Pediatric nephrology: urinary tract infections in infants

Pediatric Nephrology: Urinary Tract Infections in Infants 9 4.5

Health & Care

Pediatric Nephrology: Urinary Tract Infections in Infants

Diseases of the urinary tract, unfortunately, are not uncommon in children of the first year of life. That's why parents need to know how these diseases manifest themselves, so that at the first signs of "malfunctions" they should contact the doctor with the child. However, recognizing anxiety symptoms is not easy ...

Ekaterina Chernorutskaya Pediatrician, St. Petersburg

Symptom - asymptom?

We all know: when an organ is not in order, it hurts. But, unfortunately, this statement is not always true with regard to the kidneys. Kidneys have pain receptors only in the capsule itself, which covers this paired organ from the outside. The pain we feel when stretching the capsule, which can occur with a pronounced inflammatory process in the kidneys (pyelonephritis) or as a result of overflow of the kidneys with liquid. The latter may be associated, for example, with outflow in congenital anomalies or (in older children) - with obstruction of the urinary tract with stone. But these diseases are less common than other diseases of the urinary system. The majority of urinary tract infections in infants are asymptomatic, which is the "cunning" of kidney disease. Sometimes a child may have a few bad results of tests (note, not terrible, namely a few bad ones), which are written off for improper washing and dirty jar: the kid does not seem to care about anything - and all right. But any inflammation leads to a partial loss of the cells of the organ, and consequently, can lead to an insignificant, but still lowering of its function.

Recognizing the symptoms of these diseases from their friends and relatives, parents do not always pay attention to atypical for adults, but they are typical for a small child, for example, rare urination (for adults more frequent urination), which is one of the signs of urinary tract infections, or on the appearance of an unusual smell from a diaper with urine. More vigilant in this case are usually parents who themselves have experienced similar diseases. Of course, if both parents have a kidney or bladder disease, then the likelihood that the disease of the urinary system will manifest in the child is much higher.

Until quite recently, in hospitals where newborns operate (in large cities there are special centers for the surgery of newborns), babies with severe manifestations of the developmental defects of the urinary system have been admitted. K. they include the sensation of a "swelling" in the abdomen, a violation of urination, and significant changes in urine tests. In recent years, due to the widespread introduction of ultrasound methods of research, doctors can diagnose the defect already at the earliest stages of development and even before the birth of the baby. Usually the pregnant woman undergoes ultrasound once in trimester, i.e. three times for pregnancy. And, of course, if the parents already have a disease of the kidneys or other organs with a known inherited nature of the pathology, then it makes sense to conduct research in a specialized genetic center. 

When examining the future mother and the suspected congenital malformation of the fetus, it is usually recommended to examine the baby immediately after birth in a specialized hospital for children with congenital malformations. In such hospitals, there is usually the most "modern equipment and specialists with experience in diagnosing congenital malformations.

10 "secret signs"

But it can happen that during pregnancy there are no deviations from the side of the kidneys in an unborn baby. What are the symptoms that should alert your mom first and for what should you pay attention to the pediatrician after the birth of the child?

1. Edema. Because of their age characteristics, newborn babies are very prone to rapid edema formation. But Mom should know that swelling can be and with a number of other conditions. For example, swelling on the face and head can be observed when the cord is wrapped around the umbilical cord, on the hands and feet - with increased intrauterine pressure in late pregnancy, when the baby is undercooled, etc.

2. Decrease in the amount of urine output up to 1/3 of the age norm. For a newborn on the 15-21 day, this amount is 80-300 ml per day (it gradually increases every day, then decreases), for a child 1-6 months - 160-200 ml per day. In the first days after the birth of the baby will be observed in the hospital, and there should be no reasons for excitement, because in the first week of life, different border states are possible, related to the adaptation of the child to the conditions of a new environment for him. Among such conditions - physiological oliguria (decrease in the amount of urine) in the first 2-3 days after birth.

3. Extraction of an excessive amount of urine (polyuria), more than twice the age limit. This sign parents can often notice only when the doctor will pay attention to it or when the mother uses reusable diapers, and their consumption increases dramatically.

4. Rich color of urine, for example bright yellow, slightly brown or reddish. Especially it is necessary to pay attention of the doctor if you have casually seen an admixture of slime or blood veins in urine. This can also be a manifestation of infection. The red color of urine can also be with hematuria (the presence of red blood cells - red blood cells in the urine), which occurs in various congenital diseases, including hydronephrosis, cystic kidney changes. Do not just get upset and sound the alarm if you fed the baby with beets and the urine turned red: this is quite normal, because plant pigments and many of the dyes that we consume with food are not needed by the body, and so they are safely excreted in the urine.

5. Muddy urine. Turbidity may result from the presence of bacteria and / or leukocytes in the urine, cells that usually indicate the presence of an inflammatory process.

6. Permanent redness of the external genitalia. This can be not only a sign of their inflammation or allergies (vulvitis, vulvovaginitis), but also an indirect sign of infection of the urinary system. In this case, urine, which is different from the usual composition, unnecessarily irritates the tender skin of the baby and causes redness and itching.

