How quickly does pyelonephritis develop in children? Symptoms and treatment of pyelonephritis in children

Pyelonephritis – infectious renal pathology, which often occurs in young patients. The disease not only causes discomfort to the child, but also interferes with its normal development. If you have pyelonephritis, you should always consult a doctor. An experienced specialist will quickly diagnose the disease, distinguish it from urethritis or cystitis, and prescribe adequate treatment.

In the early stages, the disease is quickly eliminated. Timely consultation with a doctor allows you to avoid such serious complications as the appearance of ulcers in the kidneys, stones, etc.

Causes of pyelonephritis

Pyelonephritis is always caused by microorganisms. The main causative agent of pathology in young patients is Escherichia coli. Various viruses, Staphylococcus aureus, fungi and protozoa can stimulate the occurrence of the disease. When the pathology is chronic, research often reveals a number of pathogens at once.

Dangerous microorganisms penetrate the child’s kidneys:

From the genital organs and organs of the excretory system. The infection can arise from the urethra, anus, or urinary tract. This route of infection is especially common in girls.
From bones and various organs. In this way, microorganisms often penetrate the kidneys of newborns who have recently suffered from otitis media, pneumonia and other infectious diseases.
Through the lymphatic system. Kidney infection is possible due to intoxication of the body

Factors contributing to the development of the disease

The development of the pathological condition is facilitated by factors such as:

Problems with regular and complete urine outflow due to urolithiasis
Stagnation of urine due to dysfunction (including congenital) of the bladder
Diabetes
Diseases that reduce the body's natural defenses
Sinusitis and tonsillitis
Lack of personal hygiene, etc.

In infants, pathology often occurs due to refusal of natural feeding, inflammatory processes during teething and other factors that increase the load on the immune system, which is not yet fully formed and strengthened.

Types of disease

Depending on predisposing factors, there are 2 main types of disease:

Primary. This pathology occurs in the absence of pronounced concomitant factors
Secondary. The disease develops in the presence of structural anomalies in the urinary organs and functional disorders

Depending on the nature of the course, the following pathologies are distinguished:

Spicy. This type of pyelonephritis is characterized by high fever and other signs of acute inflammation.
Chronic. This type of pyelonephritis is characterized by frequent relapses, but cases of a latent course are also diagnosed, when the patient does not experience symptoms of the pathology, and changes are detected only by laboratory tests. In its chronic form, the disease can accompany a person throughout his life.

Features of the course of the disease in patients from birth to 1-1.5 years

In newborns, pyelonephritis occurs with signs of intoxication, which are expressed in:

High (up to 40 degrees) temperature
Convulsions
Pale and bluish skin
Losing body weight
Refusal to eat
Vomiting
Dehydration

Diarrhea may occur, and urination may be difficult.

At the same time, newborns cannot tell their parents where and what hurts them. This aggravates the situation and delays treatment. If you notice one or more signs of a pathological condition in your child, you should immediately make an appointment with a pediatrician. It is important for a specialist to conduct a comprehensive diagnosis that allows you to quickly distinguish a kidney infection from an intestinal infection.

Symptoms of chronic pyelonephritis

Chronic pathology is characterized by a special course. The disease is characterized by periods of remissions and exacerbations.

During remission, children do not experience any symptoms of the disease. Even during diagnosis, the doctor will not note any changes in important laboratory parameters of urine analysis (specific gravity, white blood cell content, protein, red blood cells, bacteria and casts).

The following symptoms are typical for periods of exacerbation:

Back pain
Discomfort in the abdomen
Temperature increase

Also, parents often notice that with a chronic illness, the child quickly gets tired, becomes irritable, and restless. Schoolchildren often experience a decrease in attention and, consequently, academic performance. The child is often distracted, cannot concentrate, and complains of general malaise. In some cases, the child’s physical and psychological development is delayed.

Diagnosis of the disease

To diagnose the disease, the following studies are carried out:

General urine analysis. The main indicator of the pathological process is a sharp increase in leukocytes. Red blood cell counts also increase, bacteria and other inclusions are found in the urine
Cumulative urine samples. They also indicate the presence of infection by an increase in white blood cell counts
Culture for sterility. This study is carried out to determine the causes of pathology (a specific microorganism)
General blood analysis. The development of infection is indicated by an increase in leukocyte counts. A blood test can also detect anemia.
Blood chemistry. Diagnostics allows you to determine a decrease in protein levels, an increase in urea and creatinine levels

To clarify the diagnosis, studies such as:

Ultrasound of the urinary system
X-ray examinations
Dopplerography of blood flow in the kidneys
CT, MRI, etc.

