How long to treat a genitourinary infection in a child. Signs of genitourinary tract infection in children. Diseases of the urinary system

Urinary tract infection (UTI)- this is a generic name inflammatory diseases urinary system. The concept includes urethritis,. UTI ranks second in incidence after inflammation of the respiratory system. IN childhood this pathology is also common, but its diagnosis is difficult due to the inability to make complaints and frequent disguise as other diseases (ARI,).

information During the first year of life, boys suffer from inflammation of the urinary system more often, which is associated with the presence of congenital anomalies, and after a year the ratio changes 6:1 towards an increase in this pathology among girls.

This is explained by the fact that anatomically the female urethra is located closer to anus, hence, pathogenic microflora It is easier for their intestines to enter the urethra and then into the urinary system.

Classification

UTIs can be divided into infections based on localization:

• upper sections ();
• lower sections(and urethritis).

According to the duration of the disease:

• acute(less than 3 months);
• chronic(more than 3 months).

According to the presence of complications:

• uncomplicated;
• complicated.

Causes of infection and risk factors

The direct cause of inflammation in the urinary system is bacteria. The most common pathogens are:

• coli;
• proteas;
• Klebsiella;
• pseudomonas;
• enterococci and others.

information However, for the development of the disease, the presence of bacteria is not enough; a combination of risk factors, the predisposition of the person himself, and a decrease in immune defense are necessary.

To the main risk factors in children include:

• complicated course of pregnancy in the mother (chronic pyelonephritis, gestosis, occupational hazards in the mother during pregnancy, hereditary history and others);
• decreased general and local immunity;
• malformations of the urinary system;
• violation of the outflow of urine (presence of stones, developmental anomalies, vesicoureteral-renal reflux);
• metabolic diseases () and others.

Symptoms of UTI in children

For infection in the lower sections pain syndrome comes to the fore. Older children complain of pain when urinating, frequent urination, discomfort in the stomach, above the pubis. General symptoms may also occur:

• weakness, lethargy;
• temperature increase;
• decreased appetite.

For acute pyelonephritis the pain syndrome is less pronounced. Symptoms of intoxication come to the fore:

• lethargy, weakness, fatigue;
• sleep disturbance;
• increase in body temperature.

The pain syndrome is localized in the lumbar region. When it is severe, children can take a forced position (lying on their side with their legs brought to the body), when it is weak, pain is felt when touching the lower back.

Chronic pyelonephritis More often it manifests itself as a periodic rise in temperature, pain in the lower back. Children become irritable, lethargic, and get tired quickly. With a long course, a lag in physical and mental development is possible.

UTIs in children under one year of age manifest as intoxication syndrome. It can often be disguised as other diseases (ARI, intestinal colic, ). The child becomes restless and capricious.

Diagnosis of urinary tract infection in children

For older children, the main criteria for diagnosing UTIs are the complaints presented.

important Babies have inflammation urinary system most often diagnosed by the presence indirect signs(fever, crying or visible discomfort when urinating, vomiting, diarrhea and others).

Basic diagnostic methods:

1. – the simplest and most informative. During the inflammatory process, leukocytes appear in the urine, possibly the presence of protein and bacteria.
2. Urine culture followed by determination of the pathogen and its sensitivity to antibiotics- more informative, but requires some time and money. It makes it possible not only to accurately determine the cause of inflammation, but also helps to more accurately select treatment.
3. Urinalysis according to Nechiporenko - another test to detect inflammation in the urinary tract. With its help, you can more accurately (compared to a general urine test) estimate the number of red blood cells in 1 ml of urine.
4. Ultrasound of the kidneys and pelvic system– the most commonly used instrumental method in children. If the pyelocaliceal system is dilated, this indicates pyelonephritis.

Treatment

Treatment for UTIs should begin as soon as the diagnosis is confirmed. The main treatment is antibiotic therapy. Important role also has a diet regimen.

Drug therapy

For the first episode of uncomplicated infection Most often, antibiotics from the group of protected penicillins are prescribed in the form of tablets, suspensions, capsules, syrup or 2-3 generation cephalosporins, also in oral form. Most common medications:

• Augmentin;
• Amoxiclav;
• Cefix;
• Cefaclor;
• Cefuroxime.

The duration of therapy for infections of the lower sections is 5 days, and for pyelonephritis it increases to 10.

Good effect have uroantiseptics (Furamag, Furagin and others).

For chronic UTI can be prescribed for a long time herbal preparations, having anti-inflammatory, diuretic, antibacterial effects, such as Canephron and phytolysin ointment.

dangerous Chronic pyelonephritis requires longer and more serious treatment. In some cases, it should be carried out in a hospital (severe form, severe intoxication syndrome, early childhood).

Diet and regimen

Diet and drinking regime allows you to speed up the healing process and prevent new episodes of infection:

• Sour, fried, spicy, salty foods should be excluded.
• It is important to drink plenty of fluids. This helps flush out the infection from the urinary system and prevents bacteria from lingering and multiplying. Fruit drinks made from cranberries, lingonberries, kidney teas, decoctions medicinal herbs(chamomile, birch, St. John's wort and others).

