How to cure chronic pyelonephritis in a child. Acute pyelonephritis: one of the biggest childhood troubles. What is pyelonephritis

– nonspecific microbial-inflammatory damage to the renal parenchyma and pyelocaliceal system. Pyelonephritis in children occurs with pain syndrome in lumbar region, dysuric disorders (frequent urge to urinate, pain, urinary incontinence), increased body temperature, intoxication. Diagnosis of pyelonephritis in children includes blood tests (clinical, biochemical analysis) and urine (general analysis, culture), ultrasound of the urinary system, urodynamic assessment, intravenous urography, etc. In the treatment of pyelonephritis in children, antibacterial, anti-inflammatory, antioxidant therapy, and herbal medicine are used.

General information

Pyelonephritis in children – inflammatory process, involving the pyelocaliceal system, tubules and interstitium of the kidneys. In terms of prevalence, pyelonephritis ranks second after ARVI in children, and there is a close relationship between these diseases. Thus, in pediatric urology, every 4th case of pyelonephritis in a young child is a complication of acute respiratory infection. The largest number of cases of pyelonephritis in children is registered in preschool age. Acute pyelonephritis is diagnosed 3 times more often in girls, which is due to the peculiarity female anatomy lower sections urinary tract(wider and shorter urethra).

Causes of pyelonephritis in children

The most common etiological agent causing pyelonephritis in children is Escherichia coli; Also, bacteriological culture of urine reveals Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, enterococci, intracellular microorganisms (mycoplasma, chlamydia), etc.

Infectious agents can enter the kidneys by hematogenous, lymphogenous, or urinogenic (ascending) routes. Hematogenous introduction of pathogens most often occurs in children of the first year of life (with purulent omphalitis in newborns, pneumonia, tonsillitis, pustular skin diseases, etc.). In older children, ascending infection predominates (with dysbacteriosis, colitis, intestinal infections, vulvitis, vulvovaginitis, balanoposthitis, cystitis, etc.). A major role in the development of pyelonephritis in children is played by incorrect or insufficient hygiene care for the child.

Conditions predisposing to the occurrence of pyelonephritis in children may include structural or functional abnormalities that interfere with the passage of urine: congenital kidney malformations, vesicoureteral reflux, neurogenic bladder, urolithiasis. Children with malnutrition, rickets, and hypervitaminosis D are more at risk of developing pyelonephritis; fermentopathy, dismetabolic nephropathy, helminthic infestations, etc. Manifestation or exacerbation of pyelonephritis in children, as a rule, occurs after intercurrent infections (ARVI, chickenpox, measles, scarlet fever, mumps, etc.), causing a decrease in the overall resistance of the body.

Classification

Diagnostics

If pyelonephritis in a child is first identified by a pediatrician, a mandatory consultation with a pediatric nephrologist or pediatric urologist is necessary. Complex laboratory diagnostics for pyelonephritis in children includes a clinical blood test, biochemical analysis blood (urea, total protein, protein fractions, fibrinogen, CRP), general urine analysis, urine pH, quantitative samples (according to Nechiporenko, Addis-Kakovsky, Amburge, Zimnitsky), urine culture for flora with an antibiogram, biochemical urine analysis. If necessary, studies are carried out to identify infectious agents PCR methods, ELISA. It is important to assess the rhythm and volume of spontaneous urination and control diuresis for pyelonephritis in children.

Mandatory instrumental examination for children with pyelonephritis, it involves ultrasound of the kidneys (ultrasound of the bladder if necessary), ultrasound of renal blood flow. To exclude obstructive uropathies, which are often the cause of pyelonephritis in children, it may be necessary to perform excretory urography, urodynamic studies, dynamic renal scintigraphy, renal angiography, CT scan of the kidneys and other additional studies.

Differential diagnosis of pyelonephritis in children must be carried out with glomerulonephritis, appendicitis, cystitis, adnexitis, and therefore children may need to consult a pediatric surgeon or pediatric gynecologist; conducting a rectal examination, ultrasound of the pelvic organs.

Treatment of pyelonephritis in children

Complex therapy of pyelonephritis involves drug therapy, organization of proper drinking regime and nutrition for children.

In the acute period, bed rest, a plant-protein diet, and an increase in water load by 50% compared to the age norm are prescribed. The basis for the treatment of pyelonephritis in children is antibiotic therapy, for which cephalosporins (cefuroxime, cefotaxime, cefpirome, etc.), β-lactams (amoxicillin), and aminoglycosides (gentamicin, amikacin) are used. After completing the antibacterial course, uroantiseptics are prescribed: derivatives of nitrofuran (nitrofurantoin) and quinoline (nalidixic acid).

To enhance renal blood flow and eliminate inflammatory products and microorganisms, fast-acting diuretics (furosemide, spironolactone) are indicated. For pyelonephritis, children are recommended to take NSAIDs, antihistamines, antioxidants, immunocorrectors.

