal pelvis. Therefore, during the treatment of a cold, it is necessary to conduct a general urine test.

In the absence of adequate therapy, the disease can turn into chronic pyelonephritis in children. In this case, the infection remains in the renal structures. With a slight decrease in the body's resistance, a relapse of pyelonephritis develops with a complete clinical picture.

Why does pyelonephritis occur in a child

Pyelonephritis in a child can occur only under the influence of pathogenic microflora. This disease is characterized by purulent inflammation of the renal pelvis. The process can be unilateral or affect both kidneys.

The main causes of pyelonephritis:

• acute colds;
• frequent;
• rheumatism;
• hypothermia of the body;
• incomplete emptying of the bladder during urination;
• non-compliance with personal hygiene;
• decreased immunity;
• intrauterine infection of the fetus from the mother;
• foci of chronic infection, including.

Of particular note is the fact that in children under 5 years of age, urine does not have its own antibacterial properties. This contributes to the rapid spread of infection in urinary tract. Children at this age do not have the ability to completely empty their bladder. The frequency of diagnosis of pyelonephritis in a child increases in adolescence. At this time, the infection enters the renal pelvis in an ascending way from the genitals.

The first signs of pyelonephritis in children

It is not easy even for an experienced pediatrician to consider the first signs of pyelonephritis in children. This is an insidious disease that can masquerade as a common cold. The main signs of pyelonephritis are associated with manifestations of general intoxication of the baby's body. In newborn age, with intrauterine kidney infection, the only symptom is prolonged jaundice of the skin. Unfortunately, the infant and child in younger age cannot reliably assess his condition and indicate unpleasant symptoms in the lumbar region or pain during urination. Therefore, the diagnosis is often established only after a urinalysis examination.

At an older age, the first signs of pyelonephritis in children may be:



• weakness;
• headache;
• heaviness in the lower back;
• frequent urination;
• a sharp persistent increase in body temperature;
• nausea and vomiting;
• dryness of mucous membranes and skin.

In case of any manifestations from the above list, you should immediately consult a doctor.

Reliable symptoms of pyelonephritis in children and diagnosis

Symptoms of pyelonephritis in children usually appear immediately after the onset of the disease:



• body temperature rises sharply to 39-40 ° C;
• vomiting and general weakness appear;
• the body of the child is covered with sticky sweat;
• the frequency of urination increases by 2-3 times;
• changes in urine color and smell;
• there are pains above the pubis and in the region of the lower ribs from the back.

On examination, it is revealed:

• rapid pulse;
• painful palpation upper divisions abdomen
• a positive symptom of Pasternatsky (with a light blow with the edge of the palm in the area of ​​\u200b\u200bthe kidneys, the child shudders and feels pain);
• blood pressure is slightly above normal.

A general blood and urine test, a biochemical blood test for urea and creatinine are prescribed. To clarify the type of pathogenic microflora and determine sensitivity to antibiotics, a bacterial urine culture will be done.

In the general analysis of urine, bacteriuria, a high content of leukocytes and epithelial cells are determined. In severe cases, there may be hematuria. The density of urine is reduced, the protein is not determined.

Treatment of pyelonephritis in children

Treatment of pyelonephritis in children, depending on the severity of the condition, is carried out in a hospital or at home under the supervision of a local pediatrician. The basis of treatment is antibiotic therapy. Antibiotics are used a wide range actions and preparations of nalidixic acid, which have a pronounced urological septic effect. The drug of choice is nevigramon or nitroxoline. Of the antibacterial drugs, the use of amoxiclav or augmentin is recommended.

used symptomatic therapy, aimed at lowering body temperature and removing the syndrome of intoxication. The drinking regime is intensifying. With a delay in diuresis, diuretics can be recommended.

The prognosis for life with pyelonephritis in children is favorable. Usually, all symptoms disappear within 7-10 days. However, after recovery, it is recommended to undergo regular examinations by a nephrologist at least 2 times a year.

Pyelonephritis can occur in a child at any stage of development. By paying attention to several important symptoms in a timely manner, you can cure the baby and save him from many problems that this disease leads to in the future.

