Faust William C, Diaz Mireya, Pohl Hans G
Georgetown University School of Medicine, Washington, DC, USA.
J Urol. 2009 Jan;181(1):290-7; discussion 297-8. doi: 10.1016/j.juro.2008.09.039. Epub 2008 Nov 14.
We investigated ethnic differences in the risk of post-pyelonephritic renal scarring in infants and children for possible genetic determinants.
We searched all peer reviewed articles published from 1980 through 2006 in the PubMed(R), MEDLINE(R) (Ovid), Cochrane Central Register of Controlled Trials and EMBASE(R) databases for the keywords, "renal scarring and pyelonephritis," "renal fibrosis" and "kidney scarring." References were included only when they specified acute pyelonephritis defined by a fever, positive urine culture and areas of photopenia in the renal cortex on 99mtechnetium dimercapto-succinic acid renal scans, repeat dimercapto-succinic acid scans obtained at least 3 months after acute pyelonephritis to assess for renal cortical scar formation and absence of recurrent urinary tract infection during followup. When possible data were analyzed according to patients and renal units.
Among 23 references the overall rates of renal scarring in terms of patients and renal units were 41.6% and 37.0%, respectively. In terms of patients the incidence of renal scarring following acute pyelonephritis varied by region, from 26.5% (Australia) to 49.0% (Asia). In terms of renal units the incidence of acquired renal cortical scarring varied by region, from 16.7% (Middle East) to 58.4% (Asia). When combined by vesicoureteral reflux status children and renal units with refluxing ureters exhibited an increased risk of renal scarring (odds ratios 2.8 and 3.7, respectively).
Although scarring was different across some regions, only scarring in Asian studies comparing patients displayed a statistically significant difference. A regional effect explained the heterogeneity observed in the overall estimate for patients and partly for renal units. The greatest risk of renal scarring may be imparted by the presence of vesicoureteral reflux.
我们调查了婴幼儿和儿童肾盂肾炎后肾瘢痕形成风险的种族差异，以寻找可能的遗传决定因素。
我们在PubMed(R)、MEDLINE(R)（Ovid）、Cochrane对照试验中央注册库和EMBASE(R)数据库中检索了1980年至2006年发表的所有经同行评审的文章，关键词为“肾瘢痕形成与肾盂肾炎”、“肾纤维化”和“肾瘢痕”。仅当参考文献明确指出急性肾盂肾炎的定义为发热、尿培养阳性以及99m锝二巯基丁二酸肾扫描显示肾皮质有光密度减低区域、在急性肾盂肾炎至少3个月后进行重复二巯基丁二酸扫描以评估肾皮质瘢痕形成以及随访期间无复发性尿路感染时，才纳入参考文献。如有可能，根据患者和肾单位对数据进行分析。
在23篇参考文献中，以患者和肾单位计算的肾瘢痕形成总体发生率分别为41.6%和37.0%。以患者计算，急性肾盂肾炎后肾瘢痕形成的发生率因地区而异，从26.5%（澳大利亚）到49.0%（亚洲）。以肾单位计算，获得性肾皮质瘢痕形成的发生率因地区而异，从16.7%（中东）到58.4%（亚洲）。按膀胱输尿管反流状态合并分析时，有反流输尿管的儿童和肾单位肾瘢痕形成风险增加（优势比分别为2.8和3.7）。
虽然不同地区的瘢痕形成情况有所不同，但只有亚洲研究中比较患者的瘢痕形成情况显示出统计学上的显著差异。区域效应解释了在患者总体估计以及部分肾单位估计中观察到的异质性。膀胱输尿管反流的存在可能导致肾瘢痕形成的风险最大。
