Pyelonephritis in children: treatment of acute and chronic forms. Symptoms of acute pyelonephritis in children, treatment and prevention of the disease Pyelonephritis in children symptoms treatment

– nonspecific microbial-inflammatory damage to the renal parenchyma and pyelocaliceal system. Pyelonephritis in children occurs with pain in the lumbar region, dysuric disorders (frequent urge to urinate, pain, urinary incontinence), increased body temperature, and intoxication. Diagnosis of pyelonephritis in children includes blood tests (clinical, biochemical analysis) and urine (general analysis, culture), ultrasound of the urinary system, urodynamic assessment, intravenous urography, etc. In the treatment of pyelonephritis in children, antibacterial, anti-inflammatory, antioxidant therapy, and herbal medicine are used.

General information

Pyelonephritis in children is an inflammatory process involving the pyelocaliceal system, tubules and interstitium of the kidneys. In terms of prevalence, pyelonephritis ranks second after ARVI in children, and there is a close relationship between these diseases. Thus, in pediatric urology, every 4th case of pyelonephritis in a young child is a complication of an acute respiratory infection. The largest number of cases of pyelonephritis in children is registered in preschool age. Acute pyelonephritis is diagnosed 3 times more often in girls, which is due to the peculiarity of the female anatomy of the lower urinary tract (a wider and shorter urethra).

Causes of pyelonephritis in children

The most common etiological agent causing pyelonephritis in children is Escherichia coli; Also, bacteriological culture of urine reveals Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, enterococci, intracellular microorganisms (mycoplasma, chlamydia), etc.

Infectious agents can enter the kidneys by hematogenous, lymphogenous, or urinogenic (ascending) routes. Hematogenous introduction of pathogens most often occurs in children of the first year of life (with purulent omphalitis in newborns, pneumonia, tonsillitis, pustular skin diseases, etc.). In older children, ascending infection predominates (with dysbacteriosis, colitis, intestinal infections, vulvitis, vulvovaginitis, balanoposthitis, cystitis, etc.). Improper or insufficient hygienic care for the child plays a major role in the development of pyelonephritis in children.

Conditions predisposing to the occurrence of pyelonephritis in children may include structural or functional abnormalities that interfere with the passage of urine: congenital kidney malformations, vesicoureteral reflux, neurogenic bladder, urolithiasis. Children with malnutrition, rickets, and hypervitaminosis D are more at risk of developing pyelonephritis; fermentopathy, dismetabolic nephropathy, helminthic infestations, etc. Manifestation or exacerbation of pyelonephritis in children, as a rule, occurs after intercurrent infections (ARVI, chickenpox, measles, scarlet fever, mumps, etc.), causing a decrease in the overall resistance of the body.

Classification

Diagnostics

If pyelonephritis in a child is first identified by a pediatrician, a mandatory consultation with a pediatric nephrologist or pediatric urologist is necessary. The complex of laboratory diagnostics for pyelonephritis in children includes a clinical blood test, a biochemical blood test (urea, total protein, protein fractions, fibrinogen, CRP), a general urine test, urine pH, quantitative samples (according to Nechiporenko, Addis-Kakovsky, Amburge, Zimnitsky ), urine culture for flora with antibiogram, biochemical urine analysis. If necessary, to identify infectious agents, studies are carried out using PCR and ELISA methods. It is important to assess the rhythm and volume of spontaneous urination and control diuresis for pyelonephritis in children.

Mandatory instrumental examination of children with pyelonephritis includes ultrasound of the kidneys (if necessary, ultrasound of the bladder), ultrasound examination of the renal blood flow. To exclude obstructive uropathies, which are often the cause of pyelonephritis in children, it may be necessary to perform excretory urography, urodynamic studies, dynamic renal scintigraphy, renal angiography, CT scan of the kidneys and other additional studies.

Differential diagnosis of pyelonephritis in children must be carried out with glomerulonephritis, appendicitis, cystitis, adnexitis, and therefore children may need to consult a pediatric surgeon or pediatric gynecologist; conducting a rectal examination, ultrasound of the pelvic organs.

Treatment of pyelonephritis in children

Complex therapy of pyelonephritis involves drug therapy, organization of proper drinking regimen and nutrition for children.

In the acute period, bed rest, a plant-protein diet, and an increase in water load by 50% compared to the age norm are prescribed. The basis for the treatment of pyelonephritis in children is antibiotic therapy, for which cephalosporins (cefuroxime, cefotaxime, cefpirome, etc.), β-lactams (amoxicillin), and aminoglycosides (gentamicin, amikacin) are used. After completing the antibacterial course, uroantiseptics are prescribed: derivatives of nitrofuran (nitrofurantoin) and quinoline (nalidixic acid).

