Kidney infection in children. Inflammation of the genitourinary system in a child. Useful video about urinary tract infections

Diseases of the urinary organs in children is a widespread and, due to the tendency to an asymptomatic course, an insidious problem. The meager symptoms characteristic of damage to the kidneys, bladder and urethra often lead to late diagnosis of diseases, after their transition to chronic form or in the stage of development of a complication. To avoid this problem, on the other hand, is quite simple: it is enough attentive attitude parents to the health of their child and regular monitoring of urinalysis.

Among the diseases of the urinary system, the most "popular" in childhood are pyelonephritis, glomerulonephritis, cystitis, urinary diathesis and nephroptosis (prolapse of the kidneys). Let's figure out in what situations the risk of developing these diseases increases greatly, and what signs and symptoms parents need to pay attention to in the first place.

Cystitis(inflammation of the bladder) - a deceptively "harmless" disease, the symptoms of which are quite easily stopped antibacterial drugs and also easily return if the disease has not been cured to the end. Cystitis can occur in children of any age, especially predisposed to it frequently ill children and girls during puberty. The infection can enter the bladder ascending from the inflamed urethra, or may be carried with blood from lesions chronic infection – carious teeth, untreated tonsils and adenoids, diseased ears and sinuses. Conditions that weaken the activity of the immune system predispose to the development of cystitis, such as hypothermia, malnutrition, hypovitaminosis, stress, taking certain medications (anticancer drugs, hormonal drugs).

The main symptoms of cystitis are general malaise, drawing pains lower abdomen, slight increase body temperature (usually up to 38 ° C), weakness. A characteristic symptom of cystitis is rapid, often painful urination- sometimes the child urinates up to 15 times a day. Appearance urine with cystitis can be very diverse - urine can be cloudy (due to the admixture of pus), red (due to the admixture of blood) or, outwardly, completely normal.

The main research methods confirming the diagnosis of cystitis are general urinalysis, urinalysis according to Nechiporenko, as well as ultrasound of the bladder. In some cases (with persistently recurrent cystitis), a urine culture with an antibiogram is prescribed.

Cystitis responds well to treatment with antibiotics and herbal preparations - the main thing is to maintain the regimen prescribed by the doctor and not stop treatment prematurely. An important point treatment is compliance with the drinking regime, as well as monitoring that the child's legs and Bottom part bodies were always warm.

Urethritis(inflammation of the urethra, urethra). The causes of the development of the disease are the same as with cystitis. Urethritis is more common in girls, especially adolescent girls. Sometimes under the mask of urethritis flow venereal diseases, "received" by a young girl as a result of the first unprotected sex with a sick partner. Therefore, the appearance of symptoms of urethritis in young girls should be paid special attention.

Typical manifestations of urethritis are pain and cramps along the urethra during urination. Urination is usually rapid, urine is excreted in small portions. The discomfort associated with the separation of urine contributes to sleep disturbance, appetite, and the appearance of general anxiety. Possible increase in body temperature general weakness and malaise. Both urethritis and cystitis are dangerous because of the possibility of spreading the inflammatory process to the kidneys, which can only be prevented with the help of timely diagnosis and treatment. The diagnosis of urethritis is made on the basis of the results of a general urinalysis, urinalysis according to Nechiporenko. Sometimes urine culture is performed, smears from the urethra are examined. For the treatment of urethritis, drugs from the group of uroseptics are used - they are excreted in the urine and provide a disinfecting and anti-inflammatory effect on the walls of the urethra.

Pyelonephritis(inflammation pelvicalyceal system kidneys). The cause of the development of pyelonephritis is an infection brought from outside or one's own conditionally pathogenic microflora organism, activated as a result of insufficient activity of immunity and other circumstances favorable for microbes. The development of pyelonephritis is facilitated by the presence in a child urolithiasis, anomalies in the structure of the kidneys.

A child with pyelonephritis complains of pain of varying intensity in the lumbar region, sometimes abdominal pain, an increase in body temperature is noted, accompanied by signs of intoxication (weakness, headache, sleep disturbance, appetite, etc.). The appearance of the urine either remains unchanged or the urine becomes cloudy. Pyelonephritis is unilateral and bilateral, acute and chronic. In an acute process, the symptoms of the disease and complaints are more pronounced than with an exacerbation of chronic pyelonephritis. Sometimes pyelonephritis is almost asymptomatic - this form of the disease can only be detected by a timely general urine test. Long-term untreated pyelonephritis leads to severe kidney damage, development kidney failure, hard to control arterial hypertension. The diagnosis is made on the basis of the results of a general blood and urine test, urine tests according to Nechiporenko and Zimnitsky, ultrasound of the kidneys and bladder, urine culture. Sometimes a biochemical blood test, urography is performed. Timely diagnosed pyelonephritis responds well to treatment with uroseptics, antibiotics, herbal preparations. For cupping pain symptom and facilitate the outflow of urine, antispasmodics are prescribed. Be sure to observe the drinking regimen and prevent hypothermia.

Glomerulonephritis- this is bilateral disease with damage to the glomerular apparatus of the kidneys. The development of glomerulonephritis is based on infectious process, which is initially localized in chronic foci - diseased tonsils, adenoids, inflamed paranasal sinuses nose, untreated teeth, gradually disrupts the work immune system and eventually damage the kidneys. Very often, glomerulonephritis becomes a complication of tonsillitis or scarlet fever (develops around the 3rd week of the disease), since these diseases are associated with pathogenic streptococcus, which “loves” kidney tissue very much. Typical symptoms glomerulonephritis are edema (mainly on the face, more pronounced in the morning), increased blood pressure, changes in the urine (urine acquires the color of "meat slops", that is, it becomes red-brown, cloudy). The child complains of headache, nausea. Sometimes there is a decrease in the amount of urine separated. Glomerulonephritis can have two variants of the course: acute, which ends in complete recovery, or chronic, which after a few years leads to severe impairment of kidney function and the development of renal failure.

