Pacanowska Beata, Jarmoliński Tomasz, Zimoń Tomasz, Dudarenko Grazyna
Oddział Nefrologii ze Stacja Dializ, Specjalistycznego Samodzielnego Publicznego Zakładu Opieki Zdrowotnej nad Dzieckiem i Młodzieza w Szczecinie.
Pol Merkur Lekarski. 2002 Apr;12(70):261-4.
The aim of the study was to determine the main clinical and organising difficulties affecting quality and efficacy of medical care in children with acute pyelonephritis (AP). 41 children aged 3 wk--17 yr 4 mo hospitalized for AP at the Department of Nephrology, District Children's Hospital, Szczecin, Poland in 2000 were investigated. Epidemiologic and demographic data, history, clinical presentation, auxiliary investigations, treatment and ambulatory follow-up were analysed. Instead of typical clinical picture neither diagnostic management nor the therapy fulfilled accepted standards. The main problems found were: delay of referral to hospital by primary care doctor, misdiagnosis or inaccurate primary diagnosis followed by insufficient treatment, difficulties with performing simple ambulatory tests (urinalysis, urine culture, ultrasonography) before hospitalisation and lack of co-operation between parents and nephrological outpatient clinic after discharge. For reflux and obstructive nephropathy, often presenting as urinary tract infection, are still the main cause of chronic renal failure in children in Poland the special attention was paid to necessity of thorough education of family doctors in the subject of management of such cases as well as improvement of accessibility to specialistic care.
本研究的目的是确定影响急性肾盂肾炎（AP）患儿医疗质量和疗效的主要临床及组织方面的困难。对2000年在波兰什切青市地区儿童医院肾病科因AP住院的41名年龄在3周-17岁4个月的儿童进行了调查。分析了流行病学和人口统计学数据、病史、临床表现、辅助检查、治疗及门诊随访情况。无论是诊断管理还是治疗都未达到公认标准，而不是典型的临床表现。发现的主要问题有：基层医疗医生转诊至医院的延迟、误诊或初始诊断不准确继而治疗不充分、住院前进行简单门诊检查（尿液分析、尿培养、超声检查）存在困难以及出院后家长与肾病门诊缺乏合作。由于反流和梗阻性肾病常表现为尿路感染，仍是波兰儿童慢性肾衰竭的主要原因，因此特别关注对家庭医生进行此类病例管理主题的全面教育的必要性，以及改善专科护理的可及性。
