home All hormones Diseases of the urinary organs in children: what you should pay attention to. Urinary tract infections in children: treatment, prescribed medications, symptoms, diagnosis and pediatrician recommendations

Diseases of the urinary organs in children: what you should pay attention to. Urinary tract infections in children: treatment, prescribed medications, symptoms, diagnosis and pediatrician recommendations

Uncontrolled growth bacterial flora in the urinary tract, causing the development of infectious inflammatory reactions in the urinary organs, is called in medicine – UTI (urinary tract infection). Due to insolvency immune defense and the characteristics of the child’s body, urinary tract infection in children is one of the most common pathologies, second in frequency to child's body, only intestinal and cold infections.

The development of an infectious process in a child begins with an incomprehensible ailment, and when diagnostic examination an increased concentration of microbial flora is detected in the urinary tract - the development of bacteriuria. Which is determined by the identification of bacterial colonies in an amount of more than 100 units in a portion of one milliliter of urine obtained from the bladder reservoir. Sometimes, bacteriuria is detected completely accidentally, without obvious signs pathological symptoms, with routine routine monitoring of the child’s health (asymptomatic bacteriuria).

If measures are not taken in time and the rapid growth of pathogenic flora is not stopped, the infection can manifest itself:

Development acute form pyelonephritis – inflammatory infectious process in the superficial membrane of the kidneys and the structure of the pelvis tissues.
Chronic pyelonephritis - developing as a result of repeated pathogenic attacks, which leads to fibrotic damage to the kidneys and structural deformation of the pelvicaliceal parts of the kidneys (a contributing factor is developmental anomalies in the urinary excretory system, or the presence of obstructions).
The development of acute focal inflammatory reactions in the bladder ().
Reverse, retrograde movement of urine from the bladder into the urethra (PM - reflux).
Focal sclerosis, or diffuse, leading to changes in the renal parenchyma and shrinkage of the kidney as a result of intrarenal reflux, newly developing pyelonephritis and sclerosis of the renal tissues, provoked by the reverse flow of urine from the bladder.
Generalized infection - urosepsis, provoked by the introduction of infectious pathogens and their metabolic products into the blood.

Epidemiology statistics

According to statistical data from studies, urinary tract infections in children in terms of prevalence are 18 episodes of pathology per 1 thousand. healthy babies and is determined by the gender and age of the child. The greatest susceptibility to the disease is observed in first-year children. In addition, up to 15% of infants suffer from severe bacteriuria accompanied by fever. Until the age of three months, the disease is diagnosed more often in boys, then girls are given priority.

Relapses develop in almost 30% of them within a year after treatment, and in half (50%) within five years. In a quarter of three-year-old boys, within a year after treatment, the development of causeless fever is due precisely to the recurrence of a UTI. During schooling, according to statistics, at least one episode of infection is observed in girls (almost 5%), in boys - less than 1%.

According to foreign statistics, UTIs are detected in up to 3.2% of boys and up to 2% of girls. After six months of age, this figure increases 4 times, from one year to three years - 10 times. Every year, 150,000,000 episodes of UTIs in children are diagnosed worldwide.

Classification of pathology

The classification of urethral infectious pathology in children has three components.

The presence of developmental anomalies in the urinary system, as a result of which the pathology manifests itself:

primary form - without the presence of urethral anatomical pathologies;
secondary form - against the background of congenital and acquired structural changes in the urinary system.

The focus of localization in the form of:

structural damage to renal tissue;
infectious lesion structural tissues of the bladder reservoir;
unspecified localization of infection in the urinary structure.

Stage clinical course:

stage of activity of the infectious process, in which all functions of the affected organs are preserved;
stages of complete (relief of symptoms) or incomplete (complete relief of symptoms) remission.

Genesis and development paths of UTIs in childhood

In Russia, the genesis (cause) of the development of infection is mainly due to the influence of one type of microorganism of the Enterobacteriaceae family - various strains of the collie coliform bacterium. The detection of several associations of bacterial pathogens in urine is often explained by a lack of sanitary standards when collecting urine for analysis, non-compliance with the rules for timely delivery of the sample for research, or due to the chronicity of the infectious process.

The introduction of pathogens into a child’s body can occur in different ways.

Through the hematogenous route, getting into tissues and organs with the bloodstream. It is especially often observed in the first month of adaptation after childbirth. In older children, the reason is due to several factors:

septicemia - the development of bacteriuria due to the entry of a pathogen into the blood from any infectious source;
the presence of bacterial endocarditis;
furunculosis or other infectious pathologies that provoke bacterial growth. Mainly gram (+), or fungal flora.

By upward path – due to its virulence, penetrating from the urethral and periurethral zones in an ascending manner – from the lower part of the urinary system to upper section, which is typical for children older than one year.

Lymphogenous route, due to the close relationship of adjacent organs (intestines, kidneys, bladder). The most common cause is constipation and diarrhea, which provoke the activation of intestinal pathogens and contribute to infection of the urinary tract with lymph transport. The presence of coccal representatives and enterobacteria in urine is characteristic.

Children with congenital anomalies, leading to:

To obstruction of the urethral tract (obstruction) - underdevelopment of the urethral valve, obstruction of the ureteropelvic segment.
To non-obstructive processes of urine stagnation, provoked by the retrograde flow of urine from the bladder, or due to its neurogenic dysfunction (impaired evacuation functions), which contributes to the accumulation of urine residues in the bladder reservoir and secondary provokes vesicoureteral reflux.

Not the least role in the development of the disease is played by fusion of the labia in girls, the presence of phimosis in boys and the condition of chronic constipation.

As a result of long-term studies, doubts have arisen about the involvement of UTIs alone in renal damage. It was revealed that this requires the simultaneous impact of three factors on the organ - the presence of UTI, ureteral and intrarenal reflux. At the same time, this should manifest itself at an early age, with the growing kidney being particularly sensitive to infectious effects on its membrane. Therefore, linking bacteriuria alone to renal damage has no evidence base.

