급성신우신염 환아에서 DMSA 스캔상 발견된 신결손의 예후 인자
Prognostic Factors of Renal Defects on the Initial DMSA Scan in Children with Acute Pyelonephritis
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목적:요로감염 환아 에서 영구적 신장손상을 예측하기 위하여, 연령, 발열기간 및 농뇨 지속기간 , 방광요관역류나 수신증 여부 등을 비교, 분석하였다. 방법:2000년 1월부터 2005년 1월까지 아주대학교 병원에서 요로감염으로 입원한 환아 중 DMSA에서 신장 결손을 보인 160명의 환아를 대상으로 6개월 후 추적 DMSA에서 회복된 회복군과 반흔이 남은 반흔군으로 나누어 각각의 특징을 비교분석하였다. 결과:전체 대상 환아 160명 중 106명이 추적 DMSA에서 회복을 보였고, 54명이 반흔이 남아 33.8 %의 발생률을 보였다. 반흔군에서 처음 진단 당시의 나이가 1세 이상인 환자가 회복군에 비해 많았고(P= 0.01), 발열기간, 농뇨지속 기간 등이 회복군에 비해 길었으며, 발열의 기왕력이 있었다. VCUG, Ultrasound sonography에서도 반흔군이 회복군에 비해 비정상적 결과를 보인 경우가 많았다. 결론:급성신우신염을 앓은 소아에서 감염당시 환아의 나이가 많을수록, 발열 기간이나 농뇨 지속 기간이 오래 될수록, 방광요관역류나 초음파검사 이상소견이 있는 초기 신결손이 신반흔으로 고착되는 경향을 확인할 수 있었다. 특히 잦은 발열 기왕력이 있는 경우 신손상 발생률이 높은 것을 볼 때, 이는 임상에서 미처 진단되지 못한, 혹은 잘 못 진단된 급성신우신염이 있음을 시사해 준다.
Abstract
Purpose:The purpose of this study is to determine if there are prognostic factors leading to permanent parenchymal damages to kidney in children after acute pyelonephritis. Methods:This study was conducted in 160 pediatric patients with acute pyelonephritis admitted to Ajou University Hospital from 2000 to 2005, whose renal cortical defects were confirmed by 99mTc-dimercaptosuccinic acid scintigraphy (DMSA scan). Along with the follow-up DMSA scan after 6 months, they were classified into two groups; recovered group (106) and scarred group (54). The clinical characteristics of each group were compared. Results:Among the total of 160 patients, 106 (66.3%) showed recovery of the initial defect (the recovered group), while 54 (33.8%) showed permanent defects on the follow- up DMSA scan (scarred group). Recovery rate was poor for patients of 1 year and older, or patients with the duration of fever and pyuria longer than 7 days. The recovery rate was poor in the patients with history of frequent febrile episodes and abnormal results of imaging studies, such as voiding cystourethrography (VCUG), ultrasonography. Conclusion:The recovery rate of children with renal defects on DMSA scan with acute pyelonephritis was lower when the patient is older than 1 year, when the duration of fever and pyuria exceeded 7 days, and when the patients had the histories of frequent febrile episodes and had urinary tract abnormalities on imaging studies. These findings suggest that there may be under- or mis-diagnosis of acute pyelonephritis by pediatrician.
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