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Pyelonephritis in children: treatment of acute and chronic forms. Signs of pyelonephritis in children, methods of diagnosis, treatment and possible complications Pyelonephritis in children symptoms treatment

Pyelonephritis in children: treatment of acute and chronic forms. Signs of pyelonephritis in children, methods of diagnosis, treatment and possible complications Pyelonephritis in children symptoms treatment

22.10.2020 Sport

Pediatric urinary tract infections are second only to respiratory infections. In infants, they can "disguise" as the pathology of the digestive system: acute abdomen, intestinal syndrome, dyspeptic disorder.

One of the symptoms of pyelonephritis in older children is an "unreasonable" rise in temperature from subfebrile to high numbers. Therefore, every child with an incomprehensible malaise and a rise in temperature must pass a urine test to exclude pyelonephritis.

Pyelonephritis (inflammation of the kidneys) in children is a disease of the upper urinary tract in which there is inflammation of the kidney tissue caused by microbes. The process involves not only the kidney tubules, but also the blood and lymphatic vessels.

At home, enterobacteria (E. coli, Klebsiella and Proteus) are common pathogens. Escherichia coli is in the lead; it is sown in 80–90% of cases. This is explained by the fact that the pathogen has a universal kit for damaging the tissue of the urinary tract. Due to special “fimbria”, the bacterium clings to the wall of the urinary tract and is not “washed away” by the urine stream.

The cause of infection in hospitals is Pseudomonas aeruginosa, Proteus and Klebsiella. This must be taken into account when prescribing treatment. When the pathogen is known, it is much easier to treat.

Infection routes:

  • from blood;
  • from lymph;
  • from the lower parts of the urinary tract.

Hematogenous (from blood) infection is more common in newborns. From mother to child. Prevention during pregnancy is important here, you need to be promptly examined for sexually transmitted infections.

Lymphogenous infection is due to the presence of a single lymph circulation system between the intestines and the urinary tract. Long-term bowel diseases (dysbacteriosis, colitis) reduce its protective functions, the movement of lymph stops. Stagnation greatly increases the likelihood of infection of the kidney with intestinal flora.

Ascending route of infection ( from the lower urinary tract ) occurs more often than others and is typical for girls. This is due to the structure of the urogenital area. The proximity of the two divisions promotes seeding. Normally, the progress of microbial colonies in girls is impeded by the usual microflora of the vagina, represented by lactobacilli, which produce lactic acid and create an unfavorable environment - a different pH.

By releasing hydrogen peroxide, lactobacilli inhibit the reproduction of harmful microflora. In some cases, there may be a violation of the number of vaginal flora (lack of female hormones, a decrease in the production of local immunoglobulin A, lysozyme). The balance of the relationship between the organism and microbes is disturbed, and local immunity decreases. The pathogenic organisms begin to rise unhindered from the lower sections to the kidney itself.

Strengthening general and local immunity is a reliable prevention of pyelonephritis.

Causes of the disease

The urinary tract is in constant contact with infection, but infection does not occur. This is due to the presence of local protective functions. There are many of them and they complement each other. Any disruption to their work creates a condition for illness.

Factors of adverse impact are divided into internal and external:

  • violation of urodynamics (urinary movement) - hereditary anomalies, blockage of the urinary tract, kidney stones, kidney prolapse;
  • a change in the composition of urine - glucose impurities, crystals, uric acid salts appear;
  • bacteriuria - the presence of microbes in the urine without signs of illness;
  • decrease in general immunity (treatment with cytostatics, chemotherapy);
  • bowel disease;
  • prematurity, gender (girls get sick more often), blood group IVAB and III B;
  • diseases and bad habits of the mother;
  • hypothermia;
  • early pregnancy and sex life;
  • medical manipulations in the urinary tract (bladder catheterization).

If prevention is carried out in schools in a timely manner, the incidence of childhood pyelonephritis will decrease. Girls especially need to avoid hypothermia, do not wear short skirts in cold weather, keep their feet warm and observe hygiene measures.

Features of the disease in children under one year old

The causative agent in newborns and children under one year old is Escherichia coli in 85% of cases. Subsequently, in infant boys, its share decreases to 40%, and proteus increases 33% and staphylococcus aureus to 12%.

Chlamydia contributes to the development of the disease, and from the mother, infection occurs through the blood. Immunodeficiency states, such as prematurity and HIV infection, predispose to the appearance of pyelonephritis in newborns. Then the pathogens will be fungi or their combination with bacterial flora.

The structure of the kidney in children under one year old has its own characteristics: the pelvis is also located intrarenal, the ureters are twisted and have a weak tone. Due to weak innervation, the muscular apparatus of the kidney does not contract enough.

According to experts, an early transfer to artificial feeding is disposed to illness in infants, especially in the first six months of life. In these children, the risk of getting sick increases by 2.3 times. Thus, the protective role of breastfeeding has been proven.

In young children, the disease is generalized. It is difficult, possibly the development of meningeal symptoms. The child often spits up, vomiting appears at the height of intoxication. When urinating, grunts and cries. Although these are not characteristic signs of pyelonephritis, the disease should be suspected.

It is not recommended to treat children under one year old at home due to the severity of the condition.

Forms and symptoms of pyelonephritis

In the course of the disease, pyelonephritis is divided into:

  • acute;
  • chronic.

Acute pyelonephritis has two forms: primary and secondary.

As an independent disease, primary occurs, and secondary pyelonephritis in a child appears against the background of various diseases of the urinary tract (anomalies of the ureters, kidney stones).

Acute pyelonephritis in children occurs with a high temperature of 39-40 ° C. Characterized by pain in the lower back, abdomen, joints. Expressed tremendous chills. In the acute form, the disease proceeds with severe intoxication. Worried about weakness, the characteristic posture of the child - forced bending and bringing the limb to the stomach on the side of the diseased kidney.

Obstructive pyelonephritis, which is accompanied by the death of organ cells, is very difficult. There is a state of shock with a drop in pressure, lack of urine, up to the development of acute renal failure. For older children, the course of acute pyelonephritis under the "mask" of appendicitis or flu is characteristic.

For the picture of chronic pyelonephritis for children, the same symptoms are characteristic, but they are less pronounced. The child complains of fatigue, frequent urination, which can be combined with anemia or arterial hypertension. In contrast to acute, childhood chronic pyelonephritis is dangerous by the structural restructuring of the renal pyelocaliceal system.

Diagnostics of the pyelonephritis

The first thing to do with a rise in temperature that is not associated with a cold is to check the urinalysis.

Urine examination includes two methods:

  • microscopic analysis;
  • sowing for bacterial flora and antibiotic sensitivity.

Medical recommendation: collection of urine for microscopic examination is carried out with free urination into a clean container, before antibiotic therapy begins. You must first carry out a thorough toilet of the external genital organs of the child.

The sensitivity of the method is 88.9%. When microscopic sediment attention is paid to leukocytes, erythrocytes, urine specific gravity and the presence of protein. Signs of pyelonephritis: the appearance in urine tests of 5 or more leukocytes, a change in urine density. The disadvantage of this method is the high risk of introducing microbes from the environment.

To obtain a high-quality diagnosis, the microscopic method must be combined with the bacteriological one. The modern laboratory method for confirming microbial infection is the procalcitonin test. Its average level in sick children is 5.37 ng / ml.

Ultrasound (ultrasound) - the use of color and pulsed Doppler ultrasonography significantly expands the capabilities and accuracy of the method. With its help, it is possible to identify developmental abnormalities, expansion of the pelvis, urolithiasis, hydronephrosis. Will show signs of kidney inflammation and wrinkling.

Renoscintigraphy (Scintigraphy)

The study using the isotope (Tc-99m-DMSA) allows you to identify foci that have dropped out of functioning. This is the most accurate method for detecting kidney puckering in children. In addition to the traditional method of ultrasound, MRI (magnetic resonance therapy) of the kidneys and computed tomography are used.

Treatment

Pyelonephritis therapy consists of the following stages:

  1. Antibacterial therapy.
  2. Pathogenetic.
  3. Symptomatic.
  4. Regime and proper nutrition.

Recommendations of doctors: antimicrobial therapy for pyelonephritis should be started as early as possible, ideally in the first 24 hours. A delayed onset (3-5 days) leads in 40% of cases to the appearance of areas of wrinkling in the parenchyma of the kidney, in other words, a defect is formed. Treatment is carried out over a longer course than in adults.