Symptoms

In childhood, the signs of IPPV are uncommon and manifest themselves in different ways - depending on the child’s age and severity clinical picture. General signs are due to:

manifestation of dysuric syndrome - frequent micturition accompanied by pain, enuresis, the presence of imperative urges;
pain symptoms localized in the abdomen or lower back;
signs of intoxication syndrome, manifested by fever, headache, weakness and fatigue;
urinary syndrome with signs of bacteriuria and leukocyturia.

An increase in temperature is the only nonspecific sign that requires mandatory seeding for pathogenic flora.

Signs of a UTI in infants and toddlers under one year of age include:

In premature babies - deterioration general condition with a tense abdomen, disturbances in temperature and ventilation, disruptions in metabolic processes.
In severe clinical cases, intoxication symptoms appear in the form of hepatomegaly (enlarged liver), increased anxiety, marbling of the skin, and signs of metabolic acidosis. Children refuse to breastfeed, regurgitation, diarrhea and cramps appear. Hemolytic anemia and jaundice are sometimes observed.
In one-year-old children, the symptoms are erased, but from the age of two, signs of characteristic dysuric disorders appear without changes in temperature.

In accordance with the clinical manifestation, infectious pathology is divided into severe and non-severe forms. It is by these signs that the “front” of the necessary diagnostic search and the necessary course of treatment for urinary tract infections in children are determined, according to the severity of the symptoms.

Severe infection clinic manifested by a high increase in temperature, acute symptoms intoxication and signs of varying degrees of dehydration.

Not a severe clinic infectious process in children is characterized by minor changes in temperature and independent ability to take orally medicines and fluid intake. Signs of dehydration are either completely absent or mild. The child complies with the treatment regimen without difficulty.

If a child has a low degree of adherence to treatment (low compliance), he is treated as a patient with a severe UTI.

Diagnostic examination methods

The diagnostic search begins with a physical examination - identifying strictures in girls, phimosis in boys and the presence clinical symptoms pyelonephritis.

The diagnostic search includes:

Laboratory monitoring of urine to detect pyuria ( general indicator urine) and bacteriuria (tank culture).
Detection of infectious activity - blood monitoring for leukocytosis, neutrophilia, ESR and CRP readings;
Assessment of renal dysfunction - renal tests.
– identification renal pathologies– sclerotic changes in tissue structure, signs of stricture, changes in the parenchymal membrane and in the tissue structure of the renal collecting system.
Radionuclide examination to identify functional disorders in the kidneys.
Scintigraphic scanning of the kidneys - identifying sclerotic foci and signs of nephropathy.
Mictionation - to identify pathological processes V lower sections genitourinary system.
Excretory urography, which allows you to assess the condition of the urethral tract and clarify the nature of previously identified changes.
Urodynamic examination to clarify the presence of neurogenic dysfunction of the bladder organ.

Sometimes, to assess the clinical picture and severity of the infectious process, in addition to the pediatrician, other pediatric specialists (gynecologist, urologist or nephrologist) are involved in the diagnosis.

Treatment of the disease

The leading position in the treatment process of infectious lesions of the urinary system in children is treatment. Starting medications are selected according to the resistance of the pathogen, the age of the child, the severity of the clinical course, the functional state of the kidneys and allergic history. The drug must have high efficiency against intestinal strains of collie.

In modern UTI treatment antimicrobial therapy is carried out with drugs or effectively proven analogues of “Amoxicillin + Clavualant”, “Amicocin”, “Cefotoxime”, “Ceftriaxone”, “Meropenem”, “Imipenem”, “Nitrofurantoin”, “Furazidine”. With a two-week course therapy.
Drugs with desensitizing properties (Clemastine, Lorptadine), non-steroidal drugs such as Ibuprofen.
Vitamin complexes and herbal medicine.

If asymptomatic bacteriuria is detected, treatment is limited to the prescription of uroseptics. After cupping acute clinic children are prescribed physiotherapeutic treatment - sessions of microwave and UHF, electrophoresis, applications with ozokerite or paraffin, pine baths and mud therapy.

It should be noted that when treating children, one-day and three-day courses of therapy are not used. The exception is Fosfomycin, which is recommended as a single dose.

Features of preventive measures

The neglect of the infectious process in the urinary tract can affect the child with irreversible changes in the membrane parenchymal tissues of the kidneys, causing shrinkage of the organ, the development of sepsis or hypertension. Relapses of the disease occur in 30% of children. Therefore, children at risk need prevention of relapses with uroantiseptics or antibiotics:

traditional course – up to six months;
in the presence of retrograde urine flow - until the child reaches 5 years of age, or until reflux is eliminated;
in the presence of obstructions - until they are eliminated;
taking the herbal preparation "".

If a girl is sick, it is necessary to teach her how to properly wash and wipe (from the navel to the butt).

What you need to pay attention to when girls get sick.

First of all, these are panties made of linen or cotton, preferably white, since dyes are not always of high quality and in contact with sweat can lead to unwanted reactions.

Washing should be with running water, no higher than body temperature, using clean hands, without using washcloths or any rags. Moreover, frequent use soap is not advisable. Even baby soap can wash away the natural flora, opening up access for bacteria, thereby provoking an inflammatory process. Therefore, “washing” activity should be moderate (no more than twice a day).

The ideal option is wet wipes without alcohol or antiseptic.

Another problem is the development of synechiae in girls. They are formed as a result of a lack of estrogen in the mucous tissues of the child. As a rule, pronounced synechiae can appear in the period from 1.5 to 3 years and become an obstacle to free migration and the development of stagnation of urine with all the ensuing consequences. The mother's estrogens protect the baby for up to six months.

Under no circumstances should you use mechanical force to eliminate them when washing away. There are special ointments with estrogen, they are available over the counter, which will eliminate the problem within two weeks of regular use.

If a boy has a history of infection, washing in uncut boys should only be superficial, using baby detergents.

Nature arranges it in such a way that the elasticity of the foreskin in children is not the same as in adults; it seals the foreskin, as it were, creating a protective barrier against bacteria inside, in the form of a special lubricant. And by forcibly pulling the skin off the head of the penis and treating the flesh with soap, the barrier is washed away, and the remaining soap can cause a burn of the tender flesh with the development of an infectious focus.

It should be noted that the presence of phimosis before the age of 15 is normal physiology and does not require physical intervention. Only 1% of boys by the age of 17 cannot open their penis on their own. But the problem can also be solved with the help of special ointments and various stretching procedures. Only one child out of 2 thousand peers may need surgical help.