7. Any unusual odor from the diaper. This sign can talk about pathology. This especially applies to putrefactive odor, which in most cases is a sign of infection.

8. Urination, regularly accompanied by crying. A clear connection between the crying of the child and urination is the reason for the examination, because, for example, in the renal ureteral-pelvis reflex - the return of urine from the ureter to the kidneys, which is the consequence of a congenital malformation - urine is thrown at the time of contraction of the urinary bladder at the beginning of urination - into the kidneys (normally this does not happen) and pain appears.

9. Unmotivated temperature rises, which in infants regardless of age are always written off to "teeth." If the temperature of 39 - 40 C lasts for several days, there are no signs of acute respiratory disease, acute respiratory viral infection, other visible signs of diseases, the temperature does not get knocked off by antipyretics, that is, an occasion to conduct a urinary examination and start with an urgent urinalysis.

10. Mom notes that when urinating a child is pushing or the character of the jet is intermittent, or, which is better seen in boys, there is no pressure, i.e. The urine flows without a jet.

Your doctor is a nephrologist

If neither you nor your family has encountered kidney disease, then for you it may be news that there is a whole science called "nephrology" and a specialist - a nephrologist. Nephrology (Greek nephros kidney + logos doctrine) is a section of internal diseases that studies the origin, development, clinical manifestations of kidney diseases and develops methods for their diagnosis, treatment and prevention. Unfortunately, these specialists are most often not in polyclinics, but they usually take admission in diagnostic medical centers and clinics of large clinical hospitals.

Very often, mothers ask whether taking a baby or a doctor is enough to know the results of his tests. I can assure you that the diagnosis is established after the examination, and no, even excellent, laboratory data can deny the absence of pathology, when expressed, for example, pain when urinating, there is a specific odor from the diaper, skin manifestations, etc.

What can a doctor determine, based on an external examination of the baby and conversation with you? Of course, to begin with, he will ask you about the increase in weight and appetite of the child, because the majority of congenital malformations are manifested by a poor increase in weight, a lag in development. The doctor will not forget to ask about heredity, so at home thoroughly ask your parents and the husband's parents about the transferred diseases of the excretory system. Some congenital and hereditary diseases of the kidneys can appear already in the period of newborn, others may not manifest themselves until a certain moment. For the assumption of these diseases, a detailed analysis of the pedigree is required. For example, in the case of brothers and sisters of children with a renal ureteral reflex already diagnosed, this pathology occurs in 36.5% of cases.

The history of your pregnancy is also very important for the diagnosis, so it is advisable to have an extract from the hospital and a medical record with the records of specialists who observed pregnancy, at the first visit to the nephrologist. Postponed viral-bacterial infections, the threat of termination of pregnancy at the 8th-9th week, toxicoses of the first half are risk factors for the development of renal pathology in newborns and are always taken into account when making a diagnosis.

Processes or vices?

In infants, in addition to possible infectious processes in the urinary tract, there are also manifestations of congenital malformations, which can be expressed, such as a complete doubling of the kidney, or less pronounced, such as an incomplete duplication of the internal structures (lohanok) of the kidneys. A disorder in the structure of the kidneys or ureters usually creates a prerequisite for an incorrect outflow of urine from the kidneys, which in turn is a favorable background for the growth and reproduction of bacteria that for one reason or another will be close. In the end, all ends again with a manifestation of urinary tract infection. This concept combines various infectious diseases, including cystitis - inflammation of the bladder, pyelonephritis - inflammation of the urinary part of the kidneys, urethritis - inflammation of the urethra, which are later found in adults.

There are so-called external signs - stigma (small developmental anomalies), which are often combined with malformations of internal organs. That's because of these peculiar external features and you can already suspect a malfunction in the structure of internal organs. Stigmata include, for example, the fusion of several fingers, the broad bridge of the nose (of course, if this feature is not a feature of the whole family), wide-set eyes, low ears, double eyelashes, earlobes, large birthmarks and others. The presence of stigmas, of course, does not in any way mean the mandatory presence of malformation on the part of internal organs, it can only increase the likelihood of having such a stigma, and, moreover, there must be at least five of them. For example, according to St. Petersburg researchers, 25% of children with preterm hydronephrosis (renal excretory dilatation) had multiple stigmata, and 31.7% had polycystosis (a large number of cysts in the kidneys). During the examination, among other things, the doctor "sight" will look at the abdomen, in order to detect kidneys in an unusual place or a violation of their structure, increase.

What will research say?

One of the main methods of laboratory testing, allowing to confirm an infectious or other pathological process in the kidneys, is a general urine test. Sometimes parents, coming to the reception, complain of the difficulty of collecting material for analysis, especially for girls. Let's try to find out whether this simple, at first glance, analysis is really important and necessary, and what we can see with it.

