TY - JOUR T1 - The evaluation of the relationship of clinical and laboratory evidence with renal damage in the pediatric patients that had urinary tract infections TT - İdrar yolu enfeksiyonu geçiren çocuk hastalarda klinik ve laboratuvar kanıtların böbrek hasarı ile ilişkisinin değerlendirilmesi AU - Becerir, Tülay AU - Yüksel, Selçuk AU - Seyhan, Burçin PY - 2021 DA - October Y2 - 2021 DO - 10.31362/patd.990677 JF - Pamukkale Medical Journal JO - Pam Tıp Derg PB - Pamukkale Üniversitesi WT - DergiPark SN - 1308-0865 SP - 908 EP - 915 VL - 14 IS - 4 LA - en AB - 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. KW - Urinary tract infection KW - child KW - risk factors KW - renal scar KW - fever N2 - Amaç: İdrar yolu enfeksiyonu (İYE) çocukluk çağının önemli enfeksiyon hastalıklarından birisidir. Bazı çocuklardarenal skar gelişimine neden olarak uzun dönemde ciddi komplikasyonlara neden olmaktadır. Bu çalışmadaakut piyelonefrit kliniği ile başvuran çocuk hastalarda renal hasar gelişimindeki risk faktörlerinin belirlenmesiamaçlanmıştır.Gereç ve yöntem: Çalışmamızda Pamukkale Üniversitesi Tıp Fakültesi çocuk nefroloji polikliniğine başvuranidrar yolu enfeksiyonu tanısı ile takipli hastaların dosyaları retrospektif olarak değerlendirildi. Akut piyelonefrittanısı idrar kültürü ve klinik bulgular ile kanıtlanmış ve Dimerkaptosuksinik asit renal sintigrafisi (DMSA) çekilmiş197 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 sedimentasyonhızı (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), voidingsistoüretrografi (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 fazlasüredir devam ediyor olması, tekrarlayan İYE varlığı, BK, PNL, ESH ve CRP yüksekliğinin renal hasarlanmayıartırdığı tespit edildi (p<0,001). USG ve VSUG’ nin renal hasarlanmayı gösterme açısından düşük sensitiviteyesahip olduğu görüldü.Sonuç: Hastaların başvuru sırasında tespit edilen klinik ve laboratuar verileri ile renal hasarlanma oranıbelirlenmesi bu hastalarda uygun takip ve tedavi ile morbidite ve mortalite oranının azaltılmasını sağlayabilir. CR - 1. Tullus K, Shaikh N. Urinary tract infections in children. Lancet 2020;395:1659-1668. https://doi.org/10.1016/S0140-6736(20)30676-0. CR - 2. Millner R, Becknell B. Urinary Tract Infections. Pediatr Clin North Am 2019;66:1-13. https://doi.org/10.1016/j.pcl.2018.08.002 CR - 3. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002;8;113. https://doi.org/10.1016/s0002-9343(02)01054-9 4. Moorthy I, Easty M, McHung K, Ridout D, Biassoni D, Gordon I. The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. 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Arch Dis Child 2000 82:376-380. https://doi.org/10.1136/adc.82.5.376 30. Moorthy I, Wheat D, Gordon I. Ultrasonography in the evaluation of renal scarring using DMSA scan as the gold standart. Pediatr Nephrol 2004;19:153-156. https://doi.org/10.1007/s00467-003-1363-2 CR - 31. Moorthy I, Easty M, McHugh K, Ridout D, Biassoni D, 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;90:733-736. https://doi.org/10.1136/adc.2004.057604 UR - https://doi.org/10.31362/patd.990677 L1 - https://dergipark.org.tr/tr/download/article-file/1955750 ER -