Comparative evaluation of the results of conservative and surgical methods of treatment of children with destructive forms of pyelonephritis

Abstract

BACKGROUND: The relevance of destructive pyelonephritis in pediatric practice is determined by frequency of various complications of the disease associated with a high risk of irreversible morphofunctional changes in parenchyma of affected kidney, the lack of tactical consensus in the professional community and regulatory documents regulating the procedure for diagnostic and therapeutic support of this contingent of patients.

AIM: Substantiation of the tactics of effective treatment children with destructive pyelonephritis, based on the results of a multifactorial retrospective analysis of the course and outcomes of the disease.

MATERIALS AND METHODS: The results of the analysis of medical documentation of 38 patients with destructive pyelonephritis aged 3–204 months (median 93.5) who received inpatient treatment in 2015–2019 in three specialized clinics in Moscow are presented.

RESULTS: More than half of the patients (28 children) in the acute period of the disease received conservative therapy, including infusion and antibacterial, the escalation of which was carried out with the preservation or increase of manifestations of the systemic inflammatory response syndrome, as well as negative dynamics according to ultrasound or CT data. In the group of patients (n = 10), indications for surgical treatment were formulated – decapsulation of the kidney, opening of apostemas and abscessed foci, drainage of the paranephral space. During the examination in catamnesis, realized in 50%. It was found that in the majority (91%) of children treated conservatively, a statistically significant decrease in the volume of the kidney on the affected side was registered. These complications were not detected among the operated patients.

CONCLUSION: The pharmacy of choice for starting antibacterial therapy should be inhibitor-protected beta-lactams, carbapenems, if the etiological significance of staphylococcus is suspected, it is advisable to connect linezolid. In case of laboratory signs of hypercoagulation, it is necessary to connect anticoagulants. Surgical tactics can minimize the risk of complications associated with the purulent-destructive process, contributing to regenerative processes in the kidney parenchyma. The objectification of the results of the catamnestic examination is due to the performance of nephroscintigraphy.

Keywords

destructive pyelonephritis / children / conservative therapy / surgical treatment

References

[1] Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-Based Epidemiologic Analysis of Acute Pyelonephritis. Clinical Infectious Diseases. 2007;45(3):273–280. DOI: 10.1086/519268

[2] Czaja C.A., Scholes D., Hooton T.M., Stamm W.E. Population-Based Epidemiologic Analysis of Acute Pyelonephritis // Clinical Infectious Diseases. 2007. Vol. 45. No. 3. P. 273–280. DOI: 10.1086/519268

[3] Chung VY, Tai CK, Fan CW, Tang CN. Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality. Hong Kong Med J. 2014;20(4):285–289. DOI: 10.12809/hkmj134061

[4] Chung V.Y., Tai C.K., Fan C.W., Tang C.N. Severe acute pyelonephritis: a review of clinical outcome and risk factors for mortality // Hong Kong Med J. 2014. Vol. 20. No. 4. P. 285–289. DOI: 10.12809/hkmj134061

[5] Glybochko PV, Alyaev YuG. Prakticheskaya urologiya: rukovodstvo dlya vrachei. Moscow: Medforum, 2012. 288–301 p. (In Russ.)

[6] Глыбочко П.В., Аляев Ю.Г. Практическая урология: руководство для врачей. М.: Медфорум, 2012. 288–301 c.

[7] Choong FX, Antypas H, Richter-Dahlfors A. Integrated Pathophysiology of Pyelonephritis. Microbiol Spectr. 2015,3(5). DOI: 10.1128/microbiolspec.UTI-0014-2012

[8] Choong F.X., Antypas H., Richter-Dahlfors A. Integrated Pathophysiology of Pyelonephritis // Microbiol Spectr. 2015. Vol. 3. No. 5. DOI: 10.1128/microbiolspec.UTI-0014-2012

[9] Schrier RW, Gottschalk CW. Diseases of the kidney. 6th ed. Boston: Little brown and company, 1997. 947–959 p.

