Diseases of the genitourinary system in girls. Urinary tract infection in children: causes, symptoms and treatments. Causes of infection

Inflammation genitourinary system it's 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 is more often diagnosed urinary tract 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 an acute condition are often triggered by one type of pathogenic flora. However, if favorable conditions are created, for example, the child had 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:

Neurogenic bladder;
diverticulitis;
Urolithiasis disease;
Hydronephrosis;
Vesicoureteral reflux;
Polycystic kidney disease;
Pyelectasis;
urethrocele;
Infectious disease of the mother during pregnancy;
phimosis;
Synechia of the labia.

Quite often it happens that the cause of development 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 kidney disease and Bladder.

As for the ways of penetration of infectious agents, there are several of them. Pathogenic bacteria can be carried by 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.

Concerning characteristic symptoms, then it also directly depends on which disease is progressing, the level of the body's immune defense, such as 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. AT 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 untreated, the disease will lead to the development of chronic kidney 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 complete absence of 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.

Considering anatomical features structure of the organs of the genitourinary system, cystitis in most cases worries girls rather than boys. As such, if treated in a timely manner, the disease does not pose a danger, but is accompanied by strong discomfort. 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 a nephrologist, and a gynecologist is also indicated for girls.

It is imperative that during the initial examination, the pediatrician prescribes the delivery of laboratory tests. Based on their results, a preliminary diagnosis can be made. When examining urine, a high content of leukocytes is determined in it, the presence of protein, bacteria, and 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. Thanks to him, you can also confirm the primary diagnosis, while not 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, the severity of the pathological process, and also evaluates general state child's health. Be sure to look at the age of the baby, since many antibacterial agents have limitations in this parameter, therefore, 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.

A common problem is urinary tract infection in children. It occurs more often up to 3 years due to their morphological and functional features.

Before the age of five, on average, two percent of boys and eight percent of girls fall ill at least once. Among infants, boys are more susceptible to the disease, and in the period from two to fifteen years, girls.

In pediatric urology and pediatrics, the diagnosis of UTI is in second place in frequency after viral diseases of the ENT organs. Without proper treatment, these diseases can lead to severe complications up to renal failure and disability.

The urinary system includes a pair of kidneys that filter urine, a pair of ureters that direct urine from the kidneys to the bladder, and a urethra or urethra that carries urine out of the body. When a person is healthy, in all these organs the environment is clean, without bacteria or viruses.

Children's features

Newborns have features of the genitourinary system. Their kidneys are not yet fully formed, larger than adults and unstable. Until the second year, they can be felt with your fingers. Children's kidneys fully mature by the age of three to six years.

The lymph nodes in the kidneys and intestines are very closely connected, which contributes to the rapid spread of urinary tract infections in children. The ureters in young children are still weak and uneven. Urine stagnates and becomes a breeding ground for microbes.

The bladder is higher, its capacity in infants is within 50 ml, in a child per year it increases to 150 ml. The urethra in male infants is up to 6 cm long. Its growth occurs in leaps, accelerating during puberty, reaching an average of 14–18 cm.

In girls from birth to 16 years, it grows from a centimeter to 3.3 cm. The proximity of the urethra to anal passage requires special rules of hygiene.

The excretion of urine is an inborn reflex. From six months, it is already possible to help learn to endure and go to the toilet on time. one year old baby should be asking for a potty. But even at 3 years old, a child can accidentally wet himself from strong emotions.

The essence of the disease

UTI in children is the unifying name for bacterial-inflammatory processes in the urinary system.

The manifestations of the disease depend on the site of the lesion.

Among the diseases of the urinary system in children, hydronephrosis (enlarged renal pelvis), infections, a number of kidney diseases due to metabolic disorders, and pathology of the bladder functions are most common.

Causing factors

In a child, the occurrence of infection in the urinary tract is due to the circumstances of infection, the microbial balance of the intestine and the general condition immune system. Rod-shaped bacteria of the intestinal family are leaders among bacterial pathogens, up to 90% of cases.

