방광 요관 역류가 있는 소아에서 신반흔 형성과 관련된 인자들

김경희,장성희,이대열,Kim Kyoung Hee,Jang Sung Hee,Lee Dae-Yeol 대한소아신장학회 2001 Childhood kidney diseases Vol.5 No.1

목 적 : 소아기 요로 감염은 신손상을 유발하여 신반흔, 고혈압, 단백뇨, 말기신부전증등을 일으키며 특히 방광 요관 역류는 신반흔과 밀접한 관련이 있는 것으로 알려져 있다. 본 연구의 목적은 방광 요관 역류가 있으면서 신반흔을 형성한 환아군과 형성하지 않은 환아군의 연령, 성별, 역류 등급, ACE 유전자 다형성, 그리고 신체적 성장의 소견을 비교 분석하여 신반흔에 관련된 인자들을 평가하기 위한 것이다. 대상 및 방법 : 1992년 7월부터 2000년 6월까지 요로 감염으로 전북대병원 소아과에 내원한 환아 545명중에 방광 요관 역류로 진단된 15세 미만의 환아 93명을 대상으로 후향적으로 조사하였다. 환아들은 신반흔의 유무에 따라 두 군으로 분류하여 진단시 연령과 성별, 키, 체중등을 조사하였고 방광 요관 역류와 그 정도는 배뇨중 방광 요도 조영술을 시행하였으며 신반흔은 99mTc-DMSA 신스캔으로 추적 검사를 시행하여 확진하였다. ACE 유전형은 말초 혈액의 genomic DNA에서 PCR법으로 결정하였고, 신장과 체중은 HSDS와 WHI로 나타내어 비교 분석하였다. 결 과 : 신반흔이 있는 환아 54명 중에 방광 요관 역류 환아는 47명(87$\%$)으로 방광 요관 역류가 신반흔의 중요한 인자이었다. 신반흔 형성군과 무형성군 사이의 남녀별 차이는 없었으며 신반흔 형성군의 진단시 평균 연령은 2.48${\pm}$2.65세로 무형성군의 1.26${\pm}$1.83세에 비해 유의하게 높았다(P<0.05). 방광 요관 역류의 정도는 역류 등급이 높을수록 신반흔이 생기는 비율이 높았다(P<0.05). 1세 미만의 역류가 있는 환아들은 비교적 신반흔을 잘 형성하였고 모든 연령분포에서 역류의 정도가 심할수록 신반흔이 잘 발생하였다(P<0.05) 전체 요로감염이 있었던 환아의 17.5$\%$에서 방광 요관 역류가 있었고, 이 때 동반된 요로 감염의 대부분의 원인균은 E. coli였으며(75.3$\%$, E. coli가 차지하는 비율은 양 군($76.6\%/73.9\%$)사이에 유의한 차이는 없었다(P>0.05). ACE 유전자 다형성에 따른 신반흔 형성과의 관계를 보기 위해 양 군사이를 비교하였으나 유의한 차이는 없었다(P>0.05). 신반흔의 정도와 신체적 성장과의 관계를 보기 위해 진단시의 키와 체중을 매개변수인 HSDS와 WHI로 환산하여 양 군사이를 비교하였을 때 유의한 차이는 없었다(P>0.05). 결 론 : 본 연구에서 신반흔에 관련된 인자로서는 진단시의 연령, 방광 요관 역류의 유무, 또한 역류의 정도와 관계가 있고 성별, 원인균, ACE유전자형과는 무관하였으며, 앞으로 세균의 독성요소로 작용하는 E. coli의 특성에 대한 자세한 연구와 신반흔의 정도에 따른 신체적 성장의 추적 관찰에 대한 연구가 필요할 것으로 생각된다. Purpose : The urinary tract infection associated with vesicoureteral reflux(VUR) in children may result in serious complications such as renal scarring, hypertension, proteinuria and end stage renal disease. The purpose of this study was to evaluate the factors affecting renal scar such as age, gender, grade of VUR, and ACE gene polymorphism, and body growth in the patients with and those without renal scar associated with VUR Methods : During the period from January 1994 to July 2000, We had 93 children with urinary tract infection associated with VUR who were admitted to the Department of pediatrics of Chonbuk National University Hospital. The patients were divided into two groups according to follow up 99mTc-DMSA renal scan; patients with renal scar group and those with non-scar group. We analyzed and compared the factors associated with renal scarring between the two groups. Results : There were no significant difference in gender, causative organism, ACE gene polymorphism, height and weight at diagnosis between renal scar group and non-scar group. Fifty four patients were in renal scar group and forty seven of them had VUR. The age at diagnosis was significantly higher in renal scar group (2.48${\pm}$2.64yr) than in non renal scar group (1.26${\pm}$1.83yr). Especially, the infants who were less than 1 year of age with VUR developed relatively more renal scar compared with infants older than 1 tear of age. The incidence of renal scarring showed a direct correlation with the severity of VUR. Conclusion : The factors affecting renal scar formation were age at diagnosis, presence and grade of VUR, but the other factors such as gender, causative organism, ACE gene polymorphism were not associated with renal scarring. Therefore, further evaluation about uropathogenic E coli and foflow up study about body growth associated with severity of renal scar would be necessary. (J. Korean Soc Pediatr Nephrol 5 : 43- 50, 2001)