Preventing urinary tract infections in children

Basic principles of UTI prevention:

• Explain to your child that holding back (tolerating) urination is harmful. This creates a favorable background for the proliferation of bacteria.
• If the child already goes to the toilet and serves himself, explain how to wipe his butt correctly and monitor this action.
• If the child is still small, change the diaper in a timely manner and wash the bottom correctly (from front to back).
• Dress your child according to the weather, especially pay attention to the crotch area, lower back and legs.
• Make sure that your baby does not sit in a cold place, even in hot weather.
• Your child needs to drink enough throughout the day. Be it just drinking water or juices, compotes and fruit drinks.
• If a child suffers from a chronic infection of the urinary system, then it is necessary to periodically take preventive courses of uroantiseptics.
• It is necessary to take regular tests, since UTIs (especially the upper sections and chronic forms) can occur without obvious signs.

Diseases of the urinary organs in children are a widespread and, due to their tendency to be asymptomatic, an insidious problem. Scanty symptoms characteristic of kidney damage, Bladder and urethra, often leads to late diagnosis diseases, after their transition to a chronic form or to the stage of development of complications. Avoiding this problem, however, is quite simple: just attentive attitude parents to the health of their child and regular monitoring of general urine analysis indicators.

Among the diseases of the urinary system, the most “popular” in childhood are pyelonephritis, glomerulonephritis, cystitis, urinary diathesis and nephroptosis (prolapse of the kidneys). Let's figure out in what situations the risk of developing these diseases increases greatly, and what signs and symptoms parents need to pay attention to first.

Cystitis(inflammation of the bladder) is a deceptively “harmless” disease, the symptoms of which are quite easily relieved antibacterial drugs and also easily return if the disease has not been completely cured. Cystitis can occur in children of any age; frequently ill children and girls during puberty are especially predisposed to it. The infection may enter the bladder upward path from the inflamed urethra, or can be carried with blood from foci of chronic infection - carious teeth, untreated tonsils and adenoids, diseased ears and sinuses. Predispose to the development of cystitis conditions that weaken the activity of the immune system, such as hypothermia, malnutrition, hypovitaminosis, stress, taking certain medicines(antitumor drugs, hormonal drugs).

The main symptoms of cystitis include general malaise, nagging pain lower abdomen, slight increase body temperature (usually up to 38 °C), weakness. A characteristic sign of cystitis is rapid, often painful urination- sometimes the child urinates up to 15 times a day. Appearance urine in cystitis can be very diverse - the urine can be cloudy (due to the admixture of pus), red (due to the admixture of blood) or, in appearance, completely normal.

The main research methods that confirm the diagnosis of cystitis are a general urinalysis, a Nechiporenko urine test, and an ultrasound of the bladder. In some cases (with persistently recurrent cystitis), a urine culture with an antibiogram is prescribed.

Cystitis responds well to treatment with antibiotics and herbal remedies - the main thing is to maintain the medication regimen prescribed by the doctor and not stop treatment prematurely. An important point treatment is compliance with the drinking regime, as well as monitoring that the child’s legs and Bottom part the torsos were always warm.

Urethritis(inflammation of the urethra, urethra). The reasons for the development of the disease are the same as for cystitis. Urethritis most often affects girls, especially teenage girls. Sometimes, under the guise of urethritis, sexually transmitted diseases occur, “received” by a young girl as a result of the first unprotected sex with a sick partner. Therefore, special attention should be paid to the appearance of symptoms of urethritis in young girls.

Typical manifestations of urethritis are pain and cutting along the urethra when urinating. Urination is usually frequent, urine is released in small portions. Discomfort associated with urine loss contributes to sleep disturbances, appetite disturbances, and general anxiety. Possible increase in body temperature, general weakness and malaise. Both urethritis and cystitis are dangerous due to the possibility of spreading inflammatory process on the kidneys, which can only be prevented with timely diagnosis and treatment. The diagnosis of urethritis is made based on the results of a general urinalysis and Nechiporenko urine analysis. Sometimes urine culture is performed and smears from the urethra are examined. To treat urethritis, drugs from the group of uroseptics are used - they are excreted in the urine and provide a disinfecting and anti-inflammatory effect on the walls of the urethra.

Pyelonephritis(inflammation of the renal collecting system). The cause of the development of pyelonephritis is an infection introduced from outside or its own opportunistic microflora organism, activated as a result lack of activity immunity and other circumstances favorable to microbes. The development of pyelonephritis is facilitated by the presence of urolithiasis in a child and abnormalities in the structure of the kidneys.

A child with pyelonephritis complains of pain of varying intensity in the lumbar region, sometimes abdominal pain, an increase in body temperature, accompanied by signs of intoxication (weakness, headache, sleep disturbance, appetite, etc.). The appearance of the urine either remains unchanged or the urine becomes cloudy. Pyelonephritis can be unilateral and bilateral, acute and chronic. During an acute process, the symptoms of the disease and complaints are more pronounced than during an exacerbation chronic pyelonephritis. Sometimes pyelonephritis is practically asymptomatic - this form of the disease can only be identified by a timely general urine test. Long-term untreated pyelonephritis leads to severe kidney damage, the development of renal failure, and difficult to control arterial hypertension. The diagnosis is made based on the results of a general blood and urine test, urine tests according to Nechiporenko and Zimnitsky, ultrasound of the kidneys and bladder, and urine culture. Sometimes carried out biochemical analysis blood, urography. Timely diagnosed pyelonephritis responds well to treatment with uroseptics, antibiotics, and herbal preparations. For cupping pain symptom and to facilitate the outflow of urine, antispasmodics are prescribed. Be sure to follow the drinking regime and prevent hypothermia.

