Urinary tract infection (UTI) is one of the most common pediatric infections.
It distresses the child, concerns the parents, and may cause permanent kidney
damage. A urinary
tract infection (UTI) is
a bacterial infection that affects any part of the urinary tract. Acute
pyelonephritis in children may lead to renal scarring with the risk of later
hypertension, preeclampsia during pregnancy, proteinuria, and renal
insufficiency. Recurrence of UTI is the most troublesome part. It tends to
recur quite frequently in some childrens; so much so that people may have
multiple attacks (up to 6-7 ) in one year.
Aetiology
UTIs are generally ascending in origin and caused
by perineal contaminants, usually bowel flora. However, in neonates, infection
is assumed to be hematogenous in origin rather than ascending. This feature may
explain the nonspecific symptoms associated with UTI in these patients. After
the neonatal period, bacteremia is generally not the source of infection;
rather, UTI or pyelonephritis is the cause of the bacteremia.
Bacteria cause the large majority of urinary tract infections in
children. Viral infection of the bladder is less common, while fungal
infections of the urinary tract are rare and occur most commonly in
immunocompromised individuals
Bacterial
sources include the following:
·
Escherichia coli - This is by far the most
common organism, causing more than 90% of all cases of acute pyelonephritis
·
Extended-spectrum beta-lactamase–producing E
coli is becoming more frequent
·
Klebsiella oxytoca and species
·
Proteus species
·
Enterococcus faecalis and species
·
Gram-positive organisms, including staphylococcal
species and group BStreptococcus- These are rare causes of acute
pyelonephritis
Risk Factor
Until now, High grade Vesicoureteral reflux (VUR) has been considered
the most important risk factor for post-UTI renal scar formation in children.
VUR predisposes children with UTI to pyelonephritis, and both are associated
with renal scarring. Reflux nephropathy is not always acquired; rather, it
reflects reflux-associated congenital dysplastic kidneys.
Congenital or acquired anomalies, including dysplasia, hypoplasia, and
obstruction, increase the risk for UTI, VUR, and pyelonephritis.
Pathogenesis
The exact pathogenesis of renal scarring following acute
pyelonephritis is not well understood. the acute inflammatory response that is
meant to eradicate the invading bacteria is also responsible for early renal
parenchymal damage and subsequent scarring. This process is an inflammatory
response that features chemotaxis, phagocytosis, the release of lysosomal
enzymes and superoxides, the production of peroxide and hydroxyl radicals,
tubular ischemia, and reperfusion injury. The fibrosis that follows is
initiated mainly by macrophages.
The pathogenesis of proteinuria in reflux nephropathy is also not well
understood, and it is variably attributed to immunological injury,
macromolecular trapping and mesangial dysfunction, vascular alterations and
hypertension, and glomerular hyperfiltration.
Hypertension occurs in 10 to 30% of children and young adults with renal
scarring, and it may take up to 8 years to develop. The exact cause of
hypertension due to renal scarring is not known, but it is believed to be due
to segmental ischemia with increased renin secretion, and it is not dependent
on scarring severity. However, the belief that infection and VUR are the cause
of upper tract parenchymal damage is undergoing critical review. Increasing
knowledge shows that reflux nephropathy is not always acquired but that it
rather reflects reflux-associated damage related to congenital dysplastic
kidneys.
Clinical Features & Diagnosis
Signs and symptoms of urinary tract
infection (UTI) and pyelonephritis vary with the age of the patient. Neonates
often present with nonspecific symptoms of jaundice, hypothermia or fever, poor
feeding, vomiting, and failure to thrive. Neonates, especially male newborns,
may develop hyponatremia and hyperkalemia as a result of secondary
pseudohypoaldosteronism.
Infants and young children aged 2 months
to 2 years often present with nonspecific symptoms of fever lasting longer than
48 hours, as well as with poor feeding, vomiting, and diarrhea. Their urine may
be malodorous; hematuria may be noted.