A doctor's consultation in this case is extremely necessary, since any disease can lead to complications affecting the kidneys. To avoid children's pyelonephritis, it is not necessary to allow hypothermia of the child, which can lead to colds, and it is also necessary to follow the rules of personal hygiene. Doctors say that the presence of an infection in a child, for example, caries, tonsillitis, runny nose, has a detrimental effect on general state human and kidneys including. Diseases genitourinary system are not uncommon in children. It is in children, especially in infancy, that they tend to develop rapidly.

Causes contributing to the development of pyelonephritis

In order to understand the principle of the development of such a disease as pyelonephritis, it is necessary to delve into the anatomy and find out the structure of a vulnerable organ.

The kidneys are located on both sides of the lumbar vertebrae behind the sheet of peritoneum. The right kidney is located slightly lower than the left, as it borders on the liver. The size of the body depends on the age of the child. The kidneys of newborns reach a length of 4 cm, and in adolescence their size exceeds 12 cm in length and 6 in thickness. The kidneys perform a very important function for the body - they excrete metabolic products with urine, thereby regulating the water-salt balance in the body and maintaining homeostasis.

In addition, it is the kidneys that are responsible for the production of vitamin D and substances necessary to maintain normal levels of hemoglobin in the blood and regulate blood pressure. They are needed to ensure the proper functioning of the heart, brain and other organs. The kidneys are responsible for the balance of calcium and phosphorus, contribute to the formation of bone tissue.

Types of pyelonephritis characteristic of children

according to symptoms and therapeutic methods treatment, pyelonephritis can be divided into two types.

Primary pyelonephritis

It develops in children when the internal intestinal microflora changes from normal to pathogenic. Often, dysbacteriosis can occur against the background of certain diseases, namely SARS or intestinal infections. Dysbacteriosis is a common cause of pyelonephritis in children. No less common cause of the disease are coccal infections, it can be a variety of diseases, from skin diseases to sore throats or colds. The basis for a primary kidney disease can be diseases of the genitourinary system, due to which bacteria enter the body, and then through the bladder, ureters and pelvis they penetrate to the kidneys.

Secondary pyelonephritis

Secondary kidney disease occurs for completely different reasons. In children, this is usually associated with the presence of congenital abnormalities of the urinary system, such as the incorrect position of the kidneys, bladder, ureters. This leads to poor drainage of urine or backflow to the kidneys from the lower tract. Together with urine, bacteria are often introduced into the kidney, which cause inflammation.

In some children, the kidneys do not have time to develop. Too much small size kidneys affects the productivity of their work. At birth, this is not very noticeable, but the body weight grows over time, at the same time, the load on the kidney tissue also increases, which ceases to cope with the load. Such anatomical deviations appear already in the first months of a baby's life. For timely detection of the problem, doctors advise to conduct an ultrasound examination of the child to make sure that the kidneys are of normal size and do not have pathologies, and if abnormalities are detected, this will allow immediate treatment.

Signs and symptoms of pyelonephritis

The following symptoms may indicate the presence of an inflammatory process in the kidneys of a child:

• Heat. An increase in body temperature above 38 ° C without symptoms colds, headache, general malaise, weakness, decreased or complete lack of appetite.
• Incontinence or lack of urge to urinate. The baby eats normally and consumes the usual amount of liquid, but does not go to the toilet for too long. At night, the child does not sleep well and suffers from constant urges, the smell of urine has become sharp.
• Complaints during urination. The child complains of pain in the abdomen, cries, screams, sits on the pot for a long time and makes efforts before urinating.
• Selection color.

Urine in the absence of abnormalities is a clear, light yellow liquid. If the color of the urine has become dark or it has acquired a reddish tint, then this may indicate a kidney disease, in particular, pyelonephritis. But do not panic too soon, urine can turn into an atypical color from foods such as beets, blueberries, rhubarb, carrots, vitamins and medications. If the child did not eat such foods, it is possible that the color of the discharge has changed due to the presence of red blood cells in it, which is an alarming signal.

• Liquid stools, vomiting. In infants, signs of pyelonephritis may be similar to intestinal disease and may be accompanied by poor weight gain.
• Small portions of urine. This symptom should not be ignored. You should immediately consult a doctor to find out the causes, establish a diagnosis and prescribe treatment.
• Pyelonephritis may not be accompanied severe symptoms. constant fatigue and Bad mood baby - a reason to pay attention to his health.

