Urinary tract infection in children. Urinary tract infections in children. Causes, symptoms, treatment and prevention

Urinary tract infections (UTIs) are one of the most common diseases in children under one year of age, second in frequency only to diseases of the upper respiratory tract. The wide prevalence is explained by the difficulty of diagnosis and the symptoms inherent in many diseases. Signs of the disease are not always characteristic of damage to the urinary system, ranging from fever to disturbances in the gastrointestinal tract.

If untreated, inflammation progresses rapidly, complicated by renal parenchyma, renal scarring, sepsis, hypertension and chronic renal failure.

Causes of the disease

It is worth noting that inflammation is more common in girls. This is due anatomical features: proximity to the vagina, intestines, short urethra. Influenced by gynecological diseases(ex. vulvovaginitis, vulvitis).

Most girls get sick at the age of 3-4 years. Boys are more susceptible to infections infancy, and the reason, as a rule, is some congenital anomaly genitourinary system. Urinary tract inflammation can develop in infants due to misuse diapers and poor hygiene.

Infection can enter the body in three ways:

• Ascending - directly through the urethra, affecting the bladder and then the kidneys;
• Hematogenous – for furunculosis, sepsis, bacterial endocarditis;
• Lymphogenic - from nearby organs, through a network lymphatic vessels genitourinary system and intestines.

Most often, the infection occurs upward path, with gut microorganisms being the most common cause of UTIs. Often tests show the presence of Proteus, Klebsiella, enterococci, and a little less often - streptococci, staphylococci and microbial associations.

Microbial inflammatory lesions are divided into infections of the lower (urethritis, cystitis) and upper (pyelonephritis, pyelitis) urinary tract. Both kidney inflammation and urinary tract lesions in children are called in medicine by the same term - “ infection urinary tract ", because it spreads quickly throughout the system and its localization cannot be accurately determined.

There are a number of factors that provoke irritation of the mucous membrane of the urinary system as a result of stagnation and retention of urine:

• Anomalies in the structure of the reproductive system in children, for example, synechia of the labia minora in girls, phimosis in boys;
• Congenital pathologies of the urinary system, tumors, stones, vesicoureteral reflux;
• Neurological disorders accompanied by functional disorders urination;
• Hypothermia;
• Metabolic disorders;
• Failure to comply with personal hygiene rules;
• Infections of neighboring organs, helminthic infestations.

Symptoms resulting from urinary tract inflammation

The clinical picture depends on the age of the baby, the localization of the pathology and the severity of its course, for example, with cystitis there are pronounced local signs(dysuretic), frequent, painful urination in small portions of urine. There is pain in suprapubic region. The urine itself becomes cloudy. Infants may experience urinary retention, and older children may experience incontinence.

With the progression of pathology and kidney damage, pyelonephritis develops - inflammation of the pelvis paired organ. Signs of illness include: fever, chills, lethargy, pale skin, headache, loss of appetite, nausea, vomiting, abdominal and lower back pain.

Such signs of inflammation of the kidneys and urinary tract often lead to misdiagnosis and improper treatment. This is why children who have heat and unclear intoxication, it is necessary to take a urine test.

If a urinary tract infection is suspected, comprehensive examination. To find out its severity and severity, a clinical blood test is prescribed. A conclusion is made based on the number of leukocytes, ESR, the level of acute-phase proteins and other substances.

In urine, as a rule, protein, leukocytes, and sometimes erythrocytes are found. Also, in case of inflammation, bacterial culture of urine is necessary to identify the causative agent of the infection and determine its sensitivity to antibiotics. For the analysis to be accurate, it is necessary to correctly collect urine, after washing the baby. Only the middle portion of urine is collected.

Inflammation of the urinary tract requires an ultrasound scan in children. This is necessary to assess the condition of the kidneys. To identify the cause of urinary outflow obstruction during recurrent illness(relapse) may require X-ray contrast studies - voiding cystography (for boys with the first disease, for girls with a second one), excretory urography (recurrence of pyelonephritis).

These activities are carried out only in a state of remission. Ultrasound examination and urography will allow us to establish the causes of outflow disturbances, anomalies in organ development, cystography - intravesical obstruction, vesicoureteral reflux.

Treatment of urinary tract inflammation in children

Therapy consists of a set of activities that are selected individually. A baby with cystitis can be treated at home, but a child with pyelonephritis can only be treated in a hospital. Children under 2 years of age are always hospitalized as they require fluid resuscitation and parenteral antibiotics.

Fever and severe pain require compliance bed rest. To reduce the load on the mucous membranes and renal tubules, treatment includes diet. Recommended fractional meals. If kidney function is impaired, fluid and salt are limited.

