Urinary tract infection in children. Urinary tract infections in children. Causes, symptoms, treatment and prevention. General urinary analysis

Urinary tract infection (UTI) is a common pathology of childhood, in which one or several sections of the urinary system are involved in the inflammatory process.

UTI is a collective term. This concept includes inflammation of the mucous membrane of the bladder (cystitis), and inflammation of the urethra (urethritis), and inflammation of the pyelocaliceal system of the kidney (pyelitis). Some scientists mean by the term UTI and inflammation of the kidney tissue itself (pyelonephritis).

Clinical manifestations

Urinary tract infection in young children usually manifests (begins to manifest itself) with unreasonable rises in temperature, lethargy, capriciousness. Children sleep worse, sleep becomes superficial. The process of urination is often accompanied by a sharp cry of the child.

Symptoms of urinary infection in older children are more varied. Among them, dysuric symptoms often come to the fore: frequent, painful urination, nocturia (the predominance of nighttime urine volume over daytime). Often there is urinary incontinence, both nocturnal and daytime, as well as imperative (false) urge to urinate.

Pain localization that occurs with UTI depends on the topic of the inflammatory process. With a bladder infection, children complain of pain in the lower abdomen, with urethritis, the pain syndrome is localized at the level of the genital organs, with the involvement of the inflammatory process of the kidney tissue, there is a pulling pain in the side, less often in the abdomen.

With a pronounced infectious process, dysuric symptoms of genitourinary infection in children are often dominated by intoxication phenomena: weakness, reduced concentration, deterioration in performance, fever, increased sweating.

Causes and ways of development

The causative agents of the disease can be many infectious agents: bacteria (Klebsiellaspp., Enterobacterspp., Proteusspp.), viruses, fungi. In most cases, representatives of the intestinal microflora (more often E. coli, enterococci) act as a causative factor.

Pathogenic microorganisms can enter the lesion in three ways.

1. Hematogenous: through the blood

This route of infection is predominant in young children. The main infectious focus in such cases is located outside the urinary system. A child, for example, can suffer pneumonia or purulent omphalitis (inflammation of the navel), while the pathogen enters the urinary organs with the blood stream.

2. Lymphogenic pathway

The causative agent enters the focus of inflammation with a current of lymph.

3. Ascending path

The infectious agent enters through the external genitalia. Especially often the ascending path of development of infection of the genitourinary system in children occurs in girls, which is associated with the anatomical features of the female genital organs.

Diagnostics

Diagnosis is based on the patient's complaints, a characteristic clinical picture. The child may have a change in the transparency of urine. It becomes cloudy, in some cases it resembles pus.

In the general analysis of urine, an increased content of leukocytes is noted (over 5 Le in one field of view in boys and more than 10 Le in one field of view in girls). When the upper urinary system is affected, leukocyte casts, which are glued leukocytes, as well as epithelial cells, can be detected in the urine. During bacteriological culture, colonies of bacteria are sown, the number of which is estimated from one to four crosses.

Rules for collecting a general urine test

If there are signs of a genitourinary infection in children, it is important that the urinalysis is collected correctly. Otherwise, the diagnosis may be erroneous, and the child is in vain susceptible to serious treatment.

A general urine test is collected in the morning, in a dry disposable container purchased from a pharmacy. For analysis, an average portion of urine is taken, and it is collected only after preliminary hygiene of the external genitalia. It is important to wash girls in the anteroposterior direction so as not to bring an additional infection from the anus into the vagina. In boys, the head of the penis should be well washed. Hygiene procedures are required to be carried out with the obligatory use of soap or specialized care products. The collected urine must be delivered to the laboratory for analysis within the next one and a half hours. If these conditions are not met, the laboratory assistant can detect not only leukocytes in large numbers, but also a considerable number of pathogenic bacteria in the urine obtained.

Also, infection in the urine in children is confirmed by the results of urinalysis according to Nechiporenko (in this case, an increase in the number of leukocytes over 4 million will be detected in 1 ml of urine) and the results of urinalysis according to Addis-Kakkovsky (leukocyturia more than 2,000,000 units will be detected in daily urine).

All in all blood test all specific signs of inflammation are detected: leukocytosis, a shift in the leukocyte formula towards young cell forms, an increase in the erythrocyte sedimentation rate.

At ultrasound examination urinary organs often reveal anatomical or functional anomalies, which are the main predisposing factor in the pathogenesis (appearance and progression) of the disease. Among the anatomical changes in children, doubling (triple) of the pyelocaliceal system of the kidney, hypoplasia (underdevelopment) of the renal structures, complete aplasia of the kidney (its absence), doubling of the ureter, congenital pyelectasis (expansion of the renal pelvis) are more often diagnosed than others. Functional abnormalities include the presence of vesicoureteral reflux, in which there is a disturbed outflow of urine, acquired pyelectasis, dysmetabolic nephropathy (metabolic disorders in the kidneys).

In some cases, local diagnosis can be determined by uro- and cystography, nephroscintigraphy.

Treatment

With severe symptoms of intoxication, high temperature, bed rest is mandatory. All highly extractive foods are excluded from the child's diet: smoked, salted, fried, spicy. Food should be steamed or boiled. The drinking regime is expanded by 50% compared to the age norm. The use of alkaline drinks is recommended: non-carbonated mineral water "Smirnovskaya", "Essentuki 20", pear juice, dried apricot compote.

With a slight leukocyturia (a slight increase in the level of leukocytes in the urine) and the absence of significant bacteriuria (the number of bacterial microorganisms is less than 100,000 in 1 ml of urine), it is possible to normalize the child's condition without the use of antibacterial drugs. In this case, he is prescribed uroseptics (for example, furagin, furamag, nitrofurantoin), herbal medicines that sanitize the organs of the urinary system (canephron, cystone).