[10] Schrier R.W., Gottschalk C.W. Diseases of the kidney. 6th ed. Boston: Little brown and company, 1997. 947–959 p.

[11] Angel C, Shu T, Green J, et al. Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm. Pediatr Surg Int. 2003;19(1-2):35–39. DOI: 10.1007/s00383-002-0888-y

[12] Angel C., Shu T., Green J., et al. Renal and peri-renal abscesses in children: proposed physio-pathologic mechanisms and treatment algorithm // Pediatr Surg Int. 2003. Vol. 19. No. 1-2. P. 35–39. DOI: 10.1007/s00383-002-0888-y

[13] Chen CY, Kuo HT, Chang YJ, et al. Clinical assessment of children with renal abscesses presenting to the pediatric emergency department. BMC Pediatr. 2016;16(1):189. DOI: 10.1186/s12887-016-0732-5

[14] Chen C.Y., Kuo H.T., Chang Y.J., et al. Clinical assessment of children with renal abscesses presenting to the pediatric emergency department // BMC Pediatr. 2016. Vol. 16. No. 1. P. 189. DOI: 10.1186/s12887-016-0732-5

[15] Lee BE, Seol HY, Kim TK, et al. Recent Clinical overview of renal and perirenal abscesses in 56 consecutive cases. The Korean Journal of Internal Medicine. 2008;23(3):140–148. DOI:10.3904/kjim.2008.23.3.140

[16] Lee B.E., Seol H.Y., Kim T.K., et al. Recent Clinical overview of renal and perirenal abscesses in 56 consecutive cases // The Korean Journal of Internal Medicine. 2008. Vol. 23. No. 3. P. 140–148. DOI: 10.3904/kjim.2008.23.3.140

[17] Konca C, Tekin M, Uckardes F, et al. Antibacterial Resistance Patterns of Pediatric Community-Acquired Urinary Infection: Overview. Pediatr Int. 2017;59(3):309–315. DOI: 10.1111/ped.13139

[18] Konca C., Tekin M., Uckardes F., et al. Antibacterial Resistance Patterns of Pediatric Community-Acquired Urinary Infection: Overview // Pediatr Int. 2017. Vol. 59. No. 3. P. 309–315. DOI: 10.1111/ped.13139

[19] Roberts KB. Revised AAP Guideline on UTI in Febrile Infants and Young Children. Am Fam Physician. 2012;86(10):940–946.

[20] Roberts K.B. Revised AAP Guideline on UTI in Febrile Infants and Young Children // Am Fam Physician. 2012. Vol. 86. No. 10. P. 940–946.

[21] Grabe M, Bartoletti R, Bjerklund-Johansen TB, et al. Guidelines on Urological Infections. Updates. 2014;(7):48–59.

[22] Grabe M., Bartoletti R., Bjerklund-Johansen T.B., et al. Guidelines on Urological Infections // Updates. 2014. Vol. 7. P. 48–59.

[23] Kutasy B, Coyle D, Fossum M. Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance. A Pediatric Urologist’s View. European Urology Focus. 2017;3(2-3):207–211. DOI: 10.1016/jeuf.2017.09.013

[24] Kutasy B., Coyle D., Fossum M. Urinary Tract Infection in Children: Management in the Era of Antibiotic Resistance. A Pediatric Urologist’s View // European Urology Focus 2017. Vol. 3. No. 2-3. P. 207–211. DOI: 10.1016/jeuf.2017.09.013

[25] adyrov ZA, Ribun VV, Odylov AY. Our experience with retroperitoneoscopy for pyoinflammatory diseases of kidneys and retroperitoneum. Experimental & clinical urology. 2016(1):70–77. (In Russ.)

[26] Кадыров З.А., Рибун В.В., Одилов А.Ю. Наш опыт ретроперитонеоскопического лечения гнойно-воспалительных заболеваний почек и забрюшинного пространства // Экспериментальная и клиническая урология. 2016. № 1. С. 70–77.