The menu should consist of protein-vegetable foods and dairy products. Completely exclude sour, fried, spicy foods, limit fruits and vegetables that contain a lot of acid (pomegranates, kiwi, citrus fruits, tomatoes, grapes, peppers, sauerkraut and pickles).

After cupping pain syndrome Drinking plenty of fluids is indicated. This measure is necessary to improve kidney function, since urine has an irritating effect on them. Drinking allows you to remove bacteria and their waste products from the body. It can be slightly alkaline mineral water, cranberry juice or juice.

Antibiotics are the main medication for urinary tract inflammation. The medicine is selected based on the causative agent of the disease and its sensitivity to drugs of this series. The role is played by individual characteristics baby.

The product must not be nephrotoxic. Until the results of bacterial urine culture are obtained, broad-spectrum antibiotics are prescribed - cephalosporins, carbapenems, protected penicillins, aminoglycosides.

The course of treatment for cystitis is at least a week, for pyelonephritis – at least 2 weeks. Upon completion, a control urine test is performed. Therapy can be supplemented with uroantiseptics. Probiotics are prescribed to prevent diarrhea.

Herbal medicines are used for preventive purposes. Collections that have worked well include nettle, lingonberry leaf, St. John's wort, rose hips, chamomile flowers, corn silk, yarrow, juniper berries. These plants eliminate symptoms of inflammation and have diuretic properties.

The pain syndrome is relieved with antispasmodics. To enhance antibiotic therapy, non-steroidal anti-inflammatory drugs are used. Frequent relapses require so-called local treatment.

Urinary tract infections (UTIs) are diagnosed when >5 x 104 colonies/mL are detected in urine samples obtained through a catheter, or in older children in repeated urine samples containing >105 colonies/mL. In children younger age UTIs often result from anatomical abnormalities. UTIs can cause fever, loss of appetite and vomiting, flank pain, and signs of sepsis. Treatment involves prescribing antibiotics. After recovery, imaging studies of the urinary tract are performed.

Inflammation from a UTI may involve the kidneys, bladder, or upper and lower urinary tract. STIs such as gonococcal or chlamydial urethritis, although they cause inflammation in the urinary tract, are generally not considered UTIs.

Mechanisms that maintain normal sterility of the urinary tract include an acidic urine environment, unidirectional downward movement of urine, regular emptying of the urinary tract, and normally functioning vesicoureteral and urethral sphinkerts. Dysfunction of any of these mechanisms predisposes to the occurrence of UTIs.

During the first year of life, approximately 4% of boys and 2% of girls develop a urinary tract infection (UTI). Among older, prepubertal children, UTIs occur in 3% of girls and 1% of boys.

In order to prescribe adequate therapy, UTIs should be classified by location and severity. Other factors may play important role upon further evaluation. In 75% of cases, the cause of UTI is E. coli.

Causes of urinary tract infections in children

By the age of 6 years, 3-7% of girls and 1-2% of boys experience UTIs. The peak age of UTI is bimodal with one peak in infancy and a second at 2–4 years of age (during toilet training for many children). The ratio of girls to boys in the incidence structure varies from 1:1 to 1:4 in the first 2 months of life (estimates vary primarily due to the proportion of uncircumcised boys in different populations and the exclusion of infants with urological anomalies - these are now often diagnosed in utero with using prenatal ultrasound). The girl-to-boy ratio increases rapidly with age, reaching approximately 2:1 from 2 months to 1 year, 4:1 in the second year, and >5:1 after 4 years. In girls, infections are usually ascending and less likely to cause bacteremia. The predominance of UTIs in girls at an early age is explained by both the shorter female urethra and circumcision in boys.

Predisposing factors include urinary tract malformations and obstruction, prematurity, frequent and prolonged catheterization, and lack of circumcision. Other predisposing factors in young children include constipation and Hirschsprung's disease. Risk factors in older children include diabetes, trauma and, in teenage girls, sexual intercourse.

Urinary tract abnormalities. UTIs in children indicate possible urinary tract abnormalities; these disorders, in particular, can lead to the development of infection in the presence of VUR. The likelihood of VUR varies inversely with age at first UTI event.

Microorganisms. With abnormalities of the urinary tract, infections can be caused by various microorganisms.

In the absence of abnormalities in the urinary tract, the most common pathogens are Escherichia coli strains. E. coli causes >75% of UTIs in all children age groups Oh. Less commonly, UTIs are caused by other gram-negative enterobacteria.

