What is acute pyelonephritis in children. Pyelonephritis in children: symptoms, treatment of acute and chronic. How to prevent the development of pyelonephritis in a child

A disease such as pyelonephritis in children requires prompt identification and adequate treatment. You need to carefully monitor the baby, since kidney inflammation is a dangerous disease and the symptoms cannot be ignored. Self-medication is also prohibited, as it leads to serious complications and health problems. What are the causes of pyelonephritis in children, the main symptoms and treatment of the disease.

general information

Children's pyelonephritis is an inflammatory process that develops in the tissues of the renal parenchyma and pyelocaliceal system. With pyelonephritis in children, severe pain in the lumbar region, the urge to urinate becomes more frequent, and incontinence occurs. To make an accurate diagnosis, the child needs to be shown to a doctor, who will refer the baby for examination. If the diagnosis is confirmed, a course of antibacterial and auxiliary therapy is prescribed.

Classification

Doctors divide pyelonephritis in a child into 2 types - primary and secondary pyelonephritis. In the initial manifestation, inflammation is caused by pathogenic microflora that has affected the kidneys and is rapidly developing in them. The peculiarities of secondary pyelonephritis are that the root cause of the disease is not inflammatory processes of the kidneys; more often, damage occurs due to the formation of stones, with abnormalities in the development of the organ and ureteral reflux.

Depending on how long the disease has been bothering the child, acute and chronic pyelonephritis is distinguished. In a chronic course, the child is worried about frequent relapses, and all signs of infectious damage to the organ remain. During an exacerbation, severe and acute pain, fever, problems with urination, and deterioration in general condition are disturbing.

Symptoms of the disease

A characteristic symptom of acute pyelonephritis is severe pain in the lumbar region, deterioration of health, increase in body temperature, intoxication. The child suffers from prolonged chills and fever; due to intoxication, nausea, vomiting, diarrhea, weight loss, and bacteriuria develop. In case of exacerbation with the addition bacterial infection The baby experiences pain when urinating, an increased urge to urinate, incontinence, and a burning sensation in the genitourinary system.

In a chronic course, the symptoms are blurred. Child early age becomes very tired, irritable, pale and unfocused. If the disease occurs in a latent form, then signs do not appear, but urine tests will show the development of inflammation. If you do not resort to treatment for a chronic disease, at an older age it develops into nephrosclerosis, hydronephrosis or chronic renal failure.

Causes and predisposition

The causes of pyelonephritis in young children are most often intestinal bacterial. A urine test also shows the presence of Proteus, Staphylococcus aureus, and Enterococcus. Infection enters the kidneys through hematogenous, lymphogenous or urinogenic routes. Newborn babies are infected by the hematogenous route, and older children, up to 12 years of age, are more often infected by the urinogenous route. Failure to comply with hygiene rules and irregular changes of linen also provoke the disease.

During treatment, the baby should be under the supervision of a doctor.

Congenital anomalies, complications after severe infectious diseases, with a diagnosis of hypotopia, rickets, also cause the disease. Babies with such diseases are often predisposed to pyelonephritis. The child should be under the supervision of a pediatrician and if characteristic symptom you need to immediately identify the disease and start timely treatment with the use of adequate drugs.

Features of infants

In a baby in the first year of life, the first signs of pyelonephritis are an increase in body temperature, while the baby is restless, eats poorly or refuses to feed altogether, worries and cries when urinating. On the background sharp increase temperature, there are no signs of acute respiratory infections. Monitor the frequency of urination; with inflammation, the number of urges increases, but the volume of urine is small. In this case, you need to immediately call an ambulance, and only after diagnostic studies and with bacteriuria, when the presence of bacteria in the urine is observed, the doctor determines the treatment regimen and prescribes medications. With a general blood test and the presence of inflammation, the leukocyte level increases - in girls it is more than 0−5-7, in boys it is 0−3-5.

Diagnostics

If pyelonephritis is detected in a child, the doctor sends him for a clinical analysis of blood and urine, biochemistry, and tests for the presence of infection or bacterial pathogen. During diagnosis, it is important to assess the rhythm and volume of the urge to urinate. Instrumental research consists of ultrasound of the organ and its blood flow. To exclude obstructive uropathy, the baby will need to undergo excretory urography, urodynamic study, dynamic scintigraphy kidneys, CT or MRI of the kidneys.

Treatment of the disease

The doctor selects medications and a treatment regimen for a small patient.

Treatment of pyelonephritis in children is based on the use of antibacterial therapy, uroseptic drugs and auxiliary physiotherapeutic and homeopathic procedures. A pediatric urologist or nephrologist can treat pyelonephritis in children. Based on the results of diagnostic studies and taking into account the pathogenesis, the doctor prescribes drugs, a regimen and duration of therapy. In childhood, pyelonephritis is treated for about a month or more. The basic principles of therapy and care for pyelonephritis in children are as follows:

1. Antibacterial treatment is mandatory and prescribed by the attending physician. The doctor selects the appropriate antibiotic drug, checks the presence or absence allergic reaction, after which therapy is prescribed. If a more in-depth diagnosis reveals a specific pathogen, then after 5 days the doctor changes the medicine and prescribes a new one. The total duration of therapy is at least 1.5 months.
2. The use of uroanoseptics, which helps disinfect the urinary ducts, destroys pathogenic microflora and stops their reproduction. Common medications are Nevigramon, Palin, Nitroxoline.

Children often experience kidney complications after influenza and other infectious diseases. An inflammatory process develops in them. It is not always easy to recognize, especially in babies who cannot yet speak. The symptoms that arise are similar to those of cystitis, intestinal infectious diseases, and 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 emergency antibacterial treatment so that the process does not become chronic. Diet is required.

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

In children, pyelonephritis can occur at any age. Up to 1 year of age, the incidence of the disease in girls and boys is the same. Among older children, inflammatory diseases of the urinary organs, including pyelonephritis, are 4-5 times more common in girls than in boys. This is explained by the difference in the anatomical structure of the genitourinary system. Girls have a much shorter urethra. 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 ( coli, staphylococci), viruses (adenoviruses, enteroviruses, influenza pathogens), as well as protozoan microorganisms (giardia, toxoplasma) and fungi.

