Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). Methods: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Results: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P < 0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. Conclusion: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.
Abstract
Purpose: The aim of this study was to determine the clinical characteristics, frequency of renal abnormalities and benefits of a top-down approach in children with their first febrile urinary tract infection (UTI). Methods: We reviewed 308 patients retrospectively who were admitted to Yeungnam University Hospital and were treated for their first febrile UTI from February 2006 to December 2013. We performed a comparative analysis of laboratory findings and results of imaging techniques including a Tc-99m dimercaptosuccinic acid (DMSA) renal scan. Results: Among the patients, 69% (213/308) were males, and 90% (277/308) had their first UTI episode during infancy. A DMSA renal scan was performed on all patients, and showed positive findings in 60% (184/308) of cases. Laboratory indices of inflammation were significantly higher in the DMSA-positive group (P < 0.05). There was a statistically significant difference in the age distribution between the two groups. In the DMSA-positive group, 165 patients underwent voiding cystourethrography (VCUG), and 58 (35%) cases demonstrated vesicoureteral reflux. In total, 110 patients in the DMSA-positive group, underwent repeat scanning at 6 months; 33 children (30%) demonstrated static scarring, but 77 (70%) had improved completely. The concordance of the ultrasonography (US) and VCUG was low. Older patients had more renal scarring. Conclusion: DMSA is a sensitive method for assessing the severity of inflammation and kidney injury. However, the ability of US to predict renal parenchymal damage was limited. A top-down approach in children with their first febrile UTI showed significant value.
참고문헌 (21)
- Montini G, "Febrile Urinary Tract Infections in Children", N Engl J Med, 365, pp.239~250 (2011)
- Young Seo Park, "Renal scar formation after urinary tract infection in children", Korean Journal of Pediatrics, 55(10), pp.367~370 (2012), 대한소아과학회
- Herz D, "5-Year prospective results of Dimercapto-Succinic acid imaging in children with febrile urinary tract infection: proof that the Top-Down approach works", J Urol, 184, pp.1703~1709 (2010)
- Pohl HG, "The “top-down” approach to the evaluation of children with febrile urinary tract infection", Adv Urol, pp.1~5 (2009)
- Garin EH, "Clinical significance of primary vesicoureteral reflux and urinary antibiotics prophylaxis after acute pyelonephritis: a multicenter randomized, controlled study", Pediatrics, 117, pp.626~632 (2006)
- Roussey-Kesler G, "Antibiotics prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study", J Urol, 179, pp.674~679 (2008)
- Shaw KN, "Prevalence of urinary tract infection in febrile young children in the emergency department", Pediatrics, 102, pp.16~20 (1998)
- Smellie JM, "Retrospective study of children with renal scarring associated with reflux and urinary infection", BMJ, 308, pp.1193~1196 (1994)
- Paintsil E, "Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm", Curr Opin Pediatr, 25, pp.88~94 (2013)
- Jaksic E, "Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis", Ann Nucl Med, 25, pp.37~43 (2011)
- Hardy RD, "DMSA renal scans and the top-down approach to urinary tract infection", Pediatr Infect Dis J, 27, pp.476~477 (2008)
- Jakobsson B, "Transient pyelonephritic changes on 99mTechnetium- dimercaptosuccinic acid scan for at least five months after infection", Acta Paediatr, 86, pp.803~807 (1997)
- Hansson S, "Dimercaptosuccinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection", J Urol, 172, pp.1071~1073 (2004)
- Benador D, "Are youngest children at higher risk of renal sequelae after pyelonephritis?", Lancet, 349, pp.17~19 (1997)
- Pecile P, "Age-related renal parenchymal lesions in children with first febrile urinary tract infections", Pediatrics, 124, pp.23~29 (2009)
- Lee YJ, "Risk factors for renal scar formation in infants with first episodes of acute pyelonephritis: a prospective clinical study", J Urol, 187, pp.1032~1036 (2012)
- Camacho V, "DMSA study performed during febrile urnary tract infection: a predictor of patient outcome?", Eur J Nucl Med Mol Imaging, 31, pp.862~866 (2004)
- Montitni G, "Value of imaging studies after a first febrile urinary tract infection in young children: data from Italian renal infection study 1", Pediatrics, 123, pp.e239~e246 (2009)
- 이해정, "생후 처음으로 발생한 발열성 요로감염 환자의배뇨성 방광 요도 조영술", Korean Journal of Pediatrics, 49(6), pp.653~658 (2006), 대한소아과학회
- Tsai JD, "Screening high-grade vesicoureteral reflux in young infants with a febrile urinary tract infection", Pediatr Nephrol, 27, pp.955~963 (2012)
- Roupakias S, "Dimercaptosuccinic acid scan challenges in childhood urinary tract infection, vesicoureteral reflux and renal scarring investigation and management", Minerva Urologica e Nefrologica, 69, pp.144~152 (2017)