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

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

What is acute pyelonephritis in children

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

Pyelonephritis can lead to kidney deformity

Urinary tract infections are mostly ascending in origin and are caused by microbial contamination of the perineum, usually by intestinal flora. However, in newborns, infection along the routes of infection is considered hematogenous, and not ascending. That is, the pathogen enters the kidney with the flow of blood or lymph. 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 not usually the source of infection; rather, 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, urinary tract infections, on the contrary, are more common in girls than in boys.

causative agents of the disease

The bacterial sources of acute pyelonephritis are fairly well adapted to infiltrating and surviving 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 has "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 more often unilateral when one kidney is affected. Bilateral it is called with inflammation of these organs 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 neonatal period.

Pyelonephritis in children: video

Causes of childhood pyelonephritis

In pediatrics, the development of acute pyelonephritis is due to the following risk factors:

Vesicoureteral reflux increases the risk and extent of renal cortical lesions, while clinically significant signs of pathology may 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 old, these are mainly symptoms of general intoxication and all the signs that follow from this, 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. The symptoms are usually:

• pain in the lumbar region and abdomen;
• frequent painful urination;
• cloudy urine;
• small swelling;
• phenomena of general intoxication (temperature, headache, weakness).

Girls under 11 have a 3–5% risk of infection. 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 then can adequate treatment be prescribed.

Required tests

Mandatory laboratory tests include:

• general analysis of blood and urine;
• quantitative analysis of urine with a study of sediment (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 with the identification of the degree of bacteriuria (the number of bacteria per 1 ml of urine);
• antibiogram - detection of the sensitivity of the urine flora to antibacterial drugs.

Diagnosis includes a mandatory urinalysis

Additionally, tests for immune status (blood for immunoglobulin A) and urine tests 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 on its own, but enters the body only with mother's milk.

Instrumental Research

Instrumental urological studies show external and internal changes in the kidneys, evaluate their functional abilities. They are carried out not in the acute period, but after the 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 the disease. The patient is injected intravenously with radioisotope preparations and, using a special device, their content in the organ is monitored. The procedure takes about half an hour. Despite the negligible dose of radiation (less than with conventional x-rays), such an examination is not recommended for children under one year old.
• Ultrasound examination (ultrasound) of the urinary system. It consists in examining the outlines, shape, 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, an assessment is made for the presence of vesicoureteral reflux (reverse reflux of urine).
• CT scan. Allows you to get a three-dimensional image of the kidney in various sections.
• Functional research. With their help, the speed of urination, the sensitivity of the walls of the bladder to its filling, etc. are determined.

External examination of the patient

Physical examination includes an 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 puts one palm on the kidney area, and with the edge of the second brush he taps on the back surface of the first. If the child feels pain and discomfort, then this means the presence of inflammation. A short-term increase in red blood cells in the urine after the test will additionally confirm the presence of the disease.

A positive symptom of Pasternatsky 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 (at a concentration of more than 100 thousand per 1 ml of urine), protein in the urine.
4. Functional renal anomalies.
5. Asymmetry and deformation of the pyelocaliceal system, congenital expansion of the pelvis (pyeloectasia).

Pyelonephritis must be distinguished (differentiated) from such diseases of the genitourinary system 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 their lower parts. 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 carefully treated.

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 covers only one kidney or is unevenly distributed in both.

Treatment

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

First, during the acute phase of the disease, children are shown bed rest. It should be observed while the high temperature and dysuric phenomena persist. Secondly, you need to drink plenty of water. It helps to flush out the infection and reduce the intoxication of the body. The child needs to drink, if possible, about 1.5-2 liters of fluid per day. It can be water, weak tea, non-acidic juices, compotes (from apples, pears, dried apricots, raisins).

Medical therapy

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

When choosing an antibiotic, the doctor is guided by the 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 such groups of antibiotics:

• semi-synthetic penicillins (Amoxiclav, Augmentin);
• cephalosporins (Ketacef, Mandol - 2nd generation; Klaforan, 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 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.

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

Minimal nephrotoxicity is inherent in antibiotics of the penicillin and cephalosporin groups, as well as Erythromycin. Drugs of medium toxicity in terms of action on the kidneys - Gentamicin and Tetracycline.

At the onset of the disease, when drinking plenty of water is essential, a fast-acting diuretic, such as Furosemide, is also prescribed. To relieve inflammation and get the best effect from antimicrobials, schemes are used in which they are combined with non-steroidal anti-inflammatory drugs (Voltaren, Ortofen). Take them for two weeks.

Correction of immunity is required for infants, children with a severe course of infection, as well as with a tendency to relapse. The drugs of choice in such situations are Immunal, Viferon, Cycloferon and others, but strictly on prescription.

Medication improves microcirculation in the kidneys in cases where there is a suspicion of any vascular lesions. Apply Eufillin, Cinnarizine, etc.

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

Amoxiclav is a reliable and non-toxic antibiotic
Gentamicin has a wide spectrum of antimicrobial activity.
Claritin in syrup is 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 acuteness of the process is removed, products that can irritate the urinary system are completely excluded from consumption:

Physiotherapy methods

Physiotherapy may be relevant in the decline of the active phase of pyelonephritis. When the condition is more or less stable (subacute course), then the doctor can prescribe procedures aimed at improving the outflow of urine, raising the tone of the ureters, and stimulating the general defenses of the body. 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

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

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

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

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

Another way is a laparoscopic operation, 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 the screen or monitor, looking at which the surgeon performs the necessary actions.

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

Advantages of laparoscopic surgery:

• low trauma;
• relatively quick and easy rehabilitation;
• absence of scars (punctures are tightened almost without a trace).

This method is definitely chosen if the child is under 1 year old or has a small 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 a high degree of vesicoureteral reflux, which provokes frequent relapses of pyelonephritis, then intravesical plasty of the ureteral orifice is necessary - a low-traumatic and technically simple endoscopic correction. The operation consists in the introduction of collagen gel into the outlet section of the ureter using a special needle. The gel forms a tubercle that allows the upper wall of the ureter to fit snugly against the lower one, forming an antireflux valve.

