Genitourinary infection in infants symptoms. Several important facts about the disease

Among all infectious and inflammatory diseases in children in terms of frequency of occurrence, infection is second after infection of the respiratory tract urinary tract... It is characteristic that infants can proceed quite violently or, on the contrary, asymptomatic. In the latter case, it is possible to guess about the existing inflammatory process only after receiving the results.

Symptoms of a urinary tract infection in infants

Urinary tract infection is a collective term that means the presence of an infectious and inflammatory process in the urinary organs without specifying the localization of the pathological process. An infectious and inflammatory process can occur in the upper urinary organs (kidneys, ureter) or lower urinary organs (bladder, urethra). But it is very difficult to determine the exact localization of the inflammatory process in infants, so they are often given a generalized diagnosis of urinary tract infection.

Small children under the age of one year are not able to tell where they have pain and what worries them. Parents can only guess what caused the baby's restless behavior. Urinary tract infection at this age can manifest itself with completely nonspecific symptoms that are observed with a variety of pathological conditions. These are symptoms such as:

1. Insufficient weight gain according to age;
2. Lethargy or restlessness, crying baby;
3. Fever
4. Pallor of the skin;
5. Violations of the rhythm of urination: straining when urinating, frequent or reduced urination, urinary incontinence (including at night);
6. Cloudy urine.

Diagnosis of the disease

You can confirm the presence of a urinary tract infection. laboratory research... First of all, they carry it out. For more information on how to properly collect urine from babies, see. The detection of bacteria in the urine, the level of leukocytes in excess of 10 in 1 μl signals inflammation in the urinary tract... V mandatory bacterial culture of urine is performed. The detection of bacteria in the urine of more than 10 4 CFR / ml confirms the presence of a urinary tract infection. allows you to identify the causative agent of the infection and immediately choose the right one.

In addition, to clarify the diagnosis, conducting of the organs of the urinary system is shown.... The research method allows to assess the structure and size of the renal parenchyma, to identify possible anomalies in the development of urinary organs. Young children with urinary tract infections also undergo a voiding cystography (only during remission of the disease). it X-ray examination the bladder, which is carried out during urination. The method allows you to identify vesicoureteral reflux, which promotes the development of inflammation in the urinary tract.

Principles of treating urinary tract infections in children under one year old

Active treatment of a child with a urinary tract infection should begin with the first symptoms of the disease. You can't hesitate, because an infection localized in the lower urinary organs can quickly get into the kidneys. Treatment of infants with urinary infection is carried out in a hospital.

Antibiotic therapy

Inflammation in the urinary organs is caused by bacteria, which can only be dealt with with the help of antibacterial agents. is selected taking into account the pathogen isolated during bacterial sowing. Until the results of bacterial culture are obtained, broad-spectrum antibiotics are used.

The drugs of the first choice are antibiotics from the group of cephalosporins (Cefuroxis, Cefix, Cefpodoxime), as well as protected penicillins (Augmentin, Flemoklav Solutab). If, after three days of treatment, the baby remains intoxication, fever, the doctor changes the drug. Alternative antibiotics are aminoglycosides (Amikacin, Gentamicin) and combination drugs (Sulbactomax). Duration of treatment is 7-14 days.

After the completion of antibiotic therapy, uroseptics are prescribed - nitrofurans (Furamag, Furadonin, Furagin), herbal preparations(Kanephron N). These medicines have antimicrobial effect.

Complementary treatment

With severe intoxication, the baby is prescribed detoxification agents (Reosorbilact, Xylat). Detoxification therapy promotes the active removal of bacteria from the body and, accordingly, the elimination of intoxication. At temperatures above 38 degrees, the baby can be given or. These drugs also have anti-inflammatory effects. To relieve pain, the child is credited with antispasmodics (No-Shpa, Papaverine).

In this article, we will tell you about which children have urinary tract infections and discuss which treatment is most effective for children early age(babies) and older children.
Now children are often diagnosed with various infectious diseases urinary tract: cystitis, pyelonephritis, urethritis. Urinary tract infection in children can proceed with complications, as well as without them and treatment the disease must be agreed with the pediatrician so that the disease does not go into the chronic stage. According to statistics, boys and girls under 12 months old suffer from pyelonephritis equally often. Later, the disease occurs more often in girls. When the baby catches a urinary tract infection for the second time, or after a course of treatment, the situation worsens again - do child urological examination... Symptoms may indicate inflammation of the renal pelvis (chronic pyelonephritis), which brings a lot of complications and significantly threatens the baby's health.

A child who is suspected of having an infectious disease of the urinary tract is examined using minimally invasive methods, they are very sensitive. Urinary tract infection in infants is treated only in stationary conditions and under the supervision of a pediatric urologist.

Urinary tract infections can be recognized by the following signs: frequent urination, pain (itching, burning) in the urethra, which becomes more noticeable with urge, urinary incontinence can occur at any time of the day. These are the main manifestations (symptoms) of cystitis, pyelonephritis. The latter is characterized by an increase in body temperature in a child. The infection provokes redness of the external genital tract. The kid becomes whiny, lethargic.

If the child's urination is too infrequent, this cannot be ignored. Perhaps a harmless symptom speaks of a serious illness - neurogenic bladder, which appears as a result of damage to the nervous system (central).

Urinary tract infections need to be treated early, otherwise complications cannot be avoided. The parenchyma of the kidney is damaged (sometimes wrinkled areas are formed), sepsis.

Prophylaxis such diseases is simple - you need to constantly observe hygiene, daily wash the buttocks, external genitals and groin. Treat risk areas with specialized milk, vaseline oil, or ordinary baby cream. If you suspect an infection, immediately consult with your doctor and have a urine test, preferably a general one, to check both bacterial culture and drug sensitivity.