It is also worth mentioning such enterobacteria as Klebsiella, Proteus, various gram-positive cocci, gram-negative motile microorganisms, etc. When frequent relapses and complications, a number of pathogens are found.

The occurrence of an inflammatory process is associated with infections caused by chlamydia, mycoplasmas, ureaplasmas. At the same time, pathology of the mucous membrane of the vagina and vulva can be observed, foreskin and head of the penis.

Factors that determine the occurrence bacterial infection, can act:

Prematurity.
Chronic malnutrition and underweight.
Violations of immunological reactivity.
Low hemoglobin content.
Background virus ("hand-foot-mouth syndrome", influenza, adenoviruses, herpes simplex).
Disorders in the excretion of urine from the body. These are dysfunctions of a nervous nature, urolithiasis, protrusion of the walls of the bladder, reverse reflux of urine from the bladder into the ureter, expansion of the renal calyces and pelvis, damage to the tissues of the kidneys by cysts, wrong position kidneys, defect of the ureter, narrowing of the foreskin in boys, adhesions of the labia in girls.
Gastrointestinal pathologies: microbial imbalance, difficult defecation, inflammation of the colon, infections.
Metabolic disease.
Poor hygiene of the external genital organs, improper washing of the baby.
Contact with infected lymph or blood during medical procedures.
Female gender, third or fourth blood type.

Circumcision of the foreskin significantly reduces the risk of infection urinary tract.

When the baby is still growing in the womb, the excretory function lies on the placenta. But some urine is still formed in the renal pelvis. So its expansion can be detected even before birth with the help of ultrasound. Usually, the pelvis normalizes by one and a half years.

Excess oxalic and ascorbic acid in the baby's diet can lead to metabolic disorders. At the same time, the content of salts in the urine increases, with the dissolution of which the kidneys cannot cope. In this case, a low-salt diet is necessary and plentiful drink. Sometimes these disorders are due to heredity and are associated with nutrition to a lesser extent.

Since control from nervous system in children still in the process of formation, they may experience nocturnal and daytime reflex urination without urge, inability to have time to run to the restroom. It is necessary to regularly remind the baby of the need to pee so that the bladder does not overstrain.

UTI classification

The disease can affect the upper organs of the urinary tract: the kidneys (pyelonephritis), the ureters (ureteritis), as well as the lower ones: the bladder (cystitis) and the urinary canal (urethritis). Periodization of the disease can be primary and repeated.

It can proceed easily (moderate temperature, minimal dehydration, the child is being treated) or with complications (a jump in temperature, the child vomits, he is severely dehydrated).

A repeated episode may remain at the stage of an unresolved infection, survival of the pathogen in the body without its active reproduction and metabolism, or re-infection after recovery. Symptoms can be bright, but the disease can develop and asymptomatically. Pathology is caused by viruses, bacteria or fungi.

Variation in the course of the infection

It happens that the disease in children develops asymptomatically. Urine analysis reveals the presence of leukocytes of a bacterial and non-bacterial nature, bacteria are detected in the absence of manifestations of the disease. This may indicate a hidden course.

The disease can be manifested by pain when trying to urinate, frequent going to the toilet, incontinence and incontinence of urine, unpleasant and painful sensations above the pubis. White blood cells and even blood can be found in the urine.

Problems with the kidneys and bladder can cause the baby to have a feverish state, intoxication. Pain affects the lower back, side, peritoneum, there are shootings in inguinal zone and inner thigh. Leukocytes appear in urine and blood leukocyte formula shifts to the left, erythrocyte sedimentation time accelerates.

Pathology picture

The disease can be localized anywhere in the urinary canals, so the symptoms are extremely variable. Need A complex approach. Considering the symptoms of urinary tract infection in children, we will mention the most common and lesser known pathologies.

Pyelonephritis is a lesion by microorganisms of the kidney and its calyces and pelvis. At the same time, the temperature is over 38 degrees, the child cannot be forced to eat, he has a breakdown, pain in the lower back on the one hand, and urine deficiency. In infants, the disease can cause dehydration and even provoke jaundice. In early childhood, the problems of the upper urinary system in children can be confused with a spasm of the pyloric part of the stomach, indigestion, muscle tension abdominal wall and intestinal motility disorder, irritable bowel syndrome, etc.; in older children - with a flu-like syndrome.