Duration of treatment for acute pyelonephritis in children (or exacerbation chronic process) - 1-3 months. The criterion for eliminating inflammation is the normalization of clinical and laboratory parameters. Outside of exacerbation of pyelonephritis in children, herbal medicine with antiseptic and diuretic preparations, taking alkaline mineral water, massage, exercise therapy, sanatorium treatment.

Prognosis and prevention

Acute pyelonephritis in children ends with complete recovery in 80% of cases. Complications and deaths possible in rare cases, mainly in weakened children with concomitant pathologies. The outcome of chronic pyelonephritis in 67-75% of children is progression pathological process in the kidneys, an increase in nephrosclerotic changes, the development of chronic renal failure. Children who have suffered acute pyelonephritis are observed by a nephrologist for 3 years with monthly monitoring of a general urine test. Examinations by a pediatric otolaryngologist and dentist are required once every 6 months.

Prevention of pyelonephritis in children is associated with compliance with hygiene measures, prevention of dysbacteriosis and acute intestinal infections, elimination of chronic inflammatory foci and strengthening the body's resistance. The timing of preventive vaccination is determined individually. After any infection in children, it is necessary to conduct a urine test. To prevent the development of chronic pyelonephritis in children, acute urinary infections should be adequately treated.

Symptoms of pyelonephritis in children are often absent or erased, and only a doctor can make a diagnosis in this situation. But parents should still know the characteristic signs of manifestation of this disease in your child to quickly identify the pathology and prescribe adequate treatment.

What is pyelonephritis

Pyelonephritis is a common disease in children. This is an infectious-inflammatory process and it affects the pelvis system of the kidneys and their tubules.

This disease manifests itself starting from a very early age of the child. Doctors put it in second place after acute respiratory infections. But not all parents suspect the close relationship between these two, at first glance, unrelated diseases.

In most cases, this disease occurs specifically in schoolchildren; in rare cases, it can be diagnosed in infants and preschool children.

Usmanov Sh.S., doctor highest category, urologist, candidate medical sciences, Medical On Group clinic, Kazan

Symptoms of pyelonephritis in children 3 years old may be similar to other diseases.

Kidney pyelonephritis in children often manifests itself after a severe illness the day before. respiratory disease which can cause serious complications.

Medical specialists note that girls in most cases are prone to this pathology. This is due to the characteristic structural features of the female body.

Causes

Inflammatory processes infectious nature in the kidneys can be caused by bacteria, viruses or fungal infections.

The cause of pyelonephritis can be, for example, a disease such as.

The main pathogen is E. coli, viruses and bacteria. However, with the chronic degree of the disease, several such pathogens are found in the human body.

Ways and reasons for pathogens entering the kidneys:

The hematogenous route is the entry of the pathogen to the lesion (kidneys) through the blood. In most cases, this is observed in infants who have recently suffered from pneumonia or otitis media. In schoolchildren, infection is hematogenous and occurs as a result of sepsis.
Lymphogenous infection occurs as a result of infection from the intestine to the urinary organs. This infection is observed in those who suffer from frequent digestive disorders, constipation or diarrhea. As a result, the functions of the intestinal mucosa are disrupted.
The most common route of infection is through the urethra. or genitals. In these cases, bacteria rise up and attack the kidneys. However this problem It is common among girls.

Forms of the disease

In medical practice, two types of inflammatory process in the kidneys are distinguished, namely, acute and chronic forms of the disease.

One of the signs of pyelonephritis in children is an increase in body temperature

Chronic pyelonephritis, the symptoms of which appear for 6 or more months, are recurrent or latent in the course of the disease.

With a recurrent form, the temperature rises, urination is impaired, weakness appears. In the latent form, there are no signs at all.

Acute pyelonephritis, the symptoms of which are manifested in acute pain and increased body temperature, is easier to determine than chronic.

Acute pyelonephritis in children, the treatment of which is characterized by rapid recovery, resolves after several months.

In addition to chronic and acute forms of diseases, pediatricians also distinguish between the primary and secondary degrees of the disease.

The primary form is caused by the onset of the inflammatory process in the kidneys, and the secondary form develops as a consequence of other types of diseases , at first glance, in no way related to the functioning of the kidneys.

Acute pyelonephritis: symptoms and signs

As mentioned earlier, the causes of the disease are often infectious and inflammatory processes, viruses and bacteria that penetrate the kidneys.

To get the disease out acute form has not become chronic, it is important for parents to recognize the symptoms of acute pyelonephritis in time and seek advice from a specialist in this field as soon as possible.