Such diagnostics are aimed at identifying anatomical abnormalities, allowing one to detect the cause of the pathology and determine ways to eliminate it.

Treatment

Pyelonephritis in children should be identified (symptoms) and treated as early as possible. Therapy is carried out only in a hospital. As a rule, the child stays in the ward for 2-3 weeks. After this, the little patient is sent for outpatient treatment.

Inpatient therapy is due to the need for:

Careful selection of medications
Constantly assessing the dynamics of important laboratory parameters
Intravenous and intramuscular administration of medications

The basis of treatment is:

Two-stage antibacterial therapy
Protein-plant diet
Limiting salt intake
Drinking regimen approved by a doctor
Taking antispasmodics and other drugs to relieve pain, vitamin complexes to restore the body's defenses and anti-inflammatory drugs

Young patients should adhere to bed rest.

Which doctor should you contact if you suspect your child has problems?

If you notice symptoms of the disease in your child, you should first contact your pediatrician. It is this doctor who will prescribe the initial examination. If necessary, he will refer the little patient to a consultation with a urologist or nephrologist.

Patients with chronic pyelonephritis are always seen by a urologist or nephrologist. Typically, children are registered with a specialist and monitored constantly. Once every six months, urine and blood tests are required, and an ultrasound is performed. This allows you to track all changes and control therapy. If necessary, parents are consulted by an infectious disease specialist.

Specialists such as:

Immunologist
Endocrinologist
Pulmonologist, etc.

This is due to the fact that the infection can develop not only in the kidneys, but also in other organs and entire systems of the body.

Advantages of treatment at MEDSI clinics

Providing full range of medical services for the diagnosis and treatment of pyelonephritis
Availability of everything in clinics necessary equipment for such highly informative studies such as ultrasound, radiography, MRI
Own express laboratory. In it, specialists conduct analyzes in CITO (urgent) mode. This allows you to quickly make a diagnosis or adjust treatment if blood or urine parameters change
The selection of treatment is carried out only on the basis of the results obtained from a comprehensive diagnosis
Usage well proven techniques drug therapy and blood purification
Constant contact of urologists and nephrologists with specialists from the departments of pediatrics, therapy, endocrinology, cardiology, etc.
Availability of a hospital providing comfortable conditions of stay even for the youngest patients

To use the help of MEDSI professionals, just make an appointment by phone

Urinary tract infections in children are the second most common after respiratory diseases. In infants, they can “masquerade” as pathologies 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 low-grade to high levels. Therefore, every child with an unknown malaise and a rise in temperature must undergo a urine test to exclude pyelonephritis.

Pyelonephritis (kidney inflammation) in children is a disease of the upper urinary tract, which causes inflammation of the kidney tissue caused by microbes. Not only the kidney tubules are involved in the process, but also the blood and lymphatic vessels.

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

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.

Routes of infection:

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 screened for sexually transmitted infections.

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

Ascending route of infection ( from the lower urinary tract ) is more common than others and is typical for girls. This is explained by the structure of the urogenital area. The proximity of the two sections promotes seeding. Normally, the advancement of microbial colonies in girls is hampered by the usual vaginal microflora, represented by lactobacilli, which produce lactic acid and create an unfavorable environment - a different pH.

By releasing hydrogen peroxide, lactobacilli inhibit the proliferation of harmful microflora. In some cases, there may be a disturbance in the number of vaginal flora (lack of female hormones, decreased production of local immunoglobulin A, lysozyme). The balance between the body and microbes is disrupted, and local immunity decreases. 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 constantly in contact with infection, but infection does not occur. This is explained by the presence of local protective functions. There are many of them and they complement each other. Any disruption of their work creates a condition for illness.

Adverse impact factors are divided into internal and external:

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

If prevention is carried out in a timely manner in schools, the incidence of childhood pyelonephritis will decrease. Girls especially need to avoid hypothermia, 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 of age is E. coli in 85% of cases. Subsequently, in infant boys, its share decreases to 40%, while Proteus increases to 33% and staphylococcus to 12%.