Enterococci (group D streptococci) and coagulase-negative staphylococci (eg, Staphylococcus saprophytics) are the most commonly identified causative gram-positive organisms. Fungi and mycobacteria rarely cause infection, mainly in immunocompromised patients. Adenoviruses rarely cause UTIs, and the result is predominantly hemorrhagic cystitis.

Symptoms and signs of urinary tract infections in children

In newborns, symptoms of UTI are nonspecific and include poor appetite, diarrhea, loss of appetite, vomiting, mild jaundice, lethargy, fever and hypothermia.

Infants and toddlers may also experience general symptoms such as fever, indigestion, or foul-smelling urine.

Children over 2 years of age usually develop the classic symptoms of cystitis or pyelonephritis. These include dysuria, frequent urination, urinary retention, foul odor urine, enuresis. Pyelonephritis is characterized by fever and chills.

Possible anomalies in the structure of the urinary tract may be indicated by enlarged kidneys, space-occupying formations in the retroperitoneal space, a defect in the urethral opening, and malformations of the lumbar spine. A weak urine stream may be the only sign of urinary tract obstruction or neurogenic Bladder.

Signs of pyelonephritis

Newborns:

• weight loss due to refusal to feed;
• vomiting and diarrhea;
• pale gray skin;
• jaundice;
• hyper- and hypothermia;
• often sepsis.

Infants, small children up to the 3rd year of life:

• fever;
• abdominal pain, nausea and vomiting;
• digestive disorders with weight loss;
• foul-smelling urine.

Older children:

• vomit;
• loss of appetite;
• pain in the abdomen and kidney area;
• foul-smelling urine.

Laboratory changes:

• significant bacteriuria and leukocyturia;
• increasing the level of CRP;
• increase in ESR;
• in newborns and infants hyponatremia and hyperkalemia are possible.

Signs of cystourethritis:

• burning when urinating;
• dysuria, pollakiuria;
• incontinence with urgency;
• stomach ache;
• As a rule, there is no fever or systemic signs of inflammation.

Special forms

• Asymptomatic urinary tract infection: bacteriuria with possible leukocyturia without clinical symptoms, the disease is discovered incidentally, mainly in girls aged 6-14 years.
• Complicated (secondary) pyelonephritis with urinary tract obstruction, for example, with stenosis of the ureter or ureteral orifice.

Accordingly, after the first episode of pyelonephritis, mandatory diagnostics: ultrasound examination and voiding cystourethrogram, and, if necessary, further diagnostics.

Diagnosis of urinary tract infections in children

Average portion of urine, urine taken by catheter, bladder puncture: bacteria, leukocytes.

Blood: leukocytes, CRP, ESR (pyelonephritis), creatinine (bilateral pyelonephritis).

Ultrasound examination - in every case of urinary tract infection.

Individual approach when deciding on the need for radiological studies:

• voiding cystourethrogram;
• intravenous pyelography - for complex developmental defects;
• dynamic renal scintigraphy - for urinary outflow disorders.

A urine culture should be performed for any child with a fever greater than 38°C. A clean urine sample is ideal, but if this is not possible, suprapubic aspiration is performed.

The two most common sites of UTI are the bladder (cystitis, manifested by dysuria, frequent urination, hematuria, enuresis, and pain in the suprapubic region) and the upper urinary tract (pyelonephritis, the symptoms of which are fever, flank pain, tenderness on palpation in the projection of the kidneys ). The severity of a UTI can be assessed by the degree of fever. A rise in body temperature of more than 39 °C is regarded as severe course. This is characterized by the appearance of systemic manifestations, such as vomiting and diarrhea.

The collection of anamnesis of the disease should be as detailed as possible. You should ask about the presence or absence of a history of urinary problems (difficulty urinating), constipation, recurrent infections, vesicoureteral reflux, and antenatally diagnosed kidney disease. It is also necessary to collect a family history. Any child younger than 3 months with a UTI should be referred to a pediatric urologist.

Urine tests. To make a diagnosis, it is necessary to collect urine for culture and verify significant bacteriuria. Usually urine in children early age collected using a urethral catheter, and in boys with moderate and severe phimosis - using suprapubic puncture of the bladder. Both techniques require technical skill, but catheterization is less invasive and much safer. The use of urine bags is considered less accurate for diagnosis and urine samples are less stable.

