Pyelonephritis in infants and its treatment. Pyelonephritis in children: treatment of acute and chronic forms Consequences of pyelonephritis in children

What disease in children under one year 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:

• SARS: adenovirus infection, influenza;
• intestinal infection caused by Escherichia coli (E. coli) or Coxsackie viruses;
• long-term antibiotic treatment, due to which pathogenic fungi develop in the urinary tract;
• chronic constipation, due to which the intestinal flora migrates 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 evaluates the state 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. an 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 kidney 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.

One of the most common diseases of childhood is pyelonephritis, in which an infectious and inflammatory lesion of the kidneys occurs. Pathology can develop in children of any age, but babies of the first years of life are especially susceptible to it. The chronic form of the disease is considered more dangerous than the acute form. It is sometimes difficult to diagnose it in time due to the vagueness and low severity of symptoms. At the same time, long-term chronic inflammation can lead to irreversible changes in kidney tissues.

Characteristics of chronic pyelonephritis in children

Chronic pyelonephritis in children is an inflammatory process with characteristic scarring in the kidneys that occurs after repeated or persistent infections. A pathological microorganism, finding itself in the kidney of a child, first causes acute inflammation in it. It resolves within 1–1.5 months under the influence of treatment or on its own. In the future, under the influence of many factors, including ineffective therapy or its absence, the infection may return - recur. Such a repetition of the disease scenario 2-3 times in six months will mean that pyelonephritis has passed into a chronic process, which is characterized by periodic exacerbations.

Fibrosis and deformation of the internal structure of the kidney - signs of chronic pyelonephritis

Approximately 9 out of 10 sick children successfully recover from acute pyelonephritis. But in 10% of them, the disease does not go away or recurs within 6 months. In this case, patients are diagnosed with a chronic form of the disease.

Inflammation in most cases occurs under the influence of a bacterial pathogen. The possibility of a viral nature of the disease has not been confirmed to date, although, of course, the presence of a virus is a kind of “open gate” for the development of a future bacterial infection.

The bacterial pathogen enters the urinary system of the child in three ways:

• hematogenous - through the bloodstream. Such infection is especially characteristic for infants under 1 year old, but it is possible at any other age;
• lymphogenous (extremely rare) - through the lymphatic vessels in severe intestinal infections;
• urinogenic - the infection is in the bladder and ureter, getting there from the anus or vaginal vestibule in girls. Then the infection of the kidney itself occurs in an ascending way.

There are three ways of infection in the kidney: hematogenous, lymphogenous and urinogenous.

Chronic pyelonephritis in a child's kidney is most often caused by the following pathogens:

• coli (lat. Escherichia coli);
• Klebsiella (lat. Klebsiella);
• proteus (lat. Proteus);
• enterococcus (lat. Enterococcus);
• microbial associations (mixed flora).

E. coli - the leader among the causative agents of pyelonephritis

These types of enterobacteria are permanent inhabitants of the intestine and a conditionally pathogenic component of its flora. This means that in a certain concentration within the intestines, they are not dangerous. However, getting into the urinary tract, they provoke infection. As a rule, staphylococci and streptococci penetrate the bloodstream.

Doctors identify age risk groups when the maximum incidence is recorded in children:

• infants up to a year;
• babies from 2 to 3 years old;
• children of primary school age: from 4–6 to 7–8 years;
• teenagers.

It is during these age periods that the genitourinary system of children is most vulnerable.

Pyelonephritis in children: video

Etiology and pathogenesis

The main causes of chronic pyelonephritis in children:

According to studies, about 50% of newborns who are in intensive care after birth have kidney damage.

In addition to the causes that directly cause prolonged inflammation, there are also some predisposing factors that can indirectly affect the pathogenesis of the process:

Classification

Depending on which kidney is infected, right-sided and left-sided pyelonephritis are distinguished. The disease is classified into two main types:

• primary, or non-obstructive - when the disease is not burdened by anatomical abnormalities, and this is confirmed by laboratory tests;
• secondary, or obstructive - if the process was preceded by any negative aggravating physical defects of the urinary system.

The disease goes through several phases of activity:

• active - inflammation, which is symptomatic, confirmed by the results of laboratory tests and instrumental studies;
• inactive - a latent, or latent, course that can be accidentally detected during a scheduled test;
• remission - the complete disappearance of the entire symptom complex, in fact - a clinical recovery.

The chronic course basically corresponds to secondary pyelonephritis and happens:

• obstructive - inflammation against the background of organic (congenital or acquired) disorders of the urine flow;
• non-obstructive (dysmetabolic) - when comorbidities are vascular disorders, immunological deficiency, etc.

Classification of pyelonephritis in children - table

Symptoms

Chronic pyelonephritis is characterized by an undulating course and a change of periods: exacerbation and asymptomatic. The disease can proceed latently and does not manifest itself for years. Relapses are accompanied by all the symptoms that are typical for the acute course of the disease. Babies become irritable and get tired quickly. Schoolchildren's academic performance is declining.

Signs of an exacerbation in infants include:

Such symptoms, of course, are not specific for this disease in infants, which is the difficulty in diagnosing chronic pyelonephritis in children under one year old.

In older children, the symptoms are significantly different, and the clinical picture has characteristic signs that the child can already complain about on his own:

The peculiarity of pyelonephritis in children under 10-11 years old is that girls of this age category get sick 3-5 times more often than boys. This is due to the female anatomy: the proximity of the genitals and the shorter urethra.

