How does the infection get to the kidney?
In the vast majority of cases, bacteria rise upward: from the perineum to the urethra, then to the bladder and along the ureter to the kidney. This is facilitated by vesicoureteral reflux - the backflow of urine during urination, which occurs in a significant proportion of children with repeated infections. In newborns, germs can be carried through the bloodstream. Additional factors are abnormalities in the development of the urinary tract, which impede the outflow of urine, constipation and the habit of enduring for a long time, due to which urine stagnates in the bladder.
- Ascending spread from the bladder
- Vesicoureteral reflux
- Anomalies of the urinary tract
- Hydronephrosis and urinary obstruction
- Constipation and infrequent urination
- Transmission of infection through the blood of newborns
Symptoms by age
In children of the first two years of life, pyelonephritis often manifests itself only as a fever: there is no runny nose, cough, or rash, but the child is lethargic, refuses to eat, spits up or vomits, and does not gain weight well. Jaundice sometimes occurs in newborns. For preschoolers and schoolchildren, the picture is clearer: fever with chills, pain in the lower back or side, abdominal pain, and sometimes painful urination. The urine becomes cloudy and has a pungent odor. The combination of high temperature with changes in urine analysis is a reason to suspect pyelonephritis, and not cystitis.
- High temperature without catarrhal symptoms
- Lethargy, refusal to eat, vomiting in babies
- Lower back and abdominal pain in older children
- Cloudy urine with a strong odor
- Poor weight gain in infants
- Sometimes - frequent painful urination
Survey
A urine test collected according to the rules shows leukocytes and bacteria. A urine culture taken before starting antibiotics determines the pathogen and its sensitivity. White blood cells, ESR and C-reactive protein increase in the blood - these indicators help distinguish kidney damage from cystitis. Ultrasound of the kidneys and bladder is performed in all children: it reveals anomalies, dilation of the pelvis and focal changes. For repeated episodes and in young children, voiding cystography and radioisotope testing are prescribed to detect reflux and scars.
- General urine test and culture before antibiotics
- Complete blood count, ESR, C-reactive protein
- Creatinine and blood urea
- Ultrasound of the kidneys and bladder
- Void cystography for relapses
- Radioisotope study of the kidneys
Treatment
Antibacterial therapy is started immediately after taking the culture, without waiting for the result, and then adjusted according to sensitivity. Children in the first months of life, as well as in severe condition, vomiting and dehydration, are hospitalized and treated intravenously, then switched to oral administration. The total duration of the course is usually from 7 to 14 days, and it cannot be interrupted. Adequate drinking, age-appropriate antipyretics, and regular bladder emptying are important. After recovery, the urine test is repeated, and further observation is prescribed by the doctor.
- Early initiation of antibiotic therapy
- Hospitalization of young children and in severe cases
- Course 7–14 days with correction for culture
- Adequate fluid intake and antipyretics according to age
- Control urine test after treatment
- Observation of a pediatric urologist for detected anomalies
Prevention of recurrent episodes
The main thing is to eliminate the factors that cause urine to stagnate. The child is taught to urinate every 2–3 hours and not to tolerate it, is provided with sufficient fluids, and constipation is always treated. Girls are taught to dry themselves from front to back, choose cotton underwear, and avoid long baths with foam. If vesicoureteral reflux is confirmed, the doctor may prescribe long-term prophylactic use of an antibiotic in a small dose, and in case of severe degrees and repeated pyelonephritis, surgical correction is discussed.
- Regular urination every 2–3 hours
- Sufficient drinking regime
- Active treatment of constipation
- Proper hygiene and cotton underwear
- Preventive therapy for reflux as prescribed by a doctor
- Surgical correction for severe reflux