In cystitis, bacteria damage the walls of the bladder. Clinical picture is normal or subfebrile temperature body, there are no signs of poisoning, the pain is localized in the lower abdomen, radiates to the perineum. The kid is restless, often and little by little pissing, which causes pain, cannot feel the complete release of the bladder, sometimes it is described. Babies with cystitis have delayed urination, an intermittent stream, droplets of blood after the act.

Urethritis affects the urinary canal, is infectious, and also non-infectious character. Symptoms of the disease include burning during urination, itching in the genitals, blood, pus or mucus from the urethra. At the same time, the temperature is normal. This is more of a boyish problem than a girly one. Teenagers can also get urethritis through STDs.

With asymptomatic bacteriuria, microbes are sown in the urine when total absence symptoms of the disease. More often girls suffer from it. Accompanied by cloudy urine and its unpleasant odor.

Nephrolithiasis among children is quite rare. Stone formation is caused metabolic disorders due to an imbalance in the diet or a violation of the outflow of urine with different pathologies development of the genitourinary system. The disease reveals itself as a sharp lumbar pain syndrome with shootings in the lower part of the peritoneum.

Manifestations in infants

Newborn babies and infants may be asymptomatic or exhibit odd behaviors, such as losing weight, vilifying, burping stomach contents.

Urinary tract infection in infants, due to the immaturity of kidney tissues and reduced immunity, almost never affects a specific organ, but is spread throughout the system.

If you notice any of the mentioned ailments in your baby's condition, contact your pediatrician immediately.

Establishing diagnosis

To successfully determine the infection, it may be necessary to examine several specialists: a pediatric urologist, a nephrologist, and a gynecologist. The collection of anamnesis and examination are supplemented by laboratory and instrumental diagnostic methods.

In the analysis of urine, the content of leukocytes, bacteria or blood should alert. More informative are laboratory examination urine, characterizing the condition, functionality of the kidneys and urinary tract. The ability of the kidney to accumulate and excrete urine is determined by the Zimnitsky test. In the blood, attention is paid to an abnormally high content of neutrophils, an acceleration of erythrocyte sedimentation, elevated level stress proteins.

Identification of the disease in children is based on a tank of urine culture with the definition of the source and its resistance to antibacterial drugs. It is correct to do it before antibiotic therapy. As a rule, the causative agent of infection in children is one. Sometimes urine is examined for chlamydia, ureaplasma, mycoplasma.

They study blood serum for the presence of certain antibodies or antigens, use the polymerase method chain reaction. The collection vessel must be sterilized.

The baby needs to be washed, urine collected a second after the child began to write. In case of difficulties, a catheter is used in a hospital setting. The diagnosis is justified with the simultaneous detection of pus in the urine, fever and chills, positive urine culture.

AT without fail do an ultrasound of the kidneys, vascular system, Bladder. Only with re-infection, children from three to five years old are x-rayed urinary tract during symptom relief.

Kidney tissue is studied by introducing special preparations into the body and obtaining images of the kidneys with a gamma camera, either statically or dynamically.

An endoscope is used to examine the internal organs of the urinary system. Due to the pain of the procedure general anesthesia necessarily. The activity of urine excretion from the channels is determined by measuring the rate of urination. Bladder pressure is also measured using a manometer to determine the elasticity and contractility its muscular wall.

Disease differentiation

It is important to exclude misdiagnosis and identify diseases similar to a urinary tract infection. With inflammation of the vulva and vagina, female children have a fever, itching worries, the composition of the urine changes.

The urinary tract is irritated by the use of soap, shampoo, laundry detergent. Stopping contact with these substances usually helps. Infection with worms causes itching, changes in the urine. It can be determined by scraping the area anus. In adolescents, it is logical to exclude pregnancy.

Treatment methods for the disease

Advances in the treatment of bacterial diseases make it possible to completely destroy the pathogen and restore the patient's health. Effective treatment with an infection in the urinary tract in children, it requires a certain regimen for the baby.