Diagnosis of glomerulonephritis is based on the study of the results of a general analysis of urine and blood, urine tests according to Nechiporenko, according to Zimnitsky, a biochemical blood test. Valuable information is provided by ultrasound of the kidneys, in the diagnosis chronic glomerulonephritis sometimes a kidney biopsy is performed, followed by histological examination received tissues.

Therapy for glomerulonephritis includes a diet with restriction of protein intake; drugs that improve renal blood flow, antihypertensives, diuretics, immunomodulators. AT severe cases hemodialysis is performed (hardware purification of the blood from metabolic products that diseased kidneys cannot remove).

Therapy of glomerulonephritis is a long process that begins in a hospital, and then for a long time is carried out at home. The key to success in this situation will be strict adherence to all the doctor's recommendations regarding diet, drinking regimen, taking medications, regular visits to a pediatric nephrologist and taking blood and urine tests for dynamic monitoring.

Urolithiasis disease- a disease that is characterized by the formation of calculi (stones) of various composition, shape and size in the kidneys, less often in the bladder. The basis of the disease is a metabolic disorder minerals, which in the early stages of the disease (before the formation kidney stones) is also called uric acid diathesis. Increased content some salts in the urine leads to their precipitation, crystallization with the formation of sand and stones. Stones, injuring the urinary tract, contribute to the development of inflammation, which, in turn, supports stone formation. For a long time, the disease is asymptomatic, and can only be suspected by the presence of a large number of salt crystals found in a general urine test, or accidentally detected during an ultrasound scan of the internal organs. Often, the first manifestation of urolithiasis is an attack of renal colic, caused by the movement of a stone along the urinary tract. Renal colic manifested by the sudden onset of intense pain in the lower back and lower abdomen, impaired urination, the appearance of blood in the urine. Diagnosis of urolithiasis is based on the results of a general urinalysis, ultrasound of the kidneys and bladder, often additionally prescribed general and biochemical blood tests, urine tests according to Nechiporenko, urography, radiography. Treatment of urolithiasis consists in correcting the diet (in accordance with the type of impaired metabolism), taking antispasmodics, herbal preparations. In severe cases, it is surgical removal kidney stones.

Nephroptosis is a descent of the kidney or excessive mobility of the kidney ( wandering kidney). Nephroptosis develops due to weakening ligamentous apparatus kidneys and a decrease in the fat layer around it, which is often observed in children with an asthenic physique and poorly developed muscles of the anterior abdominal wall. Often nephroptosis is diagnosed in adolescent girls who observe rigid diets. Nephroptosis is mostly asymptomatic, the appearance of signs of the disease (pain and heaviness in the lower back during prolonged standing, the appearance of blood in the urine, increased arterial pressure) is usually associated with kinking of the ureter and vascular tension caused by the displacement of the kidney. The course of the disease is affected by the degree of prolapse of the kidney, which is determined using ultrasound or radiographic research methods. Treatment of nephroptosis I-II degree- conservative, consists in the normalization of body weight (with the help of a specially selected diet) and the implementation of special exercise strengthening the muscles of the back and abdomen. In some cases, wearing a bandage is indicated. With severe kidney mobility or grade III nephroptosis, surgical treatment may be necessary.

General urine analysis

Since urinalysis is a fundamental study in urology and nephrology, let us briefly dwell on the interpretation of some of its results.

Color and clarity of urine. Normally, urine light ranges from colorless (in newborns) to amber and straw. Urine should be clear and free from impurities. Pathological is the staining of urine in various shades of red, turbidity and Brown color urine.

The smell of urine. Urine should not have a strong odor. The smell of urine gives, most often, acetone - a substance that appears in the urine with acetonemic syndrome.

Relative density(specific gravity) of urine - the norm for a newborn is 1008-1018, for children aged 2-3 years - 1010-1017, and for children over 4 years old - 1012-1020. An increase in the density of urine indicates the presence of protein and / or glucose in it, or dehydration of the body. A decrease in relative density is observed in inflammatory processes in the kidneys, with a pronounced impairment of renal function.

Protein normally absent in the urine (or does not exceed 0.002 g/l). The appearance of protein in the urine (proteinuria) is observed with glomerulonephritis, kidney damage against the background of diabetes mellitus and others. serious illnesses kidneys.

Glucose normally absent in the urine (or does not exceed 0.8 mol / l). The appearance of glucose in the urine may indicate the presence of diabetes or other endocrine diseases.

Ketone bodies or acetone are normally absent in the urine or found in minimum quantity. An increase in the level of ketone bodies is possible during acute viral infections after overwork. A high level of acetone is characteristic of acetonemic syndrome.

Bilirubin normally not detected in urine. The appearance and high values ​​of bilirubin are noted in diseases of the liver and gallbladder.

red blood cells in the urine healthy child are present in the amount of 0-2 erythrocytes per field of view. The appearance of a large number of erythrocytes is characteristic of inflammatory processes in the urethra, bladder, kidneys, urolithiasis, glomerulonephritis.

Leukocytes- Normally, up to 5 leukocytes per field of view can be present in the urine. An increased white blood cell count is a symptom of inflammation of the kidneys and urinary organs.

Epithelium may be present in a small amount. An increased number of epithelial cells is characteristic of infectious diseases urinary tract.

cylinders are normally absent in the urine of a child. Most often, the appearance of cylinders indicates the presence of kidney disease.

bacteria normally absent in urine. The appearance of bacteria is either a symptom of an inflammatory process or a sign of transient asymptomatic bacteriuria (infection without inflammation).