The development of the disease is facilitated by chlamydia, and from the mother, infection occurs through the blood. Immunodeficiency conditions, 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 of age has its own characteristics: the pelvis is located intrarenally, the ureters are tortuous and have weak tone. Due to weak innervation, the muscular apparatus of the kidney does not contract sufficiently.

According to experts, early transfer to artificial feeding, especially in the first six months of life, can lead to illness in infants. 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. The course is severe, and meningeal symptoms may develop. The child often spits up, and vomiting appears at the height of intoxication. When urinating, he 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 of age at home due to the severity of the condition.

Forms and symptoms of pyelonephritis

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

spicy;
chronic.

Acute pyelonephritis has two forms: primary and secondary.

Primary pyelonephritis occurs as an independent disease, 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, and joints. There is a tremendous chill. In the acute form, the disease occurs with severe intoxication. We are concerned about weakness; the child’s characteristic posture is forced flexion and adduction of the limb to the stomach on the side of the diseased kidney.

Obstructive pyelonephritis is very severe, which is accompanied by the death of organ cells. A state of shock occurs with a drop in pressure, lack of urine, up to the development of acute renal failure. For older children, acute pyelonephritis occurs under the “mask” of appendicitis or influenza.

The picture of chronic pyelonephritis for children is characterized by the same symptoms, but they are less pronounced. The child complains of fatigue and frequent urination, which may be combined with anemia or hypertension. Unlike acute, childhood chronic pyelonephritis is dangerous due to the structural restructuring of the renal pyelocaliceal system.

Diagnosis of pyelonephritis

The first thing to do if you have a fever that is not associated with a cold is to check your urine test.

Urine examination includes two methods:

microscopic analysis;
culture for bacterial flora and sensitivity to antibiotics.

Medical recommendation: Urine collection for microscopic examination is carried out by urinating freely in a clean container, before starting antibiotic therapy. First you need to thoroughly clean the child's external genitalia.

The sensitivity of the method is 88.9%. When microscopying sediment, attention is paid to leukocytes, red blood cells, specific gravity of urine and the presence of protein. Signs of pyelonephritis: the appearance of 5 or more leukocytes in urine tests, changes in urine density. The disadvantage of this method is the high risk of microbes from the environment.

To obtain high-quality diagnostics, the microscopic method must be combined with the bacteriological one. A modern laboratory method to confirm 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 Dopplerography significantly expands the capabilities and accuracy of the method. It can be used to identify developmental anomalies, dilation of the pelvis, urolithiasis, and hydronephrosis. Will show signs of inflammation and shrinkage of the kidney.

Renoscintigraphy (Scintigraphy)

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

Treatment

Therapy for pyelonephritis consists of the following stages:

Antibacterial therapy.
Pathogenetic.
Symptomatic.
Regime and proper nutrition.

Doctors' recommendations: Antimicrobial therapy for pyelonephritis should be started as early as possible, ideally in the first 24 hours. A late onset (on days 3-5) leads in 40% of cases to the appearance of areas of wrinkling in the kidney parenchyma, 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, and the anatomical features of the structure of the urinary tract create an obstacle to the flow of urine. Therefore, acute pyelonephritis in children ends in a chronic process with frequent relapses if treatment periods are not followed.

It takes a long time to treat. The course consists of 2 stages: initial antimicrobial therapy for 14 days and an anti-relapse course with uroseptics for a month. For developmental anomalies where there is reverse reflux of urine, anti-relapse treatment is carried out for several months or 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 tablet preparations at home. In the hospital they begin treatment by injection for 3-5 days, then transfer 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 eliminated, and the likelihood of a secondary case is reduced. Therapy will be aimed 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”, “Nitroxaline”

Mild pyelonephritis can be treated at home. Herbal medicine has proven itself well for maintenance and preventive therapy. For this purpose, you can use Canephron.

The diet for pyelonephritis in children should be age-appropriate. Be balanced, contain more protein. Spicy foods and salt should be avoided. Drinking plenty of fluids is required, 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.

Prognosis and prevention

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

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

physical exercise and sports improve blood circulation in the kidneys;
sufficient fluid intake ensures good circulation;
Timely urination removes stagnation of urine.

Children who have received treatment for pyelonephritis are subject to observation by a pediatrician and should periodically undergo urine tests. It is advisable to consult a nephrologist once a year.

Analysis of urine and urinary tract tests

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

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

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

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

How does infection occur?

Infection can enter the kidneys in three ways:

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

Classification of pyelonephritis

There are primary and secondary pyelonephritis in children.

