Update: October 2018
What disease in children under one year is manifested simply by an increase
temperature, without any other symptoms? What can be confused
with acute appendicitis or intestinal infection in preschoolers and
schoolchildren? This is acute pyelonephritis – an inflammation of the kidney tissue with
primary defeat of its main “work items”.
This is the most frequent, after acute respiratory infections, disease in children. 85% of children
fall ill in the first 6 months of life, a third of them – even in the period
newborn. But even in such babies, the disease can turn into
chronic form, if it is not treated in time. And kidney damage
children have harm to the whole body. And in severe cases, even
may necessitate permanent hemodialysis.
He did not supercool, why did he get sick?
Acute pyelonephritis in children develops not only with
hypothermia. More frequent causes of the disease are:
- ARVI: adenovirus infection, influenza;
- E. coli infection (E.coli) or
- long-term antibiotic treatment due to which urinary
pathways develop pathogenic fungi;
- chronic constipation due to which intestinal flora migrates to
the lymphatic system and spreads to the kidneys;
- colitis (inflammation of the colon);
- intestinal dysbiosis;
- inflammation of the genital organs: vulvitis or vulvovaginitis – in
girls, balanitis, balanoposthitis – in boys;
- presence of purulent inflammation in the body: pneumonia,
bacterial endocarditis, sepsis.
The causes of pyelonephritis in boys in their first year of life are
physiological phimosis, that is, a normal contraction
foreskin In addition, in newborns and children up to the year of both
pyelonephritis develops as a complication of omphalitis, inflammation
lungs, purulent tonsillitis, purulent otitis media and other organs. In that
In the event of an infection, the infection enters the kidneys through the bloodstream.
In the first year of life, acute pyelonephritis occurs in boys and
in girls with the same frequency. After этого возраста на 1
a sick boy accounts for 3 girls. This is due to the fact that
girls, the urethra is shorter, and
unsatisfactory hygiene genital organs bacteria rise
up through it, first reaching the bladder, then
мочеточников, а затем и the kidneys.
Pyelonephritis in a child is unlikely to develop if the body does not have
predisposing factors. They are:
- small age;
- early transition to artificial feeding;
- features of immunity;
- food in which urine precipitates
- pyelonephritis transferred during pregnancy;
- preeclampsia (nephropathy) during pregnancy;
- occupational hazards from the mother;
- Iron-deficiency anemia;
- impaired communication between the bladder and the nervous system
(neurogenic bladder) causing stagnation
- abnormal development of the urinary tract;
- unfavorable ecology;
- frequent colds;
- endocrine diseases;
- early onset of sexual activity;
- chronic diseases of the urinary system in the family;
- frequent chronic infections in the family;
- hypervitaminosis D.
Of the bacteria, pyelonephritis is most often (90%) caused by intestinal
wand. This microbe has several factors.
pathogenicity. These are cilia and 3 antigens, which together
immobilize urinary tract, deactivate local immune defenses
и позволяют бактерии спокойно двигаться против тока urine.
Other pathogens of pyelonephritis become Proteus, including
including Pseudomonas aeruginosa, enterococci, enterobacter, salmonella,
leptospira, gonococcus, Staphylococcus adenovirus, virus
Coxsackie. The role of chlamydia, ureaplasma and mycoplasma still
is considered. Also, the disease can be caused by fungi,
for example, Candida. The inflammatory process in the kidneys can be
caused and mycobacterium tuberculosis.
Types of pyelonephritis
Depending on the conditions of development, pyelonephritis is divided into:
- primary: appears in a child with normally developed and
properly connected urinary organs
- secondary pyelonephritis: developing or urinary
system with structural abnormalities, or if there is neurogenic urinary
bladder, or if the urine has a different pH – due to hormonal
nutritional or nutritional disorders.
Secondary pyelonephritis can be:
- обструктивным, когда нарушены условия для оттока urine;
- nonobstructive, due to either tubulopathies, or exchangeable
impaired or congenital developmental disorder.
By the nature of the course of the disease is divided into:
- chronic pyelonephritis, which can be recurrent
(periodically exacerbated) and latent (which itself is nothing
- acute pyelonephritis. He has no such division. All symptoms and
changes in urine should disappear within 6 months, and no longer
According to its course, the disease is divided into several stages:
- I active stage.
- II active stage.
- III active stage.
- Partial clinical and laboratory remission.
- Complete clinical and laboratory remission.
Pyelonephritis is also divided by preservation of renal function.
So, it can be:
- partially (partially) broken.
In chronic pyelonephritis, chronic
Symptoms of the disease
Signs of pyelonephritis in children of different ages have differences.
In newborns and infants
Acute pyelonephritis in children under one year is manifested as follows.
- high temperature;
- refusal to eat;
- regurgitation after eating;
- pale gray complexion;
- reduction or absence of weight gain;
- recurrent anxiety attacks, sometimes with redness
persons, and you will notice that this happens when urinating
or in front of him;
- maybe lying down with head thrown back
Most often the disease begins at 5-6 months, when the child or
enter the first complementary foods, or translate into artificial
feeding, or repeat vaccinations. The disease can begin
like intestinal infection (vomiting, diarrhea), but such symptoms quickly
Do preschoolers and schoolchildren
Symptoms of pyelonephritis in children older than a year already give more accurate
an indication that the kidneys are sick. It:
- In school-age children, it is more often felt in the lower back.
