Lecturer: Nykytyuk S.O.

1. Pyelonephritis in children. Etiology, Pathogenesis, Clinics, Diagnostics, Treatment and Prophylactic Lecturer: Nykytyuk S.O.

5. Etiology • Hospitalpatients: • Escherichiacoli: 40% • Coagulase-negative staphylococci: 3% • 'Other' Gram-negativebacteria: 25% • 'Other' Gram-positivebacteria: 16% • Candidaalbicans: 5% • Proteusmirabilis: 11% • Community-acquired UrinaryTractInfections: • Escherichiacoli: 80% • Coagulase-negative staphylococci: 7% • 'Other' Gram-negativebacteria: 4% • 'Other' Gram-positivebacteria: 3% • Proteusmirabilis: 6%

6. Classification of pyelonephritis • Form • Primary • Secondary • Obstructive • Dysembriogenetic • dysmetabolic • Course • Acute • Chronic • Manifest recurrent form • Latent form

7. Classification of pyelonephritis • Period • Active • Period of partial remission • Period of full clinical and laboratory remission • Renal function • Without disorders of renal function • With disorders of renal function • Chronic renal insufficiency

8. Clinical Manifestation • Extrarenal • Syndrome of intoxication • Pain syndrome • Disuria • Renal • Leukocyturia • Bacteriuria (colony count over 100 000/ml) • Mild proteinuria • Slight hematuria • TLC and ESR are high • Decreasing of total diuresis • Decreasing of specific gravity

9. Clinical Manifestation Neonates • Jaundice • Hypothermia or fever • Failure to thrive • Poor feeding • Vomiting Infants • Poor feeding • Fever • Vomiting, diarrhea • Strong-smelling urine

10. Plan of examination • Fool blood count • urinanalysis • Nechepurenko’s test • Kakovsky-Addis test • Ambyrze’s test • urine culture (more than 10,000 CFU from bladder) • Zimnitskiy’s test • Biochemical test of blood • Serum level of electrolytes • total protein, albumin and globulin level • residual nitrogen, blood urea, creatinine • Creatinine clearance • Ultrasonography of kidneys and urinary bladder. • Excretory urography • Nuclearcystography • Forgirls - swabfromthevagina

11. Data of excreatory urography • Acute pyelonephritis • Kidney is enlarged • Hypotonia of the ureters • Chronic pyelonephritis • Asymmetry of the kidneys • Deformation of calyco-pelvic system • Irregular excretion of contrast substance up to adynamia of calico-pelvic system • chronic secondary pyelonephritis • Obstruction of the urinary tract • Congenital malformations • Refluxes • Renal dysplasia

12. Data of excreatory urography

13. Excreatory urography

15. Excreatory urography

16. Diversity of reflux in the way of infection in renal tissue

17. neurogenic bladder dystonia

18. Aplasia left kidney

19. Hypoplasia left kidney

20. Different versions of doubling kidney

21. The difference between Nephroptosis and dystopiya

22. Cross dystopiya kidney

23. horseshoe–like kidney

24. Galeta-shape kidney

25. L-like kidney S-like kidney

27. Sources lymphogenous and hematogenous infection

28. Treatment • Antibacterial treatment (for 8-10 days, two cycles) - BENZYLPENICILLIN Na - 20.000-50.000 U/kg – 7-10 days • amoxiclav 25-50 mg/kg, • or cefotaxim 100-150 mg/kg, • or ceftriaxon 100 mg/kg, • or ciprophloxacin 10-20 mg/kg per day in 2 equal doses. • or macropen 30-50 mg/kg • Gentamicyn 4-7 mg/kg

29. Uroseptics • Furadonin, furagin 5-8 mg/kg 4 times per day • Nalidixic acid (negram, nevigramon) 50-60 mg/kg 4 times per day • 5-NOK, nitroxolin 8-10 mg/kg 4 times per day • Biseptol (sulfamethoxazole, trimetoprim 2 mg/kg) twice a day

30. Thank you for attention