Let us note the main signs of acute pyelonephritis in children, namely, symptoms of pyelonephritis in children 2 years of age and older:

Increased body temperature or chills when the thermometer shows above 38 degrees.
Intoxication – nausea, less often, darkening of the eyes, dizziness or fainting, drowsiness and lack of appetite.
Painful sensations. Children under 3 years of age who do not yet understand the symptoms of pain may complain of pain throughout the abdomen, less often in the area around the navel. A school-age teenager who is able to distinguish pain can feel it in the lumbar region, namely on one side - below.
One of the symptoms of pyelonephritis in children, which is less common, is.
Slight swelling of the face or limbs is possible, but only in the morning. Pronounced swelling indicates a different type of disease, since this disease is not characterized by severe swelling.
The color of the urine (darkens or becomes cloudy), and in rare cases, its odor increases.

Parents should know: the younger their child, the stronger his symptoms will be when the acute form manifests itself. Nausea, vomiting, severe pain and high fever are inevitable.

Chronic form

The symptoms of chronic pyelonephritis are not as pronounced as in the acute course of the disease. In most cases, they are characterized by fatigue, nausea and pale skin, so in this case it is very difficult to make a diagnosis.

Recurrent chronic form The disease manifests itself in the following symptoms:

pain in the back or abdomen;
disturbance in urination;
weakness;
increase in body temperature.

This is not typical for a latent type and, basically, the disease is always asymptomatic. Therefore, it is important for parents to monitor the health of their child and periodically conduct a comprehensive examination.

Only a general urine test will help identify the disease, which will show characteristic changes in the content of leukocytes and.

Safronov D.B., urologist, doctor of the highest category, Mother and Child Clinic, Perm

Pyelonephritis is insidious and often has no symptoms, which is why it is so important to preventive examinations. Delayed treatment of the disease has less effect.

Symptoms in children under one year of age

Infants cannot tell their parents about their pain and worries. That's why symptoms of pyelonephritis in infants manifest themselves in the form of anxiety, crying, often diarrhea, as a result, children under one year of age may be misdiagnosed when interpreting it.

In addition, symptoms of pyelonephritis in children under one year of age are observed in the form of:

body temperature reaching 39-40 degrees;
changes in skin color (pallor and dry skin);
frequent;
in rare cases of refusal breastfeeding, resulting in a decrease in body weight.

Signs of illness in infants can be confused with intestinal diseases , this manifests itself as indigestion (diarrhea)

Diagnostics

Often the disease is asymptomatic and therefore in this situation tests for pyelonephritis are very important, which can both confirm and refute this diagnosis.

When contacting a doctor to diagnose pyelonephritis, you must first report complaints, which include pain in the lateral area below the abdomen or lumbar region, fever, disorders in the urinary system.

When palpating the abdomen, the baby often experiences pain, however, an appropriate diagnosis can only be made after a complete laboratory test.

When diagnosing pyelonephritis, an ultrasound scan of the kidneys is required.

Diagnosis of chronic and acute pyelonephritis involves the following laboratory tests:

General urine analysis;
Urine according to Zimnitsky and urine according to Nechiporenko;
with pyelonephritis;
Renal angiography;
Kidney CT;
Ultrasonography;
Blood chemistry;
Urodynamic studies.

How to properly collect urine

Urine for pyelonephritis is one of the most important tests for medical history.

However, not all parents know how to correctly collect a portion for urine analysis for pyelonephritis.

A general urine test must be collected in the morning, having previously washed the baby so that microorganisms do not get into the container, then the first portion must be flushed down the toilet, and the middle portion must be collected in a special container.

Cumulative analyses, for example, such as according to Nechiporenko, are collected during the day, also in an average portion into a common container. You can find out how to collect a urine test according to Nechiporenko

A prerequisite for diagnosing pyelonephritis in a child is to submit urine for analysis and at the same time collect it correctly

Urine testing for sterility is carried out directly in the hospital.

Many parents of infants wonder: how to collect urine from someone who is still in diapers?

In pharmacies in last years Special containers have appeared with which you can easily collect the required portion.

Below is a table of normal indicators.

Indicators	1 day of life	1-12 months of life	1-6 years	7-12 years
Hemoglobin	180-240	115-135	110-140	110-145
Red blood cells	4,3-7,6	3,8-4,9	3,5-4,5	3,5-4,7
Color index	0,85-1,15	0,85-1,15	0,85-1,15	0,85-1,15
Platelets	180-490	180-400	160-390	160-380
ESR	2-4	4-10	4-12	4-12
Leukocytes	8,5-24,5	6-12	5-12	4-9
Eosinophils	0,5-6	0,5-7	0,5-7	0,5-7
Lymphocytes	12-36	40-72	26-60	25-55
Monocytes	2-12	2-12	2-10	2-10

Normal analysis parameters according to Nicheporenko:

Leukocytes up to 2000;
Red blood cells up to 1000;
Cylinders are normally no more than 20.

Treatment of pyelonephritis in children

Having examined the symptoms in the laboratory, treatment of pyelonephritis in children should be carried out in a hospital.

