Pyelonephritis in children - symptoms and treatment. Pyelonephritis in children: topical treatments Chronic pyelonephritis in children prognosis

The prognosis for acute pyelonephritis, if the child does not have congenital disorders in the structure of the urinary system, is usually favorable. Timely and proper treatment leads to a complete recovery. In the case of chronic pyelonephritis, especially associated with vesicoureteral reflux (reverse reflux of urine), anomalies in the structure of the organs of the urinary system, the prognosis is always serious.
Children with acute pyelonephritis and exacerbation of chronic pyelonephritis should be treated in a hospital. Bed rest is prescribed for a period, then the child is gradually transferred to a semi-bed and ward regime. Diet - close to physiological in age, complete, high-calorie. In acute periods of the disease, bone, fish and mushroom broths, seasonings, essential oils of which can irritate the mucous membranes of the urinary tract (pepper, horseradish, mustard, etc.) are excluded from food. It is necessary to limit the use of products containing oxalic acid (green salad, sorrel, spinach, radish), as well as legumes, coffee, cocoa, chocolate.

Main in treatment of pyelonephritis is antibacterial therapy, which is carried out for 1.5-3 months, and for chronic pyelonephritis - even longer. To prevent the formation of strains of microorganisms resistant to individual drugs, antibiotics must be changed periodically. Desensitizing drugs and vitamins are also used. To prevent the development of dysbacteriosis, it is necessary to constantly take preparations of the intestinal microflora - vitaflora, bifidumbacterin, lactobacterin, etc. To relieve painful spastic phenomena in the acute period of the disease, antispasmodics are prescribed - no-shpu or papaverine. Physiotherapeutic treatment is also used: UHF, paraffin and ozokerite on the kidney area.

At the same time with pyelonephritis treatment it is important to sanitize other foci of infection.
In the first 6 months after the disappearance of active manifestations of the disease, the child should be examined by a doctor at least once a month, subsequently - once every 3 months, and in the absence of a relapse within a year - twice a year. Consultations of a nephrourologist, dentist and otolaryngologist are recommended 1-2 times a year.

Before the consultation, general blood and urine tests are performed, if necessary, urine tests for the presence of bacteria, microbial count, sensitivity of the bacterial flora to antibiotics, as well as kidney function tests.

To prevent the recurrence of the disease, it is necessary to carry out preventive treatment (2-3 months after acute pyelonephritis and 6-10 months after exacerbation of chronic pyelonephritis).

Antibacterial drugs are taken for 10 days of each month. As prescribed by the doctor, the following are used: antibiotics (ampicillin, levomycetin, lincomycin, gentamicin); nitrofurans (furagin, furazolidone); derivatives of nalidixic acid (negrams, nevigramon); 8-hydroxyquinoline derivatives (5-NOC, nitroxoline); sulfonamides (urosulfan, biseptol); palin.

After the end of the course of antibacterial drugs, a 10-day course of phytotherapy is carried out. For treatment, decoctions of medicinal herbs are used that have a weak bactericidal and diuretic effect: St. John's wort, bearberry, lingonberry leaf, yarrow, nettle, dog rose, coltsfoot.

The third decade of each month remains free from taking antibacterial drugs and herbal remedies.

During anti-relapse treatment, vitamins C, group B are indicated. Vitamin B6 should be given to the child every 3-4 months for 2 weeks. In connection with long-term treatment with antibacterial drugs in order to prevent dysbacteriosis, it is recommended to constantly use fermented milk products and preparations of intestinal microflora.

It is possible to stop anti-relapse treatment only with the permission of a doctor, after achieving a stable remission with a long-term disappearance of the symptoms of the disease and the absence of its signs according to laboratory tests. During the period of stable remission, antibacterial drugs can be taken only as directed by a doctor, under the control of urine tests.

Dispensary observation of patients with pyelonephritis is carried out by a pediatrician and a nephrourologist. In the first year after reaching a stable remission, it is necessary to visit a pediatrician 2-3 times a month, in the second year of remission - 1-2 times a month, and from the third to the sixth year - 1 time in 6 months. Laboratory tests in the first year of remission are carried out twice a month, in the second year - once a month and then - once every 2 months. A nephrourologist examines patients once every 2-3 months. Preventive vaccinations for children during the period of remission of pyelonephritis can be done with the permission of the attending physician.

In order to reduce the risk of development, it is necessary to sanitize chronic foci of infection in time, carefully treat inflammatory diseases, monitor the condition of the genitourinary organs and perineum, properly wash children, and prevent constipation. Particular attention is required for children who have symptoms of vulvovaginitis (girls) or balanoposthitis (boys), children with moderate changes in the urine in the form of a slight increase in the number of leukocytes, "unmotivated" rises in body temperature, complaints of discomfort during urination. Crying and anxiety, frequent urination in young children is a sufficient reason to take a urine test and make sure that there is no inflammation of the urinary system or start treatment in a timely manner.

36 comments

Hello, my daughter was 2 months old when she was admitted to the hospital with a temperature of 39
They diagnosed acute pyelonephritis, they injected antibiotics for 10 days, then they prescribed kanifron, furangin
Right now, we are 4 months old, they passed urine and leukocytes and protein are elevated, isn’t it pyelonephritis again? ((((
Prescribed
canfron, furandinone, and pass urine for sterility

• Hello.
  In order to accurately identify whether it is pyelonephritis or not, it is necessary to pass a general urinalysis, a urine test for sterility, a biochemical analysis of urine, and blood biochemistry.
  What is important is whether or not symptoms are present other than elevated white blood cells. Is there a fever, yellowing of the skin, does the baby refuse to breastfeed, spit up often, or is there vomiting, weight loss and lethargy? After all, increased protein and leukocytes can provoke a host of other diseases.
  To be sure, it is better to do an ultrasound of the urinary system.
  Maybe you have developed into chronic pyelonephritis, it can be acute or latent. But this is very rare, and often misdiagnosed. An apparently asymptomatic increase in white blood cells may be a lower urinary tract infection.
  In any case, Kanefron should also be taken for prevention, 15 drops up to 3 times a day.

