Pyelonephritis in children: symptoms and treatment, forms of the disease. Typical symptoms of pyelonephritis in children and treatment of the disease with medication and a special diet If a child is diagnosed with acute pyelonephritis, he will be treated

Acute pyelonephritis is a dangerous disease that requires immediate therapy. Kidney inflammation can develop at any age. Pathology is often diagnosed in children. With a rapid rise in temperature, impaired urination, deterioration in general well-being, the child should be admitted to the hospital.

Description of pathology

Pyelonephritis is a nonspecific inflammation of the kidneys of an infectious nature. The most common causative agent is bacteria:

• staphylococcus;
• streptococcus;
• Escherichia coli.

Initially, the ailment in babies always develops in an acute form with pain syndrome and a significant increase in temperature. If therapy is carried out incorrectly or out of time, inflammation develops into a chronic form.

According to statistics, pyelonephritis is the second most common after acute respiratory viral infection in pediatrics. In addition, every second case of kidney inflammation in preschool children is the result of an untimely cured cold.

Pyelonephritis - non-specific inflammation of the kidneys

Pyelonephritis is diagnosed three times more often in girls. This is due to the structural features of the female urinary system. The urethra in women and girls is shorter and wider. Disease-causing bacteria freely penetrate into the bladder, and then move to the kidneys.

Classification of pyelonephritis in children

Depending on the factors that contribute to the development of inflammation, the disease can be:

• primary (when it develops independently);
• secondary (when inflammation of the kidneys is a complication of another pathological process in the body).

The following routes of transmission of infection are distinguished:

• ascending (from the urinary tract);
• descending (from other organs);
• hematogenous (the infection enters the kidneys through the blood).

In violation of the outflow of urine, pyelonephritis is called obstructive. If the urinary functions are not impaired, we are talking about non-obstructive inflammation.

Depending on the morphological changes in the affected tissue, there are:

• serous pyelonephritis (the initial stage of the disease, the kidney is enlarged and edematous);
• purulent pyelonephritis.

The latter form is considered more severe and often requires surgical intervention.

The causes of inflammation

Bacteria provoke the development of the inflammatory process, which can enter the kidneys through the urinary tract or blood. Weakened children with reduced immunity most often face the disease. Often, pyelonephritis develops as a complication of ARVI or cystitis. Diseases such as tonsillitis, otitis media, pneumonia, etc., can also cause inflammation of the kidneys. Chronic foci of inflammation in the oral cavity (for example, caries) can also trigger the development of acute pyelonephritis.

ARI can cause pyelonephritis

Improper hygienic care of the child plays a huge role in the development of the disease. Refusal to brush your teeth, dirt under the nails - all this can lead to infection in the body. If, at the same time, the child does not eat well and is rarely outdoors, the risk of developing inflammation increases. It is no coincidence that pyelonephritis is often diagnosed in children from disadvantaged families.

Congenital malformations of the kidneys or urinary tract can also provoke the development of the disease in an acute form. If the normal excretion of urine from the body is regularly disrupted, it will not be possible to do without surgical intervention.

Children with chronic illnesses are more likely to develop complications. The risk group includes patients with the following pathologies:

• rickets;
• helminthic invasions;
• hypervitaminosis D;
• endocrine disorders.

The form of pyelonephritis directly depends on the state of the child's immune system. If the body's defenses work well, inflammation can be quickly stopped without unpleasant consequences.

Symptoms

The main sign of the inflammatory process in acute pyelonephritis is a significant increase in body temperature (up to 40 ° C). Symptoms of rather severe intoxication are present. If the child knows how to talk, he will complain of body aches, dizziness, tinnitus. Babies, on the other hand, will refuse to eat and cry constantly. The following signs of an inflammatory process may also be present:

• persistent regurgitation;
• loose stools;
• weight loss.

Feeling unwell and high fever are signs of inflammation

Pain in the lower back is characteristic of acute pyelonephritis. This symptom will be more pronounced if the patient is diagnosed with inflammation in a purulent form. With tapping or physical exertion, the discomfort will intensify. Sometimes patients complain of pain without a specific localization. From the lumbar region, pulling sensations go to the entire back, neck, abdomen.

It is also worth paying attention to the following symptoms:

• frequent urge to urinate;
• pain or burning sensation when urinating;
• urinary incontinence (enuresis);
• discoloration of urine (it may become cloudy or pink in color).

A significant deterioration in the child's well-being is a reason to immediately seek medical help. It is important to understand that the inflammatory process can develop rapidly, affecting adjacent organs and tissues.

Diagnostics

It is especially difficult to identify the disease in children in the first years of life. Symptoms are very similar to other pathologies of an infectious nature. Differential diagnostics is mandatory, including the following methods:

1. Inspection. The doctor examines the lumbar region. It is possible to identify pain syndrome in a baby by light tapping.
2. General blood analysis. An increase in the level of leukocytes in the material will indicate the development of inflammation. Blood sampling is done in the morning on an empty stomach.
3. General urine analysis. The study allows you to confirm the earlier diagnosis. The most informative is the first morning urine.
4. Urine analysis according to Nechiporenko. It is necessary to determine the functionality of the urinary tract.
5. Bacterial urine culture. The study allows you to determine which pathogen provoked inflammation.
6. Ultrasound of the kidneys. Helps to determine where the inflammatory process is concentrated.
7. Computed tomography of the kidneys. The study allows you to more accurately examine the state of the kidneys. But due to the high cost, the method is not used in all clinics.

A qualified doctor will be able to make a preliminary diagnosis already at the first examination

If the pediatrician suspects pyelonephritis in a small patient, a consultation with a pediatric nephrologist or urologist will be additionally appointed. It is these narrow specialists who will conduct further therapy.

Treatment of pyelonephritis in children

Therapy of a disease in an acute form cannot do without the use of medications. In most cases, hospitalization is required. After clarifying the diagnosis, the urologist can prescribe medications from the following groups:

1. Antibiotics Medicines from this category are selected taking into account the sensitivity of the pathogenic microflora. Often used funds Sumamed, Flemoxin Solutab, Amoxiclav, Furagin, etc.
2. Herbal uroseptics. Children over 12 years old can be prescribed the drug Kanefron N.
3. Antispasmodics. Drugs in this category help relieve pain associated with spasms. Children over 6 years old can be prescribed No-shpa.
4. Non-steroidal anti-inflammatory drugs. With their help, it is possible to normalize body temperature, relieve pain. From the first days of life, the drugs Panadol, Nurofen can be prescribed.
5. Vitamins. Such therapy is carried out in complex forms of the disease, when the child's immunity is greatly weakened.

If the parents decide to treat the child at home, it is categorically impossible to choose medicines on their own. In any case, the therapy should be prescribed by a doctor.

Preparations for pyelonephritis in children - photo gallery

Kanefron-N - high-quality uroseptic No-shpa relieves spasm
Nurofen relieves pain and normalizes body temperature Sumamed is an effective antibacterial agent

In the acute period of the disease, the child is put on bed rest. In this case, the room must be provided with a temperature regime of 19-22 degrees and humidity in the range from 30 to 40%.

Diet is of great importance. It is important to reduce the burden on the kidneys, while the food should be complete and fortified. You will have to give up salty, spicy and fried foods. It is not recommended to consume foods that contribute to increased gas production. These include:

• legumes;
• non-natural drinks (juices, lemonade);
• mushrooms;
• nuts.

Proper nutrition is the key to a quick recovery with pyelonephritis

Preference will have to be given to steamed products. A sick child's menu may include:

• boiled vegetables;
• porridge;
• low-fat dairy products;
• dried fruits;
• lean meat (chicken, turkey).

An increased drinking regime will help restore kidney function faster. The child is recommended to consume water 50% more than his age norm. You can supplement the diet with fruit drinks, herbal decoctions, dried fruit compote.