Diagnosis and differential diagnosis

At the appointment, a pediatric nephrologist will assess the appearance of the skin, swelling of the face. Feel the lumbar region, with light movements tap the edge of the palm on the lateral parts of the back (percussion of the kidneys). If there is pain or discomfort, this will alert the doctor.

A similar sign is called a positive symptom of Pasternatsky, and he says about the presence of inflammation in the kidney. But the main diagnostic methods are instrumental examinations and specific tests. Diagnosis is made primarily by laboratory results. You will need:

Normally, protein in the urine can be contained in negligible amounts, practically it should not be there, as well as urea in the blood. Thus, it is possible to trace the pathological tendencies of the violation of the excretory function of the kidneys.

With the help of instrumental methods, it is possible to assess the degree of functional changes and deformation of the kidneys. The most informative urological examinations:

Chronic pyelonephritis in children during an exacerbation has common features with such diseases that require differential diagnosis:

• inflammation of the bladder (cystitis);
• parenchymal nephritis;
• glomerulonephritis;
• kidney tuberculosis.

When making a diagnosis, the doctor takes into account the totality of clinical manifestations, the data of the survey and examination of the child. The doctor systematizes complaints that may indicate pyelonephritis. Thus, in order to correctly determine the disease, a nephrologist or urologist must take into account a whole range of symptoms:

• signs of general intoxication;
• pain in the kidney area;
• urination disorders;
• changes in urine tests: the presence of neutrophils (white leukocytes), protein fractions, bacterial pathogens;
• deformation of pyelocaliceal structures;
• functional disorders.

In pediatrics, exacerbation of chronic pyelonephritis may resemble symptoms of an "acute abdomen", intestinal and respiratory infections. A characteristic hallmark of the disease is the one-sidedness of the pathological process or its asymmetry.

Treatment

Depending on the severity of the child's condition, the need for hospitalization is determined. In the active phase of the disease, bed rest is mandatory until clinical symptoms such as fever or intoxication subside, on average about a week. The main therapeutic measures are antibacterial, symptomatic, pathogenetic therapy. Treatment of chronic pyelonephritis should be carried out in three stages:

• the destruction of the pathogen and the cessation of the bacterial-inflammatory process;
• correction of immune responses against the background of a decline in active inflammation;
• prevention of possible relapses.

The main treatment is supplemented with a mandatory adjustment of the child's diet.

Medical therapy

The main drug treatment is the use of antibiotics to suppress the microbial-inflammatory process. During the period of active inflammation, this will be a course lasting from a week to three, in the inactive phase - short maintenance courses at intervals of 3-4 weeks. The nephrologist selects the drug according to the results of the antibiogram - bakposev on the sensitivity of the child's flora to different types of antibiotics. While the specific causative agent is unknown, a broad-spectrum antimicrobial agent is empirically prescribed, but such drugs have many side effects. Therefore, after determining the provocateur, it is affected by a narrow-profile antibiotic, it neutralizes specific bacteria more effectively and harms the healthy flora of the body less.

The pediatric nephrologist's approach to choosing an antibiotic is based on a number of criteria. The medicine must be:

In addition, during long courses of antibiotic therapy, it is necessary to change different groups of drugs approximately every week in order to prevent bacterial resistance. In pediatric practice for the treatment of pyelonephritis, the following groups of antibiotics are most often used:

• semi-synthetic penicillins (Amoxiclav, Augmentin);
• cephalosporins 2, 3 generations (Ketocef, Mandol, Klaforan, Fortum, Epocelin);
• aminoglycosides (Amikacin, Gentamicin).

Antibiotics are suggested to be taken orally or injected intramuscularly, depending on the age of the child and the severity of the condition. The regimen prescribed by the nephrologist must be exactly followed. This will eliminate the possibility of developing bacterial resistance to the active substance of the drug.

Ofloxacin is a broad-spectrum antibiotic that is used only as a backup uroseptic when other antimicrobials are ineffective.

Additional groups of drugs as part of the necessary complex therapy include:

• NSAIDs - non-steroidal anti-inflammatory drugs (Surgam, Ortofen) - improve the anti-inflammatory effectiveness of antimicrobial agents;
• antiallergic (Claritin, Tavegil) - prescribed in combination with antibiotics to prevent an allergic reaction;
• diuretics (Furosemide) - increase renal blood flow, relieve swelling of the parenchyma, they are used at the beginning of treatment, when abundant fluid intake is indicated;
• immunostimulants (Viferon, Cycloferon, Lysozyme) - are necessary if relapses of pyelonephritis are associated with a decrease in the body's defenses, due to the severe course of the disease, as well as during infancy. The decision on their use is made by the immunologist strictly according to indications;
• angioprotectors (Trental, Cinnarizine) - improve microcirculation of organ tissues.

Medications - photo gallery

Ortofen - non-steroidal anti-inflammatory drug
Tavegil - a drug for the treatment of allergic reactions Viferon - antiviral and immunomodulatory agent Furosemide is often prescribed at the beginning of pyelonephritis treatment.
Amoxiclav is a semi-synthetic antibiotic approved for use in children.