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

Folk remedies

As one of the components of complex treatment, therapy with folk remedies can be considered. It is advisable to use such recipes as maintenance methods during the period of remission of pyelonephritis. The dosage for children should be clarified with the attending physician.

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

Forecast and consequences

Most cases of pyelonephritis respond well to antibiotic treatment, ending without further complications. Permanent renal scarring develops in 18–24% of children after the end of the inflammatory process. Timely treatment started (within 5-7 days from the onset of the disease) significantly reduces the risk of such defects. Severe damage to the kidney parenchyma occurs in about 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 ends in complete recovery in 80-90% of cases. But if the inflammation drags on for six months or more, then it becomes chronic and is prone to periodic exacerbations.

Patients with severe cases or persistent infections are shown appropriate treatment and follow-up medical examination to prevent long-term complications.

Babies 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 associated only with sepsis. Generalized bacteremia, or blood poisoning, is rare but can develop as a result of pyelonephritis.

Rehabilitation and prevention

After suffering acute pyelonephritis, children must be observed at the dispensary for the next 3-5 years: regularly undergo examinations by a pediatrician and a nephrologist. The purpose of such medical control is to prevent re-infection attacks.

It is important to visit the dentist at least twice a year and sanitize the foci of a dormant infection. Obligatory examinations by an otolaryngologist to detect chronic tonsillitis and other inflammations of the nasopharynx. Regular urine tests are required at the time 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 there were no recurrences of the disease during the time indicated by the supervising doctor, and the urine tests were normal, then after a comprehensive examination in the hospital, the child can be deregistered.

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 runs the risk of being inside the child's genitourinary system. Newborn babies need to change diapers on time for the same reason.

Front to back - this is how you need to properly wash children, especially girls

The more often the child urinates, the more effectively the infection is washed out of the body. Therefore, it is important to monitor the regularity of emptying his bladder.

In chronic constipation, there is a threat of microbes entering the urinary system from the intestines through the common lymph flow. In addition, fecal blockages prevent the normal excretion of urine, increasing pressure inside the kidney and causing the risk of an inflammatory process in it. Therefore, it is necessary to control the regular emptying of the intestines in the child.

The slightest delay in the treatment of acute pyelonephritis in children greatly increases the risk of irreversible kidney damage. The 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 in the child of anxiety associated with urination, as well as to causeless fever and symptoms of intoxication.

In children, after influenza and other infectious diseases, there is often a complication in the kidneys. They develop an inflammatory process. It is not always easy to recognize, especially in babies who do not yet know how to talk. The resulting symptoms are similar to the manifestations of cystitis, intestinal infectious diseases, 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 urgent antibiotic treatment so that the process does not become chronic. It is necessary to follow the diet.

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

In children, pyelonephritis can occur at any age. Up to 1 year, the incidence of girls and boys is the same. Among older children, inflammatory diseases of the urination organs, including pyelonephritis, are 4-5 times more common in girls than in boys. This is due to the difference in the anatomical structure of the genitourinary system. In girls, the urethra is much shorter. 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 (E. coli, staphylococci), viruses (adenoviruses, enteroviruses, influenza pathogens), as well as protozoa (Giardia, Toxoplasma) and fungi.

How infection occurs

Infection can enter the kidneys in three ways:

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

Classification of pyelonephritis

There are primary pyelonephritis in children and secondary.

Primary- this is when the source of infection appears directly in the kidneys. The onset of primary inflammation contributes to a decrease in immunity. At the same time, opportunistic microflora begins to develop in them.

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

It is possible to develop an inflammatory process of various types. obstructive pyelonephritis is accompanied by urinary retention in the kidneys. non-obstructive- urine comes out of the kidneys freely.

Pyelonephritis can occur in 2 forms. Spicy usually resolves in 1-3 months if treatment is started without delay. Chronic pyelonephritis can last for years. The transition of the disease to a chronic form is said if the symptoms do not disappear within six months. A protracted inflammatory process can be recurrent, when the manifestations periodically return, and then there are periods of remission (temporary recovery).

It is also possible the course of chronic pyelonephritis in a latent form. In this case, the symptoms are very mild. It is possible to identify latent pyelonephritis in a child only with a thorough examination (there are characteristic changes in the composition of urine and blood that can be detected by test results).

If inflammation occurs in only one kidney, then they talk about unilateral pyelonephritis. With the defeat of both kidneys - about 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. There is a delay in urination, an abnormal accumulation of urine in the kidneys.
2. Formation of salt stones and sand. Crystals may block the renal tubules.
3. Urine reflux (reflux) from the bladder to the kidneys as a result of an increase in pressure inside it due to inflammatory edema, trauma, or a congenital defect of the organ.
4. The entry of pathogenic microorganisms into the kidneys.

In newborns, infection occurs most often by the hematogenous route (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, intestines, that is, infection occurs in an ascending way. When the intestinal mucosa is damaged, bacteria enter the kidneys with lymph, as the natural outflow of lymphatic fluid from the kidneys to the intestine is disturbed, and stagnation occurs in the vessels.

The occurrence of pyelonephritis in children contributes to improper hygienic care for babies, a rare change of diapers and underwear.

Warning: This problem is especially relevant for girls. In order not to bring the 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 a decrease in immunity, the presence of chronic inflammatory processes in a 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 are sick, who have symptoms of beriberi, anemia, rickets.

Video: Features of pyelonephritis, its diagnosis and treatment

Symptoms of pyelonephritis

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

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

There are frequent urges to urinate, but urine output in pyelonephritis is poor. Urine becomes cloudy, its color becomes more intense, an extremely unpleasant odor appears. Pain occurs when emptying the bladder. It is characteristic that in a healthy child the bulk of the urine is excreted during the daytime, and with pyelonephritis, nighttime urination becomes more frequent, 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, heart rate increases.

Acute pyelonephritis

Acute pyelonephritis develops in children in several stages.

On 1 stage 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 there is a fusion of infiltrates and the formation of an inflammation focus with a diameter of up to 2 cm. There may be several such foci.

