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Predictive Markers for Screening Renal Damage in Children with Urinary Tract infections and Vesicoureteral Reflux

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주제분류소아과학

초록

Purpose: Urinary tract infections (UTIs) are the most common and serious bacterial infections in children. Therefore, early diagnosis of vesicoureteral reflux (VUR) for treatment planning and the identification of noninvasive markers that can predict renal injury are important in patients with UTIs. We analyzed the clinical features of pediatric UTIs commonly encountered by general practitioners and reinterpreted the blood tests and imaging findings to identify the important clinical predictive markers of VUR in order to selectively perform VCUG. Methods: This retrospective study was performed among 183 children diagnosed with a UTI or acute pyelonephritis. Results: The most significant predictor of high grade and bilateral VUR identified using area under the curve analyses was hydronephrosis on kidney ultrasound images with renal cortical defects on dimercaptosuccinic acid (DMSA) kidney scan simultaneously, followed by hydronephrosis only on kidney ultrasound. Conclusion: The presence of hydronephrosis on kidney ultrasound images or cortical defects or asymmetric kidneys on the DMSA kidney scans can be predictive markers of VUR, reducing the need for VCUG. Our study can thus help minimize the exposure to radiation among patients through selective VCUG.

Abstract

Purpose: Urinary tract infections (UTIs) are the most common and serious bacterial infections in children. Therefore, early diagnosis of vesicoureteral reflux (VUR) for treatment planning and the identification of noninvasive markers that can predict renal injury are important in patients with UTIs. We analyzed the clinical features of pediatric UTIs commonly encountered by general practitioners and reinterpreted the blood tests and imaging findings to identify the important clinical predictive markers of VUR in order to selectively perform VCUG. Methods: This retrospective study was performed among 183 children diagnosed with a UTI or acute pyelonephritis. Results: The most significant predictor of high grade and bilateral VUR identified using area under the curve analyses was hydronephrosis on kidney ultrasound images with renal cortical defects on dimercaptosuccinic acid (DMSA) kidney scan simultaneously, followed by hydronephrosis only on kidney ultrasound. Conclusion: The presence of hydronephrosis on kidney ultrasound images or cortical defects or asymmetric kidneys on the DMSA kidney scans can be predictive markers of VUR, reducing the need for VCUG. Our study can thus help minimize the exposure to radiation among patients through selective VCUG.

참고문헌 (42)