How does infection occur?

Infection can enter the kidneys in three ways:

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

Classification of pyelonephritis

There are primary and secondary pyelonephritis in children.

Primary– this is when the source of infection appears directly in the kidneys. The occurrence of primary inflammation is facilitated by decreased immunity. At the same time, opportunistic microflora begins to develop in them.

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

Possible development of an inflammatory process different types. Obstructive pyelonephritis is accompanied by urine retention in the kidneys. Non-obstructive- urine leaves the kidneys freely.

Pyelonephritis can occur in 2 forms. Spicy usually resolves within 1-3 months if treatment is started promptly. Chronic pyelonephritis can last for years. The disease has become chronic if the symptoms do not disappear within six months. A protracted inflammatory process can be recurrent, when manifestations periodically return, and then periods of remission (temporary recovery) occur.

It is also possible for chronic pyelonephritis to occur in a latent form. However, the symptoms are very mild. Latent pyelonephritis can be detected in a child only with a thorough examination (observed characteristic changes in urine and blood, which can be detected by test results).

If inflammation occurs in only one kidney, then they speak of unilateral pyelonephritis. If both kidneys are affected, it is said to be bilateral.

Causes of pyelonephritis

The main causes of pyelonephritis are:

1. Availability congenital pathologies development of the kidneys and other urinary organs. Urinary retention and abnormal accumulation of urine in the kidneys occur.
2. Formation of salt stones and sand. The crystals may block the kidney tubules.
3. Reflux of urine (reflux) from Bladder into the kidneys as a result of increased pressure inside it due to inflammatory edema, injury, or a congenital defect of the organ.
4. Entry of pathogenic microorganisms into the kidneys.

In newborns, infection most often occurs hematogenously (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, and intestines, that is, infection occurs through an ascending route. When the intestinal mucosa is damaged, bacteria enter the kidneys with lymph, since the natural outflow of lymphatic fluid from the kidneys to the intestines is disrupted, causing stagnation in the vessels.

The occurrence of pyelonephritis in children is facilitated by improper hygienic care of babies and infrequent changes of diapers and underwear.

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

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

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 who exhibit symptoms of vitamin deficiency, anemia, and rickets are ill.

Video: Features of pyelonephritis, its diagnosis and treatment

Symptoms of pyelonephritis

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

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

arise frequent urge to urination, but urine output with pyelonephritis is scanty. The urine becomes cloudy, its color becomes more intense, and an extremely unpleasant odor appears. There is pain when emptying the bladder. What is characteristic is that healthy child the bulk of urine is excreted in daytime, and with pyelonephritis, night urination becomes more frequent and 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 and heart rate increases.

Acute pyelonephritis

Acute pyelonephritis develops in children in several stages.

On Stage 1 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 the infiltrates merge and a focus of inflammation with a diameter of up to 2 cm is formed. There may be several such lesions.

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

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

Warning: If a child’s temperature rises and there are no cold symptoms, it is imperative to take him to a pediatrician or pediatric urologist to have a urine test done and begin treatment immediately.

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 gets tired quickly and becomes nervous. He has pale skin. Possible appearance dull ache in back.

Chronic inflammation of the kidney can cause severe health complications for the child in the future. The consequence of chronic pyelonephritis in children is nephrosclerosis (“shrinked kidney”) - atrophy of the kidney tissue due to circulatory disorders and hypoxia, its replacement connective tissue, scar formation.

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

Features of symptoms in infants

The first sign of an infant's illness with pyelonephritis may be an increase in temperature in the absence of signs of acute respiratory viral infection. At the same time, you can observe a change in the nature of urination.

The baby urinates either too rarely or too often and a lot. At the moment of urination he cries. His urine becomes cloudy, dark, and may contain blood. Sick children are constantly capricious, sleep poorly, eat poorly, and 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, red blood cells and other indicators. Urine culture is performed to determine the composition of the microflora.

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

Held biochemical analysis urine for protein (in the absence of inflammation it should not be there), urea (a decrease in its level indicates renal failure) and other components. Testing urine using PCR and ELISA methods makes it possible to determine the type of infectious agents based on their DNA and the presence of corresponding antibodies.

Blood tests are carried out: general, protein, creatinine. A creatinine content higher than normal indicates that the kidneys are not coping with their functions.

TO instrumental methods examinations include ultrasound of the kidneys and other urinary organs, urography (X-ray using a contrast solution), computed tomography.

Video: The importance of urine analysis for urinary tract infections

Treatment

Treatment of pyelonephritis in children in the absence of complications is carried out at home. For severe manifestations acute illness, as well as when its symptoms occur 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 drink approximately 1.5 times more liquid (water, compotes, tea) than usual. If signs of renal failure are observed, the amount of fluid consumed should be limited.
3. When symptoms of pyelonephritis appear, painkillers and antipyretics (ibuprofen, paracetamol) are used.
4. Children are treated with antibiotics. They are selected depending on the results of urine and blood tests. Availability is taken into account side effects. The course of treatment is approximately 10 days, after which it is necessary to give the baby probiotics to restore intestinal function. Antibacterial drugs such as cefuroxime, ampicillin, and gentamicin are prescribed.
5. To quickly remove bacteria from the kidneys and bladder, diuretics (spironolactone, furosemide) are used. Children are prescribed anti-allergenic drugs, as well as immunostimulants.

Complete recovery is judged by the results laboratory research urine.

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

Prevention of pyelonephritis

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

Parents should monitor how often the child empties his bladder and remind him that it is time for him to go potty. The bladder should not be overfilled so that urine does not stagnate in it.

If a child has any incomprehensible symptoms, you should not self-medicate. It is imperative to consult a doctor.

The baby's health is very fragile. Therefore, pediatricians insist on regular examinations. Every mother should know the importance of a urine test - it can be used to diagnose in a timely manner acute pyelonephritis The child has. Since this disease can be associated with both colds and viruses, it is better to be on the safe side.

