Tekrarlayan üriner sistem enfeksiyonu geçiren hastaların klinik, laboratuvar ve görüntüleme yöntemlerinin karşılaştırılması
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Dosyalar
Tarih
2019
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş Amaç: Vezikoüreteral reflü (VUR), idrarın üreterovezikal bileşim yeri yetersizliğine bağlı olarak mesaneden üretere geriye kaçışını ifade eder. Pediatrik nefroloji ve çocuk cerrahi ünitelerinin en sık karşılaştıkları hastalıklardan birisidir. Tekrarlayan ÜSE tanısı alan çocukların ortalama %35'inde VUR vardır. Kanıtlanmış ÜSE geçiren her çocuk VUR açısından araştırılmalıdır. VUR doğumsal anomali, enfeksiyon, anatomik ve fonksiyonel nedenlerle ilişkili olarak gelişebilir. VUR'un toplumda görülme sıklığı yaklaşık %1'dir. VUR çocuklarda hipertansiyon, büyüme gelişme geriliği, böbrek yetersizliği gibi önemli morbidite ve mortalite nedenidir. ÜSE en sık VUR patolojisi ile ilişkilidir. Günümüzde VUR başlangıç tanısı için kullanılan ve altın standart olarak kabul edilen radyolojik tetkik ''voiding" sistoüretrogram ("VCUG") dir. Bu retrospektif çalışmanın amacı; tekrarlayan üriner sistem enfeksiyon olgularında klinik, laboratuvar ve görüntüleme yöntemlerinin değerlendirilmesi, vezikoüreteral reflü sıklığının görüntüleme yöntemleri ile belirlenmesi, tanı, tedavi ve takiplerinin yapılmasıdır. Gereç ve Yöntem: Çalışma retrospektif olarak tasarlandı. Çalışmaya Düzce Üniversitesi Tıp Fakültesi Hastanesi Çocuk Sağlığı ve Hastalıkları Bölümü 0cak 2013- Aralık 2018 yılları arasında başvuran 19 yaş altı tekrarlayan ÜSE tanısıyla takipli 135 hasta belirlenmiş dışlama kriterleri çerçevesinde dahil edildi. Hastaların demografik bilgileri, yaş, ağırlık, cinsiyet, ek hastalık, laboratuvar ve görüntüleme sonuçları, tedavi takip bilgileri alındı. Bulgular: Çalışmaya dahil edilen 135 hastanın 98 'i (%72.6) kız, 37'si (%27.4) erkekti. Kız hastalar 7.5±4.4 yaş, erkek hastalar 5.2±4.4 yaşındaydı. Kültürde üreyen bakteri sıklığı incelendiğinde, E. Coli 71 (%72.4) kız olguda sıklığı anlamlı düzeyde yüksek bulundu (P<0.001). Voiding sonucunda VUR tespit edilen 60 (%44.4) hastada VUR tespit edilmeyenlere göre anemi görülme sıklığı anlamlı düzeyde daha yüksek bulundu (P<0.006). Voidinge göre VUR(+) olan hastalarda DMSA ve MAG-3 ile yapılan görüntülemede tek taraflı patoloji sıklığı daha yüksek bulundu (P değerleri sırasıyla 0.003 ve 0.023). Sonuç: Çalışmamızda VUR tespit edilen 60 hastanın 43'ü kız (%71.6), 17'si (%28.3) erkekti.. Çalışmaya dahil edilen 135 hastaya DMSA sintigrafi yapıldı, 35 (%26.1) tek taraflı, 7 (%5.2) bilateral skar dokusu tespit edildi. Çalışmamızın sonuçları retrospektif olarak incelendiğinde, DMSA sintigrafisinin tekrarlayan üriner sistem enfeksiyonu olan çocuklarda renal hasarı saptamada çok hassas bir tanı yöntemi olduğu saptandı. Renal skar açısından risk faktörü olan hastalarda VUR'un saptanması için VCUG yapılması gereklidir. Bu hasta grubunda DMSA sintigrafisinin ve VCUG'nin kullanımının yaygınlaşması tekrarlayan üriner enfeksiyonlu çocuklarda takip stratejilerinin geliştirilmesinde yeni yaklaşımlar ve algoritmalar ortaya çıkaracaktır.