Hello, my son, 13, got sick with the flu, didn’t wear a mask, then my daughter got sick with the flu, the temperature started at 37.8, then 4 days 38.8, I gave paracetomol a pill, the pace was asleep, then I raised it again, I gave a camomile, then it went away and then some time my daughter began urinary incontinence and white discharge, I have a chest, I had a lot of stress, at first my grandfather died at the funeral, we were with the children there, we have a sleep pattern and nutrition, everything changed, I cried at the funeral after 7 days, we came home, then the son got the flu, then my husband I broke my leg Daughter sial Complains when pissing pisyun hurts urine became cloudy with a smell the hospital works like a new year it was when my husband was discharged with plaster, we gave our daughter tests but protein 1.0 leukocytes 20-3 ketone body 15 then the nephrologist said urine tests nechiporenko and ultrasound of the kidney and zhkt the second analysis of belrk 0.003 leukocytes were sent to the hospital a lot. again naliza to take blood urine we have low hemoglobin to me it is very worrying sorry so much wrote I am waiting for an answer!

Hello, my son, 13, got sick with the flu, didn’t wear a mask, then my daughter got sick with the flu, the temperature started at 37.8, then 4 days 38.8, I gave paracetomol a pill, the pace was asleep, then I raised it again, I gave a camomile, then it went away and then some time my daughter began urinary incontinence and white discharge, I have a chest, I had a lot of stress, at first my grandfather died at the funeral, we were with the children there, we have a sleep pattern and nutrition, everything changed, I cried at the funeral after 7 days, we came home, then the son got the flu, then my husband I broke my leg Daughter sial Complains when pissing pisyun hurts urine became cloudy with a smell the hospital works like a new year it was when my husband was discharged with plaster, we gave our daughter tests but protein 1.0 leukocytes 20-3 ketone body 15 then the nephrologist said urine tests nechiporenko and ultrasound of the kidney and zhkt the second analysis of belrk 0.003 leukocytes were sent to the hospital a lot. again naliza take blood urine we have low hemoglobin to me it is very exciting sorry so much written

Hello, at 5 months after the DTP vaccination, the child had a fever, didn’t go down for several days, they thought it was because of the injection, but then they decided to go to the hospital, they passed the tests and found pyelonephritis, they pierced them for 7 days and discharged, everything was fine. We are already 11 months old and the child again had a fever and again pyelonephritis, why did this happen? can it be treated? how long? how to cure a child so that he does not get sick again?

• Hello. It is difficult to answer your questions - I know from practical experience that any serious diseases that first developed in infancy are difficult and tend to relapse. This is due to the high degree of immaturity of all organs and systems - some fail. But almost all microbially caused pathologies (pneumonia, pyelonephritis, endocarditis, and others) develop against the background of intrauterine infection or a persistent decrease in immunity. There is also a very high risk of anomalies in the development of organs and systems. An additional examination is necessary - a nephrologist, an immunologist and an instrumental additional examination of the child's genitourinary system (banal ultrasound is not enough) + PCR markers of intrauterine infections. The duration of relapse and the likelihood of its recurrence directly depends on the results of consultations of narrow specialists, laboratory and instrumental examinations. It is possible to cure a child completely and not get sick only if you know the full range of causative factors and disease-provoking agents: from the causative agent of the infection to the state of the child's immunological reactivity.

Good evening. My son is almost 3 months old, they donated blood and urine before vaccination. There are elevated leukocytes in the urine. They send him for analysis according to Nicheporenko and ultrasound. The average temperature is 37 (the pediatrician said that this is the norm for babies), he pees often jerkily and sometimes strains, but does not cry. Is there a possibility that this is pyelonephritis?

• Hello. It all depends on the results of the tests and instrumental examination - there is no need to determine the likelihood of pyelonephritis now. At this age, the likelihood of congenital pathology or intrauterine infection with a focus in the kidneys or urinary tract is much higher. Just get tested as early as possible - leukocytosis in the urine of infants is a very alarming sign.

I have a daughter for 2 years for a month, a bad blood and urine test went for ultrasound, was diagnosed with pyelonephritis, was sent to the hospital, the temperature was two days and all 39.6 drank the antibiotic did not help Augmentin, now they prescribed suprax and drank kanefron that right now they will inject an antibiotic yes

Hello! My child is 6.5 months old. At 5 months old, we were in the hospital and we were diagnosed with bronchial asthma + milk allergy (were 1 month old). A month later, his temperature rose to 38.8 in the evening, the next evening it happened again, passed tests, a large number of leukocytes, protein in the urine, erythrocytes. The next day they retaken the protein, no tests are better, the temperature is 37.7, then there is no more.

• Hello! An increase in temperature in your child can be caused by SARS, or an inflammatory process in the body. Judging by the analysis, there is a bacterial infection in the blood, so the child was prescribed antibiotics. A more accurate diagnosis can be made by the doctor observing the child after an additional examination.

Hello, my daughter is 1.11, we have acute pyelonephritis. On Thursday, the temperature rose to 39, and it stayed like that until Sunday, then we went to the hospital, they put us in, they figured out for two days what the problem was, there was nothing to runny nose or cough. They donated blood increased leukocytes and soe., yesterday urine tests came as the doctor said everything is elevated there .... I’m going crazy ... the child eats well, drinks a lot and goes to the toilet a little .... they inject antibiotics for us, the doctor said they inject for 2 days and they will look there because more there is a temperature .... we drink kanefron, lineks and give injections .... today we collect urine according to Zemnitsky .... and I'm afraid that my daughter will not catch another disease because we are in the same ward where the children have terrible coughs and a runny nose ... how long should we lie down?? whether it is necessary in a hospital??

• Hello! Pyelonephritis is a rather serious disease, especially for young children. If it is not cured to the end, then regular exacerbations are possible, which can lead to serious complications and disruption of the kidneys. I would recommend that you stay in the hospital at least until the child's temperature subsides and urination returns to normal. When these symptoms subside, you can write an application for transfer to outpatient treatment. In the meantime, I recommend that you contact the attending physician with a request to transfer the child to the nephrology department (as I understand, now you are in the infectious diseases department). In the nephrology department (if your hospital has one), the chances of contracting another disease will be much less, and the treatment of the disease will be treated more professionally.

