The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections

Abstract

Purpose: Urinary tract infection (UTI) is one of the important infectious diseases of childhood age. It causes serious late-term complications by leading to development of renal scarring in some pediatric patients. In the present study, it was aimed to determine the risk factors in development of renal damage in the pediatric patients that admitted with clinical of acute pyelonephritis.

Materials and methods: In our study, the medical files of the patients were admitted to the pediatric nephrology polyclinic of Pamukkale University Medical Faculty and followed-up with the diagnosis of urinary tract infection were retrospectively evaluated. The study included 197 patients diagnosed with acute pyelonephritis (confirmed by urine culture and clinical evidence) and undergoing dimercaptosuccinic acid (DMSA) scintigraphic imaging. The clinical evidence (fever, recurrent UTI, voiding dysfunction etc.), laboratory evidence (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, polymorphonuclear leukocyte (PNL) count, mean platelet volume (MPV), platelet count, serum urea and creatinine levels) and imaging evidence
(urinary tract system ultrasonography (USG), voiding cystourethrography (VCUG) and DMSA scintigraphy) of the patients detected at admission and obtained by anamnesis were evaluated.

Results: The number of the female patients (n=153) was found significantly higher than number of the male patients (n=44) (p<0.001). It was detected that pretreatment fever of 38ºC and over, persisting clinical evidence for 2 days or longer, the presence of recurrent UTI and high levels of WBC, PNL, ESR and CRP significantly increased renal damage in the patients (p<0.001). It was determined that USG and VCUG have low sensitivity regarding prediction of renal damage.

Conclusion: Determination of renal damage rate by clinical and laboratory data detected at patient admission may contribute to a reduction in morbidity and mortality rates by applying an appropriate follow-up and treatment modality. 

Keywords

• Urinary tract infection
• child
• risk factors
• renal scar
• fever

İdrar yolu enfeksiyonu geçiren çocuk hastalarda klinik ve laboratuvar kanıtların böbrek hasarı ile ilişkisinin değerlendirilmesi

Öz

Amaç: İdrar yolu enfeksiyonu (İYE) çocukluk çağının önemli enfeksiyon hastalıklarından birisidir. Bazı çocuklarda renal skar gelişimine neden olarak uzun dönemde ciddi komplikasyonlara neden olmaktadır. Bu çalışmada akut piyelonefrit kliniği ile başvuran çocuk hastalarda renal hasar gelişimindeki risk faktörlerinin belirlenmesi amaçlanmıştır.

Gereç ve yöntem: Çalışmamızda Pamukkale Üniversitesi Tıp Fakültesi çocuk nefroloji polikliniğine başvuran idrar yolu enfeksiyonu tanısı ile takipli hastaların dosyaları retrospektif olarak değerlendirildi. Akut piyelonefrit tanısı idrar kültürü ve klinik bulgular ile kanıtlanmış ve Dimerkaptosuksinik asit renal sintigrafisi (DMSA) çekilmiş 197 hasta çalışmaya dahil edildi. Hastaların başvuru sırasında saptanan ve anamnezden elde edilen klinik (ateş, tekrarlayan İYE, işeme  disfonksiyonu vb.), laboratuar (C-reaktif protein (CRP) ve eritrosit sedimentasyon hızı (ESH), beyaz küre sayısı (BK), polimorfonükleer lökosit sayısı (PNL), ortalama platalet hacmi (MPV), trombosit sayısı, serum üre ve kreatinin düzeyleri) ve görüntüleme (üriner sistem ultrasonografi (USG), voiding sistoüretrografi (VSUG) ve DMSA sintigrafisi) bulguları incelendi. 

Bulgular: Kız hastaların sayısı (n:153) erkek hastaların sayısından (n:44) anlamlı olarak daha yüksek saptandı (p<0,001). Hastaların tedavi öncesi ateş düzeyinin 38ºC ve üzerinde olması, klinik bulguların iki gün ve daha fazla süredir devam ediyor olması, tekrarlayan İYE varlığı, BK, PNL, ESH ve CRP yüksekliğinin renal hasarlanmayı artırdığı tespit edildi (p<0,001). USG ve VSUG’ nin renal hasarlanmayı gösterme açısından düşük sensitiviteye sahip olduğu görüldü.

Sonuç: Hastaların başvuru sırasında tespit edilen klinik ve laboratuar verileri ile renal hasarlanma oranı belirlenmesi bu hastalarda uygun takip ve tedavi ile morbidite ve mortalite oranının azaltılmasını sağlayabilir. 

Anahtar Kelimeler

• idrar yolu enfeksiyonu
• çocuk
• risk faktörleri
• renal skar
• ateş

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