Firstly, when treating kidney pyelonephritis, the patient is prescribed bed rest for at least a week, or even more.

Treatment of pyelonephritis in children in the early stages is based on following a special diet, which excludes everything fried, salty, sour, carbonated drinks and teas.

With pyelonephritis, children should refrain from spicy, salty, fried foods

Afterwards, the sick baby is prescribed a comprehensive drug treatment and consists of taking anti-inflammatory, analgesic, diuretic medications and antibiotics.

The main drugs for treatment are: Tavirid, Urogram, Glamurin, Zanotsin, Canephron, in addition, they are prescribed antifungal drugs and vitamin complexes.

Treatment of pyelonephritis at home is carried out only after consulting a doctor. Traditional methods treatments can be auxiliary, and they should only be used in parallel with the main drug course of treatment, after consulting with your doctor.

Sokolov A.M., urologist, Miracle Doctor clinic, Moscow

Treatment of acute form in mandatory must be agreed with a doctor.

Parents should absolutely not self-medicate so as not to aggravate the situation, since this can cause the disease to take a chronic form, after which much more time will be required for treatment and rehabilitation.

Prevention measures

The main measures to prevent pyelonephritis in children are:

The best prevention of pyelonephritis is to protect your child from various types of infections, adherence to sleep, eating and drinking regimes

compliance with the drinking regime according to age;
timely emptying of the bladder and bowels;
treatment of inflammatory processes in other organs;
preventive examinations of the body.

This disease in the younger generation is often asymptomatic, so you should not postpone scheduled visits to your pediatrician.

And if symptoms of pyelonephritis do appear in children, then in this case parents should visit a specialist as soon as possible. As a result of laboratory research doctor with full confidence able to make an appropriate diagnosis.

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:

Kidney tissue can be affected by various pathogenic microorganisms; bacteriological culture of urine reveals: Escherichia 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.
Diseases suffered in childhood such as pneumonia or otitis may be the cause of this pathology.
Bacterial endocarditis or sepsis causes the symptoms of this disease to occur in adolescents; the pathogenic microorganism penetrates from the intestine to the kidney through the lymphatic system. This occurs with intestinal infections, diarrhea in a child suffering from chronic constipation and dysbacteriosis.
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 penetrate the urethra, but 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.
Foci of infections that remain in the body for a long time, hypothermia, worms, diabetes, quite often give rise to this insidious disease.
A disease of the genitourinary area, as well as poor hygiene, can provoke pyelonephritis.
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:

Increased body temperature, fever is common feature for all cases of pathology. Sometimes the temperature rises for no reason to 38-39 degrees.
There may be loss of appetite, drowsiness, and the child may complain of weakness and frequent headaches.
Nausea, vomiting, and muted pain in the abdomen and side are noted.
Are noticed blue circles under the eyes, the skin turns pale.
The child experiences obvious discomfort when urinating, as he feels a burning sensation and pain.
The urination pattern is disrupted: it becomes rare, perhaps more frequent, although fluid is consumed in sufficient quantities. In some cases, urinary incontinence occurs.
In infants, the course of pyelonephritis is characterized by a slight increase in weight.
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 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 fever. 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, great value They have ultrasound, X-ray examination methods, and angiography that help identify anatomical abnormalities that provoked the onset of the disease. This disease requires prompt and effective treatment. If, when an acute form is detected, the treatment course slows down, the infection will rapidly spread and lead to the development purulent processes. For long-term chronic form kidney function is impaired, chronic kidney disease may develop renal failure.

If an exacerbation of pyelonephritis is detected in children, treatment should be carried out exclusively in a hospital setting. 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 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 should be given attention to changes 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 for genitourinary system. Treatment lasts for one month. Along with antibacterial therapy for two weeks, the doctor prescribes antiseptic drugs for the urinary tract, destroying pathogenic bacteria, but not belonging to the group of antibiotics. IN initial stage During the course of treatment, antipyretic drugs and antispasmodics are used. Antioxidant therapy and various vitamins. 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 medicinal herbs, which 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 other inflammatory diseases that cause complications on the kidneys should be treated urgently.
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 foods, juices, cottage cheese and others into the diet. dairy 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 an infectious kidney disease that is quite common in people of any age. Treatment of pyelonephritis in children should take into account their age characteristics, differences in anatomy and the fact that children's body generally weaker than that of an adult. This disease manifests itself primarily by changes in the process of urination. The urine changes its color, pain occurs in the abdomen, body temperature rises, and the child experiences lethargy and weakness.

All these factors interfere with normal development and prevent regular visits. educational institutions. Therefore, if this disease occurs, each parent is obliged to immediately seek help. medical care to the doctor.