Prognostic Factors of Renal Scarring on Follow-up DMSA Scan in Children with Acute Pyelonephritis

Juyeen Lee,Byung Woo Woo,Hae Sook Kim 대한소아신장학회 2016 Childhood kidney diseases Vol.20 No.2

Purpose: Early diagnosis and treatment of urinary tract infection have been em phasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN). Methods: The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups accor ding to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesi coureteral reflux, and vesicoureteral reflux grade. Results: Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diag nosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II. Conclusion: Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

Prognostic Factors of Renal Scarring on Follow-up DMSA Scan in Children with Acute Pyelonephritis

Lee, Juyeen,Woo, Byung Woo,Kim, Hae Sook Korean Society of Pediatric Nephrology 2016 Childhood kidney diseases Vol.20 No.2

Purpose: Early diagnosis and treatment of urinary tract infection have been emphasized to prevent renal scarring. If untreated, acute pyelonephritis could cause renal injury, which leads to renal scarring, hypertension, proteinuria, and chronic renal failure. The purpose of this study was to assess risk factors of renal scarring after treatment of acute pyelonephritis (APN). Methods: The medical records of 59 patients admitted at Daegu Fatima Hospital because of APN between March 2008 and April 2015 whose renal cortical defects were confirmed by using initial technetium-99m dimercaptosuccinic acid (DMSA) scans were reviewed retrospectively. We divided 59 patients into 2 groups according to the presence of renal scar and assessed risk factors of renal scar, including sex, age at diagnosis, feeding method, hydronephrosis, bacterial species, vesicoureteral reflux, and vesicoureteral reflux grade. Results: Of 59 patients (41%), 24 showed renal scar on follow-up DMSA scan. No significant differences in sex, hydronephrosis, bacterial species, and fever duration were found between the renal-scarred and non-scarred groups. As for age at diagnosis, age of >12 months had 5.8 times higher incidence rate of renal scarring. Vesicoureteral reflux (VUR) affected renal scar formation. VUR grade III or IV had 14.7 times greater influence on renal scar formation than VUR grade I or II. Conclusion: Our data suggest that the presence of VUR and its grade and age at diagnosis are risk factors of renal scar on follow-up DMSA scan after APN.

신반흔 예측인자로서 초기 $^{99m}Technetium-dimercaptosuccinic\;Acid$ 신주사 소견과 방광요관 역류의 유무 및 정도

이수연,임소희,이대열,Lee Soo-Yeon,Lim So-Hee,Lee Dae-Yeol 대한소아신장학회 2003 Childhood kidney diseases Vol.7 No.1