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

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

Warning: When a child's temperature rises against the background of the absence of colds, it is imperative to take him to a pediatrician or pediatric urologist to do a urine test and immediately begin treatment.

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 quickly gets tired, becomes nervous. He has pale skin. There may be a dull pain in the back.

Chronic inflammation of the kidney can cause serious health complications for the child in the future. The consequence of chronic pyelonephritis in children is nephrosclerosis ("wrinkled kidney") - atrophy of the renal tissue due to circulatory disorders and hypoxia, its replacement with connective tissue, scarring.

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

Features of symptoms in infants

The first sign of an infant's disease with pyelonephritis may be an increase in temperature in the absence of signs of SARS. At the same time, a change in the nature of urination can be observed.

The baby urinates either too rarely, or very often and a lot. At the time of urination, he cries. His urine becomes cloudy, becomes dark, and blood may appear in it. Sick children are constantly naughty, sleep badly, eat poorly, 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, erythrocytes and other indicators. Urine culture is performed to determine the composition of the microflora.

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

A biochemical analysis of urine is carried out for protein (in the absence of inflammation, it should not be there), urea (a decrease in its level indicates kidney failure) and other components. The study of urine by PCR and ELISA makes it possible to establish the type of infectious agents by their DNA and the presence of appropriate antibodies.

Blood tests are carried out: general, for protein, for creatinine. The content of creatinine above the norm indicates that the kidneys are not coping with their functions.

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

Video: Importance of urinalysis for urinary tract infections

Treatment

Treatment of pyelonephritis in children in the absence of complications is carried out at home. In severe manifestations of an acute disease, as well as in the event of its symptoms 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 consume about 1.5 times more liquids than usual (water, compotes, tea). If signs of renal failure are observed, then the amount of fluid consumed should be limited.
3. When symptoms of pyelonephritis appear, painkillers and antipyretics (ibuprofen, paracetamol) are used.
4. Children are being 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 bowel function. Antibacterial drugs such as cefuroxime, ampicillin, gentamicin are prescribed.
5. Diuretics (spironolactone, furosemide) are used to quickly remove bacteria from the kidneys and bladder. Children are prescribed anti-allergic drugs, as well as immunostimulants.

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

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

Prevention of pyelonephritis

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

Parents should observe how often the child's bladder is emptying, remind him that it is time for him to use the potty. The bladder should not be overfilled so that urine does not stagnate in it.

For any incomprehensible symptoms in a child, you should not self-medicate him. It is imperative to consult a doctor.

Pyelonephritis- inflammation in the kidneys and renal pelvis - the most common disease among children, second only to inflammatory diseases of the upper respiratory tract in frequency. The prevalence of morbidity among young children, the transition to a chronic form and the possibility of irreversible consequences make it possible to consider this disease as a very serious pathology that requires a careful approach to treatment, both on the part of the doctor and the parents.

Aware means armed! To suspect a disease in time is already half the battle to recovery!

Main causes of pyelonephritis in children

Pyelonephritis in children, like any inflammatory disease, is caused by microorganisms (bacteria) that enter the kidney in various ways and begin to multiply actively. According to the etiology and pathogenesis of pyelonephritis, in the vast majority of cases, the disease is caused by Escherichia coli, which is introduced into the kidney with blood flow from the focus of chronic infection, the role of which is most often played by carious teeth, chronic tonsillitis (tonsillitis) and otitis media (ear inflammation). In more rare cases, the infection comes from the bladder or external genitalia. This is the reason for the fact that girls, due to the 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 not able to fight the infection.

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

• Complications during pregnancy and childbirth
• Short-term breastfeeding, early introduction of complementary foods
• Vitamin deficiency
• Chronic inflammatory diseases of the respiratory tract and ENT organs
• hereditary predisposition

There are so-called critical periods in the development of the child, 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 urine stagnation gives rise to active reproduction of bacteria.

There are two forms of pyelonephritis: acute and chronic. Acute pyelonephritis in children proceeds more rapidly with symptoms of severe intoxication, but with proper treatment most often ends in complete recovery. In some cases, the acute form can turn into a chronic one, which is characterized by periodic exacerbations, proceeds for 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 such that, depending on age, the symptoms of the disease manifest themselves in different ways. Signs of pyelonephritis in a child are not difficult to suspect, usually the disease proceeds with characteristic manifestations, with the only exception being young children.

Children under 1 year old

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

• An 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 numbers without any reason should immediately alert both parents and the doctor to the presence of pyelonephritis in a child. The temperature in pyelonephritis is difficult to treat with antipyretic drugs and is able to stay at high numbers for several days.

Children from 1 to 5 years old

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

Over 5 years old

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

Thus, a "typical" set of symptoms of acute pyelonephritis in children older than 5 years includes the following:

• Acute increase in body temperature up to 39-40C. It is important to remember that the hallmark of inflammation of the kidneys from colds is the absence of inflammation of the respiratory tract (runny nose, cough, itching and sore throat, earache). The temperature rises against the background of full health immediately to high rates.
• Symptoms of general intoxication - the child becomes lethargic, capricious, refuses food. Chill attacks alternate with heat attacks. Often, a headache appears against the background of temperature.
• Symptoms from the urinary system - as a rule, on the second day after the temperature rises, there is a constant aching pain 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, frothy, 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 occurs for more than 1 year and has 2 or more episodes of exacerbation during this period. This form is an alternation of recurring exacerbations (especially in the spring-autumn period) and asymptomatic periods. The manifestations of the chronic form are the same as in the acute form, only more often less pronounced. The course of chronic pyelonephritis is slow and prolonged. With frequent exacerbations, improper treatment and lack of prevention, the disease can lead to such a serious complication as renal failure.

A set of diagnostic measures

It is not difficult for an experienced doctor to make a diagnosis of Pyelonephritis, especially if there have already been episodes of the disease in the history of the disease. Usually, diagnosis of pyelonephritis in children necessarily includes a general urinalysis, a complete blood count, urine culture for microflora and ultrasound of the kidneys. If there are bacteria and leukocytes in the urine, and with an appropriate 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 such a serious one as pyelonephritis, is not limited to drugs. 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 diseases of the kidneys complex consists of the following components:

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

It is always necessary to clearly follow all the recommendations of the doctor for a speedy recovery and prevention of relapse.