Glomerulonephritis- This bilateral disease with defeat glomerular apparatus kidney The development of glomerulonephritis is based on an infectious process, which is initially localized in chronic foci– diseased tonsils, adenoids, inflamed paranasal sinuses, untreated teeth, gradually disrupts the functioning of the immune system and, ultimately, affects the kidneys. Very often, glomerulonephritis becomes a complication of tonsillitis or scarlet fever (develops around the 3rd week of the disease), since these diseases are associated with pathogenic streptococcus, which “really loves” kidney tissue. Typical symptoms glomerulonephritis are swelling (mainly on the face, more pronounced in the morning), increased blood pressure, changes in urine (urine takes on the color of “meat slop”, that is, it becomes red-brown, cloudy). The child complains of headache and nausea. Sometimes there is a decrease in the amount of urine discharge. Glomerulonephritis can have two course options: acute, which ends full recovery, or chronic, which after a few years leads to severe renal dysfunction and the development of renal failure.

Diagnosis of glomerulonephritis is based on studying the results of a general analysis of urine and blood, urine tests according to Nechiporenko, according to Zimnitsky, and a biochemical blood test. Renal ultrasound provides valuable information during diagnosis. chronic glomerulonephritis Sometimes a kidney biopsy is performed followed by histological examination received fabrics.

Therapy for glomerulonephritis includes a diet with limited intake of protein foods; drugs that improve renal blood flow, antihypertensives, diuretics, immunomodulators. In severe cases, hemodialysis is performed (hardware purification of the blood from metabolic products that diseased kidneys cannot remove).

Therapy for glomerulonephritis is a long process that begins in a hospital and then is carried out for a long time at home. The key to success in this situation will be strict adherence to all doctor’s recommendations regarding diet, drinking regimen, taking medications, and regular visits. pediatric nephrologist and taking blood and urine tests for follow-up.

Urolithiasis disease- a disease characterized by the formation of calculi (stones) of various composition, shape and size in the kidneys, and less often in the bladder. The disease is based on metabolic disorders minerals, which is on early stages diseases (before the formation kidney stones) also called uric acid diathesis. Increased content Some salts in the urine lead to their precipitation, crystallization with the formation of sand and stones. Stones, injuring the urinary tract, contribute to the development of inflammation, which, in turn, supports stone formation. For a long time the disease is asymptomatic and can only be suspected by the presence of a large number of salt crystals found during general analysis urine, or accidentally discovered during ultrasound internal organs. Often the first manifestation of urolithiasis is an attack of renal colic, caused by the movement of stones through the urinary tract. Renal colic manifests itself sudden occurrence intense pain in the lower back and lower abdomen, difficulty urinating, and the appearance of blood in the urine. Diagnosis of urolithiasis is based on the results of a general urine test, ultrasound of the kidneys and bladder; often additionally a general and biochemical blood test, Nechiporenko urine tests, urography, and radiography are prescribed. Treatment of urolithiasis involves adjusting the diet (according to the type of metabolic disorder), taking antispasmodics, and herbal preparations. In severe cases it is carried out surgical removal kidney stones.

Nephroptosis– this is the prolapse of the kidney or excessive mobility of the kidney ( wandering kidney). Nephroptosis develops due to weakening ligamentous apparatus kidneys and a decrease in the fat layer around it, which is often observed in children with an asthenic physique and poorly developed muscles of the anterior abdominal wall. Nephroptosis is often diagnosed in teenage girls who follow strict diets. Nephroptosis is mostly asymptomatic, the appearance of signs of the disease (pain and heaviness in the lower back during prolonged standing, the appearance of blood in the urine, increased arterial pressure) is usually associated with kinking of the ureter and vascular tension caused by relocation of the kidney. The course of the disease is influenced by the degree of kidney prolapse, which is determined using ultrasound or radiographic methods. Treatment of nephroptosis I-II degrees– conservative, consists of normalizing body weight (using a specially selected diet) and performing special physical exercise, strengthening the muscles of the back and abdomen. In some cases, wearing a bandage is indicated. With severe kidney mobility or nephroptosis III degree Surgical treatment may be necessary.

General urine analysis

Since a general urinalysis is a fundamental study in urology and nephrology, we will briefly discuss the interpretation of some of its results.

Urine color and clarity. Normally, the light of urine ranges from colorless (in newborns) to amber and straw-colored. Urine should be clear and free of impurities. Pathological is the coloring of urine in various shades of red, cloudiness and Brown color urine.

Urine smell. Urine should not have strong smell. The smell of urine is most often caused by acetone, a substance that appears in the urine during acetone syndrome.

Relative density(specific gravity) of urine - the norm for a newborn is 1008-1018, for children aged 2-3 years - 1010-1017, and for children over 4 years old - 1012-1020. An increase in urine density indicates the presence of protein and/or glucose in it, or dehydration. Decline relative density observed in inflammatory processes in the kidneys, with severe impairment of renal function.

Protein normally absent in urine (or does not exceed 0.002 g/l). The appearance of protein in the urine (proteinuria) is observed with glomerulonephritis, kidney damage due to diabetes mellitus and other severe kidney diseases.

Glucose normally absent in urine (or does not exceed 0.8 mol/l). The appearance of glucose in the urine may indicate the presence of diabetes mellitus or other endocrine diseases.

Ketone bodies or acetone– normally absent or found in minimal quantities in urine. Level up ketone bodies possible during acute viral infections, after overwork. High levels of acetone are characteristic of acetone syndrome.

Bilirubin Normally it is not detected in urine. Appearance and high values bilirubin levels are observed in diseases of the liver and gall bladder.

Red blood cells in urine healthy child present in the amount of 0-2 red blood cells in the field of view. The appearance of a large number of red blood cells is characteristic of inflammatory processes in the urethra, bladder, kidneys, urolithiasis, and glomerulonephritis.