Crystals and salts are normally found in small amounts and indicate acidic or alkaline reaction urine. An increased amount of salts may be evidence of uric acid diathesis or urolithiasis.

Finally

As already mentioned, a general urinalysis performed for a preventive purpose can save a child from the troubles associated with advanced diseases kidneys, bladder or urethra. The child should undergo such an examination annually - his parents should carefully monitor this. Take care of your health!

Inflammation genitourinary system is a common pathological condition in which there are various concomitant symptoms, differing in nature and severity depending on which organ is affected. According to medical statistics, such problems occur in 2% of boys and 5% of girls under the age of five.

It is also worth noting that inflammation of the urinary tract is more often diagnosed in an infant. This is because this system they have not yet fully formed, respectively, it is characterized by increased vulnerability. Let us consider in more detail the reasons why diseases of the organs of the urogenital tract develop, as well as how they manifest themselves, and what needs to be done.

When it comes to inflammatory processes, damaging organs urinary system, most often it is the lesion of the mucous membrane of the bladder that accumulates urine that is diagnosed. The main causative agent (approximately 85-90%) is Escherichia coli, much less often pathology is provoked by Staphylococcus, Klebsiella, Proteus and Enterococcus.

Processes classified as acute condition, often caused by a single type pathogenic flora. However, if created favorable conditions, for example, a child has a sharp decline protective abilities of the body, that is, became poor immunity polyvalent etiology is not excluded.

Anatomy of the urinary system. Source: cistitstop.ru

If the child was premature, or he was weakened as a result of frequent viral, possibly fungal, infectious processes, the bacterial flora may become the cause of inflammation. Doctors call the following conditions the main predisposing factors for the development of such diseases:

1. Neurogenic bladder;
2. diverticulitis;
3. Urolithiasis disease;
4. Hydronephrosis;
5. Vesicoureteral reflux;
6. Polycystic kidney disease;
7. Pyelectasis;
8. urethrocele;
9. Infectious disease of the mother during pregnancy;
10. phimosis;
11. Synechia of the labia.

Quite often it happens that the cause of the development of the inflammatory process lies in certain violations of the work. gastrointestinal tract. This manifests itself in the form of severe diarrhea, constipation and colitis. If the metabolic process is disturbed, then diseases of the kidneys and bladder can also develop.

As for the ways of penetration of infectious agents, there are several of them. Pathogenic bacteria can spread through the blood circulation or lymph flow from other affected organs, penetrate into the urogenital tract during such medical manipulation as catheterization, or be the result of a violation of the rules of intimate hygiene.

Kinds

Inflammation of the urinary tract in children can be of several types, depending on the area in which the pathological focus is located. Defeat upper divisions(pyelonephritis and pyelitis), middle (urethritis) and lower (cystitis and urethritis). Diseases are also classified into primary and recurrent. In the latter case, the reason lies in the previously incorrectly performed treatment or its inferiority.

As for the characteristic symptoms, it also directly depends on which disease is progressing, the level immune protection organism, type infection. In most cases, specialists identify pyelonephritis, inflammation of the bladder, and asymptomatic bacteriuria in pediatric patients.

Laboratory indicators of bacteriuria. Source: present5.com

The latter type of lesion is dangerous because it can progress for a long time without any signs. Therefore, parents may not know what is happening with the child's body. Bacteriuria is diagnosed through a laboratory study of the biomaterial. Alarm signals act: discoloration of urine, the appearance of an unpleasant odor.

Pyelonephritis

If there is an inflammatory process that affects the kidneys, then this is called pyelonephritis. In childhood, the disease progresses together with a pronounced increase in body temperature. Also, there are necessarily signs of intoxication (nausea, vomiting, headache, loss of appetite, refusal to eat).

Since the temperature can reach enough high performance, the child has a disorder of the gastrointestinal tract. Against this background, diarrhea appears, and if the baby is infancy, then meningeal symptoms, pain in the back and abdomen will be present. If left untreated, the disease will lead to the development of chronic renal failure.

Cystitis

With such a lesion, the inflammatory process is localized on the mucous membrane of the bladder. The main symptom is frequent painful urge to urinate, which is often false. During a bowel movement, the child may feel pain in the urethral canal, and the development of urinary incontinence is also possible.

Normal and inflamed bladder with cystitis. Source: zertcalo.ru

In infants, cystitis can cause total absence bowel movements if the inflammation is severe enough. Sometimes urine comes out in jerks and in small portions, which causes pain and discomfort to the child, so he begins to cry, knock his legs. As for the temperature, it is rarely high.

Given the anatomical features of the structure of the organs of the genitourinary system, cystitis in most cases worries girls rather than boys. As such, if it is treated in a timely manner, the disease does not pose a danger, but is accompanied by strong unpleasant sensations. If timely assistance is not provided, the infection will progress upward, leading to inflammation of the kidneys.

Diagnostics

To confirm or refute inflammation of the urinary tract in a child, you need to go for a consultation with pediatrician. After being examined by a pediatrician, a specialist can issue a referral for admission to other narrow specialists, for example, it can be a urologist or nephrologist, and a gynecologist is also indicated for girls.

Necessarily at the initial examination, the pediatrician appoints a change laboratory tests. Based on their results, a preliminary diagnosis can be made. When examining urine, it is determined high content leukocytes, the presence of protein, bacteria, erythrocytes is not excluded. Additionally, a Zimnitsky test is prescribed, a study according to Nechiporenko.

