Pyelonephritis in children under one year old: causes of inflammation of the kidneys and methods of treatment. Pyelonephritis in children: what will help you quickly cope with the disease Clinical symptoms of pyelonephritis in children

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

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

Causes contributing to the development of pyelonephritis

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

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

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

Types of pyelonephritis characteristic of children

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

Primary pyelonephritis

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

Secondary pyelonephritis

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

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

Signs and symptoms of pyelonephritis

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

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

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

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

Diagnosis of pyelonephritis

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

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

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

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

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

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

Interpretation of urinalysis results

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

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

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

How to prevent the development of pyelonephritis in a child?

prevent pyelonephritis in children simple steps will help.

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

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

The standard number of urination in a baby per day

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

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

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

Treatment of pyelonephritis

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

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

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

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

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

The root cause of the appearance of pyelonephritis - viral . The infection can get into the blood from a diseased tooth, sore throat, wounds on the body. As soon as microbes penetrate the adrenal glands, an inflammatory process begins, often ending in chronic pyelonephritis.

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

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

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

Clinical picture

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

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

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

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

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

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

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

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

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

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

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

How to identify and cure pyelonephritis?

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

An increased content of leukocytes, protein and erythrocytes is hallmark inflammation of the renal pelvis. For infants, 10,000 bacteria per 1 ml of urine is enough, and for older children, 50,000 - 100,000 bacteria are enough to diagnose pyelonephritis.

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

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

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

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

Evidence of illness can be:

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

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

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

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

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

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

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

After that, treatment begins. uroseptics that disinfect urine. These drugs include: furazidin, nalidixic, oxolinic, pipemidic acid, co-trimoxazole.

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

Prevention of acute pyelonephritis in children as such is not. The only thing you can do is to regularly take a urine test, make sure that the child does not get cold, does not walk in wet sliders. It is also worth paying Special attention health of the baby during the period of exacerbation of influenza and colds. All this will help to eliminate the prerequisites for pyelonephritis in time.

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

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

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

Informative video on the topic

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

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

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

Why does pyelonephritis occur in a child

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

The main causes of pyelonephritis:

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

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

The first signs of pyelonephritis in children

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

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

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

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

Reliable symptoms of pyelonephritis in children and diagnosis

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

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

On examination, it is revealed:

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

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

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

Treatment of pyelonephritis in children

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

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

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

What disease in children under one year old is manifested simply by an increase in temperature, without any other symptoms? What can be confused with acute appendicitis or intestinal infection in preschoolers and schoolchildren? This is acute pyelonephritis - inflammation of the kidney tissue with a primary lesion of its main "working elements".

This is the most common disease in children after ARI. 85% of children fall ill in the first 6 months of life, a third of them - even in the neonatal period. But even in such babies, the disease can go into chronic form if not treated in time. And kidney damage in children harms the entire body. And in severe cases, it can even necessitate permanent hemodialysis.

He didn't get cold, why did he get sick?

Acute pyelonephritis in children develops not only with hypothermia. More common causes diseases are:

• SARS: adenovirus infection, influenza;
• intestinal infection caused by Escherichia coli (E. coli) or Coxsackie viruses;
• long-term antibiotic treatment, due to which pathogenic fungi develop in the urinary tract;
• chronic constipation, due to which the intestinal flora migrates to lymphatic system and is carried to the kidneys;
• colitis (inflammation of the colon);
• intestinal dysbacteriosis;
• inflammation of the genital organs: vulvitis or vulvovaginitis - in girls, balanitis, balanoposthitis - in boys;
• cystitis;
• the presence of purulent inflammation in the body: pneumonia, bacterial endocarditis, sepsis.

The causes of pyelonephritis in boys of the first year of life are physiological phimosis, that is, the narrowing of the foreskin that is normal. In addition, in newborns and children up to a year of both sexes, pyelonephritis develops as a complication of omphalitis, pneumonia, purulent tonsillitis, purulent otitis media and other organs. In this case, the infection enters the kidneys with the blood stream.

