Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Clinical Significance of Hydronephrosis in Febrile Urinary Tract Infection

발열성 요로 감염 환아에서 발견된 수신증의 임상적 의의

  • Oh, Jung-Min (Department of Pediatrics, College of Medicine, Korea University) ;
  • Lee, Na-Ra (Department of Pediatrics, College of Medicine, Korea University) ;
  • Yim, Hyung-Eun (Department of Pediatrics, College of Medicine, Korea University) ;
  • Yoo, Kee-Hwan (Department of Pediatrics, College of Medicine, Korea University) ;
  • Hong, Young-Sook (Department of Pediatrics, College of Medicine, Korea University) ;
  • Lee, Joo-Won (Department of Pediatrics, College of Medicine, Korea University)
  • 오정민 (고려대학교 의과대학 소아과학교실) ;
  • 이나라 (고려대학교 의과대학 소아과학교실) ;
  • 임형은 (고려대학교 의과대학 소아과학교실) ;
  • 유기환 (고려대학교 의과대학 소아과학교실) ;
  • 홍영숙 (고려대학교 의과대학 소아과학교실) ;
  • 이주원 (고려대학교 의과대학 소아과학교실)
  • Received : 2010.03.28
  • Accepted : 2010.04.23
  • Published : 2010.04.30
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Abstract

Purpose : Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. Methods : We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than $37.5^{\circ}C$ measured in the axilla, 2) positive urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). Results : The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P<0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. Conclusion : Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar.

목 적 : 수신증은 요로 감염 환아의 30%에서 발견된다. 수신증은 다양한 원인에 의해 발생할 수 있으나, 대부분은 선천성인 것으로 알려져 있다. 저자들은 발열성 요로 감염과 수신증과의 관련성을 알아보았다. 방 법 : 2007년 1월부터 2009년 5월까지 고대구로병원에서 요로 감염 진단을 받은 183명의 의무 기록을 후향적으로 분석하였다. 결 과 : 수신증이 있는 환아는 80명, 수신증이 없는 환아는 103명이었다. 수신증이 있는 환아 중 58명이 왼쪽, 8명이 오른쪽, 14명이 양쪽에 수신증이 관찰되었으며, 대부분의 수신증 등급은 경도였다. 수신증이 없는 군과 비교 시, 신스캔 상의 초기 신결손이 수신증이 있는 군에서 유의하게 관찰되었다(수신증이 있는 군 37.5%, 수신증이 없는 군 16.5%, P<0.05). 방광 요관 역류의 발병률은 두 군 간에 차이를 보이지 않았다(수신증이 있는 군 22%, 수신증이 없는 군 12.1%). 백혈구 수치와 C 반응 단백 수치는 두 군 간에 유의한 차이가 없었다. 요로 감염을 앓은 후 약 6개월 째 시행한 신스캔 추적 검사 상에서도 신결손의 호전 여부 및 신반흔 발생은 두 군 간의 유의한 차이를 보이지 않았다. 결 론 : 저자들은 열성 요로 감염이 있는 환아의 수신증이 초기 신결손을 예측하는데 임상적으로 유용하나, 추적 검사 상의 신 반흔과는 관련이 없음을 제시하는 바이다.