Children under two years of age are treated in a medical institution, where droppers are used to administer drugs. For pain and fever, it is necessary to stay in bed and use NSAIDs, drugs for spastic pain attacks. It is important to choose a sparing and competent diet for the duration of therapy.

Treatment of urinary tract infection in children includes mandatory therapy antibacterial medicines, on average two weeks. Until the pathogen is identified, broad-spectrum antibiotics are used. The doctor calculates the dose based on the body weight, height and age of the small patient.

If the symptoms and general condition require it, the following are added to the therapy:

antipyretics;
vitamin complexes;
herbal antibacterial agents to restore the environment in the genitourinary system;
probiotics to normalize the intestinal microenvironment;
reception a large number liquids orally or intravenously.

Phytotherapy is useless in the fight against UTIs.

Outlook and relapse prevention

Positively on the state of the genitourinary system of infants is breastfeeding at least up to seven months. Feeding should be enough vegetables and fiber, as well as liquids, so that there are no congestions and difficulties with bowel movements.

Pay attention to the crying and whims of the baby in infancy. Children with a history of kidney disease should not overcool, overwork, they are allowed physiotherapy exercises.

The fundamental condition for health is proper hygiene, immediate treatment of all sources of inflammation in the body, exclusion of provoking factors. Make sure you teach your kids proper care for themselves and maintaining cleanliness.

Strengthen the child's body by reasonable hardening with the sun, fresh air and water procedures. Maintain a normal flow of urine. Children from risk groups take prophylactic antimicrobial drugs and natural antiseptics.

During the period of remission or absence of manifestations of the disease, children are vaccinated. Diseases of the urinary system tend to recur in 30 percent of cases. So regular examinations by a pediatrician and a nephrologist are required.

Urinary tract infection (UTI) is a generic name inflammatory diseases urinary system. The concept includes urethritis,. UTI ranks second in incidence after inflammation of the respiratory system. In childhood this pathology is also common, but its diagnosis is difficult due to the inability to present complaints and frequent disguise as other diseases (ARI,).

information During the first year of life, boys suffer from inflammation of the urinary system more often, which is associated with the presence of congenital anomalies, and after a year, the ratio changes 6:1 towards an increase in this pathology among girls.

This is due to the fact that anatomically, the female urethra is located closer to the anus, therefore, pathogenic microflora more easily enters their intestines into the urethra and then into the urinary system.

Classification

UTI by localization can be divided into infection:

upper divisions ();
lower divisions(and urethritis).

According to the duration of the disease:

acute(less than 3 months);
chronic(more than 3 months).

According to the presence of complications:

uncomplicated;
complicated.

Causes of infection and risk factors

Bacteria are the direct cause of the development of inflammation in the urinary system. The most common causative agents are:

coli;
proteas;
klebsiella;
pseudomonas;
enterococci and others.

information However, for the development of the disease, the presence of a bacterium is not enough, a combination of risk factors, the predisposition of the person himself, and a decrease in immune defense are necessary.

To the main risk factors in children include:

complicated course of pregnancy in the mother (chronic pyelonephritis, preeclampsia, occupational hazards in the mother during pregnancy, hereditary history and others);
decrease in general and local immunity;
malformations of the urinary system;
violation of the outflow of urine (the presence of a stone, developmental anomalies, vesicoureteral-renal reflux);
metabolic diseases () and others.

Symptoms of UTI in Children

For infections in the lower parts Pain comes to the fore. Older children complain of pain when urinating, frequent urination, discomfort in the abdomen, above the pubis. Common symptoms may also include:

weakness, lethargy;
temperature rise;
decreased appetite.

With acute pyelonephritis pain syndrome is less pronounced. The symptoms of intoxication come to the fore:

lethargy, weakness, fatigue;
sleep disturbance;
increase in body temperature.

The pain syndrome is localized in the lumbar region. With its strong severity, children can take forced position(lying on its side with the legs brought to the body), with a weak one - pain is felt when touching the lower back.

