Characteristic symptoms of pyelonephritis in children and treatment of the disease with medications and a special diet. How to recognize and treat pyelonephritis in a child Pyelonephritis in children after

Pyelonephritis is the most common kidney disease, predominantly of a bacterial nature. Most “adult” pyelonephritis has its roots in childhood. Contrast X-ray data indicate that the vast majority of infants and preschool children infected with a urinary tract infection (UTI) are susceptible to acute cases of pyelonephritis. Early recognition and prompt treatment of infections, which are quite common in children, is important to prevent later complications of inflammation such as kidney scarring, hypertension and kidney failure.

What is acute pyelonephritis in children

Pyelonephritis is an inflammatory microbial disease of the kidney tissue: the calyces, pelvis, tubules in which urine is formed, the blood and lymphatic vessels of the organ, as well as the interstitial tissue that unites all this. The process is called acute if inflammatory phenomena have developed for the first time.

Pyelonephritis can lead to kidney deformation

Urinary tract infections are mainly ascending in origin and are caused by microbial contamination of the perineum, usually intestinal flora. However, in newborns, the infection route is considered to be hematogenous and not ascending. That is, the pathogen enters the kidney through the blood or lymph flow. This feature may explain the nonspecific symptoms associated with acute pyelonephritis in infants. After the neonatal period, bacteremia (the presence of bacteria in the blood) is usually not a source of infection; rather, a UTI or pyelonephritis is the cause of the bacteremia.

The incidence of acute pyelonephritis is higher in male infants. After the age of 12 months, infectious inflammation of the urinary tract, on the contrary, is more common in girls than in boys.

Pathogens

Bacterial sources of acute pyelonephritis have become quite well adapted to penetrate and survive in the human body. In children, these are most often the following pathogens:

Types of pyelonephritis

If the infection attacked a previously healthy organ in which there were no pathological changes, such pyelonephritis is considered primary. If microbial inflammation is “layered” on existing problems, such as organic or functional disorders in the tissues of the kidney and urinary tract, then the infection is considered secondary, or complicated.

Pyelonephritis is often unilateral, when one kidney is affected. It is called bilateral when these organs are inflamed on both sides.

In the first year of life, pyelonephritis affects as many children as in the next 14 years combined. In 85% of sick babies, the disease develops before the age of six months, and in 30% - during the newborn period.

Pyelonephritis in children: video

Causes of childhood pyelonephritis

In pediatrics, the development of acute pyelonephritis is caused by the following risk factors:

Vesicoureteral reflux increases the risk and extent of renal cortical lesions, while at the same time, clinically significant signs of pathology can develop in the absence of this phenomenon.

Signs and symptoms

Clinical manifestations of pyelonephritis in infants and older children have significant differences. For children under one year of age, these are mainly symptoms of general intoxication and all the ensuing signs, which makes it difficult to establish an accurate diagnosis:

In older children, the symptoms are more pronounced; the child can already verbally complain about this or that painful sensation. Symptoms are usually:

• pain in the lower back and abdomen;
• frequent painful urination;
• cloudy urine;
• slight swelling;
• phenomena of general intoxication (fever, headache, weakness).

In girls under 11 years of age, the risk of infection is 3–5%. For boys of the same age - 1%.

Diagnosis of acute pyelonephritis in children

To confirm the diagnosis, the doctor must evaluate the results of blood and urine tests, instrumental studies and carefully examine the patient. Only after this can adequate treatment be prescribed.

Necessary tests

Mandatory laboratory tests include:

• general blood and urine analysis;
• quantitative urine analysis with sediment examination (according to Nechiporenko, Addis-Kakovsky);
• biochemical blood test for the presence of protein, urea, fibrinogen and urine for the amount of protein, oxalates, urates, etc.;
• bacterial culture of urine to identify the degree of bacteriuria (number of bacteria per 1 ml of urine);
• Antibiogram - identifying the sensitivity of urine flora to antibacterial drugs.

Diagnosis includes a mandatory urine test

Additionally, tests for immune status (blood for immunoglobulin A) and urine testing for viruses and fungi may be required.

Immunoglobulin is responsible for the immunity of the respiratory, gastrointestinal and genitourinary systems of the body, protecting them from infection. In infants, it is not synthesized independently, but enters the body only through mother's milk.

Instrumental studies

Instrumental urological studies show external and internal changes in the kidneys and evaluate their functional abilities. They are carried out not in the acute period, but after antibacterial treatment has been carried out. Thus, when the inflammation process subsides, the diagnosis is clarified using the following methods:

• Radioisotope research. Detects foci of sclerosis in the kidneys after illness. Radioisotope drugs are administered intravenously to the patient and their content in the organ is monitored using a special device. The procedure lasts about half an hour. Despite the negligible radiation dose (less than with a regular x-ray), such an examination is not recommended for children under one year of age.
• Ultrasound examination (ultrasound) of the urinary system. It consists of examining the outlines, shape, and general changes in the structures of the urinary tract.
• X-ray with contrast agent. The method determines whether there are congenital developmental anomalies. Depending on whether the contrast agent reaches the kidney or not, the presence of vesicoureteral reflux (return of urine) is assessed.
• CT scan. Allows you to obtain a three-dimensional image of the kidney in various sections.
• Functional studies. With their help, the rate of urination, the sensitivity of the bladder walls to its filling, etc. are determined.

External examination of the patient

Physical examination includes assessment of the color and condition of the skin (pallor, marbling), the presence or absence of swelling. The nephrologist conducts a test for Pasternatsky's symptom: he places one palm on the kidney area, and taps the back surface of the first with the edge of the second hand. If the child feels pain and discomfort, this means the presence of inflammation. A short-term increase in red blood cells in the urine after the test will further confirm the presence of the disease.

A positive Pasternatsky symptom indicates inflammation in the kidney

Thus, the diagnosis of acute pyelonephritis in children is based on a combination of several signs:

1. Manifestations of intoxication.
2. Pain in the lower back and when urinating.
3. Changes in the composition of urine: leukocyturia with a predominance of neutrophils, bacteriuria (in a concentration of more than 100 thousand per 1 ml of urine), protein in the urine.
4. Functional renal abnormalities.
5. Asymmetry and deformation of the pyelocaliceal system, congenital dilatation of the pelvis (pyelectasia).

Pyelonephritis must be distinguished (differentiated) from diseases of the genitourinary system such as:

• cystitis;
• glomerulonephritis;
• interstitial nephritis;
• kidney tuberculosis.

In childhood, it is difficult, and sometimes impossible, to distinguish pyelonephritis, an infection of the upper urinary tract, from cystitis, a disease of the lower urinary tract. Inflammation of the bladder is characterized by symptoms associated with difficulty urinating, occurs with or without fever, and often has no other systemic signs. Lower urinary tract infections should be treated carefully.

Often in pediatric practice, pyelonephritis is disguised as an “acute abdomen”, intestinal and respiratory infections. A distinctive feature of pyelonephritis from similar pathologies is often called the asymmetry of the lesion, that is, the inflammatory process affects only one kidney or is unevenly distributed in both.

Treatment

The clinic of acute pyelonephritis in a child requires treatment in a hospital setting, where professional assistance will be provided, including the removal of intoxication, which is characteristic of this disease.

Firstly, during the acute phase of the disease, children are prescribed bed rest. It should be observed as long as the high temperature and dysuric phenomena persist. Secondly, you need to drink plenty of fluids. It helps flush out the infection and reduce toxicity in the body. If possible, a child should drink about 1.5–2 liters of fluid per day. This can be water, weak tea, non-acidic juices, compotes (from apples, pears, dried apricots, raisins).

Drug therapy

The most important part in the treatment of acute pyelonephritis is antibiotic therapy. A course of medication is prescribed for a period of 10 to 21 days, depending on the severity of the condition. As long as the causative agent is unknown, your doctor may prescribe a broad-spectrum antimicrobial as empirical therapy. As soon as the culture results and antibiogram are ready, the prescription is adjusted by the nephrologist, and an antibacterial drug with a narrow targeted effect on a specific type of bacteria is selected.

When choosing an antibiotic, the doctor is guided by the following principles:

• minimal toxicity to the kidneys;
• high activity against the most common pathogens of urinary tract infections;
• bactericidal action (and not bacteriostatic), that is, leading to the death of bacteria;
• compatibility with other drugs used in therapy;
• changing the drug to a similar one every 7–10 days (for greater effectiveness).

In pediatrics, in the treatment of acute pyelonephritis, preference is given to the following groups of antibiotics:

• semisynthetic penicillins (Amoxiclav, Augmentin);
• cephalosporins (Ketacef, Mandol - 2nd generation; Claforan, Fortum, Epocelin - 3rd generation);
• aminoglycosides (Gentamicin, Amycin).

You should know that in severe and acute cases, it is advisable to administer drugs intramuscularly or intravenously. When the acute stage is left behind, tablet forms of drugs can be used. An important point is the need to strictly adhere to the antibiotic dosage regimen prescribed by the doctor. This is necessary in order to avoid the development of resistance of pathogenic bacteria, in other words, insensitivity to certain antibacterial drugs.

Antihistamines (Suprastin, Tavegil, Claritin) are often prescribed in combination with antibiotics; they prevent a possible allergic reaction of the body to both the medicine itself and the infection.

Minimal nephrotoxicity is inherent in antibiotics of the penicillin and cephalosporin groups, as well as Erythromycin. Medications of moderate toxicity in terms of effects on the kidneys are Gentamicin and Tetracycline.

At the beginning of the disease, when drinking plenty of fluids is extremely necessary, a fast-acting diuretic, for example, Furosemide, is also prescribed. To relieve inflammation and obtain a better effect from antimicrobial drugs, regimens are used in which they are combined with non-steroidal anti-inflammatory drugs (Voltaren, Ortofen). They are taken for two weeks.

Correction of immunity is required for infants, children with severe infection, and also with a tendency to relapse. The drugs of choice in such situations are Immunal, Viferon, Cycloferon and others, but strictly according to a doctor’s prescription.

Drugs improve microcirculation in the kidneys in cases where there is a suspicion of any vascular lesions. Eufillin, Cinnarizine, etc. are used.

Drugs for drug therapy of acute pyelonephritis in children - photo gallery

Amoxiclav is a reliable and non-toxic antibiotic
Gentamicin has a broad spectrum of antimicrobial action
Claritin syrup - a convenient antiallergic drug for children
Voltaren belongs to the group of NSAIDs
Viferon increases the activity of the immune system

Diet

In the acute period, limit:

• salt;
• protein food.