목적 : 본 연구에서는 신반흔의 고위험 환아를 규명하고자 요로감염 후 DMSA 신주사를 이용하여 급성기와 치료 후 추적 검사를 통하여 신반흔을 형성한 군과 신반흔을 형성하지 않은 군에서 방광요관 역류 유무와 등급, DMSA 신주사 소견 등을 비교 분석하여 신반흔에 관련된 인자들을 평가하고 신반흔의 예측인자로서 방광요관 역류와 급성기 DMSA 신주사 소견의 유용성을 알아보고자 하였다. 방법 : 1992년 4월부터 2002년 3월까지 전북 대학교 병원 소아과에 요로감염으로 입원한 환아 442명을 대상으로 후향적으로 조사하였다. 요로감염의 급성기에 급성기반응 지표, DMSA 신주사를 시행하였고 치료 후 VCUG를 시행하여 방광요관 역류를 진단하였고 치료 4-6개월 후 DMSA 신주사를 시행하여 신반흔 유무에 따라 두 군으로 나누어 비교 분석하였다. 결과 : 연령 분포는 두 군 모두 1세 미만이 가장 많았으나 신반흔 형성군에서는 진단당시 연령이 신반흔 무형성군에 비해 높았고 성별에 따른 유의한 차이는 보이지 않았다. 원인균으로는 E.coli가 가장 많았으며 두 군간에 원인균에 따른 차이는 없었고 급성기에 시행한 백혈구, ESR, CRP 등의 급성기 반응지표는 신반흔 형성과 상관관계를 보이지 않았다. 신반흔 형성군에서는 방광요관 역류의 빈도가 78%, 신반흔 무형성군에서는 13%이었고, grade IV 이상의 중증의 역류가 차지하는 비율이 신반흔 형성군에서 높았으며 방광요관역류와 그 정도가 신반흔 형성과 밀접한 관계가 있음을 보여주었다. 급성기에 시행한 DMSA 신주사 소견상 다초점성 신피질 결손의 빈도가 신반흔 형성군에서 53%로 신반흔 무형성군의 32%에 비해 유의하게 높았고 방광요관 역류가 있으면서 신주사상 다초점성 결손을 보인 환아의 75%에서 신반흔이 형성되었다. 결론 : 신반흔 형성은 방광요관 역류의 유무와 정도, 급성기의 DMSA 신주사 소견과 밀접한 관계가 있었다. 따라서 초기 신주사 소견과 방광요관 역류는 신반흔 발생의 위험을 예측하는데 도움을 주며 고위험군으로서 추적관찰에 유용한 정보를 제공해 줄 것으로 생각된다. Purpose : Acute pyelonephritis in children may result in permanant renal damage which later in life may lead to hypertension and renal failure. The purpose of this study was to evaluate the factors that might be useful for predicting the development of renal scar in children with urinary tract infection(UTI). Methods : We retrospectively reviewed 442 patients with UTI who were admitted to the Department of Pediatrics of Chonbuk National University Hospital, during the period from April 1992 to March 2002. The patients were divided into two groups according to the presence of renal scar on the follow-up DMSA renal scan, and we compared the factors associated with renal scarring between the two groups. Results : There were no significant differences in sex, causative organism and acute phase reactants between the groups with and without renal scar. The age at diagnosis was significantly higher in the renal scar group compared to that without scar. Of the 60 patients with renal scar, 78% had vesicoureteral reflux(VUR), but 13% of patients without scar had VUR. Furthermore, the severity of VUR was significantly correlated with renal scar formation. 53% showed multiple cortical defects on the initial DMSA renal scan, compared to 32% in the non-scar group. In addition, 76% of patients showing multiple cortical defects on the initial DMSA renal scan with VUR had renal scar. Conclusion : The presence and grade of VUR, and findings on the initial DMSA renal scan would contribute to predict risk of renal scar formation in children with UTI.

소아의 첫 발열성 요로감염에서 신 반흔에 영향을 미치는 인자

정석원,정경훈,김명현,홍영진,손병관,이지은,Jung Suk-Won,Jung Kyeong-Hun,Kim Myung-Hyun,Hong Young-Jin,Son, Byong-Kwan,Lee Ji-Eun 대한소아신장학회 2005 Childhood kidney diseases Vol.9 No.1