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 illness, when the temperature drops significantly and back pain disappears, the regimen can be expanded, but it will be much better if the child spends the entire period of illness at home.

Dieting

Diet for pyelonephritis in children as well as in adults is an essential attribute of a successful recovery. Spicy, salty, fried foods should be excluded from the child's diet, and foods high in protein should be limited. On the 7th-10th day of the course 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 water (compotes, fruit drinks, weak tea), and in chronic pyelonephritis (during remission periods) it is mandatory to drink weakly alkaline mineral waters.

Medical therapy

a) Antibiotics

All inflammatory diseases are treated with special antimicrobials (antibiotics), and childhood pyelonephritis is no exception. However, in no case should you self-treat a child - antibiotics are prescribed only by a doctor (!), Who is able to take into account all the criteria for selecting the drug, based on the severity of the disease, age and individual characteristics of the child. Treatment of acute and 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 up to 12 or up to 18 years, 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 made using a special measuring syringe or spoon.
• Antibiotics of the cephalosporin group, which are most often only in injections, therefore they are used in inpatient treatment (Cefotaxime, Cefuroxin, Ceftriaxone). However, some also exist in the form of a suspension, capsules and soluble tablets (Cedex, Suprax).
• Aminoglycosides (Sumamed, Gentamicin) and carbapenems in rare cases also take place, but they are most often used as an alternative option and as part of combination therapy.

In severe cases, the doctor can immediately take several antibiotics from different groups (combination therapy) in order to get rid of the infectious agent 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, worsened, and the temperature continues to stay at the same numbers
• With prolonged treatment for more than 10-14 days. In this case, the doctor must replace the antibiotic to prevent the development of addiction of the child's body to this drug.

b) Uroseptics

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

c) Vitamins and immunomodulators

After completing the course of basic treatment, it is imperative to restore a weakened immune system after an illness. For this purpose, immunomodulators (Viferon, Reaferon), and a complex of multivitamins are usually prescribed according to the age of the child.

d) Herbal treatment

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

Features of inpatient treatment

Treatment of pyelonephritis in children under one year old is carried out only (!) In a hospital under the close supervision of medical personnel. Older children with moderate or severe course are also necessarily hospitalized. Treatment of acute pyelonephritis in children over 10 years of age should always be carried out in a hospital (even with mild severity) in order to carry out a set of diagnostic procedures in time and identify the cause of the disease.

In the hospital, the child will receive all the necessary assistance in full

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

Often, the choice of treatment is carried out together with a pediatric urological surgeon in order to timely resolve the issue of eliminating anatomical anomalies 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 a course of basic treatment, when the child's condition returns to normal. Ultrasonic methods, UHF-therapy, magnetotherapy have proven themselves well. Also, when the inflammatory process subsides, physiotherapy exercises are indicated in the supine or sitting position, depending on the age and condition of the child.

Preventive actions

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

Primary prevention (prevention of the development of the disease) includes the timely elimination of foci of chronic infection (carious teeth, chronic otitis media and tonsillitis), strengthening immunity and avoiding hypothermia, personal hygiene (especially thorough hygiene of the external genital organs).

The secondary one implies the prevention of exacerbations and includes the doctor's recommendations: adherence to anti-relapse therapy, systematic monitoring, as well as all of the above measures of primary prevention.

Dynamic Surveillance

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

After an acute or chronic exacerbation episode - 1 time in 10 days

During remission - 1 time per month

In the first 3 years after treatment - 1 time in 3 months

Up to 15 years - 1 or 2 times a year

Systematic monitoring will 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 disease of the kidneys, which occurs quite often in children. Unpleasant symptoms, such as changes in the nature of urination, urine color, pain in the abdomen, fever, lethargy and weakness prevent the child from developing normally, attending childcare facilities - the disease requires medical attention.

Among other nephrological (with kidney damage) diseases in children, pyelonephritis is 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, we will tell in this article about this disease, its signs and methods of treatment.

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 cups and pelvis, flowing from there to the bladder, and the interstitium is the so-called interstitial tissue of the kidney that fills the space between the main renal structures, it is like a “framework” organ.

Pyelonephritis affects children of all ages. In the first year of life, girls and boys get sick with the same frequency, and after a year, pyelonephritis occurs more often in girls, which is associated with the peculiarities of 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 are often found (several pathogens at the same time).

Microorganisms can enter the kidneys in several ways:

1. Hematogenous way: by blood from foci of infection in other organs (lungs, bones, etc.). This path of spread of the pathogen is of the greatest importance in newborns and infants: they can develop pyelonephritis after suffering 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 with severe infections (bacterial endocarditis, sepsis).
2. The lymphogenous pathway is associated with the entry of the pathogen into the kidneys through the common lymphatic 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 in case of violation of the properties of the intestinal mucosa, stagnation of lymph (for example, in the case of chronic constipation, diarrhea, intestinal infections, dysbacteriosis), infection of the kidneys with intestinal microflora is possible.
3. Ascending way - from the genitals, anus, urethra or bladder, microorganisms "rise" to the kidneys. This is the most common route of infection in children older than one year, 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 the normal functioning of the organs of the urinary system and the good condition of local and general immunity, the infection does not develop. The occurrence of pyelonephritis is promoted by two groups of predisposing factors: from the side of the microorganism and from the side of the macroorganism, that is, the child himself. On the part of the microorganism, such a factor is high virulence (high contagiousness, 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 facilitated by:

1. Violations of the normal outflow of urine with anomalies in the structure of the kidneys and urinary tract, with stones in the urinary system, and even with crystalluria against the background of dysmetabolic nephropathy (kidney tubules are clogged with small salt crystals).
2. Stagnation of urine in functional disorders (neurogenic dysfunction of the bladder).
3. Vesicoureteral reflux (backflow of urine from the bladder into the kidneys) of any origin.
4. Favorable conditions for ascending infection (insufficient personal hygiene, improper washing of girls, inflammatory processes in the vulva, perineum and anus, untreated cystitis or urethritis).
5. Any acute and chronic diseases that reduce the immunity of the child.
6. Diabetes.
7. Chronic foci of infection (tonsillitis, sinusitis, etc.).
8. Hypothermia.
9. Worm infestations.
10. In children under one year old, the development of pyelonephritis is predisposed to the transition to artificial feeding, the introduction of complementary foods, teething and other factors that increase the burden on the immune system.

