Acute pyelonephritis in children

Pyelonephritis in children is a nonspecific infectious and inflammatory process that occurs in the bowel-cup system and tubulointerstitial tissue of the kidneys. In the general structure of the pathology of the urinary tract is about 50%.

Pyelonephritis in children can develop in any age period. In young children, pyelonephritis is the third most common after SARS and diseases of the gastrointestinal tract.

In recent years, it has been found that carriers of specific uroepithelial receptors and persons not secreting the protective enzyme fucosyltransferase are more likely to develop pyelonephritis. The enzyme fucosyltransferase blocks bacterial adhesion to uroepithelial receptors.

What causes acute pyelonephritis?

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Pathogenesis of acute pyelonephritis

The microorganism of E. Coli, which has the P-pili, or the type I and II-type spirits most important in the etiology, is attached to the uroepithelium receptors of the disaccharide nature.

The adhesion process can consist of two phases. In the first (reversible) type II pili (mannose-sensitive hemagglutinins) participate, in this case E. Coli will be excreted together with the tear slime.

Pathogenesis of acute pyelonephritis

Symptoms of acute pyelonephritis

Symptoms of acute pyelonephritis in a typical case are characterized by:

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

Pain in young children 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 tension. The pain is aggravated by a sharp change in the position of the body, it decreases when the waist region is warmed. Often, the pain syndrome is poorly expressed and can be detected only when palpation of the abdomen and lumbago at the waist in the area of the projection of the kidneys. There is an excision of E. Coli, and when infected in hospital conditions, the etiological importance of Klebsiella, Pseudomonas aeruginosa, enterococcus increases.

Symptoms of acute pyelonephritis

Diagnosis of acute pyelonephritis

With the functional methods of studying the kidneys with pyelonephritis, the following disorders can be detected: in the Zimnitsky trial, a decrease in the concentration capacity of the kidneys-hyposthenuria or isostenuria. Violation of the function of urine concentration testifies to the damage to the interstitial tissue of the kidney; impaired renal function to maintain CBS due to a decrease in the ability to form ammonia and a lower excretion of hydrogen ions by the cells of the renal tubules; violation of acid-ammoniogenesis reflects the function of the distal tubule of the kidneys; determination of the content of beta _2- microglobulin in the urine. A significant increase is noted with a primary lesion of the proximal tubules of the kidneys. The norm of beta _2- microglobulin in the urine is from 135 to 174 μg / l. In patients with pyelonephritis, there was an increase in its level of 3-5 or more times.

Diagnosis of acute pyelonephritis

[10], [11], [12], [13], [14], [15]

Treatment of acute pyelonephritis

Mode - bed rest in an acute period (intoxication, fever), "warmth of the bed" creates conditions for improving blood circulation in the kidneys and increasing diuresis, reducing the pain syndrome. Half-bed mode is maintained for a period of pronounced activity of the microbial-inflammatory process.

The diet for acute pyelonephritis for 7-10 days is dairy-vegetable. Food should contain in optimal amounts and proportions all essential amino acids, preferably of egg or milk origin. The diet should include fresh fruits and vegetables to maintain the vitamin and electrolyte balance. Patients do not limit the amount of fluid intake and table salt. Restriction of products containing excess sodium is carried out. Salted, fried dishes, marinades, canned products are excluded.

How is acute pyelonephritis treated?