What causes acute pyelonephritis?

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.

Factors predisposing to pyelonephritis:

• The presence of kidney disease in the family, especially the mother.
• Toxicosis of pregnant women.
• Infectious diseases of the mother during pregnancy, especially acute pyelonephritis or exacerbation of chronic.
• Intrauterine infection of the fetus.
• Congenital fetal hypotrophy, ZVUR and ischemic-hypoxic conditions of the central nervous system, kidneys.
• Immunodeficiency conditions.
• Frequent ARVI.
• Diseases of the gastrointestinal tract, both acute and chronic.
• Habitual constipation.
• Dystrophy and rickets.
• Atopic dermatitis.
• Diseases of external genital organs.
• Glistovye infestations.
• Chronic foci of infection.
• Diabetes.
• Environmental factors.
• Genetic factors.

Pyelonephritis develops in the presence of three conditions:

1. Infection.
2. Violation of urodynamics, predisposing to infection.
3. Decrease in resistance of the body and decrease of local protective renal factors.

Factors predisposing to the violation of urodynamics:

1. Anomalies of urinary tract and kidney development.
2. Bubble and ureter reflux.
3. Infringement of passableness of a ureter - compression by an additional vessel of a kidney.
4. Bend of the ureter in case of a disturbance in the normal position of the kidney (nephroptosis or rotation, dystopia).
5. Neurogenic dysfunction of the bladder.
6. Functional disorders of the ureter (spasms, hypotension).
7. Kidney dysplasia.
8. Dismetabolic disorders of purine metabolism with excess uric acid formation, oxaluria, hypercalciuria.
9. Formation of a combined pathology of the urinary and spine organs (spina bifida, scoliosis).

In recent years, the role of E. Coli in the violation of urodynamics has been established. The endotoxin component of E. Coli lipid A enhances the attachment of bacteria to the receptors of the urinary tract epithelium and through the prostaglandin system affects smooth muscle, causing functional obstruction and increased pressure in the urinary tract. In this case, the pressure in the urinary tract can reach 35 mm Hg. Which is comparable with the pressure for vesicourethral reflux.

The most common pathogens of pyelonephritis are uropathogenic strains of E. Coli (in 70%). The second place in the etiology in children is taken by proteus (3%), especially in young children and with intestinal dysbiocenosis. Proteus is a stone-forming microbe. It uses urease to break down urea to ammonia, which raises urine pH, increases damage to epithelial cells, and precipitates calcium and magnesium salts. With simultaneous inflammation and in the bladder, enterobacter is sown. In recent years, the role of mycoplasma in the etiology of pyelonephritis has increased (up to 17%), especially in children with intrauterine infections and with infection in childbirth, and often with amygrobic pyelonephritis and persistent long-term relapses. The role of chlamydia in infection in newborns in the birth canal and the persistence of chlamydia in children in the first year of life with amykrobic pyelonephritis and prolonged relapses of the disease have increased somewhat. The frequency of allocation of Klebsiella (12%) increased. Less often in the etiology of pyelonephritis are streptococcus, staphylococcus (3%), enterobacter (5%), as well as persistent latent enterovirus infection in intrauterine infection and in pyelonephritis in early childhood.

The path of infection in newborn infants and in infants is often hematogenous in the presence of foci of infection. They also have a lymphogenous pathway - with acute gastrointestinal infections, habitual constipation, with dysbiocenosis of the intestine. In children of other age periods, the urinogenic pathway of infection prevails.