The general analysis of urine involves the determination of color, relative density, reaction of urine, protein, sugar, salt. A wasp is also being investigated; with the determination of the number of erythrocytes (red blood cells), white blood cells (white blood cells) and other elements, as well as bacteria.

First of all, the doctor can determine whether the kidneys perform their function, i.e. whether they are able to sufficiently filter blood harmful to the body for metabolic products and, conversely, do not deduce whether they need useful substances. This is indicated by the density or specific gravity of urine. The more dissolved substances in the urine, the higher the density and vice versa. In children up to a year, this indicator can vary from 1002 to 1017 during the day, depending on the time of feeding and receiving fluid. Constantly low values ​​of specific gravity numbers may require additional tests to assess renal function. The presence of protein and sugar can be a signal both for the failure of the filtration process in the kidneys and for diseases of the internal organs, for example, diabetes mellitus (a violation of the absorption of sugar in the blood), which is accompanied by increased excretion of glucose in the urine.

Changing the color of urine from straw-yellow or almost transparent (in children up to 1 year) to dark yellow can talk about problems with the liver. Often parents give babies various medicines, but they forget about the dose or do not know it. A high dose, for example, of all the beloved paracetamol can lead to damage to the liver tissue and, consequently, to the color of urine in a dark yellow and even brown color. Pink and other unusual colors can occur in other diseases.

Often parents ask a question about whether the odor of acetone is normal for urine. In a healthy baby, urine has a characteristic ammonia odor. Acetone also appears with the increased disintegration of stored fat cells in the body due to a lack of nutrients necessary for the body. The consumption of fat reserves is possible with malnutrition, starvation, severe disease with high temperature, diabetes, intensive growth.

The presence of erythrocytes (red blood cells) in urine analysis is possible no more than three - and in single (not in several consecutive) analyzes. For some hereditary diseases, the presence of erythrocytes in the urine is characteristic. In older children, single analyzes with an increased amount of red blood cells are characteristic for the release of a large number of salts, while in the analysis, as a rule, the content of these salts (oxalates or urates) is marked.

But the most important thing is that the urine test informs the doctor about the possible presence of infection in the urinary tract, which is confirmed by an increase in the number of leukocytes (more than 8 in girls and more than 5 in boys). Some parents are puzzled: "How, why? The baby does not bother, he smiles, does not cry, eats well. " This is the whole danger of a urinary tract infection! In addition to bad tests, infection of the urinary tract can not be manifested at first, and in the future, in chronic course, lead to a gradual defeat of the kidney tissues.

In the planned order, the child gives the urine for the first time in 3 months, but on the doctor's order, it should be done immediately.

What examinations can a nephrologist specialist assign to an infant? If a suspected asymptomatic course of infection and (or) to identify the causative agent of infection, the doctor prescribes urine culture. In this case, the urine is collected in sterile dishes and sown to special media in a bacteriological laboratory. Since the growth of bacteria occurs not in an hour and not in two, it usually takes 3 to 5 days to obtain the results. Simultaneously, as a rule, the sensitivity of the sown bacteria to a particular antibiotic is determined, which allows us to prescribe treatment against a specific microorganism.

In an outpatient setting, a child may be assigned repeated ultrasound, and the frequency of the examinations will depend on the suspected or detected pathology and have an interval of 1 -3 months. Do not neglect the appointment of a doctor, tk. Some seemingly insignificant, developmental anomalies with the growth of a child can behave completely unpredictably, therefore require mandatory control. In the event that the baby is confirmed for some kind of violation that requires prompt correction, you and your child will, of course, be referred to a specialized hospital or diagnostic center for a more detailed examination (excretory urography, cystoscopy, cystography, etc.). They will determine the tactics of further treatment for the child.

The main thing that you should learn by reading these lines: timely diagnosis of congenital disorders and infectious processes and fast-prescribed treatment is the guarantee of your child's health in the future. All that is required of the mother is to pass the prescribed examinations with the child and listen to the opinion of specialists.

How to collect material for urinalysis?  

From the correctness of the collection of material for the general analysis of urine, its results largely depend, and consequently, the diagnosis established in the future. Therefore, we focus on the technique of collecting urine in infants.

To collect urine it is necessary to prepare a clean boiled jar, a dry napkin, a tray or a bottle with a wide neck. Before the procedure, the baby is washed with warm water and soap. Both the girl and the boy must be washed in such a way that the water drains from front to back to avoid contamination from the rectum area.

Wash areas are soaked with a tissue. Sometimes, to collect urine, it is enough to detect the time after feeding 15-20 minutes (individually) and simply substitute the jar or tray, putting your hand on the baby's suprapubic area or by using a tap of water from the tap. If it was not possible to stimulate urination in this way, then a test tube, a cone or a rubber pouch - a special urine sampler or a condom is attached to the child's genitals with the help of a sticking plaster, which, of course, is easier to produce in boys. After collection, the material is carried to the laboratory, but never stored since the evening, because with prolonged storage in the urine salt settles and bacteria multiply. Do not squeeze the urine from the diaper for analysis.