Pediatric Nephrology, University of Florida, Gainesville, FL, USA.
Pediatr Nephrol. 2019 Sep;34(9):1513-1519. doi: 10.1007/s00467-018-4045-9. Epub 2018 Aug 21.
In recent years, progress has been made on understanding the relationship between vesicoureteral reflux (VUR) and urinary tract infection (UTI). The findings on recent prospective, randomized, controlled studies have questioned the conventional VUR clinical significance and, therefore, have challenged the traditional diagnostic and therapeutic recommendations. These new studies have redefined the pathogenic role of vesicoureteral reflux in UTI as well as have disputed the routine use of urinary antibiotic prophylaxis to prevent UTI and renal damage in VUR patients. The time to overinvestigate and treat the vast majority of otherwise healthy children who have an uncomplicated UTI with long-term antibiotic prophylaxis seems to be over. Is there a role of severe VUR in the development of chronic renal disease and renal failure? New ideas are needed to answer these questions with the goal to avoid repeating past mistakes when therapeutic choices were based on expert opinions rather than facts.
近年来，人们对膀胱输尿管反流（VUR）和尿路感染（UTI）之间的关系有了更多的了解。最近的前瞻性、随机、对照研究结果对传统的 VUR 临床意义提出了质疑，因此也对传统的诊断和治疗建议提出了挑战。这些新的研究重新定义了膀胱输尿管反流在 UTI 中的致病作用，并对常规使用尿抗生素预防来预防 VUR 患者的 UTI 和肾损伤提出了质疑。对绝大多数无并发症的 UTI 患者进行长期抗生素预防治疗的过度检查和治疗的时代似乎已经结束。严重的 VUR 是否会导致慢性肾病和肾衰竭？需要新的思路来回答这些问题，以避免在治疗选择基于专家意见而不是事实时重蹈覆辙。