Acute pyelonephritis in children is an inflammatory process occurring in the kidneys. More precisely, it is a disease of the renal pelvis, which is a kind of reservoir for urine. It is from them that urine passes into the ureters.

The root cause of pyelonephritis is viral . The infection can enter the bloodstream from a sore tooth, sore throat, or wound on the body. As soon as microbes penetrate the adrenal glands, an inflammatory process begins, often ending in chronic pyelonephritis.

It is noteworthy that most often this disease affects children under the age of 5 years, in particular girls. The female genital organs are designed in such a way that it is easier for bacteria to penetrate and multiply.

In addition, this disease can be cold character . Firstly, pyelonephritis can be a complication provoked by a common ARVI. Secondly, the disease is often observed in children suffering from enuresis. Also, inflammation of the renal pelvis can occur against the background of hypothermia, accompanied by infection.

That is why, even with colds and flu, children under 7 years of age are recommended to undergo a general urine test. Late detection of the disease can lead to its chronic form.

Clinical picture

Acute pyelonephritis occurs in children of primary school age due to infection of the body with Escherichia coli, entorococcus, chlamydia, mycoplasma, ureaplasma and other bacteria. With inflammation of the renal pelvis, in 80% of cases, E. coli is found in the body of a small patient.

In infants, microbes that provoke pyelonephritis can be introduced into the kidneys through the umbilical ring, an inflamed pustular rash, and so on. Bacteria are spread by blood flow. That is, the nature of infection of children is downward.

In an older child – 12–14 years old – the inflammation may be ascending. That is, bacteria enter the urinary canal from the outside, and from there into the kidneys. This type of infection is often accompanied by inflammation of the external genitalia, dysbiosis, and intestinal inflammation. Ascending infection is more common in girls, as they have a shorter and wider urethra than boys.

Often acute pyelonephritis in a child is associated with. It is the inadequate emptying of the bladder that leads to the accumulation of urine residues in the renal pelvis. And as soon as microbes get there, inflammation begins. In addition, urine continues to flow, creating favorable environment for the growth of bacteria.

Not only cystitis provokes stagnation of urine. It may be associated with a congenital defect of the renal pelvis, in which urine is not excreted through the ureter, but is thrown back into the kidneys.

In infants, acute pyelonephritis often occurs against the background of rickets, anemia, malnutrition, and metabolic disorders. In older children, the disease may be associated with poor personal hygiene, acute viral infections, rheumatism, and weakened immunity.

Treatment of acute pyelonephritis in children is simple, but if it is not carried out on time, serious complications can arise. Up to blood poisoning and the formation of abscesses in the kidneys. On average, 80% of children recover and have no future kidney complications. But in 20% of cases, the child may lag behind in development and even become disabled. Therefore, it is so important to regularly do a urine test and respond to the slightest changes in the child’s well-being during the period of exacerbation of viral diseases.

Babies cannot talk about their feelings. They show that something is bothering them in the only way available to them - by crying. But older children, when examined by a doctor, can say that they have lower back and stomach pain . Acute pain in these areas can be the first external sign pyelonephritis.

In addition, inflammation of the renal pelvis is indicated frequent painful urination accompanied by itching and burning. Also, the child may develop a fever (up to 40 degrees), accompanied by chills. Among the general symptoms, the mother should be alerted to constant headache, weakness, lack of appetite, and cyanosis of the skin.

In young children, symptoms of acute pyelonephritis manifest themselves as high temperature, intoxication (vomiting, nausea) and, as a result, dehydration. Babies become lethargic, apathetic, often cry, begin to lose weight, and refuse to eat.

Doctors recommend that mothers pay attention not only to the frequency and nature of bowel movements (consistency and color of stool), but also to the nature of urination. If the baby cries during them, most likely he experiences itching and burning in the bladder.

How to identify and treat pyelonephritis?

Usually it is enough to diagnose acute pyelonephritis urine test . In difficult cases, to be on the safe side, the doctor may send the child to Kidney ultrasound .

An increased content of leukocytes, protein and red blood cells is characteristic feature inflammation of the renal pelvis. For infants, 10,000 bacteria per 1 ml of urine is enough, and for older children - 50,000 - 100,000 bacteria to diagnose pyelonephritis.

Since many microbes are insensitive to antibiotics, urine analysis is repeated 2-3 times throughout treatment. If there are almost no changes, other drug treatment is prescribed.

To submit urine for analysis, children 5–7 years old need to wash themselves and collect them in a sterile container. middle part jets. Infants cannot control urination, so urinals are attached to their urinary tract to collect urine.

Besides high content bacteria, a urine test helps to assess the functioning of the kidneys, exclude or identify the presence of stones, deviations in development and structure, which provoke the reflux of urine back into the kidneys. All these factors are extremely important for effective treatment acute pyelonephritis in a child.

Diagnosing pyelonephritis, especially in an infant, is extremely difficult. Therefore, it is necessary to pay attention to many external factors.

Evidence of the disease may be:

• rapid pulse;
• sharp pain in the upper abdomen;
• pain when lightly hitting the kidneys with the edge of the palm;
• high blood pressure.

Despite the complexity of diagnosis and clinical picture, acute pyelonephritis is treated in a quite accessible and simple way. First of all, the child must comply bed rest . Parents are charged with the responsibility of providing their child with complete peace. This means no TV, extraneous noise and stress.

Treatment of acute pyelonephritis in children involves special diet , excluding spicy, fatty, fried, salty, as well as spices and strong broths. In addition, it is necessary to include in the diet of a sick child as many fresh vegetables and fruits as possible, as well as juices and purees.

The basis of the menu should be diuretic fruits and berries: watermelons, melons, grapes, cherries. You can also give your child vegetable and light meat broths.

The key to rapid normalization of kidney function is plenty of warm drinks . Older children should be regularly given rosehip decoction, diluted compotes and tea. To stop fluid loss, infants are given a special solution in the form of droppers.