Chronic pyelonephritis often manifested by a periodic rise in temperature, pain in the lower back. Children become irritable, lethargic, get tired quickly. With a long course, a lag in physical and mental development is possible.

UTIs in children under one year old are manifested by intoxication syndrome. Often can be disguised as other diseases (ARI, intestinal colic, ). The child becomes restless, capricious.

Diagnosis of urinary tract infection in children

For older children, the main in the diagnosis of UTIs are complaints.

important In children, inflammation of the urinary system is more often diagnosed by the presence of indirect signs(fever, crying or visible discomfort during urination, vomiting, diarrhea, and others).

Basic diagnostic methods:

- the most simple and informative. With an inflammatory process, leukocytes appear in the urine, possibly the presence of protein, and bacteria.
Urine culture with subsequent determination of the pathogen and its sensitivity to antibiotics- more informative, but requires some time and money. It makes it possible not only to accurately determine the cause of inflammation, but also helps to more accurately select the treatment.
Urinalysis according to Nechiporenko - another of the tests to detect inflammation in the urinary tract. With it, you can more accurately (compared to a general urine test) estimate the number of erythrocytes in 1 ml of urine.
Ultrasound of the kidneys and pelvic system- most commonly used in children instrumental method. If the pyelocaliceal system is expanded, then this indicates pyelonephritis.

Treatment

Treatment for UTI should begin as soon as the diagnosis is confirmed. The main one is antibiotic therapy. Important role also has a diet, regimen.

Medical therapy

First episode of uncomplicated infection most often, antibiotics from the group of protected penicillins are prescribed in the form of tablets, suspensions, capsules, syrup or 2-3 generation cephalosporins, also in the form of an oral form. The most common medicines:

Augmentin;
Amoxiclav;
Cefix;
Cefaclor;
Cefuroxime.

The duration of therapy for infections of the lower sections is 5 days, and for pyelonephritis it increases to 10.

good effect have uroantiseptics (Furamag, Furagin and others).

For chronic UTI can be prescribed for a long time herbal preparations with anti-inflammatory, diuretic, antibacterial action, such as Kanefron and phytolysin ointment.

dangerous Chronic pyelonephritis requires a longer and more serious treatment. In some cases, it should be carried out in a hospital (severe form, severe intoxication syndrome, early childhood).

Diet and regimen

Dieting and drinking regime allows you to speed up the healing process and prevent new episodes of infection:

Sour, fried, spicy, salty should be excluded.
It is important to drink plenty of fluids. This helps flush out the infection from the urinary system, preventing bacteria from lingering and multiplying. Fruit drinks from cranberries, lingonberries, kidney teas, decoctions have a good effect. medicinal herbs(chamomile, birch, St. John's wort and others).

Prevention of urinary tract infection in children

The main provisions for the prevention of UTIs:

Explain to your child that holding back (tolerating) urination is bad. This creates a favorable background for the reproduction of bacteria.
If the child already visits the toilet and serves himself, explain how to properly wipe the bottom and control this action.
If the child is still small, change the diaper in a timely manner, properly wash the ass (front to back).
Dress your child according to the weather, especially the perineum, lower back and legs.
Make sure that your baby does not sit on the cold, even in hot weather.
The child needs to drink enough during the day. Whether it's just drinking water or juices, compotes and fruit drinks.
If a child suffers from a chronic infection of the urinary system, then it is necessary to periodically conduct preventive courses of taking uroantiseptics.
It is necessary to take it regularly, since UTIs (especially the upper sections and chronic forms) can occur without obvious signs.

Depending on the location of the urinary tract infection in children, the signs may be different: problems with urination, pain in the bladder area (often pain can be observed in the lumbar region), leukocytes and bacteria in the urine, high fever.

The infection can affect various organs of the urinary system: kidneys, ureters, bladder and urethra. In children with suspected disease, all kinds of studies are carried out, including: ultrasound of the urinary system, x-rays of the bladder and urethra, examination of the urinary tract, cystoscopy (examination internal structure Bladder). Treatment is based on uroseptics.

According to statistics, infection of the genitourinary organs in childhood ranks second, when the first are viral diseases. Most often, the disease occurs in children under one year old. Strongly severe symptoms are extremely rare, but the consequences of the disease can be very severe.

