Signs of pyelonephritis in children, methods of diagnosis, treatment and possible complications. Pyelonephritis in children: classification, course, diagnosis and treatment Pyelonephritis in children symptoms

Problems with the urinary system occur not only in adults, but also in children. The physiological characteristics of the child's body, reduced immunity, chronic foci of infection - all this contributes to the appearance of symptoms of pyelonephritis in a child, which are a serious cause for concern.

Pyelonephritis is one of the most common inflammatory diseases of the kidneys. The infectious-inflammatory process, which is localized in the renal pelvis, develops almost 3 times more often in girls, which is explained by differences in the structure of the female and male genitourinary systems. According to statistics, the most dangerous time for the onset of symptoms of pyelonephritis in children is the age from 0 to 2 years, from 4 to 7 years, as well as adolescence. Unfortunately, every year pyelonephritis only “gets younger”, as evidenced by the incidence rate among children of the first year of life. In order to notice the pathology of the kidneys in time, it is enough to have a general idea of ​​the symptoms of pyelonephritis in children.

Symptoms of pyelonephritis in children. The main causes of occurrence.

At birth, the baby's kidneys are only 30% functional, the renal tubules are shorter and narrower, and urine reabsorption is significantly lower than in adults. By about 7 years, the development of the urinary system is completed, and before that time, the risk of developing symptoms of pyelonephritis in crumbs is very high.

So, for the appearance of symptoms of pyelonephritis in a child, certain conditions are needed: weakened immunity, the presence of an infection in the body, and functionally immature kidneys. In most cases, signs of pyelonephritis in a baby appear after an acute respiratory viral infection. Children who have acute respiratory infections more than 4-5 times a year are especially susceptible to the disease.

The symptoms of pyelonephritis in children are influenced by:

Features of the child's body:

• children under five years of age are not physiologically able to completely empty the bladder;
• tortuosity or malposition of the ureters leads to stagnation of urine;
• the child's urine does not have antibacterial properties, which contributes to the reproduction of conditionally pathogenic microflora in it during stagnation;
• the immune system in children in the first months of life does not provide adequate protection against infection.

Infections:

• SARS, tonsillitis, influenza;
• the presence of caries and other foci of chronic infection (tonsillitis, sinusitis, etc.);
• infection of the fetus in utero;
• cystitis or urethritis;
• intestinal infection;
• the main causative agents of pyelonephritis: enterococci, E. coli (intestinal infection), staphylococci (tonsillitis), Pseudomonas aeruginosa.

Predisposing factors:

• hypothermia;
• frequent colds;
• poor hygiene;
• anomalies in the structure of the urinary system.

Symptoms of pyelonephritis in children under one year old.

Diagnosing the development of pyelonephritis in infants is quite difficult. In some cases, the disease is asymptomatic, which leads to an imperceptible transition of pyelonephritis to a chronic form.

The first symptoms of pyelonephritis in, due to which parents may suspect the onset of the disease, can be considered a persistent increase in temperature to 38-40 ° C, chills and anxiety with the exclusion of a cold. Frequent regurgitation, weight loss, disturbed nighttime sleep, and sweating may also indicate pyelonephritis. In addition, mom and dad should be alerted by prolonged physiological jaundice, as one of the symptoms of pyelonephritis in newborns.

IMPORTANT! A general urinalysis will help to confirm or exclude pyelonephritis, thanks to which it is possible to identify an inflammatory process in the kidneys (leukocytes, bacteria in the urine).

Examination should be carried out only after consulting a pediatrician!

The prognosis of the disease is favorable. Symptoms of pyelonephritis in children disappear within 2-3 days after the start of treatment. The transition of the disease to a chronic form is said when the symptoms of pyelonephritis in a child appear more than twice a year.

Symptoms of pyelonephritis in older children.

Symptoms of pyelonephritis in older children are represented by three main syndromes.

• Pain syndrome;
• With the development of pyelonephritis, the child complains of pulling pains in the lumbar region. Children under three years of age indicate abdominal pain of uncertain localization;
• Urinary disorders.

There is an increase in urination, the child asks to go to the toilet all the time. Portions of urine are small, after going to the toilet there is no relief, the child complains of a burning sensation at the end of the act of urination. Urinary incontinence is also characteristic of the clinical picture of pyelonephritis in children.

Urine can change its color, up to a dark yellow hue. In some cases, urine acquires a pronounced ammonia smell.

