home Audience 4 Causes of kidney inflammation in newborns. Congenital kidney pathology in newborns - nephrotic syndrome. Video: how to collect urine from newborns for analysis

Causes of kidney inflammation in newborns. Congenital kidney pathology in newborns - nephrotic syndrome. Video: how to collect urine from newborns for analysis

Pyelonephritis is a complex inflammatory process of the kidneys. This disease can occur at absolutely any age. It is dangerous because it develops very quickly, and therefore requires urgent medical attention.

Pyelonephritis in newborns poses a threat to life, since it cannot always be detected in the initial stages. Complications can affect other organs, so the child often ends up in the intensive care unit.

Feature of the disease

Kidneys play a very important role in the human body. They are responsible for removing toxic substances and breakdown products along with urine.

This organ regulates salt and water balance in the body, is responsible for the production of vitamin D, and also secretes some active components responsible for hemoglobin levels and blood pressure regulation. The proper functioning of other organs in a child largely depends on the proper functioning of the kidneys. Therefore, it is important to recognize pyelonephritis in newborns in order to prevent the development of complications.

As the disease progresses, not only the kidneys themselves become inflamed, but also the pelvis. In this case, there is a serious violation of the outflow of urine. This threatens with very serious consequences and various kinds of complications.

Main classification

According to the classification, pyelonephritis can be primary and secondary. The primary form of the disease occurs without any prerequisites or urological diseases. The infectious process begins to develop in an initially healthy organ. The secondary form of the disease is characterized by the fact that the pathology is formed in the presence of inflammation of the urinary tract. This is the most common type of disease.

According to the stage of progression, pyelonephritis in a newborn can be infiltrative and sclerotic, and according to localization - unilateral or bilateral. Initially, the child has an acute form of the disease, and the symptoms are quite pronounced. If you do not carry out a comprehensive and timely treatment, then it turns into chronic pyelonephritis.

The disease can proceed in a latent form, and in this case, the urinary syndrome is only slightly manifested. This is the most insidious type of disease, since it is almost impossible to detect it in a timely manner.

Causes

The causes of pyelonephritis in newborns are mainly associated with the penetration of infectious agents into the kidneys. Often the disease is provoked by Escherichia coli, but many other bacteria can also be the causative agent, in particular, enterococci, Klebsiella, and Proteus. They enter the kidneys through the circulatory system, lymph or from the urethra.

Most often, kidney pyelonephritis in newborns develops due to the penetration of bacteria through the ascending route. They come from the perineum and rectum. The introduction of bacteria is facilitated by improperly carried out hygiene measures, as well as a sharp weakening of the immune system. In the presence of predisposing factors, the infection rises to the bladder and then penetrates the kidneys.

The causes of pyelonephritis in a newborn boy may be associated with the presence of other diseases. In this case, the source of infection is the affected bronchi, tonsils, umbilical process, and pharynx. As the immune system weakens, bacteria enter the bloodstream and then spread to the kidneys.

Very rarely, the infection spreads through the lymphogenous route. This occurs when the mucous membrane of the urinary tract is damaged and bacteria spread from the rectum. There are several causes of pyelonephritis in newborns, such as:

congenital pathologies of the structure of the urinary system;
pregnancy pathologies;
violation of the composition of urine;
prolonged hypothermia;
the presence of inflammatory diseases;
feeding with artificial formulas;
the presence of worms;
some concomitant diseases.

In case of advanced acute inflammation, chronic pyelonephritis occurs. The disease develops due to the lack of adequate treatment or the use of ineffective antibacterial drugs. Sometimes chronicity can be triggered by certain congenital pathologies of the immune system.

Symptoms of the disease

Symptoms of pyelonephritis in newborns are quite specific. Infants cannot indicate pain and describe their sensations. Parents guess about the ongoing pathology only by indirect symptoms.

The most characteristic sign of pyelonephritis is an increase in temperature to 38-39 degrees. In a 3-month-old child, the fever is more pronounced, and the temperature can rise to 40 degrees. The course of the disease without fever is typical for premature babies.

In addition, the baby exhibits severe anxiety. The newborn's skin takes on a sickly pale hue. The baby refuses to eat food and begins to lose weight sharply. The clinical picture may be accompanied by nausea and diarrhea.

In some cases, parents with pyelonephritis in a newborn boy note a violation of urination. The stream becomes intermittent and weak.

The disease is also characterized by changes in the quality of urine. A cloudy precipitate forms in it. Urine can also contain minor blood impurities and have a rather unpleasant odor. An exacerbation of the chronic form of pyelonephritis has exactly the same symptoms as the acute course of the disease. The period of remission is characterized by the complete absence of signs of the disease. Sometimes such a pathology is accompanied by a constant slight increase in temperature.

To diagnose "pyelonephritis" in newborns, when the first signs of the course of the disease appear, parents should contact a pediatrician who, after examination, refers to a nephrologist. If assumptions regarding the presence of pyelonephritis are confirmed, the nephrologist gives a referral for a general and biochemical blood test, as well as a urine test.

In some cases, additional ultrasound diagnostics of the urinary system, excretory urography, radiography, and tomography may be prescribed. In case of particularly severe disease, a special needle is inserted into the kidney and a small amount of tissue is subsequently collected for morphological examination.

Features of treatment

To eliminate the symptoms and causes of pyelonephritis in newborns, treatment must be comprehensive. When the first signs of illness appear, the baby and his mother are hospitalized in a specialized hospital, where diuresis and the general condition of the baby are monitored. Based on this, therapy is selected and adjusted.

Specialized drug treatment is required. In particular, the following drugs are prescribed:

Treatment in a hospital setting continues for 3-4 weeks. The drugs are strictly selected by a urologist or nephrologist, giving preference to the most optimal combinations. It is strictly forbidden to treat pyelonephritis in newborns on your own, since many medications are strictly contraindicated for infants or are not effective enough when taken simultaneously.

Drug therapy

The basic principle of treating pyelonephritis in newborns is the prescription of effective and rational antibiotic therapy. Before receiving diagnostic results, doctors prescribe broad-spectrum drugs. The most commonly used antibiotics are from the penicillin group. These include Amoxiclav and Amoxicillin. In addition, infants are also allowed to take cephalosporins, in particular Ceftriaxone and Cefuroxime.

The duration of therapy is 7-10 days. It is strictly forbidden to discontinue the use of drugs prematurely, as this leads to a sustainable growth of pathogenic microflora.

If all these groups of drugs are ineffective, other antibacterial agents may also be prescribed. Newborns are prescribed macrolides and carbapenems. In case of particularly severe disease and the presence of highly resistant pathogens, the use of broad-spectrum antibiotics, fluoroquinolones, and aminoglycosides may be indicated.

For symptomatic therapy, drugs that normalize the outflow of urine are used. The most popular is Canephron. This medicine promotes faster passage of infected urine and the death of bacteria. Children are advised to take vitamins. After a course of antibiotic therapy, the use of probiotics is indicated, which help restore the normal intestinal microflora.

