Pickworth F E, Carlin J B, Ditchfield M R, de Campo M P, de Campo J F, Cook D J, Nolan T, Powell H R, Sloane R, Grimwood K
Department of Radiology, Royal Children's Hospital, Melbourne, Victoria, Australia.
AJR Am J Roentgenol. 1995 Aug;165(2):405-8. doi: 10.2214/ajr.165.2.7618567.
Failure of a kidney to grow satisfactorily in childhood is evidence of renal disease. Because kidneys may enlarge during an episode of acute pyelonephritis, concomitant renal length measurements cannot be used as baselines for growth assessment. This study was designed to determine the degree of renal enlargement in children with acute pyelonephritis and the time the enlargement takes to resolve after treatment is started to find the optimum time for obtaining baseline measurements.
In a cohort study, 180 children younger than 5 years old with their first proven acute urinary tract infection, with or without pyelonephritis, had renal scintigraphy and sonography within 15 days of starting treatment. The presence of cortical defects on scintigrams indicated pyelonephritis. The lengths of kidneys with and without scintigraphic defects (i.e., with and without pyelonephritis) were compared, adjusting for age and sex, and the length of kidneys with defects was related to time elapsed between the start of treatment and sonography.
Ninety-nine kidneys (28%) in 77 children (43%) had scintigraphic defects. Kidneys with defects were an average of 3.2 mm longer than kidneys without defects. Length and time interval between treatment and sonography in kidneys with defects correlated negatively, with mean length approaching that of kidneys without defects by 10-11 days.
Kidneys with acute pyelonephritis initially increase in length but return to normal on average by the 11th day of treatment. If poor renal growth is used as an indication of renal disease, sonography should be delayed or repeated at least 2 weeks after the start of treatment to determine the length of the uninflamed kidney.
儿童期肾脏生长未达理想状态是肾脏疾病的证据。由于肾脏在急性肾盂肾炎发作期间可能会增大，因此不能将同时进行的肾脏长度测量用作生长评估的基线。本研究旨在确定急性肾盂肾炎患儿的肾脏增大程度以及开始治疗后增大消退所需的时间，以找到获取基线测量值的最佳时间。
在一项队列研究中，180名5岁以下首次确诊为急性尿路感染（无论有无肾盂肾炎）的儿童在开始治疗的15天内接受了肾脏闪烁扫描和超声检查。闪烁扫描图上皮质缺损的存在表明患有肾盂肾炎。对有和没有闪烁扫描缺损（即有和没有肾盂肾炎）的肾脏长度进行比较，并根据年龄和性别进行调整，有缺损的肾脏长度与开始治疗至超声检查之间的时间相关。
77名儿童（43%）的99个肾脏（28%）有闪烁扫描缺损。有缺损的肾脏平均比无缺损的肾脏长3.2毫米。有缺损的肾脏长度与治疗和超声检查之间的时间间隔呈负相关，平均长度在治疗10 - 11天后接近无缺损肾脏的长度。
患有急性肾盂肾炎的肾脏最初长度会增加，但在治疗第11天平均恢复正常。如果将肾脏生长不良用作肾脏疾病的指标，超声检查应在开始治疗至少2周后延迟或重复进行，以确定未发炎肾脏的长度。
