İdrar Yolu Enfeksiyonu Tanılı Çocuklarda Ultrasonografi, Teknesyum-99m Dimerkaptosüksinik Asit Sintigrafisi ve Voiding Sistoüretrografi Bulgularının Uyumu

Yıl 2019, Cilt: 13 Sayı: 4, 277 - 282, 30.07.2019

Fatma Yazılıtaş Fatma Zehra Öztek-çelebi Sare Gülfem Özlü Evrim Kargın Çakıcı Hasibe Gökçe Çınar Ayşe Seçil Ekşioğlu Nedim Cüneyt Murat Gülaldı Mehmet Bülbül

https://doi.org/10.12956/tchd.512969

Öz

ÖZ

Amaç: Bu çalışmanın amacı idrar
yolu enfeksiyonu öyküsü olan çocuklarda ultrasonografi,
teknesyum-99m dimerkaptosüksinik asit sintigrafisi ve voiding sistoüretrografi
ile saptanan bulguların karşılaştırılması ve önemli vezikoüreteral reflü ve
renal hasar tespitini arttırırken invaziv testleri en aza indirmektir.

Gereç ve Yöntemler: Hastanemizde bir yıllık süre içinde ultrasonografi, teknesyum-99m dimerkaptosüksinik asit
sintigrafi ve voiding sistoüretrografi uygulanan idrar yolu enfeksiyonu tanılı çocuk
hastaların tıbbi kayıtları retrospektif olarak incelendi.

Bulgular: Toplam 99 (%40.9) erkek (ortalama yaşı 1.7 ± 3.1
yıl) ve 143 (%59.1) kız (yaş ortalaması 5.3 ± 3.9 yıl) hasta çalışmaya alındı.
Ultrasonografinin 196 (%81.0) hastada anormal olduğu saptandı. Vezikoüreteral
reflü 102 (%42.1) hastada gözlendi. Vezikoüreteral reflü evresi 4-5 olan hastaların
%65.7’nde teknesyum-99m dimerkaptosüksinik asit
sintigrafisinde renal parankimal skar saptandı.

Sonuç: İdrar yolu enfeksiyonu ilişkili vezikoüreteral reflü saptanması için
tarama yöntemi olan ultrasonografi vezikoüreteral reflüyü tamamen
öngörememektedir. Teknesyum-99m dimerkaptosüksinik asit sintigrafisi
ultrasonografiye göre daha güvenilir bir inceleme olsa da vezikoüreteral reflü
saptanması için günümüzde voiding sistoüretrografi en güvenilir yöntemdir.

Anahtar Kelimeler

İdrar Yolu Enfeksiyonu, Renal parankimal hasar, Ultrasonografi, Teknesyum-99m dimerkaptosüksinik asit sintigrafisi, Vezikoüreteral reflü