With severe leukocyturia, bacteriuria in 3-4 crosses, impaired general condition of the child (weakness, high fever), he needs treatment in a hospital. It is possible to carry out infusion therapy. Before obtaining the results of urine culture for the pathogen and determining its sensitivity to antibiotics, the child must be prescribed broad-spectrum antibacterial drugs (protected penicillins: amoxiclav, amoxicillin, augmentin; 3-4 generation cephalosporins: cefotaxime, ceftriaxone, cefoperazone; aminoglycosides: gentamicin, netromycin, amikacin ; less often macrolides). Antibiotics are prescribed for a period of 10–14 days with parallel sanitation of the focus of infection with uroseptics, which are used for a long time in the treatment of genitourinary infections in children, usually for 3–4 weeks.

To eliminate pain during urination, the patient at the initial stages of therapy may be recommended antispasmodics (no-shpa, spasmalgon). Throughout the treatment, it is advisable to take specialized herbal teas (for example, Uroflux), as well as herbal medicinal preparations.

If a certain anatomical anomaly contributed to the development of UTI (for example, narrowing of the mouth of one of the ureters), then its surgical correction is necessary. In such situations, frequent courses of conservative therapy are inappropriate, and the development of relapses (reappearance of symptoms) subsequently becomes inevitable.

• instill in the child the necessary hygiene skills;
• carry out a general strengthening of the body: spend more time walking in the fresh air, hardening.
• undergo regular dispensary (preventive) examinations prescribed by the attending physician, with the obligatory delivery of laboratory tests;
• course intake of multivitamins twice a year (spring and autumn);
• timely treatment of intestinal diseases, including mandatory treatment and prevention of helminthiases (worm infestation);
• avoid hypothermia;
• prevent the appearance of diaper rash of the external genitalia and inguinal folds in young children;
• conduct periodic "briefing" of older girls about the possible adverse consequences of promiscuity;
• carry out periodic anti-relapse therapy, usually 2-3 times a year, strictly according to the recommendations of the attending physician.

Infection of the genitourinary system is a common pathology in children, but with timely and correct treatment, it responds well to therapy with modern drugs. In some patients who had a UTI in childhood, the symptoms of the disease never recur later in life. In some cases, the infection becomes chronic and at the slightest provocation (non-compliance with proper hygiene, hypothermia, decreased immunity in the autumn-winter period) becomes aggravated again.

UTI prevention

A bacterial infection of the organs that produce, store, and excrete urine is called a urinary tract infection. This term is a general concept denoting a group of inflammatory processes in various parts of the urinary tract.

When the lower section is infected, urethritis (inflammation of the urethra) and cystitis develops (the process affects the mucous walls of the bladder), the upper one develops pyelonephritis (inflammation of the renal tubules) and pyelitis (the renal pelvis is affected).

These ailments can occur in every person at any age. However, few people know the fact that the prevalence of urinary tract infection in children is second only to SARS.

According to statistics, the presence of this type of infectious and inflammatory processes has a history of every eighth child of one year of age. Also, not all parents know that this pathological condition can occur without pronounced specific signs, but have severe and complex consequences.

In our article, we want to describe the causes and circumstances that contribute to the infection of the urinary tract in babies, the main clinical symptoms of ailments, effective methods for diagnosing and treating these pathological processes.

Factors predisposing to the development of UTIs in children

The prevalence of bacterial lesions of the urinary tract depends on the sex and age of the child: for example, among children under one year old, boys get sick more often, girls get sick from 2 to 15 years of age.

Urinary tract infection occurs as a result of a disorder in the coordinated processes of urine excretion. from the child's body (urodynamics) due to:

• obstructive uropathy - a pathological condition characterized by blocking the outflow of urine and leading to kidney damage;
• vesicoureteral reflux - the return of the flow of urine through the ureter from the bladder to the kidney;
• neurogenic bladder dysfunction - disorders of filling and emptying the bladder.

Another reason is metabolic disorders and development:

• diabetes;
• urolithiasis;
• nephrocalcinosis (calcareous degeneration);
• hyperuraturia (increased formation of urates);
• hyperoxalaturia (accumulation of large amounts of oxalates).

Other reasons:

• the severity of the harmful properties of microbes - the presence in the child's body of certain pathogenic serotypes;
• features of a specific reaction of the immune system - insufficient production of antibodies, a decrease in cellular immunity;
• vascular changes in the tissues of the kidneys - vasoconstriction (narrowing of the lumen of the arteries), ischemia (local decrease in blood flow);
• instrumental manipulations on the organs of the urinary system.

The main causes of childhood urinary tract infection

Pathogenic bacilli can enter the child's urinary tract with the circulating blood stream in the presence of an inflammatory process in the child's body and from the environment with insufficient or incorrect hygiene requirements.

The bacterial flora that causes the infectious and inflammatory process depends on the general state of immunity, intestinal microbiocenosis, conditions of infection, age and sex of the crumbs.

The causative agents of inflammation of the urinary system in the child's body are enterobacteria, Escherichia coli (E.coli), saprophytic and golden staphylococci (Staphylococcusaureus, S.Saprophyticus), Klebsiella (Klebsiellaspp)

Additional circumstances that provoke microbial damage include:

• anatomical features of the development of the urinary system;
• congenital anomalies of the excretory organs, predetermined by complications during childbirth or during pregnancy;
• hypothermia of the child's body;
• weak immunity;
• hereditary predisposition - the presence of chronic UTIs in parents;
• the presence of phimosis in boys (narrowing of the opening of the penis);
• synechia (fusion of the tissues of the labia) in newborn girls;
• diseases of the digestive tract - constipation, dysbacteriosis, colitis, intestinal infections.

It has been observed that in boys who have undergone a circumcision procedure (circumcision of the foreskin), cases of urinary tract infection are 5-8 times less common than in "uncircumcised".

