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, the 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 kidney projection.

Urine is often cloudy, with an unpleasant odor. Neutrophilic leukocyturia, bacteriuria, and a large amount of renal epithelium are characteristic. Proteinuria (up to 1%) and microhematuria are sometimes possible. Daily diuresis is slightly increased. The relative density of urine is normal or decreased. Cylindruria is absent in most patients.

Diuresis is often increased, imperative ("empty") urges, pollakiuria, nocturia, enuresis are possible. Extrarenal manifestations are uncharacteristic: patients usually do not have edema, arterial pressure is normal.

Signs of intoxication (fever with chills, headache, lethargy, weakness, poor appetite, pallor with a slight icteric tint, etc.) often dominate the clinical picture of the disease. Leukocytosis, neutrophilia with a shift to the left, and increased ESR are detected in the blood. Dysuric phenomena may be mildly expressed. Sometimes the clinical picture in young children resembles sepsis.

Often, pyelonephritis is clinically asymptomatic, with minimal changes in the urine.

Newborns often have bacteremia and septicemia, which are manifested by fever, pale skin with a subicteric tint (may be jaundice), vomiting, convulsions, drowsiness, and increased irritability. Diarrhea and low weight gain are usually observed. Acidosis and electrolyte disturbances in the blood are characteristic.

Acute pyelonephritis in infants and young children is manifested by an increase in body temperature, which is a constant symptom. The so-called "temperature candles" are characteristic, when the body temperature is up to 38-39 ° C for several hours, then decreases and after some time increases again. The patient has anorexia, regurgitation and vomiting, weight loss. Lethargy, impaired urination and urine output are characteristic, as well as often intestinal toxicosis and exicosis. In severe cases of acute pyelonephritis, clonic-tonic convulsions and frequent vomiting may occur - phenomena of meningism. When examining a child, attention is drawn to pallor with a subicteric shade of the skin, shadows under the eyes.

In older children, acute pyelonephritis has a triad of symptoms: fever, pain in the lower back or abdomen, and difficulty urinating. An objective examination also reveals pallor, blueness around the eyes, and a positive tapping symptom in the lower back. Decreased appetite is noted. It is necessary to determine the nature of urination: slower or faster urination, frequent urges, straining during urination, prolonged urination, daytime urinary incontinence. It is important to assess the nature of the urinary stream (poor, intermittent). An examination of the genitals and measurement of blood pressure are mandatory.

The clinical picture of pyelonephritis also depends on the nature of the functional disorders of the urinary system in the sick child.

Pyelonephritis against the background of reflux is manifested by pollakiuria, imperative urges and urinary incontinence; there may be a two-stage emptying of the bladder, delayed urination. There may be recurrent pain in the abdomen or in the projection area of one of the kidneys during urination.

Vesicoureteral reflux is an anomaly in the development of the vesicoureteral junction, leading to retrograde urine flow from the lower to the upper sections of the urinary tract. The development of reflux is based on the processes of renal tissue dysembryogenesis.

There are five degrees of vesicoureteral reflux:

• Grade I - the radiopaque substance enters only the ureter.
• Grade II - the contrast reaches the renal pelvis and calyces, the latter are not dilated and the configuration of the papillae is not changed.
• Grade III - there is slight or moderate dilation and/or tortuosity of the ureter, slight or moderate dilation of the renal pelvis with slight flattening of the papillae.
• Grade IV - there is moderate dilation and/or tortuosity of the ureter, dilation of the renal pelvis and calyces, most of the papillae are flattened, the angles of the fornices of the calyces approach a right angle.
• Grade V - there is significant dilation and tortuosity of the ureter, pronounced expansion of the renal pelvis, the calyces acquire a “mushroom-shaped” (flask-shaped) shape.

Pyelonephritis against the background of neurogenic bladder is characterized by imperative urges, the appearance of residual urine and intermittent urination, small portions of urine or pollakiuria, enuresis.

Against the background of urinary tract hypotension - rare urination, straining. In pyelonephritis against the background of metabolic disorders - a family history of metabolic pathology, the child has early manifestations of atopic dermatitis, abdominal pain, decreased urine volume and slower urination rhythm (sometimes refusal to urinate), in the urine sediment along with leukocyturia and slight short-term erythrocyturia. Against the background of metabolic disorders, when examining urine, a high relative density and the presence of oxalate, urate or phosphate salts are noted. The sediment against the background of the urine pot has a whitish or reddish tint.

Pyelonephritis against the background of renal dysplasia is characterized by a “variegated” urinary syndrome with a predominance in individual urine studies of either leukocyturia or erythrocyturia along with leukocyturia.

Pyelonephritis with Proteus vulgaris seeding is accompanied by an increase in body temperature, there may be minor symptoms of intoxication in the acute period of the disease. This is a stone-forming microbe.

With pyelonephritis with Pseudomonas aeruginosa, “temperature candles”, severe intoxication, indicators of process activity, leukocyturia and a significantly increased ESR are possible.

Enterococci have a pronounced tropism for renal tissue and pyelonephritis takes on a sluggish, persistent course.

Staphylococcal infection is characterized by a severe course of pyelonephritis with severe intoxication, often septic.

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