In the first year of life, acute pyelonephritis occurs in boys and girls with the same frequency. After this age, there are 3 girls per 1 sick boy. This is due to the fact that in girls the urethra is shorter, and with poor hygiene of the genital organs, the bacteria rise up through it, reaching first the bladder, then the ureters, and then the kidneys.

Pyelonephritis in a child is unlikely to develop if there are no predisposing factors in the body. They become:

• small age;
• prematurity;
• early transition to artificial feeding;
• features of immunity;
• nutrition, in which oxalate salts precipitate in the urine;
• pyelonephritis transferred during pregnancy;
• preeclampsia (nephropathy) during the mother's pregnancy;
• occupational hazards in the mother;
• disruption of communication between bladder And nervous system(neurogenic bladder), due to which stagnation of urine develops;
• anomalies in the development of the urinary tract;
• unfavorable ecology;
• frequent SARS;
• endocrine diseases;
• worms;
• masturbation;
• early onset of sexual activity;
• chronic diseases of the urinary system in the family;
• frequent chronic infections in the family;
• hypervitaminosis D.

Of the bacteria, pyelonephritis is most often (in 90%) caused by Escherichia coli. It is this microbe that has several pathogenicity factors. These are cilia and 3 antigens that together immobilize the urinary tract, disable local immune defenses and allow the bacteria to calmly move against the flow of urine.

Other causative agents of pyelonephritis are Proteus, including Pseudomonas aeruginosa, Enterococcus, Enterobacter, Salmonella, Leptospira, Gonococcus, Staphylococcus aureus adenovirus, Coxsackie virus. The role of chlamydia, ureaplasma and mycoplasma is still under consideration. Also, the disease can be caused by fungi, for example, Candida. Inflammatory process in the kidneys can also be caused by Mycobacterium tuberculosis.

Types of pyelonephritis

Depending on the conditions of development, pyelonephritis is divided into:

• primary: appears in a child with normally developed and correctly interconnected organs of the urinary system;
• secondary pyelonephritis: developing or in the urinary system with anomalies of the structure, or if there is a neurogenic bladder, or if the urine has a different pH - due to hormonal disorders or dietary habits.

Secondary pyelonephritis can be:

• obstructive, when the conditions for the outflow of urine are violated;
• non-obstructive, due to either tubulopathies, or metabolic disorders, or congenital developmental disorders.

According to the nature of the course, the disease is divided into:

• chronic pyelonephritis, which can be recurrent (periodically aggravated) and latent (which does not manifest itself in any way);
• acute pyelonephritis. He has no such division. All symptoms and changes in the urine should disappear within 6 months and should not recur.

In its course, the disease is divided into several stages:

1. I active stage.
2. II active stage.
3. III active stage.
4. Partial clinical and laboratory remission.
5. Complete clinical and laboratory remission.

Pyelonephritis is also divided according to the preservation of kidney function. So, it can be:

• saved;
• partially (partially) disturbed.

At chronic pyelonephritis chronic renal failure may also develop.

Symptoms of the disease

Signs of pyelonephritis in children different ages have differences. Let's consider them.

In newborns and infants

Acute pyelonephritis in children under one year is manifested by the following symptoms:

• temperature elevated to high numbers;
• refusal to eat;
• vomit;
• regurgitation after eating;
• pale gray complexion;
• reduction or lack of weight gain;
• periodic attacks of anxiety, sometimes with reddening of the face, and it can be noticed that this occurs during or before urination;
• may be lying with the head thrown back, which is similar to meningitis.

Most often, the disease begins at 5-6 months, when the child is either introduced to the first complementary foods, or transferred to artificial feeding, or vaccinations are repeated. The disease can begin as an intestinal infection (vomiting, diarrhea), but such symptoms quickly disappear.

For preschoolers and schoolchildren

Symptoms of pyelonephritis in children older than a year already give a more accurate indication that the kidneys are sick. This:

Pain

• In school-age children, it is more often felt in the lower back.
• Preschoolers have a stomach, near the navel.
• If the right kidney is inflamed, the pain may resemble appendicitis.