For treating urinary tract infections in children a course of antibiotics is prescribed. The kid should consume more liquid, dill, parsley (peeled), spinach juice, cucumber (diuretics) are added to the diet. Black currant juice relieves inflammation, it contains vitamin C... An infusion of currant leaves is also recommended.

Next, we will tell you how urinary tract infection enters the urinary tract and which microorganisms cause diseases (cystitis, pyelonephritis, urethritis). You will also learn which drug treatment is most effective in combating pathogens and how you can treat urinary tract infections with folk remedies.

Now you know how it is diagnosed a urinary tract infection in infants and what treatment of the affected parts of the urinary tract from the kidneys to the urethra and the infected bladder should be organized when symptoms of the disease are detected. You also read folk methods treatment of cystitis, pyelonephritis and other infectious diseases genitourinary system.

Next article.

Not a single internal organ of the child is immune from bacterial damage. A urinary tract infection in infants is a severe inflammation that develops in this system. Depending on the form and nature of the manifestation of the disease, the crumbs are diagnosed with urethritis, cystitis or pyelonephritis. Diseases can manifest themselves at any age. Today they are found quite often and, according to statistics, rank second after SARS. Urinary tract infections in infants occur in one in eight cases.

Parents should be aware that the disease can pass without specific manifestations. Specific signs are recorded only in severe cases. In the presence of the first symptoms of the disease, you should immediately seek help from a pediatrician. A timely diagnosis can save a young patient from complications and a sharp deterioration in the health status of a young patient.

Individual predisposition

The nature and specificity of the manifestation of this disease in children directly depends on age and gender. Before the age of one year, the disease most often affects boys, and girls suffer from it from two to fifteen years.

A genitourinary infection develops against the background of improper coordination of urine excretion from the body.

Negative urodynamics is observed in the following cases:

• Uropathy develops against the background of an obstructive situation. The disease is dangerous and can lead to a complete blockage of urine flow and damage to the underlying tissue of the kidneys.
• Reflux is a manifestation in which urine is not excreted, but passes from the bladder directly to the kidney.
• Non-inflammatory dysfunction occurs with problems with filling and emptying the bladder.

The causes of urinary tract infection may lie in the presence of the following diseases in the child's body:

• diabetes;
• stones in the kidneys;
• calcareous degeneration is observed in the body;
• pathology against which education occurs a large number urats;
• a large amount of oxalates has accumulated in the internal organs.

A blood test will help determine the type of infection.

In medical practice, the disease in newborns also develops under the influence of the following reasons:

• In the body of the crumbs, a large number of microbes of a certain pathogenic type were recorded.
• The immune system cannot produce enough antibodies, so the body's defenses are reduced at the cellular level.
• In the tissues of the kidneys, vessels can change their structure. In this case, the pathology develops against the background of narrowing or ischemia.
• Previously, medical instruments were manipulated in the organs of the genitourinary system.

The reasons for the development of pathology

Ailments urinary tract may begin due to blood flow to tissue with disease-causing bacteria. The situation is aggravated by inflammation in the child's body. Of no small importance are environment, food and the implementation of basic rules and regulations of personal hygiene.

Against the background of a decrease in the level of protection of the bacterial flora, an inflammatory process begins to develop. Its character directly depends on the level of immunity and the state of the intestines. Living conditions, age and gender of the baby can play a negative role.

Diseases of the urinary tract develop under the influence of the following negative factors:

• Individual features of the structure of the system.
• Channel anomalies can be traced in the infant from the very development. The complication process can occur during gestation or labor.
• The child suffered from severe hypothermia.
• Abnormal functioning of the immune system.
• A hereditary predisposition has a negative impact on the development of the disease.
• The boy was previously diagnosed with phimosis. The disease develops due to the narrowing of the exit from the penis.
• In girls, immediately after birth, a fusion of the labia was found, which in medical practice is known as synechia.
• The kid constantly suffers from diseases gastrointestinal tract... Constipation, dysbiosis and other intestinal infections can play a negative role.

Additionally, it should be noted that, according to statistics, boys who have undergone circumcision are eight times less likely to suffer from diseases of the genitourinary system. It involves circumcision foreskin surgical methods.

The nature of the manifestation of the disease

Symptoms of a urinary tract infection directly depend on their location and the severity of the disease. In infants, cystitis and pyelonephritis are most commonly diagnosed.

Additionally, the main signs of dangerous ailments should be highlighted:

• The instinct to suck is noticeably reduced.
• Refusal to eat due to lack of appetite.
• The kid becomes too irritable.
• Regular regurgitation that occurs more often than usual.
• Stool disorder.
• The skin becomes gray against the background of excessive intoxication.
• The kid is not gaining weight.

Female children are at increased risk of developing asymptomatic bacteriuria. The defeat of the ureters does not have a special clinical picture. However, a close examination of urine can reveal negative changes in its color and odor. The urine becomes completely transparent. Only laboratory research will help to correctly determine the number of microbes.

Diseases of the urinary tract give the baby a lot of inconvenience

Most diseases of the genitourinary system have a pronounced clinical picture... During the development of cystitis in a child, the following manifestations can be found:

• Urine is excreted in small quantities and in small portions. If the course of treatment is not started on time, then the child begins to develop incontinence.
• In addition, the baby can experience strong tension in the pubic area.
• Increased body temperature.

Any inflammation of an infectious and inflammatory nature is dangerous for the fragile body of the baby. Pyelonephritis is characterized by the following manifestations:

• The body temperature rises to 39 degrees.
• Fever.
• Refusal of the child from food.
• The skin looks pale.
• Apathy.
• Stool upset and vomiting.
• If treatment is not started on time, the child may develop encephalopathy and irritation of the meninges.
• The emergence severe pain in the lumbar region.