Keywords

References

  1. Kliegman, Behrman, Jenson, Staton. Nelson Textbook of Pediatrics. 18th edition, Philadelphia: Sounders, 2007;2223-8.
  2. Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr 1993;123:17-23. https://doi.org/10.1016/S0022-3476(05)81531-8
  3. Wald E. Urinary tract infections in infants and children: a comprehensive overview. Curr Opin Pediatr 2004;16:85-8. https://doi.org/10.1097/00008480-200402000-00016
  4. Hoberman A, Charron M, Hickey RW. Imaging studies after a first febrile urinary tract intection in young children. N Engl J Med 2003;348:195-202. https://doi.org/10.1056/NEJMoa021698
  5. Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long term follow up to determine the prognostic value of imaging after uriary tract infections. Arch Dis Child 1995;72:393-6. https://doi.org/10.1136/adc.72.5.393
  6. Peters CA. Urinary tract obstruction in children. J Urol 1995;154:1874-83. https://doi.org/10.1016/S0022-5347(01)66815-0
  7. Zerin JM. Hydronephrosis in the neonate and young infant: current concetpts. Seminars in Ultrasound CT and MRI 1994;306-15.
  8. Cartwright PC, Duckett JW, Keating MA, Snyder HM 3rd, Escala J, Blyth B, et al. Managing apparent ureteropelvic junction obstruction in newborn. J Urol 1992;148: 1224-8. https://doi.org/10.1016/S0022-5347(17)36867-2
  9. Brown T, Mandell J, Lebowitz RL. Neonatal hydronephrosis in the area of sonography. Am J Roentgenol 1987;148:959-63. https://doi.org/10.2214/ajr.148.5.959
  10. Feng Chen. Genetic and developmental basis for urinary tract obstruction. Pediatr Nephrol 2009;24:1621-32. https://doi.org/10.1007/s00467-008-1072-y
  11. Dick PT, Feleman W. Routine diagnostic imaging for childhood urinary tract infections: a systemic overview. J Pediatr 1996; 128:15-22. https://doi.org/10.1016/S0022-3476(96)70422-5
  12. Hoberman A, Wald ER. Urinary tract infections in young children. Pediatr Infect Dis J 1997;16:11-7. https://doi.org/10.1097/00006454-199701000-00004
  13. Stokeland E, Hellstrom M, Jacobasson B, Jodal U, Sixt R. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr 1996;129:815-20. https://doi.org/10.1016/S0022-3476(96)70024-0
  14. Rushton HG. Urinary tract infections in children. Epidemiology, evaluation and management. Pediatr Clin North Am 1997;44: 1133-69. https://doi.org/10.1016/S0031-3955(05)70551-4
  15. Curri ML, Mitz L, Raasch CS, Greenbaum LA. Follow-up urine cultures and fever in children with urinary tract infection. Arh Pediatr Aldolesc Med 2003;157:1237-40. https://doi.org/10.1001/archpedi.157.12.1237
  16. Bachur R. Nonresponders: prolonged fever among infants with urinary tract infections. Pediatrics 2000;105;e59. https://doi.org/10.1542/peds.105.5.e59
  17. Merric MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long term follow up to determine the prognostic value of imaging after urinary tract infections. Arch Dis child 1995;72-393-6. https://doi.org/10.1136/adc.72.5.393
  18. Jacobsson B, Svensson L. Transient pyelonephritic changes on 99m T echnetiumdimercaptossuccinic acid scan for at least five months after infection. Acta Pediatr 1997;86:803-7.
  19. Michael H. Hsigh, Ramiro J, Madden-Fuents, David R,Roth. Urologic diagnoses among infants hospitalized for urinary tract infection. Ped Urol 2009;74:100-3. https://doi.org/10.1016/j.urology.2009.02.012
  20. Dick PT, Feldman W. Routine diagnostic imaging for childhood urinary tract infections: systemic overview. J pediatr 1996; 128:15-22. https://doi.org/10.1016/S0022-3476(96)70422-5
  21. Coelho GM, Bouzada MC, Pereira AK, Figueiredo BF, Leite MR, Oliveira DS et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 2007;22:1727-34. https://doi.org/10.1007/s00467-007-0539-6
  22. Lee KJ, Kim JW, Yoon JE, Ha TS. Clinical study of urinary tract infection, natural courses, and prenatal ultrasonographic results according to the grade of hydronephrosis. Korean J Pediatr 2009;52:917-22. https://doi.org/10.3345/kjp.2009.52.8.917
  23. Giovanni M, Pietro, Z, Lisanna T, Enrico T, Waifro R, Giorgio P, et al, Value of imaging studies after a first febrile urinary tract infection in young children. Pediatrics 2009; 123:239-46..
  24. Majd M, Rushlton HG, Jantausch B, Wiedermann BL. Relatio ship among vesicoureteral reflux, P-fimbriated Escherichia coli, and acut pyelonephritis in children with febrile urinary tract infection. J Pediatr 1993;123: 17-23. https://doi.org/10.1016/S0022-3476(05)81531-8
  25. Mary P Andrich, Massoud Majd, Diagnostic Imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatrics 1992;90:436-41.
  26. Puczko-Michalczuk A, Zoch-Zwierz W, Wasilewska A, Porowska T, Korzeniecka- ozerska A. Evaluation of inflammatory and renal injury markers in youngest children with pyelonephritis. Pol Merkur Lekarski 2008;150:451-4.
  27. Gendral D. Urinary tract infection and biological markers: C-reactive protein, interleukins and procalcitonin. Arch Pediatr 1998;5 Suppl 3:269-73. https://doi.org/10.1016/S0929-693X(97)89367-0
  28. American Academy of Pediatrics, Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999; 103:843-51. https://doi.org/10.1542/peds.103.4.843
  29. Kass EJ, Kernen KM, Carey JM. Pediatric urinary tract infection and the necessity of complete urological imaging. BJU Int 2000; 86:94-6.
  30. Hansson S, Dhamey M, Sigström O, Sixt R, Stokland E, Wennerström M. Dimercaptosuccinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J urol 2004;172:1071-3. https://doi.org/10.1097/01.ju.0000135337.71154.60

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