Pyelonephritis among children is the most common nephrotic disease. But in medical practice, cases of false diagnosis of this disease often occur, when symptoms and test results are interpreted incorrectly and pyelonephritis is confused with another infection of the genitourinary system, for example, cystitis or urethritis. To be able to correctly distinguish pyelonephritis in a child from another nephrotic disease, you need to know a number of its features, symptoms, nature of development, treatment, etc.

Tubulointerstitial infectious nephritis (pyelonephritis) is an inflammatory process that occurs in the pyelocaliceal system of the kidneys, their tubules and connective tissue. The cause of inflammation is an infection caused by the activity of a pathogenic bacterium.

The kidney tubules are tubes that carry urine through them. Urine first accumulates in the calyces and pelvis, and then enters the bladder. Connective (interstitial) tissue fills the empty space between other structural elements of the kidney and represents a kind of framework that gives the organ its normal shape.

Children of any age can get pyelonephritis. In the first years of life, infants of both sexes suffer from this disease in equal proportions, but a year after birth, the chance of developing pyelonephritis in girls becomes slightly higher. This is due to the peculiarities in the structure of the female urinary system.

Infectious damage to kidney tissue can occur due to the activity of protozoan microorganisms, bacteria or viruses. The leading cause of pyelonephritis in children is E. coli, followed by Proteus, Staphylococcus aureus and various viruses (adenovirus, influenza, Coxsackie virus). In patients with the chronic form of this pathology, an association of microbes is often found, when several different pathogenic microorganisms are actively developing in the body at the same time.

Methods of infection

The pathogen can enter the body of a child, as well as the body of an adult, in the following ways:

Through blood. Infectious agents can reach the kidneys through the vessels. Most often, newborns are infected in this way. In them, pyelonephritis can occur after pneumonia, otitis media and other similar pathologies. It does not matter how far from the kidneys the infectious focus is located. In older children and adults, this method of occurrence of the disease is observed less frequently, only in cases where a person is susceptible to an extremely severe form of an infectious disease.
Spread of the pathogen through lymphatic pathways. In this case, the disease occurs when a pathogenic organism enters the lymph circulation system between the organs responsible for urination and the intestines. IN healthy body lymph flows from the kidneys to the intestines without any consequences. But in the case when the intestinal mucosa is affected infectious disease(infection, dysbacteriosis, etc.), along with lymph, bacteria from the intestinal microflora can enter the kidneys.
Sometimes pathogenic microorganisms can ascend to the kidneys from the genitals, urinary tract or anus. This route of infection is most common among children over one year of age. This method of infection is especially common among girls.

Under normal conditions urinary tract have direct contact with the external environment. Such contact is unsterile, i.e. in any case there is a possibility of foreign microflora entering the body. But if a person is healthy, his urinary organs are working properly, and local and general immunity is functioning normally, then harmful bacteria will not be able to infect the body.

Favorable factors for the development of the disease

Infection with pyelonephritis is caused by preceding factors, depending both on the pathogenic microflora that has entered the body and on the microorganism itself, more precisely, on the person. Pathogens have different virulence, i.e. ability to infect, aggressiveness and resistance to exposure immune system. The higher these indicators are for a bacterium or virus, the infection is more likely them a child. And on the human side, favorable factors for the occurrence of pyelonephritis are:

Disturbances in the functioning of the urinary system. In case of any malfunction of the kidneys, in the presence of stones in the urine outflow tract, in case of crystalluria (when the kidney tubules are clogged with small salt crystals), etc.
Problems with urine flow associated with functional disorders Bladder.
The occurrence of vesicoureteral reflux. This anomaly is a process where urine from the bladder rises up and ends up back in the kidneys.
Ascending infection can be caused by a lack of personal hygiene, inflammatory processes in the external genitalia, or untreated cystitis or urethritis.
The development of any acute or chronic disease in a child, which reduces his immunity.
Diabetes.
Various chronic infectious diseases such as tonsillitis, sinusitis, etc.
Infection of a child with worms.
Hypothermia.
In children who are not yet a year old, the development of pyelonephritis can be triggered by the transition to artificial feeding, the use of complementary foods, teething or any other processes that can undermine the infant’s immune system.

There are 2 types of pyelonephritis among both children and adults. Thus, primary pyelonephritis is distinguished. It occurs as an independent disease, which is not preceded by any factors from the urinary system. On the other hand, there is also secondary pyelonephritis, the causes of which lie in an abnormality in the structure of the urinary organs or their functional failure. This disease is also called obstructive pyelonephritis. If the pathology is caused by a metabolic disorder, then in medical circles it is usually called non-obstructive pyelonephritis.

This disease can occur in both acute and chronic forms. Acute pyelonephritis is completely cured within a couple of months after the start of therapy. The child will get rid of the chronic form of the disease within six months; you need to be prepared for the fact that about two relapses will occur during this period.