If a fungal infection of the kidneys has been proven, then antifungal agents are prescribed in tablet form. During their administration, control of therapy with the help of urography and other methods is required. After a course of antibiotic therapy, uroantiseptics are prescribed, as this helps prevent the disease from flowing into the chronic stage. These antimicrobials help eliminate the ongoing inflammatory process.

To eliminate swelling and inflammation, antihistamines are prescribed. In addition, they help relieve signs of allergies in the event of a reaction to the antibacterial agents used. In rare cases, surgical treatment may be prescribed for severe kidney damage.

Compliance with the regime

Treatment of pyelonephritis mainly takes place in a hospital and only in some cases at home. Therefore, parents must follow a certain regime during the period of therapy.

It is important to carry out exclusively natural breastfeeding during the treatment process. Maintaining careful hygiene of the newborn is also of great importance.

The progression of the infectious process to the chronic stage poses a particular danger to the child’s health, and constant exacerbations significantly worsen the quality of life. Prolonged progression of pyelonephritis leads to various complications. After suffering an acute form of the disease, mandatory dispensary registration is indicated once every 6 months for 5 years.

Possible complications

In the first month of life, the size of the baby's kidney is about 5 cm. Bacteria very quickly infect this organ of the baby. That is why pyelonephritis progresses very quickly, significantly increasing the risk of complications. This is very dangerous, as it threatens to damage other organs. a newborn boy or girl may have the following:

As a result of the fact that the load on the heart and pressure increases, hypertension begins to develop. The complications are very serious, which is why, in order to prevent them, you need to promptly seek advice from a pediatrician.

The occurrence of pyelonephritis and its complications is quite possible to prevent; the most important thing is to follow certain preventive measures, in particular:

carefully monitor the hygiene of the newborn;
put on diapers before going to bed or going for a walk;
women during breastfeeding need to follow a diet;
undergo periodic preventive examinations;
in cool weather, dress the child warmly;
support immunity;
If you detect the first signs of the disease, immediately contact your pediatrician.

After previously suffering from pyelonephritis, the child should be registered with a urologist. Consultations and examinations with a nephrologist will also be required. Particular care should be taken when administering vaccinations. If acute pyelonephritis occurs in a child, vaccination until the age of one can be postponed until the child’s health is completely normalized.

If a child has already suffered from the disease once, then it is necessary to take preventive measures to prevent relapses. To prevent the development of chronic pyelonephritis, it is extremely important:

ensure that bladder emptying is frequent and timely;
make sure your baby gets enough sleep, drinks enough fluids, and takes vitamins;
organize frequent walks in the fresh air;
periodically do a biochemical blood test.

Pyelonephritis is a very serious disease, especially for infants. If the acute form is treated incorrectly or untimely, the disease can progress to the chronic stage, which is fraught with dangerous complications and frequent relapses.

Pyelonephritis in children is an inflammatory process at the level of the upper urinary tract (in the kidneys). Unfortunately, the clinical picture of pyelonephritis in infants is no different in symptoms from cystitis (infection at the level of the lower urinary tract - bladder). Therefore, in the clinic, most often these two concepts are combined into the term febrile urinary tract infection. Despite this, studies have shown that the kidneys are most often affected in infants, so treatment of the infection begins according to the same scheme as for pyelonephritis.

Causes of pyelonephritis in children

Most often, the cause of pyelonephritis in newborns is the presence of bacteria in the blood. That is, any microbe that enters a child’s body can cause pyelonephritis.

In infants, the mechanism of occurrence of pyelonephritis is different - bacteria “rise” from the lower urinary tract, and, reaching the kidneys, provoke symptoms of pyelonephritis.

Microorganisms that most often infect the kidneys include:

coli;
Klebsiella;
enterococcus fecalis;
rarely - staphylococci and streptococci.

The first three microorganisms are normal “residents” of the intestine, but when they enter the urinary tract, they cause acute and chronic inflammatory processes.

How does pyelonephritis manifest in children?

Symptoms of pyelonephritis in children vary depending on their age. Also, they have a close connection with the mechanism of development of kidney infection. Next, we will explain how pyelonephritis manifests itself in children, depending on their age.

Pyelonephritis in newborns

Symptoms of pyelonephritis in newborns are caused by the presence of pathogenic bacteria in the blood. Therefore, the signs of the disease at this age are extremely nonspecific and do not indicate kidney damage:

jaundice;
hypothermia or fever;
poor appetite;
vomit;
developmental delay;
especially in boys - hyponatremia and hyperkalemia.

Pyelonephritis in infants

Pyelonephritis in infants and young children (from 2 months to 2 years) also has a nonspecific picture:

Symptoms of acute pyelonephritis in children of preschool and school age

Symptoms of pyelonephritis in adolescents

Similar to symptoms in adults:

chills;
back or side pain;
frequent and painful urination;
blood in the urine (hematuria).

It would be fair to note that all of the above symptoms relate to acute pyelonephritis in children.

How does chronic kidney damage manifest?

There are cases when chronic pyelonephritis in children occurs as a complication of acute pyelonephritis. Or, chronic pyelonephritis is initially detected by a random examination (ultrasound, urine test).

Thus, during the period of remission of chronic pyelonephritis, there are no symptoms. But with the slightest decrease in immunity, hypothermia, or poor hygiene, symptoms can appear in all their glory.

Treatment of pyelonephritis in children

Treatment of pyelonephritis in children is based on antibacterial therapy, hydration, as well as the use of drugs that relieve fever and pain. The duration of treatment is from 7 to 14 days, depending on the severity of the disease and the body's response to treatment.

Children with anomalies in the development of the kidneys or urinary tract must be registered with a urologist or nephrologist.

Statistics indicate that pyelonephritis in children is the most common disease of the genitourinary system; the disease is especially often registered in girls. This prevalence of the disease in childhood is primarily associated with the anatomical and physiological characteristics of the genitourinary system.

Pyelonephritis, what is it?

Pyelonephritis in children is an inflammatory process in the kidneys, which can be triggered by various microorganisms. Most often, the causative agent of the disease is the normal intestinal microflora, which enters the urinary tract in various ways; through the ureters, the microflora can rise up into the kidneys themselves and provoke inflammation.

In approximately 20% of cases, the provoking factor of inflammation is a mixed microflora, which consists of a large number of different bacteria - Escherichia coli, Proteus and various cocci. Doctors identify age groups at risk when the maximum incidence is recorded in children. These are groups of toddlers from 2 - 3 years old; from 4 - 6 to 7 - 8 years old, and the third group includes teenage children. It is during these age periods that the child’s genitourinary system is most vulnerable.

According to its clinical course, pyelonephritis is divided into acute and chronic. The acute form of the disease is characterized by complete recovery of the baby after a couple of months from the onset of the disease. In the case of chronic pyelonephritis, the clinical symptoms of the disease persist for six months or more, and a mandatory relapse of the disease is recorded.

In addition, pyelonephritis can be primary, which is formed in the presence of a chronic infection in the baby’s body, and occurs against the background of reduced immune function, and secondary, which is formed in the presence of defects and anomalies in the development of the kidneys - with dystopia or doubling of the kidneys.

What are the reasons for the development of pyelonephritis in children?