IMPORTANT! Urine that is reddish-pink in color may indicate the presence of red blood cells in it. However, we should not forget that some drugs, as well as fruits and vegetables, can stain physiological secretions.

body intoxication.

With a decrease in immune defense, any infection, as well as conditionally pathogenic microflora, can provoke the development of pyelonephritis. The waste products of pathogenic microorganisms cause poisoning - intoxication of the body. Symptoms of pyelonephritis in children in this case begin:

• from temperature rise to 38-40°C;
• pallor of the skin;
• with the appearance of weakness, lethargy, headache, anxiety;
• with chills.

The child may complain of nausea, vomiting, lack of appetite.

Symptoms of pyelonephritis in children depend on the age, stage of the disease and the defenses of the child's body. The inflammatory process in the kidneys, in the absence of proper therapy, entails serious consequences, the most harmless of which is chronic pyelonephritis.

It is quite possible to avoid kidney disease, because for this it is enough to visit a pediatrician in a timely manner and regularly take a general urine test.

” №2/2007 21.02.12

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

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

Pyelonephritis in children: causes

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

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

Types of pyelonephritis in children

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

Primary pyelonephritis

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

Secondary pyelonephritis

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

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

Symptoms of pyelonephritis in children

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

Temperature increase

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

  Urinary retention or incontinence

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

  Restlessness when urinating

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

  urine color

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

  Violation of the stool and regurgitation

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

  The child urinates in small portions.

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

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

Diagnosis of pyelonephritis in children

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

The baby will need to pass a general urine test.

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

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

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

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

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

How to read analysis results

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

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

Prevention of pyelonephritis in children

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

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

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

Urination: daily rate

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

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

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

Pyelonephritis: how to treat

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

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

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

May your child be healthy!

The kidneys are the "filtration station" of the human body. This organ performs an excretory function, removes metabolic products, excess salts, water, and toxins from the body. The state of the body as a whole depends on how the paired organ works.

A kidney disease that is often diagnosed in children is pyelonephritis. This is a non-specific infectious lesion of the organ, in which the pelvicalyceal system, tubules and interstitium are affected. The disease refers to tubulointerstitial nephritis. Pyelonephritis code according to ICD 10 - B95-97. The disease occurs in children of different ages. It can occur in acute and chronic form, requires immediate medical attention.

Reasons for the development of the disease

Pyelonephritis is associated with infection of the kidneys by pathogenic microorganisms. In most cases, this is Escherichia coli. It spreads against the flow of urine through the urethra to the kidneys, causing inflammation. The causative agents of the disease can be staphylococci, enterococci, mycoplasmas, chlamydia. Often during the diagnosis, microbial associations are detected.

Ways of entry of microorganisms into the kidneys:

• Hematogenous- with blood flow from other foci of inflammation. More often, infection in this way occurs in infants against the background of pneumonia, otitis, tonsillitis. Older children can get sick with pyelonephritis against the background of bacterial endocarditis, sepsis.
• Lymphogenic- the pathogen enters the kidneys through the lymphatic system, which connects the intestines and the urinary system. If the properties of the intestinal mucosa are disturbed or lymph stagnation occurs, the intestinal microflora can cause inflammation of the kidneys.
• ascending- the rise of infection from other organs (with vulvitis, cystitis, colitis, dysbacteriosis). Older children are more likely to become infected this way.

The urinary tract is not sterile and there is always the possibility of infection. A child's hygiene plays a big role in the development of a kidney infection.

Predisposing factors

The development of the disease can be facilitated by functional or structural anomalies in which the outflow of urine is impaired:

• nephrolithiasis;
• defects in the structure of the kidneys;
• crystalluria;
• vesicoureteral reflux;
• neurogenic bladder dysfunction.

The likelihood of developing the disease increases with:

• rickets;
• helminthic invasions;
• hypotrophy;
• transferred infections (smallpox, measles, scarlet fever);
• hypothermia;
• insufficient hygiene of the genital organs;
• in infants - complementary foods, teething, refusal to breastfeed.

On a note! All factors that contribute to a decrease in the body's defenses can serve as an impetus for the development of pyelonephritis in children.

Types and forms of pathology

In pediatrics, it is customary to distinguish 2 forms of the disease in children:

• primary- inflammation initially develops directly in the kidneys;
• secondary- occurs against the background of other factors (obstructive and non-obstructive pyelonephritis).