If urine is obtained by suprapubic puncture, the presence of any bacteria is a significant factor in the diagnosis. The presence of >5x104 colonies/ml in a catheterization specimen usually indicates a UTI. Collecting a midstream urine sample is important when counting colonies of a single pathogen (i.e. total mixed flora) in numbers >105 colonies/ml. However, UTIs are sometimes diagnosed in symptomatic children despite low colony counts on culture. Urine should be tested as soon as possible after collection or stored at 4°C if a delay of >10 minutes is expected. Sometimes UTI occurs despite a low number of colonies in the culture; this may be due to previous antibiotic therapy, high urine dilution ( specific gravity less than 1.005) or severe obstruction of the flow of infected urine. Sterile urine cultures rule out UTI.

Microscopic examination of urine is useful but does not guarantee high accuracy. Pyuria has a sensitivity of about 70% for UTI.

Test strips for detecting bacteria in urine (nitrite test) or leukocytes (leukocyte esterase test) are used quite often; if this test is positive, the diagnostic sensitivity for UTI is about 93%. The specificity of the nitrite test is quite high; a positive result on a fresh urine sample is highly accurate for UTI.

Fever, lower back pain, pyuria indicate pyelonephritis.

Blood tests. A complete blood count and examination of markers of bacterial inflammation (eg, ESR, C-reactive protein) can help diagnose infections in children with borderline urine values. Some institutions measure serum urea and creatinine during the first episode of UTI.

Urinary tract imaging. High frequency Anatomical abnormalities do not require imaging of the urinary tract. If the first episode of UTI occurs at age >2 years, most experts recommend additional examination, however, some clinicians delay imaging until the second occurrence of UTI in girls >2 years of age. Options include voiding cystourethrography (VCUG), radionuclide cystogram (RNC) with technetium-99m pertechnetate, and ultrasound.

VCUG and RNC are superior to ultrasound for detecting vesicoureteral reflux and anatomical abnormalities. Most practitioners prefer better anatomical definition of VCUG contrast as an initial test, using RNC in subsequent management to determine when reflux has resolved. Low-dose X-ray equipment closes the radiation dose gap between VCUG and RNC. These tests are recommended as soon as possible after clinical response, usually at the end of therapy when bladder reactivity has resolved and urine sterility has been restored. If imaging is not planned until the end of therapy, the child should continue to take antibiotics until prophylactic doses until vesicoureteral reflux is eliminated.

Prognosis of urinary tract infections in children

When properly managed, the disease in children rarely leads to renal failure unless they have uncorrectable urinary tract abnormalities. However, it is believed (but not proven) that repeated infections cause renal scarring, which can lead to the development of hypertension and end-stage renal disease. In children with high vesicoureteral reflux, long-term scarring occurs at a rate 4 to 6 times greater than in children with low VUR and 8 to 10 times greater than in children without VUR.

Treatment of urinary tract infections in children

• Antibiotics.
• For severe vesicoureteral reflux, a course of antibiotics and surgery.

Pyelonephritis: compulsory for newborns and infants intravenous administration, up to 3 months, for example, ampicillin, later, for example, cephalosporins. Before starting antibiotic treatment, blood and urine cultures are obtained. The duration of treatment is 10 days.

Cystitis: for example, trimethoprim for 3-5 days.

After pyelonephritis in infancy in the presence of vesicoureteral reflux and/or megaurethra: prevention repeated infections(for example, cephalosporins for infants and young children, later - trimethoprim, nitrofurantoin).

Surgical treatment - for obstruction (for example, for urethral valves - immediate surgery) or for severe vesicoureteral reflux.

With asymptomatic bacteriuria without signs of inflammation and normal results Ultrasound examination in most cases does not indicate treatment; dynamic monitoring of urine test results.

Treatment is aimed at eliminating acute infection, prevention of urosepsis and preservation of renal parenchyma functions. Antibiotics are started prophylactically in all children with toxic manifestations and in children without toxic manifestations with probable UTI (positive leukocyte esterase or nitrite test, or detection of pyuria or bacteriuria on microscopy). The rest can wait for the culture results.

In infants from 2 months to 2 years with intoxication, dehydration, or the inability to take medications orally, parenteral antibiotics are used, usually 3rd generation cephalosporins. 1st generation cephalosporins (eg, cefazolin) can be used if typical local pathogens are known to be sensitive to drugs in this group. Aminoglycosides (eg, gentamicin), although potentially nephrotoxic, are useful in complex UTIs to treat potentially resistant Gram-negative bacteria such as Pseudomonas. If blood culture is negative and clinical response is good, appropriate oral antibiotics, selected on the basis of antimicrobial specificity, can be used to complete a 2-week course. A poor clinical response suggests persistent microorganisms or obstructive lesions and requires urgent revision of ultrasound findings and repeat urine cultures.

