Treatment of secondary pyelonephritis in children. Pyelonephritis in children: classification, course, diagnosis and treatment

Urinary tract infections in children are the second most common after respiratory diseases. In infants they can “masquerade” as a pathology of the digestive organs: acute abdomen, intestinal syndrome, dyspeptic disorder.

One of the symptoms of pyelonephritis in older children is an “unreasonable” rise in temperature from low-grade to high temperatures. Therefore, every child with an unknown malaise and a rise in temperature must undergo a urine test to exclude pyelonephritis.

Pyelonephritis (kidney inflammation) in children is a disease of the upper urinary tract, which causes inflammation of the kidney tissue caused by microbes. Not only the kidney tubules are involved in the process, but also the blood and lymphatic vessels.

At home, enterobacteriaceae are a common pathogen ( coli, Klebsiella and Proteus). Escherichia coli is the leader; it is sown in 80–90% of cases. This is explained by the fact that the pathogen has a universal set for damaging the tissue of the urinary tract. Due to special “fimbriae,” the bacterium clings to the wall of the urinary tract and is not “washed away” by the flow of urine.

The cause of infection in hospitals is Pseudomonas aeruginosa, Proteus and Klebsiella. This must be taken into account when prescribing treatment. When the pathogen is known, it is much easier to treat.

Routes of infection:

• from blood;
• from lymph;
• from the lower parts of the urinary tract.

Hematogenous (from blood) infection is more common in newborns. From mother to child. Prevention during pregnancy is important here; you need to be promptly screened for sexually transmitted infections.

Lymphogenic infection is due to the presence of a single lymph circulation system between the intestines and urinary tract. Long-term intestinal diseases (dysbiosis, colitis) reduce its protective functions, and the movement of lymph stops. Stagnation greatly increases the likelihood of kidney infection by intestinal flora.

Ascending route of infection ( from the lower urinary tract ) is more common than others and is typical for girls. This is explained by the structure of the urogenital area. The proximity of the two sections promotes seeding. Normally, the advancement of microbial colonies in girls is hampered by the usual vaginal microflora, represented by lactobacilli, which produce lactic acid and create an unfavorable environment - a different pH.

By releasing hydrogen peroxide, lactobacilli inhibit the proliferation of harmful microflora. In some cases, there may be a disturbance in the number of vaginal flora (lack of female hormones, decreased production of local immunoglobulin A, lysozyme). The balance between the body and microbes is disrupted, and local immunity decreases. Pathogenic organisms begin to rise unhindered from the lower sections to the kidney itself.

Strengthening general and local immunity is a reliable prevention of pyelonephritis.

Causes of the disease

The urinary tract is constantly in contact with infection, but infection does not occur. This is due to the presence of local protective functions. There are many of them and they complement each other. Any disruption of their work creates a condition for illness.

Factors adverse effects divided into internal and external:

• violation of urodynamics (urine flow) - hereditary anomalies, blockage of the urinary tract, kidney stones, prolapse of the kidney;
• changes in the composition of urine - impurities of glucose, crystals, uric acid salts appear;
• bacteriuria - the presence of microbes in the urine without signs of disease;
• decline general immunity(cytostatic treatment, chemotherapy);
• intestinal diseases;
• prematurity, gender (girls get sick more often), blood group IVAB and III B;
• illnesses and bad habits mothers;
• hypothermia;
• early pregnancy and sexual life;
• medical manipulations in the urinary tract (bladder catheterization).

If prevention is carried out in a timely manner in schools, the incidence of childhood pyelonephritis will decrease. Girls especially need to avoid hypothermia, not wear short skirts in cold weather, keep their feet warm and observe hygiene measures.

Features of the disease in children under one year old

The causative agent in newborns and children under one year of age is E. coli in 85% of cases. Subsequently, in infant boys, its share decreases to 40%, while Proteus increases to 33% and staphylococcus to 12%.

The development of the disease is facilitated by chlamydia, and from the mother, infection occurs through the blood. Immunodeficiency conditions, such as prematurity and HIV infection, predispose to the appearance of pyelonephritis in newborns. Then the pathogens will be fungi or their combination with bacterial flora.

The structure of the kidney in children under one year of age has its own characteristics: the pelvis is located intrarenally, the ureters are tortuous and have weak tone. Due to weak innervation, the muscular apparatus of the kidney does not contract sufficiently.

According to experts, early transfer to infants can lead to illness in infants. artificial feeding, especially in the first six months of life. In these children, the risk of getting sick increases by 2.3 times. Thus, the protective role of breastfeeding has been proven.

In children early age the disease is generalized. The course is severe, and meningeal symptoms may develop. The child often spits up, and vomiting appears at the height of intoxication. When urinating, he grunts and cries. Although these are not characteristic signs of pyelonephritis, the disease should be suspected.

It is not recommended to treat children under one year of age at home due to the severity of the condition.

Forms and symptoms of pyelonephritis

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

• spicy;
• chronic.

Acute pyelonephritis has two forms: primary and secondary.

How independent disease primary occurs, and secondary pyelonephritis in a child appears against the background of various diseases of the urinary tract (anomalies of the ureters, kidney stones).

Acute pyelonephritis in children occurs with a high temperature of 39-40°C. Characterized by pain in the lower back, abdomen, and joints. There is a tremendous chill. At acute form the disease occurs with severe intoxication. The weakness is concerning; the child’s characteristic posture is forced flexion and adduction of the limb to the abdomen on the side of the diseased kidney.

Obstructive pyelonephritis is very severe, which is accompanied by the death of organ cells. A state of shock occurs with a drop in pressure, lack of urine, up to the development of acute renal failure. For older children, acute pyelonephritis occurs under the “mask” of appendicitis or influenza.

The picture of chronic pyelonephritis for children is characterized by the same symptoms, but they are less pronounced. The child complains of fatigue and frequent urination, which may be combined with anemia or hypertension. Unlike acute, childhood chronic pyelonephritis is dangerous due to the structural restructuring of the renal pyelocaliceal system.

Diagnosis of pyelonephritis

The first thing to do if you have a fever that is not associated with a cold is to check your urine test.

Urine testing includes two methods:

• microscopic analysis;
• culture for bacterial flora and sensitivity to antibiotics.

Medical recommendation: urine collection for microscopic examination carried out with free urination into a clean container, before starting antibiotic therapy. First you need to thoroughly clean the child's external genitalia.

The sensitivity of the method is 88.9%. When microscopying sediment, attention is paid to leukocytes, red blood cells, specific gravity of urine and the presence of protein. Signs of pyelonephritis: the appearance of 5 or more leukocytes in urine tests, changes in urine density. The disadvantage of the method is high risk ingress of microbes from the environment.

To obtain high-quality diagnostics, the microscopic method must be combined with the bacteriological one. Modern laboratory method A procalcitonin test is considered to confirm microbial infection. Its average level in sick children is 5.37 ng/ml.

Ultrasound (ultrasound) - the use of color and pulsed Dopplerography significantly expands the capabilities and accuracy of the method. It can be used to identify developmental anomalies, dilation of the pelvis, urolithiasis, and hydronephrosis. Will show signs of inflammation and shrinkage of the kidney.

Renoscintigraphy (Scintigraphy)

Research using an isotope (Tc-99m-DMSA) allows you to identify lesions that have fallen out of functioning. This is the most accurate method for detecting kidney shrinkage in children. In addition to the traditional ultrasound method, MRI (magnetic resonance therapy) of the kidneys and computed tomography are used.

Treatment

Therapy for pyelonephritis consists of the following stages:

1. Antibacterial therapy.
2. Pathogenetic.
3. Symptomatic.
4. Regime and proper nutrition.

Doctors' recommendations: Antimicrobial therapy for pyelonephritis should be started as early as possible, ideally in the first 24 hours. A late onset (on days 3-5) leads in 40% of cases to the appearance of areas of wrinkling in the kidney parenchyma, in other words, a defect is formed. Treatment is carried out over a longer course than in adults.