Diet

As for the drinking regimen and nutrition, first of all, the child should consume as much liquid as possible per day: compotes, non-acidic juices, weakly brewed tea, but, most importantly, clean water. Drinking plenty of water, if there are no contraindications to it, helps cleanse the blood of toxins, flush out bacteria and thereby facilitate the work of the kidneys.

It is necessary to exclude such products from the child's food:

In addition, salty foods and protein foods should not be abused, which irritate and load the kidneys with unnecessary “work”.

Physiotherapy and pyelonephritis

During the inactive phase, supportive physiotherapy procedures are relevant. Balneological and mineral resorts are shown. A good diuretic effect is exerted by waters of moderate and low mineralization (Naftusya, Borjomi). Patients are prescribed procedures that enhance local blood flow, activating the overall immunological status:

A contraindication to physiotherapy for pyelonephritis is an active inflammatory process.

Surgical intervention

The indication for surgical treatment of children with recurrent pyelonephritis is severe vesicoureteral reflux (4–5), which repeatedly provoked a recurrence of infection. In this case, the urologist recommends a minimally invasive procedure - endoscopic plastic correction of the orifice of the ureter, where a certain amount of collagen gel is injected with a special long needle. So artificially form a "substitute" valve between the bladder and ureter. An operation for VUR is not always needed, because often a child already at a younger school age independently “outgrows” the defect.

Other cases where surgery may be needed in children with pyelonephritis include:

• obstruction of the urinary tract - an obstacle to the normal outflow of urine of congenital or acquired origin;
• purulent complication or development of necrosis during the acute stage.

During serious complications, the operation is performed through an open approach using a classic incision with a scalpel. Since the surgeon needs to personally assess the picture of the disease, sanitize the foci of pus or necrosis.

Laparoscopic surgery is a sparing method of surgical intervention through 3–4 punctures with a diameter of 5–10 mm

To eliminate mechanical obstruction of the urinary tract, laparoscopic surgery is applicable, when access to the internal organs of the patient is made through three small punctures, where a manipulation tool and a miniature camera are inserted to broadcast what is happening inside the body on a special monitor, looking at which the surgeon performs the necessary actions. Laparoscopy is good with a short recovery period and minimal tissue trauma.

Folk remedies

Folk remedies do not have a direct therapeutic effect, but can be useful as part of complex therapy. Before using such prescriptions, you should consult your doctor about their appropriateness.

1. Juniper berries - used as an anesthetic and antiseptic for diseases of the urinary system. Preparation: 10-12 berries pour a glass of boiling water and leave for two hours. Strain and take as directed by your doctor.
2. Flax seed - relieves inflammation and cleanses the kidneys. Preparation: Pour 1 teaspoon of seeds with 250 ml of boiling water, keep on low heat for 10 minutes, then leave for about an hour, strain.
3. Corn silk - well known for their good diuretic effect. Preparation: 30-40 g of crushed corn stigmas pour 250 ml of boiling water and leave for 45 minutes. Cool, strain.

Pediatric doses of folk remedies for different children's ages must first be discussed with the attending nephrologist.

Folk remedies for chronic pyelonephritis: photo gallery

The best time to pick juniper berries is September and October Flax seeds are useful in inflammatory diseases of the genitourinary system Corn stigmas - herbal medicine with a diuretic effect

Features of the treatment of chronic pyelonephritis in children with a double kidney

A double kidney is a congenital genetic mutation and looks like two fused organs. The fusion can be complete - with each daughter kidney having its own pelvicalyceal system and ureter, or partial - with one ureter for two.

With a double kidney, they live fully, observing increased preventive measures

There are cases when the daughter ureter does not “flow” into the main ureter, but is brought out into the intestine or vagina. With such pathologies, the child will have urine leakage.

Children with a double kidney are initially healthy, but are more likely to develop pyelonephritis - about a quarter of children with a similar anomaly suffer from inflammation of the kidneys. Treatment of a double kidney occurs according to a scheme similar to standard therapy. If the inflammation becomes persistent chronic, the urologist decides to resect the specified organ, that is, to remove part of the abnormal kidney.

Forecast

It is completely impossible to cure chronic pyelonephritis. But it is realistic to achieve a long-term or even lifelong remission of the disease, when there are no relapses in principle. To do this, the parents of the child should engage in prevention in close cooperation with the nephrologist and urologist.

A long course of the disease without adequate treatment can lead to very serious negative consequences, up to the loss of normal organ function. Possible complications:

• kidney nephrosclerosis - the gradual replacement of functional cells with inactive ones due to prolonged chronic inflammation;
• glomerulonephritis - damage to the renal glomeruli;
• chronic renal failure - loss of kidney function.

In infants, vascular disorders of the renal tissue may additionally develop.

Prevention of chronic pyelonephritis in children

Prevention of recurrence of pyelonephritis consists of the following preventive measures:

Children with a double abnormal kidney and an increased risk of urinary tract infection should also be seen by a nephrologist.

The chronic course of pyelonephritis can drag on for many years, even decades. And the outcome will directly depend on the prevalence of the infection itself and the number of exacerbations per year.

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

Classification

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

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

There are the following types of disease.