Chronic pyelonephritis can be presented in a recurrent (when regular exacerbations are observed) or latent (there are no manifestations of symptoms, but laboratory test results show the presence of pathology) form. Latent pyelonephritis is quite rare; most often this diagnosis is made erroneously, because this disease can easily be confused with various infectious pathologies of the urinary tract or reflux nephropathy, the symptoms of which are quite mild.

Symptoms of pyelonephritis in children

Manifestations of pyelonephritis in children, the symptoms of which they often cannot describe themselves, vary quite a lot. Everything depends on the nature and speed of the pathology, its severity, the age of the patient, in parallel developing diseases etc.

And yet, doctors managed to identify the most basic signs of pyelonephritis in children:

Increase in body temperature. This is one of the most obvious symptoms because it occurs quickly and without any apparent reason. This symptom is extremely dangerous, since the temperature often rises to 38 °C, and sometimes even higher. It is often accompanied by severe fever.
Due to intoxication, the child becomes lethargic, drowsy, has a loss of appetite, nausea and vomiting. The skin turns pale, takes on a gray tint, and blue circles appear under the eyes. Most often, manifestations of intoxication are stronger in infants than in older children.
The child experiences pain in the lower back or abdomen. Children aged 4–5 years complain of pain throughout the abdomen, and older patients usually note discomfort in the lumbar region or the side of the lower body. The pain is mild, nagging, it intensifies with movement and weakens if the area of the body around it is warmed.
Sometimes there may be difficulties with urination, but this is not a permanent symptom and does not occur in all patients. The child may experience incontinence, excessively frequent or, conversely, rare urination, sometimes this process is accompanied by pain.
There may be slight swelling on the child's face.
The urine of a patient with pyelonephritis usually changes its color, becomes unnaturally cloudy, and acquires a strange smell.

Symptoms in babies

Newborns and very young children cannot describe the nature of their illness. But with pyelonephritis, they may experience a number of symptoms that are noticeable even without their obvious complaints:

Body temperature rises to 40 °C. Sometimes febrile convulsions may occur against this background.
Frequent regurgitation and vomiting.
Refusal of breast or formula, sluggish sucking.
The baby's skin becomes pale, the skin on the lips, around the mouth and above the upper lip turns blue.
With pyelonephritis, weight loss that is unnatural for children of this age is observed.
The body becomes dehydrated. The skin dries out and becomes flabby.

Children of this age cannot clearly complain of pain, but they most likely will. Excessive anxiety of the baby and his constant crying is a kind of warning about the occurrence of severe pain. About half of children of this age experience problems urinating. They may be indicated by restlessness, redness of the face, or prolonged groaning by the child before he begins to pee. Often, due to pyelonephritis, the baby may experience diarrhea. This symptom complicates the examination and often confuses doctors, since symptoms characteristic of a common intestinal infection arise.

Diagnosis of the disease

Diagnosis of pyelonephritis in children is carried out through a number of laboratory and instrumental methods research. These include:

General urine analysis. All children who have an elevated body temperature are subject to such a diagnosis. For pyelonephritis characteristic feature is an increased content of leukocytes in urine, as well as proteinuria (protein in the urine).
Urinalysis according to Nechiporenko, Amburge or Addis-Kakovsky. The purpose of these studies is also to detect increased levels of white blood cells (leukocyturia).
The biomaterial is cultured to identify the type of pathogen and its susceptibility to various antibiotics.
Blood chemistry. With its help, doctors determine the total amount of protein and protein fractions.
Biochemical urine analysis.
Each sick child undergoes ultrasound and x-ray examination of the genitourinary system. They allow you to recognize the presence of vesicoureteral reflux and various structural disorders internal organs which could contribute to the development of pyelonephritis.

Method of treatment

Pyelonephritis in young children can only be treated in a hospital setting. In this case, it is highly recommended to place the child in a highly specialized medical institution specializing in urological or nephrotic diseases. Only when inpatient treatment patient, doctors have the opportunity to regularly monitor the entire process, carry out necessary research, promptly change the therapeutic course. Treatment of pyelonephritis in young children includes several mandatory measures.

Mandatory bed rest is required for children with fever and abdominal pain. As soon as the body temperature returns to normal and the pain subsides, the patient can be transferred to the ward mode (the child is allowed to move around the room). Soon, if therapy is successful, the patient is transferred to a general regimen, including daily walks on the fresh air(lasting up to one hour) within the hospital area.

The child should follow a certain diet. The diet should be structured in such a way as to minimize the impact on the kidneys and at the same time improve metabolic processes in the body.

Antibacterial therapy medications is the most important element of the entire treatment course for pyelonephritis. Drug treatment carried out in 2 stages. Before obtaining the results of urine culture for susceptibility to antibiotics, drugs with a wide spectrum of effects are used. After doctors manage to identify the causative agent of the disease and determine which drugs affect it most strongly, broad-spectrum drugs are discontinued and antibiotics of narrow action are prescribed to replace them. Antibacterial therapy lasts for four weeks. In this case, you should change the type of treatment every 6–10 days.