A blood test is uninformative in the presence of an inflammatory process in the organs of the urogenital tract. However, some signs of pathology will still be present, for example, leukocytosis and elevated ESR. In the case of pyelonephritis, the presence of C-reactive protein is noted.

If, when performing a general analysis of urine, bacteria were identified in it, the sowing of urine on a nutrient medium is prescribed. Thanks to this, it will be possible to accurately determine what caused the disease, as well as to select antibiotics for treatment, to which the pathogenic flora does not have immunity. Sometimes PCR analysis is shown.

Features of passing a urine test according to Nechiporenko. Source: mycistit.ru

Concerning instrumental diagnostics, then the most popular method here is ultrasound screening. It can also confirm primary diagnosis without harming the baby's body. At frequent inflammations kidneys in a child, during the period of remission, it is recommended to perform excretory urography. If there is a risk of damage to the parenchyma of the organ, scintigraphy is necessary. Sometimes endoscopic examination is indicated.

Treatment

Before developing the most appropriate therapy tactics, the doctor must take into account the patient's diagnosis, severity pathological process and also evaluates the overall health of the child. Be sure to look at the age of the baby, since many antibacterial agents have restrictions on this parameter, so uncontrolled intake often causes complications and adverse reactions.

If an acute inflammatory process is diagnosed, compliance with strict bed rest. Children should not engage in active games, as well as stay on the street, they need to be at home all the time. Parents, in turn, are obliged to balance the patient's diet.

It is very important to stick to a diet. All spicy, spicy, salty and fried foods are excluded from the diet so that the inflammation does not worsen. Preference should be given fermented milk products drink plenty of fluids (water, herbal teas, fruit drinks). Cereals cooked on a mole and lean meat have a good effect on the body.

With inflammation of the urinary tract, diet should be followed.

Urinary tract infections in children are quite common, especially in children under 3 years of age. Moreover, in almost half of the cases, the inflammatory process starts asymptomatically, which is why parents do not have the opportunity to see a doctor in time. How to suspect an infection in a timely manner? How to prevent the development of complications? And how to treat the disease? Let's talk in detail!

As a rule, for the first time, a urinary tract infection "attacks" children at a very young age - from the neonatal period to three years. And in subsequent years, the disease can make itself felt again and again with relapses.

Some important facts about the disease

Urinary tract infection (including in children) refers to a sharp increase in the number pathogenic bacteria in the urinary tract. Most often, bacteria enter the urinary tract from inflamed genital organs. Most urinary tract infections (UTIs) in children are caused by bacteria such as E. coli, Enterococcus, Proteus, and Klebsiella.

In adults, urinary tract infections are usually accompanied by unpleasant symptoms(frequent and painful urination, sharp pains in the lower abdomen, etc.), but in the case of children, all these signs of an inflammatory process with UTI are often absent, with the exception of high temperature. In other words, if, doctors, not without reason, begin to suspect that he has a urinary tract infection. It is possible to refute or confirm these assumptions with a urinalysis.

In children, UTIs are, alas, quite widespread: for example, among younger children school age on average, about 8% of girls and 2% of boys already have a recurrence of a urinary tract infection.

Urinary tract infection in children: causes

It must be said that the hit dangerous bacteria into the urinary system of a child does not mean a hundred percent start of the disease. Urinary tract infection in children begins to develop only against the background of some concomitant factors that contribute to inflammation. These factors include:

• Metabolic disorders in the body;
• General hypothermia of the body or local hypothermia in the kidney area;
• In boys, a urinary tract infection often occurs against the background of phimosis (a certain anomaly in the structure of the penis);
• Violation of the rules of personal hygiene of the child (in order to avoid which parents should know elementary tricks - and).

Hypothermia is one of the most common causes of urinary tract infections in children. With hypothermia, a spasm of the vessels of the kidneys occurs, which leads to a violation of the filtration of urine, at the same time, the pressure in the urinary system decreases, and all this together often provokes the onset of the inflammatory process. Especially often, a urinary tract infection occurs precisely when a child sits on a cold stone, metal swing, etc. for a long time.

Symptoms of a urinary tract infection in children

In some cases, UTIs in children are asymptomatic, except for fever. In fact, the fever itself in the child in the absence of any other visible symptoms the disease often signals precisely the onset of inflammation in the urinary tract (we repeat: in this case, a general analysis of the child's urine should be performed). But there are situations when a urinary tract infection in children manifests itself with the following symptoms:

• Frequent urination with an extremely small amount of urine released "at a time";
• The child complains about pain or burning during "going to the toilet";
• The child complains of pain in the lower abdomen;
• Urine takes on an uncharacteristic color, density, or odor;
• (especially at night) over the age of 7-8 years;
• constant thirst;
• The general condition and behavior of the child may change - the baby becomes lethargic, capricious, whiny, loses appetite, etc.

If the baby, for no apparent reason, suddenly turned from a playful, restless "top" into a lethargic, apathetic, capricious "sleeper" (which, perhaps, again for some reason began to "spawn" at night in bed) - you will definitely not be out of place to do general analysis of the urine of the child. It is likely that the reason for these changes lies precisely in the development of urinary tract infections.

Treatment of urinary tract infection in children

The diagnosis of UTI is not made without confirmation by laboratory tests of urine (with a general analysis of urine for an infectious process in the urinary tract, it indicates abnormally a large number of leukocytes with a predominance of neutrophils). Sometimes a child is also assigned an ultrasound or x-ray study of the structural features of the urinary system. If the diagnosis of UTI is confirmed, the doctor prescribes antibiotic therapy.

The basis of effective treatment of any urinary tract infection in children and adults is the use of antibiotics appropriate for age and medical situation. Already after 24-48 hours after the start of taking the drugs, the child's well-being will noticeably improve, but it is important for parents to remember that for a true recovery, it is necessary to endure full course antibiotic therapy, which averages 7-14 days.