목 적 : 요로 감염은 조기 진단 및 치료를 적절히 하지 않으면 비 가역적인 신 손상을 초래하기 쉽다. 신 반흔을 막기 위한 요로 감염의 적절한 치료 시작 시기와 소아의 첫 발열성 요로 감염에서 신 반흔 발생과 관련한 인자를 알아보았다. 방 법 : 2000년 4월부터 2004년 4월까지 첫번째 발열성 요로 감염으로 진단된 2세이하 환아163명을 대상으로 후향적으로 조사하였다. 요로감염 급성기에는 DMSA 신 스캔, 치료 후 VCUG을 시행하고 치료 6개월 후 추적 DMSA 신 스캔을 시행, 신 반흔 유무를 평가하였다. 치료 전 발열 기간, 치료 후의 발열 기간, 총 발열기간에 따라 각각 두 군으로 분류, 진단시와 6개월 후 추적 DMSA 신 스캔 소견을 비교 분석하였다. 또한 신 반흔 유무에 따라 신 반흔 형성군과 무형성군으로 분류하여 관련된 예측 인자와의 관계를 분석하였다. 결 과 : 치료 전 발열 기간이 24시간 이하 군에서 초기 DMSA 신 스캔의 이상 소견 빈도는 23%였고 이중 33%에서 신 반흔이 발생하였다. 24시간초과 그룹에서는 각각 43%, 38%였으나 군간 유의한 차이는 없었다. 치료시작 후 발열기간이 48시간 이하이며서 초기 DMSA 검사에서 이상을 보인 환아 중 34%에서 신 반흔이 생겼고, 치료 후 열이 48시간 이상 지속된 경우는 50%에서 신 반흔이 형성되어 두 군간 차이는 없었다. 총 발열 기간 72시간 이하인 환아군의 45%에서 신 피질 결손, 19%에서 신 반흔이 나타났고, 72시간 초과인 환아군에서는 각각 31%, 57%로 신 반흔 형성률이 의미있게 높았다. 총 발열기간, 높은 CRP, 방광요관 역류가 신 반흔 형성과 관련 있었으며 이중 방광요관 역류가 가장 높은 연관을 보였다. 결 론 : 소아의 발열성 첫 요로 감염에서 치료 전 발열 기간이 24시간 이내라도 신 반흔을 완전히 예방할 수 없었고 이에 관여하는 주된 인자는 방광요관 역류였다. Purpose : Development of renal scarring is associated with delayed diagnosis and treatment of urinary tract infection(UTI). This study was performed to clarify how soon treatment should be started to Inhibit renal scarring after onset of UTI and the factors associated with renal scarring in children with a first episode of febrile UTI. Methods : We retrospectively reviewed 163 patients with a first episode of febrile UTI under the age of 2 years from April 2000 to Ap,il 2004. All patients had a DMSA renal scan and voiding cystourethrogram done in the diagnostic period, 6 months after which a follow-up renal scan was done. After patients wet-e divided into 2 groups according to the duration of fever prior to start of treatment, the duration of fever after start of treatment, and total duration of fever, initial and follow-up DMSA scan findings were analyzed among the different groups. We compared the factors associated with renal scars between the groups with and without renal scars. Results : The initial DMSA renal scan identified abnormal finding in 23% of the patients who were treated $\leq$24 hr from the onset of disease and in 43% of those with fever more than 24 hr. Renal scars developed in 33% of patients who were treated $\leq$24 hr and 38% of those with fever >24 hr prior to treatment. Renal scars developed in 34% of patients with remission of fever $\leq$48 hr after treatment and ill 50% of those with fever >48 hr after treatment. The risk for renal scars was significantly higher in children who had total duration of feyer >72 hr(67%) than in those with shorter duration(19%). In children with renal scars, VUR was most highly associated with an increased risk of renal scar formation. Conclusion : Although children with a first episode of febrile UTI are treated within 24 hr after onset of the fever, renal damage cannot be prevented completely and it is mainly associated with VUR. (J Korean Soc Pediatr Nephrol 2005;9:56-63)

급성 요로감염 환아의 신장 반흔 예측요인

백준현,박영하,황성수,전정수,김성훈,이성용,정수교 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.4