1. Primary. The absence of any causes from the urinary system is characteristic.
2. Secondary. It develops against the background of anomalies in the anatomical structure of the excretory organs. Both functional pathology in the process of urination and dysmetabolic disorders can be observed.
3. Spicy. Recovery is typical after a month or two.
4. Chronic. The disease persists for six months. Recovery may occur, and then again exacerbation. There are two forms of this type of disease:

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

The reasons

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

1. Hematogenous. Microorganisms penetrate the kidneys with pneumonia, purulent tonsillitis, or even caries. This route of infection is most often observed in newborn babies and children under one year old. It is not excluded the penetration of infection from mother to fetus in the later stages of gestation.
2. Lymphogenic. Characterized by the penetration of infection through the lymph.
3. Ascending. Microorganisms enter the excretory organs through the genitourinary system or the organs of the gastrointestinal tract. This route of infection is most often observed in older children in the presence of colitis, cystitis or dysbacteriosis. It is more often observed in girls, in particular in those who do not observe personal hygiene.

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

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

signs

Considering pyelonephritis, symptoms in children, attention should be paid to their differences in infants and older adults, as well as in the acute course of the disease and the chronic form. Therefore, we will consider them in more detail.

Features in children up to a year

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

• very, it reaches 40 degrees, subfebrile convulsions are possible;
• frequent regurgitation, vomiting;
• pallor of the skin, there is blueness around the eyes, above the upper lip, their cyanosis is characteristic;
• poor appetite, refusal of breast milk or formula is possible;
• or ;
• dryness, as well as flabbiness of the skin - characteristic signs of dehydration;
• possible severe anxiety when urinating, groaning before this is characteristic;
• crying for no reason
• diarrhea may occur, and this often interferes with the diagnosis. Then pyelonephritis can be mistaken for an intestinal infection.

Symptoms of an acute form of the disease

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

• temperature rise to 38.1 degrees, sometimes higher;
• drowsiness, lethargy;
• gray or pale skin tone, blue under the eyes is characteristic;
• nausea, possible vomiting;
• deterioration or complete lack of appetite;
• pain in the lower back or in the abdomen, may increase with a change in body position; when warmed - the intensity of pain decreases;
• possible violation of the process of urination or accompanied by painful sensations;
• morning hours slight swelling of the eyelids and face;
• visible changes in the urine, in particular turbidity, a bad smell is possible.

Signs of chronic pyelonephritis

Symptoms of this condition may include the following:

• pain in the back and abdomen;
• hyperthermia;
• symptoms of intoxication;
• poor urine counts;
• fast fatiguability;
• if the child goes to school - a decrease in academic performance;
• the chronic form at an early age may be characterized by a delay in psychomotor as well as physical development.

Diagnostics

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

• collection of complaints and personal examination of the patient;
• palpation of the abdomen to check for pain;
• diuresis control;
• clinical analysis of urine and blood;
• determination of the acidity level of urine;
• biochemical analysis of blood and urine;
• urinalysis according to Nechiporenko, Zimnitsky, Amburzha;
• antibiogram according to the results of urine culture;
• Ultrasound of the blood flow of the kidneys;
• excretory urography;
• analysis of urodynamic studies;
• scintigraphy of excretory organs;
• angiography of the kidneys;

Just do not be afraid of a long list of all kinds of tests. Not all studies will be necessary to make a diagnosis in your child, and many of them are generally prescribed in very rare cases and only when absolutely necessary.

Pyelonephritis and urinalysis

Many urine tests are performed to confirm the diagnosis. So, the fact that this disease is really present will be evidenced by the following indicators:

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

Possible complications

Hemodialysis is an essential procedure for kidney failure

The lack of proper treatment of the acute form of the disease can lead to two main consequences:

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

If we consider chronic pyelonephritis in children, then if not properly treated, this condition can lead to the development of more serious health problems, in particular, lead to tissue necrosis or sclerosis.

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

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

Treatment

Strict adherence to bed rest

The acute form of the disease requires hospitalization. Only with the constant supervision of medical personnel, it is possible to correctly assess the dynamics of the child's condition, his analyzes, to conduct additional studies in a timely manner, selecting the necessary medicines and procedures.

Treatment of pyelonephritis in children includes complex therapy.

1. Compliance with strict bed rest, as you recover, physical activity increases.
2. Dietary nutrition, in order to reduce the load on the excretory organs and correct metabolic disorders, table number 5. Protein and vegetable food is recommended.
3. Taking antibiotics. Initially, a broad-spectrum drug is prescribed, after additional studies - sensitive to this microorganism.
4. Uroantiseptics are prescribed for the disinfection of the urinary tract.
5. Antispasmodics.
6. Antipyretics.
7. Non-steroidal anti-inflammatory drugs.
8. Vitamin therapy, of particular importance is given to beta-carotene and vitamin E.
9. Reception of phytopreparations.

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

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

Children who are diagnosed with pylonephritis are registered with a neurologist and pediatrician, they are recommended a scheduled examination.

Prevention

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

1. Make sure that the baby goes to the toilet regularly, there is no urinary retention in the body.
2. Compliance with the rules of personal hygiene.
3. Regular defecation.
4. Prevention of dysbacteriosis.
5. Compliance with the correct drinking regimen.
6. Timely and adequate treatment of diseases of the genitourinary system of an inflammatory nature.
7. Carrying out an ultrasound examination of the excretory organs in children up to a year old in order to identify anomalies in the anatomical structure.

Now you know what are the signs of pyelonephritis in children, as well as ways to treat this disease. Be aware of the possibility of preventing illness if proper precautions are taken. Do not self-medicate, do not forget about the possible consequences. Contact a specialist in a timely manner, at the slightest suspicion of any deviation.