Hello! My daughter will soon be 6 months old, before vaccinations, we passed tests, found elevated leukocytes in the urine, retaken 3 times, the same thing, there is no elevated temperature, she feels cheerful, they did ultrasound of the kidneys and tests for a month, everything was fine. They sent us to the hospital for examination, our kidneys are enlarged, but it seems to be nothing, but acute pyelonephritis was determined from the urine: (((I am very worried, none of us had it, I never got sick with it, during childbirth I had green waters, maybe she picked up a bacterium from them. Tell me, is it possible to recover from this? Is it boring for me to go on a diet, I breastfeed? Is it fashionable to give a child cranberry juice? we drink water, can this disease be caused by this? Now I sing with water through force, we cry, we don’t like to drink it. We are very worried. They prescribed us furagin tablets, they check urine for sensitivity to antibiotics and tablets .... Every day we pass urine, we still we have a little hemoglobin lowered in the blood, a week ago everything was fine. Thank you

• Hello Angelina!
  The girl's disease is not associated with the presence of green waters or the intake of a small amount of liquid.
  Most often it is caused by microorganisms living in the intestines.
  The use of a small amount of liquid is also not the cause of the development of this pathology.
  However, given the fact that during the illness there is an increase in urination, the child needs to drink plenty of water.
  Cranberry juice is well suited for this purpose.

  It is possible to recover from the disease if the treatment is carried out in sufficient volume, and after the end of the main course of taking the drugs, the prevention of recurrence of the disease is carried out.
  To achieve a stable antibacterial effect, several courses of antibiotics are usually used in a row.

  You do not need to follow a special diet.
  Only fried meat and strong broths, marinades, canned food, smoked meats, sausages, sausages should be excluded from the diet.
  Salt intake should also be reduced.

Hello! My daughter has had bad urine tests since 3 months, then good ones. I was assured that I was collecting urine incorrectly and we retaken again and again. At 7 months she was referred to a nephrologist, she was admitted to the hospital with a diagnosis of acute pyelonephritis. They passed urine culture - Escherichia coli. They lay in nephrology for 10 days, they did cefataxime 2 times a day for 10 days, then after discharge furagin 21 days, kanefron. Now we are 8.5 months old, we don’t take anything, we pass tests. In the last 3 days, the temperature is 37.2, there are no signs of an acute respiratory infection. Tested, waiting for results.
Was the treatment not enough? Is this an exacerbation? Or does she already have chronic pyelonephritis?

• Hello Elvira!
  Acute pyelonephritis often becomes chronic and often has a relapsing character.
  However, an increase in temperature may accompany teething, appear in the initial period of viral and colds.

  Wait for test results.
  Depending on them, it will be possible to take therapeutic measures.

Good afternoon! The child is 2 months old, diagnosed with pyelonephritis. According to the ultrasound, 2 kidneys are enlarged. We drink the antibiotic supraks, today is the 4th day (the antibiotic is prescribed for 10-14 days, the doctor will look at the child's condition). The temperature subsided immediately and did not rise again, but the child is very lethargic and does not eat anything, we force him to drink some water. Tell me, will the child have such a condition throughout the entire course of antibiotics? Or should the child feel better every day? Thanks

• Hello Irina!
  The severity of the child's condition is not caused by taking antibiotics, but by the fact that the inflammatory process in the kidneys has not yet been stopped.
  There is an intoxication of the child's body with the waste products of bacteria.

  If for two more days the child does not begin to eat, then you should think about taking an antibiotic in injections.
  Since after taking supraks the temperature on the second day decreased, we can hope for a positive trend in the disease.

Good afternoon!
My baby is 5 months old. At 1 month we had pyelonephritis. At present, we cannot achieve a stable remission - the number of leukocytes constantly increases some time after the course of taking antibiotics, and we have already completed 5 courses !! We also have bilateral pyelectasis of the kidneys and ureterohydronephrosis on the left, congenital dilatation of the ureter.
Tell me, do you think there are any alternative methods of treatment other than antibiotics (or at least more gentle), because the child is very small?

• Hello Ekaterina!
  Treatment of pyelonephritis is carried out with the use of 2-3 courses of antibiotics.
  Then the child may be prescribed nitrofuran preparations.

  In your case, the situation is complicated by the presence of congenital anomalies in the development of the kidneys and urinary tract.
  This creates conditions for stagnation of urine and prolongation of the inflammatory process.
  The insufficient effect of antibiotic therapy may be due to the fact that the bacteria that cause inflammation of the renal tissue are not sufficiently sensitive to the effects of the drugs used.

  A bacterial culture of urine is indicated, taking into account the determination of sensitivity to antibiotics.
  This allows you to achieve clinical remission.
  Unfortunately, there is no alternative treatment option.

  The use of herbal preparations helps to improve urine output and reduce the degree of infection of the kidney tissue.
  One of them looks like this:

  Walnut leaf 25
  - wild strawberry forest grass 25
  - sage herb 25
  - stinging nettle leaf 25
  - wheatgrass root 25
  - knotweed grass 25
  - swamp grass 25
  - corn silk 20
  -yarrow color 20
  - peppermint leaf 20
  - common beans pods 20
  - birch bark 20.
  The amount of herbs is indicated in grams.

  A tablespoon of the mixture is steamed with a glass of boiling water and infused in a warm place for two hours.
  After straining, the infusion is given to the child in a warm form in a teaspoon 30 minutes before each feeding for a month.
  Every day the infusion should be updated.

Hello. The child is currently being treated in a children's hospital for acute pyelonephritis. Antibiotics were injected for a week, the temperature subsided, there were no 5 days, and now they are injecting antibiotics, and the temperature rises to 39.5. What a mess.

• Hello Lyudmila!
  Pyelonephritis, as a rule, is caused by microbes that live in the intestines of healthy individuals: Escherichia coli, Proteus vulgaris, Enterococcus, Staphylococcus aureus, blue-green pus bacillus.
  Most often, E. coli is sown from the urine.
  In the course of the course of the disease, as a rule, there is a change in the strain or even the type of pathogen.
  Repeated exacerbations can be caused by an already mixed bacterial flora.

  Anti-inflammatory treatment begins with the introduction of an antibiotic, selected on the basis of determining the sensitivity of the microbe, sown from the urine.
  It is given for 10-12 days, then replaced by another, and so 2-3 courses are carried out.

  Your child's first antibiotic was active against one or more types of organisms.
  The child's condition improved, the temperature returned to normal.

  However, after the drug was discontinued, other bacteria multiplied.
  They may be resistant to a second antibacterial given to the child.
  Therefore, the inflammatory process continues, and the temperature rises.
  In such cases, the antibiotic is replaced.

  It cannot be ruled out that the rise in temperature is associated with infection with a respiratory viral infection, and in a few days the child will develop a cough and runny nose.