To enhance renal blood flow and eliminate inflammatory products and microorganisms, fast-acting diuretics (furosemide, spironolactone) are indicated. For pyelonephritis, children are recommended to take NSAIDs, antihistamines, antioxidants, and immunocorrectors.

The duration of treatment for acute pyelonephritis in children (or exacerbation of a chronic process) is 1-3 months. The criterion for eliminating inflammation is the normalization of clinical and laboratory parameters. Outside of exacerbation of pyelonephritis in children, herbal medicine with antiseptic and diuretic preparations, taking alkaline mineral water, massage, exercise therapy, and sanatorium treatment are necessary.

Prognosis and prevention

Acute pyelonephritis in children ends with complete recovery in 80% of cases. Complications and deaths are possible in rare cases, mainly in weakened children with concomitant pathologies. The outcome of chronic pyelonephritis in 67-75% of children is the progression of the pathological process in the kidneys, the increase in nephrosclerotic changes, and the development of chronic renal failure. Children who have suffered acute pyelonephritis are observed by a nephrologist for 3 years with monthly monitoring of a general urine test. Examinations by a pediatric otolaryngologist and dentist are required once every 6 months.

Prevention of pyelonephritis in children is associated with compliance with hygiene measures, prevention of dysbacteriosis and acute intestinal infections, elimination of chronic inflammatory foci and strengthening the body's resistance. The timing of preventive vaccination is determined individually. After any infection in children, it is necessary to conduct a urine test. To prevent the development of chronic pyelonephritis in children, acute urinary infections should be adequately treated.

Pyelonephritis is an inflammation of the kidneys of an infectious nature. This disease is common among children, especially preschool age. In terms of incidence, it took second place after respiratory infections and can act as their complication. To cope with the disease, it is important to correctly diagnose pyelonephritis in children, without confusing it with clinically similar cystitis or urethritis.

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

Pathogenic microbes enter the excretory system in different ways:

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

The latter route of infection is considered the most common in children over one year old. Girls are more likely to get sick due to their anatomy.

Who is predisposed to the disease

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

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

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

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

What types of pyelonephritis do nephrologists distinguish?

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

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

Important! In rare cases, chronic pyelonephritis in children occurs in a latent form, asymptomatic, but with poor test results.

The disease can be primary, that is, independent of the condition of the urinary organs, and secondary. Secondary pyelonephritis in children occurs against the background of abnormalities of the excretory system and can be obstructive - with functional disorders or non-obstructive - with dysmetabolic disorders. A child is diagnosed with chronic secondary pyelonephritis if there are changes in the structure of the kidneys or other congenital pathologies of the excretory system. The disease is also classified by location, divided into unilateral and bilateral.

Pyelonephritis in children: symptoms and treatment

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

In babies under one year of age, the disease manifests itself in the form of a sharp increase in temperature to almost 40 degrees, dry and pale skin with a bluish halo around the mouth. The baby becomes lethargic, refuses to eat, and cries. Most babies strain and grunt when urinating, and the urine becomes dark and smells foul.

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

The main signs of acute pyelonephritis in older children:

Temperature rise to 38 degrees and above;
Lethargy or feverish state;
Pale skin and bags under the eyes;
Lack of appetite, nausea, vomiting;
Darkening of urine and change in its odor;
Nagging pain in the peritoneum and lumbar region.

Some children experience difficulty urinating and mild swelling of the face.

Chronic pyelonephritis in children, if it is not in a latent form, is characterized by alternating periods of remission and exacerbations. The latter manifest themselves with the same symptoms as the acute form of the disease. Additionally, children who have a chronic illness are more likely to be tired and do worse at school. If the disease torments a child from an early age, psychomotor and physical development may be delayed.

What is the diagnosis?

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

General analysis and biochemistry of urine and blood;
Quantitative tests according to Zimnitsky, Amburge, Addis-Kakovsky, Nechiporenko;
Study of diuresis, sediment, enzymes, urine pH;
Culture and antibiogram;
Test for fungi and viruses;
Cytological examinations to identify atypical cells;
Ultrasound examination of the kidneys and bladder;
Cystometry;
Urography, cystography;
Doppler ultrasound of renal blood flow;
Computed tomography.

Pyelonephritis is characterized by an increase in leukocytes in the urine, as well as the number of microorganisms (bacteriuria) of more than 100,000/1 ml. Proteinuria levels are less than 1 g/l, and the number of neutrophils increases by more than 50 percent. The chronic form of renal failure leads to an increase in the level of urea and creatinine and a decrease in total protein.

Is it possible to cure pyelonephritis in a child completely?

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

Any type of illness requires a change in diet, especially during exacerbations. The diet for pyelonephritis in children is aimed at reducing the load on the kidneys and correcting metabolic disorders. Diet table No. 5 is recommended without limiting salt and increasing the amount of fluid if the baby does not have renal dysfunction. Otherwise, salt and liquid will have to be limited. Protein-vegetable dishes are healthy. You need to exclude fried, fatty and spicy foods.