Therapy is carried out using uroantiseptics. These drugs help disinfect the urinary tract. They are not antibiotics, but despite this, they are able to stop pathogenic bacteria and prevent them from entering the child’s body. The course of taking such drugs is from one to two weeks.

In addition to antibiotics and uroantiseptics, patients are prescribed antipyretics, antispasmodics, agents with antioxidant properties, vitamin complexes, and anti-inflammatory drugs. It is possible to completely cure a child’s disease within 1–2 months of inpatient therapy.

Prevention of pyelonephritis in children who have already had this disease is extremely important. Even if the disease has long been cured, there is always a possibility of relapse. As a preventive measure, parents should show their children to a nephrologist at least once every 2 months. The doctor will give individual recommendations and, if necessary, prescribe preventive treatment with antibiotics for the child.

Infections are dangerous for the child’s body due to the incomplete formation of immunity. Against this background, bacteria and fungi can affect the tubules, calyces, renal pelvis and urinary tract. Chronic pyelonephritis in children leads to changes in renal tissue. Treatment is carried out taking into account the nature of the infectious agent and the age of the child. Complex therapy and a special diet will help avoid relapses of the disease and achieve stable remission.

Main causal factors In the development of the disease, infections, a decrease in protective forces body and various disorders outflow of urine. Microorganisms infect the epithelium of the renal calyces and pelvis. The inflammatory process often spreads to the tubules, lymphatic and blood vessels. The infection comes from urethra and bladder through the ureters. This is an ascending pathway that predominates among the causes of the disease. Microbes are less likely to enter the kidneys with blood and lymph from lesions chronic infection, which include tonsillitis, caries, and sinusitis.

Causes of immune system dysfunction in children:

endocrine disorders in the body caused by heredity and age;
poor environmental conditions, water and food pollution;
physical, mental and mental fatigue;
inadequate antibiotic therapy;
hypo- and vitamin deficiency;
stress.

Problems with the immune system explain the increased incidence of pyelonephritis in newborns and infants.

The period of 0–2 years marks the stage of formation of the body’s defenses, low resistance. The period from 4 to 7 years is considered problematic, when children are exposed to a variety of infectious agents in new groups. In addition, until the age of five, the child does not completely empty the bladder, and favorable environment for the proliferation of microbes. Puberty is associated with hormonal changes and the penetration of infection into the kidneys from the genital mucosa.

Pyelonephritis is more often recorded in newborn boys. After 3 months, the statistics change: for every six sick girls there is one sick male baby. A similar ratio remains in the early, preschool and teenage age periods.

The negative consequences of pyelonephritis for a child during pregnancy include poor nutrition, fetal hypoxia, premature birth, and untimely release of amniotic fluid. There is a possibility of asphyxia, jaundice, intrauterine infection and hereditary transmission of the disease. As a result of hypoxia, weak children with low weight are born.

The immediate causes of the development of pyelonephritis in children are: pathogenic microflora. The prerequisites are considered to be dysbacteriosis - vaginal or foreskin, intestines. Harmful frequent delays urination, when the child is forced to restrain the urge to kindergarten or school. Pyelonephritis occurs after cystitis, when the infection spreads through the urine. Predisposing factors are ureteral injuries, tumors or kidney stones, and poor personal hygiene.

E. coli accounts for 85% of kidney infections. Staphylococcus, enterococcus, Pseudomonas aeruginosa, and chlamydia are involved.

Various developmental anomalies contribute to kidney damage individual parts or the entire genitourinary system. The long course of the disease leads to the appearance of scars consisting of connective tissue. Anemia and arterial hypertension, chronic renal failure (CRF) occurs. Physical activity that is feasible for their peers is contraindicated for sick children. Long standing, temperature changes, and mental stress are considered harmful. Chronic renal failure in a child leads to disability.

Forms and types of disease

There is no generally accepted classification regarding the typology of pyelonephritis. Acute period, purulent inflammation takes approximately 2 months. With chronic pyelonephritis, approximately two exacerbations occur over six months or a longer period of time, followed by remissions. In this case, the swelling of the kidney is insignificant; the blood supply to the affected organ deteriorates.

Acute pyelonephritis develops suddenly with an increase in temperature to 39–40°C and lower back pain.

Studying helps doctors distinguish the main types and forms of the disease clinical manifestations, congenital anomalies and acquired pathologies. If the inflammatory process initially develops as a result of microflora from the urethra entering the kidneys, then this primary pyelonephritis. The disease is not associated with the presence of abnormalities in the child's kidneys and urinary ducts.

Secondary pyelonephritis- a consequence of abnormalities in the structure of the kidneys, pathology of the ureters and deterioration of urine outflow. Usually diagnosed in children under one year of age, although it can develop in preschool or puberty. A unilateral process is characterized by damage to only one kidney, while a bilateral process affects two kidneys. The obstructive type is associated with obstruction of the urinary tract.