Naturally, diet and drinking regimen are not enough to treat acute pyelonephritis in a child. Powerful drug therapy is required.

After analyzing urine for microorganisms, the doctor will prescribe antibiotics in tablets. In difficult cases, intramuscular or intravenous injections are prescribed. For 1–2 weeks, the child is treated with drugs containing penicillins, cephalosporins or aminoglycosides.

After them treatment begins uroseptics , disinfecting urine. These drugs include: furazidine, nalidixic, oxolinic, pipemidic acid, co-trimoxazole.

The speed of recovery depends on the severity of the disease and the level of immunity of each child. The main thing is to follow the doctor’s recommendations and not refuse hospitalization if necessary.

There is no prevention of acute pyelonephritis in children as such. The only thing you can do is regularly take a urine test, make sure that the child is not hypothermic, and does not wear wet onesies. It is also worth paying special attention to the baby’s health during periods of exacerbation of flu and colds. All this will help to eliminate the prerequisites for pyelonephritis in time.

In addition, for preventive purposes, older children can be given herbal tea, which has antimicrobial, anti-inflammatory and diuretic effects. This therapy is also indicated after a course of antibiotics.

Since herbal medicine is not suitable for infants, parents are advised to pay more attention to the personal hygiene of their children. In addition, you need to regularly show your child to the pediatrician in order to identify and treat them in time. infectious diseases, infection with worms, inflammation of the external genitalia, etc.

So, the best prevention of pyelonephritis is diligent health care. In addition, children who have suffered from this disease are recommended to register with a nephrologist and regularly visit the doctor throughout three years. You also need to constantly have your urine tested.

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Pyelonephritis in children is one of the common diseases. In younger children, this pathology and ARVI are very closely related. Approximately every fourth case of this disease occurs due to acute respiratory infections. Rapidly spreading through the urinary tract, the current process of inflammation affects the kidney tissue.

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

Causes of pathology

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

The main causes of the disease are:

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

Forms of this disease

Kidney disease specialists distinguish two forms of pyelonephritis: acute and chronic.

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

Chronic pyelonephritis. This form lasts approximately six months, during which time there is a possibility of other exacerbations. Periodically, a deviation from the norm is detected in urine tests in a child. Also, the current disease helps provoke symptoms of bacterial asthenia in the patient. The child experiences irritability, fatigue, and learning delays. This form of the disease, which manifests itself in childhood, slows down physical and psychomotor development.

Symptoms of pyelonephritis

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

1. Increased body temperature, fever is common feature for all cases of pathology. Sometimes the temperature rises for no reason to 38-39 degrees.
2. There may be loss of appetite, drowsiness, and the child may complain of weakness and frequent headaches.
3. Nausea, vomiting, and muted pain in the abdomen and side are noted.
4. Blue circles are noticed under the eyes, the skin turns pale.
5. The child experiences obvious discomfort when urinating, as he feels a burning sensation and pain.
6. The urination pattern is disrupted: it becomes rare, perhaps more frequent, although fluid is consumed in sufficient quantities. In some cases, urinary incontinence occurs.
7. In infants, the course of pyelonephritis is characterized by a slight increase in weight.
8. The smell of urine becomes quite pungent and the color changes from yellow to bright orange.

Pyelonephritis is especially difficult in newborns and infants, since they cannot complain of disturbing pain, which makes it difficult to diagnose the disease; it is characterized by a nonspecific clinical picture and general symptoms of intoxication. Clear signs pyelonephritis is an increase in body temperature to 39-40 degrees, convulsions, vomiting, regurgitation are possible, the baby refuses the breast. Pale and marbled skin tone. Lips turn a little blue. An unhealthy child experiences insufficient weight gain or loss, and in some cases, weight loss. The child cries often and is constantly restless.

Parents need to remember that any ailments of their children should be examined by a specialist doctor. Abnormal bowel movements, fever, and vomiting may be misdiagnosed as waking up. intestinal infections. To clarify the diagnosis of pyelonephritis, the doctor prescribes necessary tests. A general urine test is prescribed for children with elevated temperature. In this disease, the content of leukocytes in the urine increases noticeably, bacteria and protein levels are detected. Laboratory examination methods are designed to detect pathogens of the disease in order to select appropriate treatment methods.

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

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

A child being treated in a hospital needs to have his blood pressure measured every day. Special attention attention should be paid to changes in blood pressure in a patient with a chronic form of the disease. Often such a case indicates additional renal failure. Pathogenic bacteria can only be combated with the help of antibacterial drugs.

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

Treatment method using medicinal herbs

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

The most effective diuretics medicinal herbs, from which you can prepare decoctions: lingonberries, corn silk, birch leaves, aspen leaves, flax seeds, elderberry. To treat this pathology, it is necessary to use diuretics, antibacterial, anti-inflammatory herbs to remove microorganisms and viruses from the body, which increase during stagnation of urine. Herbal treatment helps to normalize physical and mental health.

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

To do this, the following conditions must be met:

• Parents need to observe basic hygiene rules and teach their children to follow them.
• It is necessary to maintain a drinking regime.
• It is necessary to ensure that the child drinks enough and constantly empties the bladder.
• Influenza, sore throat and others should be treated immediately inflammatory diseases which cause kidney complications.
• Children with pyelonephritis should be seen by a dentist, and if caries is present, it should be treated immediately.
• We need to fight chronic diseases, such as: diabetes, inflammation of the gallbladder and others.
• If the doctor insists on removing tonsils or adenoids, because of their chronic inflammation and the possibility of a risk of exacerbation of pyelonephritis, it is worth listening to the advice of a specialist and agreeing on surgical intervention.
• You should not forget to constantly boost your immune system and maintain a sleep and rest schedule.
• Parents need to teach their child proper nutrition, introduce natural products, juices, cottage cheese and other fermented milk products, exclude hot and spicy foods.
• Shown spa treatments and prevention.
• It is necessary to protect the child from drafts and hypothermia.
• Strengthen children all year round.