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

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

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

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

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

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

Causes of pyelonephritis

The main causes of pyelonephritis are:

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

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

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

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

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

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

Video: Features of pyelonephritis, its diagnosis and treatment

Symptoms of pyelonephritis

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

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

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

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

Acute pyelonephritis

Acute pyelonephritis develops in children in several stages.

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

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

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

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

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

Chronic pyelonephritis

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

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

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

Features of symptoms in infants

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

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

Video: Symptoms of urinary tract infections in children

Diagnosis of pyelonephritis

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

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

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

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

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

Video: The importance of urine analysis for urinary tract infections

Treatment

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

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

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

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

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

Prevention of pyelonephritis

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

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

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

Infections are dangerous for the child’s body due to the incomplete formation of immunity. Against this background, bacteria and fungi can affect the tubules, calyces, renal pelvis and urinary tract. Chronic pyelonephritis in children leads to changes in renal tissue. Treatment is carried out taking into account the nature of the infectious agent and the age of the child. Complex therapy and a special diet will help avoid relapses of the disease and achieve stable remission.

The main causative factors in the development of the disease are considered to be infections, a decrease in the body's defenses and various disorders of the outflow of urine. Microorganisms infect the epithelium of the renal calyces and pelvis. The inflammatory process often spreads to the tubules, lymphatic and blood vessels. The infection enters from the urethra and bladder through the ureters. This is an ascending pathway that predominates among the causes of the disease. Microbes are less likely to enter the kidneys with blood and lymph from foci of chronic infection, which include tonsillitis, caries, and sinusitis.

Causes of immune system dysfunction in children:

endocrine disorders in the body caused by heredity and age;
poor environmental conditions, water and food pollution;
physical, mental and mental fatigue;
inadequate antibiotic therapy;
hypo- and vitamin deficiency;
stress.

Problems with the immune system explain the increased incidence of pyelonephritis in newborns and infants.

The period of 0–2 years marks the stage of formation of the body’s defenses, low resistance. The period from 4 to 7 years is considered problematic, when children are exposed to a variety of infectious agents in new groups. In addition, until the age of five, the child does not completely empty the bladder, creating a favorable environment for the proliferation of microbes. Puberty is associated with hormonal changes and the penetration of infection into the kidneys from the genital mucosa.

Pyelonephritis is more often recorded in newborn boys. After 3 months, the statistics change: for every six sick girls there is one sick male baby. A similar ratio remains in the early, preschool and teenage age periods.

The negative consequences of pyelonephritis for a child during pregnancy include poor nutrition, fetal hypoxia, premature birth, and untimely release of amniotic fluid. There is a possibility of asphyxia, jaundice, intrauterine infection and hereditary transmission of the disease. As a result of hypoxia, weak children with low weight are born.

The immediate causes of the development of pyelonephritis in children are pathogenic microflora. The prerequisites are considered to be dysbiosis - vagina or foreskin, intestines. Frequent retention of urination is harmful when a child is forced to restrain the urge in kindergarten or school. Pyelonephritis occurs after cystitis, when the infection spreads through the urine. Predisposing factors are ureteral injuries, tumors or kidney stones, and poor personal hygiene.

E. coli accounts for 85% of kidney infections. Staphylococcus, enterococcus, Pseudomonas aeruginosa, and chlamydia are involved.

Various anomalies in the development of individual parts or the entire genitourinary system contribute to kidney damage. The long course of the disease leads to the appearance of scars consisting of connective tissue. Anemia and arterial hypertension appear, and chronic renal failure (CRF) occurs. Physical activity that is feasible for their peers is contraindicated for sick children. Long standing, temperature changes, and mental stress are considered harmful. Chronic renal failure in a child leads to disability.

Forms and types of disease

There is no generally accepted classification regarding the typology of pyelonephritis. The acute period, purulent inflammation, lasts approximately 2 months. With chronic pyelonephritis, approximately two exacerbations occur over six months or a longer period of time, followed by remissions. In this case, the swelling of the kidney is insignificant; the blood supply to the affected organ deteriorates.

Acute pyelonephritis develops suddenly with an increase in temperature to 39–40°C and lower back pain.

Doctors are helped to distinguish between the main types and forms of the disease by studying clinical manifestations, congenital anomalies and acquired pathologies. If the inflammatory process initially develops as a result of microflora from the urethra entering the kidneys, then this primary pyelonephritis. The disease is not associated with the presence of abnormalities in the child's kidneys and urinary ducts.