What parents should do:

Parents need to monitor the regularity of their child's bowel movements and bowel movements.
Eliminate synthetic and tight underwear from your wardrobe.
Adjust your diet to include fiber-rich foods to prevent constipation.

E. Komarovsky about UTI in children

Very interesting and lucidly told by the popular pediatrician Evgeny Komarovsky about urinary tract infections in children in his famous health school program. By attending the program or watching the program online, you can learn a lot of interesting and useful things - about methods of collecting urine from infants, the importance of prescribed tests, the features of antibiotic therapy and the importance of proper nutrition, and also what self-medication can lead to.

If you follow all the doctor’s recommendations, the infection, although it takes a long time, can be successfully treated. Parents are only required to be attentive to the child and promptly seek help. medical assistance to prevent the process from becoming chronic.

Diseases of the urinary organs in children are a widespread and, due to their tendency to be asymptomatic, an insidious problem. Scanty symptoms, characteristic of damage to the kidneys, bladder and urethra, often lead to late diagnosis of diseases, after they become chronic or develop into complications. Avoiding this problem, however, is quite simple: it is enough for parents to be attentive to the health of their child and regularly monitor indicators of a general urine test.

Among the diseases of the urinary system, the most “popular” in childhood are pyelonephritis, glomerulonephritis, cystitis, urinary diathesis and nephroptosis (prolapse of the kidneys). Let's figure out in what situations the risk of developing these diseases increases greatly, and what signs and symptoms parents need to pay attention to first.

Cystitis(inflammation of the bladder) is a deceptively “harmless” disease, the symptoms of which are quite easily relieved antibacterial drugs and also easily return if the disease has not been completely cured. Cystitis can occur in children of any age; frequently ill children and girls during puberty are especially predisposed to it. The infection may enter the bladder ascendingly from an inflamed urethra, or may be carried with blood from lesions chronic infection– carious teeth, untreated tonsils and adenoids, diseased ears and sinuses. Predispose to the development of cystitis conditions that weaken the activity of the immune system, such as hypothermia, malnutrition, hypovitaminosis, stress, taking certain medicines(antitumor drugs, hormonal drugs).

The main symptoms of cystitis include general malaise, nagging pain lower abdomen, slight increase in body temperature (usually up to 38 ° C), weakness. A characteristic sign of cystitis is frequent, often painful urination - sometimes the child urinates up to 15 times a day. Appearance urine in cystitis can be very diverse - the urine can be cloudy (due to the admixture of pus), red (due to the admixture of blood) or, in appearance, completely normal.

The main research methods that confirm the diagnosis of cystitis are a general urinalysis, a Nechiporenko urine test, and an ultrasound of the bladder. In some cases (with persistently recurrent cystitis), a urine culture with an antibiogram is prescribed.

Cystitis responds well to treatment with antibiotics and herbal remedies - the main thing is to maintain the medication regimen prescribed by the doctor and not stop treatment prematurely. An important point treatment is compliance drinking regime, as well as ensuring that the child’s legs and lower body are always warm.

Urethritis(inflammation of the urethra, urethra). The reasons for the development of the disease are the same as for cystitis. Urethritis most often affects girls, especially teenage girls. Sometimes, under the mask of urethritis, venereal diseases, “received” by a young girl as a result of her first unprotected sex with a sick partner. Therefore, special attention should be paid to the appearance of symptoms of urethritis in young girls.

Typical manifestations of urethritis are pain and cutting along the urethra when urinating. Urination is usually frequent, urine is released in small portions. Discomfort associated with urine loss contributes to sleep disturbances, appetite disturbances, and general anxiety. Possible increased body temperature, general weakness and malaise. Both urethritis and cystitis are dangerous due to the possibility of the inflammatory process spreading to the kidneys, which can only be prevented with timely diagnosis and treatment. The diagnosis of urethritis is made based on the results of a general urinalysis and Nechiporenko urine analysis. Sometimes urine culture is performed and smears from the urethra are examined. To treat urethritis, drugs from the group of uroseptics are used - they are excreted in the urine and provide a disinfecting and anti-inflammatory effect on the walls of the urethra.

Pyelonephritis(inflammation collecting system kidney). The cause of the development of pyelonephritis is an infection introduced from the outside or the body’s own opportunistic microflora, activated as a result of insufficient activity of the immune system and other circumstances favorable to microbes. The development of pyelonephritis is facilitated by the presence of urolithiasis, structural abnormalities of the kidneys.

A child with pyelonephritis complains of pain of varying intensity in the lumbar region, sometimes abdominal pain, an increase in body temperature, accompanied by signs of intoxication (weakness, headache, sleep disturbance, appetite, etc.). The appearance of the urine either remains unchanged or the urine becomes cloudy. Pyelonephritis can be unilateral and bilateral, acute and chronic. At acute process symptoms of the disease and complaints are more pronounced than during an exacerbation chronic pyelonephritis. Sometimes pyelonephritis is practically asymptomatic - this form of the disease can only be identified by a timely general urine test. Long-term untreated pyelonephritis leads to severe kidney damage and the development of renal failure, which is difficult to control arterial hypertension. The diagnosis is made based on the results of a general blood and urine test, urine tests according to Nechiporenko and Zimnitsky, ultrasound of the kidneys and bladder, and urine culture. Sometimes carried out biochemical analysis blood, urography. Timely diagnosed pyelonephritis responds well to treatment with uroseptics, antibiotics, and herbal preparations. To relieve pain and facilitate the outflow of urine, antispasmodics are prescribed. Be sure to follow the drinking regime and prevent hypothermia.

Glomerulonephritis- This is a bilateral disease with damage to the glomerular apparatus of the kidneys. The development of glomerulonephritis is based on an infectious process, which is initially localized in chronic foci - diseased tonsils, adenoids, inflamed paranasal sinuses nose, untreated teeth, gradually disrupts the work immune system and ultimately affects the kidneys. Very often, glomerulonephritis becomes a complication of tonsillitis or scarlet fever (develops around the 3rd week of the disease), since these diseases are associated with pathogenic streptococcus, which “really loves” kidney tissue. Typical symptoms of glomerulonephritis are swelling (mainly on the face, more pronounced in the morning), increased blood pressure, changes in urine (urine takes on the color of “meat slop,” that is, it becomes red-brown and cloudy). The child complains about headache, nausea. Sometimes there is a decrease in the amount of urine discharge. Glomerulonephritis can have two course options: acute, which ends in complete recovery, or chronic, which after a few years leads to severe impairment of renal function and the development of renal failure.