In nontoxic, nondehydrated infants and children who are able to take medications orally, oral antibiotics can be given from the beginning. The drugs of choice are TMP/SMX 5-6 mg/kg (according to TMP) 2 times a day. An alternative is cephalosporins. Therapy is changed based on culture results and determination antimicrobial sensitivity. Treatment is usually given for >10 days, although many older children with uncomplicated UTI can be treated for 7 days.

Vesicoureteral reflux. It is generally accepted that antibiotic prophylaxis reduces the recurrence of UTIs and prevents kidney damage. However, there is some long-term evidence of the potential for renal scarring and the limited effectiveness of antimicrobial prophylaxis. Current clinical researches are trying to resolve these issues, but while the results are not available, most doctors provide long-term antimicrobial prophylaxis to children with PMR, especially those in grades two to five. For patients with grade four or five VUR, it is usually recommended abdominal surgery or endoscopic injection of polymer fillers.

Prevention medications include nitrofurantoin or TMP/SMX, usually at bedtime.

In case of pyelonephritis, all children should be referred to a pediatric urologist. The course of oral antibiotic therapy is 7-10 days.

The presence of cystitis in children over 3 years of age does not require referral to a specialist in the absence of a recurrent course. If asymptomatic bacteriuria is detected, treatment is not indicated.

After a single episode of UTI, antibiotic prophylaxis is not required. After treatment, it is necessary to explain to the child’s parents the importance of consuming an adequate amount of fluid per day and regular urination.

In accordance with modern recommendations, in children under 6 months of age, ultrasound is indicated in cases of recurrent or complicated UTI. Ultrasound should be supplemented with dimercaptosuccinic acid (DMSA) scanning and voiding cystourethrography to determine the cause of UTI and evaluate scarring and renal dysfunction.

For an uncomplicated UTI, an ultrasound may be performed after the child has recovered. For older children with a single episode of UTI that responds to therapy within 48 hours, radiation diagnostic methods are not indicated.

The use of DMSC is a much more gentle method, and MCUG is indicated only for urethral dilatation detected by ultrasound, a family history of vesicoureteral reflux, urinary dysfunction, or infection caused by non-Escherichia coli.

It is important that parents know what symptoms they should contact a specialist for. In most uncomplicated cases, observation is not required.

Monitoring the patient

• Urine: color, smell, frequency of urination.
• Measure body temperature rectally 3 times a day.
• Maintenance water balance, offer fluid in sufficient quantities.

Care

• Careful hygiene of the perineum, complete emptying of the bladder.
• Avoid local cooling or exposure to dampness, as well as general hypothermia (for example, reduce the time spent in the bath).
• Local application of heat (for example, for abdominal pain): compresses, heating pads (hot water).
• In case of lack of appetite or vomiting, offer food more often (optional menu, small portions), in some cases - parenteral nutrition.

The urinary tract is the system for removing urine from the body. They begin in the kidneys and include the renal pelvis, ureters, bladder, and urethra (urethra). Urogenital infections are an inflammatory process in various parts of the urinary tract. Recognize infections of the upper urinary tract and lower urinary tract. The first category includes pyelonephritis and pyelitis. The second category includes urethritis and cystitis. What are the symptoms of development bacterial infection urinary tract and treatment methods?

Pyelonephritis- infectious bacterial inflammation of the kidneys. Inflammation may occur in only one or both kidneys. Distinctive symptoms of this disease: high fever, lower back pain, intoxication of the body. If pyelonephritis is not treated, kidney failure or kidney abscess will develop.

Ureteritis- penetration and proliferation of bacteria in the ureter.

Pyelitis- infectious disease of the renal pelvis. It can be in acute and chronic form. In children, the acute course of the disease predominates. Caused by bacteria such as E. coli and staphylococcus.

Urethritis- an inflammatory process in the urethra caused by the entry of pathogenic bacteria into the sterile environment of the urethra, most often E. coli. Symptoms of this disease are: strong smell of urine, painful urination, vomiting, pain in the lower abdomen. Urethritis can also be caused by an allergy to washing powder or detergents. In this case, no treatment is required; it goes away when the allergen is eliminated.

Cystitis- bacterial inflammation of the bladder, characterized by frequent painful urination, cloudy urine with an unpleasant odor, and may be accompanied by fever. Sometimes cystitis may not be caused by a bacterial infection, but by a tumor or stones in the bladder.

Causes of genitourinary tract infections in children

Diseases of the genitourinary system in children occur when pathogenic and opportunistic bacteria enter the sterile environment of the urinary tract. Most often this is E. coli, which can get from the anus into the child’s genitourinary tract. Infection with staphylococcus and klebsiella is possible. There are also a number of causes of inflammation:

Urogenital infections develop more often in girls due to the structural features of the body. In girls, the anus and genitourinary system are close together; in boys, the urethra is longer, which means there is less opportunity for bacteria to enter the upper urinary tract.

