Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis

被引:28
作者
González, E
Papazyan, JP
Girardin, E
机构
[1] Childrens Hosp, Dept Paediat, Paediat Nephrol Unit, CH-1211 Geneva, Switzerland
[2] Univ Hosp Geneva, Dept Radiol, Div Nucl Med, Geneva, Switzerland
关键词
pyelonephritis; cicatrix; vesico-ureteral reflux; technetium Tc. 99m dimercaptosuccinic acid;
D O I
10.1097/01.ju.0000151263.36909.91
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: We determined the impact of vesicoureteral reflux (VUR) on the size of renal lesions in children after an episode of acute pyelonephritis. Materials and Methods: A total of 161 children (mean age 2.44 years) with acute pyelonephritis were studied. All had renal lesions on dimercapto-succinic acid scintigraphy done at admission to the hospital. A second dimercapto-succinic acid scan was performed at 3 months. Voiding cystourethrography was done at 6 weeks and VUR was graded I to V. For each renal unit, layouts of renal lesions were drawn, and the damage surface was calculated and reported for the total surface of the kidney. Results: Mean size of acute lesions and scars increased with severity of reflux (p <0.0001), with an important overlap of individual values. Mean size of renal scars in the group of renal units with acute lesions was 5.8% +/- 8.5% in patients without VUR, 9.9% +/- 7.3% in those with grade I reflux, 7.7% +/- 11.0% in those with grade II reflux, 17.7% +/- 14.7% in those with grade III reflux and 17.4% +/- 27.7% in those with grade IV reflux (p <0.001). The size of renal lesions decreased significantly with time. The rate of regression of lesions decreased with increasing reflux. When analyzed according to 3 age groups sizes of scars increased significantly with age. Conclusions: VUR has an impact on the size of renal lesions after an episode of pyelonephritis. Children with a grade III or IV reflux are more likely to have larger renal scars. On the other hand, acute lesions of important size may develop even in the absence of VUR.
引用
收藏
页码:571 / 574
页数:4
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