If the little patient is completely breastfed, the mother will have to follow the diet.

Physiotherapy for pyelonephritis

If you seek medical help in a timely manner, you will be able to quickly relieve acute inflammation. However, the absence of symptoms does not mean that the disease has completely receded. Properly planned rehabilitation is of great importance. Physiotherapy procedures will help to restore kidney function faster and increase the child's immunity.

1. Electrophoresis. Medicines that restore kidney function are administered through the skin through a direct electric current.
2. Magnetotherapy. Thanks to the effect on the body of a low-frequency magnetic field, it is possible to restore immunity.
3. UHF therapy. Exposure to high frequency electromagnetic fields is carried out. The procedure improves blood flow in the tissues, due to which the damaged areas heal faster.
4. Ultrasound. The therapy using ultrasonic vibrations has a pronounced analgesic and anti-inflammatory effect.

High fever and severe pain are contraindications to physiotherapy.

Surgical intervention

If with the help of medicines it is not possible to ensure the normal outflow of urine, or a purulent process develops rapidly, the specialist decides to carry out the operation. The intervention is performed under general anesthesia. Previously, the child needs to pass a number of tests in order to choose the right anesthesia.

In the most difficult cases with pyelonephritis, surgical intervention is indispensable.

The specialist performs excision of the affected tissue or removes elements that prevent the normal outflow of urine (stones, tumors, polyps). Depending on the complexity, the operation can take 20-40 minutes. This is followed by a recovery period. As a rule, in a few days the child can get out of bed, and after 10-12 days he is discharged home.

Traditional therapy

Recipes of traditional medicine will help the child to restore the normal state of health faster. However, they should be used only during the rehabilitation period after consulting a doctor.

To prepare the product:

1. A teaspoon of seeds must be poured with a glass of boiling water.
2. The tool should be cooked over low heat for 5 minutes, then remove and leave for about an hour.
3. Strain the broth and give the child a teaspoon every two hours.

It is believed that flax seeds help relieve inflammation and promote the elimination of toxins.

The plant is widely used for pathologies of the urinary system. To prepare a medicine, you need:

1. Pour 2 tablespoons of cones with half a liter of boiling water.
2. Insist under a closed lid for 2 hours.
3. Then the product must be filtered and given to the child a tablespoon 4 times a day.

The plant is considered a natural antiseptic. It will be possible to restore the condition of the kidneys faster if you take a medicinal infusion:

1. A tablespoon of dry crushed plant must be poured with a glass of boiling water.
2. Insist under a closed lid for about an hour.
3. Then the medicine must be filtered and drunk throughout the day.

Corn silk

To prepare the product:

1. A teaspoon of raw materials must be poured with a glass of boiling water.
2. The product must be cooked over low heat for 15–20 minutes.
3. Remove from the stove and leave for another hour.

Folk remedies for pyelonephritis - photo gallery

Chamomile is a natural antiseptic
Hops are widely used in urinary tract diseases Corn silk is used to prepare a medicinal decoction Flax seeds help relieve inflammation

Treatment prognosis and prevention

With timely initiation of therapy, the disease can be completely overcome. Unpleasant symptoms disappear within 3-5 days after the start of taking the prescribed medications. Health is fully restored within a month. But refusal from the correct therapy can lead to the development of serious complications, such as:

• kidney abscess;
• blood poisoning;
• renal failure.

Any of the described complications can be fatal. In addition, pyelonephritis can develop into a chronic form. This will require a longer and more expensive treatment.

The likelihood of encountering kidney inflammation will significantly decrease if you follow a number of rules:

• monitor the nutrition of the child;
• regularly spend time with your baby in the fresh air;
• treat any diseases in a timely manner;
• maintain a healthy emotional atmosphere in the family.

Video: inflammatory kidney disease

Pyelonephritis responds well to treatment with timely medical attention. In no case should you try to restore the child's health on your own. Inflammation of the kidneys is fraught with serious complications.

Inflammation of the kidneys (pyelonephritis), unfortunately, affects not only adults, but also children. Pielo-nephritis in children occurs since the neonatal period. In the first months of life, it affects more boys, since they are more likely to have congenital anomalies of the urinary system. Starting from the second or third year of life, girls are more likely to get sick.

Why do children get pyelonephritis?

The causes of pyelonephritis in children can be reduced to two large, closely interrelated groups: a violation of urodynamics (correct urine flow) and the presence of infection. Disorders of urodynamics are detected in 50% of cases of childhood pyelonephritis and are characterized mainly by the occurrence of refluxes - reverse urine flow due to a violation of the nervous regulation of the muscles of the urinary tract. One of the variants of such reflux is the neurogenic bladder.

Congenital anomalies of the urinary system (stricture, diverticulum of the ureter or bladder, narrowing of the calyx of the kidney, urethra, phimosis, nephroptosis, hydronephrosis), urolithiasis also disrupt the outflow of urine and cause its stagnation. Inflammation of the kidneys itself is caused by pathogenic microorganisms, which, as a rule, are conditionally pathogenic flora and live in the intestines. Most often it is Escherichia coli and Proteus, but there are others: enterococci, Klebsiella, Staphylococcus aureus or cutaneous, Pseudomonas aeruginosa, fungi of the genus Candida. There is no hereditary jade.

What other factors contribute to the disease?

1. Pyelonephritis in a child can be provoked by viruses, mycoplasmas, chlamydia, as they contribute to the penetration of infection into the kidneys
2. The presence of a chronic focus of infection in the body: caries, tonsillitis, cholecystitis, vulvovaginitis, etc.
3. Diseases of the gastrointestinal tract, especially constipation and dysbiosis
4. Inadequacy of the immune response of the child's body: a decrease in the activity of leukocytes, a change in the ratio of immunocompetent cells
5. Previous damage to the kidney tissue due to the action of drugs, metabolic disorders, hypervitaminosis D, etc.

Classification, clinical manifestations and symptoms of pathology

Children's pyelonephritis is primarily divided into primary (when inflammation occurs on unchanged kidneys) and secondary, when the disease occurs against the background of developmental abnormalities, urolithiasis, refluxes, immunodeficiency, etc. Primary pyelonephritis is acute when the disease is diagnosed for the first time, and chronic if the symptoms and signs of pyelonephritis in children persist for more than 1 year. By analogy, secondary acute and secondary chronic pyelonephritis are distinguished in children. According to the prevalence of the process, there is bilateral and unilateral inflammation, for example, pyelonephritis of the left kidney or right.

Both primary and secondary acute pyelonephritis in children is characterized by the appearance of pain in the lower back or abdomen, symptoms of intoxication, dysuric disorders (urinary disorders). The pain is usually pulling, dull, noticeably intensifying with a change in body position, on a clone. It decreases in a horizontal position, in warmth (for example, lying in bed under a blanket).

Violation of urination causes concomitant cystitis, or reflex effects on the bladder from an inflamed kidney. They are expressed in frequent, painful urination, burning sensation, itching, as well as symptoms of enuresis.

The general state of health suffers: the child feels bad, lethargic, pale, does not eat well, complains of weakness, headache. In a row, the temperature lasts for several days, usually subfebrile: 37.5-38 ° C, in some cases there is a high fever with chills. Pyelonephritis without clinic, without temperature usually does not happen, very rarely.

Symptoms in young children are often limited to general manifestations: anxiety, lethargy, lack of appetite, stool disturbances, fever, weight loss, and sometimes convulsions dominate. The urine is cloudy, dark, with an unpleasant odor; children often cry during urination. With chronic pyelonephritis, psychomotor and physical development is inhibited.

How to confirm the diagnosis?

If the child has the symptoms described above, then it is necessary to consult a doctor for examination and treatment. This is done by pediatrics and pediatricians. First of all, you need to pass urine tests. Typical for pyelonephritis is a large number of leukocytes and bacteria, sometimes there are a lot of salts in the urine and epithelial cells, the norm of erythrocytes is slightly exceeded. Proteinuria is also minimal: protein in urine usually does not exceed 0.6 g / m2 / day.