Introduction-Purpose: Vesicoureteral reflux (VUR) refers to the escape back of urine from the bladder into ureters due to insufficient ureterovesical disorders. It during urination is one of the most common diseases of pediatric nephrology and pediatric surgery units. On average, 35% of children diagnosed with recurrent urinary tract infection have VUR. Every child with proven urinary tract infection should be investigated for VUR. VUR may be associated with congenital anomaly, infection, anatomical and functional reasons. VUR is a major cause of morbidity and mortality in children such as hypertension, growth retardation, renal failure. Urinary tract infection is most commonly associated with VUR pathology. Nowadays, radiological examination which is accepted as the gold standard for the initial diagnosis of VUR is voiding cystourethrogram (VCUG). The aim of this retrospective study was; evaluation of clinical, laboratory and imaging methods in recurrent urinary tract infections, determine the frequency of vesicoureteral reflux by imaging methods, and to diagnose, treat and follow-up. Material and Methods: The study was designed retrospective study. A total of 135 patients under 19 years of age with recurrent UTI who were admitted between January 2013 and December 2018 at Düzce University Faculty of Medicine Hospital Department of Pediatrics were included in the study within the framework of designated exclusion criteria. Demographic information, age, weight, gender, additional disease, laboratory and imaging results, treatment follow-up information were obtained. Findings: Of the 135 patients included in the study, 98 (72.6%) were female and 37 (27.4%) were male. Female patients were 7.5 ± 4.4 years and male patients were 5.2 ± 4.4 years old. When the frequency of bacterial growth in culture was examined, the frequency of E. coli in 71 (72.4%) girls was significantly higher (p <0.001). The incidence of anemia was significantly higher in 60 (44.4%) patients with VUR than those without VUR (P <0.006). In patients with VUR + compared to voiding, unilateral pathology frequency was higher in DMSA and MAG-3 imaging (p values 0.003 and 0.023, respectively). Results: In our study, 43 of 60 patients (71.66%) and 17 of them (28.34%) were male. 134 patients underwent DMSA scintigraphy, 35 (26.1%) unilateral and 7 (5.2%) bilateral scar tissue were detected. Our unvestigation results showed that, it was found that DMSA scintigraphy is a very sensitive diagnostic method for detecting renal damage in children with recurrent urinary tract infection. VCUG is necessary to detect VUR in patients with risk factors for renal scarring. The widespread use of DMSA scintigraphy and VCUG in this patient group will reveal new approaches and algorithms for the development of follow-up strategies in children with recurrent urinary infections.
Introduction-Purpose: Vesicoureteral reflux (VUR) refers to the escape back of urine from the bladder into ureters due to insufficient ureterovesical disorders. It during urination is one of the most common diseases of pediatric nephrology and pediatric surgery units. On average, 35% of children diagnosed with recurrent urinary tract infection have VUR. Every child with proven urinary tract infection should be investigated for VUR. VUR may be associated with congenital anomaly, infection, anatomical and functional reasons. VUR is a major cause of morbidity and mortality in children such as hypertension, growth retardation, renal failure. Urinary tract infection is most commonly associated with VUR pathology. Nowadays, radiological examination which is accepted as the gold standard for the initial diagnosis of VUR is voiding cystourethrogram (VCUG). The aim of this retrospective study was; evaluation of clinical, laboratory and imaging methods in recurrent urinary tract infections, determine the frequency of vesicoureteral reflux by imaging methods, and to diagnose, treat and follow-up. Material and Methods: The study was designed retrospective study. A total of 135 patients under 19 years of age with recurrent UTI who were admitted between January 2013 and December 2018 at Düzce University Faculty of Medicine Hospital Department of Pediatrics were included in the study within the framework of designated exclusion criteria. Demographic information, age, weight, gender, additional disease, laboratory and imaging results, treatment follow-up information were obtained. Findings: Of the 135 patients included in the study, 98 (72.6%) were female and 37 (27.4%) were male. Female patients were 7.5 ± 4.4 years and male patients were 5.2 ± 4.4 years old. When the frequency of bacterial growth in culture was examined, the frequency of E. coli in 71 (72.4%) girls was significantly higher (p <0.001). The incidence of anemia was significantly higher in 60 (44.4%) patients with VUR than those without VUR (P <0.006). In patients with VUR + compared to voiding, unilateral pathology frequency was higher in DMSA and MAG-3 imaging (p values 0.003 and 0.023, respectively). Results: In our study, 43 of 60 patients (71.66%) and 17 of them (28.34%) were male. 134 patients underwent DMSA scintigraphy, 35 (26.1%) unilateral and 7 (5.2%) bilateral scar tissue were detected. Our unvestigation results showed that, it was found that DMSA scintigraphy is a very sensitive diagnostic method for detecting renal damage in children with recurrent urinary tract infection. VCUG is necessary to detect VUR in patients with risk factors for renal scarring. The widespread use of DMSA scintigraphy and VCUG in this patient group will reveal new approaches and algorithms for the development of follow-up strategies in children with recurrent urinary infections.
Açıklama
YÖK Tez No: 604535
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Nüks, Recurrence, Vezikoüreteral reflü, Vesico ureteral reflux, Çocuk hastalıkları, Child diseases, Çocuklar, Children, Üriner sistem, Urinary tract, Üriner sistem enfeksiyonları, Urinary tract infections