Until the severity of the process is relieved, foods that can irritate the urinary system are completely excluded from consumption:

Physiotherapeutic methods

Physiotherapy may be relevant when the active phase of pyelonephritis subsides. When the condition is more or less stable (subacute), the doctor may prescribe procedures aimed at improving the outflow of urine, raising the tone of the ureters, and stimulating the body’s general defenses. These include:

If there are stones in the kidneys, then mineral water is selected in accordance with their composition. If necessary, they alkalize or, conversely, acidify the environment inside the urinary system.

Surgical intervention

Surgery may be required if acute obstruction (narrowing) of the urinary tract is diagnosed. It can be caused by the presence of congenital pathology or stones. In this situation, the nephrologist cooperates with a pediatric urological surgeon to approve the optimal solution. If normal patency of the urinary tract is not restored, then favorable conditions will be created for constant relapses of infection.

In case of urinary tract obstruction, diuretics should be prescribed solely taking into account the capacity of the child’s urinary system.

And also the reason for emergency surgical intervention is a purulent complication, which can accompany a severe form of the disease. In this case, they act immediately, because this process is dangerous with such serious complications as tissue necrosis, peritonitis and sepsis (blood poisoning).

There are several surgical options. In one of them, the operation is performed through an open approach under general anesthesia, the patient lies on his side. This method is chosen if a simultaneous overview of the entire urinary system is necessary (for example, during a purulent process). After such an intervention, a long rehabilitation period is required. There is a danger of adhesions.

Another method is laparoscopic surgery, when all manipulations occur through several small punctures with a diameter of 1 cm, into which a manipulation tool and a miniature camera are inserted. An enlarged image of the organ is transmitted to a screen or monitor, looking at which the surgeon performs the necessary actions.

Laparoscopic surgery is performed through three small punctures of 5–10 mm

Advantages of laparoscopic intervention:

• low morbidity;
• relatively quick and easy rehabilitation;
• absence of scars (punctures heal almost without a trace).

This method is definitely chosen if the child is under 1 year old or has little weight.

Vesicoureteral reflux often resolves spontaneously as the child grows and disappears by about six years of age. Sometimes even its extreme degrees (fourth and fifth) are compensated by the body on its own.

If a child has high-grade vesicoureteral reflux, which provokes frequent relapses of pyelonephritis, then intravesical plastic surgery of the ureteric orifice is necessary - a low-traumatic and technically uncomplicated endoscopic correction. The operation involves introducing collagen gel into the outlet ureter using a special needle. The gel forms a tubercle that allows the upper wall of the ureter to fit tightly against the lower wall, forming an anti-reflux valve.

The introduction of collagen gel into the mouth of the ureter forms a valve mechanism between it and the bladder

Folk remedies

Therapy with folk remedies can be considered as one of the components of complex treatment. It is advisable to use such recipes as maintenance methods during the period of remission of pyelonephritis. The dosage for children should be checked with your doctor.

Before taking any folk remedy, you need to make sure that the child is not allergic to the plant substance, having first consulted with the pediatrician.

Forecast and consequences

Most cases of pyelonephritis respond well to antibiotic treatment, ending without further complications. Permanent renal scars develop in 18–24% of children after the end of the inflammatory process. Timely treatment (within 5–7 days from the onset of the disease) significantly reduces the risk of the formation of such defects. Severe damage to the kidney parenchyma occurs in approximately 20% of children with acute pyelonephritis. About 40% of these patients develop permanent scarring, which can lead to hypertension and kidney failure.

Acute pyelonephritis in children results in complete recovery in 80–90% of cases. But if the inflammation drags on for up to six months or more, then it becomes chronic and is prone to periodic exacerbations.

For patients with severe cases or persistent infections, appropriate treatment and follow-up are indicated to prevent long-term complications.

Infants who have had pyelonephritis may develop:

• dysfunction of the tubular elements of the kidneys (arteries, veins, lymphatic vessels and renal tubules);
• secondary renal salt diabetes;
• hyperkalemia and hyponatremia.

Death is not typical for this disease. It is only associated with sepsis. Generalized bacteremia, or blood poisoning, is rare but can develop as a result of pyelonephritis.

Rehabilitation and prevention

After suffering from acute pyelonephritis, children must undergo regular medical observation over the next 3–5 years: undergo regular examinations by a pediatrician and nephrologist. The purpose of such medical control is to prevent repeated infectious attacks.

It is important to visit the dentist at least twice a year and sanitize areas of dormant infection. Examinations by an otolaryngologist are required to identify chronic tonsillitis and other inflammations of the nasopharynx. It is regularly required to take urine tests within the time limits specified by the attending physician. An ultrasound examination of the kidneys is done at least once a year.

During the rehabilitation period, sanatorium treatment is indicated. If during the time specified by the observing doctor there were no relapses of the disease, and urine tests were normal, then after a comprehensive examination in the hospital the child can be removed from the register.

An important point in prevention, to which parents of girls should pay special attention, is the correct washing of children - from front to back, and not vice versa. Otherwise, an infection from the anus risks ending up inside the child’s genitourinary system. Newborn babies need to change their diapers on time for the same reason.

From front to back - this is how you need to wash children, especially girls, correctly

The more often a child urinates, the more effectively the infection is washed out of the body. Therefore, it is important to ensure that his bladder is emptied regularly.

With chronic constipation, there is a threat of microbes entering the urinary system from the intestines through the general lymph flow. In addition, fecal debris interferes with the normal excretion of urine, increasing the pressure inside the kidney and causing the risk of an inflammatory process in it. Therefore, it is necessary to monitor the child’s regular bowel movements.

The slightest delay in treating acute pyelonephritis in children significantly increases the risk of irreversible kidney damage. Replacement of active cells with scar tissue is an extremely negative process that reduces the functionality of the organ and leads to more serious consequences. That is why it is extremely important for parents to be attentive to any manifestations of anxiety associated with urination in the child, as well as to causeless fever and symptoms of intoxication.

Children often experience kidney complications after influenza and other infectious diseases. An inflammatory process develops in them. It is not always easy to recognize, especially in babies who cannot yet speak. The symptoms that arise are similar to those of cystitis, intestinal infectious diseases, and colds. It is necessary to do urine and blood tests to clarify the type of infectious agent and the nature of the disease. The child will need immediate antibacterial treatment to prevent the process from becoming chronic. Diet is required.

One type is pyelonephritis. With this disease, inflammation of the renal calyces, pelvis, tubules, blood vessels and connective tissue occurs. In this part of the kidneys, urine accumulates and is excreted. The inflamed kidney swells and increases in size, its walls thicken.

In children, pyelonephritis can occur at any age. Up to 1 year of age, the incidence of the disease in girls and boys is the same. Among older children, inflammatory diseases of the urinary organs, including pyelonephritis, are 4-5 times more common in girls than in boys. This is explained by the difference in the anatomical structure of the genitourinary system. Girls have a much shorter urethra. It is easier for infections to enter the bladder and kidneys directly from the vagina or intestines.

The causative agents of infection can be bacteria (Escherichia coli, staphylococci), viruses (adenoviruses, enteroviruses, influenza pathogens), as well as protozoa (giardia, toxoplasma) and fungi.

How does infection occur?

Infection can enter the kidneys in three ways:

1. Ascending (urinogenic). Bacteria enter the kidneys from the genitourinary organs or intestines.
2. Hematogenous (through blood). Infection occurs if a child is sick with pneumonia, otitis, caries, cystitis, that is, the infection enters the kidneys from any organ affected by the inflammatory process.
3. Lymphogenic (through lymphatic vessels).

Classification of pyelonephritis

There are primary and secondary pyelonephritis in children.

Primary– this is when the source of infection appears directly in the kidneys. The occurrence of primary inflammation is facilitated by decreased immunity. At the same time, opportunistic microflora begins to develop in them.

Secondary pyelonephritis is a complication that occurs in the body due to the transfer of infection from other organs, disruption of the outflow of urine due to their diseases, injuries or developmental pathologies.

Various types of inflammatory processes may develop. Obstructive pyelonephritis is accompanied by urine retention in the kidneys. Non-obstructive- urine leaves the kidneys freely.

Pyelonephritis can occur in 2 forms. Spicy usually resolves within 1-3 months if treatment is started promptly. Chronic pyelonephritis can last for years. The disease has become chronic if the symptoms do not disappear within six months. A protracted inflammatory process can be recurrent, when manifestations periodically return, and then periods of remission (temporary recovery) occur.

It is also possible for chronic pyelonephritis to occur in a latent form. However, the symptoms are very mild. Latent pyelonephritis can be detected in a child only with a thorough examination (characteristic changes in the composition of urine and blood are observed, which can be detected by test results).

If inflammation occurs in only one kidney, then they speak of unilateral pyelonephritis. If both kidneys are affected, it is said to be bilateral.

Causes of pyelonephritis

The main causes of pyelonephritis are:

1. The presence of congenital pathologies of the development of the kidneys and other urinary organs. Urinary retention and abnormal accumulation of urine in the kidneys occur.
2. Formation of salt stones and sand. The crystals may block the kidney tubules.
3. Backflow of urine (reflux) from the bladder into the kidneys as a result of increased pressure inside it due to inflammatory edema, injury, or a congenital defect of the organ.
4. Entry of pathogenic microorganisms into the kidneys.

In newborns, infection most often occurs hematogenously (for example, due to inflammation of the umbilical wound, the appearance of pustules on the skin, pneumonia). In older children, pyelonephritis usually occurs as a consequence of inflammatory diseases of the genital organs, bladder, and intestines, that is, infection occurs through an ascending route. When the intestinal mucosa is damaged, bacteria enter the kidneys with lymph, since the natural outflow of lymphatic fluid from the kidneys to the intestines is disrupted, causing stagnation in the vessels.

The occurrence of pyelonephritis in children is facilitated by improper hygienic care of babies and infrequent changes of diapers and underwear.

Warning: This problem is especially relevant for girls. In order not to introduce infection into the ureters from the anus, it is important to wash the girl correctly (in the direction from the genitals to the anus, and not vice versa).

Provoking factors are also decreased immunity, the presence of chronic inflammatory processes in the child, acute infectious diseases (measles, mumps, chicken pox and others), diabetes mellitus, and.

Hypothermia of the pelvis and lower extremities is one of the main causes of inflammation of the bladder, which is often complicated by pyelonephritis. Most often, weakened children who exhibit symptoms of vitamin deficiency, anemia, and rickets are ill.

Video: Features of pyelonephritis, its diagnosis and treatment

Symptoms of pyelonephritis

In children, pyelonephritis begins with a sharp increase in temperature to 38°-38.5°C and the onset of chills. In addition to elevated temperature, other symptoms of general intoxication of the body with waste products of bacteria appear, such as headache, loss of appetite, nausea, and vomiting. The child becomes drowsy and lethargic.

The temperature may persist for several days, but there are no signs of a cold (runny nose, sore throat, cough).