Kaynakça

• Kaynaklar 1. Riccabona M. Imaging of the neonatal genito-urinary tract. Eur J Radiol. 2006 Nov;60(2):187-98. Epub 2006 Sep 7. PMID: 16959460 DOI: 10.1016/j.ejrad.2006.07.022
• 2. Riccabona M, Avni FE, Blickman JG, Dacher JN, Darge K, Lobo ML, et al. 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 2008;38:138‑45. PMID: 18071685 DOI: 10.1007/s00247-007-0695-7
• 3. Gordon I. Indications for 99m-technetium dimercaptosuccinic acid scan in children. J Urol. 1987;137:464–467. PMID: 3029435
• 4. Rossleigh MA. Renal cortical scintigraphy and diuresis renography in infants and children. J Nucl Med 2001; 42(1): 91-5.
• 5. National Collaborating Centre for Women's and Children's Health (UK). Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management. London: RCOG Press; 2007 Aug. PMID: 21290637
• 6. Blachar A, Schachter M, Blachar Y, Mogilner B, Zurkowski L, Livne PM, et al. Evaluation of prenatally diagnosed hydronephrosis by morphometric measurements of the kidney. Pediatr Radiol 1994;24:131‑4. PMID: 8078715
• 7. Fernbach SK, Feinstein KA, Schmidt MB. Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 2000 Jan-Feb;20(1):155-68; discussion 168-71. Review. DOI: 10.1148/radiographics.20.1.g00ja12155. PMID: 10682779.
• 8. Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I et al. Guidelines for 99mTc-DMSA scintigraphy in children. Eur J Nucl Med 2001;28:BP37–BP41. PMID: 11315615
• 9. Cleper R, Krause I, Eisenstein B, Davidovits M. Prevalence of vesicoureteral reflux in neonatal urinary tract infection. Clin Pediatr (Phila) 2004; 43:619–625. DOI: 10.1177/000992280404300706 PMID: 15378148
• 10. Ristola MT, Hurme T. NICE Guidelines Cannot Be Recommended for Imaging Studies in Children Younger Than 3 Years with Urinary Tract Infection. Eur J Pediatr Surg 2015;25:414–420. DOI: 10.1055/s-0034-1384646. PMID: 25077594
• 11. Ristola MT, Löyttyniemi E, Hurme T. Factors Associated with Abnormal Imaging and Infection Recurrence after a First Febrile Urinary Tract Infection in Children..Eur J Pediatr Surg. 2017 Apr;27(2):142-149. doi: 10.1055/s-0036-1572418. Epub 2016 Feb 8.PMID: 26855368
• 12. Kimata T, Kitao T, Yamanouchi S, Tsuji S, Kino M, Kaneko K. Voiding cystourethrography is mandatory in infants with febrile urinary tract infection. Tohoku J Exp Med. 2013 Dec;231(4):251-5. PMID: 24270100
• 13. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics. 1999;103:843–52. PMID: 10103321
• 14. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. 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 2011;128(3):595-610. DOI: 10.1542/peds.2011-1330. PMID: 21873693
• 15. Jodal U, Lindberg U. Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Swedish Medical Research Council. Acta Paediatr Suppl. 1999;88:87–9. PMID: 10588276
• 16. Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS. 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. 2003 Mar;14(3):739-44. PMID: 12595511
• 17. National Collaborating Centre for Women's and Children's Health (UK). Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management.London: RCOG Press; 2007 Aug.PMID: 21290637
• 18. La Scola C, De Mutiis C, Hewitt IK, Puccio G, Toffolo A, Zucchetta P, et al. Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. 2013 Mar;131(3):e665-71. doi: 10.1542/peds.2012-0164. PMID: 23439905
• 19. Kimata T, Kitao T, Yamanouchi S, Tsuji S, Kino M, Kaneko K. Voiding cystourethrography is mandatory in infants with febrile urinary tract infection. Tohoku J Exp Med. 2013 Dec;231(4):251-5. PMID: 24270100
• 20. Massanyi EZ, Preece J, Gupta A, Lin SM, Wang MH. Utility of screening ultrasound after first febrile UTI among patients with clinically significant vesicoureteral reflux. Urology. 2013 Oct;82(4):905-9. doi: 10.1016/j.urology.2013.04.026. PMID: 23768525
• 21. Vates TS, Shull MJ, Underberg-Davis SJ, Fleisher MH. Complications of voiding cystourethrography in the evaluation of infants with prenatally detectedhydronephrosis. J Urol. 1999 Sep;162(3 Pt 2):1221-3. PMID: 10458471
• 22. Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I. The Presence of Vesicoureteric Reflux Does Not Identify A Population At Risk For Renal Scarring Following A First Urinary Tract Infection. Arch. Dis. Child. 2005 Jul;90(7):733-6. DOI: 10.1136/adc.2004.057604. PMID: 15970618
• 23. Gonzales E, Papazyan JP, Giardin E. Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol 2005; 173: 571–474. DOI: 10.1097/01.ju.0000151263.36909.91. PMID: 15643259
• 24. Preda I, Jodal U, Sixt R, Stokland E, Hansson S. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection. J Pediatr 151:581–584, 584.e1. DOI: 10.1016/j.jpeds.2007.05.008. PMID: 18035134
• 25. Fouzas S, Krikelli E, Vassilakos P, Gkentzi D, Papanastasiou DA, Salakos C. DMSA scan for revealing vesicoureteral reflux in young children with urinary tract infection. Pediatrics 2010; 126:e513e9. DOI: 10.1542/peds.2009-3635. PMID: 20679300
• 26. Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, et al. European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012 Sep;62(3):534-42. doi: 10.1016/j.eururo.2012.05.059. PMID: 22698573
• 27. Pecile P, Miorin E, Romanello C, Vidal E, Contardo M, Valent F, et al. Age-related renal parenchymal lesions in children with first febrile urinary tract infections. Pediatrics. 2009 Jul;124(1):23-9. DOI: 10.1542/peds.2008-1192. PMID: 19564279