This is a bacterial-inflammatory disease of the pelvicalyceal apparatus and renal parenchyma with predominant involvement of its interstitial tissue.

Etiology and pathogenesis.

Among the microbial pathogens of pyelonephritis, Escherichia coli is more often detected, less often other types of bacteria: Klebsiella, Proteus, Pseudomonas aeruginosa, Enterococcus, Staphylococcus aureus.

In 10-25% of patients with chronic pyelonephritis, a mixed flora is found in the urine.

Infection of the kidney and collecting system occurs mainly by ascending (in 80% of patients) and hematogenous routes.

In the occurrence and development of pyelonephritis, a decrease in the immune defense of the macroorganism is important; the presence of extra- or intrarenal obstruction of the urinary tract, contributing to the stasis of urine; changes in the reactivity of the renal parenchyma, leading to a decrease in its resistance to urinary infection; pathogenicity of microbial pathogens, in particular adhesive and enzymatic properties, and their resistance to antibacterial drugs; metabolic diseases: diabetes mellitus, cystinuria, hypokalemia, etc.; the presence of extrarenal foci of infection, vulvovaginitis, dehydration, septicemia, defects in urinary tract catheterization, etc.; intestinal dysbacteriosis with an increase in the number of opportunistic microflora and translocation of microorganisms from the intestine to the urinary organs. Each of these factors may have independent significance in the occurrence of pyelonephritis, but more often the disease develops with a combination of exposure to some of them.

According to the duration of the flow:

Acute pyelonephritis - lasts about 2 months in a child, quite often accompanied by complications requiring surgical treatment. A small inflammation, as a rule, ends with a complete recovery.

Chronic pyelonephritis - lasts for 6 months or longer. It proceeds with periods of exacerbations and remissions.

There are primary and secondary pyelonephritis.

Primary pyelonephritis - develops in a child due to changes in the intestinal flora. The reason for the change in microflora is an intestinal infection. With coccal infection, influenza and tonsillitis, there are also risks of the formation of a primary form of the disease in a child. The culprit of pyelonephritis can be cystitis under the age of 10 years.

Secondary pyelonephritis - develops as a result of congenital anomalies: disorders in the structure of the kidneys, improper location of the bladder and ureters. Secondary pyelonephritis, as a rule, occurs up to a year. At the same time, in an infant, there are violations of the outflow of urinary fluid. Together with urine, bacteria enter the lower tracts and the kidney, provoking an inflammatory process. In the first year of life, underdevelopment of the kidneys can be diagnosed. This pathology leads to an increase in the load on the renal tissue every year of life. Secondary pyelonephritis can be diagnosed within 1-2 years of a child's life.

Clinic of acute pyelonephritis

At acute pyelonephritis the onset of the disease is usually acute, with fever up to 38-40 ° C, chills, headache, and sometimes vomiting.

• Pain syndrome. Older children may have unilateral or bilateral low back pain radiating to the groin, dull or colicky, persistent or intermittent.
• Dysuric disorders. Often there are painful and frequent urination (pollakiuria), as well as polyuria with a decrease in the relative density of urine to 1015-1012.
• Syndrome of intoxication. The general condition worsens, lethargy and pallor of the skin increase.

In some children, tension in the abdominal wall, pain in the iliac region and along the ureters can be observed, in others, a positive symptom of Pasternatsky.

• urinary syndrome. Neutrophilic leukocyturia and bacteriuria are determined, less often - small microhematuria and proteinuria,

In blood tests - leukocytosis, elevated ESR, slight normochromic anemia. Severe forms of pyelonephritis are rare, accompanied by sepsis, mild local manifestations, often complicated by acute renal failure, as well as erased forms of acute pyelonephritis with mild general and local symptoms and severe urinary signs (leukocyturia, bacteriuria, macrohematuria and proteinuria).

In newborns, the symptoms of the disease are mild and unspecific. The disease is manifested mainly by dyspeptic disorders (anorexia, vomiting, diarrhea), a small increase or decrease in body weight, and fever. Jaundice, bouts of cyanosis, meningeal symptoms, signs of dehydration are less common. Leukocyturia, bacteriuria, slight proteinuria are detected in all children, hyperazotemia is observed in 50-60% of cases.

In most children under 1 year of age, acute pyelonephritis develops gradually. The most persistent symptoms are fever, anoxia, regurgitation and vomiting, lethargy, pallor, urinary and urination disorders. Urinary syndrome is pronounced. Hyperasotemia in infancy is observed much less frequently than in newborns, mainly in children in whom pyelonephritis develops against the background of congenital pathology of the urinary system.

Clinic of chronic pyelonephritis

Chronic pyelonephritis is a consequence of an unfavorable course of acute pyelonephritis, which lasts more than 6 months or two or more exacerbations are observed during this period. Depending on the severity of clinical manifestations, recurrent and latent chronic pyelonephritis are distinguished. With a relapsing course, periodically recurring exacerbations are observed with more or less long asymptomatic periods. The clinical picture of recurrence of chronic pyelonephritis differs little from that in acute pyelonephritis and is characterized by a different combination of general (fever, pain in the abdomen or lower back, etc.), local (dysuria, pollakiuria, etc.) and laboratory (leukocyturia, bacteriuria, hematuria, proteinuria and etc.) symptoms of the disease. The latent course of chronic pyelonephritis is observed in approximately 20% of cases. In its diagnosis, laboratory research methods are extremely important, since patients do not have general and local signs of the disease.