Diagnosis of pyelonephritis

To confirm the diagnosis, the urologist prescribes tests. The first is a general urine test. If such an analysis did not give a complete picture, then a urine test according to Nechiporenko or Zimnitsky is prescribed.

The essence of the analysis of urine according to Nechiporenko is that the material is collected only from the middle of the jet, and the discharge at the beginning and at the end of urination is considered unusable.

To analyze urine according to Zimnitsky, you will need to collect all the urine for the day. To do this, you need to prepare containers for urination in advance and offer the child to urinate in them in time. You do not need to specifically give your baby fluids or restrict food. Such an analysis is needed to detect an inflammatory process in the kidneys or their insufficiency.

When collecting urine for analysis, you must adhere to the following recommendations:

• Do not let your child drink mineral water, it will affect the composition of the urine.
• Prepare glass containers in advance. Wash it well and pour boiling water over it to prevent bacteria and fungi from getting inside.
• Before collecting urine, monitor the hygiene of the baby, otherwise the tests will give an inaccurate result.
• When urinating, do not collect the first portion of urine.

The results of the tests will be ready in a couple of days after the transfer of urine to the laboratory. For each type of analysis, its own research method is used.

Interpretation of urinalysis results

You can understand the results of the analyzes yourself. In addition to the color and smell of urine, there are many other indicators.

• Urine should be completely transparent. The presence of cloudy impurities and flakes indicates inflammation in the urinary system.
• The reaction of urine in a healthy body is slightly acidic or neutral. This indicator depends on the nutrition of the baby. In babies, the discharge density is lower than usual, it is in the range of 1005-1020. There should be no protein in the urine at all, but a small content of it is allowed, not exceeding 0.033 g / l. The content of leukocytes is different in boys and girls. For boys, the norm is 0-3-5, for girls - 0-5-7. In the study according to Nechiporenko - up to 2000.
• There should not be erythrocytes in the urine, in the Nechiporenko study - up to 1000.
• The presence of cylinders indicates possible kidney disease. Research according to Nechiporenko allows their content, but within 20.
• Fungi and bacteria are indicated in the results with a plus sign. At large values a urine culture should be performed to determine the type of bacteria.

At the end of the examination, the doctor will explain the urine test to the parents. He also prescribes ultrasound of the kidneys and pelvic organs.

How to prevent the development of pyelonephritis in a child?

prevent pyelonephritis in children simple steps will help.

• Put your baby in disposable diapers, especially before going out and going to bed. This will reduce the chance of getting an infection.
• Monitor your child's urinary frequency. The longer the discharge remains in bladder the more microbes accumulate in them. Potty train your toddler by the age of two.
• The girl needs to be washed properly. Hand movements should go from front to back. Keep hygiene and daily change of linen.
• You should not give your baby a drink with highly carbonated drinks. Preference should be given to table mineral or plain purified water.
• Do not feed your child fatty, spicy and salty foods. Salt should be added in moderation, and meat is best steamed.

With pyelonephritis and after recovery, you will need to adhere to a special diet that the doctor will prescribe.

The standard number of urination in a baby per day

Healthy babies urinate very often, and in fairly large portions.

Children under 6 months make about 20 urination per day, up to a year - 15, up to three years - about 10.

Even if the child looks absolutely healthy, track how many times a day he goes to the potty. If the baby walks in a diaper, then it will be impossible to do this. It is necessary to observe the process of urination itself, the stream should not be interrupted, and the liquid should be light.

Treatment of pyelonephritis

In the treatment of pyelonephritis in children, uroseptics or antibiotics, homeopathic remedies and herbal medicine are used.

The duration of treatment and medications can only be determined by a nephrologist or urologist. Often the treatment lasts a couple of months. The disease is curable and after a full recovery for the well-being of the baby, it will no longer be possible to worry. After antibiotic treatment, probiotic preparations are prescribed, which are required to restore the normal microflora in the intestine.

Every six months, the baby should have a kidney examination, take tests, and also systematically visit a pediatrician and a urologist.