- У дошкольников – живот, возле пупка.
- If the right kidney is inflamed, the pain may resemble on
Pain описывается как тупая, она усиливается при перемене
body position, and decreases when the stomach warms up or
- strong urge to urinate;
- frequent urination;
- pain when urinating;
- itching or burning when urinating;
- change in the amount of urine;
- night urge to urinate;
- may be enuresis.
- Pyelonephritis temperature in school-age children is rare
reaches 38 ° C.
- Symptoms of intoxication: chills, headache, absence
- Characteristic appearance: pallor, swelling of the eyelids, “shadows”
- Urine with pyelonephritis may be muddy, maybe with blood,
may have an unpleasant smell.
In children 1.5-2 years old there are few symptoms, there may be no pain, but
symptoms of intoxication are expressed, and delay is sometimes detected
Children of 4-5 years already have pain, but it is not localized.
strictly in the stomach or lower back: the child feels it, but to describe
localization can not. Unpleasant prevails at this age
urination, change in urine amount and frequency
Signs of Chronic Pyelonephritis
This disease rarely develops in very young children. Him
symptoms depend on the stage of the pathology.
So, during remission observed:
- faster fatigue;
- decrease in progress;
- lumbar freezing;
- more frequent trips to the toilet.
If chronic pyelonephritis is younger than 2 years, then the child
lags behind in growth and development. That is, parents must pay
attention that their child is lower, paler and not as plodding as
other children, and examined by a nephrologist.
With exacerbation of chronic pyelonephritis, the symptoms will be almost
the same as in the first attack of this disease. This is both pain and
повышение температуры, и изменение характера urine. Only
the severity of these signs will be less than the first time.
If chronic pyelonephritis progresses, the child:
- anemia increases (it becomes more pale);
- blood pressure rises, which can manifest itself
headaches, facial flushing;
- уменьшение количества urine.
Making a diagnosis in some cases would be difficult
if the doctors had not agreed at the time of admission to the hospital, with
любым диагнозом, брать общий анализ urine. This diagnosis and
shows that there is inflammation in the urinary system.
Other tests for pyelonephritis are:
- general blood analysis;
- Nechiporenko analysis;
- bacteriological examination of urine;
- urine according to Zimnitsky;
- Reberg test – determination of creatinine in the blood and urine;
- urine testing by PCR – to determine the myco-,
- urine culture on Wednesday Saburo – to identify fungal
- analysis of potassium, sodium, urea and creatinine in the blood;
- vaginal smear (in girls) or urethral
the canal (in boys);
- scraping on enterobiosis.
In the diagnosis it is also important to undergo ultrasound of the urinary
systems, x-ray method – excretory urography, sometimes
– radionuclide studies of the kidneys.
In addition to the tests, you need to consult other doctors:
Oculist, phthisiologist, dentist, ENT specialist. And if the first
The specialist assesses the state of the fundus – to understand how
affects the kidney damage to the vessels, the rest should exclude
chronic infection – as a possible cause of pyelonephritis.
Treatment of acute pyelonephritis
The goals of pyelonephritis treatment in children are as follows:
- the destruction of the microorganism that caused the pyelonephritis;
- improving the blood supply to the kidneys;
- увеличение объема выделяемой urine.
It is necessary to hospitalize a child if:
- this is a child up to one year old;
- he has significant intoxication;
- he has a high body temperature;
- he has decreased urine;
- he has a bad stomach or lower back pain;
- he has increased blood pressure;
- home treatment had no effect.
In any case, the child will stay at home or go to the hospital,
3-5 days he will need to comply with bed rest. Especially when
fever, chills, pain, or
symptoms of intoxication. As soon as the symptoms start to decrease,
motor mode expands. It is very important to force the child
urinate every 2-3 hours: so will stagnation prevention
urinary tract, and the daily amount of urine can be calculated
(if you urinate in a duck or bottle).
Diet при пиелонефрите – следующая:
- protein limit to 1.5 g / kg / day;
- salt – no more than 2-3 g / day. For this dish do not need salt, but
some dosalivat they need to have a plate, based on the daily
- the exclusion of sausages, spicy dishes, fried foods, pickles,
preservation, sauces, any broths (soups – vegetable, without mushrooms and
- restriction of butter and dairy products.
Diet при остром пиелонефрите
It is necessary to additionally take the liquid in the form
клюквенного или брусничного морса, отвара из
dried apples, mineral waters of Slavyanovskaya, Smirnovskaya. Payment
additional fluid intake is as follows:
- children under 7 years old – drink 500-700 ml / day;
- in 7-10 years – 700-1000 ml;
- older than 10 years – 1000-1500 ml.
The course of fluid intake – 20 days.