– Pain syndrome in chronic pyelonephritis (CP). Pain in the lumbar region is the most common complaint of patients with chronic pyelonephritis (CP) and is observed in most of them. In the active phase of the disease, pain occurs due to stretching of the fibrous capsule of the enlarged kidney, sometimes due to inflammatory changes in the capsule itself and paranephria. Often, pain persists even after the inflammation subsides due to the involvement of the capsule in the scarring process that occurs in the parenchyma. The severity of pain is different: from a feeling of heaviness, awkwardness, discomfort to very severe pain with a recurrent course. The asymmetry of pain sensations is characteristic, sometimes they spread to the iliac region.

— Dysuric syndrome in chronic pyelonephritis (CP). With exacerbation of chronic pyelonephritis (CP), pollakiuria and stranguria are often observed. The individual frequency of urination depends on the water and food regimen and can differ significantly in healthy individuals, therefore, in patients with pyelonephritis, it is not the absolute number of urination per day that matters, but the assessment of their frequency by the patient himself, as well as the increase at night. Usually, a patient with pyelonephritis urinates often and in small portions, which may be the result of neuro-reflex urinary disorders and urinary tract dyskinesia, changes in the state of the urothelium and urine quality. If pollakiuria is accompanied by a burning sensation, pain in the urethra, pain in the lower abdomen, a feeling of incomplete urination, this indicates signs of damage to the bladder. Dysuria is especially characteristic of secondary pyelonephritis against the background of diseases of the bladder, prostate, salt diathesis, and its appearance often precedes other clinical signs of exacerbation of secondary chronic pyelonephritis (CSP). With primary pyelonephritis, dysuria is less common - in about 50% of patients. In secondary chronic pyelonephritis (VCP) - dysuria is more common - up to 70% of patients.

- Urinary syndrome in chronic pyelonephritis (CP).
Changes in some properties of urine (unusual color, turbidity, pungent odor, large sediment upon standing) can be noticed by the patient himself and serve as a reason to consult a doctor. Properly conducted urinalysis provides a lot of information in kidney diseases, including chronic pyelonephritis (CP).

For chronic pyelonephritis (CP) proteinuria The value of proteinuria usually does not exceed 1 g/L, hyaline casts are found extremely rarely. During periods of exacerbations of chronic pyelonephritis (CP), proteinuria is detected in 95% of patients.

Cylindruria atypical for pyelonephritis, although in the active phase, as already mentioned, single hyaline cylinders are often found.

Leukocyturia- a direct sign of the inflammatory process in the urinary system. Its cause in chronic pyelonephritis (CP) is the penetration of leukocytes into the urine from the foci of inflammation into the interstitium of the kidney through damaged tubules, as well as inflammatory changes in the epithelium of the tubules and pelvis.

More important than anything else is the determination and evaluation of urine density. Unfortunately, many doctors ignore this indicator. However, hypostenuria is a very serious symptom. A decrease in the density of urine is an indicator of a violation of the concentration of urine by the kidneys, and this is almost always swelling of the medulla, hence inflammation. Therefore, with pyelonephritis in the acute phase, one always has to deal with a decrease in urine density. Quite often, this symptom comes to light as the only sign of pyelonephritis. For a number of years, there may be no pathological sediment, hypertension, there may be no other symptoms, and only low urine density is observed.

Hematuria in chronic pyelonephritis (CP)

Causes of renal hematuria are inflammatory processes in the glomeruli, stroma, blood vessels, increased pressure in the renal veins, impaired venous outflow.

In chronic pyelonephritis (CP), all of these factors act, but, as a rule, macrohematuria in patients with chronic pyelonephritis (CP) is not observed, except in cases where there are complications of pyelonephritis (renal vascular necrosis, hyperemia of the mucous membrane of the urinary tract with pyelocystitis, its stone damage).

Microhematuria in the active phase of chronic pyelonephritis (CP) can be detected in 40% of patients, and in half of them it is small - up to 3-8 erythrocytes per field of view. In the latent phase of chronic pyelonephritis (CP) in the general analysis of urine, hematuria is found in only 8% of patients, in another 8% - in quantitative samples.

Thus, hematuria cannot be attributed to the main signs of chronic pyelonephritis (CP).

Bacteriuria considered the second most important diagnostic sign of pyelonephritis (after leukocyturia). From a microbiological point of view, urinary tract infection can be considered if pathogenic microorganisms are found in the urine, urethra, kidneys or prostate gland. An idea of ​​the presence of bacteriuria can be given by colorimetric tests - TTX (triphenyltetrazolium chloride) and a nitrite test, but bacteriological methods for examining urine are of diagnostic value. The presence of infection is indicated by the detection of growth of more than 10 5 organisms in 1 ml of urine.

Bacteriological examination of urine is of great importance in recognizing chronic pyelonephritis (CP), it allows you to identify the causative agent of chronic pyelonephritis (CP), conduct adequate antibiotic therapy and monitor the effectiveness of treatment.

The main method for determining bacteriuria is inoculation on solid nutrient media, which makes it possible to clarify the type of microorganisms, their number in 1 ml of urine and sensitivity to drugs.