Definition of disease

The urinary system has a number of features. Against their background, the inflammatory process develops very quickly. If the treatment was not provided on time, then the risk of developing serious consequences increases markedly.

Against the background of cystitis, pyelonephritis is also actively developing. It is dangerous and can affect a large number of internal organs. It most often affects the kidneys. It is important to diagnose the disease in a timely manner.

Only a comprehensive study will help to correctly determine the disease:

• Analysis of the state of urine, the presence of protein, erythrocytes and leukocytes in it. The number of bacteria is also important. Against their background, inflammation develops.
• For a detailed study of urine, special techniques are also used. In the course of their implementation, attention is drawn to key indicators.
• Analysis of ESR parameters. With an excessive number of leukocytes, the risk of active development of inflammation in the child's body increases.
• For correct diagnosis a bacterial urine test should be taken. Thanks to him, it will be possible to determine the type of pathogen. In the future, treatment will be easier due to a clear understanding of the susceptibility of the microorganism to antibiotics.
• You will also need to conduct a serological blood test - this is one of the screening options. Thanks to this, it is possible to detect antibodies to certain types of dangerous bacteria.
• Ultrasound is necessary to study the condition of the tissues of internal organs. The procedure helps to investigate tissue abnormalities.
• Cystomanometry is one of the most popular invasive methods that can help track urodynamics.
• Of no small importance is the rate of urine outflow. Uroflowmetry is used to detect abnormalities in this process.

Infection causes problems with urine waste

Features of the treatment of ailments

To quickly and effectively eliminate ailments in the urinary organs, it is necessary to undergo antibiotic treatment. Only a specialist in this field can choose it correctly. To eliminate this type of problem, it is advisable to use the following drugs:

• Penicillin Inhibitors Help Kill Bacteria different groups... A properly selected drug blocks the negative effects of microbes.
• Additionally, you will need to take antibiotics or aminoglycosides. This group of drugs has a pronounced antibacterial effect.
• Cephalosporins are more effective. They help eliminate harmful bacteria in a short time.
• If an infection is diagnosed in a serious condition, carbapenems should be used. These antibiotics have a broad spectrum of action.
• To eliminate the infection without visible complications, it is allowed to use uroantiseptics of plant origin. Only a doctor can choose them correctly, and self-medication can lead to serious consequences.
• For gentle action against microbes, oxyquinolines should be used. They are rapidly absorbed into the intestinal wall, so the effect is achieved within a short time.

To improve overall well-being, it is also advisable to use the following therapeutic drugs:

• Anti-inflammatory drugs without steroids.
• Preparations for desensitizing effects on the body.
• Thanks to antioxidants, all cells can quickly heal. Additionally, vitamin E is also included in the course of treatment.

To improve the general well-being of the crumbs, it is advisable to give him as much liquid as possible. Mineral water with a low alkali content has a positive effect. In the diet of the crumbs, cranberry or lingonberry juice should also be present.

It is important to direct all forces to exit their acute period. After that, it is recommended to additionally use pine needles baths, therapeutic mud and regular visits to the physiotherapy room.

With inflammation of the urinary organs for the treatment of children, only in rare cases are used medications... It is best to carry out therapy with folk methods using herbal teas.

Measures to prevent disease

Serious complications can occur if urinary tract infections are left untreated. The disease leads to damage to the parenchymal tissue. They begin to shrivel, which leads to arterial hypertension... As a result, the little patient develops renal failure or sepsis.

In this case, the likelihood of relapse increases by 25%. A nephrologist will help to minimize the negative process. The baby must be registered with him without fail. For prevention, it is advisable to use antibacterial or antiseptic drugs.

Prevention in the presence of the first symptoms of the disease:

• It is recommended to feed the baby exclusively with mother's milk. It contains enough antibodies to help it fight off the infection.
• Diapers must be used correctly. At the same time, it is important to observe all the rules and regulations of personal hygiene.
• Infectious lesions should be removed at all times.
• Using drugs to improve the immune system.
• Parents should make sure that the child has the correct daily routine.
• Elimination of factors that can negatively affect the health of the little patient.

Recognize the disease on early stage preventive examinations will help. For this, urine and blood are taken from the baby for analysis. Parents are not advised to ignore their regular delivery.

One of the very serious problems and common reason hospitalization in childhood is an infection of the urinary system. Why it arises, how it manifests itself and what in this case should be taken by the parents, you will find out in this article.

Urinary tract infection develops in children at any age, but is more common in babies under 3 years of age. To this predispose the features of the structure and work of the urinary system of the child. I will dwell on them in more detail - as I consider it important.

The organs of the urinary system are the kidneys, ureters, bladder, and urethra (urethra). The kidneys act as a natural filter that removes toxins and excess fluid from the body, as well as balancing the internal environment of the body. The bladder is the main storage reservoir for urine. It gradually fills with urine, and when its volume is more than half full, the person has an urge to urinate, that is, there is a desire to urinate, and urine from the bladder is excreted through the urethra.

By the time a baby is born, each kidney contains at least a million glomeruli and renal tubules. After birth, new glomeruli can only form in premature babies. As intrauterine and extrauterine development progresses, the kidneys tend to descend.

In a newborn baby, the maturation of the kidneys is not yet complete. The kidneys in young children are relatively larger than in adults, located below the iliac crest (up to 2 years), their structure in the first years is lobular, and the fat capsule is weakly expressed, in this regard, the kidneys are more mobile and palpable up to 2 years of age (that is, the doctor can feel them), especially the right one.