Diagnosis of glomerulonephritis is based on studying the results of a general analysis of urine and blood, urine tests according to Nechiporenko, according to Zimnitsky, and a biochemical blood test. Renal ultrasound provides valuable information during diagnosis. chronic glomerulonephritis Sometimes a kidney biopsy is performed followed by histological examination received fabrics.

Therapy for glomerulonephritis includes a diet with limited intake of protein foods; drugs that improve renal blood flow, antihypertensives, diuretics, immunomodulators. In severe cases, hemodialysis is performed (hardware purification of the blood from metabolic products that diseased kidneys cannot remove).

Therapy for glomerulonephritis is a long process that begins in a hospital and then is carried out for a long time at home. The key to success in this situation will be strict adherence to all doctor’s recommendations regarding diet, drinking regimen, taking medications, regular visits to a pediatric nephrologist and blood and urine tests for follow-up.

Urolithiasis disease- a disease characterized by the formation of calculi (stones) of various composition, shape and size in the kidneys, and less often in the bladder. The basis of the disease is a violation of mineral metabolism, which in the early stages of the disease (before the formation of kidney stones) is also called uric acid diathesis. Increased content Some salts in the urine lead to their precipitation, crystallization with the formation of sand and stones. Stones, injuring the urinary tract, contribute to the development of inflammation, which, in turn, supports stone formation. Long time the disease is asymptomatic and can be suspected only by the presence large quantity salt crystals detected during a general urine test, or accidentally discovered during an ultrasound scan internal organs. Often the first manifestation of urolithiasis is an attack of renal colic, caused by the movement of stones through the urinary tract. Renal colic is manifested by the sudden onset of intense pain in the lower back and lower abdomen, difficulty urinating, and the appearance of blood in the urine. Diagnosis of urolithiasis is based on the results of a general urine test, ultrasound of the kidneys and bladder; often additionally a general and biochemical blood test, Nechiporenko urine tests, urography, and radiography are prescribed. Treatment of urolithiasis involves adjusting the diet (according to the type of metabolic disorder), taking antispasmodics, herbal infusions. In severe cases, surgical removal of kidney stones is performed.

Nephroptosis– this is a prolapse of the kidney or excessive mobility of the kidney (wandering kidney). Nephroptosis develops due to weakening ligamentous apparatus kidneys and a decrease in the fat layer around it, which is often observed in children with an asthenic physique and poorly developed muscles of the anterior abdominal wall. Nephroptosis is often diagnosed in teenage girls who follow strict diets. Nephroptosis is mostly asymptomatic; the appearance of signs of the disease (pain and heaviness in the lower back during prolonged standing, the appearance of blood in the urine, high blood pressure) is usually associated with kinking of the ureter and tension of the vessels caused by the movement of the kidney. The course of the disease is influenced by the degree of kidney prolapse, which is determined using ultrasound or radiographic methods. Treatment of stage I-II nephroptosis is conservative and consists of normalizing body weight (using a specially selected diet) and performing special physical exercises that strengthen the muscles of the back and abdomen. In some cases, wearing a bandage is indicated. With severe kidney mobility or grade III nephroptosis, surgical treatment may be necessary.

General urine analysis

Since a general urinalysis is a fundamental study in urology and nephrology, we will briefly discuss the interpretation of some of its results.

Urine color and clarity. Normally, the light of urine ranges from colorless (in newborns) to amber and straw-colored. Urine should be clear and free of impurities. Pathological is the coloring of urine in various shades of red, cloudiness and Brown color urine.

Urine smell. Urine should not have a strong odor. The smell of urine is most often caused by acetone, a substance that appears in the urine during acetone syndrome.

Relative density(specific gravity) of urine - the norm for a newborn is 1008-1018, for children aged 2-3 years - 1010-1017, and for children over 4 years old - 1012-1020. An increase in urine density indicates the presence of protein and/or glucose in it, or dehydration. A decrease in relative density is observed during inflammatory processes in the kidneys and with severe impairment of renal function.

Protein normally absent in urine (or does not exceed 0.002 g/l). The appearance of protein in the urine (proteinuria) is observed with glomerulonephritis, kidney damage due to diabetes mellitus and others. serious illnesses kidney

Glucose normally absent in urine (or does not exceed 0.8 mol/l). The appearance of glucose in the urine may indicate the presence of diabetes mellitus or other endocrine diseases.

Ketone bodies or acetone– normally absent or found in minimal quantities in urine. An increase in the level of ketone bodies is possible during acute viral infections, after overwork. High levels of acetone are characteristic of acetone syndrome.

Bilirubin Normally it is not detected in urine. The appearance and high values of bilirubin are observed in diseases of the liver and gall bladder.

Red blood cells in the urine of a healthy child there are 0-2 red blood cells in the field of view. The appearance of a large number of red blood cells is characteristic of inflammatory processes in the urethra, bladder, kidneys, urolithiasis, and glomerulonephritis.

Leukocytes- normally, up to 5 leukocytes per field of view can be present in urine. An increased number of white blood cells is a symptom of inflammation of the kidneys and urinary organs.

Epithelium may be present in small quantities. An increased number of epithelial cells is characteristic of infectious diseases of the urinary tract.

Cylinders Normally, they are absent in the child’s urine. Most often, the appearance of cylinders indicates the presence of kidney disease.

Bacteria are normally absent in urine. The appearance of bacteria is either a symptom of an inflammatory process or a sign of transient asymptomatic bacteriuria (infection without inflammation).

Crystals and salts are normally found in small quantities and indicate an acidic or alkaline reaction in the urine. An increased amount of salts may be evidence of uric acid diathesis or urolithiasis.