How does a urinary tract infection manifest in a child?

Clinical signs of an infectious-inflammatory disease depend on its localization and the severity of the pathological process. In childhood, asymptomatic bacteriuria, cystitis and pyelonephritis most often develop.

Urinary tract infection in infants is manifested by:

• decreased sucking reflex;
• loss of appetite;
• irritable behavior;
• frequent regurgitation;
• diarrhea
• gray color of the skin - the result of intoxication;
• no weight gain.

Very often, the only symptom of a urinary tract infection is a child's fever.

signs asymptomatic bacteriuria most commonly seen in girls. This type of UTI is not accompanied by characteristic clinical manifestations, parents notice a change in the color, smell and transparency of urine. It is possible to detect the presence of microbes only with the help of laboratory tests of urine.

Manifestations of cystitis are characterized by the presence of a child:

• dysuric disorders - painful frequent urination in small portions, possibly urinary incontinence;
• tension and pain in the suprapubic area;
• subfebrile temperature.

A nursing baby will express anxiety associated with urination, crying. At the same time, he has a weak and intermittent urine stream.

The course of pyelonephritis in children is manifested:

• temperature rise to 39°C;
• chills;
• loss of appetite;
• pale skin;
• lethargy;
• diarrhea
• vomiting;
• symptoms of primary infectious encephalopathy (neurotoxicosis);
• phenomena of irritation of the meninges;
• pain in the abdomen and lower back.

In young children, urinary tract infections often hide under the guise of dyspepsia, irritable bowel syndrome, primary pylorospasm (contraction of the muscles of the pylorus of the stomach), at an older age - a flu-like condition

Diagnosis of UTI in children

The insidiousness of an infectious lesion of the urinary system lies in the rapid development of the inflammatory process. Delayed treatment leads to serious consequences.

For example, untreated cystitis turns into pyelonephritis within a few days, and this threatens the functional activity of such important organs as the kidneys. That is why the timely diagnosis of these diseases in a child is very important.

The severity of a urinary tract infection in a child should be assessed by a qualified specialist - a pediatrician, pediatric urologist or nephrologist

The diagnosis is made on the basis of a comprehensive examination, including:

1. Clinical analysis of urine - the appearance in the urine of protein, erythrocytes, a large number of leukocytes and bacteria indicates the presence of inflammation.
2. Evaluation of specific urine samples according to the method of Zimnitsky and Nechiporenko - these tests are carried out for a more detailed study of the main indicators of urine.
3. A general clinical blood test - the presence of high ESR parameters and neutrophilic leukocytes indicates the development of an inflammatory process in the child's body.
4. Bacteriological analysis of urine is the basis for diagnosing urinary tract infections. With its help, the exact type of the causative agent of the inflammatory process is established, the degree of bacteriuria and susceptibility to antibacterial drugs is assessed.
5. Serological blood test - this screening technique is used to detect the presence in the child's body of immune antibodies to certain types of pathogenic microorganisms that provoke urinary tract infection - chlamydia, mycoplasmas, ureaplasmas.
6. Ultrasound of the kidneys and bladder - these methods allow you to study the state of organ tissues and identify abnormalities in their development.
7. Cystomanometry is an invasive research method that allows to detect violations of urodynamics and bladder function.
8. Uroflowmetry, which allows you to record the rate of outflow of urine during natural urination - it is performed to detect abnormalities of the urinary tract.

Endoscopic methods (cysto- and ureteroscopy) in children are used only for chronic UTI and are carried out in the phase of weakening of clinical manifestations.

Methods of treatment of infectious and inflammatory processes in the urinary tract in children

Treatment of a urinary tract infection begins with a course of antibiotic therapy.

In modern pediatric urological practice, preference is given to such drugs as:

1. Inhibitor-protected penicillins are drugs that include an antibacterial agent and β-lactamase (a substance that blocks the microbial element): Amoxicillin, Ampiside, Augmentin.
2. Aminoglycosides - antibiotics that have a bactericidal effect (Amikacin, Isepamycin).
3. Cephalosporins belonging to one of the most effective groups of antibacterial drugs (Ceftriaxone, Cefotaxime).
4. Carbapenems are a reliable treatment for severe infections, they are broad-spectrum β-lactam antibiotics (Imipenem, Meropenem).
5. Herbal uroantiseptics are the most common agents for the treatment of asymptomatic bacteriuria and uncomplicated infections of the lower urinary tract (Furazidin, Urolesan, Canephron).
6. Oxyquinolines are sparing effective antimicrobial agents that can be rapidly absorbed in the intestine (Nitroxoline, Nitrofuratoin).

Also shown to be used:

• non-steroidal anti-inflammatory drugs - Ibuprofen, Nimesulide;
• desensitizing drugs - Loratadine, Clemastine;
• antioxidants - substances that promote healing and cell renewal: vitamin E, Miksedol, Viferon.

The child should drink plenty of fluids - slightly alkaline mineral water without gas, cranberry juice, lingonberry juice.

In addition to drug therapy, the child must follow a special diet - with urinary tract infections, the use of spicy, sour, spicy, fried and salty foods is prohibited

After the acute period of the inflammatory process subsides, children are recommended:

• coniferous baths;
• mud treatment;
• physiotherapy sessions - electrophoresis, UHF, applications with ozocerite and paraffin.

In infectious and inflammatory diseases of the urinary organs, in addition to taking medications, children need to take herbal teas.

The most effective means of herbal medicine for infectious and inflammatory processes in the urinary tract are decoctions of chamomile, knotweed, corn stigmas, helichrysum - in addition to anti-inflammatory action, they also have detoxification properties

Preventive measures

Advanced forms of infections of the excretory system in children lead to irreversible damage to the parenchymal tissue of the kidneys, their wrinkling, the development of arterial hypertension, renal failure and sepsis.

