Raz Raul, Sakran Waheeb, Chazan Bibiana, Colodner Raul, Kunin Calvin
Infectious Diseases Unit, Haemek Medical Center, Afula, 18 101, Israel.
Clin Infect Dis. 2003 Oct 15;37(8):1014-20. doi: 10.1086/377737. Epub 2003 Sep 23.
Long-term outcome of acute pyelonephritis (AP) in adults is unknown. We evaluated the frequency of renal damage 10-20 years after hospitalization for AP in adult women and the utility of technetium Tc 99m-labeled dimercaptosuccinic acid (Tc 99m-DMSA) scanning for detection of renal scars; 63 of 203 women hospitalized with AP during 1982-1992 were included in the study. Tc 99m-DMSA scanning detected renal scarring in 29 women (46%). Multivariate analysis showed that pregnancy and hypoalbuminemia (albumin level, <3.2 g/dL) at hospitalization were independent risk factors for subsequent development of renal scars. At follow-up, hypertension was observed in approximately one-fifth of patients, regardless of renal scarring status. Four women with scars had a glomerular filtration rate of < or =75 mL/min; none of them developed severe renal impairment. In conclusion, the risk of developing renal scarring after AP in adult women is high. However, clinically relevant renal damage is rare 10-20 years after AP. Tc 99m-DMSA scanning is useful for detecting renal scars in adults but is not routinely needed in practice.
成人急性肾盂肾炎（AP）的长期预后尚不清楚。我们评估了成年女性因AP住院10 - 20年后肾损伤的发生率以及锝Tc 99m标记的二巯基丁二酸（Tc 99m - DMSA）扫描检测肾瘢痕的效用；1982年至1992年间因AP住院的203名女性中有63名被纳入研究。Tc 99m - DMSA扫描在29名女性（46%）中检测到肾瘢痕形成。多变量分析显示，住院期间的妊娠和低白蛋白血症（白蛋白水平<3.2 g/dL）是随后发生肾瘢痕的独立危险因素。随访时，无论肾瘢痕状态如何，约五分之一的患者出现高血压。四名有瘢痕的女性肾小球滤过率≤75 mL/min；她们均未发展为严重肾功能损害。总之，成年女性AP后发生肾瘢痕形成的风险很高。然而，AP后10 - 20年临床上相关的肾损伤很少见。Tc 99m - DMSA扫描有助于检测成人肾瘢痕，但在实际应用中并非常规必需。