Finally

As already mentioned, a general urine test performed with for preventive purposes, can protect the child from troubles associated with advanced diseases kidneys, bladder or urethra. The child must undergo such an examination annually - his parents should closely monitor this. Take care of your health!

Urinary tract infections (UTIs) are diagnosed when >5 x 104 colonies/mL are detected in urine samples obtained through a catheter, or in older children in repeated urine samples containing >105 colonies/mL. In children younger age UTIs often result from anatomical abnormalities. UTIs can cause fever, loss of appetite and vomiting, flank pain, and signs of sepsis. Treatment involves prescribing antibiotics. After recovery, imaging studies of the urinary tract are performed.

Inflammation from a UTI may involve the kidneys, bladder, or upper and lower urinary tract. STIs such as gonococcal or chlamydial urethritis, although they cause inflammation in the urinary tract, are generally not considered UTIs.

Mechanisms that maintain normal sterility of the urinary tract include an acidic urine environment, unidirectional downward movement of urine, regular emptying of the urinary tract, and normally functioning vesicoureteral and urethral sphinkerts. Dysfunction of any of these mechanisms predisposes to the occurrence of UTIs.

During the first year of life, approximately 4% of boys and 2% of girls develop a urinary tract infection (UTI). Among older, prepubertal children, UTIs occur in 3% of girls and 1% of boys.

For purposes of appointment adequate therapy UTIs should be classified according to location and severity. Other factors may play important role upon further evaluation. In 75% of cases, the cause of UTI is E. coli.

Causes of urinary tract infections in children

By the age of 6 years, 3-7% of girls and 1-2% of boys experience UTIs. The peak age of UTI is bimodal with one peak in infancy and a second at 2–4 years of age (during toilet training for many children). The ratio of girls to boys in the incidence structure varies from 1:1 to 1:4 in the first 2 months of life (estimates vary primarily due to the proportion of uncircumcised boys in different populations and the exclusion of infants with urological anomalies - these are now often diagnosed in utero with using prenatal ultrasound). The girl-to-boy ratio increases rapidly with age, reaching approximately 2:1 from 2 months to 1 year, 4:1 in the second year, and >5:1 after 4 years. In girls, infections are usually ascending and less likely to cause bacteremia. The predominance of UTIs in girls at an early age is explained by both the shorter female urethra and circumcision in boys.

Predisposing factors include urinary tract malformations and obstruction, prematurity, frequent and prolonged catheterization, and lack of circumcision. Other predisposing factors in young children include constipation and Hirschsprung's disease. Risk factors in older children include diabetes, trauma and sexual intercourse in teenage girls.

Urinary tract abnormalities. UTIs in children indicate possible urinary tract abnormalities; these disorders, in particular, can lead to the development of infection in the presence of VUR. The likelihood of VUR varies inversely with age at first UTI event.

Microorganisms. With abnormalities of the urinary tract, infections can be caused by various microorganisms.

In the absence of abnormalities in the urinary tract, the most common pathogens are Escherichia coli strains. E. coli causes >75% of UTIs in all children age groups. Less commonly, UTIs are caused by other gram-negative enterobacteria.

Enterococci (group D streptococci) and coagulase-negative staphylococci (eg, Staphylococcus saprophytics) are the most commonly identified causative gram-positive organisms. Fungi and mycobacteria rarely cause infection, mainly in immunocompromised patients. Adenoviruses rarely cause UTIs, and the result is predominantly hemorrhagic cystitis.

Symptoms and signs of urinary tract infections in children

In newborns, symptoms of UTI are nonspecific and include poor appetite, diarrhea, loss of appetite, vomiting, mild jaundice, lethargy, fever and hypothermia.

Infants and toddlers may also experience general symptoms such as fever, indigestion, or foul-smelling urine.

Children over 2 years of age usually develop the classic symptoms of cystitis or pyelonephritis. These include dysuria, frequent urination, urinary retention, foul odor urine, enuresis. Pyelonephritis is characterized by fever and chills.

Possible anomalies in the structure of the urinary tract may be indicated by enlarged kidneys, space-occupying formations in the retroperitoneal space, a defect in the urethral opening, and malformations of the lumbar spine. A weak urine stream may be the only sign of urinary tract obstruction or neurogenic bladder.

Signs of pyelonephritis

Newborns:

Infants, small children up to the 3rd year of life:

fever;
abdominal pain, nausea and vomiting;
digestive disorders with weight loss;
foul-smelling urine.

Older children:

vomit;
loss of appetite;
pain in the abdomen and kidney area;
foul-smelling urine.

Laboratory changes:

significant bacteriuria and leukocyturia;
increasing the level of CRP;
increase in ESR;
hyponatremia and hyperkalemia are possible in newborns and infants.

Signs of cystourethritis:

burning when urinating;
dysuria, pollakiuria;
incontinence with urgency;
stomach ache;
As a rule, there is no fever or systemic signs of inflammation.

Special forms

Asymptomatic urinary tract infection: bacteriuria with possible leukocyturia without clinical symptoms, the disease is discovered accidentally, mainly in girls aged 6-14 years.
Complicated (secondary) pyelonephritis with urinary tract obstruction, for example, with stenosis of the ureter or ureteral orifice.

Accordingly, after the first episode of pyelonephritis, mandatory diagnosis: ultrasonography and voiding cystourethrogram, if necessary, further diagnostics.

Diagnosis of urinary tract infections in children

Average portion of urine, urine taken by catheter, bladder puncture: bacteria, leukocytes.

Blood: leukocytes, CRP, ESR (pyelonephritis), creatinine (bilateral pyelonephritis).

Ultrasound examination - in every case of urinary tract infection.

Individual approach when deciding on the need for radiological studies:

voiding cystourethrogram;
intravenous pyelography - for complex developmental defects;
dynamic renal scintigraphy - for urinary outflow disorders.

A urine culture should be performed for any child with a fever greater than 38°C. A clean urine sample is ideal, but if this is not possible, suprapubic aspiration is performed.

The two most common sites of UTI are the bladder (cystitis, manifested by dysuria, frequent urination, hematuria, enuresis and pain in the bladder). suprapubic region) and the upper urinary tract (pyelonephritis, the symptoms of which are fever, pain in the side, pain on palpation in the projection of the kidneys). The severity of a UTI can be assessed by the degree of fever. A rise in body temperature of more than 39 °C is regarded as severe. This is characterized by the appearance of systemic manifestations, such as vomiting and diarrhea.

