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Pyelonephritis in children: symptoms and treatment, forms of the disease

Recently, cases of the development of kidney pyelonephritis in children have become very frequent, and the disease occurs equally often in both schoolchildren and young children.

Pyelonephritis in a child - what does this mean?

Pyelonephritis in children is called an inflammatory-infectious disease of the kidneys, during which the calyx, pelvis, tubules and kidney tissue are affected. Pathological process can be unilateral or bilateral, occur independently or against the background of other diseases.

Pyelonephritis in children under one year in most cases develops as a complication after an incompletely treated acute respiratory viral infection, tonsillitis or pharyngitis. More often, the disease is diagnosed in girls, which is due to the anatomical structure of the urethra - the urethra is wide and short, which facilitates the penetration of pathogenic bacteria from the environment.


Acute and chronic pyelonephritis in children

Pyelonephritis in children

Depending on the course of the disease, the clinical picture, the duration and severity of symptoms, there are:

  1. Acute pyelonephritis;
  2. Chronic pyelonephritis.

The acute form of the disease is characterized by the development of a stormy clinical picture and the appearance of dysuric phenomena. Chronic pyelonephritis in a child develops as a result of an untreated or advanced acute kidney damage, as well as against the background of existing long-standing infectious lesions of the urinary tract.

The main sign of the transition of the disease to the chronic form of the course is the long presence of the clinical picture of pyelonephritis, as well as the occurrence of several relapses of infection over the past six months.

Depending on the causes of occurrence are distinguished:

  • Primary pyelonephritis - the pathological process develops directly in the tissues of the kidney initially;
  • Secondary pyelonephritis - the disease develops as a result of the presence of foci of infection in the body.

Infectious pathogen enters the kidney tissue in several ways:

  • With blood flow;
  • With lymph current;
  • Ascending path - from the environment.

The main causes of pyelonephritis in children are:

  • Non-compliance with the rules of personal intimate hygiene, for example, improper washing of girls, with the result that E. coli from the rectum enters the urethra and causes the development of the inflammatory process;
  • The presence in the body of foci of chronic infection, of which infectious pathogens with blood or lymph flow can move freely in the body and provoke the development of inflammatory processes - carious teeth, chronic tonsillitis;
  • Inflammatory diseases of the urogenital system, as a result of which an infectious pathogen can spread to the kidneys - urethritis, cystitis, vulvitis, vulvovaginitis, balanoposthitis;
  • Intestinal infections;
  • Purulent omphalitis - inflammation of the umbilical wound in newborns;
  • Hypothermia of the body, in particular the lumbar region;
  • Injuries and blows to the lumbar region, as a result of which the inflammatory process can develop.

Predisposing factors to the development of children's pyelonephritis are recently transferred viral infectious diseases - angina, measles, mumps, chickenpox, ARVI, scarlet fever, and also worm infestation.

Symptoms of pyelonephritis in children

Symptoms of pyelonephritis in children

The first symptoms of pyelonephritis appear suddenly, the clinical picture is characterized by the appearance of a number of signs:

  1. Increase in body temperature to 38.5-39 degrees;
  2. Chills and excessive sweating;
  3. Pain when urinating, reducing the amount of urine discharge (urine in pyelonephritis in a child is cloudy in appearance, due to the high content of leukocytes in it);
  4. Increasing weakness, lethargy, tearfulness, symptoms of intoxication;
  5. In infants, persistent regurgitation is possible, in older children vomiting begins;
  6. Diarrhea;
  7. Pain in the abdomen, lumbar region, which are aggravated by physical exertion or light tapping of the lower back (positive symptom of Pasternack).

In chronic pyelonephritis, the clinical picture of the disease is not so pronounced: the child has dysuric phenomena (pain and burning during urination, urinary incontinence), lack of appetite, pale skin, sluggish child.

In the absence of timely diagnosis and adequate treatment, the disease may be complicated by nephrosclerosis, hypertension, stretching and fluid accumulation in the kidney, the development of chronic renal failure.