Preschoolers and school-age children
present with fever for greater than 48 hours. They may complain of abdominal
pain or flank pain. Vomiting, diarrhea, and anorexia may be present. Their
urine is typically malodorous, and hematuria may be noted. Voiding-related
symptoms including enuresis, dysuria, urgency, and frequency, may occur but
need not be present.
Physical examination findings in
pediatric patients with UTI can be summarized as follows: Costovertebral angle
tenderness, Abdominal tenderness to palpation, Suprapubic tenderness to
palpation, Palpable bladder, Dribbling, poor stream, or straining to void
The American Academy of Pediatrics (AAP)
criteria for the diagnosis of UTI in children 2-24 months are the presence of
pyuria and/or bacteriuria on urinalysis and of at least 50,000 colony-forming
units (CFU) per mL of a uropathogen from the quantitative culture of a properly
collected urine specimen.
Laboratory studies includes Complete blood count (CBC) and basic
metabolic panel (for children with a presumptive diagnosis of pyelonephritis), Blood
cultures (in patients with suspected bacteremia or urosepsis), Renal function
studies (ie, serum creatinine and blood urea nitrogen [BUN] levels), Electrolyte
levels.
Voiding cystourethrography (VCUG) may be
indicated after a first febrile UTI if renal and bladder ultrasonography reveal
hydronephrosis, scarring, obstructive uropathy, or masses or if complex medical
conditions are associated with the UTI.
Management
Natural Treatment
·
Cranberry Juice produces hippuric acid in
the urine. This acidifies urine and inhibits bacterial growth. Try to drink 1
liter of UNSWEETENED cranberry juice daily.
·
Take one teaspoon of colloidal
silver morning and night. This is a natural antibiotic that destroys
bacteria, viruses, and fungal growth.
·
Vitamin C acidifies urine and thereby inhibits
bacterial growth.
·
Celery, parsley, watermelon are natural diuretics
– drink juice made with these fruits and vegetables.
·
The most important thing is to drink – lots! Pure
water is good – try to drink a glass every hour.
·
Stay away from coffee, alcohol, all sweetened
drinks, sugar, and processed foods.
HOMOEOPATHIC MANAGEMENT
Homeopathic remedies for Uti has a great role to
play in curing the infection and also in stopping their recurrence. Moreover
homeopathic medicines are very safe . They use body’s own defenses to fight the
infection. Once treated with homeopathic medicines recurrence of Urinary Tract
Infection greatly reduces and eventually stops. The top homeopathic remedies for treating UTI are
Cantharis: Strong urging to urinate—with cutting pains that are felt before the
urine passes, as well as during and after—may indicate a need for this remedy.
Only several drops pass at a time, with a scalding sensation. The person may
feel as if the bladder has not been emptied, still feeling a constant urge to
urinate.
Clematis: This remedy may be indicated if a person has to urinate frequently with
only a small amount being passed. A feeling of constriction is felt in the
urinary passage, and the flow may be interrupted, or there may be dribbling
afterward. A tingling sensation may occur, lasting long after urination is
finished.
Equisetum: If cystitis is accompanied by dull but distressing pain and a feeling of
fullness in the bladder, even after urinating, this remedy may be helpful.
Urging and discomfort are more intense when the bladder has recently been
emptied, improving over time as the bladder become more full.
Aconitum napellus: This remedy is often useful when a person feels anxious
both before and during urination, with hot, scanty urine, and a burning or
spasmodic feeling in the outlet of the bladder. It can also be helpful if
retention of urine occurs after a person has been very cold and chilled, or
after a shaking experience.
Apis mellifica: This remedy is indicated when the person frequently needs
to urinate, but only small quantities are passed. Stinging and burning
sensations are felt (especially with the last few drops) and the person may
also experience soreness in the abdomen. Heat and touch make the symptoms
worse, and cold applications, cool bathing, and open air bring relief. A lack
of thirst is another indication that Apis may be needed.