It is imperative to sow urine on the flora to determine whether there are bacteria and the type of pathogen (this will help to choose the right antibiotics). If microorganisms are inoculated with a urine culture tank taken from the middle portion after a thorough toilet of the external genital organs, then the diagnosis of urinary tract infection is considered confirmed. Additionally, the number of bacteria in 1 ml of urine is counted, if it exceeds 105, then this is also a fact in favor of inflammation of the kidney.

Diagnosis of pyelonephritis will not be complete without ultrasound of the kidneys, assessment of the functional state of the renal tissue using special tests, general blood test, biochemical analysis. Ultrasound must be done without fail, this is the only way to identify factors that interfere with the flow of urine: cysts, strictures (narrowing), stones, etc. In some cases, X-ray examination, urography, tomography, MRI may be needed.

Features of differential diagnosis

In acute pyelonephritis in children, the differential diagnosis is carried out primarily with diseases that cause abdominal pain: appendicitis, cholecystitis, pancreatitis. Chronic pyelonephritis is differentiated from infection of the lower urinary tract (cystitis), renal tuberculosis, glomerulonephritis.

The most severe complications of pyelonephritis are associated with the spread of infection to the peri-pectoral tissue (paranephritis), as well as the development of purulent inflammation of the kidney: single or multiple abscesses, sepsis. In the chronic process, arterial hypertension and kidney stones begin to appear, with the often recurrent course of pyelonephritis, chronic renal failure develops.

The main methods of treatment

Depending on the age of the child and the activity of the process, treatment can be carried out both at home and in a hospital. The indication for hospitalization is the age of up to 2 years, as well as pronounced symptoms of intoxication at an older age.

A diet for pyelonephritis in children implies the exclusion of spicy, fried foods, canned food. There are no restrictions on the drinking regime, the child can drink as much as he wants. If vomiting occurs, then the liquid is injected intravenously.

The main place in the treatment is taken by antibiotic therapy. Initially, the drug is selected empirically, with a wide spectrum of action, then according to the results of urine culture. If necessary, antibiotics are changed.

Children are allowed to use:

• Penicillin drugs: Amoxiclav, Augmentin
• Cephalosporins: Cefuroxime, Suprax or Ceftriaxone, etc.
• Aminoglycazides: Sumamed, Gentamicin
• Carbapenems: Imipenem, Meropinem.

Antibiotic treatment is carried out for 2-3 weeks, first they are administered in the form of injections, then you can switch to tablets. The effectiveness of the drug is judged by the general well-being and temperature: after 2 days it should return to normal. An antipyretic agent can be used as an adjunct in case of high fever in the first 2-3 days. After 48-72 hours after the start of therapy, it is advisable to repeat the urine culture, it should become sterile.

At the second stage of treatment, for the prevention of exacerbations, uroseptics are used - antibacterial agents that accumulate in high concentrations in the urine. For the treatment of young patients, their choice is limited, mainly nitrofurans: Furadonin, Furamag. Nalidixic acid preparations, for example Nitroxoline, have insufficient therapeutic efficacy.

The place of herbal medicine in the treatment of pyelonephritis

In children suffering from pyelonephritis, treatment with folk remedies, namely medicinal plants, is possible. They are used separately and in a fee, 20 days of each month. 10 days break, then the reception is continued with a change of plant or collection. Reviews of this scheme are very good.

Effects of medicinal herbs:

• Diuretic: kidney tea, horsetail, dill, parsley, rose hips, de-vyasila root, birch leaf
• Anti-inflammatory: celandine, plantain, St. John's wort, calendula
• Antibacterial: St. John's wort, sage, medicinal chamomile
• Improved renal blood flow: asparagus, oats
• Litholytic: watermelon, lingonberry, strawberry, dill
• Fortifying: black currant, nettle, black chokeberry, yarrow.

Many plants have not one, but several effects, for example, treatment with strawberries gives litholytic (splitting small stones) and general strengthening effects. It is also possible to use ready-made dosage forms from herbal ingredients, for example, canephron is approved for use in children over 1 year old.

How can the disease be prevented?

Prevention of pyelonephritis in children is divided into primary (prevention of acute pyelonephritis) and secondary (prevention of exacerbations). Primary prevention includes compliance with hygiene rules, strengthening immunity, timely elimination of foci of infection in the body (treatment of caries, diseases of the gastrointestinal tract, etc.), avoidance of hypothermia.

To prevent exacerbations of chronic pyelonephritis, in addition to the above, it is necessary to correct urodynamic disorders, eliminate urinary stagnation by surgical or therapeutic methods. Observe the doctor's recommendations on the regimen, diet, anti-relapse therapy. After suffering pyelonephritis, which has arisen for the first time, it is recommended to first take uroseptics in a half dose, and then or in parallel with medicinal herbs for up to 2-3 months. After an exacerbation of chronic pyelonephritis, herbal medicine is prescribed for up to 6 months.

Children's pyelonephritis is described in detail in the video:

Children after pyelonephritis should be observed in the clinic at the place of residence for at least 5 years and regularly take urine tests. How often - the doctor will decide. After stopping the exacerbation, you can walk, go to kindergarten, for other children, the little patient is not contagious. If the child is of school age, then he is exempted from physical education in the main group for 1 year, in the special group, classes are not contraindicated. You can visit the pool, get vaccinated no earlier than a month after the inflammation has stopped. Sanatorium treatment is possible in resorts with mineral waters or at the sea.

The prognosis for pyelonephritis depends on many factors. With primary acute pyelonephritis, it is possible to achieve complete recovery in 40-60% of cases, with secondary pyelonephritis, much depends on whether it is possible to eliminate the disturbances in the current and stagnation of urine.

Pyelonephritis in children is an inflammatory process of the kidneys caused by an infection. Pathology is one of the four most common childhood diseases (together with infectious diseases, diseases of the digestive and respiratory systems). Children under 7 years of age are most susceptible to pyelonephritis. Moreover, girls get sick 3 times more often than boys. This fact is associated with the characteristics of the female body. Girls have a wider urethra, allowing bacteria to enter the bladder and kidneys.

There are two forms of pathology: chronic and acute. Acute pyelonephritis is accompanied by fever, chills, headache, nausea. Pyelonephritis in older children often occurs with pain in the lumbar region, which manifests itself constantly or periodically, sometimes radiating to the groin area. The chronic form is an acute, untreated process that passes with periodic exacerbations (the symptoms are the same as in an acute illness) and asymptomatic periods.

Pyelonephritis is of two types:

• Secondary. It occurs as a result of stagnation of urine caused by pathological changes in the genitourinary system (congenital anomalies in the structure of the kidneys or bladder).
• Primary. Its appearance is not associated with residual fluid in the bladder, but is caused by other reasons (infection through the urethra or along with the blood).

Content of the article:

The reasons for the development of the disease

The body of babies is not able to withstand many bacteria. In addition, children under 4 years of age physiologically cannot completely empty the bladder. Residual fluid in the bladder favors the growth of bacteria. Often a chronic focus becomes a source of infection: tonsillitis, caries, etc.

What can cause pyelonephritis in children:

• Intrauterine infection.
• An infection that has entered the kidneys along with blood from other foci of inflammation.
• Ascending infection up to the kidneys through the urethra.
• Weak immunity.
• Long-term use of antibiotics.
• Chronic illnesses.
• Diseases of the urinary system.

Pyelonephritis- inflammatory process in the kidneys and renal pelvis is the most common disease among children, second only in frequency to inflammatory diseases of the upper respiratory tract. The wide prevalence of morbidity among children of early childhood, the transition to a chronic form and the possibility of the appearance of irreversible consequences make it possible to consider this disease as a very serious pathology that requires a careful approach to treatment, both on the part of the doctor and on the part of the parents.