Even specialists may not detect the infection in time, since most of the signs are hidden under the guise of various viral or intestinal diseases. Due to specifics child's body, infection spreads instantly, and can subsequently cause pyelonephritis.

Causes of infection

Microorganisms that cause genitourinary infection in children, depend on the immunity of the child (also sex and age). The most common bacterial pathogen- enterobacteria, including E. coli (it occurs in almost 90% of situations).

Girls get sick more often, aged 3-4 years. And in infancy, the opposite is true - boys are more likely to become infected (especially in the first 3 months of life). A particularly common cause is poor hygiene.

To avoid infection in the body, it is necessary to thoroughly study the issue of washing the child (for this, you can consult with the local pediatrician, or with the doctor in the hospital).

One of the most common causes of urinary tract inflammation is hypothermia. During which spasms of the vessels of the kidneys occur, as a result of which the filtration of urine is disturbed and the pressure in the urinary system is significantly reduced. Together, this leads to the onset of the inflammatory process. Therefore, it is especially important to ensure that the child does not sit on a cold floor, metal swings, etc.

Symptoms of UTI in Children

Infection in children manifests itself depending on the location of the concentration of inflammatory processes, the severity of the disease and the period. The most common urinary tract infections in childhood are:

pyelonephritis;
cystitis;
asymptomatic bacteremia;
urethritis.

Pyelonephritis

is an inflammation of the kidneys. Its danger is that after the disease, the full functioning of the kidneys is difficult to restore. As a result, renal failure may develop, followed by the inferiority of the body, and this is already a disability.

First of all, the temperature rises to 38 ° C (sometimes up to 38.5 ° C). Further, chills appear, signs of intoxication (lethargy, pale skin, lack of appetite, headaches). With more strong manifestation intoxication, vomiting, diarrhea, meningeal symptoms and neurotoxicosis may occur. The child has sharp pains in the lower back and / or abdomen, and when tapping on the lower back, there are pain.

In more early age when the upper urinary tract is infected, inflammatory processes can be disguised as pylorospasm, problems with urination, cutting pains in the abdomen, intestinal syndrome and etc.; in older children, the disease is hidden under a flu-like syndrome.

In infants, pyelonephritis can cause jaundice (after about the first week after birth).

Cystitis

First of all, with cystitis in children, problems with urination begin - they occur, little by little and are accompanied by painful sensations. In addition, there may be moments of urinary incontinence or complete emptying of the bladder occurs in several visits. In infants, cystitis is often manifested by urinary retention.

A child up to a year old may show a violation of the urination process by anxiety or crying, while an uneven (intermittent) stream is observed, which flows very weakly.

Cystitis usually causes pain and intense tension in the suprapubic area. Body temperature with this type of infection rarely exceeds the norm (in some cases it can reach 38 ° C).

It should be noted that it is cystitis that is most common among young children.

Asymptomatic bacteremia

Girls are more likely to experience this inflammation of the urinary tract. And the disease can be detected only after laboratory research. Because there are none special symptoms does not appear. In some situations, parents note cloudy urine in a child and a bad smell.

Most signs of UTI are directly related to age. The smallest noticed a sharp loss of appetite, lack of weight gain, and they often begin to act up. AT rare cases Infants may experience diarrhea and/or vomiting. But very often in children under the age of two years, with inflammation, only an increased body temperature can be observed. How older child, the brighter and more painful the signs.

And among them are:

pain in the lower back and abdomen;
burning and cutting during urination;
frequent urge to the toilet in small portions;
the appearance of urine changes (dark or cloudy urine, often found with blood);
the temperature rises (up to 38 ° C, accompanied by chills and weakness).

Urethritis

It should be noted that urethritis can be not only infectious, but also non-infectious. With urethritis, there is a burning sensation during urination. There are no fevers or signs of intoxication. Drops of blood can be observed in the urine (especially at the end of the emission). Even when the child does not go to the toilet, itching and burning in the genitals, and pus discharge are observed.