The pain is described as dull, it increases with a change in body position, and decreases with warming of the abdomen or lower back.

urinary disorders

• strong urge to urinate;
• frequent urination;
• pain when urinating;
• itching or burning when urinating;
• change in the amount of urine;
• nighttime urge to urinate;
• could be enuresis.

Other symptoms

• The temperature in pyelonephritis in schoolchildren rarely reaches 38 ° C.
• Symptoms of intoxication: chills, headache, lack of appetite.
• Characteristic appearance: pallor, swelling of the eyelids, "shadows" around the eyes.
• Urine with pyelonephritis may be cloudy, may be bloody, may have an unpleasant odor.

In children 1.5-2 years old, there are few symptoms, there may be no pain, but symptoms of intoxication are expressed, and sometimes urinary retention is detected.

In children 4-5 years old, pain is already manifested, but it is not localized strictly in the abdomen or in the lower back: the child feels it, but cannot describe the localization. At this age, discomfort during urination, a change in the amount of urine and frequency of urination predominate.

Signs of chronic pyelonephritis

This disease rarely develops in very young children. Its symptoms depend on the stage of the pathology.

So, during remission are observed:

• faster fatigue;
• irritability;
• decrease in academic performance;
• freezing of the lower back;
• more frequent trips to the toilet.

If chronic pyelonephritis is younger than 2 years, then the child lags behind in growth and development. That is, parents should pay attention that their child is lower, paler and not as diligent as other children, and be examined by a nephrologist.

With an exacerbation of chronic pyelonephritis, the symptoms will be almost the same as during the first attack of this disease. This is pain, and fever, and a change in the nature of urine. Only the severity of these signs will be less than the first time.

If chronic pyelonephritis progresses, the child:

• anemia increases (he becomes paler);
• blood pressure rises, which can be manifested by headaches, redness of the face;
• decrease in the amount of urine.

Diagnostics

Making a diagnosis in some cases would be difficult if the doctors had not agreed for a long time upon admission to the hospital, with any diagnosis, to take a general urine test. This diagnosis shows that there is inflammation in the urinary system.

Other tests for pyelonephritis are:

• general blood analysis;
• analysis of Nechiporenko;
• bacteriological examination urine;
• urine according to Zimnitsky;
• Reberg's test - determination of creatinine in the blood and urine;
• urinalysis by PCR - to determine myco-, ureaplasma, chlamydia;
• urine culture on Sabouraud's medium - to detect fungal flora;
• analysis of potassium, sodium, urea and creatinine in the blood;
• smear from the vagina (in girls) or from the urethra (in boys);
• scraping for enterobiasis.

In making a diagnosis, it is also important to undergo an ultrasound of the urinary system, an X-ray method - excretory urography, and sometimes radionuclide studies of the kidneys.

In addition to the tests, you need to consult other doctors: an ophthalmologist, a phthisiatrician, a dentist, an ENT doctor. And if the first specialist evaluates the condition of the fundus - in order to understand how kidney damage affects the vessels, then the rest should exclude a chronic infection - how possible cause pyelonephritis.

Treatment of acute pyelonephritis

The goals of treating pyelonephritis in children are as follows:

1. the destruction of the microorganism that caused pyelonephritis;
2. improved blood supply to the kidneys;
3. increase in urine output.

Your child will need to be hospitalized if:

• this is a child under one year old;
• he has significant intoxication;
• him heat body;
• he had a decrease in the amount of urine;
• he has severe pain in his stomach or lower back;
• he has high blood pressure;
• home treatment had no effect.

In any case, if the child stays at home or goes to the hospital, he will need to stay in bed for 3-5 days. Especially when elevated temperature, chills, availability pain syndrome or symptoms of toxicity. As soon as the symptoms begin to decrease, the motor regime expands. It is very important to force the child to urinate every 2-3 hours: this will prevent stagnation in the urinary tract, and the daily amount of urine can be calculated (if you urinate in a duck or a bottle).

Diet

The diet for pyelonephritis is as follows:

Drinking regime

Additional liquid needs to be taken cranberry or cranberry juice, a decoction of dried apples, mineral waters of Slavyanovskaya, Smirnovskaya. The calculation of additional fluid intake is as follows:

• children under 7 years old - drink 500-700 ml / day;
• at 7-10 years old - 700-1000 ml;
• over 10 years old - 1000-1500 ml.