Knowledgeable means armed! To suspect a disease in time is already half of the success to recovery!

The main causes of pyelonephritis in children

Pyelonephritis in children, like any inflammatory disease, is caused by microorganisms (bacteria), which in various ways enter the kidney and begin to actively multiply. According to the etiology and pathogenesis of pyelonephritis, in the overwhelming majority of cases, the disease is caused by E. coli, which is brought into the kidney with the blood flow from the focus of chronic infection, the role of which is most often played by carious teeth, chronic tonsillitis (tonsillitis) and otitis media (ear inflammation). In more rare cases, the infection comes from the bladder or external genitalia. This is the reason for the fact that girls, due to the short urethra, suffer from pyelonephritis and cystitis 3 times more often than boys.

However, under normal conditions, the child's body is able to cope with microorganisms. The main reason for the development of inflammation is considered to be a decrease in immunity, when the body's defenses are unable to fight the infection.

There are many reasons leading to a decrease in immunity, the main of which are:

• Complications during pregnancy and childbirth
• Short-term breastfeeding, early introduction of complementary foods
• Lack of vitamins
• Chronic inflammatory diseases of the respiratory tract and ENT organs
• Hereditary predisposition

There are so-called critical periods of a child's development, when the body is most vulnerable to the effects of infectious agents:

• From birth to 2 years
• 4-5 to 7 years old
• Teenage years

Classification of pyelonephritis

Based on the reasons that caused the disease, pyelonephritis is divided into primary and secondary. Primary pyelonephritis develops in a practically healthy child against the background of complete well-being, while secondary pyelonephritis, in turn, occurs with congenital anatomical abnormalities of the kidneys, bladder and urethra, when urinary stagnation gives rise to active reproduction of bacteria.

There are two forms of pyelonephritis: acute and chronic. Acute pyelonephritis in children proceeds more violently with symptoms of severe intoxication, but with proper treatment, it most often ends in full recovery. In some cases, the acute form can turn into a chronic one, which is characterized by periodic exacerbations, proceeds for a very long time (up to old age) and leads to irreversible complications.

The main symptoms of pyelonephritis in children

The peculiarity of pyelonephritis in children is such that, depending on age, the symptoms of the disease manifest themselves in different ways. It is not difficult to suspect the signs of pyelonephritis in a child, usually the disease proceeds with characteristic manifestations, with the exception of young children.

Children under 1 year

Pyelonephritis in children under one year old usually has the following symptoms:

• Temperature rise to 39-40 without signs of airway inflammation
• Anxiety and sleep disturbance
• Decreased appetite

An increase in temperature to high numbers for no reason should immediately alert both parents and the doctor to the presence of pyelonephritis in the child. The temperature in pyelonephritis is difficult to treat with antipyretic drugs and is able to stay at high numbers for several days.

Children from 1 to 5 years old

In children under 5 years of age, along with a high fever, abdominal pain occurs without a specific localization, nausea, and sometimes vomiting. The child is restless, cannot clearly indicate the place where it hurts.

Over 5 years old

Typical symptoms from the organs of the urinary system appear only after 5-6 years of age, when the child begins to worry about aching pain in the lumbar and suprapubic region and pain during urination.

Thus, the "typical" complex of symptoms of acute pyelonephritis in children over 5 years old includes the following:

• Acute increase in body temperature up to 39-40C. It is important to remember that the hallmark of kidney inflammation from colds is the absence of inflammation of the respiratory tract (runny nose, cough, sore throat and sore throat, ear pain). The temperature rises against the background of complete health immediately to high levels.
• Symptoms of general intoxication - the child becomes lethargic, capricious, refuses to eat. Chills are followed by hot flashes. Often, against the background of temperature, a headache appears.
• Symptoms from the urinary system - as a rule, on the second day after the temperature rises, there is a constant aching pain in the lumbar region (most often on the one hand), pain in the suprapubic region, pain when urinating. With concomitant cystitis, the urge to urinate becomes frequent up to 20 or more times a day.
• Urine with pyelonephritis in a child is visually dark, cloudy, frothy, sometimes with a reddish tint (due to the presence of blood in it).

Despite the severe course of acute pyelonephritis, with timely medical attention and proper treatment, the disease has a favorable outcome. However, the acute form often becomes chronic.

Chronic pyelonephritis

Pyelonephritis is considered chronic if it lasts more than 1 year and has 2 or more exacerbation episodes during this period. This form is an alternation of periodically recurring exacerbations (especially in the spring-autumn period) and asymptomatic periods. The manifestations of the chronic form are the same as in the acute form, only more often less pronounced. The course of chronic pyelonephritis is slow and prolonged. With frequent exacerbations, improper treatment and lack of prevention, the disease can lead to such a serious complication as renal failure.

Complex of diagnostic measures

It is not difficult for an experienced doctor to diagnose "Pyelonephritis", especially if there have already been episodes of the disease in the medical history. Usually, diagnosis of pyelonephritis in children necessarily includes a general urine test, a general blood test, urine culture for microflora and ultrasound of the kidneys. If there are bacteria and leukocytes in the urine, and with an appropriate ultrasound picture, the doctor can already make the appropriate diagnosis.

Video lecture. Pyelonephritis in children. "Medical Bulletin":

Treatment of pyelonephritis in children

Basic principles of treatment

It is important to understand that the treatment of any disease, especially such a serious one as pyelonephritis, is not limited only to drugs. Treatment is a wide range of measures aimed not only at eliminating the cause of the disease, but at preventing subsequent relapses (exacerbations).

The complex treatment of any inflammatory kidney disease consists of the following components:

1. Mode
2. Diet
3. Drug therapy
4. Physiotherapy and physiotherapy exercises

It is always necessary to strictly follow all the doctor's recommendations for a speedy recovery and prevention of relapses.

Mode

During the period of pronounced manifestations of the disease, bed or semi-bed rest is recommended. You need to forget about studying, walking and, moreover, sports training for a while. In the second week of the disease, when the temperature drops significantly and the pain in the lower back passes, the regimen can be expanded, but it will be much better if the child spends the entire period of illness at home.

Dieting

A diet for pyelonephritis in children, as well as in adults, is an integral attribute of a successful recovery. From the child's diet, it is imperative to exclude spicy, salty, fried foods, limit foods high in protein. On the 7-10th day of the course of the acute form, it is necessary to switch to a lactic acid diet with incomplete restriction of salt and protein. It is also recommended to drink abundant drinks (fruit drinks, fruit drinks, weak tea), and in case of chronic pyelonephritis (during periods of remission), it is mandatory to drink slightly alkaline mineral waters.

Drug therapy

a) Antibiotics

All inflammatory diseases are treated with special antimicrobial drugs (antibiotics), and childhood pyelonephritis is no exception. However, in no case should one engage in independent treatment of a child - antibiotics are prescribed only by a doctor (!) Who is able to take into account all the criteria for selecting a drug, based on the severity of the disease, age and individual characteristics of the child. Treatment of acute and treatment of chronic pyelonephritis in children is carried out according to the same principles.

Antibiotics for pyelonephritis in children are represented by a relatively small assortment, since many antibiotics are contraindicated until 12 or 18 years of age, therefore, specialists, as a rule, prescribe the following groups of drugs:

• Protected penicillins (Augmentin, Amoxiclav). In addition to the usual tablets, these antibiotics are available in the form of a sweet suspension for young children, and the dosage is made using a special measuring syringe or spoon.
• Antibiotics of the cephalosporin group, which are most often only injected, therefore they are used in hospital treatment (Cefotaxime, Cefuroxin, Ceftriaxone). However, some also exist in the form of a suspension, capsules and dissolving tablets (Cedex, Suprax).
• Aminoglycosides (Sumamed, Gentamicin) and carbapenems in rare cases also occur, but they are most often used as an alternative option and as part of combination therapy.