The younger the child, the longer the therapy. This approach has a simple explanation: the child has not yet developed general and local immunity, the anatomical features of the structure of the urinary tract create an obstacle to the flow of urine. Therefore, acute pyelonephritis in children ends with the chronization of the process with frequent relapses, if the terms of treatment are not followed.

It is necessary to treat for a long time. The course consists of 2 stages: starting antimicrobial therapy for 14 days and an anti-relapse course with uroseptics for a month. With developmental anomalies, where there is a reverse flow of urine, anti-relapse treatment is carried out for several months, sometimes a year, until the causes are eliminated.

It has been proven that the route of administration of the antibiotic does not affect the result. It is more convenient to use tablets at home. In the hospital, they begin to be treated by injection for 3-5 days, then they are transferred to tablets.

Commonly used antibiotics are presented in the table:

The ideal option for choosing antibiotic therapy is urine culture data.

Then blind treatment is excluded, the likelihood of a secondary case is reduced. Therapy will be directed at the cause of the disease and will minimize complications.

Anti-relapse treatment is carried out with 5-nitrofuran derivatives. These include: "Furagin" or "Furamag". From other groups: Palin, Nevigramon, Nitroxalin

Mild pyelonephritis can be treated at home. Herbal medicine has proven itself well for supportive and prophylactic therapy. For this purpose, you can use "Kanefron".

The diet for pyelonephritis in children should be age appropriate. Be balanced, contain more protein. Spicy foods and salt should be avoided. An abundant drink is provided, exceeding the age norm by 50%. Mineral water, preferably slightly alkaline (Essentuki 4, Smirnovskaya), 2-3 ml per kilogram of body weight at a time.

Forecast and prevention

Uncomplicated pyelonephritis, with proper treatment, has a favorable prognosis. Careful and timely therapy will help avoid relapses and chronic renal failure.

In order to prevent childhood pyelonephritis, you need to adhere to simple but effective rules:

  • exercise and sports improve blood circulation in the kidneys;
  • sufficient fluid intake gives good circulation;
  • timely urination removes stagnant urine.

Babies who have received treatment for pyelonephritis are subject to supervision by a pediatrician and periodically have to take urine tests. It is advisable to consult a nephrologist once a year.

Analysis of urine and urinary tract tests

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Pyelonephritis is an inflammatory process in the tissues of the kidneys caused by pathogenic bacteria. Distinguish between acute and chronic forms of pyelonephritis. The disease is more common in girls aged 2 to 15 years.

Pyelonephritis in children is a serious, but in many cases curable disease. Treatment is complex, long-term, multi-stage, with the obligatory use of antibacterial drugs. Also, the treatment regimen depends on the nature of the inflammation, the functional state of the organs of the urinary system. In addition to drug therapy, it is necessary to adhere to a strict dietary regimen and prevent recurrence.

Classification of pyelonephritis

Pyelonephritis is classified according to various criteria.

By localization:

  • unilateral;
  • bilateral.

For reasons:

  • primary: there are no abnormalities of the kidneys and urinary tract;
  • secondary: pathologies of the kidneys and urinary tract are detected.

By the form and course of the disease:

  • acute;
  • chronic;
  • purulent.

For urinary tract obstruction:

  • obstructive;
  • non-obstructive.

Today there is no generally accepted classification of pyelonephritis. First of all, this concerns the concepts of primary and secondary disease. In 90% of cases, secondary pyelonephritis occurs, which is diagnosed with a thorough examination of the child.

Signs of the disease

Acute and chronic forms are distinguished by clinical manifestations, the duration of the disease, the presence of congenital and acquired pathologies.

How do the symptoms of acute pyelonephritis manifest in children?

  • Abdominal syndrome. The child complains of pain in the abdomen, not in the lumbar region. The pain can be of a different nature: pulling, dull, paroxysmal, high and low intensity.
  • Intoxication syndrome. In children, the signs of intoxication are much more pronounced than in adults: high fever (sometimes up to 40 ° C), nausea, vomiting, severe chills, weakness, swelling, dehydration, heart palpitations.
  • Urinary Syndrome. Violations of urination are observed: usually painful and frequent urination; an increase in the volume of urine (less often there is a decrease). There may also be deviations in the color and clarity of urine.
  • Laboratory research. In the analysis of urine, an excess of the norm of leukocytes, a lot of bacteria, there is erythrocyturia (erythrocytes in the urine). In the analysis of blood - a decrease in hemoglobin, increased ESR, an increase in stab leukocytes (neutrophils), which indicates an inflammatory process of a bacterial nature.

What are the signs of chronic pyelonephritis in children?

  • The pain syndrome is not pronounced, sometimes there are dull, aching pains.
  • The temperature does not rise or rises to subfebrile (no higher than 37.5 ° C).
  • Excessive sweating is possible.
  • A large volume of urine, increased urination (dysuria), pain is not always the case.
  • Intoxication is mild.
  • The biochemical analysis of urine revealed salts (phosphates, urates, oxalates).
  • Constant fatigue, irritability, inattention, poor performance at school.

There are such forms of chronic pyelonephritis:

  • latent: latent form, for a long time without symptoms, only urinary syndrome is possible;
  • recurrent: relapses of acute pyelonephritis occur at least twice within 6 months;
  • remission: long-term absence of relapses, transition to the stage of complete recovery.

The diagnosis of "chronic secondary pyelonephritis" in children is made in the presence of congenital pathologies of the urinary system, most often in violation of the structure of the kidneys. The chronic form develops over 6 months.

Features of pyelonephritis in infants

What can provoke acute pyelonephritis in children at such an early age? The cause may be a congenital pathology of the kidneys and urinary tract, when the outflow of urine is impaired. But the disease can also provoke ARVI, bacterial, fungal and viral infections. With an inflammatory process in the kidneys, metabolic processes, the filtration process, water-salt balance, and blood pressure are disturbed. This is dangerous for the health and life of the infant.

What are the symptoms of pyelonephritis in infants?

  • In the acute form, a sharp rise in temperature without signs of ARVI.
  • Changes in urination: the diaper may remain dry for a long time or, conversely, fill up too quickly.
  • Urine acquires a pungent odor, changes color, becomes dark, cloudy, sometimes streaks of blood can be seen in it.
  • Crying while urinating.
  • Moodiness, anxiety, especially at night.
  • Digestive disorders: diarrhea, vomiting.

But there is also erased pyelonephritis in children. Symptoms in this case are mild, as a rule, the disease proceeds without pain and high fever. With a latent form of infection, only tests can confirm the diagnosis.

How babies are treated

In acute form, inpatient treatment is indicated. Therapy is the same as for older children. Compulsory course of antibiotics, uroantiseptics, herbal treatment. Probiotics are prescribed to support normal microflora. Pyelonephritis in infants is also well treated with homeopathy.

If you suspect pyelonephritis, the child must undergo a series of necessary laboratory and instrumental examinations. They will help identify the cause of inflammation, detect metabolic disorders, pathology of the kidneys and other organs of the urinary system, and obstruction of the urinary tract. A comprehensive examination of the child will help to avoid the chronic form of the disease and its dangerous complications - blood poisoning, purulent process in the kidneys, renal failure.

What is included in the diagnosis

To confirm the diagnosis, the pediatric nephrologist prescribes the following examinations:

  • general and biochemical blood test;
  • general and biochemical urine analysis;
  • study of diuresis;
  • urine analysis according to Nechiporenko, Zimnitsky and other methods;
  • analysis of sediment, urine enzymes;
  • urine culture and antibioticogram;
  • urine test for fungi and viruses;
  • urine cytology to detect atypical cells;
  • Ultrasound of the urinary tract;
  • examination of the functions of the bladder (cystometry and other methods);
  • x-ray examinations (urography, cystography);
  • cT scan.

Read more about decoding blood and urine tests in children in our other articles.




Treatment principles and prevention measures

How to treat pyelonephritis in children? Only after a comprehensive examination. After all, it often happens that doctors do not immediately differentiate this diagnosis and call it "acute stomach" or "intestinal infection". Also, the symptoms of pyelonephritis may be similar to signs of other kidney pathologies, chronic cystitis. In acute forms of the disease and in infancy, the doctor recommends hospitalization to avoid complications. What treatment does the doctor prescribe?

