婴幼儿发热性尿路感染的影像学检查评价

目的 探讨肾脏超声检查(US)、放射性核素肾静态扫描(DMSA)和排泄性膀胱尿道造影(VCUG)检查在婴幼儿发热性尿路感染(UTI)中的应用价值.方法 发热性UTI患儿人院1周内进行US及DMSA检查,2周后进行VCUG检查,急性期DMSA异常者6个月复查,并对US、DMSA和VCUG检查结果进行回顾性分析.结果 婴幼儿发热性UTI患儿160例,急性期接受US、DMSA和VCUG三项检查的共75例,VCUG检出VUR患儿23例(35个VUR肾输尿管单位),检出率为30.7%;35个VUR肾输尿管单位中,Ⅰ级反流0个,Ⅱ级8个(22.9%).Ⅲ级11个(31.4%),Ⅳ级14个(40.0%),V级2个(5.7%).35个反流肾输尿管单位中,US提示反流的有15个;无反流的114个肾输尿管单位中US提示反流的有12个,US筛查VUR的敏感性为42.9%,特异性为89.5%,阳性预测率为55.6%,阴性预测率为83.6%.35个反流的肾输尿管单位中,DMSA提示异常的有31个;无反流的114个肾输尿管单位中,DMSA提示异常的有61个,DMSA筛查VUR的敏感性为88.6%,特异性为46.5%,阳性预测率为33.7%,阴性预测率为93.0%.24例6个月后DMSA复查发现肾瘢痕形成15例,占62.5%,其中VUR患儿有10例,反流程度均为Ⅲ级或Ⅲ级以上.结论 发热性UTI婴幼儿中VUR的发生率高,以严重VUR多见,且容易形成肾瘢痕,US、VCUG和DMSA均应作为常规评估检查.     

尿路感染与原发性膀胱输尿管反流

目的 了解儿童尿路感染中原发性膀胱输尿管反流的发生情况。方法 62例尿路感染患儿行排泄性膀胱尿路造影，诊断原发性膀胱输尿管反流并分级，以做相应治疗。结果 膀胱输尿管反流在尿路感染住院患儿中比例为40.32％。结论 儿童尿路感染的住院患儿，尤其反复发作者，存在原发性膀胱输尿管反流比例较大。     

加强对儿童尿路感染和膀胱输尿管反流的认识

儿童尿路感染是婴儿和儿童中一种常见的细菌性感染,6岁以内儿童泌尿道感染(UTI)累计发病率女孩为6.6%,男孩为1.8%.UTI与膀胱输尿管反流(VUR)的关系复杂,共同存在是导致持续性的肾脏损害和疤痕化的重要因素.UTI诊断明确后最常应用的影像学检查有肾脏和尿路超声检查、排泄性膀胱尿道造影和核素肾静态显像(DMSA),其中DMSA为目前公认的诊断肾瘢痕的金标准.尽管对在不同年龄、性别和临床表现的患儿中如何正确选择相关的影像学检查有较大的争议,但多数推荐对所有2岁以下的儿童进行超声、VCUG和DMSA检查.研究还显示VUR有其一定的遗传基础,在同胞中的发病率显著高于健康儿童.随时间推移发育逐渐成熟,有部分反流可自行痊愈,大都不需要手术治疗.大多数VUR的病例,尤其是5岁以下的儿童建议使用低剂量持续性抗生素预防治疗.反流性肾病长期的并发症是发生终末期慢性肾功能衰竭.     

儿童难治性尿路感染诊断与治疗策略

儿童难治性尿路感染(UTI)是临床棘手问题,主要包括:复杂性UTI,慢性肾脏病并UTI,导管相关性UTI,代谢性疾病,治疗不规范等医源性因素导致的超广谱耐药菌、L型细菌、其他特殊病原菌感染所致的UTI,以及免疫力低下患者的UTI。本文讨论了难治性UTI的诊断治疗策略,重点讨论抗生素治疗原则、膀胱输尿管反流的治疗方法及改善患者免疫状态等。通过采取综合治疗策略,对可以手术纠正的复杂原因(如膀胱输尿管反流、梗阻等)必要时行手术治疗,有助于提高难治性UTI的疗效,减少复发率,保护肾小管功能,延缓肾间质病变进展。     

儿童尿路感染及原发性膀胱输尿管反流临床诊治的专家共识(2007 上海)

尿路感染是儿科常见的感染性疾病之一,原发性膀胱输尿管反流(VUR)在健康儿童中发病率为1%,而在尿路感染患儿中可高达20%~50%.VUR和反复尿路感染可导致持续性的肾脏损害和疤痕化,从而可能引起高血压和慢性肾损害.     