In severe cases, the doctor can immediately use several antibiotics from different groups (combination therapy) in order to get rid of the infectious pathogen as soon as possible. Sometimes one antibiotic has to be replaced with another, and this happens in the following cases:

• If 2-3 days after taking the drug, the condition has not improved or, on the contrary, has worsened, and the temperature continues to stay at the same figures
• With long-term treatment for more than 10-14 days. In this case, the doctor must replace the antibiotic to prevent the development of the child's body addiction to this drug.

b) Uroseptics

Drug therapy is not limited only to antibiotics - there are other important groups of drugs, for example, uroantiseptics (nalidixic acid). They are prescribed after a course of antibiotics for children over 2 years old.

c) Vitamins and immunomodulators

After completing the course of the main treatment, it is imperative to restore weakened immunity after an illness. For this purpose, immunomodulators (Viferon, Reaferon) are usually prescribed, and a complex of multivitamins according to the age of the child.

d) Herbal treatment

Herbal medicine for kidney disease has long proven its effectiveness, but it can only be carried out in combination with basic drugs. Bear ears, bearberry, birch buds, and field horsetail have proven themselves well. These plants have anti-inflammatory and antiseptic effects, but they need to be taken for a long time.

Features of inpatient treatment

Treatment of pyelonephritis in children under one year old is carried out only (!) In a hospital under the close supervision of medical personnel. Older children with an average or severe course are also necessarily hospitalized. Treatment of acute pyelonephritis in children over 10 years old should always be carried out in a hospital (even with mild severity) in order to timely carry out a set of diagnostic procedures and identify the cause of the disease.

In the hospital, the child will receive all the necessary assistance in full

Nursing care for pyelonephritis in children includes measures to monitor compliance with the regime during fever (especially important for children 3-10 years old), monitoring diet, timely hygiene and other measures that ensure the creation of comfortable conditions for the early recovery of the child ...

Often, the choice of treatment is carried out together with a pediatric urological surgeon in order to timely resolve the issue of eliminating anatomical anomalies if secondary acute or secondary chronic pyelonephritis is diagnosed in children.

Physiotherapy and physiotherapy exercises

Physiotherapy depends on the severity of the disease, and is most often prescribed by a physiotherapist after the course of the main treatment, when the child's condition is normalized. Ultrasound methods, UHF therapy, magnetotherapy have proven themselves well. Also, when the inflammatory process subsides, physiotherapy exercises are indicated in the supine or sitting position, depending on the age and condition of the child.

Preventive actions

Prevention of pyelonephritis in children occupies an important place in both acute and chronic forms of the disease. It is subdivided into primary and secondary.

Primary prevention (prevention of the development of the disease) includes the timely elimination of foci of chronic infection (carious teeth, chronic otitis media and tonsillitis), strengthening immunity and avoiding hypothermia, personal hygiene (especially careful hygiene of the external genital organs).

Secondary means the prevention of exacerbations and includes the doctor's recommendations: compliance with anti-relapse therapy, systematic observation, as well as all of the above measures of primary prevention.

Dynamic observation

Both acute and chronic pyelonephritis in children require dynamic follow-up by a pediatric urologist, nephrologist or pediatrician with periodic urinalysis and ultrasound of the kidneys:

After an acute or chronic exacerbation - 1 time in 10 days

During remission - once a month

In the first 3 years after treatment - 1 time in 3 months

Up to 15 years old - 1 or 2 times a year

Systematic monitoring will allow avoiding long-term complications of the disease: chronic renal failure, arterial hypertension, urolithiasis.

Urologist-andrologist of the first category, researcher of the Department of Urology and Surgical Andrology of the Russian Medical Academy of Postgraduate Education (RMAPO).

Pyelonephritis is an infectious disease of the kidneys, which occurs quite often in children. Unpleasant symptoms, such as a change in the nature of urination, the color of urine, pain in the abdomen, fever, lethargy and weakness prevent the child from developing normally, attending child care facilities - the disease requires medical attention.

Among other nephrological (with kidney damage) diseases in children, pyelonephritis occurs most often, however, there are frequent cases of overdiagnosis when another infection of the urinary system (cystitis, urethritis) is mistaken for pyelonephritis. In order to help the reader navigate the variety of symptoms, we will tell in this article about this ailment, about its signs and methods of treatment.

General information

Pyelonephritis (tubulointerstitial infectious nephritis) is an inflammatory lesion of the infectious nature of the renal pyelocaliceal system, as well as their tubules and interstitial tissue.

The renal tubules are a kind of "tubes" through which urine is filtered, urine accumulates in the cups and pelvis, coming from there to the bladder, and the interstitium is the so-called interstitial kidney tissue that fills the space between the main renal structures, it is like a "frame" organ.

Children of all ages are susceptible to pyelonephritis. In the first year of life, girls and boys suffer from them with the same frequency, and after a year, pyelonephritis occurs more often in girls, which is associated with the peculiarities of the anatomy of the urinary tract.

Causes of pyelonephritis

E. coli is the main causative agent of pyelonephritis in children.

Infectious inflammation in the kidneys is caused by microorganisms: bacteria, viruses, protozoa or fungi. The main causative agent of pyelonephritis in children is Escherichia coli, followed by Proteus and Staphylococcus aureus, viruses (adenovirus, influenza viruses, Coxsackie). In chronic pyelonephritis, microbial associations are often found (several pathogens at the same time).

Microorganisms can enter the kidneys in several ways:

1. Hematogenous route: blood from foci of infection in other organs (lungs, bones, etc.). This pathway of spread of the pathogen is of greatest importance in newborns and infants: they have pyelonephritis after pneumonia, otitis media and other infections, including in organs located anatomically far from the kidneys. In older children, the hematogenous spread of the pathogen is possible with severe infections (bacterial endocarditis, sepsis).
2. The lymphogenous pathway is associated with the entry of the pathogen into the kidneys through the general lymph circulation system between the organs of the urinary system and the intestines. Normally, lymph flows from the kidneys to the intestines, and infection is not observed. But if the properties of the intestinal mucosa are violated, lymph stagnation (for example, in the case of chronic constipation, with diarrhea, intestinal infections, dysbiosis), the kidneys may become infected with intestinal microflora.
3. Ascending path - from the genitals, anus, urethra or bladder, microorganisms "rise" to the kidneys. This is the most common route of infection in children over a year old, especially in girls.

Factors predisposing to the development of pyelonephritis

Normally, the urinary tract communicates with the external environment and is not sterile, that is, there is always the possibility of microorganisms getting into them. With normal functioning of the organs of the urinary system and good condition of local and general immunity, the infection does not develop. The onset of pyelonephritis is facilitated by two groups of predisposing factors: from the side of the microorganism and from the side of the macroorganism, that is, the child himself. On the part of the microorganism, such a factor is high virulence (high infectivity, aggressiveness and resistance to the action of the protective mechanisms of the child's body). And on the part of the child, the development of pyelonephritis is promoted by:

1. Violations of the normal outflow of urine with abnormalities in the structure of the kidneys and urinary tract, with stones in the urinary system and even with crystalluria against the background of dysmetabolic nephropathy (the kidney tubules are clogged with small salt crystals).
2. Stagnation of urine with functional disorders (neurogenic dysfunction of the bladder).
3. Vesicoureteral reflux (return of urine from the bladder to the kidneys) of any origin.
4. Favorable conditions for ascending infection (insufficient personal hygiene, improper washing of girls, inflammation in the external genitalia, perineum and anus, cystitis or urethritis untreated in time).
5. Any acute and chronic diseases that reduce the child's immunity.
6. Diabetes.
7. Chronic foci of infection (tonsillitis, sinusitis, etc.).
8. Hypothermia.
9. Helminthic invasions.
10. In children under one year old, the development of pyelonephritis is predisposed to the transition to artificial feeding, the introduction of complementary foods, teething and other factors that increase the load on the immune system.