There are quite a few reasons that provoke the disease, but all these factors can be divided into two groups - general and local. A common factor in the development of pyelonephritis in a child is a decrease in the functioning of the immune system, which is why microorganisms that are opportunistic for the child, i.e. that microflora that does not harm the child, but when the balance system is disturbed (decreased immunity) can become pathogenic and provoke disease. Decreased immunity is considered the main cause of the development of the disease.

Pyelonephritis can be classified as a group of hereditary diseases, as it is quite often registered in children with metabolic disorders in the body.

Even an intrauterine infection or intrauterine development disorder can provoke pyelonephritis. Any suffering of the fetus during gestation can cause disease in the future. According to research, about 50% of newborns who end up in intensive care after birth have kidney damage, therefore, the provoking factor in the development of pathology is intrauterine oxygen starvation of the fetus - hypoxia. The baby’s urine itself may also be a provoking factor, if the baby has problems emptying urine from the kidneys, or in the case of reflux, when urine backflows from the bladder into the kidneys.

How does the disease develop?

For the development of pyelonephritis, penetration of the pathogen into the urinary tract, most often Escherichia coli, is necessary. The pathogen can enter in various ways, for example, when washing the baby, or, what most often happens, from a dirty diaper. Parents must follow all child hygiene rules. When washing girls, the baby must be held with her tummy up, so that the water drains from the pubis.

When washing the boys. there is no particular fundamental difference. Such strict recommendations are associated with the anatomical features of the structure of the urethra. In girls, the urethra is wider and shorter, which only facilitates the movement of microorganisms to the final destination, which cannot be said about boys. With prolonged contact of a child's feces with the genitals or with irregular diaper changes, colonization of E. coli can occur in both girls and boys.

After the bacteria have entered the urinary tract, their ascending path to the kidneys begins. Fortunately, not every microorganism is able to reach the kidneys and start the process of inflammation; this requires special mechanisms and devices.

One of the conditions for the proliferation of microorganisms is a set of special toxins and antigens in the bacterial cell. On the way to the kidneys, microorganisms release toxins that can damage the urinary tract, resulting in various urinary disorders. Stagnant urine becomes an excellent environment for the development of microorganisms, and urine already saturated with microorganisms is thrown back into the kidneys, this is how microorganisms enter the kidneys, and the inflammatory process begins. Another option for the penetration of bacteria into the kidneys is the hematogenous route, i.e. with blood flow.

In order to go this long way from the ureters to the kidneys themselves, more than one generation of microorganisms may change, or even the pathogen may change to another.

Having penetrated the kidneys, microorganisms are unevenly distributed; only certain areas of the kidney, or even one kidney, can be affected. In the anatomical structure of the kidney, collecting ducts are distinguished, which are located in the center of the kidney; this is where the largest number of microorganisms accumulate. Initially, the release of toxins by microorganisms first disrupts the work of the peripheral part of the kidney, and gradually the full functioning of the entire kidney is disrupted.

How does pyelonephritis manifest?

In acute pyelonephritis, the onset of the disease is sudden, the baby’s body temperature rises to 38 - 40º, chills, excessive sweating, and headaches are characteristic. maybe even vomiting. Children may complain of pain when urinating and nagging pain in the lumbar region. It is almost impossible to diagnose pyelonephritis in newborn babies, since toddlers cannot explain what is bothering them. Most often, the disease is diagnosed accidentally, but there are also clinical symptoms, most often it is prolonged jaundice. In infants, the most typical symptom of the disease is symptoms of intoxication.

Children over 5 years old may complain of pain in the abdominal area, without clear localization, or in the suprapubic and lumbar areas. Another characteristic symptom is discomfort during urination. With proper and timely treatment of acute pyelonephritis, the prognosis is favorable - complete recovery occurs. After a couple of days, the clinical symptoms subside, and proper kidney function is gradually restored.

Acute pyelonephritis can also turn into a chronic form of the disease, but this requires the presence of predisposing factors - congenital or previous kidney disease. Chronic pyelonephritis is characterized by a change in periods of exacerbation and asymptomatic periods. The disease can be hidden and not manifest itself for many years.

Relapses are accompanied by all the typical symptoms that are typical for the acute course of pyelonephritis. Toddlers become irritable, get tired quickly, and if the baby attends school, it is precisely with this fact that his performance falls. The chronic course of pyelonephritis can drag on for many years and even decades, and the outcome will directly depend on the prevalence of the infection itself and on the number of exacerbations per year.

How to diagnose the disease?

When making a diagnosis, the doctor takes into account the totality of clinical symptoms, the data of the survey, examination of the child, instrumental and laboratory studies. During the interview, the doctor systematizes complaints that may indicate pyelonephritis. Examination and instrumental research methods are aimed at establishing the inflammatory process in the kidneys, whether there are functional disorders in the state of the kidneys, etc.

There are a number of mandatory laboratory tests, which include: general and biochemical analysis of urine and blood, general and quantitative urine tests, if there is sediment in the baby’s urine, it must be examined. Urine culture is performed to identify the causative agent of the disease, its quantity, and determine sensitivity to a specific group of antibiotics.

A biochemical blood test determines the level of creatinine and urea, which directly reflect the functioning of the kidneys. Zimnitsky tests are performed, urine pH is examined, and the daily volume of urine is calculated. There are additional research methods that will be prescribed as needed, these include urine testing for chlamydia, fungi, mycoplasma or tuberculosis microbacterium.

Instrumental research methods can be roughly classified into mandatory and additional. The group of mandatory research methods includes ultrasound of the urinary system, X-ray contrast examination, and cystometry. Additional research methods include ultrasound of the renal blood flow and CT (computed tomography).

The diagnosis is established in the presence of pain in the relevant areas, intoxication and laboratory changes in the urine: the content of blood, bacteria and protein; with impaired renal function and an increase in ESR of more than 15 mm/h.

Treatment of pyelonephritis in children

The main goal of treatment is to eliminate the infection itself, reduce the symptoms of intoxication, restore kidney function, and increase the child's body resistance. In the treatment regimen, three volume points are distinguished - a special diet, appropriate drug therapy and physiotherapy exercises.

Antibacterial therapy occupies a central place in the treatment of pyelonephritis. Antibacterial therapy drugs are selected depending on the causative agent of the disease. Usually, average doses of drugs are chosen for children, but this is not the rule. In case of acute pyelonephritis, treatment is carried out for 1 - 2 months, in case of chronic pyelonephritis it continues throughout the period of exacerbation and several months after laboratory parameters have normalized.

When drawing up a diet for a child, it is necessary to take into account the age of the baby; spicy, salty and fried foods are completely excluded; when preparing, it is necessary to use as little seasonings, spices and preservatives as possible. It is advisable to limit salt only if the child has edema and if the child has high blood pressure.

In the acute period of the disease, drinking plenty of fluids is indicated to create unfavorable conditions for microorganisms; it is best to give the baby alkaline mineral waters or fruit drinks. In order to increase urination in a child, it is advisable to introduce watermelons, melons and cucumbers into the diet.