Leukocytes- normally, up to 5 leukocytes per field of view can be present in urine. Increased quantity leukocytes is a symptom of inflammation of the kidneys and urinary organs.

Epithelium may be present in small quantity. An increased number of epithelial cells is characteristic of infectious diseases urinary tract.

Cylinders Normally, they are absent in the child’s urine. Most often, the appearance of cylinders indicates the presence of kidney disease.

Bacteria are normally absent in urine. The appearance of bacteria is either a symptom of an inflammatory process or a sign of transient asymptomatic bacteriuria (infection without inflammation).

Crystals and salts are normally found in small quantities and indicate an acidic or alkaline reaction in the urine. An increased amount of salts may be evidence of uric acid diathesis or urolithiasis.

Finally

As already mentioned, a general urine test performed with for preventive purposes, can protect the child from troubles associated with advanced diseases kidneys, bladder or urethra. The child must undergo such an examination annually - his parents should closely monitor this. Take care of your health!

Inflammation of the urinary tract in children, the symptoms of which may vary, depending on the organs affected by the pathological process, is a fairly common occurrence. Suffice it to say that according to statistics, 2% of boys before they reach the age of five and 8% of girls experience one or another pathology.

In infants the the immune system, this is the reason why all sorts of infectious processes can develop, including inflammation of the bladder. And such diseases are many times more severe than in adults. Their manifestation is usually pronounced, there are symptoms of intoxication.

Causes

Among all pathogenic flora most often the cause of inflammation of the bladder is E. coli (it is detected by frequency in half of children with similar diseases, and according to some data this figure reaches 80%). Staphylococci, Klebsiella, Proteus or Enterococcus are found much less frequently. Acute processes, as a rule, can only be caused by one type of pathogen, but in the presence of sharply reduced immunity or a congenital anomaly of the urinary system, a polyvalent etiology is possible.

Often premature or severely weakened babies develop viral or fungal infection. However, the possibility of layering cannot be ruled out. bacterial infection The child has.

Predisposing factors for development of this disease are:

• violation of the structure and innervation of the bladder (neurogenic bladder, diverticulitis);
• vesicoureteral backflow;
• pyeelectasia;
• ureterocele;
• infectious pathology in the mother during pregnancy;
• synechia of the labia (girls);
• (boys).

A frequent occurrence of the disease is caused by abnormalities in the functioning of the intestines or stomach - disruption of the flora, constipation, colitis. With metabolic pathologies, problems with the kidneys or bladder are also possible.

The infection has the ability to penetrate hematogenously or lymphogenously, if the rules are violated hygiene care for the baby, after catheterization of the bladder.

Types of diseases

Diseases of the urinary system in children can be divided according to the localization of the process:

1. Diseases of the upper sections. These include or pyelitis.
2. Average – .
3. Lower –, urethritis.

The first episode of the disease and the repeated or recurrent episode are also distinguished. In the second case, the cause of the child is untreated acute pathology or reinfection.

Symptoms

Signs of the disease depend on many conditions. This is the degree of severity, localization of the process, the state of the baby’s immunity, the type of infection. Most often, doctors have to deal with pyelonephritis, inflammation of the bladder, etc.

Pyelonephritis

Inflammation of the kidneys, or pyelonephritis, in children most often occurs with a very high temperature. In this case, all signs of intoxication are observed - lethargy, pallor, headache, loss of appetite or complete failure from food. At high temperatures, the baby develops diarrhea and vomiting, and in the smallest children meningeal symptoms are noted. This disease can lead to the development of chronic renal failure.

The child suffers from pain in the abdomen or in the lumbar area; when the back is patted in the area of ​​​​the projection of the kidneys, the pain intensifies (positive Pasternatsky's symptom).

Cystitis

The symptom of cystitis is that the baby walks “smallly” often and in small portions. At the same time, pain and pain are felt. A feeling arises incomplete emptying as a result of irritation of the mucous membrane of the bladder. Against this background, urinary incontinence often occurs.

In infants, due to severe inflammation, there is a lack of urination, or urine flows intermittent, while the child cries and kicks his legs. The temperature with this pathology rarely reaches high numbers.

This disease is more often observed in girls, and in itself does not pose any particular danger, although it causes a lot of suffering. In the absence of help, the infection can penetrate the kidneys through an ascending route, and leads to the development of pyelonephritis.

Bacteriuria

The appearance of bacteria in urine, without pronounced symptoms, can be detected only after laboratory testing. This variant develops much more often in girls.

Parents may miss this phenomenon because the baby does not complain. If you pay attention to the urine, it becomes cloudy and acquires bad smell.

Diagnostics

To correctly assess the condition of the urinary tract of a small patient, a consultation with a pediatrician is required with the assistance of pediatric urologist, a nephrologist, and sometimes a gynecologist.

First of all, pathology can be suspected after receiving data from the laboratory. In a general urine test there will be high quantity leukocytes, protein, bacteria, and sometimes red blood cells may appear. To clarify, the doctor recommends doing additional research– according to Zimnitsky and Nechiporenko.

If we consider abnormalities in the blood, then they will not be specific for this pathology, but signs of inflammation will confirm the assumption (leukocytosis, increase in ESR). Acute inflammation in a disease such as pyelonephritis can manifest itself in the appearance of alpha-gobulins and C-reactive protein.

When bacteria appear in the urine, a culture is done with it. This allows you to determine the cause of the inflammatory reaction and helps you choose the right antibiotic therapy. For some specific infections, a PCR test is performed.