Urethritis occurs mainly in boys. AT adolescence the disease can be transmitted through intimacy.

Urinary tract infection in children develops rapidly. What does it mean if urethritis is not cured in time, in just a few days it can turn into more serious illness: cystitis or pyelonephritis. Therefore, after detecting one of the signs of infection, you should immediately contact a specialist.

In all urinary tract infections in a child, the main signs can be distinguished:

elevated temperature;
frequent trips to the toilet in too small portions;
constant thirst;
urinary incontinence (it is important to note that the sign is noted starting at 8 years old);
general condition (loss of appetite, drowsiness);
pain in the lower abdomen or lower back.

Some important facts about the disease

A genitourinary infection involves a sudden spike in the number of infected bacteria in the genitourinary system. Usually, bacteria enter the urinary canal from infected genital organs.

Often symptoms that can be found in an adult (frequent trips to the toilet, accompanied by pain, cutting pains in the lower back and in the abdomen, etc.), children are absent, except elevated temperature body. In other words, when a child has a fever without other signs of a particular disease, doctors suspect that he has inflammation of the genitourinary organs. The diagnosis can be confirmed or denied after laboratory analysis urine.

Unfortunately, UTIs in children are very common: for example, among lower grades approximately 8-9% of girls and 3% of boys have already met with the disease and have a recurrence of one of the infectious diseases of the genitourinary system.

Among newborns, the disease is more common in boys, and when analyzing children aged 3 to 15 years, the situation changes completely - inflammation occurs more often in girls (there are almost 6 times more of them than boys).

Treatment of urinary tract infection in children

Urinary tract infection that occurs without complications can be treated with drugs, oral intake(sulfafurazole, amoxicillin, cefixime, nitrofurantoin). The course of treatment takes only 10 days.

Pyelonephritis implies mandatory medical intervention. In the clinic, doctors prescribe intravenous administration antibiotics. Most infectious agents are killed by Ampicillin. Many use it in conjunction with sulbactam (in some cases with aminoglycosides).

Doses are determined based on age, and administered at least once every 6 hours. In addition to these drugs, aztreonam or cephalosporins are used. Antibiotics are administered until fever and bacteriuria disappear. Next, oral preparations are started.

From the first days of a child's life, it is important to conduct a urological examination, and a very thorough one. How effective is the treatment used 24-48 hours after taking the drugs, with the help of a general urine test. Almost all hospitals and paid laboratories are involved in the analysis. According to the results, the urine should not contain bacteria and leukocytes.

If treatment does not bring results, it is worth considering an examination for a kidney abscess.

After the course of treatment (as the infection was cured), it is necessary to conduct a regular examination of the urinary tract, especially in children. Because relapses are possible, and they usually do not have any symptoms. Relapses may occur during the first 6-12 months after infection.

Conclusion

The health of children is very fragile and easily yields even to the most minor illnesses. It is important to monitor his condition regularly, in order to avoid unpleasant consequences. Treatment in children inflammatory infection urinary tract should be started at the first symptoms, according to the recommendations of a specialist.

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 brought with blood from foci of 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 frequent, 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 analysis urine, 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. Perhaps an 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 of urolithiasis in a child, 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. At acute process symptoms of the disease and complaints are more pronounced than during exacerbation 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, the development of renal failure, and arterial hypertension that is difficult to control. 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 held biochemical analysis blood, urography. 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 located in chronic foci- diseased tonsils, adenoids, inflamed paranasal sinuses nose, untreated teeth, gradually disrupts the immune system and eventually affects 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 about 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 is early stages disease (before the formation of 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. 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, and herbal preparations. In severe cases, it is surgical removal kidney stones.

Nephroptosis- this is the omission of the kidney or excessive mobility of the kidney (vagus 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 of 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 during inflammatory processes in the kidneys, with pronounced violation 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 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- Normally absent in the urine or found in a minimal amount. 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. Appearance and high values 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 red blood cells 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. Increased amount leukocytes is a symptom of inflammation of the kidneys and urinary organs.

Epithelium may be present in small amounts. 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 contained in small quantities and indicate an acidic or alkaline urine reaction. 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!