For children of different age groups, the picture of the disease is different. Typical signs of a urinary tract infection for children of all ages:

In newborns and children in the first year of life, symptoms may differ from typical signs. Young children may burp frequently, refuse to eat, become capricious, show signs of intoxication and have a temperature rise above 38 degrees.

Sometimes the only symptom of bladder inflammation may be fever. In this case, infection is determined only by bacterial culture of urine.

Diagnosis of urinary tract infection in children

For correct setting diagnosis, the pediatrician can refer little patient with parents for a consultation with a nephrologist or urologist. Sometimes a girl needs to visit a gynecologist. Must be passed general analysis blood and urine. A blood test will show the inflammatory process in two indicators: ESR and leukocytes will be increased. In urine analysis genitourinary infection in children, evidence of the appearance of protein, red blood cells and high content leukocytes. If necessary, a urine test according to Nechiporenko and bacterial culture of urine are taken to identify which bacteria caused the inflammation and their sensitivity to antibiotics.

Also, if infection is confirmed, a Ultrasound of the kidneys and urinary tract. X-rays are prescribed only for re-infection or frequent relapses of the disease. Endoscopy allows you to determine the presence of anomalies in the structure of the genitourinary system.

Subspecialists can visually distinguish a genitourinary tract infection from certain diseases with similar symptoms:

Vulvovaginitis- inflammation of the vagina in girls.

Enterobiasis — infection with pinworms.

Balanitis- disease foreskin in boys and the vestibule of the vagina in girls.

Appendicitis— the picture of the disease may be similar to urinary tract inflammation.

After confirmation of the diagnosis, treatment begins urinary infection. If the sick child's condition is mild or moderate severity, then treatment of inflammation can be done at home, when the child is a newborn or an infant and his condition is severe, treatment in a hospital is necessary.

The main remedy for curing urinary tract disease is an antibiotic, which must be taken for at least 10 days. Young children are prescribed the drug in the form of a suspension, older children in the form of tablets. Antibiotics are usually used broad action. To prevent intestinal dysbacteriosis, prebiotics are prescribed in parallel with taking an antibiotic. Uroantiseptics are often prescribed - antimicrobial drugs, for quick removal bacteria from genitourinary tract.

Diet plays an important role as an aid. Young patients need to drink a lot, limit the consumption of foods containing a lot of acid, for example, oranges, grapefruit, tomatoes. Restrictions are also being introduced on salted, smoked foods and canned food.

Prevention of genitourinary tract disease in children

To prevent primary infection or recurrence of urinary tract infections in children under one year of age, several rules must be followed:

• Breastfeeding helps to quickly develop immunity in a child.
• When introducing complementary foods, you should not give many new foods at once, as this may cause intestinal infection due to immaturity gastrointestinal tract.
• Children should be given something to drink clean water. It helps to empty the bladder in a timely manner.
• Observe hygiene rules. If the baby is wearing a diaper, it is necessary to change it promptly. If the child is wearing underwear, it is changed daily.
• Avoid hypothermia.

If infection occurs, you must urgently visit a doctor and begin treatment.

Older children need to take care of personal hygiene, change their underwear, avoid hypothermia, and do not sit on a cold surface. Parents need to ensure that underwear is the right size and does not fit too tight. Due to too tight underwear, there may be stagnation of blood in the pelvic organs, which can lead to inflammation.

Urinary tract infection in children has become global over the past decade. The concept of “urinary system infection” covers all infectious and inflammatory diseases. According to their location, they are divided into infections of the upper and lower urinary tract.

The lower ones include diseases such as cystitis, urethritis, and the upper ones include various forms of urinary system infections.

A group of organs is responsible for the formation and removal of urine from the body - these are the kidneys, ureter, bladder and urethra.

Infection in children means the presence pathogenic bacteria in one of the organs of the urinary system. Making such a diagnosis is typical only at the initial stage of diagnosis, when changes in the urine (or the appearance of bacteria) are determined, but there is no indication that the inflammatory process is at a certain point.

The first signs of the disease are often determined in the clinic, when it is not possible to establish an accurate localization of the process. Therefore, the diagnosis of “urinary tract inflammation or urinary system infection” is legitimate, and it is clarified in a specialized hospital.