Of the drugs prescribed:
- антибиотики, чья эффективность оценивается
every 3 days. These are augmentin, cefuroxime, cefotaxime, ceftriaxone.
After 14 years old, ciprofloxacin, norfloxacin or
levofloxacin. Duration of treatment up to 4 weeks, every 10-14 days
возможна смена антибиотика;
- уроантисептики: фурагин, фурадонин,
nalidixic acid, 5-nitroxoline, palin. These are not antibiotics, but
drugs that can stop the growth of bacteria. Appointed after
antibacterial therapy, a course of treatment 1-2 weeks;
- противовоспалительные препараты: это НПВС
(diclofenac, ortofen, voltaren)
- глюкоза 5%, реже солевые растворы (натрия
chloride, ringer’s solution) in the form of droppers;
- препараты для улучшения почечного кровотока:
- кроворазжижающие препараты: трентал и его
analogs of pentoxifylline and chimes;
- иммуномодуляторы и антиоксиданты – по мере
diminished inflammation. This is vitamin E, beta carotene;
- отвары трав – после окончания курса
antibiotics and uroantiseptikov:
- anti-inflammatory: chamomile, sage, tutsan;
- diuretics: horsetail, cowberry leaves, wild rose,
- regeneration enhancing: bird mountaineer, mint, root
Brewed herbs according to the instructions for each of them. On average, this
2 tablespoons, which you need to pour 250 ml of hot water and keep on
water bath for 15 minutes, after which another half an hour to insist. Drink
a glass of broth per day, dividing it into 3-4 doses. Herbs having
different action can be combined.
A course of herbal medicine – 20 days. Drink herbs need 3-4 times a year.
Herbal decoctions can be replaced with phytopreparations, for example, Kanefron,
urolesan or cistone.
See Medicines for Treating the Kidneys.
In the active stage is also assigned to the microwave procedure, in the period
remission of the disease – the course of EVT procedures. When did the baby herself
feels good, and changes in the urine are gone, for prevention
chronic process is prescribed:
- paraffin waxing on the kidney area;
- application of dirt on the kidney area;
- therapeutic (mineral, thermal, sodium chloride)
- drinking hydrocarbonate-calcium-magnesium mineral water.
Inpatient treatment usually within a month, then a child
observed in the district pediatrician and nephrologist. After discharge 1
p / month monitoring of urine, blood, every 6 months ultrasound. After
acute pyelonephritis, if there has been no relapse within 5 years,
blood and urine tests are normal, then the child is removed from the register.
Prevention of complications and chronicity
When relapse of pyelonephritis, the treatment is also carried out in conditions
hospital Courses of therapy and principles are similar to those with acute
Лечение назначается в зависимости от причины инфицирования
the kidneys. Maybe:
- surgical treatment (with abnormalities leading to obstruction,
- diet therapy (dysmetabolic nephropathy);
- psychotherapeutic methods for neurogenic urinary dysfunction
During remission, planned hospitalization is indicated for
examination and selection of anti-relapse treatment.
Anti-relapse therapy includes:
- a course of antibiotic treatment in small doses;
- uroseptics for 2-4 weeks, then a break of 1 – 3 months;
- phytotherapy for 14 days in each month.
“Under the guise of” chronic pyelonephritis is rare, but can occur
tuberculosis of the kidneys, so the consultation of a TB specialist is recommended for children.
Child with chronic pyelonephritis before transferring to an adult
the clinic is registered with a pediatrician and nephrologist, held
scheduled examinations and preventive measures.
Afterдствиями пиелонефрита у детей являются серьезные
- apostematozny jade (covered with pustules kidney);
- kidney carbuncle;
- urolithiasis disease;
- necrosis of the renal papillae;
- wrinkled bud;
- повышение blood pressure;
- renal failure, often – developing chronic
With chronic pyelonephritis often develop a condition
как вторично wrinkled почка, когда почечная ткань перестает
perform its functions, and the body can “drown” in its own
fluid accumulating in body cavities.
If pyelonephritis develops, operating work units
становится все меньше, развивается renal failure.
Adverse prognosis will also be if due to pyelonephritis
the work of the kidneys has suffered, interstitial nephritis has developed.
And even if the work of the kidneys did not deteriorate, all changes in the analyzes
urine and blood are gone, and periodic bacteriological examination
urine does not show any bacteria, and it is impossible to say that
the child fully recovered.
Pyelonephritis can be avoided if it is held every six months.
preventive examinations and timely treatment of all organs that can
become a hotbed of chronic infection. These are carious teeth, chronic.
tonsillitis, adenoiditis, helminths (worms).
If the child has already suffered pyelonephritis, then he should once in 1-3
months to pass an urinalysis and its bacteriological
study. If there is a change in urine, even if no
the child has no symptoms, preventive treatment is indicated
antibiotics, uroantiseptics, drugs that improve the work
the kidneys. Such therapy can be conducted by courses up to 5 years, because
the challenge is to prevent renal failure.
Thus, we examined pyelonephritis in children by focusing
on his symptoms and treatment.
Автор: Кривега Мария Салаватовна врач-реаниматолог