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

If necessary, the child is admitted to the nephrology or urology department of the hospital. Infants under one year old with acute pyelonephritis are also best treated in a hospital.

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

What medications will the doctor prescribe?

Treatment of pyelonephritis in children includes:

Facilities	Impact on the body	Popular drugs
Antibiotics	Get rid of pathogenic bacteria that usually cause pyelonephritis. Antibiotic treatment lasts at least 4 weeks.	“Gentamicin”, “Amicin”, “Likacin”, “Cefamandol”, “Ceftazidime”, “”, “”, “Ketocef”, “Zinacef”, “Epocelin”, “Ceftriaxone”.
Uroantiseptics	They disinfect the urinary tract and stop the proliferation of microorganisms.	“Furadonin”, “Palin”, “Negram”, “Nevigramon”, “Nitroxoline”.
Diuretics	They fight fluid stagnation at the initial stage of the disease.	"Veroshpiron", "Furosemide".
Antioxidants	Prevents pathological changes in the organs of the excretory system.	“Unito”, preparations with b-carotene, tocopherol.
Nonsteroidal anti-inflammatory drugs	Strengthen antibacterial treatment.	"Ortofen", "Surgam", "Voltaren".
Antihistamines	Eliminate allergic reactions.	"Tavegil", "Suprastin", "Claritin".

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

Phytotherapy is possible in consultation with your doctor. Suitable decoctions of diuretic and anti-inflammatory plants (horsetail, lingonberry leaf, bearberry, nettle, sage). At the pharmacy you can buy ready-made kidney teas and herbal medicines “Fitolysin”, “Canephron”, “Cyston”. All herbal remedies remove fluid from the body, remove swelling, and have a disinfecting and anti-inflammatory effect.

Important! After treatment, the child should continue to be monitored by a nephrologist to avoid relapses. So, once a month a general urine test is necessary, and once every six months an ultrasound of the kidneys. A child who has had acute pyelonephritis is removed from the register after 5 years without relapse.

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

How to prevent the return of the disease?

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

To avoid dangerous consequences and the disease becoming chronic, you must follow all the doctor’s therapeutic recommendations. Prevention of pyelonephritis in children is also important:

Clothes for the season, without overheating or hypothermia;
Strengthening the immune system - walks in nature, hardening, sports within reasonable limits;
Monitoring the regularity of trips to the toilet “in small ways”;

Recently, cases of kidney pyelonephritis in children have become more frequent, and the disease occurs equally often in both schoolchildren and young children.

Pyelonephritis in a child - what does it mean?

Pyelonephritis in children is an inflammatory and infectious disease of the kidneys, during which the calyx, pelvis, tubules and kidney tissue are affected. The pathological process can be unilateral or bilateral, occur independently or against the background of other diseases.

Pyelonephritis in children under one year of age in most cases develops as a complication after untreated acute respiratory viral infection, tonsillitis or pharyngitis. More often, the disease is diagnosed in girls, which is due to the anatomical structure of the urethra - the urethra is wide and short, which facilitates the penetration of pathogenic bacteria from the environment.

Acute and chronic pyelonephritis in children

Depending on the course of the disease, clinical picture, duration and severity of symptoms, the following are distinguished:

Acute pyelonephritis;
Chronic pyelonephritis.

The acute form of the disease is characterized by the development of a violent clinical picture and the appearance of dysuric phenomena. Chronic pyelonephritis in a child develops as a result of untreated or neglected acute kidney injury, as well as against the background of existing long-standing infectious lesions of the urinary tract.

The main sign of the disease becoming chronic is the long-term presence of the clinical picture of pyelonephritis, as well as the occurrence of several relapses of infection over the past six months.

Depending on the causes of occurrence, there are:

Primary pyelonephritis - the pathological process develops directly in the kidney tissue initially;
Secondary pyelonephritis - the disease develops as a result of the presence of foci of infection in the body.

Acute pyelonephritis, symptoms of the disease, treatment and diet:

The infectious pathogen enters the kidney tissue in several ways:

With blood flow;
With lymph flow;
Ascending - from the environment.

Main reasons the occurrence of pyelonephritis in children are:

Failure to comply with the rules of personal intimate hygiene, for example, improper washing of girls, as a result of which E. coli from the rectum enters the urethra and causes the development of an inflammatory process;
The presence in the body of foci of chronic infection, from which infectious pathogens with the blood or lymph flow can freely move in the body and provoke the development of inflammatory processes - carious teeth, chronic tonsillitis;
Inflammatory diseases of the genitourinary system, as a result of which the infectious pathogen can spread to the kidneys - urethritis, cystitis, vulvitis, balanoposthitis;
Intestinal infections;
Purulent omphalitis - inflammation of the umbilical wound in newborns;
Hypothermia of the body, in particular the lumbar zone;
Injuries and impacts to the lumbar region, as a result of which an inflammatory process can develop.