The collection of anamnesis of the disease should be as detailed as possible. You should ask about the presence or absence of a history of urinary problems (difficulty urinating), constipation, recurrent infections, vesicoureteral reflux, and antenatally diagnosed kidney disease. It is also necessary to collect a family history. Any child younger than 3 months with a UTI should be referred to pediatric urologist.

Urine tests. To make a diagnosis, it is necessary to collect urine for culture and verify significant bacteriuria. Urine is usually collected from young children using a urethral catheter, and from boys with moderate and severe phimosis - using suprapubic puncture of the bladder. Both techniques require technical skill, but catheterization is less invasive and much safer. The use of urine bags is considered less accurate for diagnosis and urine samples are less stable.

If urine is obtained by suprapubic puncture, the presence of any bacteria is a significant factor in the diagnosis. The presence of >5x104 colonies/ml in a catheterization specimen usually indicates a UTI. Midstream urine collection is important when counting colonies of a single pathogen (i.e., not the total mixed flora) of >105 colonies/mL. However, UTIs are sometimes diagnosed in symptomatic children despite low colony counts on culture. Urine should be tested as soon as possible after collection or stored at 4°C if a delay of >10 minutes is expected. Occasionally, a UTI occurs despite a low colony culture; this may be due to previous antibiotic therapy, high urine dilution (specific gravity less than 1.005), or severe obstruction of the flow of infected urine. Sterile urine cultures rule out UTI.

Microscopic examination of urine is useful but does not guarantee high accuracy. Pyuria has a sensitivity of about 70% for UTI.

Test strips for detecting bacteria in urine (nitrite test) or leukocytes (leukocyte esterase test) are used quite often; if this test is positive, the diagnostic sensitivity for UTI is about 93%. The specificity of the nitrite test is quite high; a positive result on a fresh urine sample is highly accurate for UTI.

Fever, lower back pain, pyuria indicate pyelonephritis.

Blood tests. Clinical analysis blood and marker studies bacterial inflammation(eg, ESR, C-reactive protein) can help diagnose infections in children with borderline urine values. Some institutions measure serum urea and creatinine during the first episode of UTI.

Urinary tract imaging. The high incidence of anatomical abnormalities does not suggest urinary tract imaging. If the first episode of UTI occurs at age >2 years, most experts recommend additional examination, however, some clinicians delay imaging until the second occurrence of UTI in girls >2 years of age. Options include voiding cystourethrography (VCUG), radionuclide cystogram (RNC) with technetium-99m pertechnetate, and ultrasound.

VCUG and RNC are superior to ultrasound for detecting vesicoureteral reflux and anatomical abnormalities. Most experts prefer the best anatomical definition VCUG contrast as an initial test, using RNC in subsequent management to determine when reflux has resolved. Low-dose X-ray equipment closes the radiation dose gap between VCUG and RNC. These tests are recommended as soon as possible after clinical response, usually at the end of therapy when bladder reactivity has resolved and urine sterility has been restored. If imaging is not planned until the end of therapy, the child should continue to take prophylactic antibiotics until the vesicoureteral reflux resolves.

Prognosis of urinary tract infections in children

When properly managed, the disease rarely leads to renal failure in children unless they have uncorrected urinary tract abnormalities. However, it is believed (but not proven) that repeated infections cause renal scarring, which can lead to the development of hypertension and end-stage renal disease. In children with high vesicoureteral reflux, long-term scarring occurs at a rate 4 to 6 times greater than in children with low VUR and 8 to 10 times greater than in children without VUR.

Treatment of urinary tract infections in children

Antibiotics.
For severe vesicoureteral reflux, a course of antibiotics and surgery.

Pyelonephritis: newborns and infants Necessarily intravenous administration, up to 3 months, for example, ampicillin, later, for example, cephalosporins. Before starting antibiotic treatment, blood and urine cultures are obtained. The duration of treatment is 10 days.

Cystitis: for example, trimethoprim for 3-5 days.

After pyelonephritis in infancy in the presence of vesicoureteral reflux and/or megaurethra: prevention of recurrent infections (for example, cephalosporins for infants and young children, later trimethoprim, nitrofurantoin).

Surgical treatment - for obstruction (eg urethral valves - immediate surgery) or for vesicoureteral reflux high degree expressiveness.

In most cases, with asymptomatic bacteriuria without signs of inflammation and normal ultrasound results, treatment is not indicated; dynamic monitoring of urine test results.

Treatment is aimed at eliminating acute infection, preventing urosepsis and preserving renal parenchymal function. Antibiotics are started prophylactically in all children with toxic manifestations and in children without toxic manifestations with probable UTI (positive leukocyte esterase or nitrite test, or detection of pyuria or bacteriuria on microscopy). The rest can wait for the culture results.

In infants from 2 months to 2 years with intoxication, dehydration, or the inability to take medications orally, parenteral antibiotics are used, usually 3rd generation cephalosporins. 1st generation cephalosporins (eg, cefazolin) can be used if typical local pathogens are known to be sensitive to drugs in this group. Aminoglycosides (eg, gentamicin), although potentially nephrotoxic, are useful in complex UTIs to treat potentially resistant Gram-negative bacteria such as Pseudomonas. If blood cultures are negative and clinical response is good, appropriate oral antibiotics selected based on antimicrobial specificity can be used to complete the 2-week course. A poor clinical response suggests persistent microorganisms or obstructive lesions and requires urgent revision of ultrasound findings and repeat urine cultures.

In nontoxic, nondehydrated infants and children who are able to take medications orally, oral antibiotics can be given from the beginning. The drugs of choice are TMP/SMX 5-6 mg/kg (according to TMP) 2 times a day. An alternative is cephalosporins. Therapy is changed based on culture results and antimicrobial susceptibility testing. Treatment is usually given for >10 days, although many older children with uncomplicated UTI can be treated for 7 days.