  • Bed rest. Recommended for severe intoxication within 5-7 days. It is important that the baby gets enough sleep and is warm. Physical activity, overexcitation are not allowed.
  • Diet. An important part of therapy. Food must be protein and vegetable, low-fat dairy products are allowed. Diet table # 5 is recommended. You can add a little salt to your meals, but your fluid intake is increased by 50%. Urination with this drinking regime should be frequent. You can offer compotes, tea, mineral water, juices. If there are kidney pathologies, then liquid and salt are used in limited quantities. Fried, spicy, fatty is completely excluded.
  • Antipyretic and non-steroidal anti-inflammatory drugs. Of the antipyretics, the doctor prescribes paracetamol-based drugs. Nonsteroidal anti-inflammatory drugs are used for pain relief.
  • Antibiotics. Since the inflammation of the kidneys is bacterial in nature, antibiotic therapy is prescribed to eliminate the cause of the disease. Before starting treatment, the doctor must prescribe a urine test for bacterial culture and antibiotic sensitivity. After the course, a repeated analysis for bacteriuria is prescribed - the identification of bacteria in the urine. If there is no improvement, other antibiotics are prescribed. What are the requirements for antibiotics in the treatment of pyelonephritis? Low toxicity, high concentration in the focus of inflammation, resistance to bacteria. Antibiotic therapy for severe pyelonephritis can last up to four weeks, with a mandatory change of the drug. At the first stage, in inpatient and home treatment, antibiotics are administered intramuscularly or intravenously. They can then be replaced by oral administration. For mild pyelonephritis, oral antibiotics are given initially. The most commonly used drugs are the cephalosporin series.
  • Antifungal drugs. If the fungal nature of kidney inflammation is proven, antifungal medications are prescribed in the form of tablets. During their reception, the treatment is monitored using radiopaque urography and other methods.
  • Uroantiseptics. Usually prescribed in parallel or after a course of antibiotics to prevent chronic pyelonephritis in children. These are antimicrobial drugs that relieve inflammation in the urinary tract. Children from two years old can be prescribed: "Nevigram", "Urogram", "Glamurin", "Nitroxoline" and other drugs. The most powerful uroantiseptics are "Zanocin", "Tarivid" and their analogues. These drugs belong to the reserve group and are prescribed only if no other drugs have a therapeutic effect.
  • Antihistamines. They are prescribed to relieve inflammation and swelling as an adjuvant, relieve allergies in pyelonephritis, reactions to antibiotics and other medications.
  • Phytotherapy. Diuretic and anti-inflammatory herbs are recommended (horsetail, bearberry, nettle, lingonberry leaves, St. John's wort, sage), which well remove fluid from the body, relieve swelling, have an antiseptic effect. You can use ready-made teas for the preparation of renal teas. Also recommended are pharmaceutical mixtures of herbs ("Fitolizin", "Cyston"), plant-based drops "Kanefron".

Also, according to indications, diuretics (diuretics), antioxidants, immunostimulants can be prescribed. In rare cases, with kidney pathology, obstruction of the urinary tract, surgical treatment may be prescribed. In addition to a nephrologist, sometimes a consultation with a urologist, immunologist, or surgeon is required.

How is prevention done?

If a child once suffered from pyelonephritis, this does not mean that the disease will recur. With normal kidney function and the absence of pathologies, pyelonephritis in most cases does not return. How is chronic pyelonephritis prevented in children?

  • It is recommended to avoid hypothermia, but this does not mean that the child needs to be wrapped and overheated.
  • After suffering pyelonephritis, the emptying of the bladder should be timely and frequent.
  • Also, the child should get enough sleep, eat rationally, take vitamins, and drink enough fluids.
  • It is necessary to strengthen the immune system: hardening, frequent walks in the fresh air, physical activity, swimming in clean waters, walking barefoot in summer.
  • Genital hygiene is important, since bacteria can enter the urinary tract from the genitals, intestines.
  • After suffering acute pyelonephritis, the child has been registered at the dispensary for 5 years and is monitored by specialists.
  • For prevention, a biochemical urine analysis is prescribed once every three months and more often according to indications.
  • Also, a control ultrasound of the urinary tract organs is recommended once every six months.
  • After suffering acute respiratory viral infections and other infections, a general analysis of urine and blood is recommended.
  • With persistent remission (over 5 years), the child is removed from the dispensary.

Treatment of pyelonephritis in children is carried out in a hospital in severe, acute forms. The disease must be taken seriously. With the wrong, untimely treatment, pyelonephritis can become chronic and lead to complications. Rehabilitation therapy takes several months, and control laboratory and instrumental examinations are also carried out after the illness.

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Pyelonephritis is a nonspecific infectious and inflammatory kidney disease with a predominant lesion of the pyelocaliceal system (PCS), tubules and interstitium. According to the classification of the World Health Organization (WHO), pyelonephritis belongs to the group of tubulo-interstitial nephritis and is actually an infectious tubulo-interstitial nephritis.

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

Today there is no generally accepted classification of pyelonephritis. The most frequently used classification is proposed by M. Ya.Studenikin and co-authors in 1980 ( ), which determines the form (primary, secondary), the nature of the course (acute, chronic), the activity of the disease and the function of the kidneys. V.G. Maidannik and co-authors (2002) proposed to indicate also the stage of the pyelonephritic process (infiltrative, sclerotic) and the degree of disease activity.

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

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

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

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

It is also very conditional to assign secondary dysmetabolic pyelonephritis to the group of non-obstructive ones, since with this option there are always obstruction of the renal tubules and collecting ducts by salt crystals.

Acute and chronic pyelonephritis are isolated depending on the age of the pathological process and the characteristics of clinical manifestations.

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

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

Depending on the severity of the symptoms of the disease, the active stage of chronic pyelonephritis, partial clinical and laboratory remission and complete clinical and laboratory remission can be distinguished.

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

Clinical symptoms include:

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

Urinalysis indicators are as follows:

  • bacteriuria\u003e 100,000 microbial bodies per ml;
  • leukocyturia\u003e 4000 in urine analysis according to Nechiporenko.

Blood test indicators:

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

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

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

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

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

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

The diagnosis of chronic pyelonephritis is based on a protracted course of the disease (more than 6 months), repeated exacerbations, and the identification of signs of tubulointerstitium and ChLS lesions due to bacterial infection.

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

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

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

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

Obligatory laboratory tests:

  • The level of creatinine, urea in the blood.
  • Zimnitsky test.
  • Endogenous creatinine clearance.
  • Research of pH, titratable acidity, ammonia excretion.
  • Diuresis control.
  • The rhythm and volume of spontaneous urination.

Additional laboratory tests:

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

3. Instrumental research.

Mandatory:

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

Additional:

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

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

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

Additional criteria may include:

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

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

Complications of pyelonephritis:

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

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

Pyelonephritis treatment

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

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

Dietary restrictions are intended to reduce the load on the transport systems of the tubules and correct metabolic disorders. In the active stage, Pevzner table number 5 is used without salt restriction, but with an increased drinking regime, 50% more than the age norm. The amount of salt and fluid is limited only if the kidney function is impaired. It is recommended to alternate protein and plant foods. Products containing extractives and essential oils, fried, spicy, fatty foods are excluded. Revealed metabolic disorders require special corrective diets.

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

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

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

The stage of suppression of the activity of the microbial-inflammatory process. This stage can be conditionally divided into two periods.

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

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

When choosing antibacterial drugs, it must be borne in mind that:

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

Starting antibiotic therapy is prescribed empirically, based on the most likely infectious agents. In the absence of clinical and laboratory effect, the antibiotic must be changed after 2-3 days.

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

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

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

When the activity subsides, antibacterial drugs are administered mainly orally, while "stepwise therapy" is possible, when the same drug is given orally as was administered parenterally, or a drug of the same group. Most often used during this period:

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

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

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

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

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

The antagonists are: penicillins and chloramphenicol; penicillins and tetracyclines; macrolides and chloramphenicol.

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

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

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

Nalidixic acid preparations (nevigramone, blacks) are prescribed for children over 2 years old. These agents are bacteriostatic or bactericidal, depending on the dose in relation to gram-negative flora. They cannot be administered concomitantly with nitrofurans, which have an antagonistic effect. The course of treatment is 7-10 days.

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

Pipemidic acid (palin, pimidel) affects most gram-negative bacteria and staphylococci. Appointed as a short course (3-7 days).