Relapses of inflammatory processes occur in 25% of cases. That is why a child who has had an infectious lesion of the urinary tract is under the supervision of a pediatric nephrologist. Such children undergo prophylactic treatment with antibacterial and uroseptic drugs.

Primary preventive measures include:

• breastfeeding - this product contains immune antibodies necessary to protect the child's body from infections;
• proper use of diapers and diapers;
• instilling hygiene habits in a child;
• rehabilitation of foci of chronic infection;
• maintaining immunity;
• organization of the correct daily routine;
• elimination of factors that have a negative impact on the health of the baby - hypothermia, the use of synthetic underwear and alkaline soap, etc.

I would also like to add that a preventive examination of the crumbs, namely, the delivery of urine and blood tests, can prevent the development of many pathological processes in the child's body. Caring parents should not neglect these types of research.

In this article:

According to statistics, urinary tract infections in children rank second after viral respiratory diseases. This problem is especially relevant in children under one year old. As a rule, it proceeds without any pronounced symptoms, but can have very serious consequences.

Very often, doctors do not detect urinary tract infections in children in time, as they can disguise themselves as nausea, abdominal pain, vomiting, and even signs of acute respiratory infections.

Due to the peculiarities of the child's body, it spreads quite quickly and can cause inflammation of the kidneys - pyelonephritis. And it is dangerous by the possibility of not restoring their functions in the previous mode after the disease. Further, if you skip the inflammation of the kidney, do not eliminate it in time, there will be kidney failure, and, as a result, the inferiority of the body, that is, disability.

Causes of the disease

The diversity of the microbial flora that causes urinary tract infections in children depends on the sex and age of the child, as well as on the state of his immune system. Among bacterial pathogens, enterobacteria are in the lead, in particular Escherichia coli - in almost 90% of cases, as well as other pathogenic microorganisms.

The incidence of urinary tract infections in children depends on the sex and age of the child. More often this pathology occurs in girls due to the anatomical structure of the organs of the urinary system: proximity to the vagina and intestines, shorter urethra. In girls, the peak incidence occurs at the age of 3-4 years. But in infancy, boys are more likely to get sick, especially under the age of 3 months. The causes of genitourinary infections in children in this case are usually caused by anomalies in the development of the genital organs, as well as the use of diapers and poor hygiene.

The infection can get in the following ways:

1. through the urethra to the bladder and kidneys;
2. from neighboring organs through the lymphatic system;
3. through the blood when it is infected.

Clinical symptoms of the disease

Manifestations and signs of genitourinary infection in children of the disease depend on the age of the child. After two years, the presence of a urinary tract infection may be indicated by:

• painful urination, burning sensation and pain;
• dark color of urine, the presence of blood in it;
• frequent urge to empty the bladder (in this case, urine is excreted in small portions);
• pain in the lower abdomen, suprapubic area, back and lower back;
• high body temperature (above 38 degrees).

Before the age of two years, the presence of a urinary tract infection in children is indicated by one of the following symptoms:

1. Feverish state;
2. Vomiting and diarrhea;
3. Irritability, capriciousness and tearfulness;
4. Changing the color of urine and its sharp, unpleasant odor;
5. Skin blanching and weakness;
6. Lack of appetite and even refusal to eat.

Diagnosis of urinary tract infections

If you suspect that the child has this disease, you should consult a doctor in the next day. If you delay, then there is a risk of inflammation of the kidneys. The fact of the presence of the disease is confirmed by a general urine test. If an infection is detected in the urine in children, it is advisable to take a culture for the pathogen and determine its sensitivity to antibiotics. This is necessary for an adequate, correct choice of prescribing an antimicrobial drug.

Imaging diagnostic methods

These methods include ultrasound and x-rays, they allow the doctor to see the structure of the urinary system and its organs, to detect defects and anomalies in it. These diagnostic methods are not assigned to all children, but only at the age of 3-5 years and with re-infection. Imaging methods include:

• Ultrasound examination of the kidneys. A method that is quite safe for a child, which, using ultrasound rays, displays the state of an organ on a monitor and makes it possible to judge its structure.
• X-ray. It will help to analyze the condition of the organs in the abdominal cavity and behind the peritoneum. Before the procedure, it is advisable to give the child a cleansing enema.
• Cystourethrography. For analysis, a contrast agent is introduced into the bladder using a catheter, through which the rays do not pass. Cystourethrography allows you to see the contours of the bladder and urethra. This takes two pictures. One with a full bladder. The other is directly during urination. The first picture allows you to determine the presence of passive and the second - active reflux, that is, the return of urine into the ureter, which should not normally be. With this procedure, the second phase in children often fails, but even one picture can be very important.

If a sufficiently serious pathology of the urinary tract is suspected in a child, intravenous urography can be performed in a hospital. A contrast agent is injected into a vein, filtered by the kidneys, and the whole process is recorded by a series of x-rays. This method allows a very detailed examination of the structure of the urinary tract and partly of the kidneys. And in order to qualitatively display the function of the kidneys, it is necessary to perform scintigraphy. In this case, not a contrast agent is injected into the vein, but a radioactive isotope.

A rather painful method is cystoscopy, which is indicated only in case of damage to the bladder, the presence of stones, tumors in it, or determining the volume of surgical intervention.