- Intoxication syndrome in chronic pyelonephritis (CP). With a recurrent course of pyelonephritis, its exacerbations (similar to acute pyelonephritis) are accompanied by severe intoxication with nausea, vomiting, dehydration of the body (the amount of urine, as a rule, is greater than that of a healthy person, because concentration is impaired. And since more urine is released, then, therefore, , and the need for liquid is greater).

In the latent period, patients are concerned about general weakness, loss of strength, fatigue, sleep disturbance, sweating, vague abdominal pain, nausea, poor appetite, and sometimes weight loss. Some symptoms occur in almost all patients. Prolonged low-grade fever, headache, austenization, chills are more often observed in patients with PCP.

Changes in the hemogram may be observed: ESR increases, leukocytosis appears, but the body temperature does not rise. Therefore, when there is a high temperature (up to 40 C) and there is a urinary syndrome, one should not rush to attribute this fever to pyelonephritis. It is necessary to observe a very stormy picture of pyelonephritis in order to explain this temperature to them.

- Syndrome of arterial hypertension in chronic pyelonephritis (CP);

- Syndrome of chronic renal failure in chronic pyelonephritis (CP).

Diagnostics

Diagnostic criteria:

1. intoxication, fever;

2. leukocyturia, slight proteinuria;

Z. bacteriuria 105 microbial bodies in 1 ml of urine and above;

4. Ultrasound of the kidneys: cysts, stones, congenital malformations;

5. violation of the concentration function of the kidneys.

List of main diagnostic measures:

1. Complete blood count;

2. General analysis of urine. The main laboratory sign in a young child is bacterial leukocyturia. Bacteria and leukocytes are found in the urine. Proteinuria is insignificant. Erythrocyturia does not occur in all cases and has varying degrees of severity.

3. Urine culture tank.

List of additional diagnostic measures:

Urinalysis according to Nechiporenko

For analysis, take the middle portion of morning urine in a clean, dry jar (the first portion of urine is usually from the urinary tract, therefore urine is taken from the middle portion for research). From this volume, 1 ml is taken for analysis. This volume is placed in a counting chamber and the number of shaped elements is counted. Normally, the content of formed elements in this analysis is 2000 leukocytes and 1000 erythrocytes, up to 20 hyaline cylinders occur.

The need for this group of analyzes arises in the presence of doubtful results obtained in the general analysis of urine. To clarify the data, quantify the formed elements of the urinary sediment and conduct urine tests according to Nechiporenko and Addis-Kakovsky.

Erythrocytes, like leukocytes, appearing in the urine, may be of renal origin, may appear from the urinary tract. The reasons for the appearance of erythrocytes of renal origin may be an increase in the permeability of the glomerular membrane for erythrocytes in glomerulonephritis (such hematuria is combined with proteinuria). In addition, red blood cells can appear with tumors of the kidneys, bladder, urinary tract. Blood in the urine can appear when stones damage the mucous membrane of the ureters, bladder. Hematuria can be detected only by laboratory methods (microhematuria), and can be determined visually (with macrohematuria, urine is the color of meat slops). The presence of white blood cells suggests inflammation at the level of the kidneys (acute or chronic inflammation - pyelonephritis), bladder (cystitis) or urethra (urethritis). Sometimes the level of leukocytes can also increase with glomerulonephritis. The cylinders are a "cast" of the tubules, formed from desquamated cells of the epithelium of the tubules. Their appearance is a sign of chronic kidney disease.

Zimnitsky's test

One of the main methods of functional study of the kidneys is the Zimnitsky test. The purpose of this test is to assess the ability of the kidneys to dilute and concentrate urine. For this test, urine must be collected a day before. Urine collection utensils must be clean and dry.

For analysis, it is necessary to collect urine in separate portions with an indication of the time every 3 hours, i.e. a total of 8 portions. The test allows you to evaluate the daily diuresis and the amount of urine excreted during the day and at night. In addition, the specific gravity of urine is determined in each portion. This is necessary to determine the functional ability of the kidneys.

Normal daily diuresis is 800-1600 ml. In a healthy person, the amount of urine excreted during the day prevails over its amount allocated during the night.

On average, each portion of urine is 100-200 ml. The relative density of urine ranges from 1.009-1.028. In renal failure (i.e., the inability of the kidneys to dilute and concentrate urine), the following changes are noted: nocturia - increased urine output at night compared to daytime, hypoisosthenuria - urine output with a reduced relative density, polyuria - the amount of urine excreted per day exceeds 2000 ml.

kidney ultrasound

Glomerular filtration rate (according to blood creatinine). Decrease.

Determination of creatinine, residual nitrogen, urea with calculation of glomerular filtration rate according to the Schwartz formula:

height, cm x Coefficient
GFR, ml/min. = ————————————-

blood creatinine, µmol/l

Ratio: newborns 33-40

prepubertal period 38-48

post-puberty 48-62

The main radiological symptoms acute pyelonephritis are an increase in the size of the affected kidney, spasm of the cups, their necks and the ureter on the side of the lesion. The earliest radiographic sign of chronic pyelonephritis is hypotension of the cups, pelvis and ureter on the side of the lesion.

Cystography- vesicoureteral reflux or condition after antireflux surgery.

Nephroscintigraphy- Foci of damage to the parenchyma of the kidneys.

