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.

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 loosening the waist in the area of the projection of the kidneys.

Urine is often turbid, with an unpleasant odor. Characterized by neutrophilic leukocyturia, bacteriuria, a large number of renal epithelium. Sometimes proteinuria is possible (up to 1%), microhematuria. Daily diuresis is slightly increased. The relative density of urine is normal or decreased. Cylindrarium in most patients is absent.

Diuresis is often increased, there may be imperative ("empty") desires, pollakiuria, nocturia, enuresis. Extra-genital manifestations are uncharacteristic: there is usually no edema in patients, blood pressure is normal.

Signs of intoxication (fever with chills, headache, lethargy, weakness, poor appetite, pallor with a slight icteric shade, etc.) often dominate the clinical picture of the disease. In the blood there is leukocytosis, neutrophilia with a leftward shift, increased ESR. Dysuric phenomena can be expressed bluntly. Sometimes the clinical picture in young children resembles sepsis.

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

Newborns often have bacteremia, septicemia, manifested by fever, pallor of the skin with a sub-bacterial tinge (may be jaundice), vomiting, convulsions, drowsiness, increased irritability. Usually there is diarrhea, a small increase in body weight. Characteristic acidosis, electrolyte disorders in the blood.

Acute pyelonephritis in infants and young children is manifested by an increase in body temperature, which is a constant symptom. Characterized by the so-called "temperature candles", when the body temperature to 38-39 ° C lasts for several hours, then decreases and after a certain period of time rises again. The patient has anorexia, regurgitation and vomiting, weight loss. Characteristic lethargy, urination and urination disorders, as well as often intestinal toxemia and exsicosis. In severe acute pyelonephritis, clonic-tonic convulsions and frequent vomiting-the phenomenon of meningism-can occur. When examining the child, attention is drawn to pallor with a sub-type skin tone, shadows under the eyes.

In older children, acute pyelonephritis has a triad of symptoms: fever, low back pain or abdominal pain, impaired urination. At an objective inspection pale, blue around of eyes, a positive symptom of effleurage in the field of a loin are characteristic also. Appetite impairment is noted. It is necessary to find out the nature of urination: a decrease or increase in the rhythm of urination, the presence of frequent urges, straining with urination, lengthening of the act of urination, and urinary incontinence. It is important to assess the nature of the urinary stream (leanness, intermittency). Mandatory study of the genitals, measurement of blood pressure.

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

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

Bladder and ureter reflux is an anomaly in the development of vesicoureteral anastomosis, leading to a retrograde current of urine from the lower to the upper sections of the urinary tract. The processes of dysembryogenesis of renal tissue are the basis of the development of reflux.

There are the following five degrees of vesicoureteral reflux:

• I degree - radiopaque substance enters only the ureter.
• II degree - the contrast reaches the pelvis and calyces, the latter are not expanded and the configuration of the papillae is not changed.
• III degree - there is a slight or moderate dilatation and (or) tortuosity of the ureter, a slight or moderate dilatation of the pelvis with a slight flattening of the papillae.
• IV degree - there is moderate dilatation and (or) tortuosity of the ureter, dilatation of the pelvis and calyxes, most papillae flattened, the corners of the calyx arches approach the right angle.
• V degree - there is a significant dilatation and tortuosity of the ureter, a pronounced enlargement of the pelvis, the cups acquire a "mushroom" (kolbovidnuyu) form.

Pyelonephritis in the background of a 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 hypotension of the urinary tract - a rare urination, straining. In case of pyelonephritis against the background of metabolic disturbances, the family history of family metabolism, the child's early manifestations of atopic dermatitis, abdominal pain, a decrease in urine volume and a decrease in the rhythm of urination (sometimes refusal to urinate), in urine sediment along with leukocyturia and a small short-term erythrocyturia. Against the background of metabolic disturbances, a high relative density and the presence of oxalate, urate or phosphate salts are noted in urine tests. Sediment against the background of the pot for urine has a whitish or rusty hue.

For pyelonephritis against the background of renal dysplasia, the "variegation" of the urinary syndrome is typical, with the predominance of leukocyturia and erythrocyturia in some urine studies, along with leucocyturia.

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

With pyelonephritis with Pseudomonas aeruginosa, "temperature candles", pronounced intoxication, activity indices of the process, leukocyturia and significantly increased ESR are possible.

Enterococci have a pronounced tropism for the kidney tissue and pyelonephritis acquires a sluggish, stubborn flow.

With staphylococcal infection there is a severe course of pyelonephritis with severe intoxication, often septic.

[1], [2], [3], [4], [5], [6]