목적 : 본 연구는 요로 감염 환아의 추적 ^(99m)Tc DMSA신 피질 스캔으로 신장 반흔을 진단하고, 감염 초기 스캔 소견, 요관 역류, 신장 섭취율, 연령, 성 등 관련 요인들이 신장 반흔에 미치는 영향을 분석하고자 하였다. 대상 및 방법 : 임상증상, 소변 검사 및 뇨 배양 검사로 요로 감염으로 진단된 14세 이하의 환자 83명을 대상으로 하였다. 남아 50명, 여아가 33명이었고 평균 연령은 33.7개월 이었다. 치료 시작 일주일 이내에 DMSA스캔과 배뇨성 방광 요도술을 시행하였으며, 적절한 항생제 치료 후 6개월 이후에 추적 스캔을 하였다. 추적 스캔에서 감염 초기 보였던 피질 결손이 회복되지 않은 경우를 신 반흔으로 진단하였으며, 피질 결손을 1; 신장상부나 하부의 큰 결손으로 신장 의연은 불분명하나 변형은 없는 경우. 2 ; 작은 결손으로 신장 외연의 뚜렷한 변형이 없는 경우. 3 ; 단일 결손으로 신장 외연의 국소적인 변형을 일으킨 경우. 4 ; 정상 혹은 작은 크기의 신장으로 외연의 변형이 있는 경우. 5 ; 다발성 피질 결손이 있는 경우. 6 ; 국소적인 이상 소견 없이 미만성으로 신장 섭취가 감소한 경우로 분류하였다. 배뇨성 방광 요도술에서 요관 역류는 5단계로 분류하였다. 결과 : 166개의 신장 중 감염 초기 신 피질 스캔에서 결손을 보인 신장은 115개(69.3%) 이었고, 추적 검사에서 신장 반흔으로 진단된 신장은 65개(56.5%)였다. 신 피질 스캔에서 3, 4, 5 형태 결손의 75%, 77%, 78%에서 신장 반흔이 발생된 반면, 1, 2, 6 형태 결손의 65%, 77%, 50%에서 결손이 회복되었다. 회복이 어려운 3, 4, 5 형태 결손으로 신장 반흔을 진단할 경우 DMSA스캔의 민감도, 특이도, 정확도는 각각 76.9%, 85.1%, 81.9%였다. 요관 역류는 감염 초기 스캔에서 3, 4, 5 형태의 결손을 보인 경우 역류 유무 및 정도가 신장 반흔과 유의한 연관성을 보인 반면, 1, 2, 6 형태의 결손을 보인 경우 신장 반흔과의 연관성은 유의하지 않았다. 로지스틱 분석에서 감염 초기 DMSA 스캔에서 회복 가능성이 적은 3, 4, 5 형태의 결손이 있을 경우 그렇지 않을 경우에 비해 신장 반흔을 일으킬 19.1배였다. 경한 요관 역류 나 증증 역류가 있을 경우 신장 반흔을 일으킬 위험이 각각 3.5배, 14.4배 였다. 신장 섭취율도 신장 반흔과 연관성이 있었으나 신장 반흔 위험도는 유의하지 않았다. 연령 및 성별은 신반흔과 유의한 연관성이 없었다. 결론 : 요로 감염 초기 ^(99m)Tc DMSA 스캔에서 결손이 신장 외연의 변형을 일으키거나 다발성일 경우, 신장 반흔으로 진행될 가능성이 높으며, 적극적인 치료가 필요하다. Purpose : The purpose of this study was to evaluate the usefulness of ^(99m)Tc DMSA scintigraphy on the dignosis of a renal scar in children with urinary tract infection. Materials and Methods : Eighty three patients were included in this study, who were diagnosed as the urinary tract infection on the basis of sympton, urinalysis and urine culture. ^(99m)Tc DMSA scintigraphy and voiding cystoureterography were performed within 7days before the treatment in all patients. We classified the scintigraphic findings as follow s ; 1 ; a large hypoactive upper or lower pole, 2 ; a small hypoactive area. 3 ; single defect resulting in localized deformity of the cutlines. 4 ; deformed outlines in a small or normal sized kidney. 5 ; multiple defects. 6 ; diffuse hypoactive kidney without regional impairment. Follow-up scintigraphy was done at least 6 months after the initial study. When the abnormality on the initial scintigraphy was not completely resolved on the follow up scr, the lesion was defined as containing a scar. Results : One hundred and fifteen renal units of 166 units(69.3%) showed abnormal findings on the DMSA scintigraphy. 65 units(56.5%) was diagnosed as containing renal scars on follow-up scintigraphies. Incidences of renal scar among renal units showing pattern 3, 4 and 5 on the initial scan was 75%, 78% and 78%, respectively. Whereas many of renal units showing 1, 2 and 6 pattern were recovered(65%, 76%, 50%). Sensitivity, specificity and accuracy of pattern-based DMSA scintigraphic findings on the diagnosis of renal scar was 76.9%, 85.1%%, respectively. VUR was significantly associated with the renal scar when the initial DMSA shows unrecoverable findings(pattern 3, 4, 5). Odds ratio of the renal scar in a kidney showing unrecoverable initial scintigraphic findings was 19.1. Odds ratio in a kidney with mild or moderate-to-severe VUR was 3.5 and 14.4 respectively. Conclusion : In the urinary tract infection, renal scar was significantly developed in a kidney showing unrecoverable findings on the initial DMSA scan and VUR on voiding cystoureterography.

Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan

Kyeong Eun Oh,임형은,Kee Hwan Yoo 대한소아신장학회 2020 Childhood kidney diseases Vol.24 No.2

Purpose: The aim of this study is to evaluate the clinical utility of late 6-month dimercapto-succinic acid (DMSA) renal scan in predicting vesicoureteral reflux (VUR) and long-lasting renal scars in children with first acute pyelonephritis (APN). Methods: A retrospective case study of children admitted with APN from January 2010 to July 2017 was performed. The study included patients with voiding cystourethrography (VCUG) and acute and late 6-month DMSA scan. We analyzed the clinical, laboratory and imaging findings of patients with and without late cortical defects at 6 months and those with or without VUR. Results: Among 145 children with APN, 50 (34.5%) had cortical defects on the late DMSA renal scan and 60 (41.4%) showed VUR. Thirteen of 38 (34.2%) children undergoing 18-month DMSA renal scan showed a long-lasting renal scars. Compared with children without late cortical defects, patients with late 6-month cortical defects had a higher incidence of VUR and long-lasting renal scars, and relapse of UTI (all P <0.05). In a multivariable analysis, both high-grade VUR and relapse of UTI were independently correlated with the presence of late 6-month cortical defects (P <0.05). Late cortical defects and relapse of UTI were also associated with the presence of VUR (P<0.05). Only the late 6-mo cortical defects was an independent predictor of long-lasting renal scars in children with APN (P <0.05). Conclusion: An abnormal late 6-month DMSA renal scan may be useful in identifying VUR and long-lasting renal scars in children diagnosed with APN.

Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan

Oh, Kyeong Eun,Yim, Hyung Eun,Yoo, Kee Hwan Korean Society of Pediatric Nephrology 2020 Childhood kidney diseases Vol.24 No.2

Purpose: The aim of this study is to evaluate the clinical utility of late 6-month dimercapto-succinic acid (DMSA) renal scan in predicting vesicoureteral reflux (VUR) and long-lasting renal scars in children with first acute pyelonephritis (APN). Methods: A retrospective case study of children admitted with APN from January 2010 to July 2017 was performed. The study included patients with voiding cystourethrography (VCUG) and acute and late 6-month DMSA scan. We analyzed the clinical, laboratory and imaging findings of patients with and without late cortical defects at 6 months and those with or without VUR. Results: Among 145 children with APN, 50 (34.5%) had cortical defects on the late DMSA renal scan and 60 (41.4%) showed VUR. Thirteen of 38 (34.2%) children undergoing 18-month DMSA renal scan showed a long-lasting renal scars. Compared with children without late cortical defects, patients with late 6-month cortical defects had a higher incidence of VUR and long-lasting renal scars, and relapse of UTI (all P<0.05). In a multivariable analysis, both high-grade VUR and relapse of UTI were independently correlated with the presence of late 6-month cortical defects (P<0.05). Late cortical defects and relapse of UTI were also associated with the presence of VUR (P<0.05). Only the late 6-mo cortical defects was an independent predictor of long-lasting renal scars in children with APN (P<0.05). Conclusion: An abnormal late 6-month DMSA renal scan may be useful in identifying VUR and long-lasting renal scars in children diagnosed with APN.

Renal scar formation after urinary tract infection in children

Park, Young Seo The Korean Pediatric Society 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.10

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.

Renal scar formation after urinary tract infection in children

Young Seo Park 대한소아청소년과학회 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.10

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria,and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However,reflux nephropathy is not always acquired; rather, it reflects refluxassociated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.