Symptoms of the disease

The paired organ of the urinary system performs important functions. Urine with dissolved metabolic products accumulates in the glomeruli, flows into the renal pelvis, and enters the bladder through the ureters. All of these organs are located below the waist. However, pyelonephritis is often disguised as acute stomach. In this case, general symptoms prevail over local ones. Fever occurs, the child vomits, becomes dizzy, pain is felt in the navel area, but is absent in the lumbar area.

Signs of pyelonephritis in children in acute form:

symptoms appear suddenly, often after hypothermia;
suffer from headaches, muscle pain, lumbar pain;
urine makes bad smell, changes color;
Frequent urination bothers you;
chills, fever (40°C) occur;
dry mouth;
lumbar pain;
vomit.

Pyelonephritis is severe in newborn infants. The disease begins with high fever and refusal to eat. Symptoms of pyelonephritis in infants can be recognized by their pale gray color skin, vomiting, diarrhea, lethargy. The fever persists for more than 2 days, urination is frequent. Indirectly indicate kidney damage in a 1-year-old child and in children under 3 years of age, irritability, fatigue, and anxiety before urinating.

However, the onset of pyelonephritis in early age often goes unnoticed, especially in the absence of general intoxication. If abdominal syndrome predominates, then discomfort occurs in the abdomen and pain near the navel. With urinary syndrome, urination becomes more frequent and becomes painful. The volume increases and the clarity of urine changes.

Development of signs of pyelonephritis in children with chronic form occurs over a period of at least 6 months. Intoxication and pain syndrome less pronounced. The child gets tired quickly, in the evenings his temperature rises to 37–38°, and urination becomes more frequent. The latent course of chronic pyelonephritis manifests itself in the predominance of urinary syndrome. When the disease becomes recurrent, acute attacks occur every 3 months or more often.

How to recognize pyelonephritis in a child or teenager?

The disease often occurs in the absence of pronounced signs of inflammation. Diagnosis is complicated by the lack characteristic symptoms pyelonephritis in children. Leukocytes, proteins and a large number of bacteria in the urine indicate an inflammatory process. Chronic pyelonephritis can be recognized by painful sensations when palpating the kidneys through the anterior abdominal wall, gently tapping the lower back.

Main diagnostic criteria:

A general urine test helps determine the presence of pathogens; turbidity occurs due to the presence of protein, leukocytes, and epithelial cells.
The Nechiporenko test is carried out to determine the content of leukocytes and erythrocytes in a portion of morning urine.
Ultrasound of the pelvic organs makes it possible to choose treatment tactics (medical or surgical).
A blood test shows an increase in ESR, anemia, and a change in the state of the immune system.
Urine culture allows you to identify the infectious agent - the causative agent of the disease.

The hemogram gives necessary information about the degree of inflammation. Indicators of urine analysis when cultured for microflora make it possible to determine the species of the causative agent of the disease and its sensitivity to certain antibacterial substances. A comprehensive examination is carried out to prevent complications - sepsis, chronic renal failure.

Principles of therapy

Symptoms and treatment of pyelonephritis in children depend on the causes and nature of the inflammation, the degree of urinary dysfunction. Therapy is carried out with antibiotics. It happens that in the presence of an abscess it is impossible to do without surgery. Treatment acute process carried out in an inpatient or outpatient setting, with mandatory bed rest.

Basic principles of therapy:

Nonsteroidal anti-inflammatory drugs that have analgesic effect(paracetamol, ibuprofen).
Treatment with antibiotics to fight infection and prevent purulent process.
Prescription of drugs that eliminate the effects of intoxication of the body.
Means for increasing the activity of the immune system.
Uroantiseptics (prescribed less frequently).
Antihistamines.
A gentle diet.

How to treat pyelonephritis is decided by doctors - pediatrician, nephrologist, urologist after comprehensive examination child.

High demands are placed on antibacterial agents used in pediatrics. They must be low-toxic, quickly accumulate in the lesion, and be resistant to bacterial enzymes. Used to treat pyelonephritis in infant And one year old baby protected penicillins. For example, amoxicillin + clavulanic acid.

Adolescents are usually prescribed a number of cephalosporins or fluoroquinols (cefotoxime, cefuroxime, levofloxacin, ciprofloxacin). When antibiotic therapy for pyelonephritis in children lasts more than 10 days, the drug is changed. Antibiotics are first administered intramuscularly, then oral forms are used.

The diet for pyelonephritis in children does not involve limiting salt, but the drinking regime provides for an increase in fluid by 50% more than the age norm. They give cranberry juice, fruit and berry juices, herbal teas, "Smirnovskaya" or "Slavyanovskaya" mineral water. Fatty and fried foods, spicy dishes are excluded.