We are 11 months old. We were diagnosed with acute pyelonephritis. Calicopyeloktosia 2-sided! They advise to be examined! What I don’t want! We donate blood and urine every 2 weeks for 6 months! Tests are good. How scary is it? ?What to take?

• Victoria, if a child was diagnosed with acute pyelonephritis, then changes in the analysis of blood and urine should have been noted, and appropriate treatment should have been carried out.
  The analyzes carried out by you at present every two weeks indicate that there is no exacerbation of the inflammatory process.

  However, the presence of bilateral calicopyeloectasia significantly worsens the situation.
  Expansion and stretching of the pyelocaliceal system of the kidneys leads to the fact that the tissues of the kidney are compressed.
  As a result, the outflow of urine is disturbed, conditions are created for the development of the inflammatory process.
  This extension cannot disappear over time.
  To establish its cause, a urological examination is necessary.

  It is possible that this pathology can be eliminated by surgery.
  With the development of repeated acute pyelonephritis, complications may occur in the form of purulent inflammation of the area of ​​the renal tissue, the occurrence of abscesses in the kidneys, and inflammation of the perirenal tissue.

  If you do not want to examine the child, then it is necessary to carry out further monitoring of the condition of the kidneys through regular tests.
  The use of kanefron 10 drops three times a day for 10 days is also shown.
  Monthly, this course of taking the drug should be repeated.

hello, the child has a temperature of 37.5, the doctor prescribed konifron, furagin, but he has constant vomiting and nausea, leukocytes are elevated, what to do

• Hello Hope!
  Constant nausea and vomiting indicate a severe inflammatory process.
  Perhaps it is currently spreading to the kidneys.
  If the drugs prescribed to the child are ineffective, then this indicates the seriousness of the disease and the need for its treatment in a hospital.
  An increase in the number of leukocytes in the blood and urine also indicates the activity of the inflammatory process.

  Consult a pediatric nephrologist or urologist.
  Perhaps he will find it possible to prescribe injections to the child at home.
  However, the risk of complications from urinary tract infections in children is very high.

  In addition, in the presence of vomiting, rapid dehydration of the body is possible, which can lead to seizures and deterioration of the general condition.
  Therefore, try to provide your child with plenty of fluids (mineral water, tea with vitamin juices).
  Otherwise, intravenous infusion of saline and glucose will have to be carried out.

Hello, my son had pyelonephritis at the age of 11 months, we control OAM every 2 weeks, now he is 1 year and 4 months old. I'm afraid that there may be a relapse, because there are 3-5 leukocytes in the urine, I often get acute respiratory infections. For prevention, what should we use from medicines or herbal medicine at our age? I commit myself to deal with it appropriately.

• Hello, Tatyana!
  A white blood cell count of 3-5 in a urinalysis is acceptable.
  However, pyelonephritis has a tendency to recur.
  Most often it occurs after a viral infection.
  It is best to use herbal collection, which avoids congestion in the kidneys.
  Its approximate composition is as follows:
  - field horsetail, grass 20.0
  - birch buds 30.0
  - lingonberry leaf
  - strawberry leaf
  - nettle leaf at 20.0
  - wild rose, crushed fruits 30.0
  - parsley leaf 20.0
  - knotweed, grass
  - St. John's wort, herb
  - bear ears, sheet 20.0 each.

  The mixture in the amount of 1 tablespoon is poured with 2 cups of boiling water and kept under cover for 3 hours.
  It is taken 100 g 3 times a day for a month.

Hello. my daughter is 3 years old. A year ago I was diagnosed with chronic pyelonephritis. were in the hospital. but the urinalysis remains poor leukocyte count 9000. how can we be tell me? We are seen by a nephrologist, but apart from konefron, they do not prescribe anything to us.

• Hello Irina!
  Antibiotics, preparations of the nitrofuran and nitroxoline series, sulfonamides are prescribed mainly for exacerbation of chronic pyelonephritis.
  If the child has no pain in the kidney area, there are no urination disorders, temperature rises, then it is considered that there are no clinical signs of exacerbation of chronic pyelonephritis.

  If no abnormalities are found in the blood test, and changes in the urine test are limited to the presence of an increased number of bacteria and leukocytes, the child's condition is classified as a partial clinical and laboratory remission.
  Kanefron is a harmless herbal preparation, but with such a large number of leukocytes in the urine, it is unlikely to give any therapeutic effect.

  I think that you need to contact a specialized nephrology department for advice.

Hello. A 3.5-month-old child had a high temperature for three days and leukocytes were found in the urine. We were in the hospital where we were given antibiotics. Five days later, after being treated, we developed a cough and snot. The child began to write less often. I'm very worried. Can I give him Kanefron? Thanks in advance.

• Hello Anna!
  At high temperature, cough and runny nose, the permeability of the renal vessels increases in the child, leukocytes may appear in the urine.
  There is no reason to think about the inflammatory process in the kidneys.
  A decrease in the amount of urine is also a consequence of a cold, since fluid is retained in the child's body as a result of disorders in the upper respiratory tract.

  Kanefron is a drug that relieves spasm of the renal vessels, it has a diuretic effect, relieves pain and inflammation, and improves kidney function.
  It also has an antibacterial effect.
  In this situation, it is a good homeopathic prophylactic remedy.
  You need to take it 10 drops 3 times a day for 10 days.

hello. the child has elevated leukocytes in the urine, had a high temperature for three days, now it ranges from 36.6-37.3. The doctor prescribed conifrol. Before that, there was nothing, everything was normal.

• Hello Marina!
  The fact that a child has leukocytes in the urine may indicate an inflammatory process in the kidneys or urinary tract.
  But the mere presence of leukocytes is clearly not enough to establish a diagnosis.
  Their number is of fundamental importance.

  In addition, bacteria must be present in the urine.
  The inflammatory process is accompanied by changes in the amount and color of urine.
  Pain during urination, pain in the lower abdomen, back pain.
  The number of urination increases.
  There are swelling on the legs and under the eyes.

  It is necessary to conduct a complete examination of the child.
  A blood test will determine the presence of an acute inflammatory process.
  Focal changes in the kidneys can be determined using an ultrasound examination.
  Additional studies are ordered if necessary.

  Canephron is a herbal preparation.
  It improves kidney function, reduces the permeability of the renal capillaries, has a diuretic and antibacterial effect, relieves spasm of the renal vessels.
  It also has an anti-inflammatory effect.
  There will be no harm from its use.