The cortical layer of the kidneys is underdeveloped, pyramids medulla therefore, they almost reach the capsule. The number of nephrons in young children is the same as in adults (1 million in each kidney), but they are smaller in size, their degree of development is not the same: juxtamedullary nephrons are better developed, cortical and isocortical nephrons are worse. The epithelium of the basement membrane of the glomerulus is high, cylindrical, which leads to a decrease in the filtration surface and a higher resistance at the same time. The tubules in young children, especially in newborns, are narrow, short, Henle's loop is also shorter, and the distance between the descending and ascending knees is greater.

The differentiation of the epithelium of the tubules, the loop of Henle and the collecting ducts has not yet been completed. The juxtaglomerular apparatus has not yet been formed in young children. Morphological maturation of the kidney as a whole ends by school age(by 3-6 years old). The renal pelvis are relatively well developed, in young children they are located mainly intrarenal, and the muscle and elastic tissue in them is poorly developed. A feature is the close connection of the lymphatic vessels of the kidneys with similar vessels of the intestine, which explains the ease of the transition of infection from the intestine to the renal pelvis and the development of pyelonephritis.

The kidneys are the most important organ for maintaining balance and relative constancy of the internal environment of the body (homeostasis). This is achieved by filtration in the glomeruli of water and residual products of nitrogen metabolism, electrolytes, active transport of a number of substances in the tubules. In addition, the kidneys perform an important secretory function, producing erythropoietin (this substance helps to synthesize red blood cells), renin (maintains the level of blood pressure), urokinase and local tissue hormones (prostaglandins, kinins), as well as convert vitamin D into its active form... Although the ureters in young children are relatively wider than in adults, they are more tortuous, hypotonic due to the poor development of muscle and elastic fibers, which predisposes to urinary stagnation and the development of a microbial-inflammatory process in the kidneys.
The bladder in young children is located higher than in adults, so it can be easily palpated above the pubis, which, in the absence of urination for a long time, makes it possible to differentiate its reflex delay from the cessation of urination. In the bladder, the mucous membrane is well developed, weakly elastic and muscle... The capacity of the bladder of a newborn is up to 50 ml, at one year old child- up to 100-150 ml.

The urethra in newborn boys is 5-6 cm long. Its growth is uneven: it slows down somewhat in early childhood and significantly accelerates during puberty (increases to 14-18 cm). In newborn girls, its length is 1-1.5 cm, and at 16 years old - 3-3.3 cm, its diameter is wider than that of boys. In girls, due to these features of the urethra and proximity to the anus, infection is possible, which must be taken into account when organizing care for them. The mucous membrane of the urethra in children is thin, delicate, easily injured, its folding is poorly expressed.
Urination is a reflex act carried out by congenital spinal reflexes. The formation of a conditioned reflex and neatness skills should be started from the age of 5-6 months, and by the year the child should already ask for a potty. However, in children under 3 years of age, involuntary urination can be observed during sleep, exciting games, excitement. The number of urinations in children during the neonatal period is 20-25, in infants - at least 15 per day. The amount of urine per day in children increases with age. In children over one year old, it can be calculated by the formula: 600+ 100 (x-1), where x is the number of years, 600 is the daily urine output of a one-year-old child.

The most common nephrological problems in children are enlargement of the renal pelvis (hydronephrosis), urinary tract infections, dysmetabolic nephropathies, and bladder dysfunction. A nephrologist is involved in the prevention, diagnosis and treatment of kidney diseases.

Urinary infection is a microbial-inflammatory process in any segment of the mucous membrane of the urinary tract throughout its entire length (in the urethra, bladder, pelvis, calyx), which also captures the kidney tissue itself.
Despite the fact that this does not give an exact idea of ​​the localization of the focus of inflammation, the term is widely used by pediatricians, because it corresponds to the modern point of view about the diffusion (prevalence) of the pathological process in the urinary system. This is explained by the fact that children, especially young children, due to insufficient maturity of the renal tissue, as well as reduced immunity compared to adults, practically never have isolated urethritis (inflammation of the urethra), pyelitis (inflammation of the calyx of the kidney) and even cystitis ( inflammation of the bladder).

The term "urinary tract infection" unites all infectious inflammatory diseases organs of the urinary system (OMS) and includes pyelonephritis (PN), cystitis, urethritis and asymptomatic bacteriuria.
The first signs of infectious and inflammatory diseases of the compulsory medical insurance, as a rule, are detected at the preclinical stage (outpatient clinic service, ambulance service), when, in most cases, it is not possible to establish the exact localization of the process. Therefore, a diagnosis of urinary tract or urinary tract infection is eligible. Later, in a specialized hospital, the diagnosis is specified.

Urinary infection occurs especially often in newborns and children under 3 years of age, and then the number of patients gradually decreases. Its second peak falls on people over 20 years old. Among newborns and children of the first months of life, boys and girls get sick with the same frequency, later the incidence is observed mainly in girls.

Causes of the infection.

Most often, the inflammatory process in the urinary system is caused by E. coli, it belongs to the normal saprophytic flora of the large intestine, but when it gets into the kidneys (where it should not be) it can cause a pathological process.

Less often, the cause of the pathological process can be various strains of Proteus, Pseudomonas aeruginosa and other gram-negative microorganisms, sometimes also gram-positive microbes. Among the latter, Staphylococcus aureus is most often found, entering the blood stream from an inflammatory focus in some organ, and from there into the kidney. Such a source in newborns can be purulent omphalitis (inflammation of the navel), abscess pneumonia, abscesses on the skin. The emergence and further development of infection is facilitated by helminthic invasions and inflammatory diseases of the external genital organs.

Development mechanism.