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

The reserve drug is ofloxacin (tarivid, zanocin). It has a wide spectrum of action, including on the intracellular flora. Children are prescribed only if other uroseptics are ineffective.

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

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

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

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

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

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

Immunocorrective therapy for pyelonephritis is prescribed strictly according to the indications:

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

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

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

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

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

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

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

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

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

An appropriate dietary regimen and pharmacological treatment should be included in the therapy of dysmetabolic pyelonephritis.

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

Dynamic observation of children suffering from pyelonephritis suggests the following.

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

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

Literature
  1. Borisov I.A.Pyelonephritis // In the book. "Nephrology" / ed. I. E. Tareeva. M .: Medicine, 2000.S. 383-399.
  2. Vozianov A.F., Maidannik V.G., Bidny V.G., Bagdasarova I.V. Fundamentals of childhood nephrology. Kiev: Kniga plus, 2002.S. 22-100.
  3. Ignatova M.S., Veltischev Yu. E. Pediatric nephrology. L .: Medicine, 1989.432 p.
  4. Kirillov V.I. Immunocorrective therapy of urinary tract infections in children // In the book. "Nephrology" / ed. M. S. Ignatova: a guide to pharmacotherapy in pediatrics and pediatric surgery (under the editorship of A. D. Tsaregorodtsev, V. A. Tabolin). M .: Medpraktika-M, 2003. T. 3. S. 171-179.
  5. Korovina N.A., Zakharova I.N., Mumladze E.B., Zaplatnikov A.L. Rational choice of antimicrobial therapy for urinary tract infection in children // In the book. "Nephrology" / ed. M. S. Ignatova: a guide to pharmacotherapy in pediatrics and pediatric surgery (under the editorship of A. D. Tsaregorodtsev, V. A. Tabolin). M .: Medpraktika-M, 2003. T. 3. S. 119-170.
  6. Malkoch A.V., Kovalenko A.A. Pyelonephritis // In the book. Pediatric Nephrology / ed. V.A. Tabolina and others: a practical guide to childhood diseases (edited by V.F.Kokolina, A.G. Rumyantsev). M .: Medpraktika, 2005.T. 6.P. 250-282.
  7. Papayan A.V., Savenkova N.D. Clinical nephrology of children: a guide for doctors. SPb., 1997.S. 450-501.
  8. Tebloeva L. T., Kirillov V. I., Diagnosis of urinary tract infections in children: materials of the 1st Congress "Modern methods of diagnosis and treatment of nephro-urological diseases in children." M., 1998.S. 57-60.
  9. Erman M.V. Children's nephrology in diagrams and tables. SPb .: Special literature, 1997.S. 216-253.

A.V. Malkoch, candidate of Medical Sciences
V. A. Gavrilova, doctor of Medical Sciences
Y.B. Yurasova, candidate of Medical Sciences
Russian State Medical University, Russian Children's Clinical Hospital, Moscow

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

Among other nephrological (with kidney damage) diseases in children, pyelonephritis occurs most often, however, there are frequent 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 ailment, about its signs and methods of treatment.

General information

Pyelonephritis (tubulointerstitial infectious nephritis) is an inflammatory lesion of the infectious nature of the renal pyelocaliceal system, 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, coming from there to the bladder, and the interstitium is the so-called interstitial kidney tissue that fills the space between the main renal structures, it is like a "frame" organ.

Children of all ages are prone to pyelonephritis. In the first year of life, girls and boys suffer from them 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

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

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

Microorganisms can enter the kidneys in several ways:

  1. Hematogenous pathway: blood from foci of infection in other organs (lungs, bones, etc.). This route of spread of the pathogen is of greatest importance in newborns and infants: they can develop pyelonephritis after pneumonia, otitis media and other infections, including in organs located anatomically far from the kidneys. In older children, the 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 general lymph circulation system between the organs of the urinary system and the intestines. Normally, lymph flows from the kidneys to the intestines, and infection is not observed. But if the properties of the intestinal mucosa are violated, lymph stagnation (for example, in the case of chronic constipation, with diarrhea, intestinal infections, dysbiosis), the kidneys may become infected with intestinal microflora.
  3. Ascending path - from the genitals, anus, urethra or bladder, microorganisms "rise" to the kidneys. This is the most common route of infection in children over a year old, especially in 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 getting into them. With normal functioning of the organs of the urinary system and good condition of local and general immunity, the infection does not develop. The onset of pyelonephritis is facilitated 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 a microorganism, such a factor is high virulence (high infectivity, aggressiveness and resistance to the action of the protective mechanisms of the child's body). And on the part of the child, the development of pyelonephritis is promoted by:

  1. 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 (the kidney tubules are clogged with small salt crystals).
  2. Stagnation of urine with functional disorders (neurogenic dysfunction of the bladder).
  3. Vesicoureteral reflux (return of urine from the bladder to the kidneys) of any origin.
  4. Favorable conditions for ascending infection (insufficient personal hygiene, improper washing of girls, inflammation in the external genitalia, perineum and anus, cystitis or urethritis untreated in time).
  5. Any acute and chronic diseases that reduce the child's immunity.
  6. Diabetes.
  7. Chronic foci of infection (tonsillitis, sinusitis, etc.).
  8. Hypothermia.
  9. Helminthic invasions.
  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 load on the immune system.

Pyelonephritis classification

Russian nephrologists distinguish the following types of pyelonephritis:

  1. Primary (in the absence of obvious predisposing factors from the urinary organs) and secondary (arising against the background of structural abnormalities, with functional disorders of urination - obstructive pyelonephritis; with dysmetabolic disorders - non-obstructive pyelonephritis).
  2. Acute (after 1-2 months, complete recovery and normalization of laboratory parameters occur) 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 a consequence of overdiagnosis, when an infection of the lower urinary tract or reflux nephropathy is taken for pyelonephritis, in which there are really no or weakly expressed "external" symptoms and complaints.

Symptoms of acute pyelonephritis

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

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

The following main symptoms of pyelonephritis can be distinguished:

  1. An increase in temperature is one of the main signs, which is often the only one ("unreasonable" temperature rises). Fever is usually severe and the temperature rises to 38 ° C or more.
  2. Other symptoms of intoxication: lethargy, drowsiness, nausea and vomiting, decreased or no appetite; pale or gray skin tone, periorbital shadows ("blue" under the eyes). As a rule, the more severe the pyelonephritis and the younger the child, the more pronounced the signs of intoxication will be.
  3. Pain in the abdomen or lumbar region. Children under the age of 3-4 years poorly localize abdominal pain and may complain of diffuse (all over the abdomen) pain or pain around the navel. Older children often complain of lower back pain (usually one-sided), in the side, in the lower abdomen. Mild pain, pulling, aggravated with a change in body position and subside with warming.
  4. Violation of urination is an optional sign. 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 are no pronounced edema.
  6. Changes in the appearance of urine: it becomes cloudy and may have an unpleasant odor.

Features of pyelonephritis in newborns and infants

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

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

Babies cannot complain of abdominal pain, and their analogue is unrelated child anxiety or crying. About half of infants also have anxiety when urinating or facial flushing and grunting before urinating. Often, infants with pyelonephritis develop stool disorders (diarrhea), which, combined with high fever, vomiting and signs of dehydration, makes it difficult to diagnose pyelonephritis and is mistakenly interpreted as an intestinal infection.