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

Video

Pyelonephritis is a nonspecific infectious and inflammatory disease of the kidneys with predominant damage to the pyelocaliceal system (PSS), tubules and interstitium. According to the classification of the World Health Organization (WHO), pyelonephritis belongs to the group of tubulointerstitial nephritis and is actually tubulointerstitial nephritis of infectious origin.

Today, the question of the primary and secondary nature of pyelonephritis, especially chronic, as well as the role of urinary tract obstruction in the development of certain variants remains relevant. These signs form the basis for the classification of pyelonephritis.

There is no generally accepted classification of pyelonephritis today. The most commonly used classification is that proposed by M. Ya. Studenikin and co-authors in 1980 ( ), determining the form (primary, secondary), nature of the course (acute, chronic), disease activity and kidney function. V. G. Maydannik and co-authors (2002) proposed also indicating the stage of the pyelonephritic process (infiltrative, sclerotic) and the degree of disease activity.

Primary is called pyelonephritis, in which during the examination it is not possible to identify any factors that contribute to the fixation of microorganisms in the kidney tissue, i.e. when the microbial inflammatory process develops initially healthy organ. Secondary pyelonephritis is caused by specific factors.

In turn, secondary pyelonephritis is divided into obstructive and non-obstructive. Secondary obstructive develops against the background of organic (congenital, hereditary and acquired) or functional disorders of urodynamics; secondary non-obstructive - against the background of dysmetabolic disorders (secondary dysmetabolic pyelonephritis), hemodynamic disorders, immunodeficiency states, endocrine disorders, etc.

The concept of primary or secondary disease undergoes significant changes over time. Clinical and experimental data convincingly indicate that without a preliminary disturbance of urodynamics, the pyelonephritic process practically does not develop. Obstruction of the urinary tract implies not only the presence of a mechanical obstruction to the flow of urine, but also functional disorders activities such as hyper- or hypokinesia, dystonia. From this point of view, primary pyelonephritis no longer implies any lack of disturbance in the passage of urine, since dynamic changes in urination are not excluded.

Primary pyelonephritis is quite rare - no more than 10% of all cases, and its share in the structure of the disease decreases as methods for examining the patient improve.

It is also very conditional to classify secondary dismetabolic pyelonephritis as a non-obstructive group, since with this option the phenomena of obstruction of the renal tubules and collecting ducts by salt crystals are always observed.

Acute and chronic pyelonephritis are distinguished depending on the duration pathological process and features clinical manifestations.

Acute or cyclic course of pyelonephritis is characterized by the transition of the active stage of the disease (fever, leukocyturia, bacteriuria) into a period of reverse development of symptoms with the development of complete clinical and laboratory remission with a duration of the inflammatory process in the kidneys of less than 6 months. The chronic course of pyelonephritis is characterized by the persistence of symptoms of the disease for more than 6 months from its onset or the presence of at least two relapses during this period and, as a rule, is observed with secondary pyelonephritis. According to the nature of the course, latent or recurrent chronic pyelonephritis is distinguished. The recurrent course is characterized by periods of exacerbation, occurring with the clinical picture of acute pyelonephritis (urinary and pain syndromes, symptoms of general intoxication), and remissions. The latent course of the chronic form is characterized only by urinary syndrome varying degrees expressiveness.

As the experience accumulated in the Nephrology Department of the Russian Children's Clinical Hospital shows, chronic pyelonephritis is always secondary and develops most often as an obstructive-dysmetabolic type against the background of dismetabolic nephropathy, neurogenic bladder dysfunction, obstructive uropathy, etc. Among 128 patients with chronic pyelonephritis that we observed during 2004 g., in 60 (46.9%) the disease developed against the background of dysmetabolic nephropathy, in 40 (31.2%) - against the background of neurogenic bladder dysfunction, in 28 (21.9%) - against the background of obstructive uropathies (vesi- ureteral reflux, hydronephrosis, hypoplasia and aplasia of the kidney, horseshoe kidney, lumbar dystopia of the kidney, etc.).

Depending on the severity of the signs of the disease, one can distinguish the active stage of chronic pyelonephritis, partial clinical and laboratory remission and complete clinical and laboratory remission.

The activity of chronic pyelonephritis is determined by a combination of clinical symptoms and changes in urine and blood tests.

Clinical symptoms include:

• fever, chills;
• pain syndrome;
• dysuric phenomena (when combined with cystitis).

Urinalysis indicators are as follows:

• bacteriuria >100,000 microbial bodies in 1 ml;
• leukocyturia > 4000 in urine analysis according to Nechiporenko.

Blood test indicators:

• leukocytosis with rod-nuclear shift;
• anemia;
• increased erythrocyte sedimentation rate (ESR).

Partial clinical and laboratory remission is characterized by the absence of clinical manifestations with persistent urinary syndrome. At the stage of complete clinical and laboratory remission, neither clinical nor laboratory signs of the disease are detected.

With exacerbation of recurrent pyelonephritis, an acute clinical form is observed, although general clinical symptoms are usually less pronounced. During periods of remission, the disease often does not manifest itself at all or only urinary syndrome occurs.

Often, in the chronic form, infectious asthenia is expressed in children: irritability, fast fatiguability, poor performance at school, etc.

Leukocyturia in pyelonephritis is neutrophilic in nature (more than 50% neutrophils). Proteinuria, if present, is insignificant, less than 1 g/l, and correlates with the severity of leukocyturia. Often, children with pyelonephritis have erythrocyturia, usually single unchanged red blood cells.

In the chronic dismetabolic variant, crystalluria is detected in a general urinalysis, and in a biochemical urine analysis - elevated levels oxalates, phosphates, urates, cystine, etc., in a urine test for the anti-crystal-forming ability of urine - a decrease in the ability to dissolve the corresponding salts, positive tests for calcification and the presence of peroxides.

Diagnosis of chronic pyelonephritis is based on the protracted course of the disease (more than 6 months), repeated exacerbations, identification of signs of damage to the tubulointerstitium and CLS due to bacterial infection.

