Grossman Zachi, Miron Dan
Maccabi Healthcare Services, Tel Aviv.
Harefuah. 2009 Oct;148(10):716-20, 732.
Urinary tract infection (UTI) in children might, in a minority of cases, cause renal scarring and permanent damage. Known risk factors for renal damage are: obstruction to urinary flow, vesicoureteric reflux and recurrent infections. The current recommendations for imaging and follow-up of children with first febrile UTI include renal ultrasound to rule out anatomic abnormalities, particularly obstruction, cystography for possible diagnosis of vesicoureteric reflux, and prophylactic antibiotic therapy to prevent recurrent infections in children with detected reflux. DMSA renal scanning for the detection of renal scars is recommended as part of the imaging protocol by some institutions. Recently, published data doubts the importance of the various imaging techniques, as well as the effectiveness of prophylactic antibiotic therapy. In the current review, the role of renal ultrasound is examined, especially with regards to familiar data from fetal ultrasound. The complex relationship between vesicoureteric reflux and renal scarring is presented, with the possible implications on the importance of performing routine cystography and DMSA scanning after UTI. Studies questioning the effectiveness of prophylactic antibiotic therapy emphasize the importance of rapid diagnosis and therapy of suspected recurrent UTI as the preferred approach to prevent renal damage. Imaging studies are only recommended for high risk groups and not as a routine following UTI.
儿童尿路感染（UTI）在少数情况下可能导致肾瘢痕形成和永久性损伤。已知的肾损伤危险因素包括：尿路梗阻、膀胱输尿管反流和反复感染。目前对于首次发热性UTI儿童的影像学检查和随访建议包括：肾脏超声检查以排除解剖学异常，特别是梗阻；膀胱造影术用于可能的膀胱输尿管反流诊断；以及对检测到反流的儿童进行预防性抗生素治疗以预防反复感染。一些机构建议将二巯基丁二酸（DMSA）肾扫描用于检测肾瘢痕作为影像学检查方案的一部分。最近，已发表的数据对各种影像学技术的重要性以及预防性抗生素治疗的有效性提出了质疑。在当前的综述中，研究了肾脏超声的作用，特别是关于来自胎儿超声的熟悉数据。阐述了膀胱输尿管反流与肾瘢痕形成之间的复杂关系，以及UTI后进行常规膀胱造影和DMSA扫描的重要性可能受到的影响。对预防性抗生素治疗有效性提出质疑的研究强调，快速诊断和治疗疑似反复UTI作为预防肾损伤的首选方法的重要性。影像学检查仅推荐用于高危人群，而不作为UTI后的常规检查。