Secondary pyelonephritis- a consequence of abnormalities in the structure of the kidneys, pathology of the ureters and deterioration of urine outflow. It is usually diagnosed in children under one year of age, although it can develop in preschool or puberty. A unilateral process is characterized by damage to only one kidney, while a bilateral process affects two kidneys. The obstructive type is associated with obstruction of the urinary tract.

Symptoms of the disease

The paired organ of the urinary system performs important functions. Urine with dissolved metabolic products accumulates in the glomeruli, flows into the renal pelvis, and enters the bladder through the ureters. All of these organs are located below the waist. However, pyelonephritis is often disguised as an acute abdomen. In this case, general symptoms prevail over local ones. Fever occurs, the child vomits, becomes dizzy, pain is felt in the navel area, but is absent in the lumbar area.

Signs of pyelonephritis in children in acute form:

symptoms appear suddenly, often after hypothermia;
suffer from headaches, muscle pain, lumbar pain;
urine emits an unpleasant odor and changes color;
Frequent urination bothers you;
chills, fever (40°C) occur;
dry mouth;
lumbar pain;
vomit.

Pyelonephritis is severe in newborn infants. The disease begins with high fever and refusal to eat. Symptoms of pyelonephritis in infants can be recognized by the pale gray color of the skin, vomiting, diarrhea, and lethargy. The fever persists for more than 2 days, urination is frequent. Indirectly indicate kidney damage in a 1-year-old child and in children under 3 years of age, irritability, fatigue, and anxiety before urinating.

However, the onset of pyelonephritis at an early age often goes unnoticed, especially in the absence of general intoxication. If abdominal syndrome predominates, then discomfort occurs in the abdomen and pain near the navel. With urinary syndrome, urination becomes more frequent and becomes painful. The volume increases and the clarity of urine changes.

Development of signs of pyelonephritis in children with chronic form occurs over a period of at least 6 months. Intoxication and pain are less pronounced. The child gets tired quickly, in the evenings his temperature rises to 37–38°, and urination becomes more frequent. The latent course of chronic pyelonephritis manifests itself in the predominance of urinary syndrome. When the disease becomes recurrent, acute attacks occur every 3 months or more often.

How to recognize pyelonephritis in a child or teenager?

The disease often occurs in the absence of pronounced signs of inflammation. Diagnosis is complicated by the absence of characteristic symptoms of pyelonephritis in children. Leukocytes, proteins and a large number of bacteria in the urine indicate an inflammatory process. Chronic pyelonephritis can be recognized by painful sensations when palpating the kidneys through the anterior abdominal wall and gently tapping the lower back.

Main diagnostic criteria:

A general urine test helps determine the presence of pathogens; turbidity occurs due to the presence of protein, leukocytes, and epithelial cells.
The Nechiporenko test is carried out to determine the content of leukocytes and erythrocytes in a portion of morning urine.
Ultrasound of the pelvic organs makes it possible to choose treatment tactics (medical or surgical).
A blood test shows an increase in ESR, anemia, and a change in the state of the immune system.
Urine culture allows you to identify the infectious agent - the causative agent of the disease.

The hemogram provides the necessary information about the degree of inflammation. Indicators of urine analysis when cultured for microflora make it possible to determine the species of the causative agent of the disease and its sensitivity to certain antibacterial substances. A comprehensive examination is carried out to prevent complications - sepsis, chronic renal failure.

Principles of therapy

Symptoms and treatment of pyelonephritis in children depend on the causes and nature of the inflammation, the degree of urinary dysfunction. Therapy is carried out with antibiotics. It happens that in the presence of an abscess it is impossible to do without surgery. Treatment of an acute process is carried out in an inpatient or outpatient setting, with mandatory bed rest.

Basic principles of therapy:

Non-steroidal anti-inflammatory drugs with an analgesic effect (paracetamol, ibuprofen).
Treatment with antibiotics to fight infection and prevent purulent process.
Prescription of drugs that eliminate the effects of intoxication of the body.
Means for increasing the activity of the immune system.
Uroantiseptics (prescribed less frequently).
Antihistamines.
A gentle diet.

How to treat pyelonephritis is decided by doctors - pediatrician, nephrologist, urologist after a comprehensive examination of the child.