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

• Acute pyelonephritis- characterized by an active period and complete recovery within 1-2 months.
• Chronic pyelonephritis- lasts more than 6 months with two or more relapses during this period. This form of the disease can be recurrent and latent.

Clinical picture

Signs of kidney pyelonephritis in children can vary significantly depending on its form, the severity of the process, the age of the patient, and the presence of other pathologies.

acute form

One of the main signs of acute pyelonephritis is a high temperature (38 ° C and above). Often it is the only symptom.

The child has typical manifestations of intoxication of the body:

• fever;
• drowsiness;
• nausea, vomiting;
• loss of appetite;
• prostration.

Blueness appears under the eyes, the skin becomes grayish, pale. There are pains in the lower back, in the side, in the lower abdomen. Children under 4 years of age can hardly indicate the location of the pain. The nature of the pain is pulling, aggravated by changing the position of the body. Urination may be disturbed, but not always. It can be frequent urges with scanty discharge. Urine with pyelonephritis is cloudy, possibly with an unpleasant odor. In the morning there is a slight swelling of the face, there are no pronounced edema.

Manifestations of pyelonephritis in infants

For such young children, severe intoxication is characteristic. The temperature in pyelonephritis in children under one year old can jump up to 40 ° C. The child refuses to breastfeed, constantly burps, stops gaining weight. Due to dehydration, the skin becomes dry and flabby. The baby is constantly crying and naughty due to pain in the tummy. Before the act of urination, many children have a characteristic "groaning". Due to dehydration, vomiting, stool disorders, in infants, pyelonephritis is often mistaken for an intestinal infection.

Symptoms of the chronic form

If the disease is recurrent, then during the period of exacerbation the symptoms of chronic pyelonephritis are the same as in the acute form.

With a long course of the disease, the child has infectious asthenia:

• fast fatiguability;
• irritability;
• delayed physical and psychomotor development.

Diagnostics

To confirm the presence of pyelonephritis in a child, a number of laboratory and instrumental studies are carried out, which make it possible to differentiate it from other diseases with similar symptoms.

Complex of laboratory tests:

• clinical blood test (acceleration of ESR, leukocytosis, anemia);
• biochemical blood test (determination of total urea protein, creatinine);
• general urine analysis (increase in leukocytes, bacteriuria);
• urine samples according to Nechiporenko, Zimnitsky (leukocyturia);
• urine culture for microflora and sensitivity to antibiotics;
• PCR, ELISA as needed.

A mandatory instrumental diagnostic method for suspected pyelonephritis is ultrasound of the kidneys (bladder according to indications), ultrasound of the blood flow of the kidneys. After the acute symptoms of the disease are stopped, voiding cystoureterography, excretory urography can be performed. They allow to detect anomalies of the organ.

Additional methods for diagnosing pyelonephritis in children:

• dopplerography of renal blood flow;
• uroflowmetry;
• renal angiography;
• scintigraphy.

Effective methods and features of treatment

How to treat pyelonephritis in children? It is necessary to contact a pediatric urologist or nephrologist. Treatment of pyelonephritis at home is unacceptable, you need to hospitalize the child in the department of urology or nephrology. In a hospital environment, it is possible to constantly monitor the dynamics of changes in urine and blood tests, to select more effective drug therapy.

Therapy of pediatric pyelonephritis includes a set of measures:

• organization of the drinking regime;
• diet food;
• taking medication;
• follow-up after treatment.

On a note! In 80% of cases of acute pyelonephritis, complete recovery occurs. Severe complications and death are mainly associated with the presence of concomitant diseases and a severely weakened body. In 70% of cases of the chronic form of pyelonephritis, its progression, an increase in nephrosclerotic changes in the kidneys, is observed.

Rules and diet

If a child has a fever, pain in the lower back and abdomen, he must be prescribed bed rest for the first 7 days of treatment. If there is no fever and severe pain, movement within the ward is allowed. Gradually, you can include walks on the street for 30-40 minutes on the territory of the medical institution.

The main goal of the diet for pyelonephritis in children is to reduce the load on the kidneys and correct metabolic processes. Table number 5 according to Pevzner is assigned. Fluid intake should be half the age norm. But if the kidney function is impaired or obstructive phenomena are noted, the drinking regimen will have to be reduced, the salt intake should be reduced. Any irritating foods (spicy, fatty, spicy, rich broths) are excluded from the diet.