In any course of the disease, the patient must carry out a full range of studies aimed at establishing the activity of the microbial inflammatory process, the functional state of the kidneys, the presence of signs of obstruction and metabolic disorders, and the state of the renal parenchyma. We offer the following set of studies for chronic pyelonephritis, which allows us to obtain answers to the questions posed.

1. Research to identify the activity of the microbial inflammatory process.

• Clinical blood test.
• Biochemical blood test (total protein, protein fractions, urea, fibrinogen, C-reactive protein (CRP)).
• General urine analysis.
• Quantitative urine tests (according to Nechiporenko, Amburge, Addis-Kakovsky).
• Morphology of urine sediment.
• Urine culture for flora with quantitative assessment of the degree of bacteriuria.
• Urine antibioticogram.
• Biochemical examination of urine (daily excretion of protein, oxalates, urates, cystine, calcium salts, indicators of membrane instability - peroxides, lipids, anti-crystal-forming ability of urine).

• Urine examination for chlamydia, mycoplasma, ureaplasma (polymerase chain reaction, cultural, cytological, serological methods), fungi, viruses, mycobacterium tuberculosis (urine culture, express diagnostics).
• Study of immunological status (secretory immunoglobulin A (sIgA), state of phagocytosis).

2. Studies to assess the functional state of the kidneys and tubular apparatus.

Mandatory laboratory tests:

• Level of creatinine, urea in the blood.
• Zimnitsky's test.
• Clearance of endogenous creatinine.
• Study of pH, titratable acidity, ammonia excretion.
• Diuresis control.
• Rhythm and volume of spontaneous urination.

Additional laboratory tests:

• Urinary excretion of β 2 -microglobulin (mg).
• Urine osmolarity.
• Urine enzymes.
• Ammonium chloride test.
• Zimnitsky test with dry food.

3. Instrumental research.

Required:

• Blood pressure measurement.
• Ultrasonography(ultrasound) of the urinary system.
• X-ray contrast studies (void cystography, excretory urography).
• Functional methods for studying the bladder (uroflowmetry, cystometry, profilometry).

Additional:

• Doppler ultrasound of renal blood flow.
• Excretory urography with furosemide test.
• Cystourethroscopy.
• Radionuclide studies (scintigraphy).
• Electroencephalography.
• Echoencephalography.
• CT scan
• Nuclear magnetic resonance.

Thus, the diagnosis of pyelonephritis in children is established based on a combination of the following criteria.

• Symptoms of intoxication.
• Pain syndrome.
• Changes in urinary sediment: leukocyturia of the neutrophilic type (more than 50% neutrophils), bacteriuria (more than 100 thousand microbial bodies in 1 ml of urine), proteinuria (less than 1 g/l of protein).
• Violation of the functional state of the kidneys of the tubulointerstitial type: decrease in urine osmolarity less than 800 mOsmol/l with blood osmolarity less than 275 mOsmol/l, decrease relative density urine and indicators of acido- and amoniogenesis, an increase in the level of β 2 -microglobulin in the blood plasma more than 2.5 mg/l and in the urine - above 0.2 mg/l.
• Asymmetry of contrasting of the maxillary joint, coarsening and deformation of the arches of the cups, pyelectasis.
• Lengthening of the secretory and excretory segments of renograms, their asymmetry.

Additional criteria may include:

• Increased ESR (more than 15 mm/h).
• Leukocytosis (more than 9Ё109/l) with a shift to the left.
• Increased titers of antibacterial antibodies (1:160 or more), disimmunoglobulinemia, increased number of circulating immune complexes.
• Increased levels of CRP (above 20 mcg/ml), hyper-γ- and hyper-α 2 -globulinemia.

Complications of pyelonephritis are associated with the development of purulent processes and progressive dysfunction of the tubules, leading to the development of chronic renal failure in chronic pyelonephritis.

Complications of pyelonephritis:

• nephrogenic arterial hypertension;
• hydronephrotic transformation;
• pyelonephritic wrinkled kidney, uremia;
• purulent complications (apostematous nephritis, abscesses, paranephritis, urosepsis);
• bacteremic shock.

Pyelonephritis must be differentiated from chronic cystitis, interstitial nephritis, acute glomerulonephritis with isolated urinary syndrome, chronic glomerulonephritis, kidney tuberculosis, etc. Often in pediatric practice, pyelonephritis is diagnosed as an “acute abdomen”, intestinal and respiratory infections, pneumonia, sepsis.

Treatment of pyelonephritis

Treatment of pyelonephritis involves not only antibacterial, pathogenetic and symptomatic therapy, but also the organization of the correct regimen and nutrition of the sick child.

The issue of hospitalization is decided depending on the severity of the child’s condition, the risk of complications and the social conditions of the family. In the active stage of the disease in the presence of fever and pain syndrome Bed rest is prescribed for 5-7 days.

Dietary restrictions are aimed at reducing the load on the tubular transport systems and correcting metabolic disorders. In the active stage, table No. 5 according to Pevzner is used without salt restriction, but with an increased drinking regime, 50% more age norm. The amount of salt and liquid is limited only if kidney function is impaired. It is recommended to alternate protein and plant foods. Products containing extractives and essential oils, fried, spicy, fatty foods. Detected metabolic disorders require special corrective diets.

basis drug treatment pyelonephritis is antibacterial therapy, which is based on the following principles:

• Before starting treatment, urine culture is necessary ( later treatment change based on the results of sowing);
• exclude and, if possible, eliminate factors contributing to infection;
• improvement of the condition does not mean the disappearance of bacteriuria;
• treatment results are regarded as failure if there is no improvement and/or persistence of bacteriuria;
• primary lower urinary tract infections usually respond to short courses of antimicrobial therapy; upper urinary tract - require long-term therapy;
• early relapses (up to 2 weeks) represent a recurrent infection and are caused either by the survival of the pathogen in the upper urinary tract or by ongoing seeding from the intestine. Late relapses are almost always re-infection;
• pathogens of community-acquired urinary tract infections are usually sensitive to antibiotics;
• frequent relapses, instrumental interventions on the urinary tract, recent hospitalization make one suspect an infection caused by resistant pathogens.