High demands are placed on antibacterial agents used in pediatrics. They must be low-toxic, quickly accumulate in the lesion, and be resistant to bacterial enzymes. Protected penicillins are used to treat pyelonephritis in infants and one-year-old children. For example, amoxicillin + clavulanic acid.

Adolescents are usually prescribed a number of cephalosporins or fluoroquinols (cefotoxime, cefuroxime, levofloxacin, ciprofloxacin). When antibiotic therapy for pyelonephritis in children lasts more than 10 days, the drug is changed. Antibiotics are first administered intramuscularly, then oral forms are used.

The diet for pyelonephritis in children does not involve limiting salt, but the drinking regime provides for an increase in fluid by 50% more than the age norm. They give cranberry juice, fruit and berry juices, herbal teas, “Smirnovskaya” or “Slavyanovskaya” mineral water. Fatty and fried foods, spicy dishes are excluded.

Dear readers, in this article we will talk about what pyelonephritis is in children, the symptoms and treatment of this disease. You will find out what causes this disease, find out what complications are possible, and you will also become aware of prevention methods.

Classification

This disease is infectious and affects the kidneys. It is quite often diagnosed in childhood.

Typically, babies under one year old get sick equally often, both boys and girls. But in children older than one year, pyelonephritis is more often observed in females. This is due to the peculiarities of the anatomical structure of the urinary tract.

The following types of disease are distinguished.

Primary. Characteristically, there are no causes from the urinary system.
Secondary. It develops against the background of anomalies in the anatomical structure of the excretory organs. Both functional pathology during urination and dysmetabolic disorders can be observed.
Spicy. Recovery is typical after a month or two.
Chronic. The disease persists for six months. There may be a recovery, and then an exacerbation again. There are two forms of this type of disease:

recurrent - exacerbation attacks are observed;
latent - occurs without pronounced symptoms, changes are noticeable during diagnosis.

Causes

As a rule, the disease develops against the background of infection of the body with pathogenic microflora, in particular Pseudomonas aeruginosa, Staphylococcus aureus or Escherichia coli. If we consider the ways in which a child’s body is infected, the following are distinguished:

Hematogenous. Microorganisms penetrate the kidneys during pneumonia, purulent sore throat or even caries. This route of infection is most often observed in newborns and children under one year of age. It is possible that infection can spread from mother to fetus in the later stages of pregnancy.
Lymphogenic. Infection is typically transmitted through lymph.
Rising. Microorganisms enter the excretory organs through the genitourinary system or the gastrointestinal tract. This route of infection is most often observed in older children in the presence of colitis, cystitis or dysbacteriosis. It is more often observed in girls, in particular in those who do not maintain personal hygiene.

If we consider pyelonephritis in children, the causes of this condition, the following predisposing factors should be highlighted:

neurogenic bladder;
urolithiasis disease;
vesicoureteral reflux;
abnormal structure of the excretory organs;
advanced cystitis;
chronic infectious diseases, such as tonsillitis;
hypothermia;
compliance with personal hygiene rules;
weakened immune system;
excess vitamin D in the body;
In children of the first year of life, pyelonephritis can be provoked by: the introduction of complementary foods, a change in the type of feeding, the period of teething, anything that reduces the protective functions of the body.

Signs

When considering pyelonephritis and symptoms in children, you should pay attention to their differences in infants and older children, as well as in the acute course of the disease and the chronic form. Therefore, we will look at them in more detail.

Features in children under one year old

Children at this age may experience the following symptoms of the disease:

very high, reaches 40 degrees, low-grade convulsions are possible;
frequent regurgitation, vomiting;
pallor of the skin, blueness is observed around the eyes, above the upper lip, their cyanosis is characteristic;
poor appetite, possible refusal of breast milk or formula;
or ;
dryness and sagging skin are characteristic signs of dehydration;
Possible severe anxiety when urinating, usually grunting before this;
crying for no reason;
Diarrhea may occur, and this often interferes with the diagnosis. Then pyelonephritis may be mistaken for an intestinal infection.

Symptoms of the acute form of the disease

Acute pyelonephritis in children is characterized by the presence of a number of symptoms.

temperature rise to 38.1 degrees, sometimes higher;
drowsiness, lethargy;
gray or pale skin tone, characteristic blue under the eyes;
nausea, possible vomiting;
deterioration or complete loss of appetite;
painful sensations in the lower back or abdomen, which may intensify with changes in body position; when warming up, the intensity of pain decreases;
there may be a disturbance in the process of urination or accompanying pain;
in the morning, mild swelling of the eyelids and face;
visible changes in the urine, in particular cloudiness, and a possible bad odor.