The course of fluid intake is 20 days.

Of the drugs prescribed:

• antibiotics, whose effectiveness is evaluated every 3 days. These are augmentin, cefuroxime, cefotaxime, ceftriaxone. After 14 years, ciprofloxacin, norfloxacin or levofloxacin can be used. The duration of treatment is up to 4 weeks, every 10-14 days it is possible to change the antibiotic;
• uroantiseptics: furagin, furadonin, nalidixic acid, 5-nitroxoline, palin. These are not antibiotics, but drugs that can stop the growth of bacteria. Appointed after antibiotic therapy, course of treatment 1-2 weeks;
• anti-inflammatory drugs: it is an NSAID (diclofenac, ortofen, voltaren)
• glucose 5%, less often saline solutions(sodium chloride, Ringer's solution) in the form of droppers;
• drugs to improve renal blood flow: eufillin, cinnarizine;
• blood-thinning drugs: trental and its analogues pentoxifylline and chimes;
• immunomodulators and antioxidants- as the inflammation subsides. These are vitamin E, beta-carotene;
• decoctions of herbs- after the end of the course of antibiotics and uroantiseptics:
  • anti-inflammatory: chamomile, sage, St. John's wort;
  • diuretic: horsetail, lingonberry leaves, wild rose, bearberry;
  • improving regeneration: bird knotweed, mint, licorice root.

Herbs are brewed according to the instructions for each of them. On average, this is 2 tablespoons, which you need to pour 250 ml of hot water and keep in a water bath for 15 minutes, after which you insist for another half an hour. Drink a glass of broth per day, dividing it into 3-4 doses. Herbs with different effects can be combined.

The course of phytotherapy - 20 days. You need to drink herbs 3-4 times a year. Herbal decoctions can be replaced with herbal remedies, for example, kanefron, urolesan or cystone.

Physiotherapy

In the active stage, a microwave procedure is also prescribed, in the period of subsiding the disease - a course of EVT procedures. When the child feels well, and the changes in the urine have disappeared, to prevent the chronicity of the process, the following is prescribed:

• paraffin applications on the kidney area;
• mud applications on the kidney area;
• therapeutic (mineral, thermal, sodium chloride) baths;
• drinking bicarbonate-calcium-magnesium mineral waters.

Treatment in a hospital is usually within a month, then the child is observed by a district pediatrician and a nephrologist. After discharge, 1 r / month, control of urine and blood tests, every 6 months, ultrasound. After acute pyelonephritis, if within 5 years there was no relapse, blood and urine tests are normal, then the child is removed from the register.

Chronic course of the disease

Prevention of complications and chronicity

With a recurrence of pyelonephritis, treatment is also carried out in a hospital. Courses of therapy and principles are similar to those in the acute process.

Treatment depends on the cause of the kidney infection. Maybe:

• surgical treatment (with an anomaly leading to obstruction, vesicoureteral reflux);
• diet therapy (dysmetabolic nephropathy);
• psychotherapeutic methods for neurogenic bladder dysfunction.

During the period of remission is shown planned hospitalization for examination and selection of anti-relapse treatment.

Anti-relapse therapy includes:

• a course of antibiotic treatment in small doses;
• uroseptics for 2-4 weeks, then a break of 1-3 months;
• phytotherapy for 14 days in each month.

"Under the guise" of chronic pyelonephritis is rare, but kidney tuberculosis can occur, so children are shown a consultation with a phthisiatrician. A child with chronic pyelonephritis before being transferred to an adult clinic is registered with a pediatrician and a nephrologist, scheduled examinations and preventive measures are carried out.

Complications

The consequences of pyelonephritis in children are serious diseases:

• apostematous nephritis (kidney covered with pustules);
• kidney carbuncle;
• urolithiasis disease;
• necrosis of the renal papillae;
• shriveled kidney;
• increased blood pressure;
• renal failure, more often - developing according to the chronic type.