From instrumental methods ultrasonic is used. This is a completely safe and highly informative way to confirm the diagnosis. If your child has frequent exacerbations inflammatory pathology kidneys, then it is carried out during remission excretory urography(using contrast agent). If damage is suspected, the doctor may recommend undergoing scintigraphy, which can be static or dynamic.

Problems with the lower parts of the urinary system are examined using endoscopy.

Giving help

Treatment depends on the stage of the disease, the localization of the pathological process, and the general condition of the baby. Age plays an important role, since many drugs antibacterial action may cause harm when used.

A diet with the exception of salty, hot, spicy and fried foods is also necessary. They can exacerbate inflammation processes. It is best to use lactic acid products in food and drink plenty of liquids (weak tea, decoctions of diuretic and anti-inflammatory herbs, fruit drinks, still mineral water). It is recommended to eat cereals cooked in milk and lean meat.

The main stages and principles of treating the disease involve the use of several groups of drugs.

Antibacterial treatment

Use of antibiotics. These tools should be used only after determining pathogenic microorganisms for sensitivity. If necessary quick help and the inability to wait for culture results, the doctor uses the empirical route and recommends an antibiotic that can have the broadest spectrum of action. If there is no improvement within three days, as determined by the clinical picture, then the treatment is reviewed.

Most often, protected penicillins, aminoglycosides, or cephalosporins are used in treatment. In addition, in case of severe inflammation in a child, uroantiseptics can be used.

The course of treatment should last at least one to two weeks. In order to talk about a positive result, the tests must be repeated and the result obtained.

Other drugs and methods

To relieve the process of inflammation of the urinary tract and alleviate the child’s condition, anti-inflammatory drugs (NSAIDs) should be taken.

In order to prevent sensitization of the body, which may occur due to the use of antibiotics, antihistamines are recommended.

After treatment, the child undergoes physiotherapeutic procedures to consolidate the results and prevent relapse.

Herbal medicine has a good effect. At this disease You can use baths with chamomile, calendula, sage and other anti-inflammatory herbs. It is recommended to drink lingonberry and cranberry juice.

Prevention

Prevention of infections and inflammations in a child should include the following points:

• maintaining hygiene;
• avoiding hypothermia;
• sanitization of foci of infection in the body, if any;
• adequate diet and fluid intake;
• if an episode of the disease occurs, anti-relapse treatment is recommended;
• if congenital anomalies are detected, consultation and registration with a nephrologist.

Forecast

The prognosis for this pathology depends on many factors. These include:

• timely treatment started;
• the presence of congenital abnormalities;
• the state of the baby's immunity;
• possibility of providing full assistance (drug tolerance).

In the absence of treatment and neglect of urinary tract inflammation, a child may develop an irreversible reaction with damage to the parenchymal tissue of the kidney and the development of failure. That's why the slightest manifestations problems with the urinary system require immediate contact with a specialist for examination and provision of qualified assistance.

Problems with the urinary system occur at any age. In children, these diseases are difficult to diagnose. Prevalence varies by gender and age. Girls suffer from the ages of 2 to 12 years, boys - most often in infancy. Treatment of urinary tract infections in children will be effective if you consult a specialist in a timely manner. It takes place in a hospital under the supervision of a therapist and urologist for 10-14 days.

Classification

Urology determines in children according to ICD-10, which is necessary to confirm the etiology, morphology, pathogenesis for each individual case. All infectious processes occurring in the organs of formation and excretion of urine are assigned ICD-10 codes from N00 to N99.

The localization of the inflammation process affects the type of disease. In the upper section, pyelitis and pyelonephritis develop - diseases of the kidneys and ureters. In the middle - urethritis, in the lower part - cystitis. The urethra and bladder are affected. What matters is the period of the disease, which differs in the initial form, repeated and relapse. The second occurs with untreated pathology.

Expressiveness clinical symptoms will help determine the severity of the current. The mild form is accompanied by a low temperature, which practically does not rise. The baby has slight dehydration. The severe form is manifested by sepsis, fever, and vomiting.

What are the symptoms of the disease?

Signs of a urinary tract infection in children begin with fever (in almost 90% of cases). If it is not there, pay attention to general state and additional characteristics. They differ depending on the age of the child, since infants cannot always show how they feel. They express pain by crying and kicking their legs. Most often noted:

• Poor appetite.
• Pain when urinating.
• Cloudy or bloody urine.
• Vomit.
• Irritability.

When inflammation of the organs in the upper part develops arterial hypertension, renal damage, scar formation occurs. Complicated urinary tract infections in children under one year of age occur with congenital anomalies, vesicoureteral reflux top level. Pyelonephritis in children can manifest itself as mild malaise, fatigue, and lethargy. This often happens in boys under 6 months and in girls under one year.

Urinary tract infection in 2-year-old children is characterized by sepsis. Pyelonephritis is considered when the temperature rises to 39 degrees. Feverish state lasts more than two days and other symptoms may not appear. Later, lower back pain is added on one or both sides. Less common concerns include diarrhea, vomiting, and abdominal pain.

With cystitis and urethritis, there is practically no fever, but pain and burning during urination and pressure in the abdomen are characteristic. The child goes to the toilet frequently. If urinary tract infections in children are not treated promptly, secondary enuresis develops by the age of three. Differential diagnosis will allow for early stage identify concomitant diseases: balanitis in boys and vulvitis in girls.

