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New Insights for Febrile Urinary Tract Infection (Acute Pyelonephritis) in Children

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대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2016.10|Childhood Kidney Diseases (Childhood Kidney diseases)|제20권 제2호|pp. 37-44

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참고문헌

키워드

ChildrenEpidemiologyUrinary tract infectionPyelonephritisUropathogenPathogenesis
주제분류소아과학

초록

Although asymptomatic bacteriuria, cystitis, and acute pyelonephritis (APN) have been categorized as urinary tract infections (UTIs), the immunopathogenesis of each disease is different. APN shows an age predilection; the majority of children (over 70-80%) with APN are under 1-2 years of age, with a male predominance. After 1-2 years of age, female predominance has been reported. This finding sug gests that the immature immune state of infancy may be associated with the pa­thogenesis of APN. Escherichia coli is the most common etiologic agent; other uropathogens associated with UTIs originate from the host and comprise normal flora that are continuously altered by environmental factors. Therefore, uropatho gens may have characteristics different from those of extraneous bacterial patho gens. Although antibiotic-resistant uropathogens, including extended-spectrum beta-lactamase-producing strains, are increasing in Korea and worldw ide, treat ment failure is rare in immune-competent children. The immunopathog enesis of APN remains unknown. Intact bacteria may not be the causative substances in renal cell injury; rather, smaller substances produced during bac­terial replication may be responsible for renal cell injury and scarring. Moreover, substances from host cells such as proinflammatory cytokines may be involved in renal cell injury. A dimercaptosuccinic acid scan is used to detect the site of bacterial replication in the renal parenchyma, and may be influenced by the size of the focus and the stage of APN. Traditional aggressive studies used to identify vesicoureteral reflux after the first episode of APN have been modified because of rare cases of chronic kidney disease in patients with recurrent UTI.

Abstract

Although asymptomatic bacteriuria, cystitis, and acute pyelonephritis (APN) have been categorized as urinary tract infections (UTIs), the immunopathogenesis of each disease is different. APN shows an age predilection; the majority of children (over 70-80%) with APN are under 1-2 years of age, with a male predominance. After 1-2 years of age, female predominance has been reported. This finding sug gests that the immature immune state of infancy may be associated with the pa­thogenesis of APN. Escherichia coli is the most common etiologic agent; other uropathogens associated with UTIs originate from the host and comprise normal flora that are continuously altered by environmental factors. Therefore, uropatho gens may have characteristics different from those of extraneous bacterial patho gens. Although antibiotic-resistant uropathogens, including extended-spectrum beta-lactamase-producing strains, are increasing in Korea and worldw ide, treat ment failure is rare in immune-competent children. The immunopathog enesis of APN remains unknown. Intact bacteria may not be the causative substances in renal cell injury; rather, smaller substances produced during bac­terial replication may be responsible for renal cell injury and scarring. Moreover, substances from host cells such as proinflammatory cytokines may be involved in renal cell injury. A dimercaptosuccinic acid scan is used to detect the site of bacterial replication in the renal parenchyma, and may be influenced by the size of the focus and the stage of APN. Traditional aggressive studies used to identify vesicoureteral reflux after the first episode of APN have been modified because of rare cases of chronic kidney disease in patients with recurrent UTI.

참고문헌 (56)

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관련 논문AI추천

Prognostic Factors of Renal Scarring on Follow-up DMSA Scan in Children with Acute PyelonephritisByung Woo Woo, Hae Sook Kim, Juyeen Lee대한소아신장학회 · Childhood Kidney Diseases2016 · 제20권 제2호Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection김세윤, 박용훈, 임명희, 장경미대한소아신장학회 · Childhood Kidney Diseases2017 · 제21권 제2호영아에서의 열성 요로감염: 일차성과 재발성 감염의 비교분석공도훈, 이상돈, 정석근대한요로생식기감염학회 · Urogenital Tract Infection2011 · 제6권 제2호Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)Seung Joo Lee대한소아신장학회 · Childhood Kidney Diseases2015 · 제19권 제2호An Epidemiologic Study on Hosts and Pathogens of Urinary Tract Infection in Urban Children of Korea (2012–2017)배기수, 유영명, Byeong Sub Park, Hyun Joo Jung, Kyu Jung Park, Shin Young Lee대한소아신장학회 · Childhood Kidney Diseases2019 · 제23권 제1호Which Factors Related to the Renal Cortical Defects in Infants Under 3 Months of Age with Urinary Tract Infections?김교순, Myung Hyun Cho, Yu Kyung An대한소아신장학회 · Childhood Kidney Diseases2016 · 제20권 제2호

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