The younger the child, the longer the therapy. This approach has a simple explanation: the child has not yet developed general and local immunity, anatomical features the structures of the urinary tract create an obstacle to the flow of urine. Therefore, acute pyelonephritis in children ends with a chronic process with frequent relapses, if the treatment terms are not met.

It takes a long time to treat. The course consists of 2 stages: initial antimicrobial therapy for 14 days and an anti-relapse course with uroseptics for a month. For developmental anomalies where there is reverse reflux of urine, anti-relapse treatment is carried out for several months or a year until the causes are eliminated.

It has been proven that the route of administration of the antibiotic does not affect the result. It is more convenient to use tablet preparations at home. In the hospital they begin to treat by injection for 3-5 days, then transfer to tablets.

Commonly used antibiotics are presented in the table:

The ideal option for choosing antibiotic therapy is urine culture data.

Then blind treatment is eliminated, and the likelihood of a secondary case is reduced. Therapy will be aimed at the cause of the disease and will minimize complications.

Anti-relapse treatment is carried out with 5-nitrofuran derivatives. These include: “Furagin” or “Furamag”. From other groups: “Palin”, “Nevigramon”, “Nitroxaline”

Mild pyelonephritis can be treated at home. For supportive and preventive therapy Herbal medicine has proven itself well. For this purpose, you can use Canephron.

The diet for pyelonephritis in children should be age-appropriate. Be balanced, contain more protein. Spicy foods and salt should be avoided. Drinking plenty of fluids is required, exceeding the age norm by 50%. Mineral water, preferably slightly alkaline (Essentuki 4, Smirnovskaya) 2-3 ml per kilogram of body weight at a time.

Prognosis and prevention

Uncomplicated pyelonephritis with proper treatment has favorable prognosis. Careful and timely therapy will avoid relapses and chronic renal failure.

In order to prevent childhood pyelonephritis, you need to follow simple but effective rules:

• physical exercise and sports improve blood circulation in the kidneys;
• sufficient fluid intake allows for good circulation;
• Timely urination removes stagnation of urine.

Children who have received treatment for pyelonephritis are subject to observation by a pediatrician and should periodically undergo urine tests. It is advisable to consult a nephrologist once a year.

Analysis of urine and urinary tract tests

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The most common urological disease in children and adolescents is pyelonephritis. Children often suffer from acute respiratory viral infections, which are often complicated bacterial infection, which also leads to inflammation of the kidneys. Children's pyelonephritis often does not have specific signs, therefore important timely diagnosis and adequate treatment, this will help prevent possible serious complications.

What is childhood pyelonephritis

Pyelonephritis is an infectious and inflammatory lesion of the kidneys, including the pelvis, cups and the parenchyma itself (the underlying tissue) of the organ. Preschoolers are most susceptible to the disease, and girls are more often affected, which is due to the specificity of their structure. urinary tract. Acute inflammation (newly occurring) occurs in children with urinary disorders, pain in the lumbar region, high fever and general intoxication. The chronic process has mild symptoms, and during the period of exacerbation its manifestations are the same as in acute pyelonephritis. The disease must be treated promptly and fully, as it often leads to serious complications.

Pyelonephritis is an inflammation of the kidneys that can have serious consequences.

Acute inflammation can end:

• hydronephrosis (expansion of the pelvis followed by atrophy of the renal tissue);
• nephrosclerosis (wrinkling of the kidney);
• development of purulent processes:
  • abscesses or carbuncle;
  • paranephritis (purulent inflammation of the perinephric tissue);
  • Urosepsis is a general infection of the body.

The result of a chronic inflammatory process can be chronic renal failure.

The basis of treatment is always antibacterial drugs, since the cause of pyelonephritis is a bacterial infection. In babies of the first year of life, pathogenic microorganisms enter the kidneys with the blood from other foci (hematogenously); in older children, penetration of microbes occurs in an ascending way, that is, from the lower urinary tract, genitals or intestines. No matter how the kidney becomes infected, the nephrologist must prescribe antibiotics and uroantiseptics to the child. In addition to them, other drugs are prescribed, the choice of which depends on the factors that led to the development of the disease.

Secondary obstructive pyelonephritis against the background of structural or functional disorders leading to disruption of normal urodynamics is treated jointly by a pediatric surgeon or urologist. In this case, the issue of bladder catheterization or surgery is decided to eliminate the factor contributing to obstruction (obstruction) of the urinary tract. Secondary dismetabolic (metabolic) pyelonephritis requires mandatory nutritional adjustments and the use of special medications to eliminate metabolic disorders.

Video: popular about childhood pyelonephritis

Treatment

Therapy should be comprehensive and include measures aimed at:

• elimination of pathogenic flora;
• elimination of inflammatory phenomena in the kidneys;
• restoration of their functionality;
• resumption of normal ureter;
• correction of immune abnormalities.

In addition to medications, physiotherapeutic procedures, herbal medicine, a sick child needs to organize the correct regime and nutrition. It is very important to provide the baby with the necessary amount of drink - 50% more than the age norm.

Acute pyelonephritis is usually treated in a hospital. The question of the need for hospitalization is considered taking into account the severity of the patient’s condition, the form of pathology, the likelihood of complications, social and family conditions. For older children, especially with an exacerbation of the chronic process, a hospital at home can be arranged, while parents must strictly follow all medical recommendations. The active phase of inflammation, accompanied by fever and pain, requires bed rest for 5–7 days.

In the first days of the disease, bed rest is indicated

Medicines

The choice of drugs depends on the type of pathogen, the age and condition of the child, the form of the disease and its phase (active or remission).

Antibacterial therapy, which forms the basis of treatment, should be based on the following principles:

• Before prescribing an antibiotic, a bacteriological urine test must be performed, and after receiving the results, the therapy is adjusted;
• if possible, exclude factors that contribute to kidney infection;
• during treatment, tests are monitored for the presence of bacteriuria (the content of bacteria in the urine);
• antimicrobials prescribed for a long term, otherwise the pathology cannot be corrected.

For maximum effectiveness of treatment, it is necessary to take a urine culture and determine the sensitivity of the pathogen to antibiotics

Drug therapy for exacerbation of the chronic form of the disease is carried out in three stages:

1. First, the active infectious-inflammatory process is suppressed with antibiotics.
2. Against the background of symptomatic relief, antioxidant treatment is carried out, and then immunocorrection.
3. The final stage is anti-relapse therapy.

Treatment acute inflammation usually limited to the first two stages.

Antibacterial therapy

Antimicrobial drugs for pyelonephritis are usually prescribed as follows:

• initial therapy with antibiotics until urine culture results are obtained in combination with diuretics (if there is no obstruction) and infusion (intravenous) solutions in case of severe intoxication;
• correction of treatment taking into account the results of laboratory tests - the identified pathogen and determination of its sensitivity to antibiotics.

Total duration of use antimicrobial therapy is approximately 3–4 weeks with a change of drug every 7–10 days or replacement with a uroantiseptic. With the development of functional renal failure, the dosage of the drug is reduced by about a third.

Moderate or severe forms of pyelonephritis are treated in a hospital setting with parenteral administration of drugs - intramuscularly or intravenously. The mild course of the disease allows the use of antibiotics orally - in the form of children's syrups and suspensions, which are well absorbed in the digestive tract.

Antibiotics that are usually prescribed for initial therapy:

• protected penicillins:
  • Augmentin;
• cephalosporins:
  • Cefuroxime;
  • Cefamandole;
  • Ceftazidime;
  • Ceftizoxime;
  • Cefoperazone;
  • Ceftriaxone;
• aminoglycosides (not used for home treatment, only in hospital settings):
  • Amikacin;
  • Lykacin;

During the subsidence period pathological process the child is transferred to oral administration antibiotics (in syrups or tablets). In addition to penicillins and cephalosporins, at this stage the following are prescribed:

• nitrofuran derivatives - Furadonin;
• non-fluorinated quinolones - Negram, Palin, Nitroxoline;
• combined sulfonamides - Biseptol, Co-trimoxazole (if there is no obstruction).