Signs of chronic pyelonephritis

Symptoms of this condition may include the following:

painful sensations in the back and abdomen;
hyperthermia;
symptoms of intoxication;
poor urine values;
fast fatiguability;
if the child is in school - a decrease in academic performance;
the chronic form at an early age can be characterized by delayed psychomotor as well as physical development.

Diagnostics

Parents should understand that at a young age it is difficult for a child to interpret his feelings. In addition, the disease can be latent, that is, without visible manifestations. Diagnostics includes the following procedures and studies:

collection of complaints and personal examination of the patient;
palpation of the abdomen to check for pain;
diuresis control;
clinical analysis of urine and blood;
determination of urine acidity level;
biochemical examination of blood and urine;
urine analysis according to Nechiporenko, Zimnitsky, Amburge;
antibiogram based on urine culture results;
Doppler ultrasound of kidney blood flow;
excretory urography;
analysis of urodynamic studies;
scintigraphy of excretory organs;
renal angiography;

Just don’t be intimidated by the long list of various tests. Not all tests will be necessary to diagnose your child, and many of them are generally prescribed in very rare cases and only when seriously necessary.

Pyelonephritis and urine analysis

To confirm the diagnosis, many urine tests are performed. So, the following indicators will indicate that this disease is really present:

neutrophil growth - more than 50%;
bacteriuria, microbial bodies exceed one hundred thousand per milliliter;
The density and osmolarity of urine decreases significantly, namely, less than 800 mOsmol per liter;
proteinuria with an indicator of less than 1 gram per liter.

Possible complications

Hemodialysis is an integral procedure for renal failure

Lack of proper treatment for the acute form of the disease can lead to two main consequences:

transition to a chronic form;
development of a purulent abscess.

If we consider chronic pyelonephritis in children, then in the absence of proper treatment, this condition can cause the development of more serious health problems, in particular, lead to tissue necrosis or sclerosis.

The chronic form of the disease can provoke the development of:

kidney failure, which will require regular dialysis and, possibly, organ transplantation;
arterial hypertension;
hydronephrosis, which will lead to a deterioration in the normal function of the excretory organs.

Treatment

Strict adherence to bed rest

The acute form of the disease requires hospitalization. Only with constant monitoring by medical personnel can it be possible to correctly assess the dynamics of the child’s condition, his tests, and conduct additional studies in a timely manner, selecting the necessary medications and procedures.

Treatment of pyelonephritis in children includes complex therapy.

Observance of strict bed rest, as recovery progresses, physical activity increases.
Dietary nutrition, in order to reduce the load on the excretory organs and correct metabolic disorders, table number 5. Protein and plant foods are recommended.
Taking antibiotics. Initially, a broad-spectrum drug is prescribed; after additional studies, those sensitive to this microorganism are prescribed.
Uroantiseptics are prescribed to disinfect the urinary tract.
Antispasmodics.
Antipyretics.
Non-steroidal anti-inflammatory drugs.
Vitamin therapy, with particular emphasis on beta-carotene and vitamin E.
Taking herbal medicines.

Treatment of the chronic form also requires inpatient treatment, and adherence to the same recommendations as for the acute course of the disease. After recovery it is recommended:

taking anti-relapse drugs;
course of antibiotic treatment;
taking uroseptics;
phytotherapy.

Children who have been diagnosed with pilonephritis are registered with a neurologist and pediatrician, and they are recommended for routine examination.

Prevention

Remember that the disease can be prevented by following simple rules.

Make sure that your baby goes to the toilet regularly and does not experience urine retention in the body.
Compliance with personal hygiene rules.
Regular bowel movements.
Prevention of dysbacteriosis.
Maintaining proper drinking regime.
Timely and adequate treatment of inflammatory diseases of the genitourinary system.
Conducting an ultrasound examination of organs in children under one year of age in order to identify anomalies in the anatomical structure.

Now you know what the signs of pyelonephritis in children are, as well as methods of treating this disease. Remember that you can prevent illness by taking proper precautions. Do not self-medicate, do not forget about the possible consequences. Contact a specialist in a timely manner at the slightest suspicion of any deviation.