Classification of pyelonephritis

Russian nephrologists distinguish the following types of pyelonephritis:

1. Primary (in the absence of obvious predisposing factors from the urinary organs) and secondary (arising against the background of structural abnormalities, with functional disorders of urination - obstructive pyelonephritis; with dysmetabolic disorders - non-obstructive pyelonephritis).
2. Acute (after 1-2 months, complete recovery and normalization of laboratory parameters occur) and chronic (the disease lasts more than six months, or two or more relapses occur during this period). In turn, chronic pyelonephritis can be recurrent (with obvious exacerbations) and latent (when there are no symptoms, but changes are periodically detected in the analyzes). The latent course of chronic pyelonephritis is a rare occurrence, and most often such a diagnosis is a consequence of overdiagnosis, when an infection of the lower urinary tract or reflux nephropathy is taken for pyelonephritis, in which there are really no or weakly expressed "external" symptoms and complaints.

Symptoms of acute pyelonephritis

Children 3-4 years old complain of pain not in the lower back, but all over the abdomen or around the navel.

The symptoms of pyelonephritis are quite different in different children, depending on the severity of the inflammation, the severity of the process, the age of the child, concomitant pathology, etc.

The following main symptoms of pyelonephritis can be distinguished:

1. An increase in temperature is one of the main signs, which is often the only one ("unreasonable" temperature rises). Fever is usually severe and the temperature rises to 38 ° C or more.
2. Other symptoms of intoxication: lethargy, drowsiness, nausea and vomiting, decreased or no appetite; pale or gray skin tone, periorbital shadows ("blue" under the eyes). As a rule, the more severe the pyelonephritis and the younger the child, the more pronounced the signs of intoxication will be.
3. Pain in the abdomen or lumbar region. Children under the age of 3-4 years poorly localize abdominal pain and may complain of diffuse (all over the abdomen) pain or pain around the navel. Older children often complain of lower back pain (usually one-sided), in the side, in the lower abdomen. Mild pain, pulling, aggravated with a change in body position and subside with warming.
4. Violation of urination is an optional sign. Perhaps urinary incontinence, frequent or rare urination, sometimes it is painful (against the background of previous or concomitant cystitis).
5. Slight swelling of the face or eyelids in the morning. With pyelonephritis, there are no pronounced edema.
6. Changes in the appearance of urine: it becomes cloudy and may have an unpleasant odor.

Features of pyelonephritis in newborns and infants

In infants, pyelonephritis is manifested by symptoms of severe intoxication:

• high temperature (39-40 ° C) up to febrile seizures;
• regurgitation and vomiting;
• refusal of breast (mixture) or sluggish sucking;
• pallor of the skin with perioral cyanosis (blue around the mouth, blueness of the lips and skin over the upper lip);
• weight loss or lack of weight gain;
• dehydration, manifested by dryness and flabbiness of the skin.

Babies cannot complain of abdominal pain, and their analogue is the child's unrelated anxiety or crying. About half of infants also have anxiety when urinating or facial flushing and grunting before urinating. Often, infants with pyelonephritis develop stool disorders (diarrhea), which, combined with high fever, vomiting and signs of dehydration, makes it difficult to diagnose pyelonephritis and is mistakenly interpreted as an intestinal infection.

Chronic pyelonephritis symptoms

Chronic recurrent pyelonephritis occurs with alternating periods of complete remission, when the child has no symptoms or changes in urine tests, and periods of exacerbations, during which the same symptoms occur as in acute pyelonephritis (abdominal and back pain, temperature, intoxication, changes in urine tests). In children suffering from chronic pyelonephritis for a long time, signs of infectious asthenia appear: irritability, fatigue, and school performance decreases. If pyelonephritis began at an early age, it can lead to a delay in physical, and in some cases, psychomotor development.

Diagnostics of the pyelonephritis

To confirm the diagnosis of pyelonephritis, additional laboratory and instrumental research methods are used:

1. A general urine test is a mandatory study for all feverish children, especially if their fever cannot be explained by ARVI or other reasons not related to the kidneys. Pyelonephritis is characterized by an increase in leukocytes in the urine: leukocyturia up to pyuria (pus in the urine), when leukocytes cover the entire field of view; bacteriuria (the appearance of bacteria in the urine), possibly a small number of cylinders (hyaline), mild proteinuria (protein in the urine is not more than 1 g / l), single erythrocytes. You can also read about the interpretation of urine analysis in children in this article.
2. Cumulative tests (according to Nechiporenko, Addis-Kakovsky, Amburzha): leukocyturia is detected in them.
3. Culture of urine for sterility and sensitivity to antibiotics allows you to determine the causative agent of the infection and select effective antibacterial drugs for the treatment and prevention of recurrence of the disease.
4. In a general blood test, general signs of an infectious process are found: accelerated ESR, leukocytosis (an increase in the number of leukocytes compared to the age norm), a shift in the leukocyte formula to the left (the appearance of immature leukocytes in the blood - rods), anemia (a decrease in hemoglobin and the number of erythrocytes).
5. A biochemical blood test is required to determine total protein and protein fractions, urea, creatinine, fibrinogen, CRP. In acute pyelonephritis, in the first week from the onset of the disease, an increase in the level of C-reactive protein is noted in the biochemical analysis. In chronic pyelonephritis against the background of the development of renal failure, the level of urea and creatinine increases, the level of total protein decreases.
6. Biochemical analysis of urine.
7. Kidney function is assessed using the Zimnitsky test, according to the level of creatinine and urea in a biochemical blood test and some other tests. In acute pyelonephritis, renal function is usually not impaired, and in chronic pyelonephritis, some deviations in the Zimnitsky test are often found (isostenuria is a monotonous specific gravity, nocturia is the predominance of nocturnal diuresis over daytime).
8. Blood pressure measurement is a mandatory daily procedure for children of any age who are hospitalized for acute or chronic pyelonephritis. In acute pyelonephritis, the pressure is within the age norm. When the pressure begins to rise in a child with chronic pyelonephritis, this may indicate the addition of renal failure.
9. In addition, all children undergo ultrasound of the urinary system, and after the acute symptoms subside - X-ray contrast studies (vocal cystoureterography, excretory urography). These studies can identify vesicoureteral reflux and anatomical abnormalities that contributed to the onset of pyelonephritis.
10. In specialized nephrological and urological departments for children, other studies are also carried out: various tests, Doppler ultrasonography of renal blood flow, scintigraphy (radionuclide study), uroflowmetry, CT, MRI, etc.

Complications of pyelonephritis

Pyelonephritis is a serious disease that requires timely and adequate treatment. Delays in treatment, insufficient volume of treatment measures can lead to the development of complications. Complications of acute pyelonephritis are most often associated with the spread of infection and the occurrence of purulent processes (abscesses, paranephritis, urosepsis, bacteremic shock, etc.), and complications of chronic pyelonephritis are usually caused by impaired renal function (nephrogenic arterial hypertension, chronic renal failure).

Pyelonephritis treatment

With acute pyelonephritis, the child is shown to drink plenty of fluids.

Treatment of acute pyelonephritis in children should be carried out only in a hospital setting, and it is highly desirable to hospitalize the child in an accelerated specialized department: nephrological or urological. Only in a hospital is it possible to constantly assess the dynamics of urine and blood tests, conduct other necessary studies, and select the most effective drugs.