Chronic pyelonephritis symptoms

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

Diagnostics of the 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 fever cannot be explained by ARVI or other reasons not related to the kidneys. Pyelonephritis is characterized by an increase in leukocytes in the urine: leukocyturia up to pyuria (pus in the urine), when leukocytes cover the entire field of view; bacteriuria (appearance of bacteria in the urine), possibly a small number of cylinders (hyaline), mild proteinuria (protein in the urine no more than 1 g / l), single erythrocytes. You can also read about the interpretation of urine analysis in children in this article.
  2. Cumulative tests (according to Nechiporenko, Addis-Kakovsky, Amburzha): leukocyturia is detected in them.
  3. Culture of urine for sterility and sensitivity to antibiotics allows you to determine the causative agent of the infection and select effective antibacterial drugs for the treatment and prevention of recurrence of the disease.
  4. A general blood test reveals general signs of an infectious process: accelerated ESR, 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 in the blood - rods), anemia (a decrease in hemoglobin and the number of erythrocytes).
  5. A biochemical blood test is required to determine 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, 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, renal function is usually not impaired, and in chronic pyelonephritis, some deviations in the Zimnitsky test are often found (isostenuria is a monotonous specific gravity, nocturia is the predominance of nocturnal diuresis over daytime).
  8. Blood pressure measurement is an obligatory daily procedure for children of any age who are hospitalized for acute or chronic pyelonephritis. In acute pyelonephritis, the pressure is within the age norm. When the pressure begins to rise in a child with chronic pyelonephritis, this may indicate the addition of renal failure.
  9. In addition, all children undergo ultrasound of the urinary system, and after the acute symptoms subside - X-ray contrast studies (vocal cystoureterography, excretory urography). These studies can identify vesicoureteral reflux and anatomical abnormalities that contributed to the onset of pyelonephritis.
  10. In specialized nephrological and urological departments for children, other studies are also carried out: various tests, Doppler ultrasonography of renal blood flow, scintigraphy (radionuclide study), uroflowmetry, CT, MRI, etc.

Complications of pyelonephritis

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

Pyelonephritis treatment

With 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 setting, and it is highly desirable to hospitalize the child in an accelerated specialized department: nephrological or urological. Only in a hospital is it possible to constantly assess 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. Regime - for febrile children and children complaining of pain in the abdomen or lumbar region, bed rest is prescribed in the first week of illness. In the absence of fever and severe pain, the ward mode (the child is allowed to move within his ward), then general (including daily quiet walks in the fresh air for 30-40-60 minutes on the territory of the hospital).
  2. A diet whose main goal is to reduce the burden on the kidneys and correct metabolic disorders. Recommended table No. 5 according to Pevzner without salt restriction and with an extended drinking regime (the child should receive liquids 50% more than the age norm). However, if there is impaired renal function or obstructive events in acute pyelonephritis, salt and fluid are limited. Protein-vegetable diet, with the exclusion of any irritating foods (spices, spicy foods, smoked meats, fatty foods, rich broths). In case of dysmetabolic disorders, an appropriate diet is recommended.
  3. Antibiotic therapy is the basis of drug treatment for acute pyelonephritis. It is carried out in two stages. Until the results of urine tests for sterility and sensitivity to antibiotics are obtained, the drug is selected "at random", giving preference to those that are active against the most common causative agents of urinary system infections 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 is selected that is most effective against the identified pathogen. The duration of antibiotic therapy is about 4 weeks, with an antibiotic change every 7-10 days.
  4. Uroantiseptics are drugs that can disinfect the urinary tract, kill bacteria or stop their growth, but are not antibiotics: nevigramone, palin, nitroxoline, etc. They are prescribed for another 7-14 days of administration.
  5. Other medications: antipyretic drugs, antispasmodics (for pain), drugs with antioxidant activity (unitiol, beta-carotene - provitamin A, tocopherol acetate - vitamin E), non-steroidal anti-inflammatory drugs (ortofen, voltaren).

Inpatient treatment lasts about 4 weeks, sometimes longer. After discharge, the child is sent for observation to the district 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 urine test is performed (and additionally against the background of any acute respiratory viral infection), every six months an ultrasound of the kidneys is performed. At the end of the intake of uroseptics, phytopreparations are prescribed for 1-2 months (kidney tea, lingonberry leaf, kanephron, etc.). A child who has undergone acute pyelonephritis can be removed from the register only after 5 years, provided that there are no symptoms and changes in urine tests without drug anti-relapse measures (that is, the child was not given uroseptics or antibiotics for these 5 years, and he did not have a recurrence of pyelonephritis) ...

Treatment of children with chronic pyelonephritis

Treatment of exacerbations of chronic pyelonephritis is also carried out in a hospital setting and according to the same principles as the treatment of acute pyelonephritis. Children with chronic pyelonephritis during the period of remission may also be recommended planned hospitalization in a specialized hospital for a detailed examination, 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 eliminating the cause can the disease itself be eliminated. Depending on what exactly caused the infection of the kidneys, therapeutic measures are also prescribed: surgical treatment (for vesicoureteral reflux, anomalies accompanied by obstruction), diet therapy (for dysmetabolic nephropathy), drug and psychotherapeutic measures (for neurogenic dysfunction of the bladder) etc.

In addition, in chronic pyelonephritis during the period of remission, anti-relapse measures are necessarily carried out: course treatment with antibiotics in small doses, prescribing uroseptics in courses for 2-4 weeks with interruptions from 1 to 3 months, herbal medicine for 2 weeks each month. Children with chronic pyelonephritis are monitored by a nephrologist and 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 appointed. Children with chronic pyelonephritis are monitored by a nephrologist, in addition, an infectious disease consultation may be prescribed (in unclear diagnostic cases, suspected tuberculosis, and so on). Considering the predisposing factors and the pathways of infection in the kidneys, it will be useful to consult with a specialized specialist - 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

Pyelonephritis - Inflammatory process in the kidneys and renal pelvis - the most common disease among children, second only in frequency to inflammatory diseases of the upper respiratory tract. The wide prevalence of morbidity among children of early childhood, the transition to a chronic form and the possibility of the appearance 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 on the part of the parents.

Knowledgeable means armed! To suspect a disease in time is already half of the success to recovery!

The main causes of pyelonephritis in children

Pyelonephritis in children, like any inflammatory disease, is caused by microorganisms (bacteria), which in various ways enter the kidney and begin to multiply actively. According to the etiology and pathogenesis of pyelonephritis, in the overwhelming majority of cases, the disease is caused by E. coli, which is brought into the kidney with the blood stream 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 unable 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
  • Lack of vitamins
  • Chronic inflammatory diseases of the respiratory tract and ENT organs
  • Hereditary predisposition

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

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

Pyelonephritis classification

Based on the reasons that caused the disease, pyelonephritis is divided into primary and secondary. Primary pyelonephritis develops in a practically healthy child against the background of complete well-being, while secondary pyelonephritis, in turn, occurs with congenital anatomical abnormalities of the kidneys, bladder and urethra, when urinary stagnation gives rise to active reproduction of bacteria.

There are two forms of pyelonephritis: acute and chronic. Acute pyelonephritis in children proceeds more violently with symptoms of severe intoxication, but with proper treatment, it most often ends in full 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. It is not difficult to suspect the signs of pyelonephritis in a child, usually the disease proceeds with characteristic manifestations, with the exception of young children.

Children under 1 year old

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

  • Temperature rise to 39-40 without signs of airway inflammation
  • 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 the 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 fever, there is abdominal pain 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 worry about aching pain in the lumbar and suprapubic region and pain during urination.

Thus, the "typical" complex of symptoms of acute pyelonephritis in children over 5 years old includes the following:

  • Acute increase in body temperature up to 39-40C. It is important to remember that the hallmark of kidney inflammation from colds is the absence of inflammation of the respiratory tract (runny nose, cough, sore throat and sore throat, ear pain). The temperature rises against the background of complete health immediately to high levels.
  • Symptoms of general intoxication - the child becomes lethargic, capricious, refuses to eat. Chills give way to hot flashes. Often, against the background of temperature, a headache appears.
  • 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 the one hand), 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 medical attention and proper treatment, the disease has a favorable outcome. However, the acute form often becomes chronic.

Chronic pyelonephritis

Pyelonephritis is considered chronic if it lasts more than 1 year and has 2 or more exacerbation episodes during this period. This form is an alternation of periodically recurring exacerbations (especially in the spring-autumn period) and asymptomatic periods. The manifestations of the chronic form are the same as 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.

Complex of diagnostic measures

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

The complex treatment of any inflammatory kidney disease consists of the following components:

  1. Mode
  2. Diet
  3. Drug therapy
  4. Physiotherapy and physiotherapy exercises

It is always necessary to strictly follow all the doctor's recommendations 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. For a while, you need to forget about studying, walking and, especially, sports training. In the second week of the disease, when the temperature drops significantly and the pain in the lower back passes, the regimen can be expanded, but it will be much better if the child spends the entire period of illness at home.

Diet

A diet for pyelonephritis in children, as well as in adults, is an integral attribute of a successful recovery. It is imperative to exclude spicy, salty, fried foods from the child's diet, and limit foods with a high protein content. On the 7-10th 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 abundant drinks (fruit drinks, fruit drinks, weak tea), and in case of chronic pyelonephritis (during periods of remission), it is mandatory to drink slightly alkaline mineral waters.

