Pyelonephritis in children

The term “pyelonephri­tis” comes from the merg­er of two terms — pye­los — trough, pelvis and nephros — kid­ney. Thus, the term reflects that the dis­ease affects the inflam­ma­to­ry infec­tious process in the renal pelvis and kid­ney tis­sue. At an ear­ly age in chil­dren, it can be dif­fi­cult to deter­mine exact­ly where the lesion is local­ized, so the gen­er­al term “uri­nary tract infec­tion” is often used.

Pyelonephri­tis and its types

The causative agents of pyelonephri­tis are intesti­nal microor­gan­isms — coc­ci and coli bac­te­ria: strep­to­coc­cus, staphy­lo­coc­cus, intesti­nal escherichia, pro­teus, ente­ro­coc­cus and oth­ers. Almost half of patients with pyelonephri­tis have a mixed microflo­ra. Due to pro­longed treat­ment of the dis­ease with antibi­otics, the occur­rence of a fun­gal infec­tion — can­didi­a­sis is also pos­si­ble.

A fac­tor con­tribut­ing to infec­tion of the uri­nary tract is a vio­la­tion of the out­flow of urine with signs of reflux — its reverse reflux.

In pedi­atric urol­o­gy, pyelonephri­tis is divid­ed into pri­ma­ry and sec­ondary. The pri­ma­ry inflam­ma­to­ry process of the uri­nary tract devel­ops with the nor­mal struc­ture of the organs. Sec­ondary occurs in chil­dren with a pathol­o­gy of the loca­tion or struc­ture of the blad­der, kid­neys, ureters. Accord­ing to the affect­ed area, the dis­ease can be uni­lat­er­al or bilat­er­al. Accord­ing to the dura­tion of the course — acute, chron­ic and recur­rent.

Acute pyelonephri­tis with prop­er treat­ment in 1–2 months ends with a com­plete recov­ery.

In chron­ic pyelonephri­tis, the symp­toms of the dis­ease per­sist for more than six months from the onset of the dis­ease, or there are at least two exac­er­ba­tions of the dis­ease.

Symp­toms

Symp­toms of the dis­ease are close­ly relat­ed to age. Com­mon char­ac­ter­is­tic symp­toms are fever, weak­ness, loss of appetite, and in some cas­es vom­it­ing. The tem­per­a­ture rise some­times reach­es 39–40 degrees and is accom­pa­nied by chills and sweat­ing. There may be pain in the lum­bar region, aggra­vat­ed by tap­ping. If cys­ti­tis or ure­thri­tis also occurs with pyelonephri­tis, then abdom­i­nal pain and painful uri­na­tion are observed. In the peri­od up to one year, boys are more like­ly to suf­fer from pyelonephri­tis, and lat­er, espe­cial­ly dur­ing puber­ty, this dis­ease is more com­mon in girls.

Pyelonephri­tis can often be asymp­to­matic. Par­ents should be alert­ed by the child’s rapid fatigue, pal­lor, mood swings, fre­quent trips to the toi­let at night. Often, pyelonephri­tis is diag­nosed by acci­dent when tak­ing tests when reg­is­ter­ing for a kinder­garten or nurs­ery.

Diag­no­sis

Pyelonephri­tis in chil­dren is very impor­tant to diag­nose as ear­ly as pos­si­ble and start treat­ment in a time­ly man­ner, since the baby may expe­ri­ence irre­versible changes in the kid­neys and form arte­r­i­al hyper­ten­sion.

The most wide­ly used for diag­nos­ing the dis­ease lab­o­ra­to­ry tests of urine and blood. For chil­dren, an ultra­sound exam­i­na­tion of the uri­nary sys­tem is manda­to­ry in order to iden­ti­fy or exclude the pathol­o­gy of the kid­neys and uri­nary tract. If nec­es­sary, X‑ray and instru­men­tal diag­nos­tic meth­ods are used in spe­cial­ized depart­ments.

Treat­ment

In the acute peri­od of the dis­ease, var­i­ous groups of drugs are used: sul­fanil­amide, antibi­otics, nitrox­o­line, nitro­fu­ran. Only a spe­cial­ist doc­tor can choose drugs, deter­mine the dura­tion of treat­ment, depend­ing on the clin­i­cal pic­ture and the iso­lat­ed microflo­ra. If the dis­ease is chron­ic, antibi­ot­ic treat­ment should be car­ried out in cours­es, con­trol­ling the gen­er­al con­di­tion of the patient and his tests. Chil­dren under 12 years of age are not pre­scribed flu­o­ro­quinol com­pounds, as they are tox­ic to the child’s body. If pyelonephri­tis is caused by an anom­aly in the anatom­i­cal struc­ture of the uri­nary tract, the doc­tor must decide whether surgery is appro­pri­ate.

The effec­tive­ness of phy­to­prepa­ra­tions, home­o­path­ic and immunomod­u­lat­ing agents at the sec­ond stage of pyelonephri­tis treat­ment has been proven. After the treat­ment, old­er chil­dren can improve their health in spe­cial­ized sana­to­ri­ums.

After the ill­ness, sys­tem­at­ic obser­va­tion by a spe­cial­ist doc­tor with ultra­sound exam­i­na­tion once every 6–12 months and reg­u­lar test­ing is manda­to­ry.

Pre­ven­tion

It must be remem­bered that pyelonephri­tis often occurs in chil­dren with a chron­ic focus of infec­tion. The cause of pyelonephri­tis can be inflam­ma­tion of the inter­nal organs, res­pi­ra­to­ry tract, influen­za and even caries. Path­o­gen­ic bac­te­ria can be brought from the lesion through the blood into the kid­neys and cause an inflam­ma­to­ry process in them. There­fore, it is impor­tant to heal inflam­ma­to­ry dis­eases in a time­ly man­ner, vis­it the den­tist on time, and increase the child’s immu­ni­ty.

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