Therapeutic measures for acute pyelonephritis in children:

1. Regime - for febrile children and children complaining of pain in the abdomen or lumbar region, bed rest is prescribed in the first week of the illness. In the absence of fever and severe pain, the ward mode (movement of the child within his ward is allowed), then general (including daily quiet walks in the fresh air for 30-40-60 minutes on the territory of the hospital).
2. A diet whose main goal is to reduce the burden on the kidneys and correct metabolic disorders. Pevzner's table No. 5 is recommended without restriction of salt and with an extended drinking regime (the child should receive liquids 50% more than the age norm). However, if there is impaired renal function or obstructive events in acute pyelonephritis, salt and fluid are limited. A protein-vegetable diet, with the exception of any irritating foods (spices, spicy foods, smoked meats, fatty foods, rich broths). In case of dysmetabolic disorders, an appropriate diet is recommended.
3. Antibiotic therapy is the basis of drug treatment for acute pyelonephritis. It is carried out in two stages. Until the results of urine tests for sterility and sensitivity to antibiotics are obtained, the drug is selected "at random", giving preference to those that are active against the most common causative agents of urinary system infections and are not toxic to the kidneys (protected penicillins, cephalosporins of the 2nd and 3rd generations, etc.). ). After receiving the results of the analysis, the drug is selected that is most effective in relation to the identified pathogen. The duration of antibiotic therapy is about 4 weeks, with an antibiotic change every 7-10 days.
4. Uroantiseptics are drugs that can disinfect the urinary tract, kill bacteria or stop their growth, but are not antibiotics: nevigramone, palin, nitroxoline, etc. They are prescribed for another 7-14 days of administration.
5. Other medications: antipyretic drugs, antispasmodics (for pain), drugs with antioxidant activity (unitiol, beta-carotene - provitamin A, tocopherol acetate - vitamin E), non-steroidal anti-inflammatory drugs (ortofen, voltaren).

Inpatient treatment lasts about 4 weeks, sometimes longer. After discharge, the child is sent for observation to the district pediatrician, if there is a nephrologist in the clinic, then to him too. The observation and treatment of the child is carried out in accordance with the recommendations given in the hospital, if necessary, they can be corrected by the nephrologist. After discharge, at least 1 time per month, a general urine test is performed (and additionally against the background of any acute respiratory viral infection), every six months, an ultrasound of the kidneys is performed. At the end of the intake of uroseptics, phytopreparations are prescribed for 1-2 months (kidney tea, lingonberry leaf, kanephron, etc.). A child who has undergone acute pyelonephritis can be removed from the register only after 5 years, provided that there are no symptoms and changes in urine tests without drug anti-relapse measures (that is, the child was not given uroseptics or antibiotics for these 5 years, and he did not have a recurrence of pyelonephritis) ...

Treatment of children with chronic pyelonephritis

Treatment of exacerbations of chronic pyelonephritis is also carried out in a hospital setting and according to the same principles as the treatment of acute pyelonephritis. Children with chronic pyelonephritis during the period of remission can also be recommended planned hospitalization in a specialized hospital for a detailed examination, finding out the causes of the disease and selecting anti-relapse therapy.

In chronic pyelonephritis, it is extremely important to identify the cause of its development, since only after eliminating the cause can the disease itself be eliminated. Depending on what exactly caused the kidney infection, therapeutic measures are also prescribed: surgical treatment (for vesicoureteral reflux, anomalies accompanied by obstruction), diet therapy (for dysmetabolic nephropathy), drug and psychotherapeutic measures (for neurogenic bladder dysfunction) etc.

In addition, in chronic pyelonephritis during the period of remission, anti-relapse measures are necessarily carried out: course treatment with antibiotics in small doses, prescribing uroseptics in courses for 2-4 weeks with interruptions from 1 to 3 months, herbal medicine for 2 weeks each month. Children with chronic pyelonephritis are monitored by a nephrologist and pediatrician with routine examinations up to transfer to an adult clinic.

Which doctor to contact

In acute pyelonephritis, a pediatrician usually begins examination and treatment, and then a consultation with a nephrologist is appointed. Children with chronic pyelonephritis are monitored by a nephrologist, in addition, an infectious disease consultation may be prescribed (in unclear diagnostic cases, suspected tuberculosis, and so on). Considering the predisposing factors and pathways of infection in the kidneys, it will be useful to consult with a specialized specialist - cardiologist, gastroenterologist, pulmonologist, neurologist, urologist, endocrinologist, ENT doctor, immunologist. Treatment of foci of infection in the body will help get rid of chronic pyelonephritis.

Chronic pyelonephritis: symptoms and treatment

An ailment such as pyelonephritis in children requires prompt detection and adequate treatment. It is necessary to carefully monitor the baby, since inflammation of the kidneys is a dangerous disease and the symptoms cannot be ignored. Self-medication is also prohibited, as it leads to serious complications and health problems. What are the causes of pyelonephritis in children, the main symptoms and treatment of the disease.

general information

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

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Classification

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

Depending on how long the illness bothers the child, acute and chronic pyelonephritis is released. In the chronic course of the child, frequent relapses are worried, all signs of an organ infection remain. With an exacerbation, severe and acute pains, fever, problems with urination, deterioration of the general condition disturb.

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Symptoms of the disease

A characteristic symptom of acute pyelonephritis is severe pain in the lumbar spine, deterioration of health, an increase in body temperature, and intoxication. The child suffers from prolonged chills, fever, against the background of intoxication, nausea, vomiting, diarrhea, weight loss, bacteriuria develop. With an exacerbation with the addition of a bacterial infection, the baby experiences pain during urination, frequent urge to empty the urinary system, incontinence, burning sensation in the organs of the genitourinary system.

In a chronic course, the symptoms are expressed blurred. An early child gets very tired, becomes irritated, pale, not focused. If the disease proceeds in a latent form, then the signs do not appear, but urine tests will show the development of inflammation. If you do not resort to treatment of a chronic ailment, at an older age, it flows into nephrosclerosis, hydronephrosis, or chronic renal failure.

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Causes and predisposition

The causes of pyelonephritis in young children are most often intestinal-bacterial. Urine analysis also shows the presence of Proteus, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus. Infection enters the kidney by hematogenous, lymphogenous or urinogenic routes. Newborn babies are infected by the hematogenous route, and the older ones, up to 12 years old, are more often infected by the urinogenic route. Failure to comply with the rules of hygiene, irregular change of linen also provoke ailment.

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

Congenital anomalies, complications after severe infectious diseases, with the diagnosis of hypotophia, rickets, also cause the disease. Babies with such diseases are often prone to pyelonephritis. The child should be under the supervision of a pediatrician, and if a characteristic symptom occurs, the ailment should be immediately identified and timely treatment should be started with the use of adequate drugs.

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

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

Today there is no generally accepted classification of pyelonephritis. The most commonly used classification is proposed by M. Ya.Studenikin and co-authors in 1980 ( ), which determines the form (primary, secondary), the nature of the course (acute, chronic), the activity of the disease and the function of the kidneys. V.G. Maidannik and co-authors (2002) proposed to indicate also the stage of the pyelonephritic process (infiltrative, sclerotic) and the degree of disease activity.

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

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

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

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

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

Acute and chronic pyelonephritis are isolated depending on the age of the pathological process and the characteristics of clinical manifestations.

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

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

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

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

Clinical symptoms include:

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

The indicators of urine analysis are as follows:

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

Blood test indicators:

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

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

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

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

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

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

The diagnosis of chronic pyelonephritis is based on a protracted course of the disease (more than 6 months), repeated exacerbations, and the identification of signs of tubulointerstitium and ChLS lesions due to bacterial infection.

In any course of the disease, the patient needs to carry out the entire complex of studies aimed at establishing the activity of the microbial-inflammatory process, the functional state of the kidneys, the presence of signs of obstruction and metabolic disorders, and the state of the renal parenchyma. We offer the following complex of studies in chronic pyelonephritis, which allows you to get answers to the questions posed.