Medical therapy

The main group of drugs that are prescribed to children with pyelonephritis are antibiotics. Treatment is carried out in 2 stages. Before obtaining the result of bakposev and the sensitivity of the pathogen to antibiotics, a broad-spectrum drug is given that acts against the most common pathogens of urinary tract infections. At the same time, their toxicity to the kidneys should be minimal or absent altogether. More often these are drugs of the 2nd and 3rd generation cephalosporin group, protected by penicillins. When the result of the analysis is obtained, the doctor selects a remedy that is effective against a particular microorganism.

It is necessary to take antibiotics for 4 weeks, with periodic replacement every 7-10 days, to avoid resistance of the pathogen.

For disinfection of the urinary tract, children are prescribed uroantiseptics for a course of 1-2 weeks of admission:

• Nitroxoline;
• 5-NOC;
• Palin.

After uroseptics, you can take herbal preparations that normalize kidney function (Canephron, kidney tea, Uronefron). For symptomatic treatment, other groups of drugs can additionally be used: anesthetics, antispasmodics, NSAIDs, agents with an antioxidant effect (beta-carotene, vitamin E).

After discharge from the hospital, the child should be regularly monitored by the local pediatrician or nephrologist. Once a month, you need to take a general urine test, 2 times a year, do an ultrasound of the kidneys. A child can be removed from the register only after 5 years, if during this time there were no relapses, there were no changes in urine tests.

In the chronic form of the disease, a child in remission must undergo anti-relapse treatment using a course of antibiotics in small doses, uroseptics for 2-4 weeks every 1-3 months, herbal remedies. Children with this diagnosis are observed before being transferred to an adult clinic.

Go to the address and read about the rules of nutrition and diet for kidney failure in men.

To protect a child from the development of pyelonephritis, it is necessary:

• Teach him from childhood to observe the rules of personal hygiene. This will make it possible to minimize the risk of infection in the body.
• Strengthen the immune system with vitamin therapy, walks in the fresh air, trips to the sea.
• Timely vaccinate against viral infections (measles, rubella, mumps).
• After any infectious disease, show the child to a urologist or nephrologist and pass a urine test.
• Eliminate foci of infection in the body in time.
• Conduct regular scheduled examinations at the ENT and dentist.

Pyelonephritis in children is diagnosed quite often. The reasons for the development of this infection may be different. If timely diagnosis is made and treatment is started, pathological changes in the kidneys can be avoided and chronicity of the process can be prevented. For any infections that a child encounters, it is imperative to monitor the condition of the kidneys.

In children, after influenza and other infectious diseases, there is often a complication in the kidneys. They develop an inflammatory process. It is not always easy to recognize, especially in babies who do not yet know how to talk. The resulting symptoms are similar to the manifestations of cystitis, intestinal infectious diseases, colds. It is necessary to do urine and blood tests to clarify the type of infectious agent and the nature of the disease. The child will need urgent antibiotic treatment so that the process does not become chronic. It is necessary to follow the diet.

One type is pyelonephritis. In this disease, inflammation of the renal calyces, pelvis, tubules, blood vessels and connective tissue occurs. In this section of the kidneys, urine is stored and excreted. The inflamed kidney swells and increases in size, its walls thicken.

In children, pyelonephritis can occur at any age. Up to 1 year, the incidence of girls and boys is the same. Among older children, inflammatory diseases of the urination organs, including pyelonephritis, are 4-5 times more common in girls than in boys. This is due to the difference in the anatomical structure of the genitourinary system. In girls, the urethra is much shorter. It is easier for infections to enter the bladder and kidneys directly from the vagina or intestines.

The causative agents of infection can be bacteria (E. coli, staphylococci), viruses (adenoviruses, enteroviruses, influenza pathogens), as well as protozoa (Giardia, Toxoplasma) and fungi.

How infection occurs

Infection can enter the kidneys in three ways:

1. Ascending (urinogenic). Bacteria enter the kidneys from the genitourinary organs or intestines.
2. Hematogenous (through the blood). Infection occurs if the child is sick with pneumonia, otitis media, caries, cystitis, that is, the infection enters the kidneys from any organ affected by the inflammatory process.
3. Lymphogenous (through the lymphatic vessels).

Classification of pyelonephritis

There are primary pyelonephritis in children and secondary.

Primary- this is when the source of infection appears directly in the kidneys. The onset of primary inflammation contributes to a decrease in immunity. At the same time, opportunistic microflora begins to develop in them.

