Varlam D E, Dippell J
Clementine Children's Hospital, Frankfurt/M, Germany.
Pediatr Nephrol. 1995 Feb;9(1):1-5. doi: 10.1007/BF00858952.
Functional voiding disorders and urinary tract infections are common in childhood, but are usually not accompanied by upper urinary tract deterioration. Nevertheless a small group of children remain at risk of developing chronic renal insufficiency (CRI). Clinically these children present day and night wetting. The most important parameter, however, is urinary retention which is reflected by an abnormal voiding pattern in the uroflow curve. After ruling out patients with neurogenic or anatomical disorders, nine girls with psychogenic urine retention were observed for 5 years. Terminal renal insufficiency was seen in one, CRI in five patients and in three patients the kidney function could be maintained, but they all had severe scarring of at least one kidney. Furthermore, all revealed a dilation of the bladder and the upper urinary tract. Vesicoureteral reflux occurred in six and obstruction of the ureterovesical junction in three patients. Two girls underwent repeated reflux surgery resulting in a rapid deterioration of renal function. Three patients developed hypertension and one had a hypertensive crisis with microangiopathic anaemia and acute renal failure. Psychogenic disorders and problematic family settings were observed in all cases. Bladder training, transitory suprapubic catheters, intermittent catheterisation, medication and psychotherapy can avoid severe kidney damage and achieve a stabilisation of renal function. It is important to bear this syndrome in mind when evaluating girls with asymptomatic bacteriuria and urinary retention.
功能性排尿障碍和尿路感染在儿童期很常见，但通常不会伴有上尿路恶化。然而，一小部分儿童仍有发展为慢性肾功能不全（CRI）的风险。临床上，这些儿童表现为日夜遗尿。然而，最重要的参数是尿潴留，这在尿流曲线中的排尿模式异常中得到体现。在排除神经源性或解剖学疾病患者后，对9名患有精神性尿潴留的女孩进行了5年的观察。1例出现终末期肾功能不全，5例出现慢性肾功能不全，3例患者肾功能得以维持，但他们至少有一个肾脏有严重瘢痕形成。此外，所有患者均显示膀胱和上尿路扩张。6例发生膀胱输尿管反流，3例发生输尿管膀胱连接处梗阻。2名女孩接受了反复的反流手术，导致肾功能迅速恶化。3例患者出现高血压，1例发生高血压危象，伴有微血管病性贫血和急性肾衰竭。所有病例均观察到精神障碍和有问题的家庭环境。膀胱训练、临时性耻骨上导尿管、间歇性导尿、药物治疗和心理治疗可以避免严重的肾脏损害并实现肾功能的稳定。在评估无症状菌尿和尿潴留的女孩时，记住这种综合征很重要。