Vesicoureteral reflux. It is generally accepted that antibiotic prophylaxis reduces the recurrence of UTIs and prevents kidney damage. However, there is some long-term evidence of the potential for renal scarring and the limited effectiveness of antimicrobial prophylaxis. Current clinical researches are trying to resolve these issues, but while the results are not available, most doctors provide long-term antimicrobial prophylaxis to children with PMR, especially those in grades two to five. For patients with grade four or five VUR, it is usually recommended abdominal surgery or endoscopic injection of polymer fillers.

Prevention medications include nitrofurantoin or TMP/SMX, usually at bedtime.

In case of pyelonephritis, all children should be referred to a pediatric urologist. Oral course antibacterial therapy is 7-10 days.

The presence of cystitis in children over 3 years of age does not require referral to a specialist in the absence of a recurrent course. If asymptomatic bacteriuria is detected, treatment is not indicated.

After a single episode of UTI, antibiotic prophylaxis is not required. After treatment, it is necessary to explain to the child’s parents the importance of consuming an adequate amount of fluid per day and regular urination.

According to current recommendations, in children younger than 6 months, ultrasound is indicated in cases of recurrent or complicated UTI. Ultrasound should be supplemented with dimercaptosuccinic acid (DMSA) scanning and voiding cystourethrography to determine the cause of UTI and evaluate scarring and renal dysfunction.

For an uncomplicated UTI, an ultrasound may be performed after the child has recovered. For older children with a single episode of UTI that responds to therapy within 48 hours, radiation methods diagnostics are not indicated.

The use of DMSC is a much more gentle method, and MCUG is indicated only for urethral dilatation detected by ultrasound, a family history of vesicoureteral reflux, urinary dysfunction, or infection caused by non-Escherichia coli.

It is important that parents know what symptoms they should contact a specialist for. In most uncomplicated cases, observation is not required.

Monitoring the patient

Urine: color, smell, frequency of urination.
Measure body temperature rectally 3 times a day.
Maintain fluid balance by offering fluids in sufficient quantities.

Care

Careful hygiene of the perineum, complete emptying of the bladder.
Avoid local cooling or exposure to dampness, as well as general hypothermia(for example, reduce bath time).
Local application of heat (for example, for abdominal pain): compresses, heating pads (hot water).
In case of lack of appetite or vomiting, offer food more often (optional menu, small portions), in some cases - parenteral nutrition.

In this article:

According to statistics, urinary tract infections in children occupy second place after viral respiratory diseases. This problem is especially relevant in children under one year of age. As a rule, it proceeds without any bright severe symptoms, but can have very serious consequences.

Very often, doctors do not detect genitourinary system infections in children in a timely manner, as they can be disguised as nausea, abdominal pain, vomiting and even signs of acute respiratory infections.

Due to the characteristics of the child’s body, it spreads quite quickly and can cause inflammation of the kidneys - pyelonephritis. And it is dangerous because after the disease they cannot restore their functions as before. Further, if you miss inflammation of the kidney and do not eliminate it in time, kidney failure will occur, and, as a result, inferiority of the body, that is, disability.

Causes of the disease

Diversity of microbial flora, causing infection urinary tract in children depends on the gender and age of the child, as well as on the state of his immune system. Serdi bacterial pathogens Enterobacteriaceae are in the lead, in particular Escherichia coli - in almost 90% of cases, as well as other pathogenic microorganisms.

Infection incidence rate urinary system in children depends on the gender and age of the child. More often, this pathology occurs in girls due to the anatomical structure of the organs of the urinary system: proximity to the vagina and intestines, shorter urethra. In girls, the peak incidence occurs at the age of 3-4 years. But in infancy, boys are more likely to get sick, especially under the age of 3 months. Causes genitourinary infection in children in this case, as a rule, they are caused by abnormalities in the development of the genital organs, as well as the use of diapers and non-compliance with hygiene rules.

Infection can occur in the following ways::

through the urethra into the bladder and kidneys;
from neighboring organs through the lymphatic system;
through blood during infection.

Clinical symptoms of the disease

Manifestations and signs of genitourinary infection in children depend on the age of the child. After two years, the presence of a urinary tract infection may be indicated by:

painful urination, burning and stinging sensation;
dark color of urine, presence of blood in it;
frequent urge to empty the bladder (in this case, urine is released in small portions);
pain in the lower abdomen, suprapubic region, back and lower back;
high body temperature (above 38 degrees).

Before the age of two years, the presence of a genitourinary tract infection in children is indicated by one of the following symptoms:

Feverish state;
Vomiting and diarrhea;
Irritability, moodiness and tearfulness;
Change in the color of urine and its sharp, unpleasant odor;
Pallor of the skin and weakness;
Lack of appetite and even refusal to eat.

Diagnosis of urinary tract infections

If a child is suspected of having of this disease you need to see a doctor in the next 24 hours. If you delay, there is a risk of kidney inflammation. The presence of the disease is confirmed by a general urine test. If an infection is detected in the urine of children, it is advisable to take a culture test for the pathogen and determine its sensitivity to antibiotics. This is necessary for adequate the right choice prescription of an antimicrobial drug.

Imaging diagnostic methods

These methods include ultrasound and x-rays; they allow the doctor to see the structure of the urinary system and its organs, and to detect defects and anomalies in it. These diagnostic methods are not prescribed to all children, but only at the age of 3-5 years and in case of re-infection. Imaging methods include:

Ultrasound examination of the kidneys. A fairly safe method for a child, which uses ultrasound rays to display the state of the organ on a monitor and makes it possible to judge its structure.
X-ray. It will help analyze the condition of organs in the abdominal cavity and behind the peritoneum. Before the procedure, it is advisable to give the child a cleansing enema.
Cystourethrography. To carry out the analysis, a contrast agent, through which the rays do not pass. Cystourethrography allows you to see the contours of the bladder and urethra. To do this, two photographs are taken. One with a full bladder. The other is directly during urination. The first image allows you to determine the presence of passive and the second - active reflux, that is, backflow of urine into the ureter, which normally should not exist. With this procedure, the second phase often fails in children, but even one photo can be very important.

If a child is suspected of having a fairly serious pathology of the urinary tract, a intravenous urography. The contrast agent is injected into a vein, filtered by the kidneys, and the whole process is recorded in a series x-rays. This method allows you to examine in great detail the structure of the urinary tract and partly the kidneys. And in order to qualitatively display kidney function, it is necessary to perform scintigraphy. In this case, it is not a contrast agent that is injected into the vein, but a radioactive isotope.