[27] Loran OB, Sinyakova LA, Kosova IV. Sovremennye podkhody k diagnostike i lecheniyu ostrogo neobstruktivnogo pielonefrita u zhenshchin. Medical council. 2008;(1-2):27–31. (In Russ.)

[28] Лоран О.Б., Синякова Л.А., Косова И.В. Современные подходы к диагностике и лечению острого необструктивного пиелонефрита у женщин // Медицинский совет. 2008. № 1-2. С. 27–31.

[29] Wang VS, Lee MT, Chiou JY. Relationship between Blood Lead Levels and Renal Function in Lead Battery Workers. International Archives of Occupational and Environmental Health. 2002;75:569–575. DOI: 10.1007/s00420-002-0362-0

[30] Wang V.S., Lee M.T., Chiou J.Y. Relationship between Blood Lead Levels and Renal Function in Lead Battery Workers // International Archives of Occupational and Environmental Health. 2002. Vol. 75. P. 569–575. DOI: 10.1007/s00420-002-0362-0

[31] Sharma P, Thapa L. Acute pyelonephritis in pregnancy: a retrospective study. Aust New Zeal J Obstet Gynaecol. 2007;47(4):313–315. DOI: 10.1111/j.1479-828X.2007.00752.x

[32] Sharma P., Thapa L. Acute pyelonephritis in pregnancy: a retrospective study // Aust New Zeal J Obstet Gynaecol. 2007. Vol. 47. No. 4. P. 313–315. DOI: 10.1111/j.1479-828X.2007.00752.x

[33] Kagantsov IM, Sizonov VV, Dubrov VI, et al. Renal abscess in children. Urologiia. 2021;3:129–135. (In Russ.) DOI: 10.18565/urology.2021.3.131-37

[34] Каганцов И.М., Сизонов В.В., Дубров В.И., и др. Абсцесс почки у детей // Урология. 2021. Т. 3. С. 129–135. DOI: 10.18565/urology.2021.3.131-37

[35] Linder BJ, Granberg CF. Pediatric renal abscesses: A contemporary series. Journal of Pediatric Urology. 2015;12(2):99.e1–99.e5. DOI: 10.1016/j.jpurol.2015.05.037

[36] Linder B.J., Granberg C.F. Pediatric renal abscesses: A contemporary series // Journal of Pediatric Urology. 2015. Vol. 12. No. 2. P. 99.e1–99.e5. DOI: 10.1016/j.jpurol.2015.05.037

[37] Anan’ev VA, Antonov AV. Our own method of combined treatment of acute purulent purulent pyelonephritis: first results. Urologicheskie vedomosti. 2017;7(3):34–37. (In Russ.) DOI: 10.17816/uroved7334-37

[38] Ананьев В.А., Антонов А.В. Собственная методика комбинированного лечения острого гнойного пиелонефрита: первые результаты // Урологические ведомости. 2017. Т. 7, № 3. С. 34–37. DOI: 10.17816/uroved7334-37

[39] Arbuliev КМ. Surgical policy in complicated forms of acute purulent pyelonephritis. Urologiia. 2008;(1):15–20. (In Russ.)

[40] Арбулиев К.М. Оперативная тактика при осложненных формах острого гнойного пиелонефрита // Урология. 2008. № 1. С. 15–20.

[41] Ramakrishnan K, Scheid DC. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005;71(5):933–942.

[42] Ramakrishnan K., Scheid D.C. Diagnosis and management of acute pyelonephritis in adults // Am Fam Physician. 2005. Vol. 71. No. 5. P. 933–942.