  It is possible that the child will have a cough and runny nose in a day.
  The development of a viral infection is also accompanied by an increase in the number of leukocytes in the urine.

Pyelonephritis in children is one of the most common diseases. In younger children, such a pathology and ARVI are very related to each other. Approximately one in four cases of this disease occurs due to acute respiratory infections. Rapidly spreading through the urinary tract, the current process of inflammation affects the tissues of the kidneys.

Children of different years can be exposed to this formidable anomaly. In older girls, this disease develops more often. The grounds are hidden in the structural features of the genitourinary tract, since the urination canal in girls is shorter and wider. Boys have fewer barriers to the spread of infection.

Causes of pathology

Pyelonephritis is often recognized in a child of preschool years. After identifying this disease, the cause must be urgently found.

The main cause of the disease are:

1. Kidney tissues can be affected by various pathogenic microorganisms, bacteriological culture of urine reveals: Escherichia coli, Staphylococcus aureus and other viruses. Pathogenic microorganisms and viruses can enter the kidneys in all sorts of ways: through the blood vessels, along the walls of the ureter, from the bladder through the lumen of the ureter. If several pathogens enter the child's body at the same time, chronic pyelonephritis may develop.
2. Past diseases in childhood, such as pneumonia or otitis media, can be the cause of this pathology.
3. Bacterial endocarditis or sepsis causes symptoms of this disease in adolescents, the pathogen penetrates from the intestine to the kidney through the lymphatic system. This is done with intestinal infections, diarrhea in a child suffering from chronic constipation and dysbacteriosis.
4. Often, infection occurs through the genital area, anus, urethra, or bladder. Such infection is actively manifested in girls of 3–5 years of age. Microorganisms can enter the urethra, but healthy children's immune system does not allow such an inflammatory process to develop. However, any acute or chronic illness reduces the body's immune forces.
5. Foci of infections that are in the body for a long time, hypothermia, worms, diabetes, quite often give rise to this insidious disease.
6. A disease of the genitourinary region, as well as poor hygiene, can provoke pyelonephritis.
7. After a long inflammatory process in the area of ​​​​the external genital organs, a symptom of this disease often appears.

Forms of this disease

Specialists of kidney diseases distinguish two forms of pyelonephritis: acute and chronic.

What is acute pyelonephritis in children? With an acute form of pathology, children usually recover after 1.5 months, the test data return to normal.

Chronic pyelonephritis. This form lasts about six months, during this period there is a possibility of other exacerbations. Periodically, a deviation from the norm is found in the urine tests of a child. Also, the current disease contributes to provoking a symptom of bacterial asthenia in the patient. The child notices irritability, fatigue, lagging behind in school. This form of the disease, which manifested itself in childhood, slows down physical and psychomotor development.

Symptoms of pyelonephritis

Symptoms of pyelonephritis in children are very different. Their manifestation is affected by the severity of inflammation, the presence of parallel diseases, but the main ones are:

1. Elevated body temperature, fever is a common symptom for all cases of pathology. Sometimes the temperature rises for no reason to 38-39 degrees.
2. There may be loss of appetite, drowsiness, the child complains of weakness and frequent headaches.
3. There is nausea, vomiting, muffled pain in the abdomen and side.
4. Blue circles under the eyes are noticed, the skin turns pale.
5. The child experiences obvious discomfort when urinating, because he feels a burning sensation and pain.
6. The urination regimen is disturbed: they become rare, possibly more frequent, although the liquid is consumed in sufficient quantities. In some cases, urinary incontinence occurs.
7. In infants, the course of pyelonephritis is characterized by slight weight gain.
8. The smell of urine becomes quite pungent and the color changes from yellow to bright orange.

Pyelonephritis is especially severe in newborns and infants, as they cannot complain of disturbing pain, which makes it difficult to diagnose the disease, it is characterized by a non-specific clinical picture and general symptoms of intoxication. Obvious signs of pyelonephritis are an increase in body temperature to 39-40 degrees, convulsions, vomiting, regurgitation are possible, the baby refuses to breastfeed. Paleness and marbling of the skin. Lips are a little blue. An unhealthy child has insufficient weight gain or loss, and in some cases loses it. The child often cries and has constant anxiety.

Parents need to remember that all kinds of ailments of babies should be examined by a specialist doctor. Disorder of the stool, fever, vomiting can be mistaken for the awakening of intestinal infections. To clarify the diagnosis of pyelonephritis, the doctor prescribes the necessary tests. A general urine test is prescribed for children with fever. In this disease, the content of leukocytes in the urine increases markedly, bacteria and the amount of protein are detected. Laboratory methods of examination are designed to detect pathogens in order to select appropriate methods of treatment.

In addition to laboratory examinations, ultrasound, X-ray methods of examination, angiography are of great importance, helping to identify anatomical abnormalities that provoked the onset of the disease. This disease requires prompt and effective treatment. If, upon detection of an acute form, the treatment course slows down, then the infection will spread rapidly and lead to the development of purulent processes. With a long-term chronic form, the work of the kidneys is disrupted, chronic renal failure may develop.

If an exacerbation of pyelonephritis is detected in children, treatment should be carried out exclusively in stationary conditions. Symptoms and treatment are extremely safe if a specialist in urology takes care of it. The doctor will do everything to avoid complications of the disease, he will monitor the dynamics of clinical tests, conduct additional examinations and select more effective methods of treatment.

A child who is being treated in a hospital needs to measure blood pressure every day. Particular attention should be paid to changes in blood pressure in a patient with a chronic form of the disease. Often such a case testifies to the associated renal failure. It is possible to fight pathogenic bacteria only with the help of antibacterial drugs.

The result of a urine test for sensitivity to antibiotics will help you choose effective drugs that are not toxic to the genitourinary system. Treatment lasts for one month. Together with antibacterial therapy for two weeks, the doctor prescribes antiseptic preparations for the urinary tract to the patient, which destroy pathogenic bacteria, but do not belong to the group of antibiotics. At the initial stage of the course of treatment, antipyretic drugs, antispasmodics are used. Antioxidant therapy and various vitamins are prescribed in the same order. Children need bed rest, you can only move around the ward. With normal dynamics, after a week it is allowed to walk around the hospital for 30-60 minutes.

