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La diagnosi clinica del reflusso vescico-ureterale
CLINICAL DIAGNOSIS OF VESICOURETERAL REFLUX: A MULTICENTRE STUDY
L. Peratoner, M. Pennesi
Maggio 1998 - pagg. 311 -315
Abstract
227 children with symptomatic urinary tract
infection (UTI), aged from 15 days to 4
years, entered a prospective follow-up
study, aimed at identifying some simple criteria
which might characterize children at
risk of having a vesico-ureteral reflux (VUR).
Age, sex, acute phase reactants and ultrasound
findings during the UTI acute phase,
presence or absence of fever and history of
symptoms preceding fever onset were evaluated
in children with and without VUR.
VUR was more frequent in three conditions:
in females (56%) vs males (20%) after the
first 3 months of life; in children without
other symptoms before fever onset (73%) vs
those with at least one symptom (17%); in
children with persistent ultrasonographic
pyelectasia (48%) vs those with normal
echography during UTI or with transient
pyelectasia (13%). The data provide some
simple clinical criteria to identify children
with UTI at risk of having a VUR, and might
therefore be useful to reduce the indications
for a micturating cystourethrography in children
with UTI in the first 4 years of age.
Parole chiave
Classificazione MeSH
Bibliografia
1. Bailey RR: The relationship of vesico-ureteric
reflux to urinary tract infection and chronic
pyelonephritis-reflux nephropathy. Clin
Nephrol 1, 132-41, 1973.
2. Rolleston GL, Shannon FT, Uttley WLF: Relationship of infantile vesicoureteric reflux to renal damage. BMJ 1, 460-63, 1970.
3. Goldraich NP, Barrat TM: Vesicoureteric reflux and renal scarring. In: Holliday MA, Barrat TM, Vernier RL (eds), Pediatric nephrology. Williams & Wilkins, Baltimora, 647- 66, 1987.
4. Dick PT, Feldman W: Routine diagnostic imaging for childhood urinary tract infections: A systematic overwiew. J Pediatr 128, 15-22, 1996.
5. Haycock GB: Investigation of urinary tract infection. Arch Dis Child 61, 1155-58, 1986.
6. Messi G, Peratoner L, Paduano L, Marchi AG: Epidemiology of urinary tract infections and vesico-ureteral reflux in children. Helv Paed Acta 43, 389-96, 1988.
7. Whyte KM, Abbot GD, Kennedy GC, Maling TMJ: A protocol for the investigation of infants and children with urinary tract infection. Clin Radiol 39, 278-80, 1988.
8. Haycock GB: A practical approach to evaluating urinary tract infection in children. Pediatr Nephrol 5, 401-2,1992.
9. Smellie JM, Ransley PG, Normand ICS, Prescod N, Edwards D: Development of new renal scars: a collaborative study. BMJ 290, 1957-60, 1985.
10. Carr MC, Peters CA, Retik AB, Mandell J: Urinary levels of renal tubular enzyme Nacetyl- D-glucosaminidase in relation to grade of vesicoureteral reflux. J Urol 146, 654-56, 1991.
11. Fasth A, Bjure J, Hellstrom M, Jacobsson B, Jodal U: Autoantibodies to Tamm-Horsfall glycoprotein in children with renal damage associated with urinary tract infection. Acta Ped Scand 69, 709-15, 1980.
12. Hambury DC, Calvin J: Proteinuria and enzymuria in vesicoureteric reflux. Br J Urol 70, 603-9, 1992.
13. Portman RJ, Kissane JM, Robson AM, Peterson LJ, Richardson A: Use of -2 microglobulin to diagnose tubulo interstitial renal lesions in children. Kidney Int 30, 91-98, 1986.
14. Goldraich NP: Reflux nephropathy: the place of the DMSA renal scan. In: Bailey RR (ed), Second CJ Hodson Symposium on reflux nephropathy.Typeshop, Christchurch, 9-13, 1991.