In severe cases, purulent complications and persistent flora, the patient is prescribed combination therapy:

• cephalosporins and aminoglycosides;
• penicillins and cephalosporins;
• penicillins and aminoglycosides.

Reserve drugs are:

• Ofloxacin, Zanocin - antibiotics from the fluoroquinolone group;
• Cyronem, Imipenem are antibiotics from the carbapenem group.

They are prescribed only if other drugs are ineffective.

• Bifidumbacterin;
• Linux;
• Bifiform.

After mono- or combination antibiotic therapy, treatment is continued for 10 days with uroantiseptics: preparations of nalidixic, oxolinic, pipemidic acid, nitrofurans.

Photo gallery: antimicrobial agents for pyelonephritis

Ofloxacin is a reserve drug, prescribed when other antibiotics are ineffective
Cefotaxime is an antibiotic from the group of cephalosporins, prescribed for acute and chronic pyelonephritis
Gentamicin is an antibiotic that is used to treat nephritis in older children in a hospital setting.
Amoxiclav is a protected penicillin and is the drug of choice for the treatment of any form of pyelonephritis in children.
Nitroxoline is an antimicrobial agent, prescribed as a uroseptic for pyelonephritis
Furadonin is a drug with a pronounced antimicrobial effect; it is prescribed after a course of antibiotics

Video: principles of treating kidney inflammation in children

Other drugs to treat kidney inflammation

In the first days of treatment, against the background of a large water load, diuretics are prescribed - Veroshpiron, Furosemide, Spironolactone. Diuretics provide increased blood flow in the kidneys, rapid removal of microbes and inflammatory products from the body, and relieve swelling of interstitial (loose connective) renal tissue.

Pathogenetic therapy, that is, taking anti-inflammatory, anti-sclerotic drugs, immunomodulators and antioxidants, begins 5–7 days from the onset of the disease. The child is prescribed:

• anti-inflammatory drugs:
  • Ortofen;
  • Paracetamol;
  • Surgam;
• antihistamines:
  • Suprastin;
  • Tavegil;
  • Claritin (Loratadine);
• antioxidants:
  • vitamin E;
  • Vetoron;
  • Selzinc;
  • Synergin;
  • Dimephosphone;
• agents that improve microcirculation in the renal vessels:
  • Trental (Pentoxifylline);
  • Cinnarizine;
• drugs with anti-sclerotic effect (for signs of sclerosis of the renal parenchyma):
  • Delagil;

During the period of remission, the baby is prescribed herbal medicine - diuretics, products based on herbal raw materials - Urolesan in syrup, Canephron in solution, Monurel (cranberry extract).

Photo gallery: drugs for pyelonephritis

Unithiol is a detoxification drug prescribed for severe intoxication.
Claritin is an antihistamine to prevent allergies in children
Nurofen is an anti-inflammatory drug used to eliminate inflammation, relieve pain and reduce fever
Veroshpiron is a diuretic drug, it is prescribed to eliminate edema and remove microbes and inflammatory products from the body
Voltaren is an anti-inflammatory drug prescribed to children to relieve the inflammatory process in the kidneys
Eufillin is prescribed to improve renal blood flow
Plaquenil is a drug with an anti-sclerotic effect, used in cases of high risk of scarring in the kidneys.
Triovit is a complex vitamin preparation containing vitamins C, E, A, selenium and yeast (prescribed to children from 10 years of age)
Canephron is a drug based on herbal raw materials, used for pyelonephritis during remission

Immunotherapy and anti-relapse treatment

Many children with kidney inflammation experience changes in their functioning immune system, which may influence the progression and course of the disease. Such patients are prescribed drugs to correct immunity. These drugs help shorten the active period of the disease and reduce the likelihood of relapses.

Immunotherapy is prescribed to children strictly according to indications and in agreement with a specialist immunologist. Treatment begins at the recovery stage. The following drugs are used:

• Lycopid;
• interferon preparations:
  • Viferon;
  • Reaferon;
  • Cycloferon;
  • Leukinferon;
• Lysozyme;
• T-activin;
• Myelopid.

Immunal is one of the drugs used to correct immunity in children

Anti-relapse treatment involves prescribing to a small patient antibacterial drugs for a long time and in small doses. The course of treatment is intermittent. One of the following drugs is recommended:

• Palin;
• Nevigramon;
• Furagin;

Dosages are selected individually for each patient, and the duration of therapy is also determined individually.

Biseptol is one of the drugs used for anti-relapse therapy

Diet

The nutrition of a sick child should have certain restrictions depending on the activity of the inflammatory process, kidney function, and the presence of metabolic disorders.

The diet should be aimed at sparing the kidneys, minimizing the load on the tubular and vascular system inflamed organ. In the acute phase, a dairy-vegetable diet with some restriction of protein and salt is recommended for approximately 7–10 days. For children under one year old, it is useful to take a water-tea break for 9–12 hours, then continue to feed with breast milk or an adapted fermented milk formula. After the signs of intoxication disappear, the baby can be transferred to his usual diet, while complementary foods are not yet introduced. Daily norm liquids for infant is 50 ml per kg of weight. With pyelonephritis, the volume of fluid consumed by the child should be increased. The doctor will tell you how much.

Extractive substances are excluded from a preschooler’s diet, essential oils, fried, spicy, fatty, that is, products that require large amounts of energy to process. For acute pyelonephritis, diet No. 5 is recommended. After the child’s condition begins to improve, the menu includes dietary meat - boiled or steamed. Gradually, the diet is diversified: they prepare porridges, casseroles, puddings, salads, soups, steamed meatballs, etc.

You need to feed your baby several times a day in small portions. The patient should not be overfed, but if the outflow of urine is not obstructed, there should be plenty of fluids:

• herbal decoctions;
• juices;
• compotes;
• rosehip drink;
• cranberry juice.

From one year to 3 years healthy baby per day should receive 50 ml of liquid per kg of weight, from 3 to 7 years the water norm is from 1.2 to 1.7 liters per day, and after 7 years - 1.7–2.5 liters. These volumes should be increased in case of kidney inflammation.

In the chronic form of the disease, dietary nutrition must be followed for a long time, limiting foods that can harm the tubular apparatus of the kidneys. A sufficient amount of fluid must enter the baby’s body.

With pyelonephritis, the child should receive plenty of fluids

Table: nutrition for kidney inflammation

Products that are allowed

Foods that need to be removed from the diet

vegetables and fruits: zucchini, pumpkin, melons, watermelons; beets, carrots, potatoes, cucumbers; sweet apples (baked ones are especially useful), apricots, black currant, strawberries, blueberries; dairy: low-fat milk; natural yogurt, kefir, yogurt, cottage cheese, butter; flour and cereals: stale unleavened bread, crackers, vermicelli; rice, buckwheat, oatmeal, sago; chicken eggs - in the form of a steam omelet every other day; lean fish; dietary meat: rabbit; turkey; chicken breast; veal; sweet: honey; jam; marshmallows; drinks: fruit and berry drinks (especially lingonberry and cranberry); decoction of rose hips; slightly alkaline mineral waters (Svalyava, Slavyanovskaya, Polyana Kvasova, Smirnovskaya, Essentuki); lightly brewed tea - green and black; liquid fruit and milk jelly, non-sour juices; infusions of herbs with anti-inflammatory and diuretic effects.

legumes - peas, beans, lentils; mushrooms; fish, meat broths; smoked meats, deli meats, sausages, bacon, fatty fish and meat; from vegetables: raw onion; garlic; tomatoes; radish; eggplant; sorrel; hard cheeses, cream, fatty cottage cheese; rye and freshly baked wheat bread; sweets: chocolate; buns; candies; cakes; cakes; hot and fatty sauces and seasonings; canned, pickled, salted foods; from drinks: coffee, cocoa; sweet carbonated drinks; freshly squeezed juices; mineral sodium waters.