Drug therapy

a) Antibiotics

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

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

  • Protected penicillins (Augmentin, Amoxiclav). In addition to the usual pills, 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 injected, therefore they are used in hospital treatment (Cefotaxime, Cefuroxin, Ceftriaxone). However, some also exist in the form of suspensions, capsules and dissolving tablets (Cedex, Suprax).
  • Aminoglycosides (Sumamed, Gentamicin) and carbapenems in rare cases also occur, but they are most often used as an alternative and as part of combination therapy.

In severe cases, the doctor can immediately use 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, has worsened, and the temperature continues to keep at the same figures
  • With long-term 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 only - there are other important groups of drugs, for example, uroantiseptics (nalidixic acid). They are prescribed after a course of antibiotics for children over 2 years old.

c) Vitamins and immunomodulators

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

d) Herbal treatment

Herbal medicine for kidney disease has long been proven effective, but it can only be carried out in combination with basic drugs. Bear ears, bearberry, birch buds, and field 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 an average or severe course are also necessarily hospitalized. Treatment of acute pyelonephritis in children over 10 years old should always be carried out in a hospital (even with mild severity) in order to timely carry out a set of diagnostic procedures and identify the cause of the disease.

At 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 regime during fever (especially important for children 3-10 years old), monitoring diet, timely hygiene and other measures that ensure the creation of comfortable conditions for a speedy recovery of the child ...

Often, the choice of treatment is 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 in children is diagnosed.

Physiotherapy and physiotherapy exercises

Physiotherapy depends on the severity of the disease, and is most often prescribed by a physiotherapist after the course of the main treatment, when the child's condition is normalized. Ultrasound methods, UHF therapy, and magnetotherapy have proven themselves well. Also, when the inflammatory process subsides, physiotherapy exercises are shown in a lying 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 subdivided 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 careful hygiene of the external genital organs).

Secondary means the prevention of exacerbations and includes the doctor's recommendations: adherence to anti-relapse therapy, systematic observation, as well as all of the above measures of primary prevention.

Dynamic observation

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

After an acute or chronic exacerbation - 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 old - 1 or 2 times a year

Systematic monitoring will allow avoiding 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).

Pediatric urinary tract infections are second only to respiratory infections. In infants, they can "disguise" as the pathology of the digestive system: acute abdomen, intestinal syndrome, dyspeptic disorder.

One of the symptoms of pyelonephritis in older children is an "unreasonable" rise in temperature from subfebrile to high numbers. Therefore, every child with an incomprehensible malaise and a rise in temperature must pass a urine test to exclude pyelonephritis.

What is pyelonephritis. How does infection occur

Pyelonephritis (inflammation of the kidneys) in children is a disease of the upper urinary tract in which there is inflammation of the kidney tissue caused by microbes. The process involves not only the kidney tubules, but also the blood and lymphatic vessels.

At home, enterobacteria (E. coli, Klebsiella and Proteus) are common pathogens. Escherichia coli is in the lead; it is sown in 80–90% of cases. This is explained by the fact that the pathogen has a universal kit for damaging the tissue of the urinary tract. Due to special “fimbria”, the bacterium clings to the wall of the urinary tract and is not “washed away” by the urine stream.

The cause of infection in hospitals is Pseudomonas aeruginosa, Proteus and Klebsiella. This must be taken into account when prescribing treatment. When the pathogen is known, it is much easier to treat.

Infection routes:

  • from blood;
  • from lymph;
  • from the lower parts of the urinary tract.

Hematogenous (from blood) infection is more common in newborns. From mother to child. Prevention during pregnancy is important here, you need to be promptly examined for sexually transmitted infections.

Lymphogenous infection is due to the presence of a single lymph circulation system between the intestines and the urinary tract. Long-term bowel diseases (dysbacteriosis, colitis) reduce its protective functions, the movement of lymph stops. Stagnation greatly increases the likelihood of infection of the kidney with intestinal flora.

Ascending route of infection ( from the lower urinary tract) occurs more often than others and is typical for girls. This is due to the structure of the urogenital area. The proximity of the two divisions promotes seeding. Normally, the progress of microbial colonies in girls is impeded by the usual microflora of the vagina, represented by lactobacilli, which produce lactic acid and create an unfavorable environment - a different pH.

By releasing hydrogen peroxide, lactobacilli inhibit the reproduction of harmful microflora. In some cases, there may be a violation of the number of vaginal flora (lack of female hormones, a decrease in the production of local immunoglobulin A, lysozyme). The balance of the relationship between the organism and microbes is disturbed, and local immunity decreases. The pathogenic organisms begin to rise unhindered from the lower sections to the kidney itself.

Strengthening general and local immunity is a reliable prevention of pyelonephritis.

Causes of the disease

The urinary tract is in constant contact with infection, but infection does not occur. This is due to the presence of local protective functions. There are many of them and they complement each other. Any disruption to their work creates a condition for illness.

Factors of adverse impact are divided into internal and external:

  • violation of urodynamics (urinary movement) - hereditary anomalies, blockage of the urinary tract, kidney stones, kidney prolapse;
  • a change in the composition of urine - glucose impurities, crystals, uric acid salts appear;
  • bacteriuria - the presence of microbes in the urine without signs of illness;
  • decrease in general immunity (treatment with cytostatics, chemotherapy);
  • bowel disease;
  • prematurity, gender (girls get sick more often), blood group IVAB and III B;
  • diseases and bad habits of the mother;
  • hypothermia;
  • early pregnancy and sex life;
  • medical manipulations in the urinary tract (bladder catheterization).

If prevention is carried out in schools in a timely manner, the incidence of childhood pyelonephritis will decrease. Girls especially need to avoid hypothermia, do not wear short skirts in cold weather, keep their feet warm and observe hygiene measures.

Features of the disease in children under one year old

The causative agent in newborns and children under one year old is Escherichia coli in 85% of cases. Subsequently, in infant boys, its share decreases to 40%, and proteus increases 33% and staphylococcus aureus to 12%.

The development of the disease is facilitated by chlamydia, mycoplasmosis and ureaplasmosis of the mother, infection occurs through the blood. Immunodeficiency states, such as prematurity, intrauterine infection, and HIV infection, predispose to the appearance of pyelonephritis in newborns. Then the pathogens will be fungi or their combination with bacterial flora.

The structure of the kidney in children under one year old has its own characteristics: the pelvis is also located intrarenal, the ureters are twisted and have a weak tone. Due to weak innervation, the muscular apparatus of the kidney does not contract enough.

According to experts, an early transfer to artificial feeding is disposed to illness in infants, especially in the first six months of life. In these children, the risk of getting sick increases by 2.3 times. Thus, the protective role of breastfeeding has been proven.

In young children, the disease is generalized. It is difficult, possibly the development of meningeal symptoms. The child often spits up, vomiting appears at the height of intoxication. When urinating, grunts and cries. Although these are not characteristic signs of pyelonephritis, the disease should be suspected.

It is not recommended to treat children under one year old at home due to the severity of the condition.

Forms and symptoms of pyelonephritis

In the course of the disease, pyelonephritis is divided into:

  • acute;
  • chronic.

Acute pyelonephritis has two forms: primary and secondary.

As an independent disease, primary occurs, and secondary pyelonephritis in a child appears against the background of various diseases of the urinary tract (anomalies of the ureters, kidney stones).

Acute pyelonephritis in children occurs with a high temperature of 39-40 ° C. Characterized by pain in the lower back, abdomen, joints. Expressed tremendous chills. In the acute form, the disease proceeds with severe intoxication. Worried about weakness, the characteristic posture of the child - forced bending and bringing the limb to the stomach on the side of the diseased kidney.

Obstructive pyelonephritis, which is accompanied by the death of organ cells, is very difficult. There is a state of shock with a drop in pressure, lack of urine, up to the development of acute renal failure. For older children, the course of acute pyelonephritis under the "mask" of appendicitis or flu is characteristic.

For the picture of chronic pyelonephritis for children, the same symptoms are characteristic, but they are less pronounced. The child complains of fatigue, frequent urination, which can be combined with anemia or arterial hypertension. In contrast to acute, childhood chronic pyelonephritis is dangerous by the structural restructuring of the renal pyelocaliceal system.