Therapy for pyelonephritis includes several stages: 1) suppression of the active microbial inflammatory process using an etiological approach; 2) pathogenetic treatment against the background of subsiding of the process using antioxidant protection and immunocorrection; 3) anti-relapse treatment. Therapy for acute pyelonephritis, as a rule, is limited to the first two stages; for chronic pyelonephritis, all three stages of treatment are necessary.

The stage of suppressing the activity of the microbial inflammatory process. Conditionally this stage can be divided into two periods.

The first is aimed at eliminating the pathogen before obtaining the results of urine culture and includes the appointment of initial (empirical) antibacterial therapy, diuretic therapy (for non-obstructive variants), infusion-corrective therapy for severe syndrome endogenous intoxication and hemodynamic disorders.

The second (etiotropic) period consists of correcting antibacterial therapy taking into account the results of urine culture and determining the sensitivity of the microorganism to antibiotics.

When choosing antibacterial drugs, it is necessary to consider that:

The duration of antibacterial therapy should be optimal, ensuring complete suppression of pathogen activity. Thus, its duration is usually about 4 weeks in the hospital with a change of antibiotic every 7-10 days (or replacement with a uroseptic).

Initial antibiotic therapy is prescribed empirically, based on the most likely causative agents of infection. If there is no clinical and laboratory effect, the antibiotic must be changed after 2-3 days.

In case of manifest severe and moderate pyelonephritis, drugs are administered mainly parenterally (intravenously or intramuscularly) in a hospital setting.

We list some antibiotics used in the initial treatment of pyelonephritis:

• semisynthetic penicillins in combination with β-lactomase inhibitors - amoxicillin and clavulanic acid: augmentin - 25-50 mg/kg/day, orally - 10-14 days; amoxiclav - 20-40 mc/kg/day, orally - 10-14 days;
• 2nd generation cephalosporins: cefuroxime (zinacef, ketocef, cefurabol), cefamandol (mandol, cefamabol) - 80-160 mg/kg/day, intravenously, intramuscularly - 4 times a day - 7-10 days;
• 3rd generation cephalosporins: cefotaxime (claforan, clafobrine), ceftazidime (Fortum, Vicef), ceftizoxime (epocelin) - 75-200 mg/kg/day, intravenously, intramuscularly - 3-4 times a day - 7-10 days; cefoperazone (cephobid, cefoperabol), ceftriaxone (rocephin, ceftriabol) - 50-100 mg/kg/day, intravenously, intramuscularly - 2 times a day - 7-10 days;
• aminoglycosides: gentamicin (gentamicin sulfate) - 3.0-7.5 mg/kg/day, intravenously, intramuscularly - 3 times a day - 5-7 days; amikacin (amicin, lykacin) - 15-30 mg/kg/day, intravenously, intramuscularly - 2 times a day - 5-7 days.

During the period of subsiding activity, antibacterial drugs are administered mainly orally, while “step therapy” is possible, when the same drug is given orally as was administered parenterally, or a drug of the same group. The most commonly used during this period are:

• semisynthetic penicillins in combination with β-lactomase inhibitors: amoxicillin and clavulanic acid (Augmentin, amoxiclav);
• 2nd generation cephalosporins: cefaclor (Ceclor, Vercef) - 20-40 mg/kg/day;
• 3rd generation cephalosporins: ceftibuten (cedex) - 9 mg/kg/day, once;
• nitrofuran derivatives: nitrofurantoin (furadonin) - 5-7 mg/kg/day;
• quinolone derivatives (non-fluorinated): nalidixic acid (negram, nevigramon) - 60 mg/kg/day; pipemidic acid (palin, pimidel) - 0.4-0.8 g/day; nitroxoline (5-NOK, 5-nitrox) - 10 mg/kg/day;
• sulfamethoxazole and trimethoprim (cotrimoxazole, biseptol) - 4-6 mg/kg/day for trimethoprim.

In case of severe septic flow, microbial associations, multiresistance of microflora to antibiotics, when affecting intracellular microorganisms, as well as to expand the spectrum of antimicrobial action in the absence of culture results, combination antibacterial therapy is used. In this case, bactericidal antibiotics are combined with bactericidal, bacteriostatic with bacteriostatic antibiotics. Some antibiotics are bactericidal against some microorganisms and bacteriostatic against others.

Bactericidal drugs include: penicillins, cephalosporins, aminoglycosides, polymyxins, etc.

Bacteriostatic drugs include: macrolides, tetracyclines, chloramphenicol, lincomycin, etc.

Potentiate the action of each other (synergists): penicillins and aminoglycosides; cephalosporins and penicillins; cephalosporins and aminoglycosides.

Antagonists are: penicillins and chloramphenicol; penicillins and tetracyclines; macrolides and chloramphenicol.

From the point of view of nephrotoxicity, erythromycin, drugs of the penicillin group and cephalosporins are non-toxic or low-toxic; moderately toxic - gentamicin, tetracycline, etc.; Kanamycin, monomycin, polymyxin, etc. have pronounced nephrotoxicity.

Risk factors for nephrotoxicity of aminoglycosides are: duration of use for more than 11 days, maximum concentration above 10 mcg/ml, combination with cephalosporins, liver disease, high creatinine levels.

After a course of antibiotic therapy, treatment should be continued with uroantiseptics.

Nalidixic acid preparations (nevigramon, negram) are prescribed to children over 2 years of age. These agents are bacteriostatics or bactericides, depending on the dose, against gram-negative flora. They should not be prescribed simultaneously with nitrofurans, which have an antagonistic effect. The course of treatment is 7-10 days.

Gramurin, a derivative of oxolinic acid, has wide range effects on gram-negative and gram-positive microorganisms. It is used in children aged 2 years and over for a course of 7-10 days.

Pipemidic acid (palin, pimidel) has an effect on most gram-negative bacteria and staphylococci. It is prescribed in a short course (3-7 days).

Nitroxoline (5-NOK) and nitrofurans are drugs with broad bactericidal action.