Physiotherapeutic procedures

Physiotherapy can be used both in the acute phase of the disease and during remission. The procedures are carried out with the aim of eliminating the inflammatory process, normalizing renal blood flow and diuresis, and strengthening the body's defenses.

Methods that have an anti-inflammatory effect and normalize renal blood flow:

1. UHF - treatment electromagnetic field ultra high frequency. 5–7 procedures are prescribed in the acute phase.
2. Microwave therapy is treatment with an ultra-high frequency electromagnetic field. Used for a week after UHF.
3. Electrophoresis with calcium preparations, antimicrobial agents on the lumbar region. Up to 10 sessions are prescribed.
4. Ultrasound treatment. Used to eliminate inflammation in children over three years of age in the phase of mitigating acute symptoms.
5. Thermal procedures - applications of ozokerite, paraffin, inductothermy (exposure to the body by a magnetic field). Can be used during remission.
6. Warm sodium chloride baths. Prescribed to children outside the period of exacerbation, a total of 7–10 procedures.

Sodium chloride baths are one of the methods of physiotherapy for pyelonephritis in remission

In case of urinary reflux (backflow of urine into the pelvis), urodynamic disturbances and atony of the ureters, procedures are used to stimulate:

• SMT, or amplipulse therapy. Impact on muscle tissue alternating pulse electric current to eliminate congestion, edema, and stimulate metabolic processes. The method can be used for children from six months of age.
• DDT, or diadynamothermy - treatment with pulsed electric current of different frequencies and in different modes. Apply to the projection of the ureters to stimulate them.

Surgical treatment

In case unsuccessful therapy antibiotics and other drugs in case of impaired urine outflow, doctors are forced to resort to catheterization of the ureter. If this measure does not give the desired effect, the child is indicated for urgent surgery. Indications for surgical intervention:

• violent symptoms with a sharp deterioration in the child’s condition;
• very high temperature and leukocytosis (may indicate the development purulent complications- apostematous pyelonephritis or renal carbuncle);
• oliguria - lack of urine (may indicate obstruction of the urinary tract, for example, when the ureter is blocked by a stone).

Often the nature and extent of the intervention are determined already on the operating table. Surgeons strive to perform organ-preserving operations in children:

• kidney decapsulation (removal of the fibrous renal capsule);
• nephrostomy (insertion of a tube into the pelvis to drain urine out);
• opening and draining abscesses or carbuncles.

If the purulent focus is located on the lower or upper pole of the kidney, resection of this area is performed. If a stone is found in the pelvis, a pyelonephrolithotomy is performed, that is, dissection of the pelvis and removal of the stone.

If there is a need for surgery, surgeons strive to perform organ-preserving intervention

In severe cases, when there is complete absence of functioning of the damaged kidney and the health of the second organ is preserved, nephrectomy is performed. The operation involves complete removal of the diseased kidney. The success of surgery depends on the degree of organ damage, the age of the child, general condition his body and the timeliness of manipulations.

Pyelonephritis is a disease for which herbs are not only possible, but even necessary. Still, you should not self-medicate; you need to use herbal remedies recommended by your doctor and in the dosages prescribed by him. Plants with antiseptic, diuretic, and anti-inflammatory effects are recommended.

Cranberry, lingonberry or blueberry juice as an antiseptic and diuretic:

1. Mash a pound of fresh washed berries and squeeze out the juice.
2. Pour two liters of boiling water over the berries and simmer over low heat for 10 minutes.
3. Strain the broth and mix with the squeezed juice.
4. If the child does not have allergies, you can add honey to the fruit drink before drinking it.

A decoction of spreading cornflower (harlay) as an anti-inflammatory agent:

1. Take 5 g of dry herbs per 200 ml of water.
2. Boil in a water bath for 5 minutes.
3. Leave until cool, filter.

Diuretic kidney tea:

1. Brew a teaspoon of dry Orthosiphon stamen herb with boiling water (200 ml).
2. Leave for 15–20 minutes.
3. Drink warm.

Oatmeal decoction as an anti-inflammatory agent:

1. Take 200 g of oats per liter of milk.
2. Boil for 20 minutes.
3. Strain and take warm. You can add a rosehip drink to the decoction.

Antimicrobial, diuretic renal collection:

1. Rose hips, chicory root, yarrow herb, chamomile, bearberry and leaves ( better than kidneys) birch trees must be taken in equal parts.
2. Pour a tablespoon of the mixture into 300 ml of water.
3. Boil in a water bath for 15 minutes.
4. Leave covered. Strain.
5. Top up with boiled water to the original volume.
6. Drink the decoction half an hour before meals.

An infusion of bearberry or a decoction of corn silk is recommended as a strong diuretic. Bearberry is taken at the rate of 2 teaspoons per glass of boiling water and infused in a thermos for 3–4 hours. To decoction corn silk, take a spoonful of the raw material in a glass of water and boil for 10 minutes.

Photo gallery - plants for kidney inflammation

Harlay, or spreading cornflower, has pronounced antiseptic, anti-inflammatory and diuretic properties.
Oatmeal decoction is useful for kidney inflammation
Bearberry is used as a diuretic and anti-inflammatory agent for pyelonephritis
Corn silk- strong diuretic
Orthosiphon stamen has pronounced diuretic and anti-inflammatory properties
Cranberry juice - highly effective antiseptic for the treatment of pyelonephritis

Doctor Komarovsky about the treatment of pyelonephritis

Pediatrician Komarovsky calls pyelonephritis an insidious disease that requires long-term and persistent treatment, which should be based on the use of antibiotics. Despite the fact that urinary tract infections are easier to eliminate than other infectious diseases, since all drugs pass through the kidneys, treatment for pyelonephritis has its own characteristics. The doctor notes that failure to complete treatment is fraught with the formation of L-forms of bacteria, which for the time being do not manifest themselves in any way, but remain viable. Whenever favorable conditions such microorganisms begin to multiply intensively and lead to relapse of the disease. And the chronic recurrent form of pyelonephritis is much more difficult to cure than the acute process that has arisen for the first time, since bacteria that have survived due to inadequate therapy are resistant to antibiotics.

The main thesis that Dr. Komarovsky draws out during one of his general education lectures is that pyelonephritis is easier to treat than other infections, but takes longer.

Dr. Komarovsky urges parents not to try to treat their child on their own, to trust doctors and, in case of suspicious symptoms, immediately contact specialists.

Video: Dr. Komarovsky about pyelonephritis and timely urine testing

Disease prognosis

Acute kidney inflammation ends in recovery without consequences in approximately 80% of cases. Terrible complications and deaths are rare, only in severely weakened children with concomitant pathologies. Persistent scarring of the kidney parenchyma develops in 15–20% of children after the inflammation has subsided.

The outcome of the chronic form of the disease in 65–75% of cases can be progression pathological changes in the kidneys - the development of nephrosclerosis (wrinkling of the kidney) and renal failure. Full recovery can be observed only in children with primary chronic pyelonephritis. But with full treatment, even the secondary form of the disease, which arose against the background of urodynamic disturbances due to various initial pathological changes, can be brought to stable remission.

Children who have had the disease must be observed by a nephrologist for 3 years with mandatory monitoring of a general urine test every month, a biochemical urine test every 3–6 months, and an ultrasound scan of the kidneys once every six months.

A child after suffering from pyelonephritis should long time register with a nephrologist

During the period of remission of chronic pyelonephritis, you need to visit a nephrologist 1-2 times a year until the age of 15, then the dispensary records are transferred to the general practitioner in the adult network.

Deregistration is possible provided that complete remission is maintained for 5 years after the last full clinical and laboratory examination of a child who has suffered an acute form of the disease.

What disease in children under one year of age manifests itself simply as an increase in temperature, without any other symptoms? What can be confused with acute appendicitis or intestinal infection in preschoolers and schoolchildren? This is acute pyelonephritis - inflammation of the kidney tissue with primary damage to its main “working elements”.