Clinical picture

Symptoms vary depending on the severity, location of inflammation, type of infection and the state of the baby’s immunity. They will indicate methods for choosing treatment and diagnosis. It is important to pay attention to the little things, as they will indicate not only the degree of the disease, but also the neglect of the health condition and related ailments.

What urinary tract infections can be identified in a 2 year old child? Pyelonephritis can occur in a child regardless of age. It is characterized by intoxication and high fever. First, appetite is disrupted, then the child completely refuses food. At this age, meningeal symptoms are noted. If you do not receive proper treatment in time, it develops chronic form renal failure.

Cystitis is a disease in which children often need to go to the toilet. They may empty their bladder every 10-15 minutes with a feeling of stinging and pain. Due to irritation of the mucous membrane, a feeling of incomplete emptying occurs, therefore urinary incontinence is noted. There is no urination, the temperature reaches 40 degrees. Occurs more often in girls. Untimely treatment leads to pyelonephritis.

Bacteriuria is a disease in which bacteria multiply in urine. They are identified only after laboratory research. Parents often miss urinary tract infections in children under one year old, since the baby does not complain. However, the urine becomes cloudy, has an unpleasant odor, and contains flakes, impurities, and blood.

Reasons for the development of inflammation

Diseases appear due to exposure to enterobacteria, including coli. Development is affected by mycoplasmosis and urogenital chlamydia. Among the causes of urinary tract infections in children are anemia and immunodeficiency. This includes disturbances in urodynamics:

• Pyeelectasia.
• Kidney dystopia.
• Bladder diverticulum.
• Polycystic disease.
• Urolithiasis disease.
• Infection of the mother during pregnancy.
• Ureterocoel.
• Synechia of the labia in girls.
• Phimosis in boys.

The presence of pathogenic serotypes in the body matters, insufficient output antibodies, ischemia, operations on the urinary system. Problems arise with dysbacteriosis, colitis, frequent constipation. Increase the risk of developing the disease metabolic disorders. It is necessary to monitor genital hygiene. Correct technique washing will prevent infection from entering the genitourinary tract.

Pathogenic flora includes E. coli, which is detected in 80% of children. In addition, the development of urinary tract infections in children is influenced by bacteria from the class of enterococci and staphylococci. Most often, the disease begins with a single pathogen. If immunity is reduced, there are congenital anomalies, several types of viruses take part in the process. In weak children, a layer of bacterial infection occurs due to the development of fungus.

A specific code for urinary tract infection in children in ICD-10 is necessary for planning diagnosis, selection preventive measures, to prescribe treatment. A complex approach will help troubleshoot problems. It includes a complete drug treatment, diet and hygiene.

Diagnostics definition of diseases

It is necessary to carry out a number of serious examinations. The severity and severity is determined using a blood test. It reflects the content of leukocytes and the level of acute-phase proteins. The basis is bacteriological culture of urine. It will be used to confirm the degree of bacteriuria and susceptibility to antibiotics.

Additionally, urine samples are prescribed for mycoplasma, ureplasma, and chlamydia. It is necessary to do an ultrasound of the kidneys, bladder, and blood vessels. The image shows abnormalities of the urinary system and impaired urine outflow. With frequent exacerbations, the child undergoes urography using a contrast agent during the period of remission. Static and dynamic scintigraphy will help confirm damage to the kidney parenchyma.

For urinary tract infections in children, it is provided by a pediatrician, nephrologist, urologist and gynecologist. Experts prescribe studies on Zimnitsky and Nechiporenko. In the blood, signs of inflammation are manifested by increased CO, leukocytosis, and alpha globulins. At specific infection take a PCR sample.

Methods for confirming infection

Problems encountered in lower section The urinary system is determined using endoscopy. Cystoscopy and ureteroscopy will help detect cystitis, urethritis, and abnormalities in the structure of the ureter. Anatomical changes are diagnosed in the form of such deviations:

• Doubled renal pyelocaliceal system.
• Underdevelopment of structures.
• Hypoplasia.
• Kidney aplasia, its absence.
• Enlargement of the renal pelvis.

Among the functional deviations is ureteral reflux with impaired urine outflow. Deviation leads to metabolic disorders in the kidneys. Children are admitted to a specialized urology department. Here, doctors use test strips to detect bacteria in urine within minutes. Leukocytes are detected using a similar esterase-sensitive test.

Treatment of diseases in children

Recommendations for urinary tract infections in children must be fully followed to achieve get well soon. Complex and individual treatment will be required. For cystitis, medications are taken at home if the mother strictly follows the doctor’s instructions.

Pyelonephritis can be treated in a hospital. Hospitalization is strongly recommended for infants under two years of age. Children are given infusion therapy and antibiotics are administered. For pain and fever, it is prescribed bed rest. The diet includes frequent eating in small portions. This will reduce the load on the mucous membranes and kidney tubules.

Drug therapy is necessary to treat urinary tract infections in children already at the initial stage. Antimicrobial agents have a wide spectrum of action. For cystitis, medications are taken for at least a week, for pyelonephritis - 10-14 days. If necessary, uroantiseptics are prescribed. To relieve pain you will need antispasmodics. A course of antibiotics is required, and then repeated tests are taken.

Among clinical recommendations urinary tract infections in children is a diet. Impaired kidney function suggests that it is necessary to reduce salt intake and limit the amount of fluid. It is recommended to consume protein and plant foods, dairy products. The diet should not contain fatty and fried foods, sour fruits. They irritate the mucous membrane. Kiwis, grapes, tomatoes, citrus fruits, pomegranates are not allowed.

