방광요관역류를 가진 소아에서의 신초음파 소견
Ultrasonographic Findings in Children with Vesicoureteral Reflux
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목적: 본 연구는 방광요관역류를 보이는 소아에서 신초음파 이상소견에 대해 알아보고자 하였다. 방법: 2000년 1월부터 2010년 12월까지 일산병원 소아청소년과에 내원하여 요로감염증으로 입원한 후 배뇨성 방광요도조영술을 시행하여 방광요관역류를 진단받은 83명의 소아를 대상으로 총 166 신단위를 후향적으로 분석하였다. 결과: 대상 소아 중 1세 미만의 평균 나이는 3.1±2.56개월이었고, 1세 이상의 평균 나이는 58.9±43.01개월이었다. 신초음파 이상소견을 보이는 신단위에서 방광요관역류가 있는 경우는 73.9%였고, 신초음파 정상소견을 보이는 신단위에서 방광요관역류가 있는 경우는 58.7%였으며 이는 통계적으로 유의한 차이를 보였다(P=0.049). 로지스틱 회귀분석에서 신초음파 이상소견이 있을 경우 방광요관역류가 있을 확률은 약 2배 증가하였다. 방광요관역류가 있는 신단위에서 신초음파 정상소견을 보이는 경우는 52.8%, 피질음영증가 16.7%, 수신증 17.6%, 요관확장 8.3%, 수신증을 동반한 요관확장 1.9% 등이었다. 이 중 수신증(82.6%), 요관확장(100%), 중복요관(66.6%), 손상된 위축신(100 %)이 있는 경우 방광요관역류의 빈도가 상대적으로 높았다. 결론: 방광요관역류가 있는 신단위에서 신초음파 이상소견으로 방광요관역류의 중증도를 예측하는 것은 가능하지 않으나 방광요관역류의 존재를 예측하는 것은 가능하다. 그러므로 수신증, 요관확장 같은 신초음파 이상소견이 있을 시, 배뇨성 방광요도조영술의 시행이 필요할 것이다.
Abstract
Purpose: The aim of this study is to investigate the renal ultrasonographic findings in children with vesicoureteral reflux (VUR). Methods: We retrospectively reviewed the medical records of 83 patients who were diagnosed with VUR and underwent ultrasonography at Ilsan hospital between January 2000 and December 2010. Results: Among 166 renal units, 108 (65.0%) were found to have vesicoureteral reflux (VUR). Fifty-one (73.9%) had VUR in renal units with abnormal ultrasonography (USG), whereas 57 (58.7%) had VUR in renal units with normal USG. Abnormal USG findings were independent risk factors for VUR (Odds ratio, 1.98; 95% CI, 1.01-3.89; P=0.045). In renal units with VUR, the number of normal USG finding was 52.8%, and the abnormal findings were as follows; increased cortical echogenicity 16.7%, hydronephrosis 17.6%, megaureter or ureter dilatation 8.3%, hydronephrosis and ureter dilatation 1.9%, duplication of ureter 1.9%, and atrophic kidney 0.9%. The prevalence of VUR was relatively higher in renal units with hydronephrosis (23/19, 82.6%), ureter dilatation (9/9, 100%), duplication of ureter (2/3, 66.6%), and atrophic kidney (1/1, 100%). Conclusion: Our study indicates that VUR was associated with abnormal USG findings. When there are abnormal USG findings such as hydronephrosis, ureter dilatation, duplication of ureter, and atrophic kidney in children with UTI, VCUG is recommended to detect VUR after controlling UTI.
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