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

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

doi:10.12956/tchd.512969

Research Article

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

Year 2019, Volume: 13 Issue: 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

Abstract

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.

Keywords

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

References

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

Year 2019, Volume: 13 Issue: 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

Abstract

References

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

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Details

Primary Language	Turkish
Subjects	Internal Diseases
Journal Section	ORIGINAL ARTICLES
Authors	Fatma Yazılıtaş 0000-0001-6483-8978 Fatma Zehra Öztek-çelebi 0000-0002-2203-5904 Sare Gülfem Özlü 0000-0002-9609-1511 Evrim Kargın Çakıcı 0000-0002-1697-6206 Hasibe Gökçe Çınar This is me 0000-0003-2687-1544 Ayşe Seçil Ekşioğlu This is me 0000-0002-7044-5270 Nedim Cüneyt Murat Gülaldı This is me 0000-0003-1478-5294 Mehmet Bülbül This is me 0000-0001-9007-9653
Publication Date	July 30, 2019
Submission Date	January 15, 2019
Published in Issue	Year 2019 Volume: 13 Issue: 4

Cite

Vancouver	Yazılıtaş F, Öztek-çelebi FZ, Özlü SG, Kargın Çakıcı E, Çınar HG, Ekşioğlu AS, Gülaldı NCM, Bülbül M. İdrar Yolu Enfeksiyonu Tanılı Çocuklarda Ultrasonografi, Teknesyum-99m Dimerkaptosüksinik Asit Sintigrafisi ve Voiding Sistoüretrografi Bulgularının Uyumu. Turkish J Pediatr Dis. 2019;13(4):277-82.

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