Differential Diagnosis

Bladder infection in children can be similar to other diseases from which it must be distinguished:

1. Vulvovaginitis in girls. With this disease, fever, itching, and changes in the urine are also noted. However, the inflammatory process with it does not affect the genitourinary tract, but affects the vestibule of the vagina and the vagina.
2. Urethritis. Inflammation of the urethra or its irritation with various chemical components that make up soap, shampoo, washing powder. As a rule, it does not require specific treatment and disappears on its own after a few days.
3. Worm invasion. Pinworm infestation will cause itching, irritation, and changes in urine composition. To identify, a scraping of the anal area is taken and it is advisable to repeat it three times.
4. Balanitis. It is manifested by inflammation of the vestibule of the vagina in girls and the foreskin in boys. The doctor will determine the differences during a visual examination.
5. appendicitis. Acute pain in the lower abdomen with inflammation of the appendix can also be mistaken for inflammation of the urinary tract. This is another reason not to delay a visit to the doctor.

Disease classification

In children, urinary tract infections are classified as either primary or recurrent. Recurring are divided into groups:

• Unresolved infection as a result of the selection of non-optimal doses of antibiotics, non-compliance with the established treatment regimen, malsorption syndrome, drug-resistant pathogen.
• Persistence of the pathogen, which will require medical or surgical intervention, as a persistent focus is formed in the urinary tract.
• Reinfection, in which each episode is a new infection.

From a clinical point of view, urinary infection in children is divided into severe and non-severe.

Treatment of urinary tract infections

All measures aimed at treating genitourinary infections in children should be selected individually, depending on age and only by a doctor. Children under 2 years of age, as a rule, are treated inpatiently, as parenteral administration of antibiotics and diffuse therapy are necessary. Bed rest is necessary for severe fever and pain.

To reduce the load on the renal tubules and mucous membranes, frequent feeding of the child is recommended - 5-6 times a day. If impaired renal function is detected, salt and fluid restriction is recommended. In nutrition, preference is given to protein and plant foods, as well as dairy products. From the diet it is necessary to exclude products that irritate the mucous membrane of the urinary tract: canned food, marinades, spices and fried foods. It is also desirable to limit foods with a high content of acids: citrus fruits, tomatoes, pomegranates, kiwi, grapes, sweet peppers, pickled and salted vegetables.

When the pain syndrome is eliminated, it is necessary to drink plenty of fluids to prevent irritation of the mucous membranes of the urinary tract from exposure to urine, remove microorganisms and waste products of toxins.

Antimicrobial drugs are considered the main method of eliminating infection. The antibiotic and optimal, adequate doses are selected taking into account the type of pathogen and its sensitivity, as well as the age of the child. They must be nephrotoxic, the duration of administration is from 7 to 14 days. Sometimes treatment is supplemented with uroantiseptics, and probiotics are recommended to prevent disturbance of the intestinal microflora.

Prevention of urinary tract infections in children

Preventive measures will avoid primary, and in some cases, secondary infection:

1. It is advisable to continue breastfeeding as long as possible, at least 6-7 months. According to doctors, this will protect a child up to two years from the occurrence of urinary tract infections.
2. When introducing complementary foods, give as many vegetables, fruits, and whole grains as possible, which prevent constipation.
3. Try to make food varied, introduce vitamins and minerals into the diet for the normal development of organs and systems.
4. Timely respond to manifestations of capriciousness and tearfulness in infancy, as the child cannot tell about his condition.
5. At any age, it is necessary to ensure that a sufficient amount of water enters the child's body, which will not allow congestion in the kidneys to develop.
6. It is also very important to adhere to the rules of personal hygiene, especially for girls. When bathing, it is advisable to use not soap and shampoo, but special soft gels. It is necessary to wash the genitals daily and also change underwear regularly.
7. If possible, thoroughly wipe the genital area, perineum after changing the diaper.
8. In case of temperature fluctuations of the disease, protect the child from hypothermia.
9. In the first months of life, closely monitor the development of the child. In case of detection of anomalies of the genital organs or abnormal functioning of the urinary tract, consult a doctor.

If cases of infection have already been observed, it is advisable to take herbal remedies for a long time to prevent relapses. These are medicinal preparations, which include herbs with anti-inflammatory and diuretic effects. It is advisable to take them under the supervision of a doctor, as some of them are quite strong biologically active substances. In any case, you should not prescribe them to the child yourself.

After the course of treatment, the doctor must prescribe control tests. Maintenance therapy with antibiotics at the optimal dose and schedule may be needed.

Useful video about urinary tract infections

Interstitial cystitis (CHRONIC), Infection of the urinary tract without known localization (N39.0), Acute tubulointerstitial nephritis (N10), Acute cystitis (N30.0), Pyonephrosis (N13.6), Chronic tubulointerstitial nephritis (N11)

Nephrology for children, Pediatrics

general information

Short description

Union of Pediatricians of Russia

ICD 10:

N10/ N11/ N13.6/ N30.0/ N30.1/ N39.0

Definition

Urinary tract infection (UTI)- growth of bacteria in the urinary tract.

Bacteriuria- the presence of bacteria in the urine (more than 105 colony-forming units (CFU) in 1 ml of urine) isolated from the bladder.

Asymptomatic bacteriuria is called bacteriuria, detected during a dispensary or targeted examination in a child without any complaints and clinical symptoms of a disease of the urinary system.

Acute pyelonephritis t - an inflammatory disease of the renal parenchyma and pelvis, resulting from a bacterial infection.

Acute cystitis- inflammatory disease of the bladder, bacterial origin.

Chronic pyelonephritis- kidney damage, manifested by fibrosis and deformation of the pelvicalyceal system, as a result of repeated attacks of urinary tract infection. As a rule, it occurs against the background of anatomical anomalies of the urinary tract or obstruction.

Vesicoureteral reflux (VUR) retrograde flow of urine from the bladder to the ureter.

Reflux nephropathy- focal or diffuse sclerosis of the renal parenchyma, the root cause of which is vesicoureteral reflux, leading to intrarenal reflux, repeated attacks of pyelonephritis and sclerosis of the renal tissue.

Urosepsis- a generalized nonspecific infectious disease that develops as a result of the penetration of various microorganisms and their toxins from the organs of the urinary system into the bloodstream.