Classification of pyelonephritis

Russian nephrologists distinguish the following types of pyelonephritis:

1. Primary (in the absence of obvious predisposing factors from the urinary organs) and secondary (occurring against the background of anomalies of the structure, with functional disorders of urination - obstructive pyelonephritis; with dysmetabolic disorders - non-obstructive pyelonephritis).
2. Acute (after 1-2 months there is a 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 the analyzes). The latent course of chronic pyelonephritis is a rare occurrence, and most often such a diagnosis is the result of overdiagnosis, when an infection of the lower urinary tract or reflux nephropathy is taken for pyelonephritis, in which “external” symptoms and complaints are really absent or mild.

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.

The symptoms of pyelonephritis are quite different in different children, depending on the severity of the inflammation, the severity of the process, the age of the child, comorbidities, etc.

The following main symptoms of pyelonephritis can be distinguished:

1. An increase in temperature is one of the main signs, often being the only one (“unreasonable” temperature rises). Fever is usually severe, the temperature rises to 38 ° C and above.
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 in the lumbar region. Children under the age of 3-4 years poorly localize abdominal pain and may complain of diffuse (throughout the abdomen) pain or pain around the navel. Older children often complain of pain in the lower back (usually unilateral), in the side, in the lower abdomen. The pains are not sharp, pulling, aggravated by changing the position of the body and subside when warmed.
4. Urination disorders are an optional symptom. Perhaps urinary incontinence, frequent or rare urination, sometimes it is painful (against the background of previous or concomitant cystitis).
5. Slight 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, 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 the breast (mixture) or sluggish sucking;
• pale skin with perioral cyanosis (blue around the mouth, cyanosis of the lips and skin above the upper lip);
• weight loss or lack of weight gain;
• dehydration, manifested by dryness and flabbiness of the skin.

Toddlers cannot complain of abdominal pain, and their counterpart is the child's unrelated anxiety or crying. Approximately half of infants also have restlessness when urinating or reddening of the face and "groaning" before the act of urination. Often in infants against the background of pyelonephritis, stool disorders (diarrhea) occur, 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 and changes in urine tests, and periods of exacerbations, during which the same symptoms occur as in acute pyelonephritis (pain in the abdomen and back, temperature, intoxication, changes in urinalysis). In children suffering from chronic pyelonephritis for a long time, signs of infectious asthenia appear: irritability, fatigue, school performance decreases. If pyelonephritis began 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 study for all children with fever, especially if their temperature increase 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 completely cover the field of view; bacteriuria (the appearance of bacteria in the urine), a small number of cylinders (hyaline), mild proteinuria (protein in the urine is not more than 1 g / l), single erythrocytes. You can also read about the interpretation of urinalysis in children in this article.
2. Accumulative samples (according to Nechiporenko, Addis-Kakovsky, Amburge): leukocyturia is detected in them.
3. Sowing 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 recurrence of the disease.
4. In the general blood test, general signs of an infectious process are found: ESR acceleration, leukocytosis (an increase in the number of leukocytes compared to the age norm), a shift in the leukocyte formula to the left (the appearance of immature leukocytes - rods in the blood), anemia (a decrease in hemoglobin and the number of erythrocytes).
5. Be sure to conduct a biochemical blood test with the determination of total protein and protein fractions, urea, creatinine, fibrinogen, CRP. In acute pyelonephritis, in the first week from the onset of the disease, an increase in the level of C-reactive protein is noted in the biochemical analysis. 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 analysis of urine.
7. Kidney function is assessed using the Zimnitsky test, by the level of creatinine and urea in a biochemical blood test and some other tests. In acute pyelonephritis, kidney function is usually not impaired, and in chronic pyelonephritis, some deviations are often found in the Zimnitsky test (isostenuria - monotonous specific gravity, nocturia - the predominance of nighttime diuresis over daytime).
8. Measurement of blood pressure is a mandatory daily procedure for children of any age who are in the hospital for acute or chronic pyelonephritis. In acute pyelonephritis, the pressure is within the age norm. When the pressure begins to rise in a child with chronic pyelonephritis, this may indicate the addition of kidney failure.
9. In addition, all children undergo an ultrasound scan of the urinary system, and after the subsidence of acute phenomena, X-ray contrast studies (micturation cystoureterography, excretory urography). These studies allow to identify vesicoureteral reflux and anatomical abnormalities that contributed to the onset of pyelonephritis.
10. Other studies are also carried out in specialized nephrological and urological pediatric departments: various tests, renal blood flow dopplerography, scintigraphy (radionuclide study), uroflowmetry, CT, MRI, etc.

Complications of pyelonephritis

Pyelonephritis is a serious disease that requires timely adequate treatment. Delays in treatment, insufficient volume of ongoing therapeutic 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 acute pyelonephritis, the child is shown to drink plenty of fluids.

Treatment of acute pyelonephritis in children should be carried out only in a hospital, and hospitalization of the child in a highly specialized department: nephrological or urological 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 drugs.

