González Elsa, Papazyan Jean-Pierre, Girardin Eric
Paediatric Nephrology Unit, Department of Paediatrics, Children's Hospital, Geneva, Switzerland.
J Urol. 2005 Feb;173(2):571-4; discussion 574-5. doi: 10.1097/01.ju.0000151263.36909.91.
We determined the impact of vesicoureteral reflux (VUR) on the size of renal lesions in children after an episode of acute pyelonephritis.
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.
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.
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.
我们确定了膀胱输尿管反流（VUR）对急性肾盂肾炎发作后儿童肾损伤大小的影响。
共研究了161例急性肾盂肾炎患儿（平均年龄2.44岁）。所有患儿入院时均进行了二巯基丁二酸闪烁扫描，显示有肾损伤。3个月时进行了第二次二巯基丁二酸扫描。6周时进行了排尿性膀胱尿道造影，并将VUR分为I至V级。为每个肾单位绘制肾损伤布局图，计算损伤面积并报告其占肾脏总面积的比例。
急性损伤和瘢痕的平均大小随反流严重程度增加而增大（p<0.0001），个体值有重要重叠。在有急性损伤的肾单位组中，无VUR患儿的肾瘢痕平均大小为5.8%±8.5%，I级反流患儿为9.9%±7.3%，II级反流患儿为7.7%±11.0%，III级反流患儿为17.7%±14.7%，IV级反流患儿为17.4%±27.7%（p<0.001）。肾损伤大小随时间显著减小。损伤的消退率随反流程度增加而降低。按3个年龄组分析时，瘢痕大小随年龄显著增加。
VUR对肾盂肾炎发作后的肾损伤大小有影响。III级或IV级反流患儿更易出现较大的肾瘢痕。另一方面，即使没有VUR，也可能出现较大面积的急性损伤。
