评估发热性泌尿道感染儿童的“自上而下”方法。
The "top-down" approach to the evaluation of children with febrile urinary tract infection.
作者信息
Pohl Hans G, Belman A Barry
机构信息
Division of Urology, Children's National Medical Center, Washington, DC 20010, USA.
出版信息
Adv Urol. 2009;2009:783409. doi: 10.1155/2009/783409. Epub 2009 Mar 30.
Abstract
The evaluation of children presenting with urinary tract infection (UTI) has long entailed sonography and cystography to identify all urological abnormalities that might contribute to morbidity. The identification of vesicoureteral reflux (VUR) has been of primary concern since retrospective studies from the 1930s to 1960s established a strong association between VUR, recurrent UTI, and renal cortical scarring. It has been proposed that all VUR carries a risk for renal scarring and, therefore, all VUR should be identified and treated. We will not discuss the controversies surrounding VUR treatment in this review focusing instead on a new paradigm for the evaluation of the child with UTI that is predicated on identifying those at risk for scarring who are most deserving of further evaluation by cystography.
摘要
对患有尿路感染（UTI）的儿童进行评估长期以来都需要超声检查和膀胱造影，以识别所有可能导致发病的泌尿系统异常。自20世纪30年代至60年代的回顾性研究证实膀胱输尿管反流（VUR）、复发性UTI和肾皮质瘢痕形成之间存在密切关联以来，VUR的识别一直是主要关注点。有人提出，所有VUR都有导致肾瘢痕形成的风险，因此，所有VUR都应被识别并治疗。在本综述中，我们不会讨论围绕VUR治疗的争议，而是专注于一种评估UTI患儿的新范式，该范式基于识别那些最有可能形成瘢痕且最值得通过膀胱造影进行进一步评估的患儿。
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