Predisposing factors to the development of childhood pyelonephritis are recent viral infectious diseases - tonsillitis, measles, mumps, chickenpox, ARVI, scarlet fever, as well as helminthic infestation.

The first symptoms of pyelonephritis appear suddenly, the clinical picture is characterized by the appearance of a number of signs:

Increase in body temperature to 38.5-39 degrees;
Chills and excessive sweating;
Pain when urinating, a decrease in the amount of urine discharged (urine with pyelonephritis in a child is cloudy in appearance, which is due to the high content of leukocytes in it);
Increasing weakness, lethargy, tearfulness, symptoms of intoxication of the body;
Infants may experience constant regurgitation; older children may vomit;
Diarrhea;
Pain in the abdomen and lumbar region, which intensifies with physical activity or light tapping on the lower back (positive Pasternatsky symptom).

In chronic pyelonephritis, the clinical picture of the disease is not so pronounced: the child has dysuric symptoms (pain and burning when urinating, urinary incontinence), there is no appetite, the skin is pale, the child is lethargic.

In the absence of timely diagnosis and adequate treatment, the disease can be complicated by nephrosclerosis, arterial hypertension, distension and accumulation of fluid in the kidney, and the development of chronic renal failure.

Symptoms, signs and treatment of kidney failure:

Diagnosis of the disease

As a rule, when the above clinical symptoms are detected in a child, parents rush to seek medical help from a pediatrician. Having collected a history of the child’s life and illness, the doctor conducts an initial examination, which includes auscultation, palpation of the abdomen, and tapping on the lumbar region.

If kidney inflammation is suspected, the doctor will give the child a referral for consultation with a nephrologist or urologist. To confirm the diagnosis, the patient must undergo a comprehensive detailed examination, which includes:

Blood tests (general clinical and biochemistry);
Urine tests (general, according to Nechiporenko, according to Amburge, determination of urine pH and bacterial culture of urine);
Ultrasound of the kidneys;
Sometimes, to determine the pathogen, PCR diagnostics and the ELISA method are prescribed.

In some cases, it is advisable to perform CT, excretory urography and renal angiography.

Pediatric pyelonephritis must be differentiated from pelvic inflammatory diseases in girls and acute appendicitis, so sometimes, in addition to consulting a nephrologist or urologist, the patient needs to consult a pediatric gynecologist and surgeon.

Effective treatment of pyelonephritis in children is based on drug therapy, diet and drinking regimen.
During the acute period of the disease, the child should remain in bed. If there is no appetite, then parents should not insist, the only exception being breast milk in breastfed children.

The basis of treatment of the disease is antibacterial drugs. Antibiotics for pyelonephritis in children are selected by a specialist on an individual basis after testing the sensitivity of the infectious pathogen to the drug.

Preference is given to drugs from the cephalosporin series - Ceftriaxone, Cefuroxime, Cefodex, Cefotaxime. Along with antibiotics, depending on the age of the child, uroseptics are prescribed - Furadonin, Furazolidone, Nitrofuril.

At high temperatures, as well as to relieve pain in the lumbar region, the patient is prescribed drugs based on Paracetamol - Panadol suspension, Efferalgan, Tsefekon suppositories.

In addition to drug treatment, it is very important to maintain a drinking regime, increasing the daily dose of fluid to 1.5-2 liters, and for infants older than 6 months to 750 ml.

During the period when the acute clinical picture of the disease subsides, the child is prescribed herbal medicine, physiotherapeutic procedures, exercise therapy, massage, mineral water treatment, and sanatorium-resort treatment.

A child who has suffered pyelonephritis must be registered with a urologist or nephrologist for 1 year, after which, in the absence of complications of the disease or its relapses, the patient can be removed from the register.

Causes of development of chronic pyelonephritis, diagnosis, treatment and diet:

Diet for pyelonephritis in children

During the acute phase of the disease, if the patient has no appetite, you should not insist on eating, but the drinking regime must be strictly observed. After normalization of body temperature and relief of the acute phase of pyelonephritis, the child is offered a gentle diet.

The following are temporarily excluded from the diet:

Meat and fish of fatty varieties;
Chocolate;
Fresh bread;
Butter;
Strong tea and coffee drink;
Baking.

Preference is given to dairy-vegetable dishes, in particular boiled porridges cooked in water with the addition of milk, vegetables and fruits, vegetable soups, cottage cheese, kefir, and yogurt. Turkey and rabbit in the form of steamed cutlets are allowed.