复杂先天性肛门直肠畸形合并尿路感染影响因素的临床研究

目的:探讨复杂先天性肛门直肠畸形（congenital anorectal malformations,CAM）患儿的性别、直肠盲端与泌尿道异常交通、泌尿生殖系统畸形、膀胱输尿管反流和脊髓神经系统畸形与尿路感染的关系。方法:收集2016年2月至2018年9月收治于重庆医科大学附属儿童医院的95例复杂CAM患儿的临床资料...     

原发性膀胱输尿管反流及反流性肾病的影像学诊断

原发性膀胱输尿管反流是输尿管膀胱交界区的先天性异常。目前国内此病报道较少，现就我们近年遇到的16例原发性膀胱输尿管反流报告如下。材料与方法一、一般资料本组16例中男11例，女5例，年龄lmo～10a，平均3a。病史数天到6a。主要临床表现为尿频、尿急等反复泌尿系感染11例．     

儿童原发性膀胱输尿管反流突破性尿路感染的风险因素分析

目的总结分析儿童原发性膀胱输尿管反流(vesicoureteral reflux, VUR)发生突破性发热性尿路感染(urinary tract infection, UTI)的相关因素。方法回顾性分析2018年1月至2022年11月中国医科大学附属盛京医院经排泄性膀胱尿道造影诊断的儿童原发性膀胱输尿管反流患儿临床资料, 总结其临床特点, 并对其进行电话随访, 收集患儿临床资料及影像学资料, 将随访过程中发生突破性发热性UTI的患儿作为研究组, 未发生突破性发热性UTI的患儿作为对照组, 进行单因素及多因素Logistic回归分析。结果共140例膀胱输尿管反流患儿纳入本研究, 其中女童62例, 男童78例;首次发生UTI的中位年龄为4个月;双侧膀胱输尿管反流76例, 单侧膀胱输尿管反流64例;高级别膀胱输尿管反流65例(65/140, 46.4%);存在膀胱直肠功能障碍50例(50/140, 35.7%);其中68例(68/140, 48.6%)至少经历1次突破性发热性UTI, 72例(72/140, 51.4%)在诊断VUR后口服预防剂量抗生素期间无UTI。单因素分析结果显示, 是否...     

膀胱输尿管反流90例临床回顾分析

目的探讨输尿管膀胱反流(VUR)的临床特征。方法回顾分析2012年1月至2017年12月期间因发热性尿路感染住院治疗并经排泄性尿路造影(MCU)确诊VUR的患儿的临床资料。结果 90例患儿中男41例、女49例,中位年龄0.90岁;双侧反流46例,其中神经源性膀胱4例。51例1岁以下患儿中,男性28例、女性23例;10例5岁以上患儿中,仅1例男性患儿。6例手术治疗,其余84例内科保守治疗,其中随访到48例。随访患儿中,15例尿路感染复发,5例因肾瘢痕、患侧肾小球滤过率下降转为手术治疗;25例于一年后复查MCU,1例反流级别加重、12例无变化、5例减轻、7例消失。8例患儿首次肾静态显像(DMSA)发现肾脏缩小、肾瘢痕形成,36例患儿半年后复查DMSA发现10例出现肾瘢痕。结论婴儿期发热性尿路感染患儿,尤其是男孩应注意是否存在VUR。DMSA、MCU等检查不能相互取代。双侧VUR患儿应排除神经源性膀胱及合并其他畸形。     

婴幼儿胃食管反流病61例

胃食管反流（GER）是指胃内容物反流入食管,病理性反流伴有症状时称为胃食管反流病（GERD）。由于解剖生理特点,婴幼儿发病较多,现将我院收治的门例婴儿GERD报告如下。临床资料一、对象：系我院1995年6月～1998年6月的住院病人。年龄＜6mo35人,＜la6人,＜Zall人,＜3a9人。男46例,女15例。二、临床表现：呕吐32例（52％）,咽下困难、喘鸣各1例门．6％）,反复呼吸道感染36例（59％）,哮喘6例（9．8％）,反复窒息2例（3．2％）,营养不良门例（13％）。三、辅助检查1．动态24h食管PH监测：用便携式24hPH自动记录仪（Digitrap…     