A rather painful method is cystoscopy, which is indicated only if the bladder is damaged, there are stones, tumors in it, or determination of volumes surgical intervention.

Differential diagnosis

Bladder infection in children may be similar to other diseases from which it must be distinguished:

Vulvovaginitis in girls. This disease also causes fever, itching, and changes in the urine. However, the inflammatory process does not affect the genitourinary tract, but affects the vestibule and vagina.
Urethritis. Inflammation of the urethra or its irritation by various chemical components included in soap, shampoo, washing powder. As a rule, it does not require specific treatment and goes away on its own after a few days.
Worm infestation. A pinworm infection will cause itching, irritation, and changes in the composition of the urine. To identify it, a scraping of the anal area is taken and it is advisable to repeat it three times.
Balanitis. It manifests itself as inflammation of the vaginal vestibule in girls and the foreskin in boys. The doctor will determine the differences during a visual examination.
Appendicitis. Acute pain in the lower abdomen with inflammation of the appendix can also be mistaken for inflammation of the urinary tract. This is another reason not to delay your visit to the doctor.

Classification of the disease

In children, genitourinary tract infections are classified as primary or recurrent. Repetitive ones are divided into groups:

Unresolved infection as a result of the selection of suboptimal doses of antibiotics, non-compliance established mode treatment, malsorption syndrome, drug-resistant pathogen.
Persistence of the pathogen, which will require medical or surgical intervention, as a persistent focus is formed in the urinary tract.
Repeated infection, in which each episode represents a new infection.

From a clinical point of view urinary infection in children it is divided into severe and non-severe.

Treatment of genitourinary tract infections

All measures aimed at treating genitourinary infections in children should be selected individually, depending on age, and only by a doctor. Children under 2 years of age, as a rule, are treated inpatiently, as parenteral administration of antibiotics and diffusion therapy are necessary. Bed rest necessary for severe fever and pain.

To reduce the load on the kidney tubules and mucous membranes, it is recommended to feed the child frequently - 5-6 times a day. If renal dysfunction is detected, salt and fluid restriction is recommended. In nutrition, preference is given to protein and plant foods, as well as dairy products. It is necessary to exclude from the diet foods that cause irritation of the mucous membrane of the urinary tract: canned food, marinades, spices and fried foods. It is also advisable to limit foods high in acids: citrus fruits, tomatoes, pomegranates, kiwi, grapes, Bell pepper, pickled and salted vegetables.

When pain syndrome eliminated, it is necessary to drink plenty of fluids to prevent irritation of the mucous membranes of the urinary tract from exposure to urine, to remove microorganisms and waste products of toxins.

Antimicrobial drugs are considered the main method of eliminating infection. The antibiotic and optimal, adequate doses are selected taking into account the type of pathogen and its sensitivity, as well as the age of the child. They must be nephrotoxic, the duration of administration is from 7 to 14 days. Sometimes treatment is supplemented with uroantiseptics, and to prevent violations intestinal microflora Probiotics are recommended.

Prevention of genitourinary tract infections in children

Preventive measures will help avoid primary, and in some cases, secondary infection:

It is advisable to continue breastfeeding for as long as possible, at least 6-7 months. According to doctors, this will protect a child under two years of age from urinary tract infections.
When introducing complementary foods, give as much vegetables, fruits and food products as possible. whole grain which prevent constipation.
Try to make your diet varied, introduce vitamins and minerals into the diet for the normal development of organs and systems.
Respond in a timely manner to manifestations of capriciousness and tearfulness in infancy, since the child cannot talk about his condition.
At any age, it is necessary to ensure that the child’s body receives a sufficient amount of water, which will prevent congestion from developing in the kidneys.
It is also very important to adhere to the rules of personal hygiene, especially for girls. When bathing, it is advisable to use special soft gels rather than soap and shampoo. It is necessary to wash your genitals daily and also change your underwear regularly.
If possible, thoroughly wipe the genital area and perineum after changing the diaper.
In case of temperature changes of the disease, protect the child from hypothermia.
In the first months of life, carefully monitor the child's development. If abnormalities of the genital organs or abnormal functioning of the urinary tract are detected, consult a doctor.

If cases of infection have already been observed, it is advisable to take herbal medicines for a long time to prevent relapses. This medicinal fees, which contain herbs with anti-inflammatory and diuretic effects. It is advisable to take them under the supervision of a doctor, as some of them are quite strong biologically active substances. In any case, you should not prescribe them to your child yourself.

After the course of treatment, the doctor must prescribe control tests. Maintenance antibiotic therapy may be needed optimal dose and according to a certain scheme.

Useful video about urinary tract infections

– a group of microbial-inflammatory diseases of the urinary system: kidneys, ureters, bladder, urethra. Depending on the location of the inflammation, urinary tract infection in children can manifest as dysuric disorders, pain in the bladder or lower back, leukocyturia and bacteriuria, and temperature reaction. Examination of children with suspected urinary tract infection includes urine tests (general, culture), ultrasound of the urinary system, cystoureterography, excretory urography, cystoscopy. The basis for the treatment of urinary tract infections in children is the prescription of antimicrobial drugs and uroantiseptics.

Treatment of urinary tract infections in children

The main place in the treatment of urinary tract infections in children belongs to antibacterial therapy. Before a bacteriological diagnosis is established, initial antibiotic therapy is prescribed on an empirical basis. Currently, in the treatment of urinary tract infections in children, preference is given to inhibitor-protected penicillins (amoxicillin), aminoglycosides (amikacin), cephalosporins (cefotaxime, ceftriaxone), carbapenems (meropenem, imipenem), uroantiseptics (nitrofurantoin, furazidin). The duration of the course of antimicrobial therapy should be 7-14 days. After completion of the course of treatment, a repeat laboratory examination of the child is carried out.

Vaccination of children is carried out during periods of clinical and laboratory remission.

Primary prevention of urinary tract infections in children should include instilling proper hygiene skills, sanitizing chronic foci of infection, and eliminating risk factors.