International Medical Journal, Vol. 21., Iss. 4, 2015, P. 24−27.
TOPICAL ISSUES OF DIAGNOSIS AND TREATMENT OF PYELONEPHRITIS IN EARLY-AGE CHILDREN
Kharkiv National Medical University, Ukraine
Urinary tract infections represent the most common bacterial infection in children under 2 years. Questions of treatment and diagnosis of pyelonephritis in infants and toddlers are topical issues due to the increasing prevalence of the disease, peculiarities of course, difficulties of diagnosis, and limited options of antibacterial therapy in children under 3 years. One hundred ninety−eight histories of children with pyelonephritis (92 cases of infants and 106 cases of 1−3−year−old children) were analyzed. The diagnosis was made and treatment was administered according to the national standards. Age and gender peculiarities of prevalence (decrease in prevalence in boys with age in contrast to increase in girls), clinical presentation (increase in oligosymptomatic or asymptomatic course of pyelonephritis), pathogenetic mechanisms of development (high level of urogenital abnormalities and vesicoureteral reflux) and etiology (shift to Gram−negative bacterial infection, decrease in antibacterial sensitivity) of pyelonephritis in children under 3 years were revealed. Every other patient with pyelonephritis had one or more risk factors for urinary tract infections such as compromised obstetric and gynecological history, pathology of pregnancy and labor, hereditary predisposition, phymosis, gastrointestinal disorders (constipations, disbacteriosis), rickets etc. Increase in pyelonephritis morbidity, high frequency of oligosymptomatic or asymptomatic course in infants and toddlers demand laboratory and instrumental investigations of the children with risk factors for early detection of urinary tract anomalies and pyelonephritis. With due account for potential recurrent and chronic course of pyelonephritis in children (particular with urodynamic problems), alternation of causative factors, heterogeneous spectrum of bacterial infection in different regions regular microbiological monitoring as well as detection of microbial associations are necessary for eradication of the infection.
Key words: pyelonephritis, early−age children, diagnosis, treatment, microbiological monitoring.