The reserve drug is ofloxacin (Tarivid, Zanocin). It has a wide spectrum of action, including on intracellular flora. It is prescribed to children only if other uroseptics are ineffective.

The use of biseptol is possible only as an anti-relapse agent in the latent course of pyelonephritis and in the absence of obstruction in the urinary tract.

In the first days of the disease, against the background of increased water load, fast-acting diuretics (furosemide, veroshpiron) are used, which increase renal blood flow, ensure the elimination of microorganisms and inflammatory products and reduce swelling of the interstitial tissue of the kidneys. The composition and volume of infusion therapy depend on the severity of the intoxication syndrome, the patient's condition, hemostasis, diuresis and other kidney functions.

The stage of pathogenetic therapy begins when the microbial inflammatory process subsides against the background of antibacterial drugs. On average, this occurs on the 5-7th day from the onset of the disease. Pathogenetic therapy includes anti-inflammatory, antioxidant, immunocorrective and anti-sclerotic therapy.

A combination with anti-inflammatory drugs is used to suppress inflammatory activity and enhance the effect of antibacterial therapy. It is recommended to take non-steroidal anti-inflammatory drugs - ortofen, voltaren, surgam. The course of treatment is 10-14 days. The use of indomethacin in pediatric practice is not recommended due to a possible deterioration in the blood supply to the kidneys, decreased glomerular filtration, water and electrolyte retention, and necrosis of the renal papillae.

Desensitizing agents (tavegil, suprastin, claritin, etc.) are prescribed for acute or chronic pyelonephritis in order to relieve the allergic component infectious process, as well as with the development of sensitization of the patient to bacterial antigens.

The complex therapy for pyelonephritis includes drugs with antioxidant and antiradical activity: tocopherol acetate (1-2 mg/kg/day for 4 weeks), unithiol (0.1 mg/kg/day intramuscularly once, for 7-10 days), b-carotene (1 drop per year of life, 1 time per day for 4 weeks), etc. Among the drugs that improve kidney microcirculation, trental, cinnarizine, and aminophylline are prescribed.

Immunocorrective therapy for pyelonephritis is prescribed strictly according to indications:

• infancy;
• severe variants of kidney damage (purulent lesions; aggravated by multiple organ failure syndrome; obstructive pyelonephritis against the background of reflux, hydronephrosis, megaureter, etc.);
• long-term (more than 1 month) or recurrent course;
• intolerance to antibiotics;
• features of the microflora (mixed flora; flora multiresistant to antibiotics; unusual nature of the flora - Proteus, Pseudomonas, Enterobacter, etc.).

The prescription of immunocorrective therapy is made only after agreement with an immunologist and should include immunological monitoring, relative “selectivity” of the prescription, a short or intermittent course and strict adherence to the dosage and regimen of drug administration.

Immunal, sodium nucleate, t-activin, levamisole hydrochloride, lycopid, immunofan, reaferon, leukinferon, viferon, cycloferon, myelopid, lysozyme are used as immunotropic agents for pyelonephritis and urinary tract infections in children.

If patients have signs of sclerosis of the renal parenchyma, it is necessary to include in the treatment complex drugs with an anti-sclerotic effect (delagil) for a course of 4-6 weeks.

During the period of remission, a necessary continuation of treatment is herbal medicine (collections of St. John's wort, lingonberry leaves, nettles, corn silk, bearberry, rose hips, birch buds, yarrow, sage, chamomile in combinations).

Anti-relapse therapy for pyelonephritis involves long-term treatment antibacterial drugs in small doses and is carried out, as a rule, in an outpatient setting.

For this purpose, use: biseptol at the rate of 2 mg/kg for trimethoprim and 10 mg/kg for sulfamethoxazole 1 time per day for 4 weeks (use with caution in case of obstructive pyelonephritis); furagin at a rate of 6-8 mg/kg for 2 weeks, then at normal tests urine transition to 1/2-1/3 dose for 4-8 weeks; prescribing one of the drugs pipemidic acid, nalidixic acid or 8-hydroxyquinoline every month for 10 days in usual dosages for 3-4 months.

For the treatment of frequently recurrent pyelonephritis, a “duplicate” regimen can be used: nitroxoline at a dose of 2 mg/kg in the morning and biseptol at a dose of 2-10 mg/kg in the evening.

At any stage of treatment of secondary pyelonephritis, it is necessary to take into account its nature and the functional state of the kidneys. Treatment of obstructive pyelonephritis should be carried out jointly with a urologist and pediatric surgeon. In this case, the decision to prescribe diuretics and increase the water load should be made taking into account the nature of the obstruction. The issue of surgical treatment must be resolved in a timely manner, since in the presence of obstruction of urine flow at any level of the urinary system, the prerequisites for the development of relapse of the disease remain.

The treatment of dysmetabolic pyelonephritis should include an appropriate dietary regimen and pharmacological treatment.

With the development of renal failure, it is necessary to adjust the doses of medications in accordance with the degree of decrease in glomerular filtration.

Dynamic observation of children suffering from pyelonephritis suggests the following.

• Frequency of examination by a nephrologist: during exacerbation - once every 10 days; during remission during treatment - once a month; remission after completion of treatment for the first 3 years - once every 3 months; remission in subsequent years until the age of 15 years - 1-2 times a year, then observation is transferred to therapists.
• Clinical and laboratory tests: general urine analysis - at least once every 1 month and against the background of acute respiratory viral infections; biochemical urine analysis - once every 3-6 months; Ultrasound of the kidneys - once every 6 months. According to indications - cystoscopy, cystography and intravenous urography.

Removal from the dispensary register of a child who has suffered acute pyelonephritis is possible if clinical and laboratory remission is maintained without therapeutic measures (antibiotics and uroseptics) for more than 5 years after a full clinical and laboratory examination. Patients with chronic pyelonephritis are observed before transfer to the adult network.

Literature

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A. V. Malkoch, Candidate of Medical Sciences
V. A. Gavrilova, Doctor of Medical Sciences
Yu. B. Yurasova, Candidate of Medical Sciences
RGMU, RDKB, Moscow