There are 3 known routes of infection in the kidney: hematogenous (through the blood), urinogenic (up from the urethra along the urinary tract) and lymphogenous, in which the pathogen is introduced into the kidney through the lymphatic vessels that go from the bladder along the ureters (this route is rejected by many authors). The hematogenous pathway is most common in newborns and children in the first months of life. In older children, the ascending (urinogenic) pathway becomes of primary importance when infection occurs from the lower urinary tract. The predominant incidence of morbidity among girls is a consequence of the easier ascent of the infection along urethra, since they have it relatively wider and shorter. In this case, hygienic care of the child is important. Especially easily and often, the infection penetrates with urine from the bladder into the overlying sections and kidneys in the presence of vesicoureteral reflux (urinary backflow), which is a pathological phenomenon resulting from insufficiency of the valve mechanism of the ureters or vesicoureteral junction. Neurogenic bladder dysfunction may also play a role. The presence of reflux, as well as other obstructions to the outflow of urine due to congenital malformations the formation of the urinary system or the resulting stones contributes to the development of pyelonephritis. Above the obstacle, there is a mechanical retention of bacteria in the urine.

In newborns, the development of the disease is facilitated by the structural and functional immaturity of the urinary tract and the tubular nephron. Also important are the infectious process in the mother during pregnancy, late gestosis (contributes to metabolic disorders in the child in the early postnatal period), asphyxia of the child during childbirth, sepsis during the neonatal period.

In children of the first years of life, severe gastrointestinal disorders with dehydration, inflammatory lesions of the external genital organs (vulvitis, vulvovaginitis), pneumonia, hypotrophy, rickets, hypervitaminosis D predispose to the development of pyelonephritis.

V preschool age the development of urinary tract infection is facilitated by helminthic invasions, the presence of foci of chronic infection.
An important role is assigned to hereditary metabolic disorders, fermentopathies. Favorable conditions for the development of the disease are created with metabolic disorders, accompanied by increased urinary excretion of oxalates, urates, phosphates, cystine and calcium. Along with the listed factors in the development of pyelonephritis, the immunological reactivity of the body, factors of local cellular defense are of great importance.

Most often, acute urinary infection occurs in the form of pyelonephritis (primary non-obstructive and secondary obstructive) or cystopyelonephritis. Less often, such forms as cystourethritis and cystitis are observed.
Pyelonephritis (PN) is a nonspecific, acute or chronic microbial inflammation in the pyelocaliceal system and interstitial tissue of the kidneys with involvement of the tubules, blood and lymphatic vessels in the pathological process.

Cystitis is a microbial-inflammatory process in the wall of the bladder (usually in the mucous and submucous layer).

Asymptomatic bacteriuria is a condition when, in the complete absence of clinical manifestations of the disease, bacteriuria is detected in one of the following ways:
- 10 or more microbial bodies in 1 ml of urine;
- or more than 105 colonies of microorganisms of the same species, grown by sowing 1 ml of urine taken from the middle stream;
- or 103 or more colonies of microorganisms of the same type when inoculating 1 ml of urine taken by a catheter;
- or any number of colonies of microorganisms when inoculating 1 ml of urine obtained by suprapubic puncture of the bladder. The presence of bacteria in the general analysis of urine is not a reliable criterion for bacteriuria.

Predisposing factors and risk groups.

The development of an infectious and inflammatory process in the urinary system, as a rule, occurs in the presence of predisposing factors on the part of the baby's body, the main of which is the obstruction of the flow of urine at any level.

This allows us to identify conditional risk groups for the development of infection of the urinary system:
- children with impaired urodynamics (urinary obstruction): anomalies in the development of the urinary system, vesicoureteral reflux, nephroptosis, urolithiasis, etc.;
- children with metabolic disorders in the urinary system: glucosuria, hyperuricemia, dysmetabolic nephropathy, etc.;
- disorders of urinary tract motility (neurogenic dysfunction);
- children with reduced general and local resistance: premature babies, often ill children, children with systemic or immune diseases, etc.;
- children with a possible genetic predisposition: OMS infection, abnormalities in the development of OMS, vesicoureteral reflux, etc. in relatives, a history of OMS infection of the child himself;
- children with constipation and chronic diseases intestines;
- female children, children with III (B0) or IV (AB) blood groups.

In the prenatal period, the kidneys do not function as an excretory organ - this role is played by the placenta. However, a minimal amount of urine is still formed and accumulates in the renal pelvis (a kind of funnel attached to each kidney, where small portions of urine are collected). As a result, the pelvis expands even before the baby is born. Such changes are detected during pregnancy by ultrasound or in the first months of a child's life. In most cases, the size of the pelvis returns to normal by 1 - 1.5 years. Sometimes the enlargement of the pelvis occurs as a result of the reflux of urine into them from the bladder called vesicoureteral reflux. This is a serious pathology that can lead to changes in the kidney tissue. Therefore, all children in the first months of life need to undergo ultrasound of the kidneys and urinary tract. If an expansion of the pelvis is found, you need to constantly monitor their size and monitor urine tests.

Dysmetabolic nephropathies are various metabolic disorders that are characterized by an increased amount of salts in the urine. Most often, salts of oxalates, phosphates and urates are found in urine. Their appearance in most cases is associated with the child's dietary habits and the inability of his kidneys to dissolve large quantities salts. The predominance of foods rich in oxalic acid and vitamin C in the diet (cocoa, chocolate, spinach, celery, beets, parsley, currants, radishes, sour apples, broths, cottage cheese, etc.) can increase the amount of oxalates in urine. Foods rich in purines (strong tea, cocoa, coffee, chocolate, sardines, liver, pork, offal, broths, fatty fish, tomatoes, sour mineral waters) can increase the amount of urates. An increase in the level of phosphate in urine is facilitated by foods rich in phosphorus (beef liver, cheese, cottage cheese, caviar, fish, beans, peas, chocolate, oatmeal, pearl barley, buckwheat and millet groats, alkaline mineral waters, etc.) However, in some children, dysmetabolic disorders caused by deeper, sometimes hereditary reasons and depend on the nature of the diet to a lesser extent. Salt crystals are dangerous because they can damage the kidney tissue, causing inflammation; in addition, they can serve as a background for the development of urinary tract infections and accumulate in the kidney and pelvis, forming stones. The basis for the correction of dysmetabolic disorders is a specific diet with the exclusion of foods rich in the corresponding salts, and the intake of a large amount of liquid.