If a urinary tract infection in a child is not treated in time (either simply “missing” the onset of inflammation, or deliberately ignoring medical intervention), then its advanced form threatens children's health certain complications. The most frequent of which is chronic pyelonephritis in other words - inflammation of the kidneys.

How to collect baby urine for analysis

Since the reliability of the diagnosis for suspected urinary tract infection is based on the result of the analysis of the child's urine, it is very important to collect the material for this analysis correctly and pass it on time. And to know what mistakes in this case are made most often:

• To collect urine, it is advisable not to use a jar that up to this point already had some contents in it (for example, you bought it with baby food / pickles / jam or something else), and then it was washed with soap, dishwashing detergent or laundry detergent. The fact is that particles of any substances that have been in this container can one way or another be reflected in the analyzes of your child, clearly distorting the picture of what is happening. Ideally, to collect analyzes, you need to use special sterile containers that are sold at any pharmacy.
• For collecting urine from newborns and infants, convenient devices have long been invented - special urinals, which save parents from the need to “squeeze out” diapers or guard near the baby, spread out on oilcloth ... These devices are completely safe, they are hermetically glued to the child’s genitals, do not cause any discomfort to the baby and are simply removed.
• No more than 1.5 hours should elapse between the moment of urine collection and its entry into the laboratory.. In other words, you can’t collect urine from a child at bedtime, then put it in the refrigerator, and in the morning “on a blue eye” donate such material to the laboratory - this analysis will not be reliable.

Is it possible to treat UTIs with "folk" remedies?

Alas, when it comes to treating children from a particular disease, parents (out of ignorance or due to well-established clichés) confuse in which cases which method of treatment is appropriate. So it turns out that we often give our children the strongest medicines in situations where it is quite possible to do without them (the most striking example is the use of antibiotics for supposedly preventive purposes), and at the same time we try to treat bacterial infections with decoctions and lotions "by grandmother's recipe.

In the case of a urinary tract infection, parents should be clearly aware that this is a dangerous bacterial disease, which over time, without proper treatment, is at great risk of developing into a chronic form and giving complications.

Application of modern antibacterial agents for the treatment of UTI is the only adequate and effective treatment. But which antibiotic will be the most effective and at the same time safe - the doctor will tell you, based on the situation and individual characteristics child.

However, in fairness it should be said that several years ago in Europe there were studies involving women with cystitis (one of the forms of UTI), the result of which showed that drinking concentrated cranberry juice significantly helps to reduce the number of bacteria in the urinary tract. In other words, cranberries helped kill bad bacteria in urinary tract infections in ladies. To date, no such studies have been conducted in children. However, it is logical to assume that if your child is not allergic to cranberries, then it would not be out of place to include it in the diet of a child diagnosed with a UTI.

And also remember: no medicinal antibiotics cannot be used as a prophylaxis (including against the development of urinary tract infections in children), but cranberry fruit drinks, jelly and jam, on the contrary, can become reliable and tasty protectors against infection.

Urinary tract infections (UTIs) are diagnosed by detecting >5x104 colonies/mL in catheter-obtained urine specimens or in older children in repeated urine specimens containing >105 colonies/mL. In young children, UTIs are often the result of anatomical abnormalities. UTIs can cause fever, anorexia and vomiting, flank pain, and signs of sepsis. Treatment involves the appointment of antibiotics. After recovery, imaging studies of the urinary tract are performed.

Inflammation in UTIs may involve the kidneys, bladder, or upper and lower urinary tract. STIs such as gonococcal or chlamydial urethritis, although they cause inflammation in the urinary tract, are generally not classified as UTIs.

Mechanisms that maintain normal sterility of the urinary tract include acidic urine, unidirectional downward movement of urine, regular emptying of the urinary tract, and normally functioning vesicoureteral and urethral sphinkers. Failure of any of these mechanisms predisposes to UTIs.

In the first year of life, approximately 4% of boys and 2% of girls develop a urinary tract infection (UTI). Among older, prepubertal children, UTIs occur in 3% of girls and 1% of boys.

For the purposes of appointment adequate therapy UTIs should be classified according to location and severity. Other factors may play important role on further evaluation. In 75% of cases, the cause of UTI is Escherichia coli.

Causes of urinary tract infections in children

UTI by the age of 6 years suffer 3-7% of girls and 1-2% of boys. The peak age of UTI is bimodal with one peak in infancy and a second peak at 2–4 years of age (during toilet training for many children). The ratio of girls to boys in the incidence structure varies from 1:1 to 1:4 in the first 2 months of life (estimates differ primarily due to the proportion of uncircumcised boys in different populations and the exclusion of infants with urological anomalies - currently they are often diagnosed in utero with assistance of prenatal ultrasound). The girl-to-boy ratio increases rapidly with age, reaching approximately 2:1 from 2 months to 1 year, 4:1 in the second year, and >5:1 after 4 years. In girls, infections are usually ascending and rarely cause bacteremia. The predominance of UTIs in girls at an early age is explained both by the shorter female urethra and circumcision in boys.

Predisposing factors include urinary tract malformations and obstruction, prematurity, frequent and prolonged catheterization, and lack of circumcision. Other predisposing factors in young children include constipation and Hirschsprung disease. Risk factors in older children include diabetes mellitus, trauma, and, in adolescent girls, sex.

Urinary tract anomalies. UTIs in children indicate possible urinary tract abnormalities; these disorders, in particular, can lead to the development of infection in the presence of VUR. The probability of VUR varies inversely with the age of the first case of UTI.