Classification

ICD-10 coding

Acute tubulointerstitial nephritis (N10);

Chronic tubulointerstitial nephritis (N11);

N11.0 Non-obstructive chronic pyelonephritis associated with reflux;

N11.1 - Chronic obstructive pyelonephritis;

N11.8 - Other chronic tubulointerstitial nephritis;

N11.9 - Chronic tubulointerstitial nephritis, unspecified;

N13.6 - Abscess of the kidney and perirenal tissue;

N30.0 - Acute cystitis;

N30.1 - Interstitial cystitis (chronic)

N39.0 - Infection of the urinary tract without established localization.

Classification

1. By the presence of structural anomalies of the urinary tract

Primary - without the presence of structural abnormalities of the urinary tract

Secondary - against the background of structural anomalies of the urinary tract

2. By localization

Pyelonephritis (with damage to the renal parenchyma and pelvis)

Cystitis (if the bladder is affected)

Urinary tract infection without established localization

3. By stage

active stage

remission stage

Examples of diagnoses

Acute pyelonephritis, active stage. Kidney functions are preserved.

Urinary tract infection, 1 episode, active stage. Kidney functions preserved

Urinary tract infection, recurrent course, active stage. Kidney functions are preserved.

Reflux nephropathy. Secondary chronic pyelonephritis. remission stage. Kidney functions are preserved.

Acute cystitis, active stage. Kidney functions are preserved.

Etiology and pathogenesis

Among the causative agents of urinary tract infections in children, gram-negative flora predominates, with about 90% of infection with Escherichia coli bacteria. Gram-positive microorganisms are represented mainly by enterococci and staphylococci (5-7%). In addition, nosocomial infections are isolated with strains of Klebsiella, Serratia and Pseudomonas spp. In newborns, streptococcus groups A and B are relatively common causes of urinary tract infections. Recently, there has been an increase in the detection of Staphylococcus saprophyticus, although its role remains controversial.

Currently, more than half of the E. coli strains in UTIs in children have become resistant to amoxicillin, but remain moderately sensitive to amoxicillin/clavulanate.

Among the many factors that cause the development of urinary tract infections, the biological properties of microorganisms colonizing the renal tissue and urodynamic disorders (vesicoureteral reflux, obstructive uropathy, neurogenic bladder dysfunction) are of priority importance.

The most common route of infection is ascending. The reservoir of uropathogenic bacteria is the rectum, perineum, lower urinary tract.

The anatomical features of the female urinary tract (short wide urethra, the proximity of the anorectal region) cause a high incidence and recurrence of UTIs in girls and girls.

In the ascending pathway of the spread of urinary tract infection, after the bacteria have overcome the vesicoureteral barrier, they multiply rapidly with the release of endotoxins. In response, the local immunity of the macroorganism is activated: activation of macrophages, lymphocytes, endothelial cells, leading to the production of inflammatory cytokines (IL 1, IL 2, IL 6, tumor necrosis factor), lysosomal enzymes, inflammatory mediators; lipid peroxidation is activated, which leads to damage to the renal tissue, primarily to the tubules.

The hematogenous pathway for the development of urinary tract infection is rare, typical mainly for the neonatal period with the development of septicemia and in infants, especially in the presence of immune defects. This pathway is also found in infection with Actinomyces species, Brucella spp., Mycobacterium tuberculosis.

Epidemiology

The prevalence of UTI in childhood is about 18 cases per 1000 children. The incidence of UTI depends on age and sex, with children in the first year of life suffering more often. In infants and young children, UTI is the most common severe bacterial infection, occurring in 10-15% of hospitalized febrile patients of this age. Before the age of 3 months, UTI is more common in boys, at an older age - in girls. At primary school age: 7.8% for girls and 1.6% for boys. With age after the first episode of UTI, the relative risk of recurrence increases.

Recurrence rate:

Girls:

30% within 1 year after the first episode;

50% within 5 years of the first episode;

Boys - 15-20% within 1 year after the first episode.

Diagnostics

Complaints and anamnesis

In newborns and infants: fever often up to febrile figures, vomiting.

In older children: temperature rises (usually to febrile numbers) without catarrhal phenomena, vomiting, abdominal pain, dysuria (frequent and / or painful urination, imperative urge to urinate).

Physical examination

During a physical examination, it is recommended to pay attention to: pallor of the skin, the presence of tachycardia, the appearance of a symptom of dehydration (mainly in newborns and infants), the absence of catarrhal phenomena in the presence of fever (often to febrile numbers, less often subfebrile), a sharp smell of urine, in acute pyelonephritis - a positive symptom of Pasternatsky (soreness when tapped or, in young children, when pressed with a finger between the base of the 12th rib and the spine).

Laboratory diagnostics

As a diagnostic method, it is recommended to conduct a clinical urinalysis with a count of the number of leukocytes, erythrocytes and the determination of nitrates.

Comments: in children during a period of fever without symptoms of damage to the upper respiratory tract, a general urinalysis (determination of leukocyturia, hematuria) is indicated.

Comments: data from a clinical blood test: leukocytosis above 15x10 9 / l, high levels of C-reactive protein (CRP) (≥10 mg / l) indicate a high probability of a bacterial infection of the renal localization.

. It is recommended that if leukocyturia is detected more than 25 in 1 μl or more than 10 in the field of view and bacteriuria more than 100,000 microbial units / ml when cultured urine for sterility, the diagnosis of urinary tract infection is considered the most likely.

. It is not recommended to consider isolated pyuria, bacteriuria or a positive nitrate test in children under 6 months of age as signs of a urinary tract infection, since the listed indicators are not reliable signs of this pathology at this age.

Comment: Differential diagnostic criteria for acute cystitis and acute pyelonephritis are shown in Table 1.