Strengthening the body and eliminating factors that contribute to the development of the disease occupy a leading place in the treatment of pyelonephritis. This requires compliance with the child’s sleep and wakefulness schedule, the appointment of special physical education, a review of the child’s diet and vitamin therapy. If the child has concomitant diseases, then they must be stopped. Hygiene measures have an equally important role, parents need to learn the rules of hygiene, and teach the baby accordingly.

Prevention

Any chronic infection, even carious teeth, is capable of provoking the disease. It is for these reasons that it is necessary to carefully monitor the health of the child. Babies who have suffered pyelonephritis are subject to dispensary observation by several specialists at once - a nephrologist, dentist, etc.

It is necessary to visit a nephrologist every 10 days during an exacerbation, monthly during treatment, and once every three months after treatment. It is necessary to visit a somatologist every 3-4 months, since such children are characterized by lightning-fast progression of caries and its multiple forms.

Puzkarapuz. special correspondent

Date of publication: 02/12/2013 15:29

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Both acute and chronic pyelonephritis occurs in children of any age, even in newborns and infants. Among newly born babies, the ratio of boys and girls with kidney inflammation is 1:2, among infants - 1:5. The fact that the disease is more common in female infants is explained by the anatomical features of their urethra - it is short, wide and high, which creates favorable conditions for infection to penetrate into the upper urinary organs.

Causes and origin of pyelonephritis in children

Pyelonephritis is a bacterial inflammation of the pyelocaliceal system of the kidneys and their interstitial (connective) tissue. The development of this phenomenon in young children contributes to the presence of purulent foci in the body. Sources of infection can occur in acute tonsillitis or respiratory disease, but more often they are observed in chronic inflammatory processes that are latent.

With pyelonephritis, the cups and pelvis of the diseased kidney are most affected

Often pyelonephritis is a complication of cystitis. Very often, this kidney disease develops against the background of pneumonia, tonsillitis, SARS, infectious lesions of the stomach and intestines. The main role in the development of the inflammatory process is played by the weakness of the immune system at an early age.

In the origin of pyelonephritis in both newborns and infants, an important place is occupied by infection that occurs in the postpartum period. For the development of the pathological process, the condition of the upper parts of the urinary system at the time of penetration of pathogenic microorganisms into them is of particular importance. The influence of toxins, vitamin deficiency, and allergies can provoke inflammation of the connective tissue of the kidneys - interstitial nephritis, which creates a favorable background for the further development of infectious lesions in these organs.

Any deterioration in the condition of the kidney may be a prerequisite for the development of pyelonephritis

In approximately 75% of babies under one year of age, pyelonephritis is secondary, that is, arising as a result of some pathology. In infants, it usually appears against the background of dynamic or mechanical obstruction (obstruction) of the urinary tract.

Some forms of the disease are based on natural factors. The development of pyelonephritis can be promoted by:

hereditary immunodeficiency conditions;
lack of enzymes in the epithelium of the tubules of the nephrons of the kidney;
hereditary metabolic disorders.

Children with congenital anomalies of the urinary tract, especially the kidneys, develop pyelonephritis 9–10 times more often than healthy children. This is explained by the fact that an unnaturally located or improperly formed kidney is more susceptible to external influences, in particular, infection.

Children with congenital kidney defects are especially susceptible to pyelonephritis

In the development of pyelonephritis in infants, poor nutrition plays an important role, especially after the introduction of complementary foods. In such conditions, protein overload of a small organism can occur due to a lack of fluid in the child’s diet. A significant factor for the occurrence of pyelonephritis in infants is also pneumonia, especially if it is caused by pathogenic staphylococcus.

There is some connection between the incidence of kidney inflammation and vaccination of children in the first year of life. This complication is mainly due to violation of immunization rules. In such cases, the following are of great importance:

the presence of a focus of infection in the child’s body;
the degree of individual sensitivity of the baby to the vaccine;
the speed of the child’s body’s reaction to the drug.

In infants, pyelonephritis is usually obstructive. An important role in this case is played by the obstruction to the free flow of urine that has arisen in the ureter, the kidney itself, or the isthmus of the bladder. Most often in infants, obstruction occurs in the area of the vesicoureteral, urethral-vesical or ureteropelvic segment. The disease occurs as a result of the phenomenon of reflux (reverse flow of urine) during congestion in the bladder and is often accompanied by dysfunction of the digestive system.

In the first year of life, the development of pyelonephritis is favored by:

excess vitamin D2 (ergocalciferol);
exudative diathesis;
inflammatory diseases of the external genital organs;
disorders of the stomach and intestines;
exhaustion (hypotrophy).

Photo gallery: factors contributing to the development of pyelonephritis in infants

An excess of vitamin D2 leads to the deposition of calcium and phosphorus in the kidneys, which negatively affects their condition. Abdominal pain in a newborn indicates a disorder of gastric or intestinal function Red cheeks in a child are not always a sign of health; many children suffer from diathesis Hypotrophy in an infant may cause the development of pyelonephritis From the external genitalia, the infection can easily spread to the bladder and higher, to the kidneys, especially in girls

Video: pediatric urologist talks about vesicoureteral reflux

The role of maternal health in the occurrence of pyelonephritis in a newborn

Intrauterine infection of the kidney is also possible. In this case, pyelonephritis develops in a child in the first hours after birth. Infection can occur in the womb through amniotic fluid, blood and placenta from a mother who had a genitourinary infection during pregnancy. Children born to sick mothers are more likely to have asymptomatic bacteriuria (the presence of bacteria in fresh urine) and pyelonephritis than those born to healthy women.

Mothers of many newborns suffering from kidney inflammation suffered from sore throat or flu during pregnancy, childbirth, or the postpartum period. These women often experienced late toxicosis of pregnancy, and their children had metabolic disorders and a decrease in the body's defenses, which also contributed to the development of the inflammatory process in the kidneys.

Thus, in newborns the following are of great importance for the development of pyelonephritis:

hereditary predisposition;
the presence of an infectious-inflammatory process in the mother during pregnancy;
late toxicosis in the mother, in particular nephropathy.

Late toxicosis of pregnancy is one of the main risk factors for the development of pyelonephritis in a newborn.

Complicated childbirth, accompanied by asphyxia (suffocation) of the fetus, and therefore oxygen starvation of its kidney tissue, also contributes to the baby developing pyelonephritis in the first days or weeks of his life.

Symptoms, forms and manifestations of the disease

The body of a small child is characterized by an increased speed of response to any irritation. As a result, the inflammatory process rapidly develops in the kidneys. This leaves a certain imprint on the symptoms of pyelonephritis: in newborns and infants, this disease often has an uncharacteristic course. The clinical picture of kidney inflammation in infants is extremely varied and is largely determined by:

the presence of favorable conditions for it;
activity of the infectious process;
its severity and distribution;
the nature of concomitant pathologies.

Clinic of acute pyelonephritis

At an early age, pyelonephritis in the vast majority of cases (about 85%) begins acutely. The first thing parents pay attention to is a sudden change in the behavior and general condition of the baby. The child becomes either lethargic or restless, his daytime and night sleep is disturbed, and he loses interest in the world around him. The baby loses his appetite and noticeably loses weight, is capricious, and often cries.