There is a frequent urge to urinate, but urine output with pyelonephritis is scanty. The urine becomes cloudy, its color becomes more intense, and an extremely unpleasant odor appears. There is pain when emptying the bladder. It is characteristic that in a healthy child the bulk of urine is excreted during the daytime, but with pyelonephritis, night urination becomes more frequent and urinary incontinence occurs.

Children usually complain of stabbing or aching pain in the lower back, and sometimes in the lower abdomen. The patient develops swelling under the eyes (especially after sleep). Blood pressure rises and heart rate increases.

Acute pyelonephritis

Acute pyelonephritis develops in children in several stages.

On Stage 1 Small infiltrates (pustules) form in the kidneys. At this stage, antibiotics can easily cope with the infection, the main thing is to start therapy on time.

On 2 stages the infiltrates merge and a focus of inflammation with a diameter of up to 2 cm is formed. There may be several such lesions.

For 3 stages pyelonephritis is characterized by the fusion of individual foci and the appearance of an extensive purulent abscess. In this case, destruction of the kidney parenchyma occurs, which is accompanied by an increase in temperature to 40°-41°C, severe symptoms of body poisoning and lower back pain. The pain intensifies if you lightly tap on the back in the kidney area, and is felt more strongly when moving or lifting heavy objects. It also occurs under the lower ribs.

If the abscess ruptures, its contents enter the abdominal cavity. Blood poisoning develops, which most often leads to death.

Warning: If a child’s temperature rises and there are no cold symptoms, it is imperative to take him to a pediatrician or pediatric urologist to have a urine test done and begin treatment immediately.

Chronic pyelonephritis

During the period of remission of pyelonephritis, pain, fever and other symptoms are absent. The temperature does not rise above 37.5°C. But the child gets tired quickly and becomes nervous. He has pale skin. A dull pain in the back may occur.

Chronic inflammation of the kidney can cause severe health complications for the child in the future. The consequence of chronic pyelonephritis in children is nephrosclerosis (“shrinked kidney”) - atrophy of the kidney tissue due to poor circulation and hypoxia, its replacement with connective tissue, and scar formation.

Chronic renal failure (impaired kidneys' ability to filter blood and excrete urine) may occur. With age, hypertension and heart failure develop.

Features of symptoms in infants

The first sign of an infant's illness with pyelonephritis may be an increase in temperature in the absence of signs of acute respiratory viral infection. At the same time, you can observe a change in the nature of urination.

The baby urinates either too rarely or too often and a lot. At the moment of urination he cries. His urine becomes cloudy, dark, and may contain blood. Sick children are constantly capricious, sleep poorly, eat poorly, and often spit up.

Video: Symptoms of urinary tract infections in children

Diagnosis of pyelonephritis

To confirm the diagnosis of pyelonephritis, the child must undergo an examination, which includes a general urine test for leukocytes, red blood cells and other indicators. Urine culture is performed to determine the composition of the microflora.

You may need to analyze urine collected during the day (Zimnitsky analysis). Its specific gravity is determined, by which one can judge the functionality of the kidneys and the ability to filter blood.

A biochemical analysis of urine is performed for protein (in the absence of inflammation it should not be there), urea (a decrease in its level indicates renal failure) and other components. Testing urine using PCR and ELISA methods makes it possible to determine the type of infectious agents based on their DNA and the presence of corresponding antibodies.

Blood tests are carried out: general, protein, creatinine. A creatinine content higher than normal indicates that the kidneys are not coping with their functions.

Instrumental examination methods include ultrasound of the kidneys and other urinary organs, urography (X-ray using a contrast solution), computed tomography.

Video: The importance of urine analysis for urinary tract infections

Treatment

Treatment of pyelonephritis in children in the absence of complications is carried out at home. In case of severe manifestations of an acute disease, as well as when its symptoms occur in infants, patients are hospitalized.

Treatment for pyelonephritis is carried out according to the following principle:

1. The child is prescribed bed rest.
2. A diet is prescribed: salt intake is limited. Food should be vegetable and protein, low in fat. The child should drink approximately 1.5 times more liquid (water, compotes, tea) than usual. If signs of renal failure are observed, the amount of fluid consumed should be limited.
3. When symptoms of pyelonephritis appear, painkillers and antipyretics (ibuprofen, paracetamol) are used.
4. Children are treated with antibiotics. They are selected depending on the results of urine and blood tests. The presence of side effects is taken into account. The course of treatment is approximately 10 days, after which it is necessary to give the baby probiotics to restore intestinal function. Antibacterial drugs such as cefuroxime, ampicillin, and gentamicin are prescribed.
5. To quickly remove bacteria from the kidneys and bladder, diuretics (spironolactone, furosemide) are used. Children are prescribed anti-allergenic drugs, as well as immunostimulants.

Complete recovery is judged by the results of laboratory urine tests.

Drug treatment of pyelonephritis in children is supplemented by the use of herbal diuretics and anti-inflammatory drugs (decoctions of bearberry, corn silk, string, mint, yarrow).

Prevention of pyelonephritis

The main measure to prevent the occurrence of urological diseases, including pyelonephritis, is compliance with the rules of hygienic care for children (frequent changes of diapers, maximum limitation of their use, thorough washing of children).

Parents should monitor how often the child empties his bladder and remind him that it is time for him to go potty. The bladder should not be overfilled so that urine does not stagnate in it.

If a child has any incomprehensible symptoms, you should not self-medicate. It is imperative to consult a doctor.

Pyelonephritis– the inflammatory process in the kidneys and renal pelvis is the most common disease among children, second in frequency only to inflammatory diseases of the upper respiratory tract. The wide prevalence of morbidity among children of early childhood, the transition to a chronic form and the possibility of irreversible consequences make it possible to consider this disease a very serious pathology that requires a careful approach to treatment, both from the doctor and from the parents.

Aware means armed! Suspecting the disease in time is already half the success of recovery!

Basic causes of pyelonephritis in children

Pyelonephritis in children, like any inflammatory disease, is caused by microorganisms (bacteria), which enter the kidney in various ways and begin to actively multiply. According to the etiology and pathogenesis of pyelonephritis, in the vast majority of cases the disease is caused by E. coli, which is carried into the kidney through the bloodstream from a source of chronic infection, the role of which is most often played by carious teeth, chronic tonsillitis (tonsillitis) and otitis (ear inflammation). In more rare cases, the infection comes from the bladder or external genitalia. This is precisely the reason for the fact that girls, due to their short urethra, suffer from pyelonephritis and cystitis 3 times more often than boys.

However, under normal conditions, the child’s body is able to cope with microorganisms. The main reason for the development of inflammation is considered to be a decrease in immunity, when the body’s defenses are unable to fight infection.

There are many reasons leading to a decrease in immunity, the main of which are:

• Complications during pregnancy and childbirth
• Short breastfeeding, early introduction of complementary foods
• Lack of vitamins
• Chronic inflammatory diseases of the respiratory tract and ENT organs
• Hereditary predisposition

There are so-called critical periods of child development when the body is most vulnerable to the effects of infectious agents:

• From birth to 2 years
• From 4-5 to 7 years
• Teenage years

Classification of pyelonephritis

Based on the causes of the disease, pyelonephritis is divided into primary and secondary. Primary pyelonephritis develops in a practically healthy child against the background of complete well-being; secondary, in turn, occurs with congenital anatomical anomalies of the kidneys, bladder and urethra, when stagnation of urine provides the prerequisites for the active proliferation of bacteria.

There are two forms of pyelonephritis: acute and chronic. Acute pyelonephritis in children occurs more violently with symptoms of severe intoxication, but with proper treatment it most often ends in complete recovery. In some cases, the acute form can become chronic, which is characterized by periodic exacerbations, lasts a very long time (up to old age) and leads to irreversible complications.

The main symptoms of pyelonephritis in children

The peculiarity of pyelonephritis in children is that, depending on age, the symptoms of the disease manifest themselves differently. It is not difficult to suspect signs of pyelonephritis in a child; usually the disease occurs with characteristic manifestations, with the only exception being young children.

Children under 1 year

Pyelonephritis in children under one year of age usually has the following symptoms:

• Increase in temperature to 39-40 without signs of inflammation of the respiratory tract
• Anxiety and sleep disturbance
• Decreased appetite

An increase in temperature to high levels without any reason should immediately alert both parents and the doctor to the presence of pyelonephritis in the child. The temperature with pyelonephritis is difficult to treat with antipyretic drugs and can remain at high levels for several days.

Children from 1 year to 5 years

In children under 5 years of age, along with a high temperature, abdominal pain without a specific localization, nausea, and sometimes vomiting appear. The child is restless and cannot clearly indicate the place where it hurts.

Over 5 years old

Typical symptoms from the urinary system appear only after 5-6 years of age, when the child begins to be bothered by aching pain in the lumbar and suprapubic region and pain when urinating.

Thus, the “typical” set of symptoms of acute pyelonephritis in children over 5 years of age includes the following:

• Acute increase in body temperature to 39-40C. It is important to remember that the distinguishing feature of kidney inflammation from colds is the absence of inflammation of the respiratory tract (runny nose, cough, sore throat, earache). The temperature rises against the background of complete health immediately to high levels.
• Symptoms of general intoxication - the child becomes lethargic, capricious, refuses food. Attacks of chills are replaced by attacks of fever. Often, a headache occurs against the background of fever.
• Symptoms from the urinary system - as a rule, on the second day after the temperature rises, constant aching pain appears in the lumbar region (most often on one side), pain in the suprapubic region, pain when urinating. With concomitant cystitis, the urge to urinate becomes frequent up to 20 or more times a day.
• Urine with pyelonephritis in a child is visually dark, cloudy, foamy, sometimes with a reddish tint (due to the presence of blood in it).

Despite the severe course of acute pyelonephritis, with timely seeking medical help and proper treatment, the disease has a favorable outcome. However, often the acute form becomes chronic.

Chronic pyelonephritis

Pyelonephritis is considered chronic if it lasts more than 1 year and has 2 or more episodes of exacerbation during this period. This form is an alternation of periodically recurring exacerbations (especially in the spring-autumn period) and asymptomatic periods. The manifestations of the chronic form are the same as those of the acute form, only most often less pronounced. The course of chronic pyelonephritis is slow and long-lasting. With frequent exacerbations, improper treatment and lack of prevention, the disease can lead to such a serious complication as renal failure.

Set of diagnostic measures

It is not difficult for an experienced doctor to diagnose “Pyelonephritis,” especially if there have already been episodes of the disease in the medical history. Usually, diagnosis of pyelonephritis in children necessarily includes a general urine test, a general blood test, urine culture for microflora and an ultrasound of the kidneys. If there are bacteria and leukocytes in the urine, and with a corresponding ultrasound picture, the doctor can already make an appropriate diagnosis.