  1. Bitsori M, "Pediatric urinary tract infections : diagnosis and treatment", Expert Rev Anti Infect Ther, 10, pp.1153~1164 (2012)
  2. Peters C, "Vesicoureteral reflux associated renal damage : congenital reflux nephropathy and acquired renal scarring", J Urol, 184, pp.265~273 (2010)
  3. Elder JS, "Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children", J Urol, 157, pp.1846~1851 (1997)
  4. Downs SM, "Technical report: urinary tract infections in febrile infants and young children. The urinary tract subcommittee of the American academy of pediatrics committee on quality improvement", Pediatrics, 103, pp.e54~ (1999)
  5. Mattoo TK, "Pediatric Nephrology", pp.1716~1735 (2016), Lippincott Williams &Wilkins
  6. Gordon I, "Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection : a systematic review and meta-analysis", J Am Soc Nephrol, 14, pp.739~744 (2003)
  7. Peters CA, "Summary of the AUA guideline on management of primary vesicoureteral reflux in children", J Urol, 184, pp.1134~1144 (2010)
  8. Williams G, "Vesicoureteral reflux", J Am Soc Nephrol, 19, pp.847~862 (2008)
  9. Berrocal T, "Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features", Radiographics, 22, pp.1139~1164 (2002)
  10. Johnin K, "Pediatric voiding cystourethrography : An essential examination for urologists but a terrible experience for children", Int J Urol, 26, pp.160~171 (2019)
  11. Bensman A, "Pediatric Nephrology", pp.1299~1310 (2009), Springer-Verlag
  12. Abolfazl Mahyar, "Are Clinical, Laboratory, and Imaging Markers Suitable Predictors of Vesicoureteral Reflux in Children With Their First Febrile Urinary Tract Infection?", Investigative and Clinical Urology, 55(8), pp.536~541 (2014), 대한비뇨의학회
  13. Schmidt B, "Work-up of pediatric urinary tract infection", Urol Clin North Am, 42, pp.519~526 (2015)
  14. Lebowitz RL, "International system of radiographic grading of vesicoureteric reflux. International reflux study in children", Pediatr Radiol, 15, pp.105~109 (1985)
  15. Mattoo TK, "Vesicoureteral reflux and reflux nephropathy", Adv Chronic Kidney Dis, 18, pp.348~354 (2011)
  16. Huang HP, "Renal ultrasonography should be done routinely in children with first urinary tract infections", Urology, 71, pp.439~443 (2008)
  17. Belman AB, "Vesicoureteral reflux", Pediatr Clin North Am, 44, pp.1171~1190 (1997)
  18. Zee RS, "Urinary tract infections in children with prenatal hydronephrosis : A risk assessment from the society for fetal urology hydronephrosis registry", J Pediatr Urol, 12, pp.261.e1~7 (2016)
  19. Visuri S, "Incidence of urinary tract infections in infants with antenatally diagnosed hydronephrosis-A retrospective single center study", J Pediatr Surg, 52, pp.1503~1506 (2017)
  20. Braga LH, "Risk factors for febrile urinary tract infection in children with prenatal hydronephrosis : a prospective study", J Urol, 193, pp.1766~1771 (2015)
  21. Skoog SJ, "Pediatric vesicoureteral reflux guidelines panel summary report : clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates", infants with prenatal hydronephrosis, 2010, pp.184, 1145~1151
  22. Brophy MM, "Vesicoureteral reflux and clinical outcomes in infants with prenatally detected hydronephrosis", J Urol, 168, pp.1716~1719 (2002)
  23. Logvinenko T, "Predictive value of specific ultrasound findings when used as a screening test for abnormalities on VCUG", J Pediatr Urol, 11, pp.176.e1~7 (2015)
  24. Berrocal T, "Mild hydronephrosis in newborns and infants : can ultrasound predict the presence of vesicoureteral reflux", Pediatr Nephrol, 22, pp.91~96 (2007)
  25. 이대용, "3개월 미만 요로감염 영아에서 중증 방광 요관 역류의 예측인자", Childhood Kidney Diseases, 12(2), pp.178~185 (2008), 대한소아신장학회
  26. Ghobrial EE, "Value of ultrasound in detecting urinary tract anomalies after first febrile urinary tract infection in children", Clin Pediatr(Phila), 55, pp.415~420 (2016)
  27. Nelson CP, "Ultrasound as a screening test for genitourinary anomalies in children with UTI", Pediatrics, 133, pp.e394~403 (2014)
  28. Pohl HG, "The"top-down"approach to the evaluation of children with febrile urinary tract infection", Adv Urol, pp.783409~ (2009)
  29. 장경미, "Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection", Childhood Kidney Diseases, 21(2), pp.114~120 (2017), 대한소아신장학회
  30. Hong IK, "Prediction of vesicoureteral reflux in children with febrile urinary tract infection using relative uptake and cortical defect in DMSA scan", Pediatr Neonatol, 59, pp.618~623 (2018)
  31. Sheu JN, "Acute 99mTc DMSA scan predicts dilating vesicoureteral reflux in young children with a first febrile urinary tract infection : a population-based cohort study", Clin Nucl Med, 38, pp.163~168 (2013)
  32. Snodgrass WT, "Prevalence and risk factors for renal scars in children with febrile UTI and", or VUR : a cross-sectional observational study of 565 consecutive patients, 2013, pp.9, 856~863
  33. Soylu A, "Predictors of renal scar in children with urinary infection and vesicoureteral reflux", Pediatr Nephrol, 23, pp.2227~2232 (2008)
  34. Orellana P, "Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project", Pediatr Nephrol, 19, pp.1122~1126 (2004)
  35. Riccabona M, "Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007", Pediatr Radiol, 38, pp.138~145 (2008)
  36. Hellström M, "Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection", AJR Am J Roentgenol, 152, pp.801~804 (1989)
  37. Subcommittee on urinary tract infection, "Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128, pp.595~610 (2011)
  38. Ahmed SM, "Evaluation and treatment of urinary tract infections in children", Am Fam Physician, 57, pp.1573~1580 (1998)
  39. Parmaksız G, "Role of new biomarkers for predicting renal scarring in vesicoureteral reflux: NGAL, KIM-1, and L-FABP", Pediatr Nephrol, 31, pp.97~103 (2016)
  40. Mohammadjafari H, "The role of urinary TIMP1 and MMP9 levels in predicting vesicoureteral reflux in neonates with antenatal hydronephrosis", Pediatr Nephrol, 29, pp.871~878 (2014)
  41. Abedi SM, "Urinary matrix metalloproteinase 9 and tissue inhibitor of metalloproteinase 1 biomarkers for predicting renal scar in children with urinary tract infection", Turk J Urol, 43, pp.536~542 (2017)
  42. Chromek M, "Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinases-1 in acute pyelonephritis and renal scarring", Pediatr Res, 53, pp.698~705 (2003)

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Predictors of High-grade Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections박신애, 이민주, 이오경, 최엄지대한소아신장학회 · Childhood Kidney Diseases2017 · 제21권 제2호Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan임형은, Kee Hwan Yoo, Kyeong Eun Oh대한소아신장학회 · Childhood Kidney Diseases2020 · 제24권 제2호Association of Renal and Bladder Ultrasonography Findings with Urinary Tract Infection Recurrence, High- Grade Vesicoureteral Reflux, and Renal Scarring이준호, 정수진, Hyeil Jin, Hye Won Park대한소아신장학회 · Childhood Kidney Diseases2015 · 제19권 제2호A Renal Size Discrepancy among the Findings of Renal Sonogram in Children with Their First Episode of Pyelonephritis is One of the Useful Parameters to Predict the Presence of Cortical Defects on the Acute DMSA Renal Scan이선경, 이준호, Bo kyeong Jin, Yoowon Kwon대한소아신장학회 · Childhood Kidney Diseases2019 · 제23권 제1호Predictors of renal scars in infants with recurrent febrile urinary tract infection: a retrospective, single-center study이선경, 이준호, Han Jae Ha대한소아신장학회 · Childhood Kidney Diseases2022 · 제26권 제1호Clinical Efficacy of a Top-down Approach for Children with a First Febrile Urinary Tract Infection김세윤, 박용훈, 임명희, 장경미대한소아신장학회 · Childhood Kidney Diseases2017 · 제21권 제2호

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