The onset of the disease is accompanied by fever, abdominal pain, and dehydration. General intoxication is expressed by nausea, vomiting, diarrhea. Occasionally, cyanosis of the skin is noted. 2–3 days after the onset of the inflammatory process, the affected kidney becomes painful to touch. Sometimes convulsions and loss of consciousness may occur. Functions are impaired:

liver;
circulatory organs;
digestive system;
adrenal glands and other endocrine glands.

In 5% of newborns with acute pyelonephritis, toxic hepatitis is observed, which manifests itself as jaundice.

Sometimes pyelonephritis in newborns is complicated by hepatitis, which manifests itself as a jaundiced discoloration of the skin.

The rapid onset of inflammation in the kidneys is associated with the generalized nature of the bacterial attack. The younger the child, the more acute the course of the disease. Some children experience short-term (within two to three days) increases in body temperature up to 38.5 °C. In the intervals between attacks of fever, the child was lethargic and inactive.

After repeated severe episodes of hyperthermia, bacterial shock can develop, which without emergency treatment is fatal. Fortunately, in most children, body temperature returns to normal within 3–5 days.

In 75% of cases, with inflammation of one kidney, functional changes are found in the second. Extrarenal symptoms of pyelonephritis are more pronounced in children in whom this disease develops against the background of congenital pathologies that prevent the normal outflow of urine. The course of acute pyelonephritis in newborns is usually severe, often complicated by blood poisoning.

The most severe complication of acute pyelonephritis in newborns is blood poisoning, or sepsis, which without emergency intensive care can be fatal.

It happens that in infants the disease begins subacutely. In this case, all of the listed symptoms are much less pronounced. In infants of the first year of life, subacute pyelonephritis may not be accompanied by an increase in body temperature and dysfunction of the digestive organs. First of all, yellowness of the skin and whites of the eyes is observed.

Acute purulent pyelonephritis

Acute purulent form of the disease is observed in 6–10% of all cases of pyelonephritis in children of the first year of life and most often represents a renal carbuncle, apostematous nephritis, or a combination of both. Girls get sick twice as often as boys. Unlike adults, purulent pyelonephritis in children often develops primarily (without an underlying disease).

Apostematous nephritis (Late Latin apostematosus, from the Greek arostema abscess, abscess; synonym pustular nephritis) is a metastatic suppurative process in the kidney, manifested by the formation of many pustules, mainly in its cortical substance.

The course of this form of kidney inflammation in newborns and infants is extremely severe. Generalization of the infectious process quickly occurs. There are pronounced signs of general intoxication:

high body temperature in combination with pneumonia;
breast refusal;
excitement, anxiety;
vomiting, often uncontrollable;
pallor;
weight loss;
bloating;
diarrhea;
high leukocytosis in the blood and increased erythrocyte sedimentation rate;
protein and blood in the urine.

The tongue and skin are dry, the pulse is rapid, breathing is shallow. The eyelids are swollen, there are bruises under the eyes. Sometimes there is pain and difficulty urinating (the child cries during this act).

Purulent kidney diseases, such as carbuncle or apostematous nephritis, are extremely severe in infants

Chronic pyelonephritis in the first year of life

Chronic kidney inflammation is a consequence or continuation of the acute phase of this process. However, for many sick infants this does not happen. Often, based on information from a survey of parents, it is impossible to establish the symptoms of acute pyelonephritis in a child in the recent past. Therefore, there is every reason to believe that chronic inflammatory phenomena in the kidneys of an infant may also be primary. Perhaps the disease had a gradual course from the very beginning, and the transition from its acute to chronic type occurred unnoticed.

In the absence of characteristic signs, acute pyelonephritis in newborns and infants could remain undiagnosed.

The following factors contribute to the transition of an acute inflammatory process to a chronic one:

stagnation of urine, in which the kidney is not completely freed from this fluid;
the presence of foci of chronic infection in the child’s body that were not treated in the acute stage of the disease or immediately after it;
abnormalities of the kidneys or lower urinary tract;
incorrect or insufficiently intensive and long-term therapy for acute pyelonephritis;
weakening of the body's immune defense due to other diseases.

In 25% of all sick children, only one of the organs suffers from inflammation, most often the right one. With bilateral chronic pyelonephritis, the degree of kidney change is radically different. In one of them, it is only difficult to identify any signs of damage, and in the second, the last stage of the process is observed - nephrosclerosis (wrinkling).

The image taken during an ultrasound examination in color Doppler mode shows that a kidney with nephrosclerosis is practically deprived of blood supply

The clinic of chronic pyelonephritis in infants is most often characterized by a gradual onset with moderate manifestations of intoxication. Depending on the nature of the symptoms, there are two main forms of this disease in infants - latent and wave-like.

Latent form

The latent form of the disease is diagnosed when a child is examined for another pathology or during a routine preventive examination. Only in a small proportion of sick infants, with careful observation, it is possible to identify several deviations from the norm:

fatigue;
body weight loss;
poor appetite;
inactivity;
grayish skin color, pallor;
low-grade fever (37–37.5 °C);
intermittent abdominal pain of unknown origin;
anemia;
urinary retention or incontinence;
arterial hypertension.

Wavy variety

The wave-like form of chronic pyelonephritis is the most common. The child’s condition and clinical picture depend on the period of the disease - during an exacerbation or outside of it. In the first case, the general condition of the baby is disrupted. Manifestations of the disease are similar to those in the acute form of pyelonephritis, but the body temperature almost always remains at subfebrile levels and is never high.

In approximately half of young patients, the signs of pathology are more pronounced and combined with anemia. As a rule, these are children in whom secondary pyelonephritis arose as a result of developmental defects that cause disturbances in the outflow of urine. These symptoms are especially pronounced in bilateral pathologies of the upper urinary tract, as well as in vesicoureteral reflux.

Outside of exacerbation, manifestations of pyelonephritis persist, but are much less pronounced. The process becomes latent.

Diagnostics

Often, the clinical manifestations of acute pyelonephritis in infants are not recognized in a timely manner, since they are classified as signs of the underlying pathology against which they arose. In such cases, kidney inflammation is usually diagnosed with an exacerbation or wave-like course of the infectious process in these organs. Less commonly, this disease is discovered accidentally in infants when assessing the results of routine laboratory urine tests or based on symptoms of general intoxication. In most babies in the first year of life, it is very difficult to determine the presence of pyelonephritis and the time of its onset.

It is especially difficult to diagnose kidney inflammation in infants with a latent chronic form. Since this type of disease has an asymptomatic course, the characteristic signs of pyelonephritis are very weakly expressed or may be completely absent. As a rule, such children are admitted to the hospital for examination with a diagnosis of hypotrophy of unknown etiology. Inflammation of their kidneys is detected only with careful observation of laboratory tests of urine and blood, taken multiple times.

A high concentration in the blood of nitrogen-containing products of protein metabolism (creatinine, urea, etc.) - hyperazotemia - occurs much less frequently in infants than in newborns. Usually this phenomenon is observed in those children in whom pyelonephritis has developed against the background of a congenital anomaly of the urinary organs.