Prevention of pyelonephritis in a child

Prevention of pyelonephritis in children is:

Timely treatment of acute respiratory viral infections and infectious and inflammatory diseases;
Monitoring the condition of tooth enamel, treating caries at the initial stage of its development;
No hypothermia;
Maintaining personal intimate hygiene, in particular proper washing of girls - from front to back;
Regular change of disposable diapers for children under one year of age;
Strengthening immunity, vaccination according to age.

The prognosis of acute pyelonephritis in children, with timely diagnosis and comprehensive treatment, is favorable, in 95% of patients there is a complete recovery and in only 5% the disease becomes chronic with periods of exacerbations and remissions.

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

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

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

Primary is called pyelonephritis, in which the examination fails to identify any factors that contribute to the fixation of microorganisms in the kidney tissue, that is, when a microbial inflammatory process develops in an initially healthy organ. Secondary pyelonephritis is caused by specific factors.

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

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

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

It is also very conditional to classify secondary dismetabolic pyelonephritis as a non-obstructive group, since with this option the phenomena of obstruction of the renal tubules and collecting ducts by salt crystals are always observed.

Acute and chronic pyelonephritis are distinguished depending on the duration of the pathological process and the characteristics of clinical manifestations.

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

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

Depending on the severity of the signs of the disease, one can distinguish the active stage of chronic pyelonephritis, partial clinical and laboratory remission and complete clinical and laboratory remission.

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

Clinical symptoms include:

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

Urinalysis indicators are as follows:

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

Blood test indicators:

leukocytosis with rod-nuclear shift;
anemia;
increased erythrocyte sedimentation rate (ESR).

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

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

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

Leukocyturia in pyelonephritis is neutrophilic in nature (more than 50% neutrophils). Proteinuria, if present, is insignificant, less than 1 g/l, and correlates with the severity of leukocyturia. Often, children with pyelonephritis experience erythrocyturia, usually single unchanged red blood cells.

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

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

In any course of the disease, the patient must carry out a full range of studies aimed at establishing the activity of the microbial inflammatory process, the functional state of the kidneys, the presence of signs of obstruction and metabolic disorders, and the state of the renal parenchyma. We offer the following set of studies for chronic pyelonephritis, which allows us to obtain answers to the questions posed.

1. Research to identify the activity of the microbial inflammatory process.

Clinical blood test.
Biochemical blood test (total protein, protein fractions, urea, fibrinogen, C-reactive protein (CRP)).
General urine analysis.
Quantitative urine tests (according to Nechiporenko, Amburge, Addis-Kakovsky).
Morphology of urine sediment.
Urine culture for flora with quantitative assessment of the degree of bacteriuria.
Urine antibioticogram.
Biochemical examination of urine (daily excretion of protein, oxalates, urates, cystine, calcium salts, indicators of membrane instability - peroxides, lipids, anti-crystal-forming ability of urine).

Urine examination for chlamydia, mycoplasma, ureaplasma (polymerase chain reaction, cultural, cytological, serological methods), fungi, viruses, mycobacterium tuberculosis (urine culture, express diagnostics).
Study of immunological status (secretory immunoglobulin A (sIgA), state of phagocytosis).

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

Mandatory laboratory tests:

Level of creatinine, urea in the blood.
Zimnitsky's test.
Clearance of endogenous creatinine.
Study of pH, titratable acidity, ammonia excretion.
Diuresis control.
Rhythm and volume of spontaneous urination.

Additional laboratory tests:

Urinary excretion of β 2 -microglobulin (mg).
Urine osmolarity.
Urine enzymes.
Ammonium chloride test.
Zimnitsky test with dry food.

3. Instrumental research.

Required:

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

Additional:

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

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

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

Additional criteria may include:

Increased ESR (more than 15 mm/h).
Leukocytosis (more than 9Ё109/l) with a shift to the left.
Increased titers of antibacterial antibodies (1:160 or more), disimmunoglobulinemia, increased number of circulating immune complexes.
Increased levels of CRP (above 20 mcg/ml), hyper-γ- and hyper-α 2 -globulinemia.

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

Complications of pyelonephritis:

nephrogenic arterial hypertension;
hydronephrotic transformation;
pyelonephritic wrinkled kidney, uremia;
purulent complications (apostematous nephritis, abscesses, paranephritis, urosepsis);
bacteremic shock.

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

Treatment of pyelonephritis

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

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

Dietary restrictions are aimed at reducing the load on the tubular transport systems and correcting metabolic disorders. In the active stage, table No. 5 according to Pevzner is used without salt restriction, but with an increased drinking regime, 50% more than the age norm. The amount of salt and liquid is limited only if kidney function is impaired. It is recommended to alternate protein and plant foods. Products containing extractives and essential oils, fried, spicy, fatty foods are excluded. Detected metabolic disorders require special corrective diets.

