Leonardo Cristiane R, Filgueiras Maria Francisca T, Vasconcelos Mônica M, Vasconcelos Roberta, Marino Viviane P, Pires Cleidismar, Pereira Ana Cristina, Reis Fernanda, Oliveira Eduardo A, Lima Eleonora M
Pediatric Nephrourology Unit, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Pediatr Nephrol. 2007 Nov;22(11):1891-6. doi: 10.1007/s00467-007-0564-5. Epub 2007 Sep 14.
Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by (99m)technetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P = 0.07). Although UTI was not a risk factor, it was associated with VUR (P = 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.
对下尿路功能障碍（LUTD）患儿肾瘢痕形成的危险因素进行了评估。评估了120例患者的病历，内容涉及性别、膀胱输尿管反流（VUR）的存在、膀胱容量、逼尿肌过度活动、残余尿量、发热性尿路感染（UTI）、菌尿、便秘、逼尿肌括约肌不协调（DSI）、最大膀胱测压容量时的高逼尿肌压力（PMCC）、低顺应性以及膀胱壁厚度和小梁形成情况。通过锝-二巯基丁二酸肾扫描（DMSA）诊断肾瘢痕形成。在38例患者（31%）中检测到肾瘢痕形成。在单因素分析中，VUR、UTI、膀胱容量减少、尿残余以及膀胱壁小梁形成和增厚与瘢痕形成相关。多因素分析显示VUR（P < 0.0001）是肾瘢痕形成的独立危险因素。膀胱壁厚度是一个边缘性危险因素（P = 0.07）。虽然UTI不是危险因素，但它与VUR相关（P = 0.03）。在我们的分析中，VUR是主要危险因素；然而，肾瘢痕形成可能是多因素导致的，因为VUR与UTI相关。