This is the most common disease in children after acute respiratory infections. 85% of children get sick in the first 6 months of life, a third of them during the neonatal period. But even in such babies, the disease can become chronic if it is not treated in time. And kidney damage in children harms the entire body. And in severe cases, it can even cause the need for continuous hemodialysis.

He wasn't hypothermic, so why did he get sick?

Acute pyelonephritis in children develops not only with hypothermia. More common causes of the disease are:

• ARVI: adenovirus infection, flu;
• intestinal infection caused by Escherichia coli (E.coli) or Coxsackie viruses;
• long-term treatment with antibiotics, due to which pathogenic fungi develop in the urinary tract;
• chronic constipation, due to which intestinal flora migrates into lymphatic system and spreads to the kidneys;
• colitis (inflammation of the colon);
• intestinal dysbiosis;
• inflammation of the genital organs: vulvitis or vulvovaginitis - in girls, balanitis, balanoposthitis - in boys;
• cystitis;
• the presence of purulent inflammation in the body: pneumonia, bacterial endocarditis, sepsis.

The causes of pyelonephritis in boys of the first year of life are: physiological phimosis, that is, a normal narrowing foreskin. In addition, in newborns and children under one year of age of both sexes, pyelonephritis develops as a complication of omphalitis, pneumonia, purulent tonsillitis, purulent otitis and other organs. In this case, the infection enters the kidneys through the bloodstream.

In the first year of life, acute pyelonephritis occurs in boys and girls with the same frequency. After this age, there are 3 girls for every 1 sick boy. This is due to the fact that girls have a shorter urethra, and with poor genital hygiene, bacteria rise up it, first reaching the bladder, then the ureters, and then the kidneys.

Pyelonephritis is unlikely to develop in a child if there are no predisposing factors in the body. They become:

• young age;
• prematurity;
• early transition to artificial feeding;
• characteristics of immunity;
• a diet in which oxalate salts precipitate in the urine;
• pyelonephritis suffered during pregnancy;
• gestosis (nephropathy) during the mother's pregnancy;
• maternal occupational hazards;
• disruption of communication between the bladder and nervous system(neurogenic bladder), which causes urinary stagnation;
• developmental anomalies of the urinary tract;
• unfavorable environment;
• frequent ARVI;
• endocrine diseases;
• worms;
• masturbation;
• early onset of sexual activity;
• chronic diseases urinary system in the family;
• frequent chronic infections in the family;
• hypervitaminosis D.

Among bacteria, pyelonephritis is most often (90%) caused by Escherichia coli. This microbe has several pathogenicity factors. These are cilia and 3 antigens, which together immobilize the urinary tract, disable local immune protection and allow the bacteria to move quietly against the urine flow.

Other causative agents of pyelonephritis are Proteus, including Pseudomonas aeruginosa, Enterococci, Enterobacter, Salmonella, Leptospira, Gonococcus, Staphylococcus aureus adenovirus, Coxsackie virus. The role of chlamydia, ureaplasma and mycoplasma is still being considered. The disease can also be caused by fungi, such as Candida. The inflammatory process in the kidneys can also be caused by Mycobacterium tuberculosis.

Types of pyelonephritis

Depending on the conditions of development, pyelonephritis is divided into:

• primary: appears in a child with normally developed and correctly interconnected organs of the urinary system;
• secondary pyelonephritis: developing either in the urinary system with structural anomalies, or if there is a neurogenic bladder, or if the urine has a different pH - due to hormonal disorders or dietary habits.

Secondary pyelonephritis can be:

• obstructive, when the conditions for the outflow of urine are disrupted;
• non-obstructive, caused either by tubulopathies, or metabolic disorders, or congenital disorder development.

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

• chronic pyelonephritis, which can be recurrent (periodically aggravated) and latent (which does not manifest itself in anything);
• acute pyelonephritis. He has no such division. All symptoms and changes in urine should disappear within 6 months and not recur.

According to its course, the disease is divided into several stages:

1. I active stage.
2. II active stage.
3. III active stage.
4. Partial clinical and laboratory remission.
5. Complete clinical and laboratory remission.

Pyelonephritis is also divided according to the preservation of kidney function. So, it could be:

• saved;
• partially (partially) disrupted.

With chronic pyelonephritis, chronic renal failure can also develop.

Symptoms of the disease

Signs of pyelonephritis in children of different ages vary. Let's look at them.

In newborns and infants

Acute pyelonephritis in children under one year of age is manifested by the following symptoms:

• elevated temperature to high levels;
• refusal to eat;
• vomit;
• regurgitation after eating;
• pale gray complexion;
• loss or lack of weight gain;
• periodic attacks of anxiety, sometimes with redness of the face, and you can notice that this occurs during or before urination;
• there may be lying with the head thrown back, which looks like meningitis.

Most often, the disease begins at 5-6 months, when the child is either introduced to the first complementary foods, or transferred to artificial feeding, or vaccinations are repeated. The disease may begin as an intestinal infection (vomiting, diarrhea), but such symptoms quickly pass.

In preschoolers and schoolchildren

Symptoms of pyelonephritis in children older than one year already give a more accurate indication that the kidneys are sick. This:

Pain

• In school-age children, it is more often felt in the lower back.
• For preschoolers - the belly, near the navel.
• If the right kidney is inflamed, the pain may resemble appendicitis.

The pain is described as dull, it intensifies with changes in body position, and decreases with warming of the abdomen or lower back.

Urinary disorders

• strong urge to urinate;
• frequent urination;
• pain when urinating;
• itching or burning when urinating;
• change in the amount of urine;
• night urge to urinate;
• may be enuresis.

Other symptoms

• The temperature for pyelonephritis in school-age children rarely reaches 38°C.
• Symptoms of intoxication: chills, headache, lack of appetite.
• Characteristic appearance: pallor, swelling of the eyelids, “shadows” around the eyes.
• Urine with pyelonephritis may be cloudy, may contain blood, and may have an unpleasant odor.

In children 1.5-2 years old, there are few symptoms, there may be no pain, but symptoms of intoxication are pronounced, and sometimes urinary retention is detected.

Children 4-5 years old already experience pain, but it is not strictly localized in the abdomen or lower back: the child feels it, but cannot describe the localization. At this age they predominate discomfort when urinating, changes in the amount of urine and frequency of urination.

Signs of chronic pyelonephritis

This disease rarely develops in very young children. Its symptoms depend on the stage of the pathology.

So, during remission the following are observed:

• faster fatigue;
• irritability;
• decline in academic performance;
• freezing of the lower back;
• more frequent hikes to the toilet.

If chronic pyelonephritis is younger than 2 years, then the child is delayed in growth and development. That is, parents should pay attention to the fact that their child is shorter, paler and not as diligent as other children, and be examined by a nephrologist.

With an exacerbation of chronic pyelonephritis, the symptoms will be almost the same as during the first attack of this disease. This includes pain, increased temperature, and changes in the nature of urine. Only the severity of these signs will be less than the first time.

If chronic pyelonephritis progresses, the child:

• anemia increases (he becomes paler);
• blood pressure increases, which can manifest itself as headaches and facial flushing;
• decrease in the amount of urine.

Diagnostics

Making a diagnosis in some cases would be difficult if doctors had not long ago agreed upon admission to the hospital, with any diagnosis, to take general analysis urine. This diagnosis shows that there is inflammation in the urinary system.

Other tests for pyelonephritis are:

• general blood test;
• Nechiporenko's analysis;
• bacteriological examination urine;
• urine according to Zimnitsky;
• Rehberg test - determination of creatinine in blood and urine;
• urine testing using PCR method - to determine myco-, ureaplasma, chlamydia;
• urine culture on Sabouraud's medium to identify fungal flora;
• analysis of potassium, sodium, urea and creatinine in the blood;
• a smear from the vagina (in girls) or from the urethra (in boys);
• scraping for enterobiasis.