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

Before starting treatment, a urine culture is necessary (later treatment is changed based on the culture results);
exclude and, if possible, eliminate factors contributing to infection;
improvement of the condition does not mean the disappearance of bacteriuria;
treatment results are regarded as failure if there is no improvement and/or persistence of bacteriuria;
primary lower urinary tract infections usually respond to short courses of antimicrobial therapy; upper urinary tract - require long-term therapy;
early relapses (up to 2 weeks) represent a recurrent infection and are caused either by the survival of the pathogen in the upper urinary tract or by ongoing seeding from the intestine. Late relapses are almost always re-infection;
pathogens of community-acquired urinary tract infections are usually sensitive to antibiotics;
frequent relapses, instrumental interventions on the urinary tract, recent hospitalization make one suspect an infection caused by resistant pathogens.

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

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

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

The second (etiotropic) period consists of correcting antibacterial therapy taking into account the results of urine culture and determining the sensitivity of the microorganism to antibiotics.

When choosing antibacterial drugs, it is necessary to consider that:

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

Initial antibiotic therapy is prescribed empirically, based on the most likely causative agents of infection. If there is no clinical and laboratory effect, the antibiotic must be changed after 2-3 days.

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

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

semisynthetic penicillins in combination with β-lactomase inhibitors - amoxicillin and clavulanic acid: augmentin - 25-50 mg/kg/day, orally - 10-14 days; amoxiclav - 20-40 mc/kg/day, orally - 10-14 days;
2nd generation cephalosporins: cefuroxime (zinacef, ketocef, cefurabol), cefamandol (mandol, cefamabol) - 80-160 mg/kg/day, intravenously, intramuscularly - 4 times a day - 7-10 days;
3rd generation cephalosporins: cefotaxime (claforan, clafobrine), ceftazidime (Fortum, Vicef), ceftizoxime (epocelin) - 75-200 mg/kg/day, intravenously, intramuscularly - 3-4 times a day - 7-10 days; cefoperazone (cephobid, cefoperabol), ceftriaxone (rocephin, ceftriabol) - 50-100 mg/kg/day, intravenously, intramuscularly - 2 times a day - 7-10 days;
aminoglycosides: gentamicin (gentamicin sulfate) - 3.0-7.5 mg/kg/day, intravenously, intramuscularly - 3 times a day - 5-7 days; amikacin (amicin, lykacin) - 15-30 mg/kg/day, intravenously, intramuscularly - 2 times a day - 5-7 days.

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

semisynthetic penicillins in combination with β-lactomase inhibitors: amoxicillin and clavulanic acid (Augmentin, amoxiclav);
2nd generation cephalosporins: cefaclor (Ceclor, Vercef) - 20-40 mg/kg/day;
3rd generation cephalosporins: ceftibuten (cedex) - 9 mg/kg/day, once;
nitrofuran derivatives: nitrofurantoin (furadonin) - 5-7 mg/kg/day;
quinolone derivatives (non-fluorinated): nalidixic acid (negram, nevigramon) - 60 mg/kg/day; pipemidic acid (palin, pimidel) - 0.4-0.8 g/day; nitroxoline (5-NOK, 5-nitrox) - 10 mg/kg/day;
sulfamethoxazole and trimethoprim (cotrimoxazole, biseptol) - 4-6 mg/kg/day for trimethoprim.

In severe septic conditions, microbial associations, multiresistance of microflora to antibiotics, when affecting intracellular microorganisms, as well as to expand the spectrum of antimicrobial action in the absence of culture results, combination antibacterial therapy is used. In this case, bactericidal antibiotics are combined with bactericidal, bacteriostatic with bacteriostatic antibiotics. Some antibiotics are bactericidal against some microorganisms and bacteriostatic against others.

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

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

Potentiate the action of each other (synergists): penicillins and aminoglycosides; cephalosporins and penicillins; cephalosporins and aminoglycosides.

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

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

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

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

Nalidixic acid preparations (nevigramon, negram) are prescribed to children over 2 years of age. These agents are bacteriostatics or bactericides, depending on the dose, against gram-negative flora. They should not be prescribed simultaneously with nitrofurans, which have an antagonistic effect. The course of treatment is 7-10 days.

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

Pipemidic acid (palin, pimidel) has an effect on most gram-negative bacteria and staphylococci. It is prescribed in a short course (3-7 days).

Nitroxoline (5-NOK) and nitrofurans are drugs with broad bactericidal action.

The reserve drug is ofloxacin (Tarivid, Zanocin). It has a wide spectrum of action, including on intracellular flora. It is prescribed to children only if other uroseptics are ineffective.

