Çocukluk Çağı Tekrarlayan İdrar Yolu Enfeksiyonlarının Klinik Özellikleri Ve Görüntüleme Yöntemleri ile Değerlendirilmesi

Year 2024, Volume: 7 Issue: 2, 233 - 238, 30.06.2024

Meriban Karadoğan Müferet Ergüven Nurdan Yildiz

Abstract

Giriş ve Amaç: Çocukluk çağının oldukça yaygın enfeksiyonlarından olan üriner sistem enfeksiyonları, akut ve uzun dönemde komplikasyonlara neden olabilmektedirler. Bu retrospektif çalışmada, tekrarlayan idrar yolu enfeksiyonu (İYE) tanısı alan hastaların, klinik özellikleri ve renal skar gelişimi için risk faktörlerinin belirlenmesi amaçlanmıştır.
Yöntem: Temmuz 1987-Aralık 2008 tarihleri arasında Göztepe Eğitim ve Araştırma Hastanesi Çocuk Nefroloji Polikliniği’ne başvuran 791 hastanın başvuru yaşı, şikayeti, cinsiyeti ve görüntüleme yöntemleri kaydedildi. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodlar ve ki-kare test kullanıldı.
Bulgular: Hastaların %77 (n=609)’i kız, %23 (n=182)’i erkek; yaş ortalaması 5,27±3,74 idi. En sık şikayetler ateş (%42,2), karın ağrısı (%27,3), idrar kaçırma (%18,6) idi. USG ile 220 hastada üriner sistemde patoloji tespit edildi. Voiding sistoüreterografi ile 293 hastada (%37) vezikoüreteral reflü (VUR), dimerkapto-süksinik asit sintigrafi ile 165 hastada (%20,9) skar, 28 hastada (%3,5) hipoaktivite saptandı. Erkek çocuklarda VUR oranı (%46,2; n=84), kız çocuklardan (%34,3; n=209) yüksek bulundu (p<0.01). VUR görülen çocuklarda skar görülme oranı (%34,8; n=102), görülmeyenlerden (%12,7; n=63) ve febril İYE geçiren hastalarda skar oranı (%30, n=101), afebril İYE geçirenlerden (%14, n=64) yüksek bulundu (p<0,01). Üriner sistemi anatomik ve fonksiyonel olarak normal olan olguların %11,1’inde skar mevcuttu. USG’ nin VUR tespitinde duyarlılığın %33,10; özgüllüğün %81,73; skar tespitinde duyarlılığın %37,5, özgüllüğün %96,8 olarak bulundu.
Sonuç: Üriner sistem enfeksiyonları ciddi komplikasyonlara yol açabilmesi nedeni ile önemini hala korumaktadır. Her yaş grubunda tekrarlayan enfeksiyonda ilk görüntüleme yöntemleri USG ve Tc-DMSA olmalıdır. USG, VUR ve skar saptamada etkin değildir. USG’de pelvik dilatasyon ve/veya DMSA’da skar saptanan hastalarda yüksek dereceli reflü olasılığı artmış olduğundan VCUG mutlaka yapılmalıdır.

Keywords

çocuk, idrar yolu enfeksiyonları, skar, vezikoüreteral reflü

Ethical Statement

Araştırmaya başlamadan önce SB. Göztepe Eitim ve Araştırma Hastanesi Etik Kurulu’ndan 10 Mart 2009 tarihinde ve 55/F nolu karar ile yazılı izin alınmıştır.

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