Pyelonephritis must be differentiated from cystitis, interstitial nephritis. For both diseases, leukocyturia is a characteristic and often the only symptom. With pyelonephritis, it is neutrophilic, with interstitial nephritis it is lymphocytic (the predominance of lymphocytes in the urocytogram). Pathological, true, bacteriuria (100,000 microbial bodies in 1 ml of urine and above), a high titer of antibacterial antibodies (1:160 and above) are characteristic signs of pyelonephritis. With interstitial nephritis, bacteriuria is not detected, the titer of antibodies in the blood serum to the standard strain of E. coli is determined no higher than in a dilution of 1:10, 1:40. Pyelonephritis must be differentiated from chronic glomerulonephritis, renal tuberculosis, vulvitis or vulvovaginitis. To clarify the origin of leukocyturia, a parallel determination of the content of leukocytes in the middle portion of urine and in the discharge from the vagina is carried out. Finally, the localization of the inflammatory process in the organs of the genitourinary system helps to establish a comprehensive examination of each child by a nephrologist and gynecologist.

Forecast. Acute primary pyelonephritis with proper and timely treatment often ends in complete recovery (in 80-90% of cases). Deaths (10-20%) occur mainly among newborns. The transition of acute pyelonephritis to chronic is more often possible with secondary pyelonephritis, but often (40%) relapses are also observed in the primary disease.

The prognosis of chronic pyelonephritis is less favorable. In most patients, pyelonephritis lasts several decades, beginning in childhood. Its severity can be aggravated by a number of complications, of which the most common are renal papillary necrosis, urolithiasis and arterial hypertension. Chronic pyelonephritis ranks third (after congenital kidney disease and glomerulonephritis) among the causes leading to the development of chronic renal failure and death.

Treatment.

Aimed at the elimination of kidney infection, increasing the reactivity of the body, restoring urodynamics in secondary pyelonephritis.

Antibacterial therapy in 3 stages:

Stage 1 - antibiotic therapy - 10-14 days;

Empirical (starting) choice of antibiotics:

- "Protected" penicillins: amoxicillin / clavulanate, amoxicillin / sulbactam; Amoxicillin / clavulanate * 40-60 mg / kg / 24 hours (as amoxicillin) in 2-3 oral doses

- III generation cephalosporins: cefotaxime, ceftazidime, ceftriaxone, cefixime, ceftibuten. Cefotaxime Children under 3 months - 50 mg / kg / 8 hours Children over 3 months - 50-100 mg / kg / 24 hours 2-3 times a day

Severe flow:

- Aminoglycosides: netromycin, amikacin, gentamicin; - Carbapenems: imipenem, meropenem; Gentamicin Children under 3 months - 2.5 mg / kg / 8 hours Children over 3 months - 3-5 mg / kg / 24 hours 1-2 times a day

 IV generation cephalosporins (cefepime).

With the effectiveness of treatment observed:

- clinical improvement within 24-48 hours from the start of treatment;

 eradication of microflora in 24-48 hours;

 reduction or disappearance of leukocyturia for 2-3 days from the start of treatment.

Changing the antibacterial drug if it is ineffective after 48-72 hours should be based on the results of a microbiological study and the sensitivity of the isolated pathogen to antibiotics.

Stage 2 - uroseptic therapy (14-28 days).

1. Derivatives of 5-nitrofuran:

 Furagin - 7.5-8 mg / kg (not more than 400 mg / 24 hours) in 3-4 doses;

- Furamag - 5 mg / kg / 24 hours (no more than 200 mg / 24 hours) in 2-3 doses.

2. Non-fluorinated quinolones:

- Negram, nevigramon (in children older than 3 months) - 55 mg / kg / 24 hours in 3-4 doses;

- Palin (in children older than 12 months) - 15 mg / kg / 24 hours in 2 divided doses.

Stage 3 - preventive anti-relapse therapy.

Antibacterial treatment should be carried out taking into account the sensitivity of the urine microflora to antibacterial drugs. As a rule, levomycetin is prescribed for children under 3 years old, 0.15-0.3 g 4 times a day; ampicillin - 100-200 mg / kg per day; gene-tamycin - 0.4 mg/kg 2 times a day; oxacillin for children under 3 months - 200 mg / kg per day, up to 2 years - 1 g per day, over 2 years - 2 g per day; erythromycin for children under 2 years old - 5-8 mg / kg 4 times a day, over 2 years old - 0.5-1.0 g per day. Of the chemotherapy drugs, furagin is used at 0.05-0.1 g 3 times a day, urosulfan at 0.5 g 2-4 times a day, nevigramon 0.25-1.0 g per day in 3-4 doses, 5-NOC 0.05-0.1 g 4 times a day. When prescribing drugs, the state of kidney function is taken into account.

Sanitation of foci of infection is important, with secondary pyelonephritis - timely restoration of urodynamics with the help of surgical intervention, as well as measures to eliminate metabolic disorders. The patient must be registered with the dispensary during the entire period of clinical and laboratory remission until recovery, which can be discussed with long-term preservation of complete remission (at least 3 years). In recent years, great importance has been attached to the normalization of the intestinal microflora (bifidumbacterin and other drugs that restore the normal intestinal microflora).

Symptomatic therapy: antipyretic, detoxification, infusion - usually carried out in the first 1-3 days;

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: E. coli, Staphylococcus aureus and other viruses. Pathogens 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 cause 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 turn 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, which help to identify anatomical abnormalities that provoked the onset of the disease, are of great importance. 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 beneficial 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.

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