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

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

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

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

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

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

Immunocorrective therapy for pyelonephritis is prescribed strictly according to indications:

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

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

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

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

During the period of remission, a necessary continuation of treatment is herbal medicine (collections of St. John's wort, lingonberry leaves, nettles, corn silk, bearberry, rose hips, birch buds, yarrow, sage, chamomile in combinations).

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

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

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

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

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

With the development of renal failure, it is necessary to adjust the doses of medications in accordance with the degree of decrease in glomerular filtration.

Dynamic observation of children suffering from pyelonephritis suggests the following.

Frequency of examination by a nephrologist: during exacerbation - once every 10 days; during remission during treatment - once a month; remission after completion of treatment for the first 3 years - once every 3 months; remission in subsequent years until the age of 15 years - 1-2 times a year, then observation is transferred to therapists.
Clinical and laboratory tests: general urine analysis - at least once every month and against the background of acute respiratory viral infections; biochemical urine analysis - once every 3-6 months; Ultrasound of the kidneys - once every 6 months. According to indications - cystoscopy, cystography and intravenous urography.

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

Literature

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

A. V. Malkoch, Candidate of Medical Sciences
V. A. Gavrilova, Doctor of Medical Sciences
Yu. B. Yurasova, Candidate of Medical Sciences
RGMU, RDKB, Moscow

Inflammatory pathologies of the upper parts of the kidneys occur even in the youngest patients. The course of pyelonephritis in a newborn child is quite severe and requires careful monitoring. Delayed diagnosis and incorrectly selected treatment contribute to the transition of the disease to a chronic form.

What it is?

Pyelonephritis is a disease in which the excretory function of the kidneys is impaired. This pathology can develop at any age: in infants, adults and teenagers. In very young children, pyelonephritis often occurs together with cystitis, which has given doctors reason to use the term “urinary tract infection.” The use of this term is not recognized by all specialists, however, it still exists in pediatric urological practice.

For pyelonephritis in children the pyelocaliceal system and adjacent areas of the renal tissue are damaged. The renal pelvis is a structural formation in the kidney that is necessary for the storage and further drainage of produced urine. Normally they look like a funnel. With pyelonephritis, the renal pelvis changes its original shape and becomes very dilated.

According to statistics, registered forms of pyelonephritis begin to be registered in babies as early as 6 months of age. Earlier cases of the disease are extremely rare, so they are considered not statistically significant. Girls suffer from pyelonephritis somewhat more often than boys. This feature is due to the presence of a shorter urethra, which contributes to a more intense spread of infection.

Causes

The development of inflammation in the kidneys in children can be caused by exposure to a variety of causative factors. If the cause of pyelonephritis is reliably established, then this form of the disease is called secondary, that is, developed as a result of some specific action of external or internal causes. To eliminate unfavorable symptoms in this case, it is first necessary to treat the underlying pathology.

Primary pyelonephritis is a pathological condition that occurs for an unknown reason. Such forms are found in every tenth baby. Treatment of primary pyelonephritis is symptomatic.

To normalize the child’s well-being, various medications are used, which are prescribed in a complex manner.

Secondary pyelonephritis can be caused by:

Viral infections. The culprits of the disease are often adenoviruses, Coxsackie viruses, and ECHO viruses. Pyelonephritis in this case occurs as a complication of a viral infection. The incubation period for such forms of diseases is usually 3-5 days. In some cases, the disease may have a latent course and does not actively manifest itself.
Bacterial infections. The most common pathogens include: staphylococci, streptococci, E. coli, toxoplasma, ureaplasma, Pseudomonas aeruginosa and other anaerobes. The course of the disease in this case is quite severe and occurs with severe symptoms of intoxication.

To eliminate unfavorable symptoms, antibiotics with a uroseptic effect are required.

Congenital developmental anomalies. Severe anatomical defects in the structure of the kidneys and urinary tract contribute to impaired urine outflow. The presence of various strictures (pathological narrowings) in the pyelocaliceal system causes a violation of excretory function.
Severe hypothermia. The cold reaction causes a pronounced spasm of blood vessels. This leads to reduced blood supply to the kidney and disruption of its function.

Chronic diseases of the gastrointestinal tract. The anatomical proximity of the kidneys to the abdominal organs determines their involvement in the process of various pathologies of the digestive system. Severe intestinal dysbiosis is often a provoking cause of impaired metabolism.
Gynecological diseases (in girls). Congenital pathologies of the genital organs in babies often cause an upward spread of infection. In this case, the bacterial flora can enter the kidneys by penetrating the genitourinary tract from the vagina.

Symptoms in children under one year of age

Determining the clinical signs of pyelonephritis in infants is a rather difficult task. Often it can occur in children in a latent or hidden form. Typically, this clinical variant of the disease is detected only by laboratory tests.