Often the acute onset of the disease, fever and obvious symptoms of intoxication prompt doctors to diagnose influenza or ARVI. However, the main difference between pyelonephritis and these ailments is the absence of catarrhal phenomena in the child’s upper respiratory tract. With kidney inflammation, the patient has neither a runny nose nor a cough.

Catarrhal phenomena, such as hyperemia of the throat, are typical of influenza, but are not characteristic of pyelonephritis

Methods used in the diagnosis of pyelonephritis

First of all, the doctor examines the child and asks the parents about the medical history. The specialist should know how the pregnancy went, whether there were any complications during childbirth, whether the baby was born full-term, whether his close relatives had problems with the kidneys. For instrumental diagnosis of pyelonephritis in infants of the first year of life, the same methods are used as in adults.

Lab tests

After examining and collecting anamnesis, the specialist sends the baby to the laboratory for urine and blood tests. The inhibition of kidney function is evidenced by a decrease in the density of urine and a violation of the excretory ability of these organs. The presence of an inflammatory process in the kidneys is indicated by an increased number of leukocytes, bacteria and protein in urine, sometimes cylinders. A bacteriological examination of urine is carried out to determine the causative agent of the disease.

In the blood during acute pyelonephritis the following is observed:

shift of the leukocyte formula to the left;
increase in ESR (erythrocyte sedimentation rate);
pronounced leukocytosis.

Video: how to collect urine from newborns for analysis

Kidney ultrasound

Ultrasound examination is the first and main instrumental procedure, which is prescribed to all newborns and infants with suspected pyelonephritis without exception. The method allows detecting obstruction at any level, examining the structure and structure of the kidneys, as well as determining the intensity of their blood supply.

Ultrasound examination of the kidneys is the most popular and simplest method for diagnosing pyelonephritis in infants

Renography and scintigraphy

Radionuclide renography and dynamic computer scintigraphy examine kidney function using a special drug injected into a vein, which, once in the urinary organs, emits gamma photons. The latter are recorded by a special camera. As a result, the doctor receives images, graphs and charts that show kidney function in detail in real time.

In addition to the functional state of organs, using these methods, their sizes and contours are determined, information about blood supply, patency of the urinary tract and the direction of urine flow is obtained. Dynamic gamma scintigraphy makes it possible to identify at an early stage dysfunction not only of each of the kidneys, but also of its individual segments, and also to monitor the effectiveness of treatment.

Kidney scintigraphy is a non-invasive research method that is used to diagnose various pathologies of the urinary system

Thermometry

Thermometry is repeated measurement of temperature at various points of the body according to a special scheme. This method is especially necessary when diagnosing pyelonephritis in children of the youngest age group. Using thermometry, the localization of the inflammatory process is clarified: it is determined whether one or both kidneys are affected.

X-ray excretory urography

The excretory urography method is based on the ability of the urinary system to secrete a contrast agent administered intravenously along with urine. Commonly used compounds are iodine. The X-ray picture of pyelonephritis largely depends on the duration of the disease, the intensity of its manifestations, and the presence or absence of an obstruction in the urinary tract. Typically, in the acute form of the disease, an enlargement of the diseased kidney is observed. Chronic pyelonephritis is characterized by 4 signs visible on the urogram:

asymmetry of both kidneys;
deformation of the collecting system;
reduction in parenchyma thickness;
uneven release of radiopaque contrast agent.

Cystography

Cystography is an X-ray examination of the bladder after filling it with a contrast agent. The latter is introduced either from the bottom up through the urethra, or from the top down, that is, the method in this case looks like the final stage of excretory urography. In children, the second method is usually used. Cystography is performed for the purpose of timely detection of vesicoureteral reflux.

Vesicoureteral reflux has 5 degrees of severity, which can be determined using a cystogram

Angiography

Renal angiography is the study of renal vessels using a contrast agent. It is a highly informative diagnostic method, but is rarely prescribed to children in the first year of life. The method is used mainly to differentiate pyelonephritis from arterial hypertension. At an early stage of the disease, narrowing of the renal artery and sclerotic changes in the vascular branches inside the organ are noted.

Sometimes, with advanced pyelonephritis, angiography reveals areas in the kidney that are completely devoid of blood vessels. Doctors call this phenomenon a symptom of burnt wood.

Treatment of pyelonephritis in newborns and infants

The choice of treatment tactics for infants with pyelonephritis depends on the form of the pathology and the patency of the urinary tract (urodynamics).

Therapy for acute pyelonephritis

If the patency of the urinary tract is normal, then antibacterial therapy is carried out taking into account the sensitivity of the microflora to drugs. The type of drug must be changed every 4–5 days to prevent the development of forms of microorganisms resistant to it.

In case of severe illness, the child is prescribed broad-spectrum antibiotics in combination with sulfonamide medications. If Proteus and Pseudomonas aeruginosa were found in the urine, then two antibacterial agents are used, and they are administered intravenously and in large doses.

If acute pyelonephritis has developed due to urinary tract obstruction, then conservative therapy will be effective only in combination with surgery, which will ensure normal urine outflow. Main indications for surgery:

lack of effect from the use of medications;
a sharp deterioration in the child’s general condition, significant leukocytosis, an increase in body temperature to critical levels;
the presence of an obstruction or compression (squeezing) in the urinary tract.

The final volume and nature of the intervention is established on the operating table. In children, surgical treatment of the kidneys is carried out while preserving the organs.

Treatment of kidney carbuncle or apostematous nephritis should be as intensive as possible, since suppurative processes in newborns and infants are very prone to generalization with blood poisoning. In addition, with this type of disease, severe infectious and toxic damage to other organs is often observed.

The scale and type of surgery for purulent pyelonephritis in infants is the same as in adults. However, the youngest patients especially need to try to preserve the organ, so the kidney is removed only when its purulent melting is complete. After surgery, intensive antibacterial therapy is carried out.

Therapeutic measures for the chronic form of the disease

Treatment of children in the first year of life with chronic pyelonephritis is more effective the earlier it is started. First of all, it is necessary to resume the free passage of urine. Conservative therapy should precede surgery and continue for a long time after it, since elimination of anatomical defects and normalization of urine outflow do not lead to a reversal of the disease. In some children with restored urodynamics, pyelonephrotic shrinkage of the kidney and a sharp decrease in its functionality continue.

The absolute indication for surgery is urinary tract obstruction, regardless of the degree of anatomical defects and the age of the child. Expectant tactics in this case is unacceptable. Even with the subsequent use of medications to stop the pyelonephrotic process, surgical intervention will help maintain kidney function only at the level that was before the operation.

In a third of sick babies, after the resumption of urodynamics, a persistent subsidence of the inflammatory process occurs after 7–11 months. With an exacerbation of the disease, the course of treatment continues for three years.

Drug therapy is aimed at achieving the following goals:

elimination or suppression of the causative agent of the disease;
slowing down the process of scar tissue formation;
restoration and stabilization of kidney function.

Antibacterial treatment plays an important role. Its effectiveness depends on preserved renal function, the correct choice of drug and its ability to concentrate in the urine.