Table 1 - Differential diagnostic criteria for acute cystitis and acute pyelonephritis

Instrumental diagnostics

Comment:Ultrasound diagnostics is the most accessible and common technique that allows you to assess the size of the kidneys, the state of the pelvicalyceal system, the volume and condition of the bladder wall, to suspect the presence of anomalies in the structure of the urinary system (expansion of the pelvicalyceal system (PCS), ureteral stenosis, etc. .), stones. To identify the above reasons, it is necessary to conduct an ultrasound examination with a full bladder, as well as after micturition.

Comment: In children with the 1st episode of UTI, voiding cystography reveals vesicourethral reflux (VUR) of the 3-5th stage. only in 17% of cases, 1-2 st. - in 22% of children, usually with changes in ultrasound.

Indications for cystography:

- all children under 2 years of age after a febrile episode of UTI in the presence of pathological changes on ultrasound (an increase in the size of the kidney, dilatation of the PCS) - in remission;

- recurrent UTI.

. Static nephroscintigraphy is recommended to be performed with a radiopharmaceutical DMSC (dimercaptosuccinic acid-DMSA) to detect foci of nephrosclerosis no earlier than 6 months after an acute episode.

Comments: Indications:

- UTI against the background of vesicoureteral reflux (1 time in 1-1.5 years)

- Recurrent course of UTI without structural anomalies of the urinary system (1 time in 1-1.5 years).

. Dynamic nephroscintigraphy with a micturition test is recommended to be performed with the 99mTs-Technemag radiopharmaceutical to detect vesicoureteral reflux, including a low degree. A voiding test study is performed in children who can control the process of urination.

Excretory urography, magnetic resonance urography (MR urography) - it is recommended to be performed as an auxiliary technique to detect obstruction, anomalies in the development of the organs of the urinary system (after excluding VUR).

Complications

Complications

1. In the absence of adequate treatment of acute urinary tract infection, urosepsis may develop;

2. With a recurrent course of urinary tract infection and / or the development of UTI against the background of VUR - the development of reflux nephropathy.

Patient management

If episodes of urinary tract infection recur more than 2 episodes in girls and more than 1 in boys, an examination is recommended to rule out VUR.

Comment: In the first 3 months of observation in acute pyelonephritis and after an exacerbation of chronic pyelonephritis, a general urine test is performed once every 10 days, within 1-3 years - monthly, then - 1 time in 3 months.

Urine culture is carried out with the appearance of leukocyturia more than 10 in p / sp and / or with unmotivated temperature rises without catarrhal phenomena.

A urine sample according to Zimnitsky, the determination of the level of blood creatinine is carried out 1 time per year.

Ultrasound examination of the kidneys and bladder - 1 time per year.

Repeated instrumental examination (cystography, radioisotope nephroscintigraphy) is performed once every 1-2 years in chronic pyelonephritis with frequent exacerbations and established VUR.

Vaccination within the framework of the National Immunization Schedule during the period of UTI remission.

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Treatment

Conservative treatment

Table 2 - Spectrum of antibacterial drugs used to treat UTIs in outpatients.

**It should be remembered that with a decrease in endogenous creatinine clearance of less than 50 ml / min, the dose of the drug is halved!

When prescribing an antibacterial drug, it is recommended to focus on the sensitivity of microorganisms.

. In VUR and recurrent UTI, long-term antimicrobial prophylaxis is recommended for an average of 3 to 12 months. .

In hospitalized patients, especially infants, who find it difficult to give the drug orally, it is usually recommended to start antibiotic therapy from the parenteral route of administration of the drug in the first three days (Table 3), followed by the transition to oral administration. In the absence of severe intoxication and the child's ability to receive the drug through the mouth, it is recommended to consider oral administration of the drug from the first day.

Table 3 - Antibacterial drugs for parenteral use

Forecast

The vast majority of cases of acute urinary tract infection end in recovery. Focal wrinkling of the kidneys is found in 10-20% of patients who have had pyelonephritis, especially with recurrent infection and the presence of vesicoureteral reflux. When VUR is detected at an early age (less than 2 years), cicatricial changes in the kidney after 5 years are found in 24% of cases, in older children - in 13% of cases. Thus, more active diagnosis and treatment at an early age reduces the risk of progression to the stage of chronic renal failure. Arterial hypertension develops in 10% of children with reflux nephropathy.

Hospitalization

Indications for hospitalization

1. Children of early age (less than 2 years old);

2. The presence of symptoms of intoxication;

3. Inability to perform oral rehydration in the presence of signs of dehydration;

4. Bacteremia and sepsis;

5. Recurrent course of UTI to exclude its secondary nature and selection of adequate anti-relapse treatment.

Comment: The length of stay in the hospital for UTI is 10-14 days. In the absence of these indications, medical care for children with a urinary tract infection can be carried out on an outpatient basis or a specialized day hospital.

Prevention

Prevention and dispensary observation

Regular emptying of the bladder and bowels

Sufficient fluid intake

Hygiene of the external genital organs

The presence of vesicoureteral reflux 2-5 st.;

Recurrent infections of the urinary tract;

Severe anomalies in the development of the urinary tract before surgical correction.

Comments:The duration of prophylaxis is selected individually, usually at least 6 months. Drugs used for long-term antimicrobial prophylaxis are listed in Table 4.

Table 4 - Drugs used for long-term antimicrobial prophylaxis

Additionally, in some cases, it is recommended to use herbal medicine with a bactericidal effect.

. It is recommended to consult a pediatric gynecologist or andrologist, since in some children the cause of dysuric disorders and leukocyturia is local inflammation of the genitals - vulvitis or balanitis. The presence of phimosis may predispose to the development of urinary tract infection.

. All children at 1 year of age are recommended to undergo ultrasound of the kidneys and bladder.