In making a diagnosis, it is also important to undergo an ultrasound of the urinary system, an x-ray method - excretory urography, sometimes - radionuclide studies of the kidneys.

In addition to the tests, you need to consult other doctors: an ophthalmologist, a phthisiatrician, a dentist, an ENT doctor. And if the first specialist evaluates the condition of the fundus of the eye - in order to understand how kidney damage affects the blood vessels, then the rest must exclude chronic infection - as a possible cause of pyelonephritis.

Treatment of acute pyelonephritis

The goals of treatment of pyelonephritis in children are as follows:

1. destruction of the microorganism that caused pyelonephritis;
2. improving blood supply to the kidneys;
3. an increase in the volume of urine excreted.

The child will have to be hospitalized if:

• this is a child under one year old;
• he has significant intoxication;
• he has a high body temperature;
• his urine output has decreased;
• he has severe stomach or lower back pain;
• he has high blood pressure;
• home treatment had no effect.

In any case, whether the child stays at home or goes to the hospital, he will need to remain on bed rest for 3-5 days. Especially when elevated temperature, chills, presence pain syndrome or symptoms of intoxication. Once the symptoms begin to subside, the motor pattern expands. It is very important to force the child to urinate every 2-3 hours: this will both prevent stagnation in the urinary tract and daily amount urine can be counted (if you urinate in a duck or bottle).

Diet

The diet for pyelonephritis is as follows:

Drinking regime

You need to take additional liquid in the form of cranberry or lingonberry juice, decoction of dried apples, mineral waters Slavyanovskaya, Smirnovskaya. The calculation of additional fluid intake is as follows:

• children under 7 years old - drink 500-700 ml/day;
• at 7-10 years old – 700-1000 ml;
• over 10 years – 1000-1500 ml.

The course of fluid intake is 20 days.

The following medications are prescribed:

• antibiotics, whose effectiveness is assessed every 3 days. These are augmentin, cefuroxime, cefotaxime, ceftriaxone. After 14 years, ciprofloxacin, norfloxacin or levofloxacin can be used. The duration of treatment is up to 4 weeks, the antibiotic can be changed every 10-14 days;
• uroantiseptics: furagin, furadonin, nalidixic acid, 5-nitroxoline, palin. These are not antibiotics, but drugs that can stop the growth of bacteria. Appointed after antibacterial therapy, course of treatment is 1-2 weeks;
• anti-inflammatory drugs: these are NSAIDs (diclofenac, ortofen, voltaren)
• glucose 5%, less often saline solutions (sodium chloride, Ringer's solution) in the form of droppers;
• drugs to improve renal blood flow: aminophylline, cinnarizine;
• blood thinners: trental and its analogues pentoxifylline and chimes;
• immunomodulators and antioxidants– as inflammation subsides. This is vitamin E, beta-carotene;
• herbal decoctions– after completing a course of antibiotics and uroantiseptics:
  • anti-inflammatory: chamomile, sage, St. John's wort;
  • diuretics: horsetail, lingonberry leaves, rose hips, bearberry;
  • improving regeneration: bird knotweed, mint, licorice root.

Herbs are brewed according to the instructions for each of them. On average, this is 2 tbsp, which needs to be poured into 250 ml hot water and keep in a water bath for 15 minutes, then leave for another half hour. Drink a glass of decoction a day, dividing it into 3-4 doses. Herbs having different action, can be combined.

Herbal medicine course – 20 days. You need to drink herbs 3-4 times a year. Herbal decoctions can be replaced with herbal remedies, for example, canephron, urolesan or cystone.

Physiotherapy

During the active stage, a microwave procedure is also prescribed; during the period of subsidence of the disease, a course of EVT procedures is prescribed. When the child feels well and changes in the urine have disappeared, to prevent chronicity of the process, the following is prescribed:

• paraffin applications on the kidney area;
• mud applications to the kidney area;
• medicinal (mineral, thermal, sodium chloride) baths;
• drinking bicarbonate-calcium-magnesium mineral waters.

Treatment in a hospital usually lasts for a month, then the child is observed by a local pediatrician and nephrologist. After discharge, 1 r/month control of urine and blood tests, ultrasound every 6 months. After acute pyelonephritis, if there has been no relapse for 5 years, blood and urine tests are normal, then the child is removed from the register.

Chronic course of the disease

Prevention of complications and chronicity

In case of relapse of pyelonephritis, treatment is also carried out in a hospital setting. Courses of therapy and principles are similar to those for an acute process.

Treatment is prescribed depending on the cause of the kidney infection. Maybe:

• surgical treatment (for an anomaly leading to obstruction, vesicoureteral reflux);
• diet therapy (dysmetabolic nephropathy);
• psychotherapeutic methods for neurogenic bladder dysfunction.

During remission it is indicated planned hospitalization for examination and selection of anti-relapse treatment.

Anti-relapse therapy includes:

• a course of antibiotic treatment in small doses;
• uroseptics for 2-4 weeks, then a break of 1 - 3 months;
• herbal medicine for 14 days each month.

“Under the mask” of chronic pyelonephritis is rare, but kidney tuberculosis can occur, so children are advised to consult a phthisiatrician. Before being transferred to an adult clinic, a child with chronic pyelonephritis is registered with a pediatrician and nephrologist, and routine examinations and preventive measures are carried out.

Complications

The consequences of pyelonephritis in children are serious diseases:

• apostematous nephritis (kidney covered with pustules);
• kidney carbuncle;
• urolithiasis;
• necrosis of the renal papillae;
• wrinkled kidney;
• increased blood pressure;
• renal failure, more often developing in a chronic manner.

Forecast

In chronic pyelonephritis, a condition such as a secondary wrinkled kidney often develops, when the renal tissue ceases to perform its functions, and the body can “drown” in its own fluid that accumulates in the body cavities.

If pyelonephritis develops, there are fewer and fewer active working units, and renal failure develops. An unfavorable prognosis will also occur if, due to pyelonephritis, kidney function is affected and interstitial nephritis develops.

And even if kidney function did not deteriorate, all changes in urine and blood tests are gone, and periodic bacteriological examination of urine does not show any bacteria, and it is impossible to say that the child has fully recovered.

Prevention

You can avoid pyelonephritis if you undergo preventive examinations every six months and promptly treat all organs that can become a source of chronic infection. These are carious teeth chronic tonsillitis, adenoiditis, helminths (worms).

If a child has already suffered pyelonephritis, then he must undergo a general urine test and bacteriological examination once every 1-3 months. If there are changes in the urine, even if the child has no symptoms, it is indicated preventive treatment antibiotics, uroantiseptics, drugs that improve kidney function. Such therapy can be carried out in courses of up to 5 years, because the goal is to prevent renal failure.

Thus, we examined pyelonephritis in children, focusing on its symptoms and treatment.

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

Characteristics of chronic pyelonephritis in children

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

Fibrosis and deformity internal structure kidneys - signs of chronic pyelonephritis

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

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

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

• hematogenous - through the bloodstream. Such infection is especially typical for infants under 1 year of age, but is possible at any other age;
• lymphogenous (extremely rare) - through the lymphatic vessels in severe intestinal infections;
• urinogenic - the infection ends up in the bladder and ureter, getting there from the area anus or the vestibule of the vagina in girls. Then the kidney itself becomes infected in an ascending manner.

There are three ways of infection entering the kidney: hematogenous, lymphogenous and urinogenic.

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

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

Escherichia coli is the leader among the causative agents of pyelonephritis

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

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

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

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

Pyelonephritis in children: video

Etiology and pathogenesis

The main causes of chronic pyelonephritis in children:

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

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

Classification

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

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

The disease goes through several phases of activity:

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

The chronic course mainly corresponds to secondary pyelonephritis and happens:

• obstructive - inflammation against the background of organic (congenital or acquired) disturbances in urine flow;
• non-obstructive (dysmetabolic) - when the concomitant pathology is vascular disorders, immunological deficiency, etc.

