Acute pyelonephritis in children

Pyelonephritis in children is a non-specific infectious and inflammatory process occurring in the renal pelvis and calyces and tubulointerstitial tissue of the kidneys. It accounts for about 50% of the overall pathology of the urinary tract.

Pyelonephritis in children can develop at any age. In young children, pyelonephritis is the third most common disease after acute respiratory viral infections and gastrointestinal diseases.

In recent years, it has become clear that carriers of specific uroepithelial receptors and individuals who do not secrete the protective enzyme fucosyltransferase are more prone to developing pyelonephritis. The enzyme fucosyltransferase blocks bacterial adhesion to uroepithelial receptors.

What causes acute pyelonephritis?

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Pathogenesis of acute pyelonephritis

The most significant microorganism in etiology is E. coli, which has P-fimbriae, or pili of types I and II, and attaches to the receptors of the uroepithelium of a disaccharide nature.

The adhesion process may consist of two phases. The first (reversible) involves type II pili (mannose-sensitive hemagglutinins), in which case E. coli will be isolated along with the rejected mucus.

Pathogenesis of acute pyelonephritis

Symptoms of acute pyelonephritis

Symptoms of acute pyelonephritis are typically characterized by:

1. pain syndrome;
2. urinary syndrome;
3. dysuric disorders;
4. symptoms of intoxication.

In young children, pain is localized in the abdomen, in older children - in the lower back. The pain is not acute, rather it is a feeling of tension and strain. The pain intensifies with a sharp change in body position, decreases with warming of the lower back. Often, the pain syndrome is weakly expressed and is detected only by palpation of the abdomen and tapping on the lower back in the area of the projection of the kidneys. has a seeding of E. coli, and in case of infection in a hospital setting, the etiological significance of Klebsiella, Pseudomonas aeruginosa, and Enterococcus increases.

Symptoms of acute pyelonephritis

Diagnosis of acute pyelonephritis

Functional methods of kidney examination in pyelonephritis may reveal the following abnormalities: Zimnitsky's test - decreased concentrating ability of the kidneys - hyposthenuria or isosthenuria. Impaired urine concentrating function indicates damage to the interstitial tissue of the kidney; impaired renal function in maintaining acid-base balance due to decreased ability to form ammonia and decreased excretion of hydrogen ions by renal tubular cells; impaired acido-ammoniogenesis reflects the function of the distal renal tubules; determination of beta ₂ -microglobulin content in urine. A significant increase is observed with predominant damage to the proximal renal tubules. The norm of beta ₂ -microglobulin in urine is from 135 to 174 μg/l. In patients with pyelonephritis, its level has been shown to increase by 3-5 or more times.

Diagnosis of acute pyelonephritis

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Treatment of acute pyelonephritis

Regime - bed rest in the acute period (intoxication, increased temperature), "the warmth of the bed" creates conditions for improving blood circulation in the kidneys and increasing diuresis, reducing pain syndrome. Semi-bed rest is maintained during the period of pronounced activity of the microbial-inflammatory process.

The diet for acute pyelonephritis for 7-10 days is dairy and vegetable. The food should contain all essential amino acids in optimal quantities and ratios, preferably of egg or dairy origin. The diet should include fresh fruits and vegetables to maintain vitamin and electrolyte balance. Patients are not limited in the amount of fluid and table salt they take. Products containing excess sodium are limited. Salty, fried foods, marinades, and canned foods are excluded.

How is acute pyelonephritis treated?