Forecast

In chronic pyelonephritis, a condition such as a secondarily wrinkled kidney often develops, when the renal tissue ceases to perform its functions, and the body can “drown” in its own fluid that accumulates in the body cavities.

If pyelonephritis develops, there are fewer active working units, and kidney failure develops. An unfavorable prognosis will also be if, due to pyelonephritis, the work of the kidneys has suffered, interstitial nephritis has developed.

And even if the kidney function did not deteriorate, all the changes in the urine and blood tests were gone, and the periodic bacteriological examination of the urine does not show any bacteria, and it is impossible to say that the child has fully recovered.

Prevention

You can avoid pyelonephritis if you undergo preventive examinations every six months and treat all organs that can become a focus of chronic infection in a timely manner. These are carious teeth chronic tonsillitis, adenoiditis, helminths (worms).

If the child has already suffered pyelonephritis, then every 1-3 months he should take a general urine test and its bacteriological examination. If there are changes in the urine, even if the child has no symptoms, preventive treatment with antibiotics, uroantiseptics, drugs that improve kidney function is indicated. Such therapy can be carried out in courses of up to 5 years, because the task is to prevent kidney failure.

Thus, we examined pyelonephritis in children, focusing on its symptoms and treatment.

Pyelonephritis is inflammation in the kidneys caused by an infection. The pelvicalyceal system, tubules and renal tissue are affected.The pelvis is a funnel-shaped reservoir formed by the fusion of the large calyces and serves to store urine, which then enters the bladder.

The tubules are small tubes that filter urine, and the kidney tissue is the organ tissue that fills the space between the main structures.Inflammation begins after infection enters the kidneys and in children it is one of the most common diseases, second only to respiratory diseases.

Pyelonephritis occurs in people of any age from 6 months to old age. However, it is most common in young children. This is due to the fact that there are still no antimicrobial substances in their urine, and the anatomy of the children's urinary system is somewhat different from that of an adult.

IN early age in girls, this occurs 5 times more often than in boys due to the fact that their urethra is built differently and it is very easy to bring the infection there, after which it quickly moves up and reaches.

Inflammation in the kidneys is caused by bacteria, the most common causative agent is E. coli. In addition to it, diseases can be provoked by streptococci and enterococci.

In addition to bacteria, viruses, protozoa, and fungi cause inflammation.

Microorganisms can enter the kidneys in several different ways:

• Hematogenous - by blood from other organs in which the focus of infection is located. A particularly common path for newborns, in whom pyelonephritis can occur after pneumonia or otitis media, and even organs located in a completely different part of the body can be foci of infection. In older children, the infection can reach the renal system only with more severe diseases.
• Urinogenic (or ascending) - microorganisms located in the anus and genitals, urethra and bladder, as it were, rise up and enter the kidneys. This is the most common route of infection in girls, because due to the structure of the urethra, bacteria easily get inside it and rise up. That is why girls are more susceptible to the disease than boys.
• The lymphogenic pathway is based on the infection entering the kidneys through the lymphatic circulation system. As a rule, lymph goes from the kidneys to, but if there are any problems, for example, damage to the intestinal mucosa, stagnation of lymph with constipation, diarrhea, intestinal infections, the kidneys can be infected with intestinal microflora.

Conditions and factors

Inflammation in the kidneys provokes a certain pathogen, but there are also some conditions and factors that favor the onset of the disease.

So, basically pyelonephritis occurs under the following conditions:

• reduced immunity
• diseases of the kidneys and urinary tract that prevent the normal outflow of urine

The following factors contribute to the occurrence of inflammation:

• severe hypothermia
• acute cold disease
• frequent sore throats
• scarlet fever
• intestinal dysbacteriosis
• teeth with caries, which can become a focus of infection
• inability to completely empty the bladder when urinating
• neglect of personal hygiene
• urolithiasis, in which there are obstructions in the urinary tract
• vesicoureteral reflux - urine from the bladder flows back into the kidneys
• increased load on immune system due to the transition from breastfeeding to artificial feeding, the start of complementary foods, as well as the eruption of the first teeth

All of the above factors contribute to the occurrence of pyelonephritis in children when a pathogen enters the body.