[43] Cheng CH, Tsai MH, Su LH, et al. Renal abscess in children: a 10-year clinical and radiologic experience in a tertiary medical center. The Pediatric Infectious Disease Journal. 2008;27(11):1025–1027. DOI: 10.1097/INF.0b013e31817b617b

[44] Cheng C.H., Tsai M.H., Su L.H., et al. Renal abscess in children: a 10-year clinical and radiologic experience in a tertiary medical center // The Pediatric Infectious Disease Journal. 2008. Vol. 27. No. 11. P. 1025–1027. DOI: 10.1097/INF.0b013e31817b617b

[45] Palagin IS, Sukhorukova MV, Dekhnich AV, et al. Antimicrobial resistance of pathogens causing community-acquired urinary tract infections in Russia: results of multicenter study “DARMIS-2018”. Clinical microbiology and antimicrobial chemotherapy. 2019;21(2):134–146. (In Russ.) DOI: 10.36488/cmac.2019.2.134-146

[46] Козлов Р.С., Палагин И.С., Сухорукова М.В., и др. Антибиотикорезистентность возбудителей внебольничных инфекций мочевых путей в России: результаты многоцентрового исследования «ДАРМИС-2018» // Клиническая микробиология и антимикробная химиотерапия. 2019. Т. 21, № 2. С. 134–146. DOI: 10.36488/cmac.2019.2.134-146

[47] Beloborodov VB, Gusarov VG, Dekhnich AV, et al. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms. Messenger of anesthesiology and resuscitation. 2020;17(1):52–83. (In Russ.) DOI: 10.21292/2078-5658-2020-16-1-52-83

[48] Белобородов Б.В., Гусаров В.Г., Дехнич А.В., и др. Методические рекомендации Российской некоммерческой общественной организации «Ассоциация анестезиологов-реаниматологов», Межрегиональной общественной организации «Альянс клинических химиотерапевтов и микробиологов», Межрегиональной ассоциации по клинической микробиологии и антимикробной химиотерапии (МАКМАХ), общественной организации «Российский Сепсис Форум» «Диагностика и антимикробная терапия инфекций, вызванных полирезистентными микроорганизмами» // Вестник анестезиологии и реанимации. 2020. Т. 17. № 1. С. 52–83. DOI: 10.21292/2078-5658-2020-16-1-52-83

[49] Koçak M, Büyükkaragöz B, Çelebi Tayfur A, et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection. Pediatr Int. 2016;58(6):467–471. DOI: 10.1111/ped.12842

[50] Koçak M., Büyükkaragöz B., Çelebi Tayfur A., et al. Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection // Pediatr Int. 2016. Vol. 58. No. 6. P. 467–471. DOI: 10.1111/ped.12842

[51] Stein R, Dogan HS, Hoebeke P, et al. Urinary Tract Infections in Children: EAU/ESPU Guidelines. European urology. 2015;67(3):546–558. DOI: 10.1016/j.eururo.2014.11.007

[52] Stein R., Dogan H.S., Hoebeke P., et al. Urinary Tract Infections in Children: EAU/ESPU Guidelines // European urology. 2015. Vol. 67. No. 3. P. 546–558. DOI: 10.1016/j.eururo.2014.11.007

[53] Woo B, Jung Y, Kim HS. Antibiotic susceptibility patterns in children with urinary tract infection: a retrospective study of 8 years in one center. Original Article Child Kidney Dis. 2019;23(1):22–28. DOI: 10.3339/jkspn.2019.23.1.22

[54] Woo B., Jung Y., Kim H.S. Antibiotic susceptibility patterns in children with urinary tract infection: a retrospective study of 8 years in one center // Original Article Child Kidney Dis. 2019. Vol. 23. No. 1. P. 22–28. DOI: 10.3339/jkspn.2019.23.1.22

[55] Nelson JD. Nelson`s Pediatric Antimicrobial Therapy. American Academy of Pediatrics 26th Edition. 2020:121–123.

[56] Nelson J.D. Nelson`s Pediatric Antimicrobial Therapy // American Academy of Pediatrics 26th Edition. 2020. P. 121–123.

[57] Safina AI. Pyelonephritis in young children: a modern approach to diagnosis and treatmen. Practical medicine. 2012;(7-1):50–56. (In Russ.)

