Modern Pediatrics.Ukraine.2019.8(104):57-70; doi 10.15574/SP.2019.104.57
Budnik T. V.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

For citation: Budnik TV. (2019). Microbial inflammatory diseases of the urinary system in children. Modern Pediatrics. Ukraine. 8(104): 57-70. doi 10.15574/SP.2019.104.57
Article received: Aug 16, 2019. Accepted for publication: Dec 01, 2019.

The article is the result of a compilation of modern domestic and foreign sources regarding the determining aspects of microbial-inflammatory diseases of the urinary tract in children: prevalence, etiology, pathogenesis, diagnostic and therapeutic algorithms, their level of evidence. Attention is also drawn to the issues of prevention of recurrent urinary tract infection (UTI), rehabilitation and clinical examination of patients. It is noted that UTI is quite common in childhood: 8% of girls and 2% of boys have at least one episode by the age of seven. Peak age is Bimodal, one peak at infancy and the other peak from 2 to 4 years (at the time of toilet training). The most common pathogen is E. coli, which is approximately 85% in the structure of uropathogens of all age groups of children. The clinical signs and symptoms of UTIs depend on the age of the child, but all children with an unclear fever between the ages of 2 and 24 months should be evaluated for UTIs. Assessment of older children may depend on the clinical picture and laboratory symptoms. For example, positive leukocyte esterase and/or nitrite test according to the dipstick test; pyuria of at least 10 leukocytes in the field of view under microscopy and bacteriuria in culture. Physiological mechanisms that counteract the UTI include acidity and free passage of urine, timely emptying of the bladder, intact urogenital and urethral sphincters, as well as complete immunological and mucosal barriers. The abnormality of any of these mechanisms shapes the predisposition to UTI. Renal parenchymal defects are diagnosed in 3–15% of children within one to two years of the first diagnosed UTI. Recently, most authors think that parenchymal scarring due to coronary artery disease occurs in patients with renal dysplasia and with a background of Vesicoureteric Reflux (VUR). The increased rate of E. coli resistance formation has made amoxicillin unacceptable for the empirical treatment of UTI in most children. So the drugs of choice today are cephalosporins and nitrofuran for the lower parts of the urological tract. Preventive courses of antibiotics do not reduce the risk of subsequent episodes of UTI, even in children with mild and moderate VUR.
No conflict of interest was declared by the author.
Key words: microbial-inflammatory diseases, urinary system, children.

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