Disorders of the bladder in young children are mainly associated with the immaturity of its regulation by the nervous system. They usually go away as the child grows. However, functional disorders can serve as a background for the development of deeper organic disorders; in addition, they give the child psycho-emotional discomfort, contribute to a negative mood. The most common cases in children are enuresis, daytime urinary incontinence, urinary incontinence, and neurogenic bladder.

Urinary incontinence is involuntary urination without urging; enuresis is bedwetting. Incontinence should be distinguished from urinary incontinence, in which there is an urge to urinate, but the child cannot hold urine, "run to the toilet." Often urinary incontinence manifests itself in the form of "letting in underpants" or "wet underpants" syndrome, when at first a small amount of urine is poured into the underpants, and then the bladder sphincter is triggered and urination stops. In young children, a clear reflex to urination has not yet been fully formed, so they easily “forget” about the urge, switch attention, “flirt”. The child should be encouraged to urinate periodically. Otherwise, urinary disturbances and bladder hyperextension may occur, which can lead to the appearance of vesicoureteral reflux (urine backflow from the bladder into the ureters).

Variants of the course of urinary tract infection

In children, one can conditionally distinguish three variants of its course.
Option one. Clinical manifestations diseases are absent. The study of urine reveals: bacterial leukocyturia, abacterial leukocyturia, isolated bacteriuria. Possible reasons: infectious lesion at any level of the genitourinary system - asymptomatic bacteriuria, latent infection of the lower urinary tract, latent course of PN, vulvitis, balanitis, phimosis, etc.

Option two. Clinical manifestations in the form of dysuria (pain during urination, pollakiuria, urinary incontinence or incontinence, etc.); pain or discomfort in the suprapubic area. Urinary syndrome in the form of bacterial leukocyturia (possibly in combination with hematuria of varying severity) or abacterial leukocyturia. Possible causes: cystitis, urethritis, prostatitis.

Option three. Clinical manifestations in the form of fever, symptoms of intoxication; pain in the lower back, side, abdomen, radiating to the groin, inner surface hips. Urinary syndrome in the form of bacterial leukocyturia or abacterial leukocyturia, sometimes moderate hematuria. Changes in the blood: leukocytosis, neutrophilia with a shift to the left, accelerated ESR. Possible causes: pyelonephritis, pyelonephritis with cystitis (with dysuria).

Features of the course of pyelonephritis.

In the clinic of pyelonephritis in young children, symptoms of intoxication prevail. Possible development of neurotoxicosis, the appearance of meningeal symptoms, frequent regurgitation and vomiting at the height of intoxication. Often in children of the first year of life, a complete refusal to eat is possible with the development of malnutrition. On examination, attention is drawn to the pallor of the skin, periorbital cyanosis, possibly pasty eyelids.

Often pyelonephritis at an early age proceeds under various "masks": dyspeptic disorders, sharp stomach, pylorospasm, intestinal syndrome, septic process, etc. When such symptoms appear, it is necessary to exclude the presence of an infection of the urinary system.

In older children, "general infectious" symptoms are less pronounced, often "causeless" rises in temperature are possible against the background of normal health. They are characterized by fever with chills, symptoms of intoxication, constant or recurrent pain in the abdomen and lumbar region, a positive symptom of tapping. Perhaps the course of pyelonephritis under the "mask" of influenza or acute appendicitis.

Features of the course of cystitis.

In older children and adults, cystitis most often proceeds as "local suffering", without fever and symptoms of intoxication. With hemorrhagic cystitis, the leading in the urinary syndrome will be hematuria, sometimes gross hematuria (urine of the color of meat slops). In infants and young children, cystitis often occurs with symptoms of general intoxication and fever. They are characterized by the frequent development of stranguria (urinary retention).

Kidney stone disease in children develops less often than in adults. Stones are formed from salt crystals, which are dissolved in normal urine; they can be located in the tissue of the kidney, renal pelvis and their cups, bladder. The formation of stones is associated with impaired metabolism (in particular, mineral), non-observance of the diet, as well as with obstructed outflow of urine with various malformations of the urinary system. Often, nephrolithiasis is combined with pyelonephritis, since the stone creates conditions for the development of infection. The disease is usually manifested by bouts of acute lower back pain radiating to the lower abdomen.

Seizures renal colic often accompanied by vomiting, fever, gas and stool retention, urination disorder. Blood is found in the urine (this is due to the fact that when a stone passes through the urinary tract, their mucous membrane is damaged). Treatment in most cases is prompt.

Diagnosis of infection.

Often, diseases of the urinary system are hidden, so any unusual symptoms that appear in a child should alert parents and the attending physician. Fortunately, these symptoms are easy to spot.
Kidney Disease Symptoms:
· Unmotivated increase in temperature (without ARVI symptoms);
· Recurrent pain in the lower abdomen or in the lumbar region;
· Daytime "admitting" of urine;
· Nocturnal and daytime enuresis;
· Frequent or frequent urination.

To diagnose infections of the urinary system, laboratory instrumental research methods are used.