Microorganisms. With abnormalities of the urinary tract, infections can be caused by various microorganisms.

In the absence of abnormalities in the urinary tract, the most common pathogens are strains of Escherichia coli. coli causes >75% UTI in all children age groups. More rarely, UTIs are caused by other gram-negative enterobacteria.

Enterococci (group D streptococci) and coagulase-negative staphylococci (eg, Staphylococcus saprophytics) are the most commonly identified causative Gram-positive organisms. Fungi and mycobacteria rarely cause infection, mainly in immunocompromised patients. Adenoviruses rarely cause UTIs, and hemorrhagic cystitis develops predominantly.

Symptoms and signs of urinary tract infections in children

In newborns, symptoms of UTIs are nonspecific and include poor appetite, diarrhea, anorexia, vomiting, mild jaundice, lethargy, fever and hypothermia.

Infants and toddlers may also experience general symptoms such as fever, dyspepsia, or foul-smelling urine.

Children older than 2 years usually develop the classic symptoms of cystitis or pyelonephritis. These include dysuria, urinary frequency, urinary retention, fetid odor urine, enuresis. Pyelonephritis is characterized by fever, chills.

Possible anomalies in the structure of the urinary tract can be indicated by an increase in the kidneys, volumetric formations in the retroperitoneal space, a defect in the opening of the urethra, and malformations of the lumbar spine. A weak urine stream may be the only sign of urinary tract obstruction or a neurogenic bladder.

Signs of pyelonephritis

Newborns:

• weight loss due to refusal to feed;
• vomiting and diarrhea;
• pale gray skin;
• jaundice;
• hyper- and hypothermia;
• often sepsis.

Infants, small children up to the 3rd year of life:

• fever;
• abdominal pain, nausea and vomiting;
• digestive disorders with weight loss;
• fetid urine.

Older children:

• vomit;
• loss of appetite;
• pain in the abdomen and kidney area;
• fetid urine.

Lab changes:

• significant bacteriuria and leukocyturia;
• increase in the level of SRV;
• increase in ESR;
• in newborns and infants, hyponatremia and hyperkalemia are possible.

Signs of cystourethritis:

• burning sensation when urinating;
• dysuria, pollakiuria;
• incontinence with imperative urges;
• stomach ache;
• there is usually no fever and systemic signs of inflammation.

special shapes

• Asymptomatic urinary tract infection: bacteriuria with possible leukocyturia without clinical symptoms, the disease is discovered by chance, mainly in girls aged 6-14 years.
• Complicated (secondary) pyelonephritis with obstruction of the urinary tract, for example, with stenosis of the ureter or the mouth of the ureter.

Accordingly, after the first episode of pyelonephritis, mandatory diagnostics: ultrasound procedure and voiding cystourethrogram, if necessary, further diagnostics.

Diagnosis of urinary tract infections in children

The average portion of urine, urine taken with a catheter, bladder puncture: bacteria, leukocytes.

Blood: leukocytes, CRP, ESR (pyelonephritis), creatinine (bilateral pyelonephritis).

Ultrasound - in every case of urinary tract infection.

Individual approach in deciding the need for radiological examinations:

• voiding cystourethrogram;
• intravenous pyelography - with complex malformations;
• dynamic scintigraphy of the kidneys - with violations of the outflow of urine.

A urine culture should be performed in every child with a fever over 38°C. A clean urine sample is ideal, but if this is not possible, suprapubic aspiration is performed.

The two most common sites for UTIs are the bladder (cystitis, manifested by dysuria, urinary frequency, hematuria, enuresis, and abdominal pain). suprapubic region) and upper urinary tract (pyelonephritis, the symptoms of which are fever, pain in the side, tenderness on palpation in the projection of the kidneys). The severity of a UTI can be assessed by the degree of fever. An increase in body temperature above 39°C is considered severe course. This is characterized by the appearance of systemic manifestations, such as vomiting and diarrhea.

The medical history should be as detailed as possible. It is necessary to ask about the presence or absence of a history of urinary problems (difficulty urinating), constipation, recurrent infections, vesicoureteral reflux, and antenatal kidney disease. It is also necessary to collect a hereditary history. Any child under 3 months of age with a UTI should be referred to a pediatric urologist.

Urinalysis. To make a diagnosis, it is necessary to collect urine for culture and verify significant bacteriuria. Usually, urine is collected from young children using a urethral catheter, and from boys with moderate to severe phimosis, using a suprapubic puncture of the bladder. Both techniques require technical skills, but catheterization is less invasive and much safer. The use of urinals is considered less accurate for diagnosis, and urine samples are less stable.

If urine is obtained by suprapubic puncture, the presence of any bacteria is significant in the diagnosis. The presence of >5 x 104 colonies/mL in a catheter specimen is usually indicative of a UTI. Mid-stream urine collection is important when counting colonies of a single pathogen (i.e. not total mixed flora) at >105 colonies/mL. However, sometimes a UTI is diagnosed in symptomatic children despite low quantity colonies at seeding. Urine should be analyzed as soon as possible after collection or stored at 4°C if a delay in analysis of >10 minutes is expected. Occasionally, UTI occurs despite a low colony culture, this may be due to prior antibiotic therapy, high dilution of the urine (specific gravity less than 1.005), or severe obstruction of the flow of infected urine. Sterile urine cultures rule out UTIs.

Microscopic examination of urine is useful, but does not guarantee high accuracy. Pyuria has a sensitivity of about 70% for UTIs.

Test strips to detect bacteria in the urine (nitrite test) or white blood cells (leukocyte esterase test) are used quite often; if this test is positive, the diagnostic sensitivity for UTI is about 93%. The specificity of the nitrite test is quite high; a positive result in a fresh urine sample is highly accurate for UTIs.