Video lecture. Pyelonephritis in children. "Medical Bulletin":

Treatment of pyelonephritis in children

Basic principles of treatment

It is important to understand that the treatment of any disease, especially something as serious as pyelonephritis, is not limited to medications. Treatment is a wide range of measures aimed not only at eliminating the cause of the disease, but at preventing subsequent relapses (exacerbations).

Treatment of any inflammatory kidney diseases is complex and consists of the following components:

1. Mode
2. Diet
3. Drug therapy
4. Physiotherapy and exercise therapy

You should always strictly follow all the doctor’s recommendations for a speedy recovery and prevention of relapses.

Mode

During the period of pronounced manifestations of the disease, bed or semi-bed rest is recommended. You need to forget about studying, walking and, especially, sports training for a while. In the second week of the illness, when the temperature drops significantly and the lower back pain goes away, the regimen can be expanded, but it will be much better if the child spends the entire period of the illness at home.

Diet

Diet for pyelonephritis in children, as well as in adults, is an integral attribute of successful recovery. Spicy, salty, fried foods should be excluded from the child’s diet, and foods high in protein should be limited. On days 7-10 of the acute form, it is necessary to switch to a lactic acid diet with incomplete restriction of salt and protein. It is also recommended to drink plenty of fluids (compotes, fruit drinks, weak tea), and in case of chronic pyelonephritis (during periods of remission), it is mandatory to drink slightly alkaline mineral waters.

Drug therapy

a) Antibiotics

All inflammatory diseases are treated with special antimicrobial drugs (antibiotics), and childhood pyelonephritis is no exception. However, in no case should you self-treat a child - antibiotics can only be prescribed by a doctor(!), who is able to take into account all the criteria for selecting a drug, based on the severity of the disease, age and individual characteristics of the child. Treatment of acute and treatment of chronic pyelonephritis in children is carried out according to the same principles.

Antibiotics for pyelonephritis in children are represented by a relatively small range, since many antibiotics are contraindicated under 12 or 18 years of age, so specialists usually prescribe the following groups of drugs:

• Protected penicillins (Augmentin, Amoxiclav). In addition to the usual tablets, these antibiotics are available in the form of a sweet suspension for young children, and the dosage is done using a special measuring syringe or spoon.
• Antibiotics of the cephalosporin group, which most often only come in injections, so they are used for inpatient treatment (Cefotaxime, Cefuroxin, Ceftriaxone). However, some also exist in the form of suspension, capsules and soluble tablets (Cedex, Suprax).
• Aminoglycosides (Sumamed, Gentamicin) and carbapenems also occur in rare cases, but most often they are used as an alternative and as part of combination therapy.

In severe cases, the doctor may use several antibiotics from different groups at once (combination therapy) in order to get rid of the infectious pathogen as soon as possible. Sometimes one antibiotic has to be replaced with another, and this happens in the following cases:

• If 2-3 days after taking the drug the condition has not improved or, on the contrary, has worsened, and the temperature continues to remain at the same levels
• For long-term treatment more than 10-14 days. In this case, the doctor must replace the antibiotic to prevent the child’s body from developing an addiction to this drug.

b) Uroseptics

Drug therapy is not limited only to antibiotics - there are other important groups of drugs, for example, uroantiseptics (nalidixic acid). They are prescribed after a course of antibiotics for children over 2 years of age.

c) Vitamins and immunomodulators

Having completed the course of basic treatment, it is imperative to restore weakened immunity after illness. For this purpose, immunomodulators (Viferon, Reaferon) and a complex of multivitamins are usually prescribed according to the child’s age.

d) Herbal treatment

Herbal medicine for kidney diseases has long proven its effectiveness, but it can only be carried out in combination with basic medications. Bear ears, bearberry, birch buds, and horsetail have proven themselves well. These plants have anti-inflammatory and antiseptic effects, but they must be taken over a long period of time.

Features of inpatient treatment

Treatment of pyelonephritis in children under one year of age is carried out only(!) in a hospital under the close supervision of medical personnel. Older children with moderate or severe cases are also required to be hospitalized. It is advisable to always treat acute pyelonephritis in children over 10 years of age in a hospital (even with mild severity) in order to carry out a set of diagnostic procedures in a timely manner and identify the cause of the disease.

In the hospital, the child will receive all the necessary care in full.

Nursing care for pyelonephritis in children includes measures to monitor adherence to the regime during fever (especially important for children 3-10 years old), monitoring diet, carrying out timely hygiene and other measures that ensure the creation of comfortable conditions for a speedy recovery of the child .

Often, the choice of treatment is made together with a pediatric urologist surgeon to timely resolve the issue of eliminating anatomical abnormalities if secondary acute or secondary chronic pyelonephritis is diagnosed in children.

Physiotherapy and exercise therapy

Physiotherapy depends on the severity of the disease, and is most often prescribed by a physiotherapist after the course of primary treatment, when the child’s condition returns to normal. Ultrasound methods, UHF therapy, and magnetic therapy have proven themselves well. Also, when the inflammatory process subsides, physical therapy in a lying or sitting position is indicated, depending on the age and condition of the child.

Preventive actions

Prevention of pyelonephritis in children plays an important role in both acute and chronic forms of the disease. It is divided into primary and secondary.

Primary prevention (preventing the development of the disease) includes timely elimination of foci of chronic infection (carious teeth, chronic otitis and tonsillitis), strengthening the immune system and avoiding hypothermia, personal hygiene (especially careful hygiene of the external genitalia).

Secondary implies the prevention of exacerbations and includes the doctor’s recommendations: compliance with anti-relapse therapy, systematic observation, as well as all of the above primary prevention measures.

Dynamic observation

Both acute and chronic pyelonephritis in children require dynamic observation by a pediatric urologist, nephrologist or pediatrician with periodic urine examination and ultrasound of the kidneys:

After an acute episode or an episode of exacerbation of a chronic one – once every 10 days

During remission - once a month

In the first 3 years after treatment – ​​once every 3 months

Up to 15 years – 1 or 2 times a year

Systematic monitoring will help avoid long-term complications of the disease: chronic renal failure, arterial hypertension, urolithiasis.

Urologist-andrologist of the first category, researcher at the Department of Urology and Surgical Andrology of the Russian Medical Academy of Postgraduate Education (RMAPO).

Pyelonephritis is an infectious kidney disease that occurs quite often in children. Unpleasant symptoms, such as changes in the nature of urination, the color of urine, pain in the abdomen, fever, lethargy and weakness prevent the child from developing normally and attending childcare centers - the disease requires medical attention.

Among other nephrological (kidney damage) diseases in children, pyelonephritis is the most common, but there are also cases of overdiagnosis when another infection of the urinary system (cystitis, urethritis) is mistaken for pyelonephritis. In order to help the reader navigate the variety of symptoms, in this article we will tell you about this disease, its signs and treatment methods.

General information

Pyelonephritis (tubulointerstitial infectious nephritis) is an inflammatory lesion of the infectious nature of the pyelocaliceal system of the kidneys, as well as their tubules and interstitial tissue.

The renal tubules are a kind of “tubes” through which urine is filtered, urine accumulates in the calyces and renal pelvis, flowing from there into the bladder, and the interstitium is the so-called interstitial tissue of the kidney, filling the space between the main renal structures, it is like a “framework” organ.

Children of all ages are susceptible to pyelonephritis. In the first year of life, girls and boys suffer from it with the same frequency, and after a year, pyelonephritis occurs more often in girls, which is associated with the anatomy of the urinary tract.

Causes of pyelonephritis

Escherichia coli is the main causative agent of pyelonephritis in children.

Infectious inflammation in the kidneys is caused by microorganisms: bacteria, viruses, protozoa or fungi. The main causative agent of pyelonephritis in children is Escherichia coli, followed by Proteus and Staphylococcus aureus, viruses (adenovirus, influenza viruses, Coxsackie). In chronic pyelonephritis, microbial associations (several pathogens at the same time) are often detected.

Microorganisms can enter the kidneys in several ways:

1. Hematogenous route: through the blood from foci of infection in other organs (lungs, bones, etc.). This route of spread of the pathogen is of greatest importance in newborns and infants: in them, pyelonephritis can develop after pneumonia, otitis media and other infections, including in organs located anatomically far from the kidneys. In older children, hematogenous spread of the pathogen is possible in severe infections (bacterial endocarditis, sepsis).
2. The lymphogenous route is associated with the entry of the pathogen into the kidneys through the common lymph circulation system between the organs of the urinary system and the intestines. Normally, lymph flows from the kidneys to the intestines, and infection is not observed. But if the properties of the intestinal mucosa are impaired, lymph stagnation (for example, in the case of chronic constipation, diarrhea, intestinal infections, dysbiosis), the kidneys may become infected with intestinal microflora.
3. Ascending path - from the genitals, anus, urethra or bladder, microorganisms “rise” to the kidneys. This is the most common route of infection in children over one year of age, especially girls.

Factors predisposing to the development of pyelonephritis

Normally, the urinary tract communicates with the external environment and is not sterile, that is, there is always the possibility of microorganisms entering them. With normal functioning of the urinary system and good state of local and general immunity, infection does not develop. The occurrence of pyelonephritis is promoted by two groups of predisposing factors: from the microorganism and from the macroorganism, that is, the child himself. On the part of the microorganism, such a factor is high virulence (high infectivity, aggressiveness and resistance to the action of the protective mechanisms of the child’s body). And on the part of the child, the development of pyelonephritis is promoted by:

1. Disturbances in the normal outflow of urine due to abnormalities in the structure of the kidneys and urinary tract, with stones in the urinary system and even with crystalluria due to dysmetabolic nephropathy (small salt crystals clog the kidney tubules).
2. Stagnation of urine in functional disorders (neurogenic dysfunctions of the bladder).
3. Vesicoureteral reflux (return of urine from the bladder to the kidneys) of any origin.
4. Favorable conditions for ascending infection (insufficient personal hygiene, improper washing of girls, inflammatory processes in the external genitalia, perineum and anus, untreated cystitis or urethritis).
5. Any acute or chronic diseases that reduce the child’s immunity.
6. Diabetes.
7. Chronic foci of infection (tonsillitis, sinusitis, etc.).
8. Hypothermia.
9. Helminthic infestations.
10. In children under one year of age, the development of pyelonephritis is predisposed by the transition to artificial feeding, the introduction of complementary foods, teething and other factors that increase the load on the immune system.