Herbal treatment method

Along with the use of anti-inflammatory drugs in the treatment of pyelonephritis, traditional medicine is widely used. There are many medicinal herbs that have a curative effect on the functioning of the kidneys and help to eliminate the disease. The advantage of this effect on the disease is that there are absolutely no contraindications in taking medicinal herbs. An exceptional limitation is a particular intolerance to certain herbs.

The most effective diuretic medicinal herbs from which decoctions can be prepared are: lingonberries, corn stigmas, birch leaves, aspen leaves, flax seeds, elderberry. For the treatment of this pathology, it is necessary to use diuretic and antibacterial, anti-inflammatory herbs to remove microorganisms and viruses from the body, which increase in the process of urine stagnation. Herbal treatment contributes to the normalization of physical and mental health.

With this pathology, prevention is aimed at the general improvement of the child and, therefore, at the exclusion of the causes that contribute to the occurrence of infection in the urinary tract.

For this, the following conditions must be met:

• Parents need to follow basic hygiene rules and teach children to follow them.
• It is necessary to maintain a drinking regimen.
• It is necessary to ensure that the child drinks enough and constantly empties the bladder.
• Influenza, tonsillitis and other inflammatory diseases that give complications to the kidneys should be urgently treated.
• Children with pyelonephritis should be observed by a dentist, and if there is caries, it should be treated immediately.
• It is necessary to fight chronic diseases, such as: diabetes mellitus, inflammation of the gallbladder and others.
• If the doctor is persistent in removing the tonsils or adenoids, due to their chronic inflammation and the possibility of a risk of exacerbation of pyelonephritis, it is worth heeding the advice of a specialist and agreeing to surgery.
• You should not forget to constantly increase the immune system and observe the regime of sleep and rest.
• Parents need to teach their child proper nutrition, introduce natural products, juices, cottage cheese and other fermented milk products into the diet, exclude spicy and spicy foods.
• Showing sanatorium treatment and prevention.
• It is necessary to protect the child from drafts and hypothermia.
• Temper children all year round.

Approximately 80% of cases of acute pyelonephritis in children end with an absolute recovery. Complications and lethality are very rare, mainly in very weak children with concomitant diseases. The consequence of the chronic form of the disease in 65-75% of children is an increase in the abnormal process in the kidneys, exacerbation of nephrosclerotic changes.

Video

” №2/2007 21.02.12

Pyelonephritis in children may occur at any age. Several characteristic symptoms indicate inflammation of the kidneys. By noticing them in time and starting treatment, you will save the child from a serious illness.

Consultation and assistance of a specialist in this case is vital. Any mother faces very serious and responsible tasks - to take care of the baby, monitor his health, help him develop comprehensively. The less often a child coughs and sneezes, the higher the chance that he will not have kidney problems. Do not be surprised, because everything in the body is interconnected. Doctors say: the constant presence of so-called chronic foci of infection (tonsillitis, caries, adenoids) negatively affects the condition of the kidneys. And diseases of the urinary system in children are not only common, but also tend to increase, and often in newborns and young children.

Pyelonephritis in children: causes

Let's start with anatomy. Agree: to understand causes of pyelonephritis and to be able to prevent it, you need to know what the structure and functions of the organ that comes under attack.
The kidneys are located in the retroperitoneal space on either side of the spine. The sizes vary according to the age of the child (for example, in a newborn they are 4 cm long, and by the age of 12 each kidney has a length of 10-12 cm, a width of 5-6 cm and a thickness of 4 cm). This paired organ is called the main filter of the body. It is the kidneys with a double force that remove metabolic products (substances we do not need) and bring them out in the form of urine, regulate the water-salt balance, that is, they perform the main function of the body - maintaining homeostasis.

Another important function of the kidneys is the production of vital biologically active substances responsible for the regulation of blood pressure, for maintaining the desired level of hemoglobin. The full functioning of the kidneys is a necessary condition for the normal functioning of the heart, brain, lungs ... The kidneys are also responsible for the production of vitamin D, for phosphorus-calcium metabolism, which affect the proper formation of the bone skeleton.

Types of pyelonephritis in children

By its nature and characteristics of therapy pyelonephritis is divided into two types.

Primary pyelonephritis

Most often it occurs due to a change in the flora that is in the child's intestines and is considered opportunistic. Under adverse conditions (frequent SARS, intestinal infections), dysbacteriosis occurs - one of causes of pyelonephritis. Also, urologists consider complications of coccal infections to be the causes of primary inflammation of the kidneys, whether it is a skin disease or (much more often) tonsillitis, influenza. Cystitis also often becomes the culprit of pyelonephritis. Microbes enter the urinary system through the urethra. Then they end up in the bladder, then in the ureters, pelvis, and finally in the kidneys.

Secondary pyelonephritis

Secondary pyelonephritis cause nature. The occurrence of the disease is often due to congenital anomalies of the urinary system. The child may have abnormalities in the structure or location of the kidneys, ureters, bladder. Because of this, there is a violation of the outflow of urine, or it is thrown back into the kidney from the lower tract. Together with the jet, bacteria get there, which cause the inflammatory process.

There are cases of underdevelopment of the kidneys. Due to being too small, there is less kidney tissue functioning in the body than it needs. At first it is imperceptible. But the child grows, the load on the kidney tissue increases, and then the organ cannot cope with its function. Similar anatomical features are detected already in the first weeks of a child's life. In this connection, many doctors recommend an ultrasound examination as early as possible to make sure that everything is in order with the kidneys. And if a pathology is detected, start immediate treatment.

Symptoms of pyelonephritis in children

Pay attention to the signs of pyelonephritis, which you should definitely alert.

Temperature rise

• The child has a fever, the thermometer shows 38-39 ° C. There is no cough or runny nose. The throat is not red and does not hurt. The baby has weakness, headache, reduced appetite.

  Urinary retention or incontinence

• The child drinks as usual, but does not urinate for a suspiciously long time, or vice versa - asks to go to the toilet too often. The nights are especially restless. The kid does not sleep well due to the fact that he constantly wants to use the potty. There is a strong smell of urine.

  Restlessness when urinating

• The child first grunts, whimpers, even screams, and only then does it “in a small way”. A 2-3-year-old baby complains of pain in the lower abdomen and urinates with effort.

  urine color

• Normally, it should be straw yellow. Do you see that the urine is dark? So problems are not ruled out. Keep in mind that some medicines give a pinkish-red tint to urine, as well as berries and vegetables: strawberries, carrots, beets. If the child did not eat anything like this the day before, the color change indicates the presence of erythrocytes (blood cells), which happens with many diseases of the kidneys and bladder, including pyelonephritis in children.