Causes of urinary tract infections

Children of any age are susceptible. But most often they occur in newborns, infants and children under three years of age. Up to a year, boys are more susceptible to diseases of the urinary system, since they have a congenital anomaly of the genitourinary system for up to 5–8 months. And in girls, the development of the disease is most often observed after two and before 12–13 years, since their urethra is very short and the infection easily penetrates the genitourinary tract.

The main causes of infections are the entry of bacteria into the child’s urinary system. In 70–90% of cases, this is an opportunistic bacterium of the normal human flora.

Since the exit tracts of the gastrointestinal tract are in close proximity to the urinary tract, this often leads to the penetration of pathogenic microorganisms into the urethra, and from there their movement is allowed to other parts (ureter, pelvis, kidneys).

Activation of the pathogen occurs when immunity is reduced, so you should not neglect hygiene and allow hypothermia. Other pathogens that can cause the disease include:

• staphylococcus;
• streptococcus;
• enterococci;
• enterobacteria;
• Proteus.

Other disorders may also cause the infection:

• natural anomalies of the genitourinary tract (balanoposthitis in boys, synechiae in girls, reverse outflow of urine);
• disruption of the urine excretion process (reflux, obstructive uropathy);
• urination disorder due to neurological problems;
• in education diabetes mellitus or kidney stones;
• when neighboring organs become infected ( genital area, gastrointestinal), the presence of helminths;
• excessive consumption of spicy foods and spices, as well as poor nutrition;
• baby from mother to child (if the mother develops an infectious pathology);
• in newborns - the presence of a purulent, inflamed navel (omphalitis);
• various actions on the urinary tract (installation of a catheter, puncture of the bladder, surgery).

Signs of a urinary tract infection

Not all parents immediately notice symptoms in their children. It is quite difficult to recognize a urinary tract infection in children under one year of age:

• the child does not speak yet, he is not able to describe his feelings;
• he is unable to regulate and control his urination;
• signs of the disease are also characteristic of other manifestations of the disease.

Urinary tract infection in infants is diagnosed in the same way as in adults. The signs are the same for all children:

• burning;
• frequent urination;
• pain in lumbar region, in a stomach.

Parents can understand that the child is in pain and it is associated with urination by the following signs:

• cries and becomes restless when urinating;
• shows anxiety, is capricious;
• reacts poorly to touch on the back, especially the lower back or tummy.

Manifestations of pyelonephritis

Urinary tract infection includes a group of diseases, therefore clinical manifestations are different for each type. The following symptoms are characteristic of pyelonephritis:

• pronounced intoxication of the body (lethargy, poor appetite, impotence);
• the onset of the disease begins with a sharp increase in body temperature to 38 degrees, as well as with a characteristic fever;
• nausea, vomiting. Infants experience a sharp decrease in body weight;
• decrease in the amount of daily urine;
• Infants sometimes develop dehydration.

In newborns, pyelonephritis provokes the appearance of jaundice (on the 7th–8th day from birth, an increase in bilirubin in the blood occurs).

Pyelonephritis is dangerous because of its complications; it leads to shrinkage of the kidney and loss of its functions, and this provokes the development of renal failure.

If a child is suspected of having cystitis, then the following symptoms are typical:

• There are no signs of intoxication.
• Body temperature rises to 38–39 degrees.
• The child wants to constantly empty his bladder, while he goes to the toilet every 10-15 minutes or involuntarily urinates in his pants.
• Pain in a child is typical in the pubic area or slightly higher, and the pain itself often radiates to the perineum. He behaves restlessly, this continues even at night.
• Even with frequent urges to go to the toilet, the child has difficulty emptying the bladder, since urine does not have time to collect in the required amount. An inflamed bladder calls for emptying it again and again, and each release of urine is accompanied by pain and stinging.

• Urine becomes sharp bad smell, becomes cloudy and may change color.
• At the end of urination, sometimes a few drops of blood appear - this is terminal hematuria, characteristic of cystitis.

Features of cystitis

Of all urinary tract infections, cystitis is much more common than others, especially in girls.

If a child is suspected of having urethritis, the following symptoms may occur:

• The child has no fever or intoxication.
• When urinating, they appear nagging pain in the bladder.
• The penis in boys is itchy and may discharge from urethra. Girls feel itching on the outside of their genitals.
• In newborns and infants, the symptoms are nonspecific: regurgitation, diarrhea, weight loss, fever up to 38 degrees.
• There is a frequent desire to empty the bladder.

Urethritis is susceptible to to a greater extent boys, girls have a wider and shorter urethra, so the infection passes higher, causing pyelonephritis or cystitis.

How to get rid of urinary tract infections in children?