Forms of pyelonephritis

In children up to a year, 2 main forms of the disease are distinguished:

• Primary form.develops in an initially healthy organ with normal anatomical structure and the absence of any pathologies. That is, there are no anatomical factors and anomalies that usually provoke this ailment. Pyelonephritis occurs in this form due to intestinal dysbacteriosis, based on adverse conditions, for example, frequent SARS or intestinal infections. Microbes enter the urethra, from where they penetrate the urinary bladder and kidneys through the urinogenic route.
• secondary form.In this case, the child is inherently predisposed to the occurrence of this disease due to congenital anomalies structures of the urinary system. These may be violations in the structure or anatomical location of the kidneys themselves, as well as other organs of this system. All this interferes with the normal outflow, either causing it to stagnate, or throwing it back into the kidneys along with the bacteria that cause inflammation. It is also possible such an anomaly as the underdevelopment of the kidneys, because of which their size is too small and the functionality, accordingly, is reduced. If at first it is not so noticeable, then with the growth of the child, the load on the kidneys increases, and they no longer cope with their task.

Symptoms

In different children, the symptoms vary greatly and depend on the severity of the disease, comorbidities and the age of the child.

However, there are some common symptoms that may suggest the presence of pyelonephritis:

• Elevated temperature. In a child, it rises to 38-39 ° C, and for no apparent reason. This is the main sign, which is often the only one. The baby does not have a cough or a runny nose, but only a pronounced fever and increased sweating.
• Lethargy, drowsiness and lack of appetite, nausea and regurgitation.
• Pale skin tone. The skin may be gray in color, and blue under the eyes also appears. There may be slight swelling of the face and eyelids.
• Sleep disturbance. The child becomes lethargic and sleepy during the day, and restless and suffers from insomnia at night.
• Pain in the abdomen and lumbar region, aggravated by movement. Unfortunately, at the age of one year, the child cannot yet report his or her painful sensations, but by how restless the baby has become, the parent will immediately understand that something is bothering him.
• Painful urination. It can also be determined by the restless behavior of the child during urination - the child may grunt, whimper and even scream.
• Violation of urination. Especially alarming if the baby urinates in small portions. He can also walk too often “in a small way” or, conversely, too rarely, despite the fact that he consumes water no less than usual. The normal number of urination per day for a baby up to six months is up to 20 times, from six months to a year - up to 15 times. The jet should be light, continuous and full.
• Urine color. The normal color of the nursery is light yellow and transparent. When disturbed, it becomes cloudy and acquires a darker shade. If the color is pinkish red, then this indicates the presence of blood cells in the urine. This happens with kidney damage, including pyelonephritis. Urine can also acquire a strong unpleasant odor.

Diagnostics

• organs of the urinary system
• excretory urography - a radiopaque substance is injected intravenously and, depending on changes in the functioning of the kidneys, the presence of developmental anomalies that were already present at birth is detected
• radioisotope renography - a study of the kidneys, which in case of pyelonephritis will show the asymmetry of organ damage
• kidneys - a study of the renal tissue, but is prescribed only as a last resort, when it is not possible to make an accurate diagnosis for some reason.

Preparing for a urine test

In order for the diagnosis to be made most accurately, it is necessary to carefully follow some rules before it:

• do not give the baby mineral water the day before, as this can distort the results of the analysis
• to collect the analysis, buy a special container at the pharmacy, wash it thoroughly and pour boiling water over it
• collect material for analysis in the morning
• Wash your baby thoroughly beforehand.
• no need to put the jar right away as the first urine is not very accurate, so collect after the first couple of seconds of urination

If the results of the general analysis are not satisfactory and there are deviations from the norm, then a study may be prescribed. If kidney failure or inflammation is suspected, an analysis is prescribed.

Test results will be available within 1-2 days. Having studied them, the urologist will explain in detail the state of health of the baby, but the diagnosis does not end there.

Treatment

Only a specialist can prescribe treatment and the necessary drugs.First of all, the normal outflow of urine is restored, if it has been disturbed, a catheter can be installed.