Secondary pyelonephritis- this is a complication that occurs in the body due to the transfer of infection from other organs, violation of the outflow of urine in their diseases, injuries or developmental pathologies.

It is possible to develop an inflammatory process of various types. obstructive pyelonephritis is accompanied by urinary retention in the kidneys. non-obstructive- urine comes out of the kidneys freely.

Pyelonephritis can occur in 2 forms. Spicy usually resolves in 1-3 months if treatment is started without delay. Chronic pyelonephritis can last for years. The transition of the disease to a chronic form is said if the symptoms do not disappear within six months. A protracted inflammatory process can be recurrent, when the manifestations periodically return, and then there are periods of remission (temporary recovery).

It is also possible the course of chronic pyelonephritis in a latent form. In this case, the symptoms are very mild. It is possible to identify latent pyelonephritis in a child only with a thorough examination (there are characteristic changes in the composition of urine and blood that can be detected by test results).

If inflammation occurs in only one kidney, then they talk about unilateral pyelonephritis. With the defeat of both kidneys - about bilateral.

Causes of pyelonephritis

The main causes of pyelonephritis are:

1. The presence of congenital pathologies of the development of the kidneys and other urinary organs. There is a delay in urination, an abnormal accumulation of urine in the kidneys.
2. Formation of salt stones and sand. Crystals may block the renal tubules.
3. The reflux of urine (reflux) from the bladder into the kidneys as a result of an increase in pressure inside it due to inflammatory edema, trauma, or a congenital defect of the organ.
4. The entry of pathogenic microorganisms into the kidneys.

In newborns, infection occurs most often by the hematogenous route (for example, due to inflammation of the umbilical wound, the appearance of pustules on the skin, pneumonia). In older children, pyelonephritis usually occurs as a consequence of inflammatory diseases of the genital organs, bladder, intestines, that is, infection occurs in an ascending way. When the intestinal mucosa is damaged, bacteria enter the kidneys with lymph, as the natural outflow of lymphatic fluid from the kidneys to the intestine is disturbed, and stagnation occurs in the vessels.

The occurrence of pyelonephritis in children contributes to improper hygienic care for babies, a rare change of diapers and underwear.

Warning: This problem is especially relevant for girls. In order not to bring the infection into the ureters from the anus, it is important to wash the girl correctly (in the direction from the genitals to the anus, and not vice versa).

Provoking factors are also a decrease in immunity, the presence of chronic inflammatory processes in a child, acute infectious diseases (measles, mumps, chicken pox and others), diabetes mellitus, and.

Hypothermia of the pelvis and lower extremities is one of the main causes of inflammation of the bladder, which is often complicated by pyelonephritis. Most often, weakened children are sick, who have symptoms of beriberi, anemia, rickets.

Video: Features of pyelonephritis, its diagnosis and treatment

Symptoms of pyelonephritis

In children, pyelonephritis begins with a sharp rise in temperature to 38 ° -38.5 ° C, the onset of chills. In addition to fever, other symptoms of general intoxication of the body with bacterial waste products appear, such as headache, loss of appetite, nausea, and vomiting. The child becomes drowsy and lethargic.

The temperature can last for several days, but there are no signs of a cold (runny nose, sore throat, cough).

There are frequent urges to urinate, but urine output in pyelonephritis is poor. Urine becomes cloudy, its color becomes more intense, an extremely unpleasant odor appears. Pain occurs when emptying the bladder. It is characteristic that in a healthy child the bulk of the urine is excreted during the daytime, and with pyelonephritis, nighttime urination becomes more frequent, urinary incontinence occurs.

Children usually complain of stabbing or aching pain in the lower back, and sometimes in the lower abdomen. The patient develops swelling under the eyes (especially after sleep). Blood pressure rises, heart rate increases.

Acute pyelonephritis

Acute pyelonephritis develops in children in several stages.

On 1 stage small infiltrates (pustules) form in the kidneys. At this stage, antibiotics can easily cope with the infection, the main thing is to start therapy on time.

On 2 stages there is a fusion of infiltrates and the formation of an inflammation focus with a diameter of up to 2 cm. There may be several such foci.

For 3 stages pyelonephritis is characterized by the fusion of individual foci and the occurrence of an extensive purulent abscess. In this case, the destruction of the kidney parenchyma occurs, which is accompanied by an increase in temperature to 40 ° -41 ° C, severe symptoms of poisoning of the body and pain in the lower back. The pain intensifies if you lightly tap on the back in the area of ​​the kidneys, it is felt more strongly when moving, lifting heavy objects. It also occurs under the lower ribs.