Imaging the urinary tract in children with urinary tract infection

Aim: To evaluate whether ultrasonography (US) alone is sufficient in imaging the urinary tract in 1185 children with urinary tract infection (UTI). Methods: The reports on US and voiding cystourethrography (VCUG) were reviewed. Results: Initial US was normal in 861/1185 patients (73%). VCUG revealed abnormal findings in 285/861 (33%), of which grade III–V vesicoureteral reflux (VUR) comprised 97 cases (11%). During follow‐up, VUR had resolved in 88/97 (91%) patients: in 50/57 (88%) patients without active treatment for VUR, in 27/29 (93%) with endoscopic and in 11/11 (100%) with open surgery for VUR. During follow‐up, 11/97 patients (11%) had developed new renal scarring detectable in US, but no renal impairment occurred. Except for VUR, VCUG showed nonobstructive urethral valves in two infant boys with normal initial US. Thus, in 861 children with normal initial US, 40 patients with grade III–V VUR and two patients with significant nonreflux pathology may have benefited from surgical treatment, giving the total number of possibly missed pathological finding in 42/861 (4.9%) cases if VCUG had not been performed. Conclusion: We suggest that children with UTI could be examined using US alone and to use VCUG only after additional indications.     

Imaging in urinary tract infection.

The relationship of vesicoureteric reflex (VUR) and renal scarring was studied in 94 children (188 kidneys) with proved urinary tract infection in a district general hospital. There were 61 girls and 33 boys, with nine girls and 17 boys aged less than 1 year, 31 girls and nine boys aged between 1 and 5 years, the remaining 28 children were over 5 years of age. All children had a micturating cystourethrogram and a 99mTc (technetium) dimercaptosuccinic acid (DMSA) scan. Forty two of the 188 kidneys were scarred and 70 of the kidneys had VUR. Only 37.1% of the kidneys with reflux were scarred but 61.9% of the scarred kidneys had VUR. In children of less than 1 year, 48% of kidneys with VUR were scarred whereas 70.6% of scarred kidneys had reflux. In children between 1 and 5 years of age only 36.4% of kidneys with VUR were scarred but 63.2% of scarred kidneys had VUR. There is good correlation between the detection of a scarred kidney on DMSA and the presence of vesicoureteric reflux. However the detection of reflux particularly in children over 1 year of age shows poor correlation with renal scarring. This suggests that the primary imaging in children over 1 year of age presenting with a urinary tract infection should be of the kidney: a cystogram should be performed only if the DMSA scan is abnormal.     

Imaging and treatment strategies for children after first urinary tract infection

PURPOSE OF REVIEW: To highlight recent controversies regarding the rationale and effectiveness of imaging and treatment strategies for children who experience a first urinary tract infection. RECENT FINDINGS: The yield of renal ultrasound for children who have had a first urinary tract infection is relatively low, and the most commonly identified abnormalities are of unclear clinical significance. If concerned about renal ultrasound abnormalities, clinicians should not be reassured by a normal late trimester prenatal ultrasound because its negative predictive value is not sufficiently high. Vesicoureteral reflux is neither necessary nor sufficient for developing renal scars. Some pyelonephritis and renal scarring may be related to vesicoureteral reflux that is missed by standard voiding cystourethrogram but detectable during positional instillation of contrast cystography. Dimercaptosuccinic acid scans provide important information about presence of pyelonephritis and renal scars, and have high negative predictive value for ruling out high-grade (III-V) vesicoureteral reflux. Antimicrobial prophylaxis may not be effective for preventing recurrent infections and may result in antimicrobial resistance. Endoscopic therapy (Deflux) has demonstrated moderate success in correcting vesicoureteral reflux, but little is known about its impact on recurrent infection and renal scarring. SUMMARY: Debate continues about optimal imaging strategies after first urinary tract infection. More research is needed on the effectiveness of interventions designed to prevent recurrent infections and renal scarring.     

Renal ultrasound and excretory urography in infants and young children with urinary tract infection

The main purpose of the study was to see whether excretory urography (EU) can be safely replaced by ultrasound (US) in children with urinary tract infection (UTI) younger than 6 years. 101 hospitalised children were admitted to the prospective study. They were all diagnosed as having UTI and were treated accordingly. All children had voiding cystography (VCU), EU and US done. US and EU correlated well in 94% of the cases. In all 6 cases with discrepancy between EU and US, the VCU was abnormal. Our results confirm the data from other authors, that VCU and US should be sufficient as an initial work-up on children with UTI, while EU should be done only in the cases with abnormal findings on either one or both of the former investigations. However, it should be kept in mind that some cases of parenchymal involvement or mild subpelvic stenosis can be missed using this protocol. If EU is obtained only in the cases with abnormal US and/or VCU, only 55 children (54%) in our group would have had an EU done.