Constant increase in frequency of microbial inflammatory disease of the kidneys and urinary tract infections, including pyelonephritis, relapse trand, disease progression with the development of irreversible damage of nephroparenchyma and the chronicity development requires attention to this problem. The variety of pathogens causing pyelonephritis made the diagnosis of pyelonephritis in children extremely difficult. Therefore, it was necessary to study etiological features of pyelonephritis in children, depending on their age and gender. Material and methods. We examined 100 children aged 0-18 with inflammatory disease of the kidneys and urinary tract infections. All patients were divided into 3 groups depending on their age. Group 1 included patients aged from 0 to3, group 2 consisted of patients aged from 4 to 7 and group 3 had patients aged from 8 to 18. Microbiological examination was performed on these patients, too. 52% of children had acute pyelonephritis, 31% of children had chronic pyelonephritis and 17% of children had various microbial and inflammatory disorders such as urinary tract infections, dismetabolic nephropathy, neurogenic bladder dysfunction, kidney malformation, nephrodysplasia, toxic and metabolic nephropathy, neuro-muscular dysfunction of the bladder and etc. Significant difference was found between boys and girls. Results and discussion. Our research showed that incidence of inflammatory disease of the kidneys and urinary tract infections was higher among girls than boys. Acute pyelonephritis incidence was 3.3 times higher among girls than boys, and chronic pyelonephritis incidence was 6.8 times higher among girls than boys, due to anatomy and physiology of the female urinary system. The children often suffered inflammatory disease of the kidneys and urinary tract infections at their youngest age (0 to 3 years old) – 46 cases, including 26% of acute pyelonephritis, 11% of chronic pyelonephritis and 9% of other inflammatory disease of the kidneys and urinary tract infections. Our study demonstrated that inflammatory disease of the kidneys and urinary tract infections incidence was higher among girls in the age group from 0 to 3 years where it was 33% (including acute pyelonephritis in 18%, chronic pyelonephritis in 10% of patients), which was slightly less at age from 8 to 18 and comprised 30% including acute pyelonephritis in 15% of patients, and chronic pyelonephritis in 12% of patients. In the age group from 4 to 7 years the inflammatory disease of the kidneys and urinary tract infections incidence was 19% (girls – 15%, boys – 4%) and the incidence of acute pyelonephritis was 10% (7% - girls, 3% - boys), and chronic pyelonephritis was 6% (5% – girls, 1% – boys). The acute pyelonephritis patients of group 1 had mean age of 1 year 9 months (girls) and 11 months (boys). The chronic pyelonephritis patients of group 1 had mean age of 1 year 8 months (girls) and 8 months (boys). The mean age of boys was less the mean age of girls, both among patients with acute and chronic pyelonephritis. The acute pyelonephritis patients of group 2 had mean age of 4 years 1 month (girls) and 5 years (boys). The chronic pyelonephritis patients of group 2 had mean age of 5 years 2 months (girls) and 4 years (boys). The acute pyelonephritis patients of group 3 had mean age of 12 years 8 months (girls) and 11 years (boys). The chronic pyelonephritis patients of group 3 had mean age of 12 years 9 months (girls) and 8 years (boys). The bacteriological investigation was performed and determined 149 strains (82 strains from children with acute pyelonephritis, 49 strains from children with chronic pyelonephritis and 18 strains from patients with other inflammatory disease of the kidneys and urinary tract infections). The major pathogens that caused inflammatory disease of the kidneys and urinary tract infections in children were: E. faecalis (35.6%), E. coli (37.6%), K.pneumoniae (18.1%), Proteus spp. (8.7%). The most causative agent was E. coli (16.8%), which was registered in children aged from 0 to 3. In children aged from 8 to 18 inflammatory disease of the kidneys and urinary tract infections were often caused by E. coli and E. faecalis (15.4% each). Conclusions. The obtained results showed that the most common causes of acute pyelonephritis were E. coli in children aged from 0 to 3 and from 8 to 18; E. faecalis in children aged from 8 to 18 (17.1%). Analysis revealed that the major pathogens causing chronic pyelonephritis were E. faecalis and E. coli (14.3% each) in children aged from 0 to 3, and E. coli (18.4%) in children aged from 8 to 18. In children aged from 4 to 7 chronic pyelonephritis was caused by E.faecalis, E. coli, K. pneumoniae in equal frequency (6.1% each). As for inflammatory disease of the kidneys and urinary tract infections, the most common causes were E. coli in children aged from 0 to 3 and E. faecalis in children aged from 8 to 18 (22.2%).
Keywords: microorganisms, pyelonephritis, children, etiologic factors, age category
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