Therapeutic measures for acute pyelonephritis in children:

1. Mode - 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 regimen is ward (the child is allowed to move within his room), then - general (including daily calm walks in the fresh air for 30-40-60 minutes on the territory of the hospital).
2. Diet, the main purpose of which 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 extended drinking regimen (the child should receive liquids 50% more than the age norm). However, if in acute pyelonephritis there is a violation of kidney function or obstructive phenomena, salt and liquid are limited. A protein-vegetable diet, with the exclusion of any irritating foods (spices, spicy dishes, smoked meats, fatty foods, rich broths). With dysmetabolic disorders, an appropriate diet is recommended.
3. Antibacterial therapy is the basis of medical treatment of acute pyelonephritis. It is carried out in two stages. Before obtaining 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, cephalosporins of the 2nd and 3rd generations, etc. ). After receiving the results of the analysis, the drug that is most effective against the identified pathogen is selected. The duration of antibiotic therapy is about 4 weeks, with a change of antibiotic 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 admission.
5. Other medications: antipyretics, 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 there is a nephrologist in the clinic, then to him too. The observation and treatment of the child is carried out in accordance with the recommendations given in the hospital, if necessary, they can be corrected by the nephrologist. After discharge, at least 1 time per month, a general urinalysis is performed (and additionally against the background of any acute respiratory viral infection), an ultrasound of the kidneys is performed every six months. Upon completion of taking uroseptics, phytopreparations are prescribed for 1-2 months (kidney tea, lingonberry leaf, kanefron, etc.). A child who has had acute pyelonephritis can be removed from the register only after 5 years, provided that there are no symptoms and changes in urine tests without taking anti-relapse medications (that is, the child was not given uroseptics or antibiotics for these 5 years, and he did not have a relapse of pyelonephritis) .

Treatment of children with chronic pyelonephritis

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

In chronic pyelonephritis, it is extremely important to identify the cause of its development, since only after the cause has been eliminated, the disease itself can be eliminated. Depending on what exactly caused the infection of the kidneys, therapeutic measures are also prescribed: surgical treatment (with vesicoureteral reflux, anomalies accompanied by obstruction), diet therapy (with dysmetabolic nephropathy), medication and psychotherapeutic measures (with neurogenic bladder dysfunction) etc.

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

Which doctor to contact

In acute pyelonephritis, a pediatrician usually begins examination and treatment, and then a consultation with a nephrologist is prescribed. Children with chronic pyelonephritis are observed by a nephrologist, an infectious disease specialist can additionally be prescribed (in unclear diagnostic cases, suspected tuberculosis, and so on). Given the predisposing factors and ways of getting the 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 help get rid of chronic pyelonephritis.

Chronic pyelonephritis: symptoms and treatment

Such an ailment as pyelonephritis in children requires prompt identification and adequate treatment. It is necessary to carefully monitor the crumbs, since inflammation of the kidneys is a dangerous disease and 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 on 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 must be shown to the doctor, who will send the crumbs 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 primary manifestation, inflammation is caused by pathogenic microflora that has affected the kidneys and is rapidly developing in them. Features of secondary pyelonephritis are that the primary cause of the disease is not inflammatory processes of the kidneys, more often the lesion occurs due to the formation of stones, with abnormalities in the development of the organ and ureteral reflux.

Depending on how long the disease bothers the child, acute and chronic pyelonephritis is released. In the chronic course of the child, frequent relapses are disturbing, all signs of an infectious lesion of the organ remain. During an exacerbation, severe and acute pain, fever, problems with urination, 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, intoxication. The child suffers from prolonged chills, fever, against the background of intoxication, nausea, vomiting, diarrhea, weight loss, bacteriuria develop. With an exacerbation with the addition of a bacterial infection, the baby experiences pain during urination, frequent urge to empty the bladder, incontinence, burning sensation in the organs of the genitourinary system.

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

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Causes and predisposition

The causes of pyelonephritis in young children are most often enteric-bacterial. Urinalysis also shows the presence of Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus. The infection enters the kidneys by hematogenous, lymphogenous or urinogenic routes. Newborn babies are infected by the hematogenous route, and older ones, up to 12 years old, are more often infected by the urinogenic route. Non-compliance with the rules of hygiene, irregular change of linen also provoke an illness.

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

Congenital anomalies, complications after severe infectious diseases, with a diagnosis of hypotophia, 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 ailment should be immediately identified and timely treatment should be started using adequate drugs.

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

Etiology and pathogenesis.

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

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

Infection of the kidney and collecting system occurs mainly by 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 the stasis of urine; 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 dysbacteriosis with an increase in the number of opportunistic microflora and translocation of microorganisms from the intestine to the urinary organs. Each of these factors may have independent significance in the occurrence of pyelonephritis, but more often the disease develops with a combination of exposure to some of them.

According to the duration of the flow:

Acute pyelonephritis - lasts about 2 months in a child, quite often accompanied by complications requiring surgical treatment. A small inflammation, as a rule, ends with a complete recovery.

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

There are primary and secondary pyelonephritis.

Primary pyelonephritis - develops in a child due to changes in the intestinal flora. The reason for the change in microflora is an intestinal infection. With coccal infection, influenza and tonsillitis, there are also risks of the formation of a primary form of the disease in a child. The culprit of pyelonephritis can be cystitis under the age of 10 years.

Secondary pyelonephritis - develops as a result of congenital anomalies: disorders in the structure of the kidneys, improper location of the bladder and ureters. Secondary pyelonephritis, as a rule, occurs up to a year. At the same time, in an infant, there are violations of the outflow of urinary fluid. Together with urine, bacteria enter the lower tracts and the kidney, provoking 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 renal 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 fever up to 38-40 ° C, chills, headache, and sometimes vomiting.

• Pain syndrome. Older children may have unilateral or bilateral low back pain radiating to the groin, dull or colicky, persistent or intermittent.
• Dysuric disorders. Often there are painful and frequent urination (pollakiuria), as well as polyuria with a decrease in the relative density of urine to 1015-1012.
• Syndrome of intoxication. 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 symptom of Pasternatsky.

• urinary syndrome. Neutrophilic leukocyturia and bacteriuria are determined, less often - small microhematuria and proteinuria,

In blood tests - leukocytosis, elevated ESR, slight normochromic anemia. Severe forms of pyelonephritis are rare, accompanied by 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 severe urinary signs (leukocyturia, bacteriuria, macrohematuria and proteinuria).