Diagnostics of the pyelonephritis

The first thing to do with a rise in temperature that is not associated with a cold is to check the urinalysis.

Urine examination includes two methods:

  • microscopic analysis;
  • sowing for bacterial flora and antibiotic sensitivity.

Medical recommendation: collection of urine for microscopic examination is carried out with free urination into a clean container, before the start of antibiotic therapy. You must first carry out a thorough toilet of the external genital organs of the child.

The sensitivity of the method is 88.9%. When microscopic sediment attention is paid to leukocytes, erythrocytes, urine specific gravity and the presence of protein. Signs of pyelonephritis: the appearance in urine tests of 5 or more leukocytes, a change in urine density. The disadvantage of this method is the high risk of introducing microbes from the environment.

To obtain a high-quality diagnosis, the microscopic method must be combined with the bacteriological one. The modern laboratory method for confirming microbial infection is the procalcitonin test. Its average level in sick children is 5.37 ng / ml.

Ultrasound (ultrasound) - the use of color and pulsed Doppler ultrasonography significantly expands the capabilities and accuracy of the method. With its help, it is possible to identify developmental abnormalities, expansion of the pelvis, urolithiasis, hydronephrosis. Will show signs of kidney inflammation and wrinkling.

Renoscintigraphy (Scintigraphy)

The study using the isotope (Tc-99m-DMSA) allows you to identify foci that have dropped out of functioning. This is the most accurate method for detecting kidney puckering in children. In addition to the traditional method of ultrasound, MRI (magnetic resonance therapy) of the kidneys and computed tomography are used.

Treatment

Pyelonephritis therapy consists of the following stages:

  1. Antibacterial therapy.
  2. Pathogenetic.
  3. Symptomatic.
  4. Regime and proper nutrition.

Recommendations of doctors: antimicrobial therapy for pyelonephritis should be started as early as possible, ideally in the first 24 hours. A delayed onset (3-5 days) leads in 40% of cases to the appearance of areas of wrinkling in the parenchyma of the kidney, in other words, a defect is formed. Treatment is carried out over a longer course than in adults.

The younger the child, the longer the therapy. This approach has a simple explanation: the child has not yet developed general and local immunity, the anatomical features of the structure of the urinary tract create an obstacle to the flow of urine. Therefore, acute pyelonephritis in children ends with the chronization of the process with frequent relapses, if the terms of treatment are not followed.

It is necessary to treat for a long time. The course consists of 2 stages: starting antimicrobial therapy for 14 days and an anti-relapse course with uroseptics for a month. With developmental anomalies, where there is a reverse flow of urine, anti-relapse treatment is carried out for several months, sometimes a year, until the causes are eliminated.

It has been proven that the route of administration of the antibiotic does not affect the result. It is more convenient to use tablets at home. In the hospital, they begin to be treated by injection for 3-5 days, then they are transferred to tablets.

Commonly used antibiotics are presented in the table:

The ideal option for choosing antibiotic therapy is urine culture data.

Then blind treatment is excluded, the likelihood of a secondary case is reduced. Therapy will be directed at the cause of the disease and will minimize complications.

Anti-relapse treatment is carried out with 5-nitrofuran derivatives. These include: "Furagin" or "Furamag". From other groups: Palin, Nevigramon, Nitroxalin

Mild pyelonephritis can be treated at home. Herbal medicine has proven itself well for supportive and prophylactic therapy. For this purpose, you can use "Kanefron".

The diet for pyelonephritis in children should be age appropriate. Be balanced, contain more protein. Spicy foods and salt should be avoided. An abundant drink is provided, exceeding the age norm by 50%. Mineral water, preferably slightly alkaline (Essentuki 4, Smirnovskaya), 2-3 ml per kilogram of body weight at a time.

Forecast and prevention

Uncomplicated pyelonephritis, with proper treatment, has a favorable prognosis. Careful and timely therapy will help avoid relapses and chronic renal failure.

In order to prevent childhood pyelonephritis, you need to adhere to simple but effective rules:

  • exercise and sports improve blood circulation in the kidneys;
  • sufficient fluid intake gives good circulation;
  • timely urination removes stagnant urine.

Babies who have received treatment for pyelonephritis are subject to supervision by a pediatrician and periodically have to take urine tests. It is advisable to consult a nephrologist once a year.

Analysis of urine and urinary tract tests

An ailment such as pyelonephritis in children requires prompt detection and adequate treatment. It is necessary to carefully monitor the baby, since inflammation of the kidneys is a dangerous disease and the symptoms cannot be ignored. Self-medication is also prohibited, as it leads to serious complications and health problems. What are the causes of pyelonephritis in children, the main symptoms and treatment of the disease.

general information

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

In childhood, the risk of contracting infectious diseases is quite high, because the child's immunity has not yet been formed and cannot fully resist pathogenic microorganisms. One of the most dangerous infectious diseases is pyelonephritis. Inflammation of the kidneys in newborns and young and older children can lead to undesirable consequences, so you need to know its signs and be able to take timely measures to eliminate the pathology.

What is pyelonephritis and what are the causes of its occurrence in children?

Pyelonephritis in children is an infectious inflammation of the kidneys. The infection enters the calyx-pelvic region of the kidneys, affects its tubules and soft tissues around. Since the excretory organ has a complex structure, the withdrawal from work of even a small area leads to a malfunction of the entire kidney.

In children under one year old, the frequency of the disease does not depend on gender; by the age of 2-3 years, the probability of kidney damage in girls is higher. This is due to the structural features of the female body, but the likelihood of kidney inflammation in the boy also exists.

The causes of pyelonephritis can be divided into 2 main groups. The first is infection. It can enter the body by an ascending, lymphogenous or hematogenous route. In the first case, bacteria enter through the urinary system - girls have a urethra through which pathogens can easily pass, so the risk of infection is higher than that of the opposite sex. The main causative agents of such inflammation are Escherichia coli, Staphylococcus aureus, Enterococcus, pathogenic fungi, Klebsiella (we recommend reading :).

In other cases, the infection spreads through the lymphatic tract or through the blood, moving to the internal organs. Pyelonephritis can be a complication of angina, otitis media, tonsillitis or other viral diseases.

The second group includes kidney pathologies. Their main function is filtering. The organ cleans the body of infiltrates and toxins, removes them along with urine, therefore, a failure in its work leads to a delay in harmful metabolic products and poisoning of the body. It is the abnormal structure of the kidneys or urinary system that is considered the most common cause of pyelonephritis in children.

Types and symptoms of pyelonephritis in children under one year of age and older

The danger of the disease lies in the possible occurrence of morphological changes in the excretory organ, disruption of its functioning. In children, immunity is not yet fully formed, and it is more difficult for him to fight the virus. Particular attention should be paid to the health of the urinary system for those parents whose children suffer from urolithiasis, kidney pathologies, spinal cord injuries, and immunodeficiency.

Acute and chronic

The classification of pyelonephritis is based on the division of the disease by type of functional disorder. Each of them has characteristic features that differ in the severity of the inflammatory process. Acute pyelonephritis in children has the following symptoms:

  • body temperature above 38˚, which lasts a long time;
  • signs of intoxication: nausea, vomiting, apathy, pale skin color, refusal to eat, dark circles under the eyes;
  • change in urine in color, smell, or consistency;
  • pulling pains in the lower abdomen, radiating to the lower back and subsiding with warming.

 Pyelonephritis has a wide range of symptoms (sometimes it can be confused with another disease), therefore, a doctor's examination and tests are necessary for an accurate diagnosis

Pyelonephritis in newborns is expressed by the following symptoms:

  • vomiting, frequent regurgitation;
  • temperature up to 40˚;
  • convulsions;
  • lack of appetite, breast refusal;
  • manifestations of dehydration: rare urination, loose and dry skin;
  • loose stools;
  • pale skin that turns red before urinating;
  • restlessness, unreasonable crying.

Unlike the acute form, chronic pyelonephritis in children does not go away quickly. Treatment will take several months, and later relapses may occur.

Symptoms of a chronic disease will be observed only during the period of exacerbations, but they will not differ from the signs of acute inflammation. With a prolonged course of the condition, a sick child may have:

  • mental retardation, decreased academic performance;
  • agitation, irritability;
  • decreased physical activity;
  • fast fatiguability.