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

• Clinical blood test.
• Biochemical blood test (total protein, protein fractions, urea, fibrinogen, C-reactive protein (CRP)).
• General urine analysis.
• Quantitative analyzes of urine (according to Nechiporenko, Amburzhe, Addis-Kakovsky).
• Morphology of urine sediment.
• Culture of urine for flora with a quantitative assessment of the degree of bacteriuria.
• Antibioticogram of urine.
• Biochemical examination of urine (daily excretion of protein, oxalates, urates, cystine, calcium salts, indicators of membrane instability - peroxides, lipids, anticrystalline ability of urine).

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

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

Obligatory laboratory tests:

• The level of creatinine, urea in the blood.
• Zimnitsky test.
• Endogenous creatinine clearance.
• Investigation of pH, titratable acidity, ammonia excretion.
• Diuresis control.
• The rhythm and volume of spontaneous urination.

Additional laboratory tests:

• Urinary excretion of β 2 -microglobulin (mg).
• Osmolarity of urine.
• Urine enzymes.
• Ammonium chloride sample.
• Zimnitsky's test with dry eating.

3. Instrumental research.

Mandatory:

• Measurement of blood pressure.
• Ultrasound examination (ultrasound) of the urinary system.
• X-ray contrast studies (vocal cystography, excretory urography).
• Functional methods for examining the bladder (uroflowmetry, cystometry, profilometry).

Additional:

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

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

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

Additional criteria may include:

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

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

Complications of pyelonephritis:

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

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

Pyelonephritis treatment

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

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

Dietary restrictions are intended to reduce the load on the transport systems of the tubules and correct metabolic disorders. In the active stage, table No. 5 according to Pevzner is used without restriction of salt, 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 plant foods. Products containing extractives and essential oils, fried, spicy, fatty foods are excluded. Revealed metabolic disorders require special corrective diets.

The basis of drug treatment for pyelonephritis is antibiotic therapy, which is based on the following principles:

• before starting treatment, urine culture is necessary (later treatment is changed based on the results of the culture);
• 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 usually respond to short courses of antimicrobial therapy; upper urinary tract - require long-term therapy;
• early relapses (up to 2 weeks) represent a recurrent infection and are caused either by the survival of the pathogen in the upper urinary tract, or by continued colonization from the intestine. Late relapses are almost always re-infection;
• pathogens of community-acquired urinary tract infections are usually sensitive to antibiotics;
• frequent relapses, instrumental interventions on the urinary tract, recent hospitalization make one suspect an infection caused by resistant pathogens.

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

The stage of suppression of the activity of the microbial-inflammatory process. This stage can be conditionally subdivided into two periods.

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

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

When choosing antibacterial drugs, it must be borne in mind that:

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

Initial antibiotic therapy is prescribed empirically based on the most likely infectious agents. In the absence of clinical and laboratory effect, it is necessary to change the antibiotic after 2-3 days.

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

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

• semi-synthetic penicillins in combination with β-lactomase inhibitors - amoxicillin and clavulanic acid: augmentin - 25-50 mg / kg / day, by mouth - 10-14 days; amoxiclav - 20-40 mk / kg / day, inside - 10-14 days;
• 2nd generation cephalosporins: cefuroxime (zinacef, ketocef, cefurabol), cefamandol (mandol, cefamabol) - 80-160 mg / kg / day, intravenously, intramuscularly - 4 times a day - 7-10 days;
• 3rd generation cephalosporins: cefotaxime (claforan, clafobrin), ceftazidime (fortum, vice), ceftizoxime (epocelin) - 75-200 mg / kg / day, intravenously, intramuscularly - 3-4 times a day - 7-10 days; cefoperazone (cefobid, cefoperabol), ceftriaxone (rocefin, ceftriabol) - 50-100 mg / kg / day, intravenously, intramuscularly - 2 times a day - 7-10 days;
• aminoglycosides: gentamicin (gentamicin sulfate) - 3.0-7.5 mg / kg / day, intravenously, intramuscularly - 3 times a day - 5-7 days; amikacin (amycin, likacin) - 15-30 mg / kg / day, intravenously, intramuscularly - 2 times a day - 5-7 days.

During the period of dying down of activity, antibacterial drugs are administered mainly orally, while "stepwise therapy" is possible, when the same drug is given orally as was administered parenterally, or a drug of the same group. Most often used during this period:

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

In case of severe septic course, microbial associations, multi-resistance of microflora to antibiotics, when exposed to intracellular microorganisms, as well as to expand the spectrum of antimicrobial action in the absence of culture results, combined antibiotic therapy is used. In this case, bactericidal antibiotics are combined with bactericidal, bacteriostatic with bacteriostatic antibiotics. Some antibiotics act bactericidal against some microorganisms, and bacteriostatic against others.

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

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

Potentiate each other's action (synergists): penicillins and aminoglycosides; cephalosporins and penicillins; cephalosporins and aminoglycosides.

The antagonists are: penicillins and chloramphenicol; penicillins and tetracyclines; macrolides and chloramphenicol.

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

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

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

Nalidixic acid preparations (nevigramone, blacks) are prescribed for children over 2 years old. These agents are bacteriostatics or bactericides, depending on the dose in relation to gram-negative flora. They should not be administered concurrently with nitrofurans, which have an antagonistic effect. The course of treatment is 7-10 days.

Gramurin, a derivative of oxolinic acid, has a broad spectrum of action on gram-negative and gram-positive microorganisms. It is used in children aged 2 years and older for a course of 7-10 days.

Pipemidic acid (palin, pimidel) affects most gram-negative bacteria and staphylococci. Appointed as a short course (3-7 days).

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

The reserve drug is ofloxacin (tarivid, zanocin). It has a wide spectrum of action, including on the intracellular flora. Children are prescribed only if other uroseptics are ineffective.

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

In the early days of the disease, against the background of increased water load, fast-acting diuretics (furosemide, veroshpiron) are used, which enhance 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 stage of pathogenetic therapy begins when the microbial-inflammatory process subsides against the background of antibacterial drugs. On average, this occurs on the 5-7th day from the onset of the disease. Pathogenetic therapy includes anti-inflammatory, antioxidant, immunocorrective and anti-sclerotic therapy.

The combination with anti-inflammatory drugs is used to suppress the activity of inflammation and enhance the effect of antibiotic therapy. It is recommended to take non-steroidal anti-inflammatory drugs - Ortofen, Voltaren, Surgam. The course of treatment is 10-14 days. The use of indomethacin in pediatric practice is not recommended due to a possible deterioration in the blood supply to the kidneys, a decrease in glomerular filtration, water and electrolyte retention, and renal papillary necrosis.

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

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

Immunocorrective therapy for pyelonephritis is prescribed strictly according to the indications:

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

Immunocorrective therapy is prescribed only after agreement with an immunologist and should provide for immunological monitoring, relative "selectivity" of prescription, short or intermittent course and strict adherence to dosages and regimen of drug administration.

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

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

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

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

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

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

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

An appropriate dietary regimen and pharmacological treatment should be included in the therapy of dysmetabolic pyelonephritis.

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

Dynamic observation of children suffering from pyelonephritis suggests the following.

• Frequency of examination by a nephrologist: with exacerbation - 1 time per 10 days; during remission during treatment - once a month; remission after the end of treatment for the first 3 years - once every 3 months; remission in subsequent years up to the age of 15 years - 1-2 times a year, then observation is transferred to therapists.
• Clinical and laboratory tests: general urine analysis - at least 1 time per month and against the background of acute respiratory viral infections; 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 pyelonephritis is possible while maintaining clinical and laboratory remission without therapeutic measures (antibiotics and uroseptics) for more than 5 years after a full clinical and laboratory examination. Patients with chronic pyelonephritis are followed up before transfer to the adult network.

Literature

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A. V. Malkoch, Candidate of Medical Sciences
V. A. Gavrilova, Doctor of Medical Sciences
Y.B. Yurasova, Candidate of Medical Sciences
Russian State Medical University, Russian Children's Clinical Hospital, Moscow