In newborns, the symptoms of the disease are mild and unspecific. The disease is manifested mainly by dyspeptic disorders (anorexia, vomiting, diarrhea), a small increase or decrease in body weight, and fever. Jaundice, bouts of cyanosis, meningeal symptoms, signs of dehydration are less common. Leukocyturia, bacteriuria, 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, urinary and urination disorders. Urinary syndrome is pronounced. Hyperasotemia 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 an unfavorable course of acute pyelonephritis, which lasts more than 6 months or two or more exacerbations are observed during this period. Depending on the severity of clinical manifestations, recurrent and latent chronic pyelonephritis are distinguished. With a recurrent course, periodically recurring exacerbations are observed with more or less long asymptomatic periods. The clinical picture of recurrence of chronic pyelonephritis differs little from that in acute pyelonephritis and is characterized by a different combination of general (fever, pain in the abdomen or lower back, etc.), local (dysuria, pollakiuria, etc.) and laboratory (leukocyturia, bacteriuria, hematuria, proteinuria and 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 the inflammation subsides due to the involvement of the capsule in the scarring process that occurs in the parenchyma. The severity of pain is different: from a feeling of heaviness, awkwardness, discomfort to very severe pain with a recurrent course. The asymmetry of pain sensations is characteristic, sometimes they spread to the iliac region.

— Dysuric syndrome in chronic pyelonephritis (CP). With exacerbation of chronic pyelonephritis (CP), pollakiuria and stranguria are often observed. The individual frequency of urination depends on the water and food regimen and can differ significantly in healthy individuals, therefore, in patients with pyelonephritis, it is not the absolute number of urination per day that matters, but the assessment of their frequency by the patient himself, as well as the increase at night. Usually, a patient with pyelonephritis urinates often and in small portions, which may be the result of neuro-reflex urinary disorders and urinary tract dyskinesia, changes in the state of the urothelium and urine quality. If pollakiuria is accompanied by a burning sensation, pain in the urethra, pain in the lower abdomen, 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, salt diathesis, and its appearance often precedes other clinical signs of exacerbation of secondary chronic pyelonephritis (VCP). With primary pyelonephritis, dysuria is less common - in about 50% of patients. In secondary chronic pyelonephritis (VCP) - dysuria is more common - up to 70% of patients.

- Urinary syndrome in chronic pyelonephritis (CP).
Changes in some properties of urine (unusual color, turbidity, pungent odor, large sediment upon standing) can be noticed by the patient himself and serve as a reason to consult a doctor. Properly conducted urinalysis provides a lot of information in kidney diseases, including chronic pyelonephritis (CP).

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

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

Leukocyturia- a direct sign of the 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 evaluation of urine density. Unfortunately, many doctors ignore this indicator. However, hypostenuria is a very serious symptom. A decrease in the density of urine is an indicator of a violation of the concentration of urine by the kidneys, and this is almost always swelling of the medulla, hence inflammation. Therefore, with pyelonephritis in the acute phase, one always has to deal with a decrease in urine density. Quite often, this symptom comes to light as the only sign of pyelonephritis. For a number of years there may be no pathological sediment, hypertension, there may be no other symptoms, and only low density of urine is observed.

Hematuria in chronic pyelonephritis (CP)

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

In chronic pyelonephritis (CP), all of these factors act, but, as a rule, macrohematuria in patients with chronic pyelonephritis (CP) is not observed, except in cases where there are complications of pyelonephritis (renal vascular necrosis, hyperemia of the mucous membrane of the urinary tract with pyelocystitis, its stone 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 erythrocytes per field of view. In the latent phase of chronic pyelonephritis (CP) in the general analysis of urine, hematuria is found in only 8% of patients, in another 8% - in quantitative samples.

Thus, hematuria cannot be attributed to the main signs of chronic pyelonephritis (CP).

Bacteriuria considered the second most important diagnostic sign of pyelonephritis (after leukocyturia). From a microbiological point of view, urinary tract infection can be considered if pathogenic microorganisms are found in the urine, urethra, kidneys or prostate gland. An idea of ​​the presence of bacteriuria can be given by colorimetric tests - TTX (triphenyltetrazolium chloride) and a nitrite test, but bacteriological methods for examining urine are of 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), conduct adequate antibiotic therapy and monitor the effectiveness of treatment.

The main method for determining bacteriuria is sowing on solid nutrient media, which makes it possible to clarify the type of microorganisms, their number 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 of the body (the amount of urine, as a rule, is greater than that of a healthy person, because concentration is impaired. And since more urine is released, then, therefore, , and the need for liquid is greater).

In 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 a urinary syndrome, one should not rush to attribute this fever to pyelonephritis. It is necessary to observe a very stormy picture of pyelonephritis in order to explain this temperature to them.

- Syndrome of arterial hypertension in chronic pyelonephritis (CP);

- Syndrome of chronic renal failure 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. violation of the concentration function of the kidneys.

List of main diagnostic measures:

1. Complete blood count;

2. General analysis of urine. The main laboratory sign in a young 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 the middle portion of morning urine in a clean, dry jar (the first portion of urine is usually from the urinary tract, therefore urine is taken from the middle portion for research). 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 cylinders occur.

The need for this group of analyzes arises in the presence of doubtful results obtained in the general analysis of urine. To clarify the data, quantify the formed elements of the urinary sediment and conduct urine tests according to Nechiporenko and Addis-Kakovsky.

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

Zimnitsky's test

One of the main methods of functional study of the kidneys is the Zimnitsky test. The purpose of this test is to assess the ability of the kidneys to dilute and concentrate urine. For this test, urine must be collected a day before. Urine collection utensils must be clean and dry.

For analysis, it is necessary to collect urine in separate portions with an indication of the time every 3 hours, i.e. a total of 8 servings. The test allows you to evaluate the 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 ability of the kidneys.

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

Ultrasound of the kidneys

Glomerular filtration rate (according to blood creatinine). Decrease.

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

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

blood creatinine, µmol/l

Ratio: newborns 33-40

prepubertal period 38-48

post-puberty 48-62

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

Cystography- vesicoureteral reflux or condition after antireflux surgery.