[58] Сафина А.И. Пиелонефрит у детей раннего возраста: современные подходы к диагностике и лечению // Практическая медицина. 2012. № 7-1. С. 50–56.

[59] Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases. Clin Infect Dis. 2011;52(5):103–120. DOI: 10.1093/cid/ciq257

[60] Gupta K., Hooton T.M., Naber K.G., et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases // Clin Infect Dis. 2011. Vol. 52. No. 5. P. 103–120. DOI: 10.1093/cid/ciq257

[61] Shishimorov IN, Magnitskaya OV, Shatalova OV, et al. Urinary tract infections in children. Journal of VolgSMU. 2020;(2):3–8. (In Russ.) DOI: 10.19163/1994-9408-2020-2(74)-3-8

[62] Шишиморов И.Н., Магницкая О.В., Шаталова О.В., и др. Инфекции мочевыводящих путей у детей // Вестник ВолгГМУ. 2020. № 2. С. 3–8. DOI: 10.19163/1994-9408-2020-2(74)-3-8

[63] Svirin PV, Vdovin VV, Sukhanova GA, et al. Faktory patologicheskogo trombo-obrazovaniya u detei i podrostkov s trombozami, ne svyazannymi s kateteriza-tsiei sosudov. Pediatria. Journal named after G.N. Speransky. 2009;87(4):73–78. (In Russ.)

[64] Свирин П.В., Вдовин В.В., Суханова Г.А., и др. Факторы патологического тромбообразования у детей и подростков с тромбозами, не связанными с катетеризацией сосудов // Педиатрия. 2009. Т. 87, № 4. С. 73–78.

[65] Bitsori M, Raissaki M, Maraki S, Galanakis E. Acute focal bacterial nephritis, pyonephrosis and renal abscess in children. Pediatr Nephrol. 2015;30(11):1987–1993. DOI: 10.1007/s00467-015-3141-3

[66] Bitsori M., Raissaki M., Maraki S., Galanakis E. Acute focal bacterial nephritis, pyonephrosis and renal abscess in children // Pediatr Nephrol. 2015. Vol. 30. No. 11. P. 1987–1993. DOI: 10.1007/s00467-015-3141-3

[67] Poliantsev AA, Demidenko YA, Sidorov DN, Kouznetsov AA. Ways of improvement in diagnostics of acute destructive pyelonephritis. Journal of VolgSMU. 2011;(3):18–20. (In Russ.)

[68] Полянцев А.А., Демиденко Я.А., Сидоров Д.Н., Кузнецов А.А. Пути улучшения диагностики острого деструктивного пиелонефрита // Вестник ВолгГМУ. 2011. Т. 3, № 39. С. 18–20.

[69] Chernova YuG, Nejmark AI, Momot AP. Effect of cryoprecipitate on neoangiogenesis in patients with purulent pyelonephritis. Urology reports (St. Petersburg). 2020;10(1):43–49. (In Russ.) DOI: 10.17816/uroved10143-49

[70] Чернова Ю.Г., Неймарк А.И., Момот А.П. Влияние криопреципитата на неоангиогенез у больных гнойным пиелонефритом // Урологические ведомости. 2020. Т. 10, № 1. С. 43–49. DOI: 10.17816/uroved10143-49

[71] Sinyakova LA, Bernikov EV, Loran OB. Kidneys functional state in patients suffered purulent pyelonephritis. Urology herald. 2018;6(4):49–59. (In Russ.) DOI: 10.21886/2308-6424-2017-6-4-49-59

[72] Синякова Л.А., Берников Е.В., Лоран О.Б. Функциональное состояние почек у больных, перенесших гнойный пиелонефрит // Вестник урологии. 2018. Т. 6, № 4. С. 49–59. DOI: 10.21886/2308-6424-2017-6-4-49-59

RIGHTS & PERMISSIONS

Kuzovleva G.I., Grushitskaya E.V., Staroverov O.V., Rostovskaya V.V., Shmyrov O.S., Zakharov A.I.