Classification of pyelonephritis

Russian nephrologists distinguish the following types of pyelonephritis:

1. Primary (in the absence of obvious predisposing factors on the part of the urinary organs) and secondary (arising against the background of structural anomalies, with functional disorders of urination - obstructive pyelonephritis; with dysmetabolic disorders - non-obstructive pyelonephritis).
2. Acute (after 1-2 months there is complete recovery and normalization of laboratory parameters) and chronic (the disease lasts more than six months, or two or more relapses occur during this period). In turn, chronic pyelonephritis can be recurrent (with obvious exacerbations) and latent (when there are no symptoms, but changes are periodically detected in tests). The latent course of chronic pyelonephritis is a rare phenomenon, and most often this diagnosis is a consequence of overdiagnosis, when pyelonephritis is mistaken for lower urinary tract infection or reflux nephropathy, in which there are really no or mild “external” symptoms and complaints.

Symptoms of acute pyelonephritis

Children 3-4 years old complain of pain not in the lower back, but throughout the abdomen or around the navel.

Symptoms of pyelonephritis vary quite significantly in different children, depending on the severity of inflammation, the severity of the process, the age of the child, concomitant pathology, etc.

The following main symptoms of pyelonephritis can be distinguished:

1. An increase in temperature is one of the main signs, often the only one (“unreasonable” rises in temperature). Fever is usually severe, the temperature rises to 38°C or higher.
2. Other symptoms of intoxication: lethargy, drowsiness, nausea and vomiting, decreased or lack of appetite; pale or gray skin tone, periorbital shadows (“blue” under the eyes). As a rule, the more severe the pyelonephritis and the younger the child, the more pronounced the signs of intoxication will be.
3. Pain in the abdomen or lumbar region. Children under 3-4 years of age do not localize abdominal pain well and may complain of diffuse pain (throughout the entire abdomen) or pain around the navel. Older children more often complain of pain in the lower back (usually one-sided), in the side, and in the lower abdomen. The pain is mild, nagging, intensifies with changes in body position and subsides when warmed up.
4. Urinary problems are an optional symptom. Possible urinary incontinence, frequent or rare urination, sometimes it is painful (against the background of previous or concomitant cystitis).
5. Mild swelling of the face or eyelids in the morning. With pyelonephritis, there is no pronounced edema.
6. Changes in the appearance of urine: it becomes cloudy and may have an unpleasant odor.

Features of pyelonephritis in newborns and infants

In infants, pyelonephritis is manifested by symptoms of severe intoxication:

• high temperature (39-40°C) up to febrile convulsions;
• regurgitation and vomiting;
• refusal of breast (formula) or sluggish sucking;
• pale skin with perioral cyanosis (blueness around the mouth, cyanosis of the lips and skin above the upper lip);
• weight loss or lack of weight gain;
• dehydration, manifested by dry and sagging skin.

Babies cannot complain of abdominal pain, and their analogue is the child’s unrelated restlessness or crying. About half of infants also experience restlessness when urinating or facial flushing and “groaning” before urination. Often, infants with pyelonephritis experience stool disorders (diarrhea), which, combined with high fever, vomiting and signs of dehydration, makes it difficult to diagnose pyelonephritis and is mistakenly interpreted as an intestinal infection.

Symptoms of chronic pyelonephritis

Chronic recurrent pyelonephritis occurs with alternating periods of complete remission, when the child has no symptoms or changes in urine tests, and periods of exacerbations, during which the same symptoms occur as with acute pyelonephritis (abdominal and back pain, fever, intoxication, changes in urine tests). Children who suffer from chronic pyelonephritis for a long time show signs of infectious asthenia: irritability, fatigue, and decreased performance at school. If pyelonephritis begins at an early age, it can lead to a delay in physical, and in some cases, psychomotor development.

Diagnosis of pyelonephritis

To confirm the diagnosis of pyelonephritis, additional laboratory and instrumental research methods are used:

1. A general urine test is a mandatory test for all children with fever, especially if their fever cannot be explained by ARVI or other causes not related to the kidneys. Pyelonephritis is characterized by an increase in leukocytes in the urine: leukocyturia up to pyuria (pus in the urine), when leukocytes cover the entire field of view; bacteriuria (the appearance of bacteria in the urine), possibly a small number of casts (hyaline), mild proteinuria (protein in the urine no more than 1 g/l), single red blood cells. You can also read about the interpretation of urine analysis in children in this article.
2. Cumulative tests (according to Nechiporenko, Addis-Kakovsky, Amburge): leukocyturia is detected in them.
3. Culture of urine for sterility and sensitivity to antibiotics allows you to determine the causative agent of the infection and select effective antibacterial drugs for the treatment and prevention of relapse of the disease.
4. A general blood test reveals general signs of an infectious process: acceleration of ESR, leukocytosis (increased number of leukocytes compared to the age norm), shift of the leukocyte formula to the left (appearance of immature leukocytes in the blood - rods), anemia (decrease in hemoglobin and number of red blood cells).
5. A biochemical blood test is required to determine total protein and protein fractions, urea, creatinine, fibrinogen, and CRP. In acute pyelonephritis, in the first week from the onset of the disease, a biochemical analysis shows an increase in the level of C-reactive protein. In chronic pyelonephritis, against the background of the development of renal failure, the level of urea and creatinine increases, and the level of total protein decreases.
6. Biochemical urine analysis.
7. Kidney function is assessed using the Zimnitsky test, the level of creatinine and urea in a biochemical blood test and some other tests. In acute pyelonephritis, renal function is usually not impaired, but in chronic pyelonephritis, some deviations in the Zimnitsky test are often detected (isosthenuria - monotonic specific gravity, nocturia - predominance of nighttime diuresis over daytime).
8. Measuring blood pressure is a mandatory daily procedure for children of any age who are hospitalized for acute or chronic pyelonephritis. In acute pyelonephritis, the pressure is within the age norm. When blood pressure begins to rise in a child with chronic pyelonephritis, this may indicate renal failure.
9. In addition, all children undergo an ultrasound of the urinary system, and after the acute phenomena subside, X-ray contrast studies (voice cystoureterography, excretory urography). These studies can identify vesicoureteral reflux and anatomical abnormalities that contribute to the occurrence of pyelonephritis.
10. In specialized nephrology and urology pediatric departments, other studies are also carried out: various tests, Dopplerography of renal blood flow, scintigraphy (radionuclide study), uroflowmetry, CT, MRI, etc.

Complications of pyelonephritis

Pyelonephritis is a serious disease that requires timely and adequate treatment. Delays in treatment and insufficient volume of treatment measures can lead to the development of complications. Complications of acute pyelonephritis are most often associated with the spread of infection and the occurrence of purulent processes (abscesses, paranephritis, urosepsis, bacteremic shock, etc.), and complications of chronic pyelonephritis are usually caused by impaired renal function (nephrogenic arterial hypertension, chronic renal failure).

Treatment of pyelonephritis

In case of acute pyelonephritis, the child is advised to drink plenty of fluids.

Treatment of acute pyelonephritis in children should be carried out only in a hospital setting, and hospitalization of the child in a highly specialized department: nephrology or urology is highly desirable. Only in a hospital is it possible to constantly evaluate the dynamics of urine and blood tests, conduct other necessary studies, and select the most effective medications.

Therapeutic measures for acute pyelonephritis in children:

1. Regimen - children with fever and children who complain of pain in the abdomen or lumbar region are prescribed bed rest in the first week of illness. In the absence of fever and severe pain, the regime is ward (the child is allowed to move within the confines of his room), then general (including daily quiet walks in the fresh air for 30-40-60 minutes on the hospital grounds).
2. A diet whose main purpose is to reduce the load on the kidneys and correct metabolic disorders. Table No. 5 according to Pevzner is recommended without salt restriction and with an expanded drinking regimen (the child should receive 50% more fluid than the age norm). However, if in acute pyelonephritis there is impaired renal function or obstructive phenomena, salt and fluid are limited. A protein-vegetable diet, with the exclusion of any irritating foods (spices, spicy foods, smoked foods, fatty foods, rich broths). For dysmetabolic disorders, an appropriate diet is recommended.
3. Antibacterial therapy is the basis of drug treatment of acute pyelonephritis. It is carried out in two stages. Before receiving the results of a urine test for sterility and sensitivity to antibiotics, the drug is selected “at random”, giving preference to those that are active against the most common pathogens of the urinary system and are not toxic to the kidneys (protected penicillins, 2nd and 3rd generation cephalosporins, etc. ). After receiving the analysis results, the drug that is most effective against the identified pathogen is selected. The duration of antibacterial therapy is about 4 weeks, with the antibiotic changed every 7-10 days.
4. Uroantiseptics are drugs that can disinfect the urinary tract, kill bacteria or stop their growth, but are not antibiotics: nevigramon, palin, nitroxoline, etc. They are prescribed for another 7-14 days of use.
5. Other medications: antispasmodics, antispasmodics (for pain), drugs with antioxidant activity (unithiol, beta-carotene - provitamin A, tocopherol acetate - vitamin E), non-steroidal anti-inflammatory drugs (ortofen, voltaren).

Treatment in a hospital lasts about 4 weeks, sometimes longer. After discharge, the child is sent for observation to the local pediatrician; if the clinic has a nephrologist, then to him too. The child is observed and treated in accordance with the recommendations given in the hospital; if necessary, they can be corrected by a nephrologist. After discharge, a general urine test is performed at least once a month (and additionally against the background of any ARVI), and an ultrasound of the kidneys is performed every six months. Upon completion of taking uroseptics, herbal medicines (kidney tea, lingonberry leaf, canephron, etc.) are prescribed for 1-2 months. A child who has suffered acute pyelonephritis can be removed from the register only after 5 years, provided there are no symptoms and changes in urine tests without taking medicinal anti-relapse measures (that is, the child was not given uroseptics or antibiotics during these 5 years, and he did not experience a relapse of pyelonephritis) .

Treatment of children with chronic pyelonephritis

Treatment of exacerbations of chronic pyelonephritis is also carried out in a hospital setting and according to the same principles as the treatment of acute pyelonephritis. Children with chronic pyelonephritis during the period of remission may also be recommended planned hospitalization in a specialized hospital for a detailed examination, clarification of the causes of the disease and selection of anti-relapse therapy.

In chronic pyelonephritis, identifying the cause of its development is extremely important, since only after eliminating the cause will it be possible to eliminate the disease itself. Depending on what exactly caused the kidney infection, therapeutic measures are also prescribed: surgical treatment (for vesicoureteral reflux, anomalies accompanied by obstruction), diet therapy (for dysmetabolic nephropathy), medication and psychotherapeutic measures (for neurogenic bladder dysfunction) etc.

In addition, in case of chronic pyelonephritis during the period of remission, anti-relapse measures are necessarily carried out: a course of antibiotic treatment in small doses, the prescription of uroseptics in courses for 2-4 weeks with breaks of 1 to 3 months, herbal medicine for 2 weeks of each month. Children with chronic pyelonephritis are observed by a nephrologist and pediatrician with routine examinations until transfer to an adult clinic.