Nephroscintigraphy- Foci of damage to the parenchyma of the kidneys.

Pyelonephritis must be differentiated from cystitis, interstitial nephritis. For both diseases, leukocyturia is a characteristic and often the only symptom. With pyelonephritis, it is neutrophilic, with interstitial nephritis - 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. With 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 in 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 the discharge from the vagina is carried out. Finally, the 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 in the primary disease.

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

Treatment.

Aimed at the elimination of kidney infection, increasing the reactivity of the body, 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 (as amoxicillin) in 2-3 oral doses

III generation cephalosporins: cefotaxime, ceftazidime, ceftriaxone, cefixime, ceftibuten

Severe flow:

- 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).

With the effectiveness of treatment observed:

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

 eradication of microflora in 24-48 hours;

 reduction or disappearance of leukocyturia for 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 (not more than 400 mg / 24 hours) in 3-4 doses;

- Furamag - 5 mg / kg / 24 hours (no more than 200 mg / 24 hours) in 2-3 doses.

2. Non-fluorinated quinolones:

- Negram, nevigramon (in children older than 3 months) - 55 mg / kg / 24 hours in 3-4 doses;

- Palin (in children older than 12 months) - 15 mg / kg / 24 hours in 2 divided doses.

Stage 3 - preventive anti-relapse therapy.

Antibacterial treatment should be carried out taking into account the sensitivity of the urine microflora to antibacterial drugs. As a rule, levomycetin is prescribed for children under 3 years old, 0.15-0.3 g 4 times a day; ampicillin - 100-200 mg / kg per day; gene-tamycin - 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. Of the chemotherapy drugs, furagin is used at 0.05-0.1 g 3 times a day, urosulfan at 0.5 g 2-4 times a day, nevigramon 0.25-1.0 g per day in 3-4 doses, 5-NOC 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, with secondary pyelonephritis - timely restoration of urodynamics with the help of surgical intervention, as well as measures to eliminate metabolic disorders. The patient must be registered with the dispensary during the entire period of clinical and laboratory remission until recovery, which can be discussed with long-term preservation of complete remission (at least 3 years). In recent years, great importance has been attached to the normalization of the intestinal microflora (bifidumbacterin and other drugs that restore the normal intestinal microflora).

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

The health of the baby is very fragile. Therefore, pediatricians insist on regular examinations. Every mother should know the importance of urinalysis - it can be used to diagnose acute pyelonephritis in a child in time. Since this disease can be associated with both colds and viruses, it is better to play it safe.

Acute pyelonephritis in children is an inflammatory process that occurs in the kidneys. To be more precise - a disease of the renal pelvis, which are a kind of reservoir for urine. It is from them that urine passes into the ureters.

The root cause of the appearance of pyelonephritis - viral . The infection can get into the blood from a diseased tooth, sore throat, wounds 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 overtakes children under the age of 5 years, in particular, girls. The female reproductive organs are designed in such a way that it is easier for bacteria to penetrate and multiply in them.

In addition, this disease can be catarrhal character . Firstly, pyelonephritis can be a complication provoked by a banal SARS. 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 the addition of an infection.

That is why even with colds and flu, children under 7 years old are recommended to take 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 against the background of infection of the body with E. coli, enterococcus, chlamydia, mycoplasma, ureaplasma and other bacteria. With inflammation of the renal pelvis, in 80% of cases, Escherichia 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 carried by the bloodstream. That is, the nature of the infection of children is descending.

In an older child - 12-14 years old - inflammation can be ascending. That is, bacteria enter the urinary canal from the outside, and already from it into the kidneys. This type of infection is often accompanied by inflammation of the external genitalia, dysbacteriosis, inflammation of the intestine. 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 incomplete 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 thrive.

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, metabolic disorders. In older children, the disease may be associated with poor personal hygiene, acute viral infections, rheumatism, weakened immunity.

The treatment of acute pyelonephritis in children is simple, but if not done on time, serious complications can occur. 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 an exacerbation of viral diseases.

Babies can't talk about their feelings. They show that something is bothering them, the only way available to them is by crying. But older children on examination 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 can raise the fever (up to 40 degrees), accompanied by chills. Of the general symptoms, the mother should be alerted by constant headache, weakness, lack of appetite, cyanosis of the skin.

In young children, the symptoms of acute pyelonephritis are manifested in the form high fever, toxicity (vomiting, nausea) and, as a result, dehydration. Babies become lethargic, lethargic, often cry, begin to lose weight, refuse to eat.

Doctors recommend that mothers pay attention not only to the frequency and nature of bowel movements (the consistency and color of the 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 cure pyelonephritis?

Usually enough to diagnose acute pyelonephritis urinalysis . In difficult cases, for reinsurance, the doctor can send the child to Ultrasound of the kidneys .

An increased content of leukocytes, protein and erythrocytes 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 are enough to diagnose pyelonephritis.

Since many microbes are insensitive to antibiotics, the urine test is repeated 2-3 times throughout the treatment. If there is almost no change, another drug treatment is prescribed.

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

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

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

Evidence of illness can be:

• rapid pulse;
• sharp pain in the upper abdomen;
• soreness with a light blow with the edge of the palm of the hand on the kidneys;
• increased blood pressure.

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

Treatment of acute pyelonephritis in children involves a 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 mashed potatoes.

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 drink . Older children should be regularly given rosehip broth, diluted compotes and tea. To stop fluid loss, infants are given a special solution in the form of droppers.

Naturally, diet and drinking regimen is not enough for the treatment of acute pyelonephritis in a child. Strong drug therapy is needed.

After analyzing the 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 that, treatment begins. uroseptics that disinfect urine. These drugs include: furazidin, 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 recommendations of the doctor and not to refuse hospitalization, if necessary.

Prevention of acute pyelonephritis in children as such is not. The only thing you can do is to regularly take a urine test, make sure that the child does not get cold, does not walk in wet sliders. It is also worth paying special attention to the health of the baby during the period of exacerbation of influenza 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. Such 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 identify and treat infectious diseases, infection with worms, inflammation of the external genital organs, etc. in time.

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

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