Primary and secondary

Depending on the nature of the disease, primary and secondary pyelonephritis are distinguished. In the first case, we are talking about infection. Pathogenic microorganisms enter the urinary system, the inflammatory process begins. In the secondary form of the disease, abnormalities in the structure of the kidneys, their tubules or cavities become the cause of the pathology - inflammation causes urinary retention.

Diagnosis of the disease

In the event of acute symptoms, parents should seek immediate medical attention. First of all, the doctor will refer the child to a general and biochemical analysis of urine and blood. Additionally, tests are made for bacterial culture, the pediatrician needs to find out the cause of the inflammation.

During the diagnosis, it is important to take into account the number of urinations and urges. Ultrasound diagnostics will help to assess the condition of the kidneys. Using impulsive or color Doppler ultrasound, it is possible to identify morphological changes in the kidneys, urolithiasis, pelvic anomalies.


 Kidney ultrasound in a child

If in doubt about the diagnosis, the specialist can refer the child to one of the additional studies:

  • excretory urography;
  • urodynamic research;
  • dynamic kidney scintigraphy;
  • CT or MRI of the kidneys.

Features of the treatment of children of different ages

The principles of treatment of pyelonephritis will depend on its form, but the main rule of therapy is complexity. This includes treatment with pills - antimicrobial drugs, anti-inflammatory drugs, and uroseptics are used to prevent relapse. The therapy is complemented by a special dietary regimen, the establishment of a daily regimen and folk remedies.

Antibiotics and other drugs

Therapy for pyelonephritis in children involves a long course, the duration of which will depend on the age of the child. The younger the patient, the longer it takes to take medications - this is due to the underdevelopment of the urinary system. Drug treatment involves 2 stages: antimicrobial therapy and anti-relapse course.


At the first stage, antibiotics are usually used, among them:

  • Latest generation cephalosporins. Prescribed to children from 0 to 3 months old, introduced into the body by injection or inhalation.
  • Amoxicillin is a broad-spectrum penicillin antibiotic. It can be prescribed to infants from 4 months.
  • Furamag. The tablets are allowed for children over 3 years old, the antimicrobial agent differs in that it does not suppress the immune system.
  • Fosfomycin. The solution in ampoules has a wide spectrum of action; in infants it is prescribed when absolutely necessary.

In order to properly prescribe an antibiotic, the doctor needs to see the results of the bacterial culture test. This will help you understand which infection needs to be treated. Among the effective uroseptics are: Furagin, Palin, Nevigramon, Nitroxalin.

Special diet

Diet is an essential attribute of a quick recovery. A special menu is aimed at enhancing the diuretic functions of the body, therefore, the amount of salt, proteins and carbohydrates in the diet decreases. The severity of the diet depends on the condition of the baby - in the acute form of the disease, the patient will have to endure more restrictions than in the chronic one.


 With pyelonephritis, the child must drink large amounts of fluids daily

The main principles of nutrition include:

  1. Reducing the load on the kidneys in the first days of exacerbation. To do this, it is necessary to reduce portions, and bring the number of meals to 5-6 times a day.
  2. Liquid will help to reduce pain - the child should drink at least 2 liters per day. In this case, it is allowed to replace water with compotes, herbal teas or natural juices.
  3. The last stage is necessary to normalize the work of the organ, prevent relapses.

The third principle of nutrition implies compliance with the following recommendations:

  • in the first days of an exacerbation, the child only eats drinks, vegetables and fruits;
  • after a few days, milk porridge is added to the diet;
  • it is advisable to include in the diet foods with a diuretic effect, such as watermelons, zucchini, melons (see also:);
  • fish and meat are introduced into the diet only after all symptoms of the disease disappear, the protein norm enters the body through dairy products;
  • if the child is not allergic to honey, be sure to give him 2 tbsp. l. product, it is not necessary to eat the sweetness at a time, you can stretch the intake for a day;
  • in severe forms, salt is excluded from the diet, after an exacerbation, the rate reaches 6 grams. per day;
  • the baby should eat vegetables and fruits every day;
  • give preference to boiled, steamed or baked food;
  • the ban includes: marinades, pickles, mushrooms, smoked products, legumes, onions, garlic, hot spices, rich fish and meat broths.

 A child's diet should contain a lot of vegetables and fruits that shift the pH of urine to the alkaline side.

Folk remedies

Traditional medicine has almost no contraindications, with the exception of individual intolerance to the components. Home remedies are a great addition to your complex therapy. Among the popular recipes are:

  1. Lingonberry tincture. For cooking 1 tbsp. l. pour the leaves of the plant with a glass of boiling water, leave for 30 minutes. Drink the remedy in three doses - it has an excellent diuretic effect.
  2. Corn silk. They also have a diuretic effect. Part of the plant must be crushed, 2 cl. l. the resulting composition, pour a glass of boiling water, leave for 60 minutes. Drink the filtered infusion during the day for 1/3 cup.
  3. Bearberry tincture. A ready-made collection can be purchased at the pharmacy. 30 gr. pour raw materials ½ liter of water, bring the mixture to a boil and leave for 30 minutes. Drink the strained broth, 100 ml during the day.
  4. Elderberry broth. The berry known in Siberia is famous for its diuretic effect. 1 tbsp. l. plant leaves, pour a glass of boiling water, boil the mixture a little over low heat, cool, drink 1 tbsp. l. three times a day.
  5. Birch decoction. Use dry leaves or tree buds. To prepare the product, take 2 tbsp. l. leaves or 1 tbsp. l. crushed kidneys, add 400 ml of boiling water and 1 tsp. soda. The broth should be infused, then strain it and take 100 ml 4 times a day before meals. The course of treatment is 7 days or as long as the doctor recommends.

 You can cure pyelonephritis and restore normal kidney function with a decoction of birch

Physiotherapy and massage

Physiotherapy, exercise therapy and massage have proven themselves well as rehabilitation methods. They are prescribed after the main treatment, depending on the patient's condition and age. Exercise should be selected by a doctor, since depending on the form of inflammation, the patient may have restrictions on physical activity.

Physical education can be carried out at home, the main thing is to make sure that the child is well-being, his temperature should be normal. Alternate easy and hard exercises, give your baby time to rest. When the kidney is lowered, gymnastics can be done only in the supine position.

Physiotherapy exercises and massage for pyelonephritis are aimed at:

  • acceleration of the body's metabolic processes;
  • activation of blood flow in the kidneys;
  • normalization of renal excretory function;
  • increased immunity and physical endurance.

The duration of the classes will depend on the age:

  • 20-25 minutes for children under 7;
  • 30 minutes for elementary school students;
  • 40 minutes for older children.

 Comprehensive treatment of the disease necessarily includes light physical activity.

Possible complications of pyelonephritis

If the treatment of the disease began on time, then most often it goes away without any consequences. Pediatrics contains the following statistics: 80% of children, including young children, have a disease of mild or moderate severity. The approximate duration of treatment is one month. However, in cases where the disease was not diagnosed in time, the following complications are possible:

  • development of renal failure in acute or chronic form, in extreme cases, death is possible;
  • intoxication of the body, bacteriostatic shock, blood poisoning;
  • the appearance of pus, abscess;
  • hypertension;
  • pneumonia;
  • a decrease in the level of hemoglobin in the blood, iron deficiency anemia;
  • rickets;
  • kidney coma;
  • intestinal dysbiosis;
  • hypoxia of the brain.

Preventive measures

Prevention of pyelonephritis in children is necessary in two cases: to avoid the disease or to prevent relapse. The main preventive measure is to strengthen the immune system.

If the child's body can resist infection, then infection will not occur. Other preventive measures:

  • timely treatment of infections - even caries can become the basis for kidney inflammation;
  • observe the water regime according to the age-related needs of the child - the liquid "flushes" the body, ridding it of pathogenic bacteria;
  • make sure that the baby's diet contains vitamin C - it not only strengthens the immune system, but also increases the acidity of urine, neutralizing bacteria;
  • personal hygiene should be daily, girls are washed from front to back;
  • explain to the child that you do not need to endure, if you want to go to the toilet, you need to empty the bladder to the end;
  • children should not be hypothermic - cold contributes to the development of inflammation;
  • a mother should regularly change the diaper of a one-year-old child and make sure that wet linen does not come into contact with the genitals.

Pyelonephritis can be diagnosed in children at any age - this is a common diagnosis. Do not be afraid, the main thing is to recognize the problem in time and start treatment, then the disease will pass without consequences.

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