Which doctor should I contact?

In case of acute pyelonephritis, a pediatrician usually begins examination and treatment, and then a consultation with a nephrologist is scheduled. Children with chronic pyelonephritis are observed by a nephrologist; an additional consultation with an infectious disease specialist may be prescribed (in unclear diagnostic cases, suspected tuberculosis, and so on). Considering the predisposing factors and routes of infection into the kidneys, it will be useful to consult with a specialized specialist - a cardiologist, gastroenterologist, pulmonologist, neurologist, urologist, endocrinologist, ENT doctor, immunologist. Treatment of foci of infection in the body will also help get rid of chronic pyelonephritis.

Chronic pyelonephritis: symptoms and treatment

A disease such as pyelonephritis in children requires prompt identification and adequate treatment. You need to carefully monitor the baby, since kidney inflammation is a dangerous disease and the symptoms cannot be ignored. Self-medication is also prohibited, as it leads to serious complications and health problems. What are the causes of pyelonephritis in children, the main symptoms and treatment of the disease.

general information

Children's pyelonephritis is an inflammatory process that develops in the tissues of the renal parenchyma and pyelocaliceal system. With pyelonephritis, children experience severe pain in the lumbar region, the urge to urinate becomes more frequent, and incontinence occurs. To make an accurate diagnosis, the child needs to be shown to a doctor, who will refer the baby for examination. If the diagnosis is confirmed, a course of antibacterial and auxiliary therapy is prescribed.

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Classification

Doctors divide pyelonephritis in a child into 2 types - primary and secondary pyelonephritis. In the initial manifestation, inflammation is caused by pathogenic microflora that has affected the kidneys and is rapidly developing in them. The peculiarities of secondary pyelonephritis are that the root cause of the disease is not inflammatory processes of the kidneys; more often, damage occurs due to the formation of stones, with abnormalities in the development of the organ and ureteral reflux.

Depending on how long the disease has been bothering the child, acute and chronic pyelonephritis is distinguished. In a chronic course, the child is worried about frequent relapses, all signs of infectious damage to the organ remain. During an exacerbation, severe and acute pain, fever, problems with urination, and deterioration in general condition are disturbing.

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Symptoms of the disease

A characteristic symptom of acute pyelonephritis is severe pain in the lumbar region, deterioration of health, increased body temperature, and intoxication. The child suffers from prolonged chills and fever; due to intoxication, nausea, vomiting, diarrhea, weight loss, and bacteriuria develop. During an exacerbation with the addition of a bacterial infection, the baby experiences pain when urinating, an increased urge to urinate, incontinence, and a burning sensation in the genitourinary system.

In a chronic course, the symptoms are blurred. A young child becomes very tired, becomes irritated, pale and unfocused. If the disease occurs in a latent form, then signs do not appear, but urine tests will show the development of inflammation. If you do not resort to treatment for a chronic disease, at an older age it develops into nephrosclerosis, hydronephrosis or chronic renal failure.

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Causes and predisposition

The causes of pyelonephritis in young children are most often intestinal bacterial. A urine test also shows the presence of Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus. Infection enters the kidneys through hematogenous, lymphogenous or urinogenic routes. Newborn babies are infected by the hematogenous route, and older children, up to 12 years of age, are more often infected by the urinogenous route. Failure to comply with hygiene rules and irregular changes of linen also provoke the disease.

During treatment, the baby should be under the supervision of a doctor.

Congenital anomalies, complications after severe infectious diseases, with a diagnosis of hypotopia, rickets, also cause the disease. Babies with such diseases are often predisposed to pyelonephritis. The child should be under the supervision of a pediatrician, and if a characteristic symptom occurs, the disease must be immediately identified and timely treatment begun using adequate medications.

This is a bacterial-inflammatory disease of the collecting apparatus and renal parenchyma with predominant involvement of its interstitial tissue.

Etiology and pathogenesis.

Among the microbial pathogens of pyelonephritis, Escherichia coli is most often detected, and other types of bacteria are less common: Klebsiella, Proteus, Pseudomonas aeruginosa, Enterococcus, Staphylococcus.

In 10-25% of patients with chronic pyelonephritis, mixed flora is found in the urine.

Infection of the kidney and collecting system occurs mainly through the ascending (in 80% of patients) and hematogenous routes.

In the occurrence and development of pyelonephritis, a decrease in the immune defense of the macroorganism is important; the presence of extra- or intrarenal obstruction of the urinary tract, contributing to urinary stasis; changes in the reactivity of the renal parenchyma, leading to a decrease in its resistance to urinary infection; pathogenicity of microbial pathogens, in particular adhesive and enzymatic properties, and their resistance to antibacterial drugs; metabolic diseases: diabetes mellitus, cystinuria, hypokalemia, etc.; the presence of extrarenal foci of infection, vulvovaginitis, dehydration, septicemia, defects in urinary tract catheterization, etc.; intestinal dysbiosis with an increase in the amount of opportunistic microflora and translocation of microorganisms from the intestine to the urinary organs. Each of these factors may have an independent significance in the occurrence of pyelonephritis, but more often the disease develops with a combination of the effects of some of them.

In accordance with the duration of the flow:

Acute pyelonephritis - lasts about 2 months in a child, quite often accompanied by complications requiring surgical treatment. Minor inflammation usually results in complete recovery.

Chronic pyelonephritis – lasts for 6 months or longer. It occurs with periods of exacerbations and remissions.

There are primary and secondary pyelonephritis.

Primary pyelonephritis develops in a child due to changes in intestinal flora. The cause of changes in microflora is an intestinal infection. With coccal infection, influenza and sore throat, there is also a risk of the child developing the primary form of the disease. The culprit of pyelonephritis can be cystitis under the age of 10 years.

Secondary pyelonephritis - develops as a result of congenital anomalies: abnormalities in the structure of the kidneys, improper location of the bladder and ureters. Secondary pyelonephritis usually occurs before one year of age. In this case, the infant has disturbances in the outflow of urinary fluid. Along with urine, bacteria penetrate into the lower tract and kidney, causing an inflammatory process. In the first year of life, underdevelopment of the kidneys can be diagnosed. This pathology leads to an increase in the load on the kidney tissue every year of life. Secondary pyelonephritis can be diagnosed within 1-2 years of a child’s life.

Clinic of acute pyelonephritis

At acute pyelonephritis The onset of the disease is usually acute, with an increase in body temperature to 38-40 ° C, chills, headache, and sometimes vomiting.

• Pain syndrome. Older children may have unilateral or bilateral lower back pain radiating to the groin area, dull or colicky, constant or intermittent.
• Dysuric disorders. Painful and frequent urination (pollakiuria), as well as polyuria with a decrease in the relative density of urine to 1015-1012, are often observed.
• Intoxication syndrome. The general condition worsens, lethargy and pallor of the skin increase.

In some children, tension in the abdominal wall, pain in the iliac region and along the ureters can be observed, in others - a positive Pasternatsky sign.

• Urinary syndrome. Neutrophilic leukocyturia and bacteriuria are detected, less often - slight microhematuria and proteinuria,

Blood tests revealed leukocytosis, elevated ESR, slight normochromic anemia. Severe forms of pyelonephritis are rare, accompanied by symptoms of sepsis, mild local manifestations, often complicated by acute renal failure, as well as erased forms of acute pyelonephritis with mild general and local symptoms and pronounced urinary signs (leukocyturia, bacteriuria, gross hematuria and proteinuria).

In newborns, the symptoms of the disease are mild and non-specific. The disease is manifested mainly by dyspeptic disorders (anorexia, vomiting, diarrhea), slight gain or loss of body weight, and fever. Less common are jaundice, bouts of cyanosis, meningeal symptoms, and signs of dehydration. Leukocyturia, bacteriuria, and slight proteinuria are detected in all children; hyperazotemia is observed in 50-60% of cases.

In most children under 1 year of age, acute pyelonephritis develops gradually. The most persistent symptoms are fever, anoexia, regurgitation and vomiting, lethargy, pallor, and problems with urination and urination. Urinary syndrome is pronounced. Hyperazotemia in infancy is observed much less frequently than in newborns, mainly in children in whom pyelonephritis develops against the background of congenital pathology of the urinary system.

Clinic of chronic pyelonephritis

Chronic pyelonephritis is a consequence of the unfavorable course of acute pyelonephritis, which lasts more than 6 months or during this period two or more exacerbations are observed. Depending on the severity of clinical manifestations, recurrent and latent chronic pyelonephritis are distinguished. In a relapsing course, periodically recurring exacerbations with more or less long asymptomatic periods are observed. The clinical picture of relapse of chronic pyelonephritis differs little from that of acute pyelonephritis and is characterized by a different combination of general (fever, abdominal or lower back pain, etc.), local (dysuria, pollakiuria, etc.) and laboratory (leukocyturia, bacteriuria, hematuria, proteinuria, etc.) etc.) symptoms of the disease. The latent course of chronic pyelonephritis is observed in approximately 20% of cases. In its diagnosis, laboratory research methods are extremely important, since patients do not have general and local signs of the disease.

— Pain syndrome in chronic pyelonephritis (CP). Pain in the lumbar region is the most common complaint of patients with chronic pyelonephritis (CP) and is observed in most of them. In the active phase of the disease, pain occurs due to stretching of the fibrous capsule of the enlarged kidney, sometimes due to inflammatory changes in the capsule itself and paranephria. Often, pain persists even after inflammation subsides due to the involvement of the capsule in the scarring process occurring in the parenchyma. The severity of pain varies: from a feeling of heaviness, awkwardness, discomfort to very severe pain with a recurrent course. Asymmetry of pain is characteristic, sometimes it spreads to the iliac region.

— Dysuric syndrome in chronic pyelonephritis (CP). During exacerbation of chronic pyelonephritis (CP), pollakiuria and stranguria are often observed. The individual frequency of urination depends on the water and nutritional regime and can differ significantly in healthy individuals, therefore, in patients with pyelonephritis, it is not the absolute number of urinations per day that matters, but the assessment of their frequency by the patient himself, as well as the frequency at night. Typically, a patient with pyelonephritis urinates frequently and in small portions, which may be a consequence of neuro-reflex disorders of urination and dyskinesia of the urinary tract, changes in the condition of the urothelium and the quality of urine. If pollakiuria is accompanied by a burning sensation, pain in the urethra, pain in the lower abdomen, and a feeling of incomplete urination, this indicates signs of damage to the bladder. Dysuria is especially characteristic of secondary pyelonephritis against the background of diseases of the bladder, prostate gland, salt diathesis, and its appearance often precedes other clinical signs of exacerbation of secondary chronic pyelonephritis (SCP). In primary pyelonephritis, dysuria is less common - in approximately 50% of patients. In secondary chronic pyelonephritis (SCP), dysuria is more common - up to 70% of patients.