If the abscess breaks, its contents enter the abdominal cavity. Blood poisoning develops, which most often leads to death.

Warning: When a child's temperature rises against the background of the absence of colds, it is imperative to take him to a pediatrician or pediatric urologist to do a urine test and immediately begin treatment.

Chronic pyelonephritis

During the period of remission of pyelonephritis, pain, fever and other symptoms are absent. The temperature does not rise above 37.5°C. But the child quickly gets tired, becomes nervous. He has pale skin. There may be a dull pain in the back.

Chronic inflammation of the kidney can cause serious health complications for the child in the future. The consequence of chronic pyelonephritis in children is nephrosclerosis ("wrinkled kidney") - atrophy of the renal tissue due to circulatory disorders and hypoxia, its replacement with connective tissue, scarring.

Chronic renal failure (impaired ability of the kidneys to filter blood and excrete urine) may occur. With age, hypertension develops, heart failure.

Features of symptoms in infants

The first sign of an infant's disease with pyelonephritis may be an increase in temperature in the absence of signs of SARS. At the same time, a change in the nature of urination can be observed.

The baby urinates either too rarely, or very often and a lot. At the time of urination, he cries. His urine becomes cloudy, becomes dark, and blood may appear in it. Sick children are constantly naughty, sleep badly, eat poorly, often spit up.

Video: Symptoms of urinary tract infections in children

Diagnosis of pyelonephritis

To confirm the diagnosis of "pyelonephritis", the child must undergo an examination, which includes a general urine test for leukocytes, erythrocytes and other indicators. Urine culture is performed to determine the composition of the microflora.

You may need to analyze urine collected during the day (analysis according to Zimnitsky). Its specific gravity is determined, by which one can judge the functionality of the kidneys, the ability to filter blood.

A biochemical analysis of urine is carried out for protein (in the absence of inflammation, it should not be there), urea (a decrease in its level indicates kidney failure) and other components. The study of urine by PCR and ELISA makes it possible to establish the type of infectious agents by their DNA and the presence of appropriate antibodies.

Blood tests are carried out: general, for protein, for creatinine. The content of creatinine above the norm indicates that the kidneys are not coping with their functions.

Instrumental methods of examination include ultrasound of the kidneys and other organs of urination, urography (X-ray using a contrast solution), and computed tomography.

Video: Importance of urinalysis for urinary tract infections

Treatment

Treatment of pyelonephritis in children in the absence of complications is carried out at home. In severe manifestations of an acute disease, as well as in the event of its symptoms in infants, patients are hospitalized.

Treatment for pyelonephritis is carried out according to the following principle:

1. The child is prescribed bed rest.
2. A diet is prescribed: salt intake is limited. Food should be vegetable and protein, low in fat. The child should consume about 1.5 times more liquids than usual (water, compotes, tea). If signs of renal failure are observed, then the amount of fluid consumed should be limited.
3. When symptoms of pyelonephritis appear, painkillers and antipyretics (ibuprofen, paracetamol) are used.
4. Children are being treated with antibiotics. They are selected depending on the results of urine and blood tests. The presence of side effects is taken into account. The course of treatment is approximately 10 days, after which it is necessary to give the baby probiotics to restore bowel function. Antibacterial drugs such as cefuroxime, ampicillin, gentamicin are prescribed.
5. Diuretics (spironolactone, furosemide) are used to quickly remove bacteria from the kidneys and bladder. Children are prescribed anti-allergic drugs, as well as immunostimulants.

Full recovery is judged by the results of laboratory tests of urine.

Drug treatment of pyelonephritis in children is supplemented by taking herbal diuretics and anti-inflammatory drugs (decoctions of bearberry, corn stigmas, string, mint, yarrow).

Prevention of pyelonephritis

The main measure to prevent the occurrence of urological diseases, including pyelonephritis, is the observance of the rules of hygienic care for children (frequent change of diapers, maximum restriction of their use, thorough washing of children).

Parents should observe how often the child's bladder is emptying, remind him that it is time for him to use the potty. The bladder should not be overfilled so that urine does not stagnate in it.

For any incomprehensible symptoms in a child, you should not self-medicate him. It is imperative to consult a doctor.

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.

Causes

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

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 cause 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.