To identify the activity and localization of the microbial-inflammatory process. Mandatory laboratory tests such as CBC and biochemical analysis blood (total protein, protein fractions, creatinine, urea, fibrinogen, CRP). General urine analysis; quantitative urine tests (according to Nechiporenko); sowing urine for flora with a quantitative assessment of the degree of bacteriuria; urine antibioticogram (antibiotic sensitivity); biochemical examination of urine (daily excretion of protein, oxalates, urates, cystine, calcium salts, indicators of membrane instability - peroxides, lipids, anticrystalline ability of urine).

In some cases, additional laboratory tests will be required, such as quantitative urine tests (according to Amburge, Addis-Kakovsky); morphology of urine sediment; urine test for chlamydia, mycoplasma, ureaplasma (PCR, culture, cytological, serological methods), fungi, viruses, mycobacterium tuberculosis (urine culture, express diagnostics); study of immunological status (sIgA, state of phagocytosis).

In addition to analyzes, special studies are also carried out to characterize the functional state of the kidneys, tubular apparatus and bladder.
Laboratory tests are mandatory: the level of creatinine, urea in the blood; Zimnitsky test; endogenous creatinine clearance; research of pH, titratable acidity, ammonia excretion; diuresis control; the rhythm and volume of spontaneous urination.

Required and instrumental research such as measuring blood pressure; Ultrasound of the urinary system; X-ray contrast studies (vocal cystoscopy, excretory urography) - with repeated episodes of IMS and only in the phase of minimal activity or remission.

Additionally, a nephrologist may prescribe Doppler ultrasound (USDG) of the renal blood flow; excretory urography, cystoureteroscopy; radionuclide studies (scintigraphy); functional methods bladder studies (uroflowmetry, cystometry); electroencephalography; echoencephalography; CT scan; Magnetic resonance imaging.
Consultations of specialists are required: pediatric gynecologist or urologist. If necessary: ​​neurologist, otorhinolaryngologist, ophthalmologist, cardiologist, dentist, surgeon.

Principles of treatment of infectious diseases of the urinary system.

V acute period or in case of an exacerbation, the child should be treated in a hospital or at home under the supervision of a doctor. After the child is discharged from the hospital certain time periodically observed by a nephrologist or urologist, whose appointments must be strictly followed. An exacerbation of the disease can be caused by any infection, therefore, try to protect the child from contact with patients with influenza, sore throat, acute respiratory diseases. Much attention should be paid to the elimination of chronic foci of infection (timely treat teeth, eliminate foci in the pharynx, paranasal sinuses). Children who have had kidney disease should avoid overwork and hypothermia, significant physical activity... After being discharged from the hospital, the child is allowed to engage in physiotherapy exercises, but classes in sports sections, participation in competitions are prohibited. These restrictions are eventually canceled. Measures aimed at strengthening the body, wise use of natural factors nature - sun, air and water. To prevent the spread of infection from the lower urinary tract, especially in girls, it is necessary to strictly observe the hygiene of the external genital organs. Removing obstacles that interfere with the normal outflow of urine is also of great importance.

Treatment of microbial-inflammatory diseases of the urinary system involves not only antibacterial, pathogenetic and symptomatic therapy, but also the organization of the correct regimen and nutrition of the sick child.

The question of hospitalization is decided depending on the severity of the child's condition, the risk of complications and the social conditions of the family - the younger the child, the more likely it is to be treated in a hospital. During the active stage of the disease, in the presence of fever and pain, bed rest is prescribed for 5-7 days. With cystitis and asymptomatic bacteriuria, hospitalization is usually not required. In the acute period, table No. 5 according to Pevzner is used: without salt restriction, but with an increased drinking regime, 50% more than the age norm. The amount of salt and fluid is limited only if the kidney function is impaired. It is recommended to alternate protein and vegetable food... Products containing extractives and essential oils, fried, spicy, fatty foods. Revealed metabolic disorders require special corrective diets.
Drug therapy IMS includes antibacterial drugs, anti-inflammatory, desensitizing and antioxidant therapy.

Carrying out antibacterial therapy is based on the following principles: before starting treatment, urine culture ( later treatment change based on the results of sowing); exclude and, if possible, eliminate factors contributing to infection; improvement of the condition does not mean the disappearance of bacteriuria; the results of treatment are regarded as failure in the absence of improvement and / or persistence of bacteriuria.
Primary lower urinary tract infections (cystitis, urethritis), as a rule, respond to short courses of antimicrobial therapy; upper urinary tract infections (nephritis and pyelonephritis) - require long-term therapy.

Pyelonephritis treatment includes several stages:
- suppression of an active microbial-inflammatory process using antibiotics and uroseptics (here urine culture for antibiotic sensitivity is taken into account).
- against the background of the process subsiding, stimulation of antioxidant protection and immunocorrection is carried out,
- stage of anti-relapse treatment.
Therapy acute process, as a rule, is limited to the first two stages, with chronic, all three stages of treatment are included.

When choosing antibacterial drugs the following requirements must be taken into account: the drug must be active against the most common pathogens of the urinary system, not be nephrotoxic (like gentamicin, for example), create high concentrations in the inflammation focus (in urine, kidney tissue), have a predominantly bactericidal effect, be active at pH values ​​of the patient's urine, with a combination of several drugs, drug interaction should be observed.
The duration of antibiotic therapy should be optimal, providing complete suppression of the activity of the pathogen; usually is in the hospital about 3-4 weeks with a change of antibiotic every 7-10 days (or replacement with uroseptic).

Starting antibiotic therapy is prescribed empirically (without waiting for sowing), based on the most likely infectious agents. In the absence of clinical and laboratory effect after 2-3 days, it is necessary to change the antibiotic. In severe and moderate PN, drugs are administered mainly parenterally (intravenously or intramuscularly) in a hospital setting. With mild and, in some cases, moderate course of PN hospital treatment not required, antibiotics are administered orally, the course of treatment is 14 to 20 days.