Treatment of urinary tract infections in children is aimed at bacteriological examination, identification of the pathogen and antibacterial, pathogenetic and symptomatic therapy.

The issue of hospitalization of a child is decided with the parents, but the younger he is, the likelihood of treatment in a hospital increases, especially if pyelonephritis is suspected.

Antibacterial therapy begins even before the result is obtained, based on the most likely causative agents of infection; if there is no positive effect within 2 days, the drug is replaced with another.

The main methods of treatment consist of the following measures:

• Antibacterial treatment - after obtaining the result of bacteriological urine culture, it is prescribed suitable drug. Preference is given to penicillins and cephalosporins. The dosage is selected individually by the doctor, taking into account the child’s age, weight and general condition. The course of treatment ranges from 7 to 21 days. It is not recommended to interrupt treatment, even if the symptoms of the disease have gone away - this risks relapses and disruption of the genitourinary tract.
• The use of diuretics, uroseptics - they help to increase renal blood flow, ensure the elimination of microorganisms and the removal of inflammatory products, and relieve swelling of the interstitial tissue of the kidneys.

• The use of non-steroidal anti-inflammatory drugs - they help enhance the effect of antibacterial therapy and relieve the inflammatory process.
• Live bacteria (probiotics or prebiotics) are prescribed. To prevent the occurrence of intestinal dysbiosis while taking antibiotics.
• The use of antispasmodics that reduce pain: No-Shpa, Papaverine, Baralgin.

Diet

She plays an important role in complex therapy to eliminate infection urinary system. For infants, only breastfeeding is recommended.

Children after 7 months – light dishes without spices, excess fat and salt. Dairy-vegetable foods and fruits that promote alkalization of urine are indicated. After eliminating the pain syndrome, it is recommended to increase drinking to remove intoxication from the body (compotes, fruit drinks, mineral still water). IN acute period table No. 5 according to Pevzner is used.

In almost 80% of patients, with a correctly selected treatment regimen and modern antibacterial agents, urinary tract therapy leads to complete recovery in the child. In rare cases, relapses and exacerbation of the disease occur.

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 damage to the kidneys, bladder and urethra, often lead to late diagnosis of diseases, after their transition to chronic form or at the stage of development of complications. Avoiding this problem, however, is quite simple: it is enough for parents to be attentive to the health of their child and regularly monitor indicators of a general urine test.

Among the diseases of the urinary system, the most “popular” in childhood are pyelonephritis, glomerulonephritis, cystitis, urine-salt 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 can enter the bladder ascendingly from the inflamed urethra, or it 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 in the lower abdomen, slight increase body temperature (usually up to 38 °C), weakness. A characteristic sign of cystitis is frequent, 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 ensuring that the child’s legs and lower body are 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 mask of urethritis, venereal diseases, “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 increased body temperature, general weakness and malaise. Both urethritis and cystitis are dangerous due to the possibility of the inflammatory process spreading to 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 the body’s own opportunistic microflora, 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 and the development of renal failure, which is 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 is a bilateral disease with damage to the glomerular apparatus of the kidneys. The basis for the development of glomerulonephritis is infectious process, which is initially localized in chronic foci - diseased tonsils, adenoids, inflamed paranasal sinuses nose, untreated teeth, gradually disrupts the work 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 of 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 impairment of kidney function 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 of the resulting tissue.

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, regular visits to a pediatric nephrologist and 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 in the early stages of the disease (before the formation of kidney stones) is 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. Long time the disease is asymptomatic and can be suspected only by the presence large quantity salt crystals detected during a general urine test, or accidentally discovered during an ultrasound scan internal organs. Often the first manifestation of urolithiasis is an attack of renal colic caused by the movement of a stone along urinary tract. Renal colic is manifested by the sudden onset of 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, herbal infusions. In severe cases it is carried out surgical removal kidney stones.

Nephroptosis– this is a prolapse of the kidney or excessive mobility of the kidney (wandering kidney). Nephroptosis develops due to weakening of the ligamentous apparatus of the kidney 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 stage I-II nephroptosis is conservative and 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 grade III nephroptosis, 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. A decrease in relative density is observed during inflammatory processes in the kidneys, with pronounced violation 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. An increase in the level of ketone bodies is possible during acute viral infections, after overwork. High level acetone is characteristic of acetonemic 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. An increased number of white blood cells is a symptom of inflammation of the kidneys and urinary organs.

Epithelium may be present in small quantities. An increased number of epithelial cells is characteristic of infectious diseases of the 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 of the kidneys, bladder or urethra. The child must undergo such an examination annually - his parents should closely monitor this. Take care of your health!