Jacobson S H, Eklöf O, Lins L E, Wikstad I, Winberg J
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Pediatr Nephrol. 1992 Jan;6(1):19-24. doi: 10.1007/BF00856822.
In a previous report the long-term prognosis of 30 patients with renal scarring after pyelonephritis in childhood was described. In this study, we have related the extent of renal scarring present in childhood to the conditions in early adulthood. A radiological progression of scarring from childhood to adulthood was seen in one-third of the kidneys. The 7 patients with bilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate and higher plasma vasopressin at follow-up than 13 healthy controls. The 20 patients who had unilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate, higher diastolic blood pressure and higher plasma renin at follow-up than controls; 4 had hypertension. The most important finding was that children with unilateral disease are at risk of serious long-term complications. Filtration fraction at follow-up was higher in patients with extensive renal scarring in childhood compared with those with a normal renal area or small scars in childhood (r = -0.43, P less than 0.05). This may indicate glomerular hyperfiltration by remnant glomeruli. This paper emphasizes t the potential seriousness of childhood urinary tract infections especially when early infantile infections are overlooked. A follow-up of more than 4 decades may be necessary before the ultimate prognosis can be established, especially in patients with unilateral renal disease. It is advised that most patients with post-infectious renal scars are followed as high-risk patients, and that treatment continuity is established between paediatricians, nephrologists and, when required, obstetricians.
在之前的一份报告中，描述了30例儿童肾盂肾炎后肾瘢痕形成患者的长期预后。在本研究中，我们将儿童期存在的肾瘢痕程度与成年早期的情况相关联。三分之一的肾脏出现了从儿童期到成年期瘢痕形成的影像学进展。与13名健康对照相比，7例儿童期双侧瘢痕形成的患者在随访时肾面积更小、肾小球滤过率更低且血浆血管加压素更高。20例儿童期单侧瘢痕形成的患者在随访时肾面积更小、肾小球滤过率更低、舒张压更高且血浆肾素更高；4例患有高血压。最重要的发现是单侧疾病患儿有发生严重长期并发症的风险。与儿童期肾面积正常或瘢痕较小的患者相比，儿童期有广泛肾瘢痕形成的患者随访时的滤过分数更高（r = -0.43，P < 0.05）。这可能表明残余肾小球存在肾小球高滤过。本文强调儿童尿路感染的潜在严重性，尤其是早期婴儿感染被忽视时。在确定最终预后之前，可能需要超过40年的随访，尤其是单侧肾病患者。建议将大多数感染后肾瘢痕患者作为高危患者进行随访，并在儿科医生、肾病学家以及必要时的产科医生之间建立连续的治疗。