Fever, back pain, pyuria indicate pyelonephritis.

Blood tests. Clinical Analysis blood and marker testing bacterial inflammation(eg, ESR, C-reactive protein) may help diagnose infections in children with borderline urine values. Some institutions measure serum urea and creatinine during the first episode of UTI.

Imaging of the urinary tract. The high frequency of anatomical abnormalities does not suggest imaging of the urinary tract. If the first episode of UTI occurs at age >2 years, most experts recommend additional examination however, some clinicians delay imaging until a second UTI occurs in girls >2 years of age. Options include urinary cystourethrography (VCUG), radionuclide cystogram (RNC) with technetium-99m pertechnetate, and ultrasound.

VCUG and RNC are better than ultrasound for detecting vesicoureteral reflux and anatomical abnormalities. Most specialists prefer better anatomical VCUG contrast as the initial test, using RNC in subsequent management to determine when the reflux has resolved. Low dose X-ray equipment narrows the radiation dose gap between VCUG and RNC. These tests are recommended as soon as possible after clinical response, usually at the end of therapy when bladder reactivity has resolved and urine sterility has been restored. If imaging is not planned until the end of therapy, the child should continue to take prophylactic antibiotics until the vesicoureteral reflux has resolved.

Prognosis of urinary tract infections in children

When properly managed, the disease rarely leads to kidney failure in children unless they have uncorrected urinary tract abnormalities. However, it is believed (but not proven) that repeated infections cause kidney scarring, which can lead to hypertension and end-stage kidney disease. In children with high vesicoureteral reflux, long-term scarring occurs 4-6 times faster than in children with low VUR and 8-10 times faster than in children without VUR.

Treatment of urinary tract infections in children

• Antibiotics.
• In severe vesicoureteral reflux, a course of antibiotics and surgery.

Pyelonephritis: newborns and infants must intravenous administration, up to 3 months, for example, ampicillin, later, for example, cephalosporins. Before starting antibiotic treatment - blood and urine cultures. The duration of treatment is 10 days.

Cystitis: for example, trimethoprim for 3-5 days.

After pyelonephritis in infancy in the presence of vesicoureteral reflux and / or megaurethra: prevention of re-infections (eg, cephalosporins in infants and young children, later - trimethoprim, nitrofurantoin).

Surgical treatment - for obstruction (for example, with urethral valves - immediate operation) or for severe vesicoureteral reflux.

With asymptomatic bacteriuria without signs of inflammation and normal results ultrasound in most cases, treatment is not indicated; dynamic monitoring of the results of urine tests.

Treatment is aimed at eliminating acute infection, prevention of urosepsis and preservation of the functions of the renal parenchyma. Antibiotics are started prophylactically in all children with toxic manifestations and children without toxic manifestations with a probable UTI (positive leukocyte esterase or nitrite test, or detection of pyuria or bacteriuria on microscopy). The rest can wait for the results of the sowing.

In infants 2 months to 2 years of age who are intoxicated, dehydrated, or unable to take oral medications, use parenteral antibiotics usually 3rd generation cephalosporins. 1st generation cephalosporins (eg, cefazolin) may be used if typical local pathogens are known to be sensitive to this group of drugs. Aminoglycosides (eg, gentamicin), although potentially nephrotoxic, are useful in complex UTIs for the treatment of potentially resistant Gram-negative bacteria such as Pseudomonas. If blood cultures are negative and clinical response is good, appropriate oral antibiotics, selected on the basis of antimicrobial specificity, may be used to complete the 2-week course. A poor clinical response suggests microorganism resistance or obstructive lesions and requires urgent revision of the ultrasound findings and repeat urine cultures.

In non-toxic, non-dehydrated infants and children who are able to take oral medications, antibiotics can be given by mouth from the start. The drugs of choice are TMP/SMX 5-6 mg/kg (according to TMP) 2 times a day. An alternative are cephalosporins. Therapy is changed based on culture results and antimicrobial susceptibility testing. Treatment is usually given for >10 days, although many older children with uncomplicated UTIs can be treated within 7 days.

Vesicoureteral reflux. It is generally accepted that antibiotic prophylaxis reduces the recurrence of UTIs and prevents kidney damage. However, there are some long-term data on the possibility of developing renal scarring and little effectiveness of antimicrobial prophylaxis. Current clinical researches are trying to address these issues, but until results are available, most physicians provide long-term antimicrobial prophylaxis for children with VUR, especially those in grades two through five. For patients with fourth or fifth grade VUR, it is usually recommended abdominal operation or endoscopic injection of polymeric fillers.

Preventive medications include nitrofurantoin or TMP/SMX, usually at bedtime.

In the case of pyelonephritis, all children should be referred to a pediatric urologist. The course of oral antibiotic therapy is 7-10 days.

The presence of cystitis in children older than 3 years does not require referral to a specialist in the absence of a recurrent course. If asymptomatic bacteriuria is detected, treatment is not indicated.

After a single episode of UTI, antibiotic prophylaxis is not required. After treatment, it is necessary to explain to the parents of the child the importance of drinking an adequate amount of fluid per day and regular urination.

In accordance with modern recommendations, in children under 6 months of age, ultrasound is indicated for recurrent or complicated UTIs. Ultrasound should be complemented by a dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography to elucidate the cause of a UTI and evaluate for scarring and renal dysfunction.

In the case of an uncomplicated UTI, an ultrasound examination may be performed after the child has recovered. For older children with a single episode of UTI responding to therapy within 48 hours, beam methods diagnosis is not shown.

DMSC is much more gentle, and VCUG is only indicated for urethral dilatation on ultrasound, a family history of vesicoureteral reflux, urinary incontinence, or non-E. coli infection.