The use of antibiotics is associated with some difficulties. Firstly, with their long-term use, pathogenic microflora develop resistance to them. Therefore, the drug needs to be changed every few days. Secondly, antibacterial agents can provoke intestinal upset, dysbacteriosis, and fungal infections. Intensive therapy with their use can be justified only during periods of exacerbation of chronic pyelonephritis. In these cases, treatment should be similar to that for acute primary attacks of the disease.

In addition to antibiotics, sulfonamide drugs are widely used to treat infants with chronic pyelonephritis. However, they are eliminated from the body very slowly, so they are contraindicated at the first signs of renal failure.

To increase the child's immunity, the introduction of bacteriophages, staphylococcal toxoid, and Levamisole is used in combination with antibiotics. In advanced stages of pyelonephritis, there may be a need to correct the manifestations of kidney failure, normalize blood pressure, restore the function of the digestive and circulatory systems, and eliminate anemia.

A bacteriophage is a special virus that destroys pathogenic bacteria

Nutrition and folk remedies

You should try to maintain breastfeeding as long as possible. From the second half of the baby’s life, you can pay attention to herbal medicines, which are given to the child if he does not have allergies and only as prescribed by a doctor. In case of persistent remission of chronic pyelonephritis, herbal medicine may be the only method of maintenance treatment. The baby is prescribed infusions and decoctions of herbs with diuretic, bactericidal and anti-inflammatory effects for oral administration.

For maintenance therapy of chronic pyelonephritis, infants from 6 months of age can drink a medicinal drink prepared according to the following recipe:

Mix dry currant, lingonberry and strawberry leaves in a ratio of 2:1:3.
Pour 4 tbsp. l. prepared raw materials 1 liter of boiling water.
Cover and let stand for 1 hour.
Strain the finished infusion and give the child 1 tbsp. l. three times a day.

From the age of 7 months, it is recommended to give a decoction or infusion of rose hips as a diuretic to a baby; when closer to one year, the baby can already eat pieces of pulp on his own or drink watermelon juice. From 8–9 months, prune compote will be useful.

Breastfeeding, fresh air and decoctions of medicinal herbs will help the baby recover faster

Disease prognosis

The best outcome of the disease is achieved only if the baby is treated in a specialized nephrology hospital. Next, the child must undergo a course of maintenance therapy at least once a year for 3–5 years and be under medical supervision.

For several years after intensive therapy for pyelonephritis, the child should be under medical supervision of doctors

The prognosis of pyelonephritis is favorable in most cases, but can be difficult. If there are no congenital severe defects of the urinary system, then approximately a tenth of sick infants recover within a few months. In 50–60% of children, the disease recedes only after persistent long-term treatment. Everyone else, unfortunately, will have to live with this problem all their lives, and in such patients, after years, kidney failure begins to steadily develop.

In children with secondary chronic pyelonephritis caused by malformations of the urinary tract, the pathological process in the kidneys rapidly progresses. Inflammation often worsens, gradually leading to the development of chronic renal failure (CRF). Only timely diagnosis and urgent adequate therapy can stop the progression of the disease and avoid this extremely life-threatening condition. Primary chronic pyelonephritis is very rarely complicated by renal failure.

Prevention of kidney inflammation in babies under one year of age

If infection occurs in utero, then children in the first months of life experience purulent-septic pathologies, including inflammation of the kidneys. Therefore, newborns whose mothers suffered from late toxicosis of pregnancy and any inflammatory ailments while expecting a child should be considered at risk for possible pyelonephritis. In these children, it is necessary to eliminate disorders of protein, water-electrolyte and other types of metabolism as early as possible.

It is necessary to carry out proper hygienic care of the baby's external genitalia. You need to be especially attentive to girls: they should be washed with running water from front to back (towards the anus).

Every expectant mother should do her best to protect herself from infections, hypothermia, and avoid crowded places, stuffy, unventilated rooms.

Video: Dr. Komarovsky about urine analysis and urinary tract infections

Thus, the main clinical manifestations of pyelonephritis in the first months of a child’s life are symptoms of general intoxication with dysfunction of the digestive organs and retardation in physical development. They are often mistaken for signs of another childhood disease, and diagnosis of kidney inflammation is delayed. That is why every mother whose baby belongs to the risk group for the development of pyelonephritis should be extremely attentive to the condition of her baby from the first hours after his birth. Timely detection of this formidable and insidious disease allows treatment to begin as early as possible and give the child a chance to grow up healthy.

Nowadays, urinary tract diseases and inflammatory processes of the kidneys are quite common. Pyelonephritis in an infant is a serious pathology, characterized by certain features of its course, specific symptoms, and requiring immediate treatment. What are the causes of the disease in infants, and how to recognize it in time for treatment?

Kidney inflammation in children

Inflammation of the kidneys of an infectious nature is called pyelonephritis. The disease is quite common in children one month of age (mainly affecting girls), and has a close relationship with cold viral infections. Frequent colds and other factors influence the occurrence of the inflammatory process in the kidneys. Pyelonephritis in children (who are under 1 year of age), depending on the type and form of the disease, usually responds well to treatment. After completing the therapeutic course, you must be registered with a doctor for 5 years to prevent relapse of the disease.

Types and forms of the disease

In medicine, two forms of the disease are classified:

Primary pyelonephritis - develops in an initially healthy organ.
Secondary - develops against the background of existing kidney diseases (urolithiasis, glomerulonephritis).

Secondary pyelonephritis, in turn, is divided into types:

obstructive - disruption of the outflow of urine and the addition of bacterial flora;
non-obstructive - urinary tract patency is normal.

According to the clinical course, the disease is divided into the following types:

Acute - characterized by a sudden exacerbation of symptoms and an equally rapid recovery.
Chronic - transition of the disease to a relapsing stage (asymptomatic course of the disease, sometimes followed by periods of exacerbations).

Based on the prevalence of the process, the following types of kidney inflammation are distinguished:

Unilateral pyelonephritis is the most common type of disease in young children, which affects one kidney (left or right).
Bilateral - left and right sides (both kidneys) are affected. This disease can cause kidney failure.

According to the method of infection in the kidneys, pyelonephritis occurs:

hematogenous (ascending), when infection occurs through the blood;
urogenic - through the urinary tract;
lymphogenous - with lymph flow from foci of infection (intestines, urethral organs).

Causes of illness in newborns

The most common causative agent of the disease is Escherichia coli, as well as lesser known bacteria such as enterococci, chlamydia, and the microbe Proteus. Bacteria in newborn children are introduced through the blood - in a hematogenous (ascending) way. Infection occurs with purulent sore throat, pneumonia, and various dermatoses.

Pyelonephritis in children under one year of age can be caused by other reasons:

hereditary kidney disease or congenital pathologies;
chemical eating and digestive disorder;
childhood disease - rickets or, conversely, excess vitamin D;
presence of helminthiasis;
inflammation of the bladder (cystitis);
diabetes;
complications after illnesses - respiratory infection, chickenpox, measles.

Symptoms of pyelonephritis in infants

A sign of illness may be a high temperature without signs of a cold.