— Urinary syndrome in chronic pyelonephritis (CP).
Changes in some properties of urine (unusual color, cloudiness, pungent odor, large sediment when standing) can be noticed by the patient himself and serve as a reason to consult a doctor. A correctly conducted urine test provides very important information in case of kidney diseases, including chronic pyelonephritis (CP).

For chronic pyelonephritis (CP) proteinuria The amount of proteinuria usually does not exceed 1 g/l, hyaline casts are found extremely rarely. During periods of exacerbation of chronic pyelonephritis (CP), proteinuria is detected in 95% of patients.

Cylindruria is atypical for pyelonephritis, although in the active phase, as already mentioned, single hyaline casts are often found.

Leukocyturia- a direct sign of an inflammatory process in the urinary system. Its cause in chronic pyelonephritis (CP) is the penetration of leukocytes into the urine from foci of inflammation into the interstitium of the kidney through damaged tubules, as well as inflammatory changes in the epithelium of the tubules and pelvis.

More important than anything else is the determination and assessment of urine density. Unfortunately, many doctors ignore this indicator. However, hyposthenuria is a very serious symptom. A decrease in urine density is an indicator of a violation of urine concentration by the kidneys, and this is almost always swelling of the medulla, hence inflammation. Therefore, with pyelonephritis in the acute phase, you always have to deal with a decrease in urine density. Quite often this symptom is detected as the only sign of pyelonephritis. For a number of years there may be no pathological sediment, hypertension, or other symptoms, but only low density urine.

Hematuria in chronic pyelonephritis (CP)

Causes of renal hematuria are inflammatory processes in the glomeruli, stroma, blood vessels, increased pressure in the renal veins, and impaired venous outflow.

In chronic pyelonephritis (CP), all of the above factors are at work, but, as a rule, gross hematuria in patients with chronic pyelonephritis (CP) is not observed, except in cases where complications of pyelonephritis occur (necrosis of the renal vessels, hyperemia of the mucous membrane of the urinary tract with pyelocystitis, its calculus damage).

Microhematuria in the active phase of chronic pyelonephritis (CP) can be detected in 40% of patients, and in half of them it is small - up to 3-8 red blood cells in the field of view. In the latent phase of chronic pyelonephritis (CP), hematuria is detected in a general urine analysis in only 8% of patients, and in another 8% - in quantitative samples.

Thus, hematuria cannot be considered one of the main signs of chronic pyelonephritis (CP).

Bacteriuria is considered the second (after leukocyturia) diagnostic sign of pyelonephritis. From a microbiological point of view, we can talk about urinary tract infection if pathogenic microorganisms are found in the urine, urethra, kidneys or prostate gland. Colorimetric tests—TTX (triphenyltetrazolium chloride) and nitrite test—can give an idea of ​​the presence of bacteriuria, but bacteriological methods for examining urine have diagnostic value. The presence of infection is indicated by the detection of growth of more than 10 5 organisms in 1 ml of urine.

Bacteriological examination of urine is of great importance in recognizing chronic pyelonephritis (CP), it allows you to identify the causative agent of chronic pyelonephritis (CP), carry out adequate antibacterial therapy and monitor the effectiveness of treatment.

The main method for determining bacteriuria is culture on solid nutrient media, which makes it possible to clarify the type of microorganisms, their quantity in 1 ml of urine and sensitivity to drugs.

— Intoxication syndrome in chronic pyelonephritis (CP). With a recurrent course of pyelonephritis, its exacerbations (similar to acute pyelonephritis) are accompanied by severe intoxication with nausea, vomiting, dehydration (the amount of urine is usually greater than in a healthy person, because concentration is impaired. And since more urine is excreted, then, consequently , and the need for fluid is greater).

During the latent period, patients are concerned about general weakness, loss of strength, fatigue, sleep disturbance, sweating, vague abdominal pain, nausea, poor appetite, and sometimes weight loss. Some symptoms occur in almost all patients. Prolonged low-grade fever, headache, austenization, chills are more often observed in patients with PCP.

Changes in the hemogram may be observed: ESR increases, leukocytosis appears, but the body temperature does not rise. Therefore, when there is a high temperature (up to 40 C) and there is urinary syndrome, there is no need to rush to attribute this fever to pyelonephritis. It is necessary to observe a very violent picture of pyelonephritis in order to explain this temperature to them.

— Arterial hypertension syndrome in chronic pyelonephritis (CP);

— Chronic renal failure syndrome in chronic pyelonephritis (CP).

Diagnostics

Diagnostic criteria:

1. intoxication, fever;

2. leukocyturia, slight proteinuria;

Z.bacteriuria 105 microbial bodies in 1 ml of urine and above;

4. Ultrasound of the kidneys: cysts, stones, congenital malformations;

5. impaired concentration function of the kidneys.

List of main diagnostic measures:

1. General blood test;

2. General urine analysis. The main laboratory sign in a small child is bacterial leukocyturia. Bacteria and leukocytes are found in the urine. Proteinuria is insignificant. Erythrocyturia does not occur in all cases and has varying degrees of severity.

3. Urine culture tank.

List of additional diagnostic measures:

Urinalysis according to Nechiporenko

For analysis, take an average portion of morning urine into a clean, dry jar (the first portion of urine is usually from the urinary tract, so urine is taken from the middle portion for testing). From this volume, 1 ml is taken for analysis. This volume is placed in a counting chamber and the number of shaped elements is counted. Normally, the content of formed elements in this analysis is 2000 leukocytes and 1000 erythrocytes, up to 20 hyaline casts are found.

The need to conduct this group of tests arises when there are questionable results obtained in a general urine test. To clarify the data and quantify the formed elements of urinary sediment, urine tests are performed according to Nechiporenko and Addis-Kakovsky.

Red blood cells, like leukocytes appearing in the urine, may be of renal origin or may appear from the urinary tract. The reasons for the appearance of erythrocytes of renal origin may be an increase in the permeability of the glomerular membrane for erythrocytes during glomerulonephritis (such hematuria is combined with proteinuria). In addition, red blood cells can appear with tumors of the kidneys, bladder, and urinary tract. Blood in the urine can appear when stones damage the mucous membrane of the ureters and bladder. Hematuria can only be detected by laboratory methods (microhematuria), or can be determined visually (with macrohematuria, urine is the color of meat slop). The presence of leukocytes suggests inflammation at the level of the kidneys (acute or chronic inflammation - pyelonephritis), bladder (cystitis) or urethra (urethritis). Sometimes the level of leukocytes can increase with glomerulonephritis. The cylinders are a “cast” of the tubules, formed from desquamated tubular epithelial cells. Their appearance is a sign of chronic kidney disease.

Zimnitsky test

One of the main methods of functional testing of the kidneys is the Zimnitsky test. The purpose of this test is to evaluate the kidneys' ability to dilute and concentrate urine. To carry out this test, urine must be collected one day before. The container for collecting urine must be clean and dry.

To carry out the analysis, it is necessary to collect urine in separate portions indicating the time every 3 hours, i.e. 8 portions in total. The test allows you to evaluate daily diuresis and the amount of urine excreted during the day and at night. In addition, the specific gravity of urine is determined in each portion. This is necessary to determine the functional capacity of the kidneys.

Normal daily diuresis is 800-1600 ml. In a healthy person, the amount of urine excreted during the day prevails over the amount excreted during the night.

On average, each portion of urine is 100–200 ml. The relative density of urine ranges from 1.009-1.028. In case of renal failure (i.e., the inability of the kidneys to dilute and concentrate urine), the following changes are noted: nocturia - increased urine output at night compared to daytime, hypoisosthenuria - urine output with a reduced relative density, polyuria - the amount of urine excreted per day exceeds 2000 ml.

Kidney ultrasound

Glomerular filtration rate (based on blood creatinine). Decline.

Determination of creatinine, residual nitrogen, urea with calculation of glomerular filtration rate using the Schwartz formula:

height, cm x Coefficient
GFR, ml/min. = ————————————-

blood creatinine, µmol/l

Coefficient: newborns 33-40

prepubertal period 38-48

post-pubertal period 48-62

Main radiographic symptoms acute pyelonephritis are an increase in the size of the affected kidney, spasm of the cups, their necks and the ureter on the affected side. The earliest radiological sign of chronic pyelonephritis is hypotension of the cups, pelvis and ureter on the affected side.

Cystography- vesicoureteral reflux or condition after antireflux surgery.

Nephroscintigraphy– lesions of the renal parenchyma.

Pyelonephritis must be differentiated from cystitis and interstitial nephritis. For both diseases, leukocyturia is a characteristic and often the only symptom. With pyelonephritis it is neutrophilic, with interstitial nephritis it is lymphocytic (the predominance of lymphocytes in the urocytogram). Pathological, true, bacteriuria (100,000 microbial bodies in 1 ml of urine and above), a high titer of antibacterial antibodies (1:160 and above) are characteristic signs of pyelonephritis. In interstitial nephritis, bacteriuria is not detected; the titer of antibodies in the blood serum to the standard strain of E. coli is determined no higher than a dilution of 1:10, 1:40. Pyelonephritis must be differentiated from chronic glomerulonephritis, renal tuberculosis, vulvitis or vulvovaginitis. To clarify the origin of leukocyturia, a parallel determination of the content of leukocytes in the middle portion of urine and in vaginal discharge is carried out. The final localization of the inflammatory process in the organs of the genitourinary system helps to establish a comprehensive examination of each child by a nephrologist and gynecologist.

Forecast. Acute primary pyelonephritis, with proper and timely treatment, often ends in complete recovery (in 80-90% of cases). Deaths (10-20%) occur mainly among newborns. The transition of acute pyelonephritis to chronic is more often possible with secondary pyelonephritis, but often (40%) relapses are also observed with the primary disease.

The prognosis for chronic pyelonephritis is less favorable. In most patients, pyelonephritis lasts several decades, starting in childhood. Its severity can be aggravated by a number of complications, the most common of which are necrosis of the renal papillae, urolithiasis and arterial hypertension. Chronic pyelonephritis ranks third (after congenital kidney diseases and glomerulonephritis) among the causes leading to the development of chronic renal failure and death.

Treatment.

Aimed at eliminating kidney infection, increasing the body's reactivity, restoring urodynamics in secondary pyelonephritis.

