Renal scarring in children under 36 months hospitalised for acute pyelonephritis

详细信息    查看全文

• 作者：Begoñ ; a Rodrí ; guez-Azor^a ; José ; Miguel Ramos-Fern&aacute ; ndez^b ; ^c ; ^{dr.jmramos@gmail.com} ; ^{josem.ramos.sspa@juntadeandalucia.es} ; Sonia S&aacute ; nchiz-C&aacute ; rdenas^a ; Ana Cordó ; n-Martí ; nez^b ; Begoñ ; a Carazo-Gallego^e ; David Moreno-Pé ; rez^c ; ^d ; ^e ; Antonio Urda-Cardona^a
• 关键词：Renal scar ; Pyelonephritis ; Voiding cystourethrography ; DMSA-scintigraphy
• 刊名：Anales de Pediatría (English Edition)
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：86
• 期：2
• 页码：76-80
• 全文大小：420 K
• 卷排序：86

文摘

Acute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication.ObjectivesTo review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology.MethodA retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events.ResultsA total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to Escherichia coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i-iii, and 32.9% iv-v grade VUR. Six patients had iv-v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases).ConclusionsAlmost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv-v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers.