MULTI-DIMENSIONAL APPROACH FOR CHILDREN’S URINARY TRACT INFECTION (UTI)

 ABSTRACT

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. The condition can occur occasionally or recur frequently. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of this disorder.

INTRODUCTION

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 MANIFESTATIONS

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.

DIAGNOSIS

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 urinary tract infection 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.

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition.

Indicated Remedies	Indications
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.
Staphysagria:	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.
Sarsaparilla:	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	near specific medicine for treating e-coli infection. It helps in treating the recurrence of E coli Infection.

 

CONCLUSION

In a significant number of children, homoeopathic treatment can help to prevent recurrence of frequent urinary tract infection, thus helping children avoid  renal scarring, hypertension & renal insufficiency, the treatment with homoeopathy has two stages in cases of long standing. acute inflammation needs to be treated with a different set of medicines and its recurrence to be treated once the acute stage is over. deep-acting medicines are required to treat the constitution and bring about lasting relief. it is true that this method takes a longer time, but it is also the best one because not only the urinary tract infection are cured but also the patient.