Diagnosis of the disease

As a rule, when the above clinical symptoms are detected in a child, parents rush to seek medical attention from a pediatrician. After collecting a history of life and illness of the child, the doctor conducts a primary examination, which includes auscultation, palpation of the abdomen, tapping on the lumbar region.

If you suspect inflammation of the kidneys, the doctor gives the child a referral for consultation with a nephrologist or urologist. To confirm the diagnosis, the patient must undergo a comprehensive detailed examination, which includes:

  • Blood tests (general clinical and biochemistry);
  • Urine tests (total, according to Nechiporenko, Hambourge, determination of urine pH and bacterial culture of urine);
  • Ultrasound of the kidneys;
  • Sometimes, to determine the pathogen, prescribe PCR diagnostics and ELISA.

In some cases, it is advisable to carry out CT, excretory urography and angiography of the kidneys.

Children's pyelonephritis must be differentiated from inflammatory diseases of the small pelvis in girls, acute appendicitis, glomerulonephritis , therefore, in addition to consulting a nephrologist or a urologist, the patient sometimes needs to consult a children's gynecologist and a surgeon.

Treatment of pyelonephritis in children, drugs and antibiotics

Treatment of pyelonephritis in children, drugs and antibiotics

Effective treatment of pyelonephritis in children is based on drug therapy, diet and drinking regimen.
During an acute period of illness, the child should be in bed. If the appetite is absent, then parents should not insist, the only exception is breast milk in babies who are breastfed.

The basis of the treatment of the disease are antibacterial drugs. Antibiotics for pyelonephritis in children are selected by an expert on an individual basis after conducting a test for the sensitivity of an infectious pathogen to a drug.

Preference is given to drugs from the cephalosporin series - Ceftriaxone, Cefuroxime, Cefodex, Cefotaxime. Along with antibiotics, uroseptics are prescribed depending on the age of the child - Furadonin, Furazolidone, Nitrofuril.

At high temperature, as well as for the relief of pain in the lumbar region, patients are prescribed Paracetamol-based drugs - Panadol suspension, Efferalgan, Cefecon suppositories.

In addition to drug treatment, it is very important to observe the drinking regimen, increasing the daily dose of the liquid to 1.5-2 liters, and for infants over 6 months to 750 ml.

During the period of subsiding of the acute clinic of the disease, the child is prescribed phytotherapy, physiotherapeutic procedures, exercise therapy, massage, treatment with mineral waters, and sanatorium-resort treatment.

  • The child after suffering pyelonephritis should be in the dispensary at the urologist or nephrologist for 1 year, after which, in the absence of complications of the disease or its recurrence, the patient can be removed from the register.

Diet for children with pyelonephritis

During the acute phase of the disease in the absence of an appetite, the patient should not insist on eating, but the drinking regime must be strictly followed. After the body temperature is normalized and the acute phase of pyelonephritis is stopped, the child is offered a sparing diet.

From the diet at the time excluded:

  • Fatty meat and fish;
  • Chocolate;
  • Fresh bread;
  • Butter;
  • Strong tea and coffee drink;

Preference is given to dairy-vegetable dishes, in particular, boiled porridge cooked on water with milk, vegetables and fruits, vegetable soups, cottage cheese, kefir, yogurt. Meat allowed turkey and rabbit in the form of steamed meatballs.

Prevention of pyelonephritis in a child

Prevention of pyelonephritis in children are:

  • Timely treatment of ARVI and infectious and inflammatory diseases;
  • Monitoring the state of tooth enamel, treatment of caries at the initial stage of its development;
  • Lack of hypothermia;
  • Compliance with personal intimate hygiene, in particular the correct washing of girls - from front to back;
  • Regular change of disposable diapers in children under one year;
  • Strengthening immunity, vaccination by age.

The prognosis of acute pyelonephritis in children, with timely diagnosis and complex treatment is favorable, in 95% of patients full recovery occurs and only in 5% the disease becomes chronic with periods of exacerbations and remissions.


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