In the early days of the disease, against the background of increased water load, fast-acting diuretics are used, which help to increase renal blood flow, ensure the elimination of microorganisms and inflammation products and reduce the swelling of the interstitial tissue of the kidneys. The composition and volume of infusion therapy depend on the severity of the intoxication syndrome, the patient's condition, indicators of hemostasis, diuresis and other renal functions.
The combination with anti-inflammatory drugs is used to suppress the activity of inflammation and enhance the effect of antibiotic therapy. The use of non-steroidal anti-inflammatory drugs is recommended. The course of treatment is 10-14 days.

Desensitizing agents (Tavegil, Suprastin, Claritin, etc.) are prescribed for acute or chronic PN in order to relieve the allergic component of the infectious process, as well as when the patient develops sensitization to bacterial antigens.
The complex of PN therapy includes drugs with antioxidant and antiradical activity: Tocopherol acetate, Unithiol, Beta-carotene, etc. Of the drugs that improve kidney microcirculation, Trental, Cinnarizin, Euphyllin are prescribed.

Anti-relapse therapy involves long-term treatment with antibacterial drugs in small doses and is carried out, as a rule, in an outpatient clinic. For this purpose, use: Furagin for 2 weeks, then, with normal urine tests, switch to 1 / 2–1 / 3 doses within 4–8 weeks; prescribing one of the preparations of pipemidic acid, nalidixic acid or 8-hydroxyquinoline for 10 days each month at usual dosages for 3-4 months.

Treatment of cystitis.

Treatment of cystitis involves general and local effects. Therapy should be aimed at normalizing urinary disorders, eliminating the pathogen and inflammation, and eliminating pain. V acute stage diseases, bed rest is recommended until the dysuric phenomena subside. The general warming of the patient is shown. Dry heat is applied to the bladder area.

Diet therapy provides for a gentle regimen with the exclusion of acute, spicy dishes, spices and extractives. Shown are dairy products, fruits that promote urine alkalinization. It is recommended to drink plenty of fluids (slightly alkaline mineral waters without gas, of course, fruit drinks, weakly concentrated compotes) after relieving pain. An increase in urine output reduces the irritating effect of urine on the inflamed mucous membrane, promotes the flushing of inflammation products from the bladder. Reception mineral water(Slavyanovskaya, Smirnovskaya, Essentuki) at the rate of 2-3 ml / kg 1 hour before meals has a weak anti-inflammatory and antispasmodic effect, changes the pH of urine. Drug therapy for cystitis includes the use of antispasmodic, uroseptic and antibacterial agents. At pain syndrome shows the use of age-related doses of No-shpa, Papaverin, Belladona, Baralgin.

In acute uncomplicated cystitis, it is advisable to use oral antimicrobial drugs, which are excreted mainly by the kidneys and create a maximum concentration in the bladder. The minimum course of treatment is 7 days. In the absence of sanitation of urine against the background of antibiotic therapy, an additional examination of the child is required. Uroseptic therapy includes the use of drugs of the nitrofuran series (Furagin), non-fluorinated quinolones (drugs of nalidixic and pipemidic acids, derivatives of 8-hydroxyquinoline).
V last years for the treatment of cystitis, fosfomycin (Monural) is widely used, taken once and having a wide antimicrobial spectrum of action. In the acute period of the disease, herbal medicine is carried out with antimicrobial, tanning, regenerating and anti-inflammatory effect. Used as an anti-inflammatory agent lingonberry leaf and fruits, oak bark, St. John's wort, calendula, nettle, coltsfoot, plantain, chamomile, blueberries, etc. Barley, nettle, and lingonberry leaves have a regenerating effect.

Management of children with asymptomatic bacteriuria.

The decision to use antibiotic therapy for asymptomatic bacteriuria is always difficult for the physician. On the one hand, the absence of a clinical picture and a pronounced urinary syndrome does not justify the use of a 7-day course of antibiotics and uroseptics due to possible side effects... In addition, the doctor often has to overcome parental bias against the use of antibacterial drugs.
On the other hand, shorter courses are ineffective, since they only shorten the period of bacteriuria, creating "imaginary well-being", and do not prevent subsequent development clinical symptoms diseases. Also, short courses of antibiotics contribute to the emergence of resistant strains of bacteria. In most cases, asymptomatic bacteriuria does not require treatment. Such a patient needs additional examination and clarification of the diagnosis.

Antibiotic therapy is necessary in the following situations:
- in newborns and infants and young children (up to 3-4 years), since they may have a rapid development of PN;
- in children with structural abnormalities of compulsory health insurance;
- in the presence of prerequisites for the development of PN or cystitis;
- with chronic PN (cystitis) or previously transferred;
- when clinical symptoms of IMS appear.
Most often, uroseptics are used for asymptomatic bacteriuria.

Dynamic observation of children suffering from urinary tract infections:

The child should be monitored by a pediatrician in conjunction with a nephrologist.
During the period of exacerbation, the nephrologist looks - 1 time in 10 days; remission during treatment - once a month; remission after the end of treatment for the first 3 years - 1 time in 3 months; remission in subsequent years until the age of 15 years - 1-2 times a year, then the observation is transferred to therapists.

Clinical and laboratory research:
- general analysis urine - at least 1 time per month and against the background of ARVI;
- biochemical analysis of urine - once every 3–6 months;
- Ultrasound of the kidneys - once every 6 months.

According to indications - carrying out cystoscopy, cystography and intravenous urography. Removal from the dispensary registration of a child who has undergone acute IMHI is possible while maintaining clinical and laboratory remission without treatment measures(antibiotics and uroseptics) for more than 5 years, after a full clinical and laboratory examination. Patients with chronic IMHI are followed up before transfer to the adult network.