  Violation of the stool and regurgitation

• Symptoms of pyelonephritis in infants often resemble manifestations of intestinal diseases. In addition, the baby is not gaining weight well.

  The child urinates in small portions.

• Do not lose sight of such an alarm signal, immediately go to the doctor. After a thorough examination, he will be able to make an accurate diagnosis and prescribe effective treatment.

Pyelonephritis in children can also be hidden, asymptomatic. But if you carefully observe the baby, you will notice that he gets tired faster, and his mood is constantly changing.

Diagnosis of pyelonephritis in children

First of all, the urologist will give directions for tests.

The baby will need to pass a general urine test.

To properly collect a general (or clinical) analysis, follow the recommendations of a specialist.

• Do not give your child any mineral water the day before. It will certainly change the reaction of urine.
• Prepare a small glass jar: wash it thoroughly and pour boiling water over it (so that excess bacteria and fungi are not found in the contents later).
• In the morning, be sure to thoroughly wash the baby, otherwise the analysis will be inaccurate.
• Substitute the container immediately. The first drops may not be completely clear, which will affect the result of the study.

If the doctor did not like the general analysis, he will prescribe a urine test according to Nechiporenko. It is necessary to prepare the baby for it in the same way as in the previous case. Take part of the urine from the "middle" of the jet.

The third, most frequent type of analysis is according to Zimnitsky. It is resorted to when kidney failure or inflammation is suspected in a child. The procedure will take a whole day and eight jars. The baby should urinate in prepared containers. It should not be forced and specially watered. There are no special dietary restrictions.

All urine tests are examined in the laboratory within 1-2 days. In each case, different methods are used.

How to read analysis results

• Transparency must be perfect. Cloudy-looking urine and flakes in it indicate the presence of salts or inflammation of the kidneys and urinary tract.
• It is desirable that the reaction be slightly acidic. Neutral or alkaline depends on the nutrition of the child.
• The density of urine in babies is reduced due to the immaturity of the kidney cells and ranges from 1005-1020.
• There is no protein in a good assay, but protein filtration up to 0.033 g/L is acceptable.
• Bacteria and fungi in the analysis are indicated by a certain amount of the + sign. The more it is, the worse, and then it is necessary to conduct a urine culture to identify the microbe.
• Leukocytes in boys are acceptable in the amount of 0-3-5, in girls - 0-5-7, according to Nechiporenko - no more than 2000.
• Erythrocytes should be single or absent in the general analysis of urine, according to Nechiporenko - no more than 1000.
• Cylinders in the general analysis indicate a severe kidney disease, in the Nechiporenko study, the norm is no more than 20.

Of course, the urologist will clarify the picture of the child's health by examining the urine test. But this is not the end of the survey. He will probably prescribe an ultrasound of the kidneys and bladder.

Prevention of pyelonephritis in children

Prevention will help protect the baby from inflammation. And no complicated actions are required from you.

1. Use disposable diapers. It is advisable to wear them before walking and going to bed. The genitals of the crumbs should be in contact with secretions as little as possible - this reduces the risk of infections.
2. Keep your child's bladder emptying regularly. The longer the liquid is in it, the more bacteria accumulate. A child should be potty trained by the age of 2. Remind your child to use the potty or go to the toilet during playtime or when out for a walk. Can't stand it!
3. Wash the girl only from front to back. Change her panties daily. If you notice redness of the external genitalia or discharge, take a bath with a decoction of chamomile or calendula.
4. Give your baby only purified water. Don't get carried away with soda. And if you buy mineral water, give preference to the dining room.
5. Take care of a healthy diet for your baby: do not give him anything fatty, spicy, salty! Salt food sparingly, steam meat, refuse strong broths.

A child who has had pyelonephritis, the doctor will prescribe a special diet.

Urination: daily rate

Healthy children empty the bladder quite often and in large portions. We provide an example table.

• up to 6 months: 20 times a day
• up to 1 year: 15 times
• by 3 years: 7-10 times

Even if the baby is not worried about anything, watch for several days how he "walks in a small way." Naturally, this can be done provided that the child will not be in a diaper for several hours in a row. So not only it is impossible to track the rhythm of urination, but also to see the stream, which ideally should be light, good filling and continuous.

Pyelonephritis: how to treat

In case of pyelonephritis in children antibiotic therapy is indispensable. Various uroseptic preparations, herbal medicine and homeopathy are also widely used.

Only a urologist or nephrologist can tell you exactly what medication is needed and how long the treatment will last. It usually takes several months, intermittently. Don't let that scare you! After you cope with the inflammation, you can not worry about the health of the baby. After finishing taking antibiotics, the baby will have to take probiotics, drugs based on living organisms that restore the intestinal flora. There are a lot of such tools, and each has its own peculiarity. Therefore, only a specialist can prescribe what is right for your baby.

Do not forget that every six months or a year the child needs to do an ultrasound examination. Also regularly visit a pediatrician, a urologist with him and take urine tests at the clinic more often than is done during a medical examination.

May your child be healthy!

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

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

Pyelonephritis in children, like any inflammatory disease, is caused by microorganisms (bacteria) that enter the kidney in various ways and begin to multiply actively. According to the etiology and pathogenesis of pyelonephritis, in the vast majority of cases, the disease is caused by Escherichia coli, which is introduced into the kidney with blood flow from the focus of chronic infection, the role of which is most often played by carious teeth, chronic tonsillitis (tonsillitis) and otitis media (ear inflammation). In more rare cases, the infection comes from the bladder or external genitalia. This is the reason for the fact that girls, due to the short urethra, suffer from pyelonephritis and cystitis 3 times more often than boys.

However, under normal conditions, the child's body is able to cope with microorganisms. The main reason for the development of inflammation is considered to be a decrease in immunity, when the body's defenses are not able to fight the infection.

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

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

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

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

Classification of pyelonephritis

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

There are two forms of pyelonephritis: acute and chronic. Acute pyelonephritis in children proceeds more rapidly with symptoms of severe intoxication, but with proper treatment most often ends in complete recovery. In some cases, the acute form can turn into a chronic one, which is characterized by periodic exacerbations, proceeds for a very long time (up to old age) and leads to irreversible complications.

