Primer Vezikoüreteral Reflüde Renal Kortikal Anormallik ve İdrar Yolu Enfeksiyonu İlişkisinin Değerlendirilmesi

Yıl 2021, Cilt: 31 Sayı: 1, 65 - 69, 31.01.2021

Muhammet İrfan Dönmez Ahmet Midhat Elmacı Esma Keleşalp

Öz

Amaç: Renal skar, primer veziko-üreteral reflü VUR hastalarında konjenital veya kazanılmış şekilde gözlenebilir. Renal displazi ise embriyolojik gelişimdeki kusurlar sonucunda ortaya çıkar ve VUR ile birliktelik gösterebilir. Bu çalışmamızda amaç VUR tanısı ile takip edilen hastalarda skar ve displastik böbrek sıklığını ve bunun İYE ile olan ilişkisini araştırmaktır.Gereç ve Yöntem: Kliniğimizde 2012-2018 tarihleri arasında primer VUR tanısı ile takip edilen hastaların dosyaları retrospektif olarak incelendi. Sekonder VUR tanılı hastalar Nörojenik mesane, posterior uretral valv vb. çalışma dışı bırakıldı. Hastaların yaş, cinsiyet, idrar analizi, dimerkaptosüksinik asit DMSA sintigrafi ve işeme sistoüretrografi İSUG bulguları kaydedildi. Dilate VUR, İSUG’da ≥grade 3 VUR olarak kabul edildi. Renal skar ve displazinin İYE, VUR derecesi, lateralite ve cinsiyet ile ilişkisi olup olmadığı araştırıldı.Bulgular: Çalışmaya, kriterlere uyan toplam 121 hasta dahil edildi. Hastaların 66’ı kız %55 iken 55’i erkek %45 idi. Ortanca yaş 6 ay 2-42 ay olarak bulundu. Çalışmamızda 58 hastada %48 bilateral VUR saptanırken, 78 hastada %65 dilate VUR tespit edildi. İYE, toplamda 76 hastada %62,8 saptandı. Tüm hastaların 33’ünde %27,3 displastik böbrek gözlenirken, 20’sinde %16,5 renal skar tespit edildi. Displazik böbrekli olgularda İYE sıklığı istatistiksel anlamlı oranda daha az p

Anahtar Kelimeler

Vesikoüreteral refl, skar, displaz, idrar yolu enfeksiyonu, çocuk sağlığı ve hastalıkları

Assessment of renal cortical anomalies in primary vesicoureteric reflux and its association with urinary tract infections

Öz

Objective: Renal scars may be observed either as congenital or acquired in patients with vesicoureteral reflux VUR . On the other hand, renal dysplasia occurs due to faulty embryogenesis and may accompany VUR. The aim of this study is to observe the rates of renal scarring and dysplasia in patients with primary VUR and to evaluate its association with urinary tract infections UTI .Material and Methods: Files of the patients that were followed-up in our clinic with the diagnosis of VUR between 2012 and 2018 were retrospectively reviewed. Those with secondary VUR Neuropathic bladder, posterior urethral valves etc. were excluded. Age, gender, diagnosis of UTI, DMSA dimercaptosuccinic acid scan and VCUG voiding cystourethrography results were noted. VUR ≥grade 3 were regarded as dilating. The relationships of renal scarring and renal dysplasia with UTI, VUR degree, laterality and gender were assessed.Results : There were 121 patients in the cohort, 66 girls 55% and 55 boys 45% with a median age of 6 months range 2-42 months . VUR was bilateral in 58 48% while it was dilating in 78 65% . UTI was detected in 76 patients 62.8% . Dysplastic kidney was present in 33 patients 27.3% and renal scars were present in 20 16.5% . UTI rate was statistically lower in dysplastic kidneys p

Anahtar Kelimeler

Vesicoureteric reflux, scar, dysplasia, urinary tract infection, pediatrics

Kaynakça

• Mattoo TK, Mathews R. Vesicoureteral reflux and renal scarring. In: Avner ED, Harman WE, Niaudet P, Yoshikawa N, editors. Pediatric nephrology. Berlin: Springer; 2009. p. 1311–28.
• Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis. 2011 Sep;18(5):348-54.
• Mathew R, Matto TK (2008) Vesicoureteral Reflux. In: Ge- ary DF, Schaefer F (eds) Comprehensive pediatric nephro- logy, 1st edn. Mosby Elsevier, Philadelphia, pp 499–525.
• Sjöström S, Sillén U, Jodal U, Sameby L, Sixt R, Stokland E. Predictive factors for resolution of congenital high gra- de vesicoureteral reflux in infants: results of univariate and multivariate analyses. J Urol 2010 Mar;183(3):1177-84.
• Nguyen, H. T., Herndon, C. D., Cooper, C. et al.: The So- ciety for Fetal Urology consensus statement on the evaluati- on and management of antenatal hydronephrosis. J Pediatr Urol, 6: 212, 2010.
• Skoog SJ, Peters CA, Arant BS, et al. Pediatric vesicourete- ral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoure- teral reflux and neonates/infants with prenatal hydroneph- rosis. J Urol 2010;184:1145-51.
• Snodgrass WT, Shah A, Yang M, Kwon J, Villanueva C, Traylor J et al. Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol 2013 Dec;9(6 Pt A):856-63.
• Thergaonkar RW, Hari P. Current Management of Urinary Tract Infection and Vesicoureteral Reflux. Indian J Pediatr 2019 Dec 11. doi: 10.1007/s12098-019-03099-9.
• Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of re- nal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010; 126:1084-91.
• Gonzalez E, Papazyan JP, Girardin E. Impact of vesicoure- teral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol 2005; 173:571-4.
• Lin KY, Chiu NT, Chen MJ, Lai CH, Huang JJ, Wang YT et al. Acute pyelonephritis and sequelae of renal scar in pe- diatric first febrile urinary tract infection. Pediatr Nephrol 2003;18:362-5.