It is important that parents know which symptoms should be treated by a specialist. In most uncomplicated cases, observation is not required.

Patient monitoring

• Urine: color, smell, frequency of urination.
• Measurement of body temperature rectally 3 times a day.
• Maintaining water balance, offer liquid in sufficient quantity.

Care

• Careful hygiene of the perineum, complete emptying of the bladder.
• Avoid local cooling or exposure to dampness, as well as general hypothermia (for example, reduce bathing time).
• Local application of heat (for example, for abdominal pain): compresses, heating pads (hot water).
• In the absence of appetite or vomiting, food should be offered more often (menu of choice, small portions), in some cases - parenteral nutrition.

One of the most common causes of childhood illness is urinary tract infection in children. Most of all, this is observed in children under the age of one, who need full care. When infected, patients do not always show symptoms, but serious complications often occur, which are difficult to cure. How to determine the presence of the disease?

General information about the disease

Infectious inflammation of the urinary tract in children most often manifests itself without symptoms and is detected when comprehensive examination patient. For diseases of the urine excretory system the body quickly succumbs to infectious effects, as a result of which the kidneys become inflamed in the child. To examine the child for infection, a general urinalysis, ultrasound is prescribed. After the study, the baby is prescribed a treatment complex, which includes antibiotics and uroantiseptics, which are supported by traditional medicine.

Reasons for the development of pathology

Inflammation of the urinary tract in childhood occurs due to various harmful microorganisms. Which infection will spread in the body depends on what gender the child is, how old he is and what condition his immune system is in. The most common microbes include enterobacteria, among which Escherichia coli is more often found. Other factors in the occurrence of diseases of the urinary system can be:

• urodynamic disorders (ureteric reflux, malfunctioning of the bladder);
• reduced efficiency of the immune system (due to the production of a small amount of antibodies, cell immunity decreases);
• disturbed metabolic processes;
• changes in vessels located in the renal tissues;
• abnormal structure of the organs of the reproductive system, congenital anomalies;
• spread of infection in the genitals or intestinal environment;
• the appearance of worms in a child;
• surgical intervention in the urinary tract.

According to statistics, the disease is more common in patients under one year old, however, depending on gender and age, different indicators morbidity. Most often, the pathology is diagnosed in girls due to the fact that their urinary canal is close to the vagina, and the female urethra is much shorter than that of men. Girls most often get sick at the age of 3-4 years. Infection of the genitourinary system in infants is more typical for a boy. In this case, inflammation of the urinary tract in a child occurs due to the abnormal development of the genital organs. In addition, the reason for the appearance of a urinary tract infection in infants may be improper care.

Factors contributing to the development of infectious inflammation

There are many predisposing factors that cause bladder infections in children. Among them are disturbed normal urinary outflow, obstructive uropathy, reflux of the bladder and urinary tract. Pathology develops due to a deterioration in the functioning of the immune system, impaired metabolic processes and also appears in patients with diabetes, renal calcification. Infections can also enter the urinary tract due to medical interventions, after which harmful microorganisms are able to multiply more actively.

Classification of harmful microorganisms

According to the prevalence of inflammation, there are microorganisms that have affected the upper sections of the excretory system (kidneys, ureters) and lower divisions(bladder, urethra). Thus, if the upper sections are affected, pyelitis, pyelonephritis is diagnosed, and if the lower ones are infected, cystitis, urethritis. Depending on the period of occurrence, the disease occurs in the first episode or recurrent. The disease is sometimes reinforced by secondary infection. Looking at what symptoms appear in the patient, a mild and severe infection is isolated (complications appear, it is difficult to tolerate).

Symptoms of urinary tract infections in children

Symptoms appear depending on the age of the small patient. In children under the age of 2, fever, vomiting, diarrhea appear, the shade of the urethra changes, and the skin turns pale. Newborns have no appetite, they are naughty a lot, cry and become irritable. In patients aged 2 years and above, pain begins during urination, the urine is dark in color, the lower abdomen hurts, and the body temperature rises to 38 degrees and above.

Features of the manifestation in the baby

In infants, infectious inflammation of the genitourinary system manifests itself to a greater extent without signs: temperature indicators practically do not increase, intoxication, gray skin, apathetic state, anorexia may occur. If a patient has acute bacterial cystitis, then his temperature rises above 38 degrees.

Diagnostic measures

Laboratory methods of examination

Bacteriological method for the study of urine

The bacteriological method is the main one when examining a patient for the presence of urinary infections. Such a study allows you to determine the type of harmful microorganism, as well as the level of its sensitivity to antibiotics. To have accurate results, you must adhere to the rules for conducting the examination, as well as have sterile instruments.

General urinary analysis

Another, no less reliable way to study a patient is a general urinalysis. It can be used to determine the number of leukocytes, erythrocytes in the urine, as well as protein level. When increased performance talk about the occurrence of inflammatory processes in the organs of the urinary system, including in the kidneys and in the bladder.

General method of blood testing

To determine the presence of inflammatory processes in the urinary system, a general blood test is performed. Using this method, an elevated leukocyte level can be detected, high ESR and changes in leukocyte formula. Often, inflammatory processes are characteristic of the development of pyelonephritis. For urethritis or cystitis, inflammation is less common.

Instrumental diagnostic methods

Ultrasound as a method of examination

Ultrasound is allowed to be performed regardless of age. Using the ultrasound examination method, it is possible to see the real size and condition of the kidneys, determine the stones in the urinary system, assess the volume of the bladder, as well as the presence of inflammatory processes in it. Ultrasound makes it possible to determine the abnormal development of organs in the early stages.