If the disease proceeds with the development of symptoms, then pyelonephritis in a child can be suspected based on certain signs. These include:

The appearance of fever. The body temperature of a sick child rises to 38-39 degrees. Against the background of such a fever, the baby develops chills and intoxication increases. The elevated temperature persists for 3-5 days from the onset of the disease. It usually increases in the evening.

Behavior change. The child becomes less active and sleepy. Many babies want to be held more. Children of the first year of life during the acute period of the disease play less with toys and become more passive.
Decreased appetite. The baby does not attach well to the mother's breast or completely refuses breastfeeding. The long course of the disease leads to the fact that the child begins to gradually lose weight.
Change in skin color. They become pale and dry. Hands and feet may be cold to the touch. The child may also feel chills.

Frequent urination. In very young children, this sign can be observed when changing diapers. If the diaper requires changing too often, this indicates that the baby has a urinary disorder.
Pain when tapped in the lumbar region. Only a doctor can identify this symptom. This simple diagnostic test has been successfully used for quite a long time to detect pain in the projection of the kidneys. If a child has inflammation in the kidneys, then during such a study he will cry or quickly change his body position.
Changes in mood. A newborn baby cannot tell his mother where he hurts. He expresses all his complaints only by crying.

If your baby has pain in the kidney area or discomfort when urinating, he will become more capricious and whiny. Any changes in the baby’s behavior should alert parents and give rise to consultation with their doctor.

Diagnostics

When the first signs of illness appear, you should definitely show your baby to the doctor. You can first consult with the attending pediatrician who is observing the baby. However, urologists deal with the problems of treatment and diagnosis of pyelonephritis and other kidney diseases. The opinion of this specialist will be decisive when drawing up treatment tactics, especially in the case of anatomical defects in the kidney structure.

To establish a diagnosis First, a clinical examination of the baby is carried out, during which the doctor identifies all the specific symptoms of the disease. Then the doctor will recommend an examination regimen, which includes a mandatory general blood and urine test. These simple and informative tests are necessary to establish infectious forms of pyelonephritis.

Thus, with bacterial and viral pathologies of the kidneys, peripheral leukocytosis appears in the general blood test - an increase in the number of leukocytes. The ESR also increases, and the normal values in the leukocyte formula change. In a general urine test, the number of leukocytes also increases, pH and color change, and in some cases specific gravity. To establish the exact pathogen, urine culture is carried out with mandatory determination of sensitivity to various antibacterial agents and phages.

Babies with severe signs of pyelonephritis also undergo an ultrasound examination of the kidneys. This method allows you to identify all the anatomical defects in the structure of the urinary organs that the child has, as well as establish the correct diagnosis.

This test is safe and does not cause any pain to the baby. Kidney ultrasound is prescribed on the recommendation of a pediatrician or pediatric urologist.

The use of other, more invasive diagnostic methods in infants is most often not used. They are quite painful and can cause numerous complications in the child. The need for them is very limited. After conducting the entire range of examinations and establishing an accurate diagnosis, the pediatric urologist prescribes the necessary treatment regimen for the sick child.

Treatment

The main goal of therapy is to prevent the process from becoming chronic. Acute forms of pyelonephritis should be treated quite carefully. Only properly selected therapy and regular monitoring of its effectiveness will lead to a complete recovery of the baby from the disease. Primary pyelonephritis with an unknown cause that causes them is treated symptomatically. For this purpose, various medications are prescribed to eliminate the unfavorable symptoms of the disease.

For the treatment of pyelonephritis in the youngest patients, the following methods are used:

Organizing a proper daily routine. Severe symptoms of intoxication lead to the fact that the baby constantly wants to sleep. There is no need to limit him in this. To restore immunity, the child needs both night and full daytime rest. During sleep, the baby gains strength to fight the disease.
Breastfeeding on demand. It is very important that during illness the baby receives all the necessary nutrients, which are fully contained in breast milk. To normalize the child's drinking regime, you should additionally drink boiled water, cooled to a comfortable temperature.

For babies receiving complementary foods, various fruit juices and compotes, previously diluted with water, are suitable drinks.

Drug therapy. Prescribed only by the attending physician. For infectious forms of pyelonephritis, various combinations of antibiotics with a wide spectrum of action are used. Some of the antibacterial drugs, especially older generations, have nephrotoxic properties (damage kidney tissue).

Self-prescription of antibacterial agents for the treatment of pyelonephritis in newborns and infants is unacceptable.

Phytotherapy. Used in babies older than 6-8 months. Lingonberries and cranberries are used as uroseptic medicinal plants. They can be used as part of various fruit drinks and compotes. These natural medicines have excellent anti-inflammatory effects and can improve kidney function.
Vitamin therapy. It is especially effective in children with congenital immunodeficiency conditions. Adding additional vitamins to a child’s diet strengthens the immune system and helps restore the baby’s health faster.