Information

Sources and literature

1. Clinical recommendations of the Union of Pediatricians of Russia
   1. 1. Pediatric nephrology: a practical guide / ed. E. Loiman, A. N. Tsygin, A. A. Sargsyan. M.: Litterra, 2010. 400 p. 2. CLINICAL PRACTICE GUIDELINE from American Academy of pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics, 2011, v 128, N3, p. 593-610 3. R. Stein, H. S. Dogan, P. Hoebeke, R Kocvaraet al. Urinary Tract Infections in Children: EAU/ESPU Guidelines. European urology, 2015, v 67, p. 546–558 4. Ammenti A, Cataldi L, Chimenz R, et al. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr, 2012, v. 10, pp. 451–457. 5. Whiting P, Westwood M, Watt I, Cooper J, Kleijnen J. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: A systematic review. BMC Pediatr, 2005, v. 5(1): 4. 6. DeMuri G. P., Wald E. R. Imaging and antimicrobial prophylaxis following the diagnosis of urinary tract infection in children. Pediatr. inf. Dis. J. 2008; 27(6): 553-554. 7. Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev 2007(4):CD003772. 8. Hewitt I.K. et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study trials. Pediatrics 2008; 122: 486. 9. Toffolo A, Ammenti A, Montini G. Long-term clinical consequences of urinary tract infections during childhood: A review. Acta Pædiatr 2012, v.101, p.1018-31.

Information

Keywords

Children

urinary tract infection

Pyelonephritis

Cystitis

List of abbreviations

CRP - C-reactive protein

VUR - vesicourethral reflux

DMSA (dimercaptosuccinic acid-DMSA

UTI - urinary tract infection

IL-interleukin

urinary tract

PCT - procalcitonin

VUR - vesicoureteral reflux

Ultrasound - ultrasonography

PCS - pelvicalyceal system

Criteria for assessing the quality of medical care

Table 1 - Organizational and technical conditions for the provision of medical care.

Table 2 - Criteria for the quality of medical care

If the doctor has diagnosed your child with a UTI, you will probably need more information about what the infection is, how it occurs, the symptoms, and how the treatment is selected - read about this in the article.

Causes of UTI

Causes of a urinary tract infection:

Violation of urodynamics (vesicoureteral reflux, obstructive uropathy, neurogenic bladder dysfunction).

The severity of the pathogenic properties of microorganisms (certain serotypes, the ability of E. coli to adhere to the uroepithelium, the ability of Proteus to secrete urease, etc.).

Features of the patient's immune response (decrease in cell-mediated immunity under the influence of factors produced by macrophages and neutrophils, insufficient production of antibodies).

1. Symptoms of urinary tract infections in infants

   In young children (up to a year), the symptoms of infection are few and nonspecific: the temperature is normal or slightly elevated, intoxication, expressed in the gray color of the skin, apathy, anorexia, weight loss. Preschool children rarely complain of back or lower back pain, more often the only symptom is a rise in temperature. In acute bacterial cystitis 38C and above 38.5 with involvement of the upper urinary tract. For urinary tract infections, a recurrent course is characteristic.

   Diagnosis of urinary tract infection based on the analysis of urine with its bacteriological examination. It is important to teach parents how to properly collect urine.

   However, if a urine test showed bacteriuria(presence of bacteria), it is necessary to repeat the examination in order to avoid incorrect diagnosis, and subsequently in vain treatment of children with antibacterial drugs.

   In the analysis of urine with an infection of the urinary system, bacteria, lymphocytes, erythrocytes are found, and protein is possible. In boys, normally, 2-3 leukocytes can be detected, in girls, 5-7 leukocytes in the field of view, erythrocytes 1-2 in the field of view. A more accurate number of leukocytes can be determined by samples according to Nichiporenko, Amburge, Adissa-Kakovsky. The absence of leukocyturia excludes the diagnosis of pyelonephritis and cystitis. For the diagnosis of a urinary tract infection, red blood cells or protein in the urine are not diagnostic. In the presence of symptoms of infection, proteinuria confirms the diagnosis of pyelonephritis.

   For diagnosis, they also ultrasound examination of the kidneys and bladder, excretory urography, nephroscytigraphy, radioisotope radiography, urodynamic studies. Ultrasound and urography can detect obstruction and anomaly in the development of the organs of the urinary system, cystography - vesicoureteral reflux and intravesical obstruction.

   Treatment of UTIs in Children

   Treatment of urinary tract infections are based on the basic principles:

   The appointment of antibacterial drugs in accordance with the sensitivity of the pathogen.

   Reduction of intoxication at high activity of the process.

   Long-term antimicrobial prophylaxis in case of detection of vesicoureteral reflux and recurrence of urinary infection.

   Timely correction of violations of urodynamics of the urinary tract.

   Increasing the immunological reactivity of the child's body.

   How are urinary infections in newborns treated?

   In newborns In children, the antibiotic is administered parenterally, in most other children, orally. In case of sensitivity to the drug, the urine becomes sterile 24 hours after the start of treatment. If bacteria persist in the urine during treatment, it indicates the resistance of the pathogen to the drug. Other symptoms of inflammation persist longer, fever up to 2-3 days, leukocyturia up to 3-4 days, an increase in ESR can be observed up to 3 weeks. The duration of antibiotic treatment averages 10 days.

   In children with cystitis the goal of treatment is to relieve dysuria, which resolves within 1-2 days for most, so taking an antibiotic for 3-5 days is usually sufficient. In children with pyelonephritis persistence of infection and shrinkage of the kidney must be prevented. In patients at high risk of progression, prophylaxis should be given over several years. During treatment, it is necessary to carry out explanatory work with parents about the need for preventive courses of treatment, about a possible unfavorable prognosis in the presence of progression factors.