Classification of pyelonephritis in children - table

Symptoms

Chronic pyelonephritis is characterized by a wave-like course and alternating periods: exacerbation and asymptomatic. The disease can be hidden and not manifest itself for years. Relapses are accompanied by all the symptoms that are typical for acute course diseases. Kids become irritable and get tired quickly. Schoolchildren's academic performance is falling.

Signs of an exacerbation in infants include:

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

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

The peculiarity of pyelonephritis in children under 10–11 years of age is that girls in this age category are affected 3–5 times more often than boys. This is due to female anatomy: the proximity of the genital organs and the shorter urethra.

Diagnosis and differential diagnosis

At the appointment, the pediatric nephrologist will evaluate the appearance of the skin and swelling of the face. He will probe the lumbar region and lightly tap the side of the back with the edge of his palm (percussion of the kidneys). If pain or discomfort occurs, the doctor will be alerted.

This sign is called a positive Pasternatsky symptom, and it indicates the presence of inflammation in the kidney. But the main diagnostic methods are instrumental examinations and specific tests. The diagnosis is made primarily based on the results laboratory research. You will need:

Normally, protein in the urine can be contained in negligible quantities; practically it should not be there, just like urea in the blood. Thus, it is possible to trace the pathological tendencies of the disorder excretory function kidney

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

Chronic pyelonephritis in children during exacerbation has common features with the following diseases requiring differential diagnosis:

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

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

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

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

Treatment

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

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

The main treatment is supplemented with mandatory adjustments to the child’s diet.

Drug therapy

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

Approach pediatric nephrologist the choice of antibiotic is based on a number of criteria. The medicine should be:

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

• semisynthetic penicillins (Amoxiclav, Augmentin);
• cephalosporins 2, 3 generations (Ketocef, Mandol, Claforan, Fortum, Epocelin);
• aminoglycosides (Amikacin, Gentamicin).

Antibiotics are suggested to be taken orally or administered intramuscularly, it depends on the age of the child and the severity of the condition. The dosage regimen prescribed by the nephrologist must be strictly followed. This will eliminate the possibility of bacteria developing resistance to active substance medications.

Ofloxacin is a broad-spectrum antibiotic that is used only as a reserve uroseptic when others antimicrobials ineffective.

Additional groups of drugs included in the required complex therapy include:

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

Medications - photo gallery

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

Diet

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

It is necessary to exclude the following foods from the child’s food:

In addition, you should not overuse salty foods and protein foods, which irritate and burden the kidneys with unnecessary “work.”

Physiotherapy and pyelonephritis

During the inactive phase, supportive physiotherapeutic procedures are relevant. Shown are balneological and mineral resorts. Waters of moderate and low mineralization (Naftusya, Borjomi) have a good diuretic effect. Patients are prescribed procedures that increase local blood flow and activate the general immunological status:

A contraindication to physical therapy for pyelonephritis is an active inflammatory process.

Surgical intervention

Indication for surgical treatment children with recurrent pyelonephritis is vesicoureteral reflux severe(4–5), which repeatedly provoked recurrence of infection. In this case, the urologist recommends a minimally invasive procedure - endoscopic plastic correction of the ureteric orifice, where a certain amount of collagen gel is injected with a special long needle. This is how a “substitute” valve is artificially formed between bladder and ureter. Surgery for PMR is not always necessary, because often the child is already a junior school age The defect “outgrows” on its own.

Other cases when you may need surgery in children with pyelonephritis, include:

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

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

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

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

Folk remedies

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

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

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

Folk remedies against chronic pyelonephritis: photo gallery

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

Features of the treatment of chronic pyelonephritis in children with double kidneys

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

People with a double kidney live fully, observing increased preventive measures

There are cases when the daughter ureter does not “flow” into the main one, but is discharged into the intestine or vagina. With such pathologies, the child will leak urine.

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

Forecast

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

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

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

Infants may additionally develop vascular disorders of the renal tissue.

Prevention of chronic pyelonephritis in children

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

Children with double abnormal kidney and an increased risk of infection of the urinary system should also be observed by a nephrologist.

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

In childhood, the risk of contracting infectious diseases is quite high, because the child’s immunity is not yet formed and cannot resist pathogenic microorganisms in to the fullest. One of the dangerous infectious diseases is pyelonephritis. Inflammation of the kidneys in newborns and young and older children can lead to undesirable consequences, therefore, it is necessary to know its signs and be able to take timely measures to eliminate the pathology.

What is pyelonephritis, and what are the causes of its occurrence in children?

Pyelonephritis in children is an infectious inflammation of the kidneys. The infection enters the pyelocaliceal region of the kidneys, affects its tubules and soft fabrics around. Since the excretory organ has a complex structure, the failure of even a small area leads to a malfunction of the entire kidney.

In children under one year of age, the incidence of the disease does not depend on gender; by the age of 2-3 years, the likelihood of kidney damage in girls is higher. This is due to the structural features of the female body, but the likelihood of kidney inflammation in a boy also exists.

The causes of pyelonephritis can be divided into 2 main groups. The first is infection. It can enter the body by ascending, lymphogenous or hematogenous routes. In the first case, bacteria enter through the urinary system - girls have a urethra through which pathogenic microorganisms can easily pass, so the risk of infection is higher than in representatives of the opposite sex. The main causative agents of such inflammation are Escherichia coli, staphylococcus, enterococcus, pathogenic fungi, Klebsiella (we recommend reading:).

In other cases, the infection spreads through the lymphatic tract or through the blood, moving up to internal organs. Pyelonephritis can become a complication of tonsillitis, otitis media, tonsillitis or other viral diseases.

The second group includes kidney pathologies. Their main function is filtering. The organ cleanses the body of infiltrates and toxins, removes them along with urine, so a malfunction in its work leads to a delay harmful products metabolism and poisoning of the body. Exactly irregular structure kidney or urinary system is considered the most common cause pyelonephritis in children.

Types and symptoms of pyelonephritis in children under one year of age and older

The danger of the disease lies in the possible occurrence of morphological changes excretory organ, disruption of its functioning. In children, the immune system is not yet fully formed, and it is more difficult for it to fight the virus. Particular attention to the health of the urinary system should be paid to those parents whose children suffer from urolithiasis, kidney pathologies, spinal cord injuries, and immunodeficiency.

Acute and chronic

The classification of pyelonephritis is based on the division of the disease into types of functional impairment. Each of them has characteristic signs that differ in the severity of the inflammatory process. Acute pyelonephritis in children has the following symptoms:

• body temperature above 38˚, which lasts for a long time;
• signs of intoxication: nausea, vomiting, apathy, pale skin color, refusal to eat, dark circles under the eyes;
• change in urine color, smell or consistency;
• nagging pain in the lower abdomen, radiating to the lower back and subsiding when warmed up.

Pyelonephritis has wide range symptoms (sometimes it can be confused with another disease), therefore, for an accurate diagnosis, a doctor’s examination and tests are necessary

Pyelonephritis in newborns is expressed by the following symptoms:

• vomiting, frequent regurgitation;
• temperature up to 40˚;
• convulsions;
• lack of appetite, breast refusal;
• manifestations of dehydration: rare urination, loose and dry skin;
• loose stools;
• pale skin that turns red before urinating;
• restless state, causeless crying.

Unlike the acute form, chronic pyelonephritis in children does not go away quickly. Treatment will take several months, and relapses may subsequently occur.

Symptoms chronic disease will be observed only during exacerbations, but they will not differ from signs of acute inflammation. With a prolonged course of the condition, a sick child may develop:

• mental retardation, decreased academic performance;
• excitement, irritability;
• decreased physical activity;
• fatigue.

Primary and secondary

Depending on the nature of the disease, primary and secondary pyelonephritis are distinguished. In the first case, we are talking about an infection. Pathogenic microorganisms enter the urinary system, and the inflammatory process begins. In the secondary form of the disease, the pathology is caused by abnormalities in the structure of the kidneys, their tubules or cavities - inflammation causes urinary retention.