Acute forms of diseases: what to do

Treatment of urinary tract infections in children in the form of acute pyelonephritis start as early as possible. This will avoid the risk of developing renal scarring. On the first day after UTI is identified, therapy is prescribed with bactericidal antibiotics. They are selected based on the received diagnostic results. Pay attention to the child's condition.

Fluoroquinols are practically not used in pediatrics, as the risk of damage to growing joints increases. The drugs are used to treat older children, but not as first choice. Five days are prescribed drugs that are administered subcutaneously or intramuscularly. After this, antibiotics are taken orally.

The initial phase of treatment is the most important, but vomiting is common in children. In this case, drugs such as Cefixime and Cefisox are prescribed. Numerous positive reviews for a urinary tract infection, the child received therapy with aminopenicillins or cephalosporins. You will need drugs with antipyretic and anti-inflammatory effects. This includes Nurofen, Paracetamol. Diazepam is given to prevent seizures.

During treatment it is necessary good rest. The baby should be kept warm, consume enough fluids, and should not feel thirsty. Drinking regularly will increase urine output. At this time, the release of inflammatory products occurs, limiting the spread of bacteria. Drinks and food should be warm. Recommended herbal teas, if the child agrees to drink them.

What to pay attention to during treatment

For the treatment of acute cystitis, the effectiveness of therapy is determined by testing the sensitivity of bacteria. Check your urine before prescribing antibiotics. In some cases, the use of chemotherapy will be necessary medicines. The duration of treatment depends on the severity and stage of the disease.

Children are prescribed medications for a period of up to 5 days. At this time there should not be a lot of outdoor games, more bed rest. The consumption of fruit drinks and mineral water without gas is allowed. Antihistamines are required to reduce negative impact on the intestines. Physiotherapeutic procedures will help consolidate the results and prevent relapse. Baths with chamomile, calendula and sage have worked well.

Prevention and prognosis of the disease

Some children are prone to urinary tract infections. The use of simple complexes will help minimize the risk of their development. Even infants need a drinking regime. The liquid will prevent constipation, which affects the development of bacteria. If complementary feeding has already begun, it is recommended to diversify your diet with vegetables and whole grains.

Doctors do not recommend stopping breastfeeding. Milk will protect the baby from infection. If it is possible to hold on natural feeding, the process should be continued as long as possible. Girls' genitals are not washed liquid soap. When changing diapers, use wet wipes. Good hygiene will help prevent the development of bacteria in your urine. However, it is important to contact specialists in a timely manner so that at the first suspicion of infection development, get tested and begin treatment.

It is difficult to predict the course of the disease. There are several factors influencing diseases of the urinary system:

• Congenital abnormalities.
• Baby's immunity.
• Drug tolerance.
• Providing full assistance.

Congenital anomalies indicate that an individual consultation with a nephrologist or urologist will be required. If the girl has already suffered from urinary tract inflammation, drugs from the nitrofuran group are indicated. Parents should take care of the health of their babies immediately after birth. Avoid hypothermia, change the diaper regularly, monitor urination, color and characteristics of urine. It is important to pay attention to your baby's complaints.

In young children, lesions in the urinary organs are especially dangerous. Untimely treatment can lead to damage to the parenchymal tissue of the kidney. In this case, an irreversible reaction develops with subsequent tissue damage. Diseases at an early stage can be treated, and constant adherence to the rules will avoid relapses and prevent the development chronic stage and complications.

Urinary tract infections (UTIs) occur in 18 children out of 1000. Statistics show that by the age of 7, 9% of girls and 2% of boys are diagnosed with at least one UTI. Let's consider the causes of development, symptoms, features of diagnosis and treatment of urinary tract infections in children.

Urinary tract infections in children are a microbial inflammatory disease of the urinary system without specifying a specific location. The diagnosis of “urinary tract infection” is especially valid in infants and early age due to the anatomical and physiological characteristics of the ureter (long and with a wide lumen, prone to kinks) and with the peculiarities of the immunological reactivity of the body, the consequence of which is the ease of spread of infection.

What factors contribute to the development of urinary tract infection in a child: causes of UTI

The urinary tract includes a complex of organs responsible for the formation and removal of urine from the body. These are the kidneys, ureters, bladder and urethra. UTIs are caused by the growth of bacteria in any part of the urinary system. Infection of the urinary tract is a consequence of the penetration of the pathogen through the bloodstream from other infected organs or a violation of the outflow of urine due to the abnormal location or pathological structure of the organs of the urinary system.

In childhood, the development of a urinary tract infection can be promoted by:

• Poor nutrition.
• Hypothermia.
• Gastrointestinal diseases.
• Weakness of the body (in premature babies).

The main factors for the occurrence of UTIs are :

• Problems with urodynamics in the form of obstructive uropathy, neurogenic bladder dysfunction, and the presence of vesicoureteral reflux.
• Exchange deviations in the form of hyperuraturia, nephrocalcinosis, hyperoxalaturia or urolithiasis.
• Operations on the urinary tract.
• Vascular changes in renal tissue (ischemia or vasoconstriction).
• Individual characteristics of immunity patient (insufficient antibody production, decreased immune response).
• Pronounced pathogenesis of microorganisms .
• Violations in distal sections colon in the form of constipation, microflora imbalance.
• TO causes of UTI also apply hereditary factor .
• Failure to comply with hygiene rules and improper washing of children.

