kidney infections (Pyelonephritis) - Neonatal Disorders

What is Pyelonephritis?

Pyelonephritis is a type of kidney infection that typically starts in the bladder or urethra and travels up to one or both kidneys. It is a serious condition that requires prompt medical attention, especially in children, to prevent potential complications.

What Causes Pyelonephritis?

The most common cause of pyelonephritis in children is a bacterial infection, often by Escherichia coli (E. coli). Other bacteria can also be responsible. The infection usually begins as a urinary tract infection (UTI) that spreads to the kidneys.

Who is at Risk?

Children, particularly girls, are at higher risk due to their shorter urethras, which make it easier for bacteria to reach the bladder. Other risk factors include:

Previous UTIs
Vesicoureteral reflux (VUR), where urine flows backward from the bladder to the kidneys
Urinary tract abnormalities
Impaired immune system
Incomplete bladder emptying

What are the Symptoms?

Symptoms of pyelonephritis in children can vary depending on age but commonly include:

High fever
Chills
Abdominal or back pain
Nausea and vomiting
Frequent urination
Painful urination
Blood in the urine

Infants may exhibit nonspecific symptoms such as irritability, poor feeding, and failure to thrive.

How is Pyelonephritis Diagnosed?

Diagnosis begins with a thorough medical history and physical examination. Tests may include:

Urinalysis: To check for bacteria, white blood cells, and other signs of infection.
Urine culture: To identify the specific bacteria causing the infection.
Blood tests: To check for signs of infection and kidney function.
Imaging studies: Ultrasound, VCUG (voiding cystourethrogram), or DMSA scan to assess the kidneys and urinary tract.

What is the Treatment?

Treatment usually involves antibiotics. The choice of antibiotic and duration of treatment depend on the severity of the infection and the child's age. Hospitalization may be required for severe cases, or if the child is very young, to administer antibiotics intravenously and monitor for complications.

Can Pyelonephritis be Prevented?

Preventive measures include:

Encouraging children to drink plenty of fluids.
Ensuring regular and complete emptying of the bladder.
Proper toilet hygiene, especially for girls, to prevent bacteria from entering the urinary tract.
Prompt treatment of any UTIs to prevent them from spreading to the kidneys.
Regular follow-up with a pediatrician if the child has a history of UTIs or urinary tract abnormalities.

What are the Potential Complications?

If left untreated, pyelonephritis can lead to serious complications such as:

Kidney damage or scarring, which can affect kidney function.
Sepsis, a life-threatening response to infection.
Hypertension (high blood pressure) later in life.

Early diagnosis and appropriate treatment are crucial to prevent these complications.