Antibacterial therapy in 3 stages:

Stage 1 – antibiotic therapy – 10-14 days;

Empirical (starting) choice of antibiotics:

 “Protected” penicillins: amoxicillin/clavulanate, amoxicillin/sulbactam; Amoxicillin/clavulanate*40-60 mg/kg/24 hours (according to amoxicillin) in 2-3 doses orally

 III generation cephalosporins: cefotaxime, ceftazidime, ceftriaxone, cefixime, ceftibuten. Cefotaxime Children under 3 months - 50 mg/kg/8 hours Children over 3 months - 50-100 mg/kg/24 hours 2-3 times a day

Severe:

 Aminoglycosides: netromycin, amikacin, gentamicin; - Carbapenems: imipenem, meropenem; Gentamicin Children under 3 months - 2.5 mg/kg/8 hours Children over 3 months - 3-5 mg/kg/24 hours 1-2 times a day

- IV generation cephalosporins (cefepime).

When treatment is effective, the following are observed:

- clinical improvement within 24-48 hours from the start of treatment;

 eradication of microflora after 24-48 hours;

 reduction or disappearance of leukocyturia 2-3 days from the start of treatment.

Changing the antibacterial drug if it is ineffective after 48-72 hours should be based on the results of a microbiological study and the sensitivity of the isolated pathogen to antibiotics.

Stage 2 – uroseptic therapy (14-28 days).

1. Derivatives of 5-nitrofuran:

 Furagin – 7.5-8 mg/kg (no more than 400 mg/24 hours) in 3-4 doses;

 Furamag – 5 mg/kg/24 hours (not more than 200 mg/24 hours) in 2-3 doses.

2. Non-fluorinated quinolones:

 Negram, nevigramon (in children over 3 months) – 55 mg/kg/24 hours in 3-4 doses;

 Palin (in children over 12 months) – 15 mg/kg/24 hours in 2 doses.

Stage 3 – preventive anti-relapse therapy.

Antibacterial treatment should be carried out taking into account the sensitivity of urine microflora to antibacterial drugs. As a rule, chloramphenicol is prescribed to children under 3 years of age at 0.15-0.3 g 4 times a day; ampicillin - 100-200 mg/kg per day; gentamycin - 0.4 mg/kg 2 times a day; oxacillin for children under 3 months - 200 mg/kg per day, up to 2 years - 1 g per day, over 2 years - 2 g per day; erythromycin for children under 2 years old - 5-8 mg/kg 4 times a day, over 2 years old - 0.5-1.0 g per day. Chemical drugs used include furagin 0.05-0.1 g 3 times a day, urosulfan 0.5 g 2-4 times a day, nevigramon 0.25-1.0 g per day in 3-4 doses, 5-NOK 0.05-0.1 g 4 times a day. When prescribing drugs, the state of kidney function is taken into account.

Sanitation of foci of infection is important; in case of secondary pyelonephritis, timely restoration of urodynamics through surgical intervention, as well as measures to eliminate metabolic disorders. The patient must be registered with a dispensary during the entire period of clinical and laboratory remission until recovery, which can be considered if complete remission is maintained for a long time (at least 3 years). In recent years, great importance has been attached to the normalization of intestinal microflora (bifidumbacterin and other drugs that restore normal intestinal microflora).

Symptomatic therapy: antipyretic, detoxification, infusion - usually carried out in the first 1-3 days;

The baby's health is very fragile. Therefore, pediatricians insist on regular examinations. Every mother should know the importance of a urine test - with its help, acute pyelonephritis can be diagnosed in a child in a timely manner. Since this disease can be associated with both colds and viruses, it is better to be on the safe side.

Acute pyelonephritis in children is an inflammatory process occurring in the kidneys. More precisely, it is a disease of the renal pelvis, which is a kind of reservoir for urine. It is from them that urine passes into the ureters.

The root cause of pyelonephritis is viral . The infection can enter the bloodstream from a sore tooth, sore throat, or wound on the body. As soon as microbes penetrate the adrenal glands, an inflammatory process begins, often ending in chronic pyelonephritis.

It is noteworthy that most often this disease affects children under the age of 5 years, in particular girls. The female genital organs are designed in such a way that it is easier for bacteria to penetrate and multiply.

In addition, this disease can be cold character . Firstly, pyelonephritis can be a complication provoked by a common ARVI. Secondly, the disease is often observed in children suffering from enuresis. Also, inflammation of the renal pelvis can occur against the background of hypothermia, accompanied by infection.

That is why, even with colds and flu, children under 7 years of age are recommended to undergo a general urine test. Late detection of the disease can lead to its chronic form.

Clinical picture

Acute pyelonephritis occurs in children of primary school age due to infection of the body with Escherichia coli, entorococcus, chlamydia, mycoplasma, ureaplasma and other bacteria. With inflammation of the renal pelvis, in 80% of cases, E. coli is found in the body of a small patient.

In infants, microbes that provoke pyelonephritis can be introduced into the kidneys through the umbilical ring, an inflamed pustular rash, and so on. Bacteria are spread by blood flow. That is, the nature of infection of children is downward.

In an older child – 12–14 years old – the inflammation may be ascending. That is, bacteria enter the urinary canal from the outside, and from there into the kidneys. This type of infection is often accompanied by inflammation of the external genitalia, dysbiosis, and intestinal inflammation. Ascending infection is more common in girls, as they have a shorter and wider urethra than boys.

Often acute pyelonephritis in a child is associated with. It is the inadequate emptying of the bladder that leads to the accumulation of urine residues in the renal pelvis. And as soon as microbes get there, inflammation begins. In addition, urine continues to flow, creating a favorable environment for bacteria to multiply.

Not only cystitis provokes stagnation of urine. It may be associated with a congenital defect of the renal pelvis, in which urine is not excreted through the ureter, but is thrown back into the kidneys.

In infants, acute pyelonephritis often occurs against the background of rickets, anemia, malnutrition, and metabolic disorders. In older children, the disease may be associated with poor personal hygiene, acute viral infections, rheumatism, and weakened immunity.

Treatment of acute pyelonephritis in children is simple, but if it is not carried out on time, serious complications can arise. Up to blood poisoning and the formation of abscesses in the kidneys. On average, 80% of children recover and have no future kidney complications. But in 20% of cases, the child may lag behind in development and even become disabled. Therefore, it is so important to regularly do a urine test and respond to the slightest changes in the child’s well-being during the period of exacerbation of viral diseases.

Babies cannot talk about their feelings. They show that something is bothering them in the only way available to them - by crying. But older children, when examined by a doctor, can say that they have lower back and stomach pain . Acute pain in these areas may be the first external sign of pyelonephritis.

In addition, inflammation of the renal pelvis is indicated frequent painful urination accompanied by itching and burning. Also, the child may develop a fever (up to 40 degrees), accompanied by chills. Among the general symptoms, the mother should be alerted to constant headache, weakness, lack of appetite, and cyanosis of the skin.

In young children, symptoms of acute pyelonephritis manifest themselves as high temperature, intoxication (vomiting, nausea) and, as a result, dehydration. Babies become lethargic, apathetic, often cry, begin to lose weight, and refuse to eat.

Doctors recommend that mothers pay attention not only to the frequency and nature of bowel movements (consistency and color of stool), but also to the nature of urination. If the baby cries during them, most likely he experiences itching and burning in the bladder.

How to identify and treat pyelonephritis?

Usually it is enough to diagnose acute pyelonephritis urine test . In difficult cases, to be on the safe side, the doctor may send the child to Kidney ultrasound .

An increased content of leukocytes, protein and red blood cells is a characteristic sign of inflammation of the renal pelvis. For infants, 10,000 bacteria per 1 ml of urine is enough, and for older children - 50,000 - 100,000 bacteria to diagnose pyelonephritis.

Since many microbes are insensitive to antibiotics, urine analysis is repeated 2-3 times throughout treatment. If there are almost no changes, other drug treatment is prescribed.

To submit urine for analysis, children 5–7 years old need to wash themselves and collect the middle part of the stream in a sterile container. Infants cannot control urination, so urinals are attached to their urinary tract to collect urine.

In addition to the increased content of bacteria, a urine test helps to evaluate the functioning of the kidneys, exclude or identify the presence of stones, deviations in development and structure, which provoke the reflux of urine back into the kidneys. All these factors are extremely important for the effective treatment of acute pyelonephritis in a child.

Diagnosing pyelonephritis, especially in an infant, is extremely difficult. Therefore, it is necessary to pay attention to many external factors.

Evidence of the disease may be:

• rapid pulse;
• sharp pain in the upper abdomen;
• pain when lightly hitting the kidneys with the edge of the palm;
• high blood pressure.

Despite the complexity of diagnosis and clinical picture, acute pyelonephritis is treated in a quite accessible and simple way. First of all, the child must comply bed rest . Parents are charged with the responsibility of providing their child with complete peace. This means no TV, extraneous noise and stress.

Treatment of acute pyelonephritis in children involves special diet , excluding spicy, fatty, fried, salty, as well as spices and strong broths. In addition, it is necessary to include in the diet of a sick child as many fresh vegetables and fruits as possible, as well as juices and purees.

The basis of the menu should be diuretic fruits and berries: watermelons, melons, grapes, cherries. You can also give your child vegetable and light meat broths.

The key to rapid normalization of kidney function is plenty of warm drinks . Older children should be regularly given rosehip decoction, diluted compotes and tea. To stop fluid loss, infants are given a special solution in the form of droppers.

Naturally, diet and drinking regimen are not enough to treat acute pyelonephritis in a child. Powerful drug therapy is required.

After analyzing urine for microorganisms, the doctor will prescribe antibiotics in tablets. In difficult cases, intramuscular or intravenous injections are prescribed. For 1–2 weeks, the child is treated with drugs containing penicillins, cephalosporins or aminoglycosides.

After them treatment begins uroseptics , disinfecting urine. These drugs include: furazidine, nalidixic, oxolinic, pipemidic acid, co-trimoxazole.

The speed of recovery depends on the severity of the disease and the level of immunity of each child. The main thing is to follow the doctor’s recommendations and not refuse hospitalization if necessary.

There is no prevention of acute pyelonephritis in children as such. The only thing you can do is regularly take a urine test, make sure that the child is not hypothermic, and does not wear wet onesies. It is also worth paying special attention to the baby’s health during periods of exacerbation of flu and colds. All this will help to eliminate the prerequisites for pyelonephritis in time.

In addition, for preventive purposes, older children can be given herbal tea, which has antimicrobial, anti-inflammatory and diuretic effects. This therapy is also indicated after a course of antibiotics.

Since herbal medicine is not suitable for infants, parents are advised to pay more attention to the personal hygiene of children. In addition, you need to regularly show the child to the pediatrician in order to promptly identify and treat infectious diseases, infection with worms, inflammation of the external genitalia, etc.

So, the best prevention of pyelonephritis is diligent health care. In addition, children who have suffered from this disease are recommended to register with a nephrologist and regularly visit the doctor for three years. You also need to constantly have your urine tested.

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