Pyelonephritis in children

Pyelonephritis in children less than adults, may be the cause of resistant hypertension and renal failure.
The disease are particularly susceptible infants. A significant role in the emergence of pyelonephritis belongs to the age characteristics of the urinary system and lower resistance to infection in the first months of a child's life. Predisposing factors are the pathology of pregnancy and childbirth, inflammatory lesions in the body of mother and child, asphyxia and intracranial birth trauma, acute respiratory and gastrointestinal disease of the newborn, which is a violation of renal blood flow, there dystrophy tubules CSOs epithelium and increases the permeability of the vascular wall. Not a smaller role in the emergence of pyelonephritis in children belongs congenital anomalies of the kidneys and urinary tract. Significant predisposing role in the development of pyelonephritis plays gipervitaminoz D (see Gipervitaminoz).
Clinical symptoms of pyelonephritis in children is very diverse, uncommon (subfebrile temperature, periodically, with high rises, developmental delays, fatigue, loss of appetite, pallor, pain in the back and abdomen, anemia).
In infants pyelonephritis often occurs with symptoms of the disorder of the function of the gastrointestinal tract (vomiting, diarrhea), headache, frequent and painful urination, oliguria.
Long before the changes in the urine can be observed temperature increase. With age, the clinical picture is approaching that of adults. Most children for pyelonephritis is different scarce symptoms, the disease is discovered by accident. For pyelonephritis in children long, with periods of remission and exacerbation.
In the diagnosis of pyelonephritis, use the same methods as adults. For the reasons and factors that contributed to the emergence of pyelonephritis, you need a more in depth study of obstetric and family history, the history of the development of the child and, based on the data, conduct targeted biochemical and immunological research in specialized Nephrology departments.
The forecast. In most patients the process progresses, leading to nephrosclerosis and kidney failure. In preventing adverse outcome of pyelonephritis in children is of great importance of early diagnostics and timely treatment.
Treatment. It is necessary to eliminate the reasons that caused or contributed to the emergence of the disease: metabolic disorders due to hereditary enzymopathies (see), the anomalies of the kidneys and urinary tract.
With the purpose of suppression of infectious, inflammatory process antibacterial preparations: orosol, sulfonamides (prosulpin, sulfadimetoksin), antibiotics (chloramphenicol, streptomycin, erythromycin, gliatilin, ampicillin, oxacillin), drugs nitrofuranovye series (furadonin 0,005 g on 1 kg of weight per day, furagin in the same doses), derivatives nalidiksova acid (blacks 60 mg/kg of body weight per day, nikodin 0.1 g/kg per day). The effectiveness of antibacterial therapy increases in combination with antibiotics drugs nitrofuranovye series, as well as derivative nalidiksova acid.
Duration of treatment is determined by the severity of pyuria and of bacteriuria (see Peoria). The duration of the disease and the absence of the effect of the therapy is shown by appointment quinoline drugs, for example hingamin (delagil, Raskin, chloroquine) in a dose of 5-10 mg/kg / day, 5-NOK 100 to 400 mg per day, depending on age. The treatment is carried out under careful medical supervision. All children with pyelonephritis should be under medical supervision.
Prevention: timely and energetic therapy of infectious diseases, struggle with focal infection, eliminating mechanical and dynamic obstacles (congenital or acquired pathology) the normal flow of urine, increasing of common resistance of an organism of the child.

Pyelonephritis in children is less common than in adults. Children Peoria due pyelonephritis in 2/3 of the cases. Some adults, patients with chronic P., the disease begins in childhood. P. may be the cause of resistant hypertension and renal failure in older children, adolescents, and especially among young people.
Etiology P. in children heterogeneous agents most often Escherichia coli and Staphylococcus. In children of early age possible hematogenous and lymphogenous ways of spreading the infection. The development of the Isthmus, in addition to infection, caused by mechanical or dynamic obstacle to the flow of urine. Increased pressure in the pelvis and subsequent reflux leads to the introduction of infection in renal tissue, where its further spread is mainly interstitium.
When P. in children morphological changes in connection with small barred process and slowness of its development are expressed less, than in adults, and wrinkled kidney in children is less common.
For acute pyelonephritis characterized by sudden onset, high fever, chills, headache, paleness. Small children often prevail toxicosis with dehydration, gastrointestinal and neurological symptoms. Older children often note of pain in the lower back or abdomen, dysuric phenomena. Objective examination is uncharacteristic data, a symptom of Pasternatskogo expressed not always. Acute P. accompanied by leukocytosis, neutrophilia, a shift to the left. Urine - proteinuria (more than 1 PPT). massive leukocyturia, a small amount of red blood cells, including leached, cylinders, epithelium ("tailed" cells).
The diagnosis. To recognize chronic P. difficult because it is often hidden flows, without clinical and urinary syndrome, revealing itself in the further development of resistant hypertension and the onset of renal failure. The symptomology of chronic pyelonephritis (low grade fever with high rises, developmental delays, fatigue, loss of appetite, pallor, pain in the back and abdomen, anemia) may remind many other diseases. Quite soon comes the violation reabsorbtion and secretory function of kidneys, later glomerular filtration. For P. long, often wavy. Diagnosis of P. in children is based on the same data as adults.
Forecast P. serious. In most patients the process progresses, leading to nephrosclerosis and kidney failure.
Recovery is possible only if timely, long-term and systematic treatment of acute pyelonephritis and after removal of the local factor (anomalies, stones).
Treatment. The nature of the diet should be determined by the function of the kidneys. Antibacterial therapy (sulfa drugs, antibiotics, furadonin), conducted a combined basis and repeated cycles, should be combined with supportive therapy (vitamins, gamma globulin, plasma, blood transfusion). When anomalies and unilateral pyelonephritis - reconstructive operations, nephrectomy.
Prevention: timely and energetic therapy of infectious diseases, struggle with focal infection, eliminating mechanical and dynamic obstacles to the normal flow of urine, increase of a common resistibility.