How does a urinary tract infection manifest in children under one year of age and older: signs of a UTI in the table

Symptoms of UTI in children under one year of age and older

Age	Signs of a UTI
Up to a year	Painful sensations when touching the tummy and lumbar region, accompanied by anxiety and crying. Decreased or increased urine volume. Frequent urination. Weak and intermittent stream of urine. Atypical and unpleasant odor of urine. Change in color (rich yellow or pink, reddish) and turbidity. Swelling may occur. Decreased appetite. Temperature increase. Indigestion, vomiting and/or diarrhea.
Over 1 year old	Fever. Pain in the back and abdomen. Dysuric phenomena (changes in the volume of urine excreted during the day, increased frequency of urination, intermittency of the stream, cloudiness of urine and changes in its color). Increased feeling of thirst.

Symptoms of a urinary tract infection are nonspecific, so to diagnose accurate diagnosis and prescribing effective therapy requires additional diagnostics.

Candidate of Medical Sciences A.M. Rivkin about UTI:

The term UTI implies the presence of an infection in urinary tract(tubules, pelvis, ureter, bladder, urethra). The main criterion for the diagnosis of UTI is the presence of bacteriuria, but the detection of bacteriuria does not always indicate inflammation, which is typical for asymptomatic bacteriuria. Bacteriuria can be transient, when colonization of the microbe does not occur, and therefore no inflammatory process occurs. The presence of an inflammatory process is determined clinical signs(intoxication, pain syndrome), paraclinical indicators - accelerated ESR, leukocytosis with neutrophyllosis, increased concentration of acute phase proteins (CRP).

Methods for diagnosing urinary tract infections in children: what tests and examinations will help identify UTIs?

To avoid useless antibiotic therapy, an accurate diagnosis is required. Since symptoms cannot give a clear picture of the disease, it is necessary to do a urine test with bacteriological testing. Bacteriuria must be confirmed twice, so if bacteria are present in the urine, it must be retested. One of the diagnostic methods is a urine test for nitrites (nitrates in the urine are the norm, and nitrites are a process of vital activity of microorganisms).

How to treat a urinary tract infection in a child under one year of age or older? Table.

After making an accurate diagnosis, the doctor prescribes treatment taking into account the location of the infection and the extent of the damage. The earlier therapy begins, the lower the risk of complications. Since infections are bacterial in nature, the main treatment is antibiotic therapy. Any treatment, including urinary tract infections, must be comprehensive.

Basic principles of treatment of UTIs in children under one year of age and older

Age	Features of UTI treatment
Up to a year	Antibiotics are prescribed wide range actions, most often in the form of suspensions. If oral administration is not possible, it is recommended intravenous administration antibiotics. The course must last at least 7 days. Symptomatic treatment consists of prescribing anti-inflammatory, analgesic and antipyretic drugs (eg ibufen), as well as vit. E as an antioxidant. Maintenance physiotherapy after the elimination of an acute infection: electrophoresis, UHF, paraffin or ozokerite applications, etc.
Over 1 year old	Prescription of pathogen-sensitive antibiotics for a course of at least 7 days, antitoxic therapy, correction of urodynamics (if necessary), antimicrobial prophylaxis in case of recurrence, increasing the general immunological reactivity of the child’s body. A diet excluding salty, spicy, fried and smoked foods is recommended; it is also necessary to increase the volume of liquid you drink by half (water, cranberry juice, blackcurrant or pear juice, still mineral water, dried apricot compote, etc.) to prevent retention and reproduction bacteria in the urinary system.

In modern medicine, inhibitor-protected penicillins, cephalosporins, carbopenems, aminoglycosides, and uroantiseptics are used to treat UTIs. A drug necessary for the child for UTIs, only a doctor can prescribe; self-medication is unacceptable.

Professor N.A. Korovina on the treatment of cystitis in children:

Treatment of cystitis in children should be comprehensive and include general and local impact. In case of acute cystitis, bed rest is recommended. Rest is necessary to help reduce dysuric phenomena and normalize the function of the bladder and urinary system as a whole. General warming of the patient and local warming are indicated. thermal procedures. Dry heat can be applied to the bladder area. “Sitz” baths are effective at a temperature of +37.5°C with a solution of herbs that have antiseptic effect(chamomile, St. John's wort, sage, oak bark). Under no circumstances should you take hot baths, as the heat high temperatures may cause additional hyperemia with impaired microcirculation in the bladder.

Food should not be irritating; it is advisable to exclude all hot, spicy foods and spices. Dairy and vegetable products, fruits rich in vitamins are shown. It is advisable to use yoghurts enriched with lactobacilli in the diet of patients with cystitis, which are capable, due to the properties of adhesion to the mucous membrane of the urogenital tract, to prevent the recurrence of the microbial inflammatory process in the urinary tract in a child. The use of fruit drinks made from cranberries and lingonberries is effective.

The drinking regime is determined by the patient's needs. However, in case of acute cystitis, it is better to recommend drinking plenty of fluids (50% higher than the required volume), which increases diuresis and helps flush out inflammatory products from the bladder. The daily amount of fluid is distributed evenly throughout the day. It is better to recommend increasing the drinking regime for acute cystitis after removal pain syndrome. Shown are slightly alkaline mineral water, fruit drinks, weakly concentrated compotes.

Prevention of urinary tract infection in children: how to prevent the disease?

If the urinary system has a normal structure, then urinary tract infections can be prevented by:

• strengthening the immune system;
• avoiding hypothermia;
• hygiene (regular washing of the perineum in the direction from the urinary tract to the anus);
• timely change of wet and soiled diapers and underwear;
• compliance with the water regime;
• good nutrition;
• observance of a special diet by a nursing mother (a minimum of sweets and proper nutrition).