Signs of pyelonephritis in children may include the following symptoms:

an increase in body temperature up to 40 degrees in the complete absence of cold symptoms (sneezing, coughing, runny nose);
baby's refusal to breastfeed or formula milk;
the child’s crying and whims for no apparent reason;
impaired or excessive outflow of urine - long breaks between urinations or, conversely, urinary incontinence;
change in urine color and the presence of a characteristic pungent odor;
restless sleep of the child at night;
weight deficiency;
baby's fatigue and lethargy.

Diagnostics

If suspicious symptoms are detected in young children, parents consult a pediatrician. If you suspect urinary tract or kidney disease, contact a pediatric urologist. The urologist will give directions for the necessary tests. The first direction is a general urine test. To correctly collect the morning urine sample, you should prepare a sterile glass jar and wash the baby before the procedure, otherwise the analysis may give inaccurate results.

The second direction is taking a test according to Nechiporenko (the middle portion of urine is examined). The third direction of analysis, which is carried out most often, is according to Zimnitsky. It is done if an inflammatory process in the kidneys or renal failure is suspected. The collection procedure is a little more complicated - it is necessary to collect an average portion of urine during each urination into 8 different containers.

A biochemical blood test will help evaluate the work of internal organs.

To diagnose the disease (in addition to urine tests), they carry out:

A laboratory diagnostic method is a biochemical blood test that allows you to evaluate the functioning of internal organs (liver, kidneys, bladder).
Instrumental research methods - ultrasound of the kidneys and urethra.
Collection of stool for bacteriological examination (determines the presence of helminthic infestations in infants).
Carrying out a rectal examination (finger examination of the rectum).

is an inflammation of the kidneys in a breastfed child, which is provoked by pathogenic microorganisms.
Girls are more susceptible to infection than boys; they are diagnosed with pyelonephritis 6 times more often. In infants, pyelonephritis is diagnosed mainly at 4-5 months, when they begin to be transferred to artificial feeding. In newborns, the disease is detected in 1-3% of cases, and most often these children are premature.

The course of the disease in young children has some differences and depends on the age of the child.

So, in infants, the following symptoms will be noted:

Increase in body temperature to high values, fever will last for two days or more;

Complete renunciation of breast sucking;

Frequent regurgitation;

Urine has an unpleasant odor;

Intestinal disorders with a predominance of loose stools;

During urination, the newborn may show anxiety, which is expressed in crying;

The child may show increased drowsiness

Urination occurs in small portions;

The younger the child is, the faster he will lose weight, especially against the background of a high temperature.

During the newborn period, pathogenic bacteria that provoke pyelonephritis circulate in the child’s blood, so the symptoms of the disease are not specific to this inflammation:

Body temperature can drop to critically low values, or reach high levels, causing a feverish state;

Often there is yellowing of the skin;

The child refuses to breastfeed;

Repeated regurgitation and vomiting are observed;

In newborn male infants, hyponatremia and hyperkalemia are detected, although the development of these conditions is also possible in girls;

The child is delayed in development.

Causes of pyelonephritis in infants

In most cases, during the newborn period, the cause of the development of the disease is the entry of bacteria into the child’s blood. Circulating through the bloodstream, they reach the kidneys by hematogenous route and cause inflammation of their tissues and systems. Therefore, almost any microbe can lead to the development of disease in a newborn.

As for infants, they are more likely to have an ascending route of infection, when pathogenic microorganisms enter the kidneys from the bladder. In most cases, pyelonephritis in infants is provoked by Escherichia coli (read also:) although clesibella, bacteria of the enterococcus group, and, less commonly, staphylococci, streptococci, viruses, and fungi can invade the kidney tissue. Kidney damage due to microbial associations is possible.

The following factors contribute to the development of the disease:

Purulent omphalitis of newborns;

Pneumonia;

intestinal dysbacteriosis;

Pustular lesions of the skin;

intestinal infections;

Vulvitis, vulvovaginitis, cystitis, balanoposthitis;

Incorrect and insufficient child care, non-compliance with the rules for washing infants;

Anomalies in the development of the urinary system that impede the normal passage of urine;

Congenital kidney malformations;

Vesicoureteral reflux;

Hypotrophy;

prematurity;

Excess vitamin D;

Previous infectious diseases that contribute to a decline in the body’s immune forces.

As a rule, the first person to diagnose pyelonephritis in infants is a pediatrician, who sends the child and his parents for a mandatory consultation with a pediatric nephrologist or a pediatric urologist. To confirm the diagnosis you will need to do:

Urine culture for flora with a mandatory antibiogram;

Biochemical urine analysis;

The Zimnitsky test is performed in the Reiselman interpretation, when urine is collected not every 3 hours, but in the rhythm in which the child urinates;

It is possible to detect the disease by PCR and ELISA;

Evaluation of spontaneous urination and control of diuresis are important.

Also, the child is sent for ultrasound of the kidneys and bladder. Cystourethrography is not performed after the first episode of illness in a child; it is performed in cases of repeated pyelonephritis, or if hydronephrosis, sclerosis of renal vessels, and obstruction are detected during ultrasound.
Treatment of pyelonephritis in infants

Treatment of pyelonephritis in infants is based on the following principles:

Maintain bed rest during the entire febrile period;

Refusal to introduce complementary foods, without restrictions on natural protein foods;

Timely hygiene measures in compliance with the rules of washing babies;

Conducting symptomatic therapy using antipyretic, detoxifying and infusion medications;

Performing antibacterial therapy.

The main condition for ridding a child of the disease is antibacterial therapy, which is carried out in three stages. At the first stage, which lasts from 10 days to 2 weeks, the child is treated with protected penicillins at the doctor’s choice: Amoxiclav or Ampicillin in combination with Sulbactam. Third generation cephalosporins are also used: Cefotaxime, Ceftazidime, Cefixime, Ceftriaxone, Ceftibuten. When the disease is severe, aminoglycosides (Netromycin, Gentamicin, Amikacin), 4th generation cephalosporins (Cefepime) or carbapenems (Imipenem, Meropenem) are administered.

The second stage of treatment is reduced to uroseptic therapy, which is performed over 2-3 weeks. It is performed with the help of 5-nitrofuran derivatives (Furagin, Furamag), and with the help of non-fluorinated quinolones (Negram, Nevigramon, after a year - Palin), combined sulfonamides (after the age of 2 months, Co-trixomazole is allowed).

The third stage of treatment consists of preventive anti-relapse therapy. To do this, for a long time (possibly up to a year), the child is given nitrofuran drugs - Furagin, Furamag and a course of herbal therapy is carried out, preferably monophytotherapy, taking into account individual intolerance.

Canephron N can be used as herbal medicines to prevent pyelonephritis in infants, offering the child 15 drops up to 3 times a day.

Probiotics (Linex, Acipol) are used to treat dysbiosis. For a month, the child is given vitamins A, B6, E, which is a prerequisite for antioxidant therapy. Subsequently, it is carried out in courses.

After an episode of acute pyelonephritis, a child is subject to clinical observation for five years, and in case of relapses - constantly.

Education: Diploma in general medicine received from Volgograd State Medical University. Immediately received a specialist certificate in 2014.