Diagnosis of the disease

If acute symptoms appear, parents should immediately consult a doctor. First of all, the doctor will refer the child for a general and biochemical analysis of urine and blood. Additionally, bacterial culture tests are done; the pediatrician needs to find out the cause of the inflammation.

During diagnosis, it is important to take into account the number of urinations and urges. Ultrasound diagnostics will help assess the condition of the kidneys. Using pulsed or color Doppler ultrasound, it is possible to identify morphological changes in the kidneys, urolithiasis, and anomalies of the pelvis.

Ultrasound of the kidneys in a child

If there is doubt about the diagnosis, the specialist may refer the child for one of the following additional studies:

• excretory urography;
• urodynamic study;
• dynamic renal scintigraphy;
• CT or MRI of the kidneys.

Features of treatment for children of different ages

The principles of treatment for pyelonephritis will depend on its form, but the main rule of therapy is complexity. This includes treatment with tablets - antimicrobial drugs, anti-inflammatory drugs, and uroseptics are used to prevent relapse. Therapy is supplemented by a special nutritional plan, establishing a daily routine and folk remedies.

Antibiotics and other drugs

Therapy for pyelonephritis in children involves a long course, the duration of which will depend on the age of the child. The younger the patient, the longer it is necessary to take medications - this is due to the underdevelopment of the urinary system. Drug treatment involves 2 stages: antimicrobial therapy and anti-relapse course.

At the first stage, antibiotics are usually used, among them:

• Latest generation cephalosporins. Prescribed to children from 0 to 3 months, introduced into the body by injection or inhalation.
• Amoxicillin – penicillin antibiotic wide spectrum of action. Can be prescribed to infants from 4 months.
• Furamag. The tablets are approved for children over 3 years of age; the antimicrobial agent differs in that it does not suppress the immune system.
• Fosfomycin. The solution in ampoules has wide range actions, infants prescribed when absolutely necessary.

To correctly prescribe an antibiotic, the doctor needs to see the results of the bacterial culture test. This will allow you to understand which infection needs to be treated. Among the effective uroseptics are: Furagin, Palin, Nevigramon, Nitroxalin.

Special diet

Diet is an essential attribute of rapid recovery. A special menu is aimed at enhancing the diuretic functions of the body, so the amount of salt, proteins and carbohydrates in the diet is reduced. The severity of the diet depends on the baby’s condition - with an acute form of the disease, the patient will have to endure more restrictions than with a chronic one.

With pyelonephritis, the child must drink plenty of fluids daily

The main principles of nutrition include:

1. Reducing the load on the kidneys in the first days of an exacerbation. To do this, it is necessary to reduce portions and increase the number of meals to 5–6 times a day.
2. Liquids will help reduce pain - the child should drink at least 2 liters per day. In this case, it is allowed to replace water with compotes, herbal teas or natural juices.
3. The last stage is necessary to normalize the functioning of the organ and prevent relapses.

The third principle of nutrition involves following the following recommendations:

• in the first days of an exacerbation, the child consumes only drinks, vegetables and fruits;
• after a few days, milk porridge is added to the diet;
• it is advisable to include foods with a diuretic effect in the diet, such as watermelons, zucchini, melons (see also:);
• fish and meat are introduced into the diet only after all symptoms of the disease have disappeared; the norm of protein enters the body through dairy products;
• If the child is not allergic to honey, be sure to give him 2 tbsp. l. product, it is not necessary to eat sweets at once, you can spread the intake over the day;
• at severe forms Salt is excluded from the diet; after an exacerbation, the norm reaches 6 grams. per day;
• The baby should eat vegetables and fruits every day;
• give preference to boiled, steamed or baked food;
• The following are prohibited: marinades, pickles, mushrooms, smoked products, legumes, onions, garlic, hot spices, rich fish and meat broths.

The child’s diet should contain a lot of vegetables and fruits, which shift the urine pH to the alkaline side

Folk remedies

Traditional medicine has almost no contraindications, with the exception of individual intolerance to the components. Home remedies will be an excellent addition to complex therapy. Popular recipes include:

1. Lingonberry tincture. To prepare 1 tbsp. l. pour a glass of boiling water over the leaves of the plant, leave for 30 minutes. Drink the product in three doses - it has an excellent diuretic effect.
2. Corn silks. They also have a diuretic effect. Part of the plant must be chopped, 2 tbsp. l. pour a glass of boiling water over the resulting composition and leave for 60 minutes. Drink 1/3 cup of the strained infusion throughout the day.
3. Bearberry tincture. You can purchase a ready-made mixture at the pharmacy. 30 gr. raw materials, pour ½ liter of water, bring the mixture to a boil and leave for 30 minutes. Drink 100 ml of the strained broth throughout the day.
4. Elderberry decoction. The berry, known in Siberia, is famous for its diuretic effect. 1 tbsp. l. pour a glass of boiling water over the leaves of the plant, boil the mixture a little over low heat, cool, drink 1 tbsp. l. three times a day.
5. Birch decoction. Use dry leaves or buds of the tree. To prepare the product, take 2 tbsp. l. leaves or 1 tbsp. l. chopped kidneys, add 400 ml of boiling water and 1 tsp. soda The broth should brew, then strain it and take 100 ml 4 times a day before meals. The course of treatment is 7 days or as long as recommended by the doctor.

You can cure pyelonephritis and restore normal kidney function with birch decoction

Therapeutic exercise and massage

Physiotherapy, exercise therapy and massage have proven themselves as rehabilitation methods. They are prescribed after the main treatment and depend on the patient’s condition and age. Exercises should be selected by a doctor, since depending on the form of inflammation, the patient may have restrictions on physical activity.

Physical education can be carried out at home, the main thing is to make sure that the child is feeling well, his temperature should be normal. Alternate between easy and difficult exercises, give your baby time to rest. When a kidney prolapses, you can do gymnastics only in a lying position.

Therapeutic exercise and massage for pyelonephritis are aimed at:

• acceleration of the body's metabolic processes;
• activation of blood flow in the kidneys;
• normalization of renal excretory function;
• increasing immunity and physical endurance.

The duration of classes will depend on age:

• 20-25 minutes for children under 7 years old;
• 30 minutes for primary schoolchildren;
• 40 minutes for older children.

Complex treatment disease necessarily includes light physical activity

Possible complications of pyelonephritis

If treatment for the disease begins on time, then most often it passes without any consequences. Pediatrics contains the following statistics: 80% of children, including young children, have mild or medium degree gravity. The approximate duration of treatment is one month. However, in cases where the disease was not diagnosed in time, the following complications are possible:

• development of renal failure in acute or chronic form, in extreme cases, death is possible;
• intoxication of the body, bacteriostatic shock, blood poisoning;
• the appearance of pus, abscess;
• hypertension;
• pneumonia;
• decreased hemoglobin level in the blood, iron deficiency anemia;
• rickets;
• renal coma;
• intestinal dysbiosis;
• hypoxia of the brain.

Preventive measures

Prevention of pyelonephritis in children is necessary in two cases: to avoid the disease or to prevent relapses. The main preventive measure is strengthening the immune system.

If the child’s body can resist infection, then infection will not occur. Other preventive measures:

• timely treatment of infections - even caries can become the basis for kidney inflammation;
• maintain a water regime according to the child’s age needs - the liquid “washes” the body, ridding it of pathogenic bacteria;
• Make sure that your baby’s diet contains vitamin C - it not only strengthens the immune system, but also increases the acidity of urine, neutralizing bacteria;
• personal hygiene should be daily; girls should be washed from front to back;
• Explain to your child that you don’t have to endure it if you want to go to the toilet, you need to empty your bladder completely;
• children should not be overcooled - cold promotes the development of inflammation;
• Mom should change her diaper regularly one year old child and ensure that wet underwear does not come into contact with the genitals.

Pyelonephritis can be diagnosed in children at any age - this is a common diagnosis. Don’t be afraid, the main thing is to recognize the problem in time and start treatment, then the disease will go away without consequences.