The pyelonephritis is a upper urinary tract infection (kidneys and pelvis) to be differentiated from cystitis. The latter being a lower urinary tract infection. The pyelonephritis is a severe infection who can destroy the kidney, which is not the case with cystitis.
“In infants, pyelonephritis is very often the cause of renal abnormality : most of the time a vesicoureteric reflux due to the immaturity of the valve, ”explains Dr Jean Lalau Keraly. More rarely, “it can be a pyelo-ureteral junction syndrome. “
Always remember to practice urine analysis at a infant whose only symptom is an isolated fever. You can start with a urine test on a strip : for this it is enough to place a compress in the diaper and to apply the strip on it as soon as the compress is wet, in order to check the presence or not of leukocytes and nitrites. If the strip is positive, aECBU (cytobacteriological examination of the urine) is performed to determine the causative germ.
“It is generally Escherichia Coli, specifies the pediatrician. However, we are moving more and more towards antibiotic resistant germs. “
Pyelonephritis: how is it treated?
The results of an ECBU requiring 48 hours, the antibiotic treatment starts before.
“Depending on the result of the ECBU, the antibiogram and the improvement in the infant’s condition, the antibiotic treatment is continued or modified,” explains Dr Lalau Keraly. In infants less than three months old, “antibiotic therapy is given by intravenous route and therefore requires a hospitalization of a few days. From the age of 4 to 5 months, if the infant is otherwise healthy, and it is a first infection, a oral antibiotic treatment. “
An ultrasound to look for a malformation
It is important to make a ultrasound check after pyelonephritis in order to look for a malformation syndrome such as vesicoureteric reflux or pyelo-urethral junction syndrome. In these cases, regular checks are carried out.
” One antibiotic treatment in small doses and over the long term, over several months, can be put in place ”, explains the pediatrician. In the three quarters of cases, the rvesicoureteric flow heals spontaneously, reassures the pediatrician. But sometimes surgery may be necessary. ” The pyelo-ureteral junction syndrome is a lot less frequent. “It can also heal spontaneously,” informs Dr Lalau Keraly. Otherwise, surgery to correct the malformation is performed. It requires a few days of hospitalization in order to verify that the urine passes well and that the kidneys are functioning properly. “