The main symptoms of pyelonephritis in children

The peculiarity of pyelonephritis in children is such that, depending on age, the symptoms of the disease manifest themselves in different ways. Signs of pyelonephritis in a child are not difficult to suspect, usually the disease proceeds with characteristic manifestations, with the only exception being young children.

Children under 1 year old

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

• An increase in temperature to 39-40 without signs of inflammation of the respiratory tract
• Anxiety and sleep disturbance
• Decreased appetite

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

Children from 1 to 5 years old

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

Over 5 years old

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

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

• Acute increase in body temperature up to 39-40C. It is important to remember that the hallmark of inflammation of the kidneys from colds is the absence of inflammation of the respiratory tract (runny nose, cough, itching and sore throat, earache). The temperature rises against the background of full health immediately to high rates.
• Symptoms of general intoxication - the child becomes lethargic, capricious, refuses food. Chill attacks alternate with heat attacks. Often, a headache appears against the background of temperature.
• Symptoms from the urinary system - as a rule, on the second day after the temperature rises, there is a constant aching pain in the lumbar region (most often on one side), pain in the suprapubic region, pain when urinating. With concomitant cystitis, the urge to urinate becomes frequent up to 20 or more times a day.
• Urine with pyelonephritis in a child is visually dark, cloudy, frothy, sometimes with a reddish tint (due to the presence of blood in it).

Despite the severe course of acute pyelonephritis, with timely seeking medical help and proper treatment, the disease has a favorable outcome. However, often the acute form becomes chronic.

Chronic pyelonephritis

Pyelonephritis is considered chronic if it occurs for more than 1 year and has 2 or more episodes of exacerbation during this period. This form is an alternation of recurring exacerbations (especially in the spring-autumn period) and asymptomatic periods. The manifestations of the chronic form are the same as in the acute form, only more often less pronounced. The course of chronic pyelonephritis is slow and prolonged. With frequent exacerbations, improper treatment and lack of prevention, the disease can lead to such a serious complication as renal failure.

A set of diagnostic measures

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

Video lecture. Pyelonephritis in children. "Medical Bulletin":

Treatment of pyelonephritis in children

Basic principles of treatment

It is important to understand that the treatment of any disease, especially such a serious one as pyelonephritis, is not limited to drugs. Treatment is a wide range of measures aimed not only at eliminating the cause of the disease, but at preventing subsequent relapses (exacerbations).

Treatment of any inflammatory diseases of the kidneys complex consists of the following components:

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

Mode

During the period of pronounced manifestations of the disease, bed or semi-bed rest is recommended. You need to forget about studying, walking and, especially, sports training for a while. In the second week of illness, when the temperature drops significantly and back pain disappears, the regimen can be expanded, but it will be much better if the child spends the entire period of illness at home.

Dieting

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

Medical therapy

a) Antibiotics

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

Antibiotics for pyelonephritis in children are represented by a relatively small range, since many antibiotics are contraindicated up to 12 or up to 18 years, so specialists usually prescribe the following groups of drugs:

• Protected penicillins (Augmentin, Amoxiclav). In addition to the usual tablets, these antibiotics are available in the form of a sweet suspension for young children, and the dosage is made using a special measuring syringe or spoon.
• Antibiotics of the cephalosporin group, which are most often only in injections, therefore they are used in inpatient treatment (Cefotaxime, Cefuroxin, Ceftriaxone). However, some also exist in the form of a suspension, capsules and soluble tablets (Cedex, Suprax).
• Aminoglycosides (Sumamed, Gentamicin) and carbapenems in rare cases also take place, but they are most often used as an alternative option and as part of combination therapy.

In severe cases, the doctor can immediately take several antibiotics from different groups (combination therapy) in order to get rid of the infectious agent as soon as possible. Sometimes one antibiotic has to be replaced with another, and this happens in the following cases:

• If 2-3 days after taking the drug, the condition has not improved or, on the contrary, worsened, and the temperature continues to stay at the same numbers
• With prolonged treatment for more than 10-14 days. In this case, the doctor must replace the antibiotic to prevent the development of addiction of the child's body to this drug.

b) Uroseptics

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

c) Vitamins and immunomodulators

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

d) Herbal treatment

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

Features of inpatient treatment

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

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

Often, the choice of treatment is carried out together with a pediatric urological surgeon in order to timely resolve the issue of eliminating anatomical anomalies if secondary acute or secondary chronic pyelonephritis is diagnosed in children.

Physiotherapy and exercise therapy

Physiotherapy depends on the severity of the disease, and is most often prescribed by a physiotherapist after a course of basic treatment, when the child's condition returns to normal. Ultrasonic methods, UHF-therapy, magnetotherapy have proven themselves well. Also, when the inflammatory process subsides, physiotherapy exercises are indicated in the supine or sitting position, depending on the age and condition of the child.

Preventive actions

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

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

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

Dynamic Surveillance

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

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

- During remission - 1 time per month

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

- Up to 15 years - 1 or 2 times a year

Systematic monitoring will avoid long-term complications of the disease: chronic renal failure, arterial hypertension, urolithiasis.

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

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

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

Acute pyelonephritis in children develops not only with hypothermia. More common causes of the disease are:

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

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

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

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

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

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

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

Types of pyelonephritis

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

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

Secondary pyelonephritis can be:

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

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

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

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

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

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

• saved;
• partially (partially) disturbed.

In chronic pyelonephritis, chronic renal failure may also develop.

Symptoms of the disease

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

In newborns and infants

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

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

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

For preschoolers and schoolchildren

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

Pain

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

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

urinary disorders

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

Other symptoms

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

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

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

Signs of chronic pyelonephritis

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

So, during remission are observed:

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

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

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

If chronic pyelonephritis progresses, the child:

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

Diagnostics

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

Other tests for pyelonephritis are:

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

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

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

Treatment of acute pyelonephritis

The goals of treating pyelonephritis in children are as follows:

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

Your child will need to be hospitalized if:

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

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

Diet

The diet for pyelonephritis is as follows:

Drinking regime

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

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

The course of fluid intake is 20 days.

Of the drugs prescribed:

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

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

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

Physiotherapy

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

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

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

Chronic course of the disease

Prevention of complications and chronicity

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

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

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

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

Anti-relapse therapy includes:

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

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

Complications

The consequences of pyelonephritis in children are serious diseases:

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

Forecast

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

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

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

Prevention

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

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

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