Belladonna: This remedy may be beneficial if urging to urinate is frequent and
intense, and the bladder feels very sensitive. A cramping or writhing sensation
may be felt in the bladder area. Small amounts of highly-colored urine pass.
(This remedy is sometimes helpful if a person passes small amounts of blood and
no serious cause can be found on medical examination.)
Berberis vulgaris: Cystitis with twinges of cutting pain, or a burning feeling
that extends to the urethra and its opening, may indicate a need for this
remedy. The passage may also burn at times when no attempt at urination is
being made. After emptying the bladder, the person feels as if some urine still
remains inside. Urging and discomfort are often worse from walking.
Borax: This remedy can be helpful for cystitis with smarting pain in the
urinary opening and aching in the bladder, with a feeling that the urine is
retained. Children may cry or shriek, afraid to urinate because they know the
pain is coming. Borax is
often indicated for people who are sensitive to noise and inclined toward
motion sickness.
Chimaphila umbellata: If a person has a troublesome urge to urinate but has to
strain (or even stand up and lean forward) to make it pass, this remedy may be
useful. A scalding sensation may be felt while the urine flows, with a feeling
of straining afterward.
Causticum: In paralytic conditions about the
bladder Causticum deserves first place. It is one of our great remedies in
enuresis, and its characteristics are involuntary micturition at night in
sleep, when coughing, sneezing or blowing the nose, showing a weakness of the
sphincter.
Mercurius corrosives:
Has tenesmus of the bladder with intense burning. The burning is less, but the
tenesmus is greater, than in Cantharis. The passing of the urine drop by drop
reminds of Aconite, which has the same symptoms.
Lycopodium: This remedy may be helpful if a person has to urinate frequently during
the night and passes large amounts of urine. Or the person may feel a painful
urge, but has to strain to make the urine flow. Pain may be felt in the back
before the urine passes. (If fever is present, the urine has a reddish color,
or discomfort is felt in the kidney region, the person should see a doctor.)
Nux vomica: Irritable bladder with a constant need to urinate, passing
only small amounts, suggests a need for this remedy. Burning or cramping pain
may be felt in the bladder area, with an itching sensation in the urethra while
the urine passes. The person may feel very irritable, impatient, and chilly.
Symptoms may be relieved by hot baths or other forms of warmth.
Terebinth: The urine of Terebinth is one of its
most characteristic features. It is smoky, turbid, depositing a sediment like
coffee grounds, which indicates the presence of disintegrated blood cells.
Haematuria from venous congestion of the kidneys calls often for Terebinth. It
has burning during micturition and most painful strangury; the urine, too, may
contain albumen and has the odor of violets.
Sarsaparilla: This remedy is often useful in cystitis and often helps when symptoms
are unclear, or if other remedies have not been effective. Frequent urging is
felt, with burning pain at the end of urination. Urine passes when the person
is standing up, but only dribbling occurs while sitting. Flakes or sediment are
sometimes seen in the urine. (Sarsaparilla is sometimes helpful when stones are forming or the kidneys
are involved; however, these conditions need a doctor’s care.)
Sepia: This remedy may be helpful if a person has to urinate frequently, with
sudden urging, a sense that urine will leak if urination is delayed, and small
amounts of involuntary urine loss. The person may experience a bearing-down
feeling in the bladder region, or pressure above the pubic bone. A person who
needs this remedy often feels worn-out and irritable, with cold extremities,
and a lax or sagging feeling in the pelvic area.
Staphysagria: This remedy is often indicated for cystitis that develops in a woman
after sexual intercourse, especially if sexual activity is new to her, or if
cystitis occurs after every occasion of having sex. Pressure may be felt in the
bladder after urinating, as if it is still not empty. A sensation that a drop
of urine is rolling through the urethra, or a constant burning feeling, are
other indications. Staphysagria is also useful for cystitis that develops after illnesses with extended
bed rest, or after the use of catheters.
Coli Bacillinum is a near specific medicine for treating e-coli
infection. It helps in treating the recurrence of E coli Infection.
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