15. Jakobsson B, Soderlundh S, Berg U: Diagnostic significance of 99m-Tc-DMSA scintigraphy in urinary tract infection. Arch Dis Child 67, 1338-42, 1992.
16. Kass EJ, Fink-Bennet D, Cacciarelli AA, Balon H, Pavlock S: The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis. J Urol 148, 606- 8, 1992.
17. Rosenberg AR, Rossleigh MA, Brydon MP, Bass SJ, Leighton DM, Farnsworth RH: Evaluation of acute urinary tract infection in children by dimercaptosuccinic acid scintigraphy: a prospective study. J Urol 148, 1746- 49, 1992.
18. de Man P, Claesson I, Johanson IM, Jodal U, Svanborg Eden C: Bacterial attachment as a predictor of renal abnormalities in boys with urinary tract infection. J Pediat 115, 915- 22, 1989.
19. Lomberg H, Hanson LA, Jacobsson B, Jodal U, Leffler H, Svanborg Eden C: Correlation of P blood group, vesicoureteral reflux and bacterial attachment in patients with recurrent pyelonephritis. N Engl J Med 308, 1189-92, 1983.
20. Smellie JM, Normand ICS: Urinary infections in children. Arch Dis Child 61, 895-905, 1985.
21. Kenda R, Kenig T, Silc M, Zupancic Z: Renal ultrasound and excretory urography in infants and young children with urinary tract infection. Pediatr Radiol 19, 299-301, 1989.
22. Rickwood AM, Carty HM, McKendrick T, Williams MPL, Jackson M, Pilling DW, Sprigg A: Current imaging of childhood urinary infections: prospective survey. BMJ 304, 663-65, 1992.
23. Noe HN: The long-term results of prospective sibling reflux screening. J Urol 148, 1739-42, 1992.
24. Van den Abbeele AD, Treeves ST, Lebowitz RL, Bauer SB, Davis RT, Retik A, Colodny A: Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography. Pediatrics 79, 147-53, 1987.
25. Kramer MS, Tange SM, Drummond KN, Mills EL: Urine testing in young febrile children: a risk-benefit analysis. J Pediatr 125, 6- 13, 1994.
2. Rolleston GL, Shannon FT, Uttley WLF: Relationship of infantile vesicoureteric reflux to renal damage. BMJ 1, 460-63, 1970.
3. Goldraich NP, Barrat TM: Vesicoureteric reflux and renal scarring. In: Holliday MA, Barrat TM, Vernier RL (eds), Pediatric nephrology. Williams & Wilkins, Baltimora, 647- 66, 1987.
4. Dick PT, Feldman W: Routine diagnostic imaging for childhood urinary tract infections: A systematic overwiew. J Pediatr 128, 15-22, 1996.
5. Haycock GB: Investigation of urinary tract infection. Arch Dis Child 61, 1155-58, 1986.
6. Messi G, Peratoner L, Paduano L, Marchi AG: Epidemiology of urinary tract infections and vesico-ureteral reflux in children. Helv Paed Acta 43, 389-96, 1988.
7. Whyte KM, Abbot GD, Kennedy GC, Maling TMJ: A protocol for the investigation of infants and children with urinary tract infection. Clin Radiol 39, 278-80, 1988.
8. Haycock GB: A practical approach to evaluating urinary tract infection in children. Pediatr Nephrol 5, 401-2,1992.
9. Smellie JM, Ransley PG, Normand ICS, Prescod N, Edwards D: Development of new renal scars: a collaborative study. BMJ 290, 1957-60, 1985.
10. Carr MC, Peters CA, Retik AB, Mandell J: Urinary levels of renal tubular enzyme Nacetyl- D-glucosaminidase in relation to grade of vesicoureteral reflux. J Urol 146, 654-56, 1991.
11. Fasth A, Bjure J, Hellstrom M, Jacobsson B, Jodal U: Autoantibodies to Tamm-Horsfall glycoprotein in children with renal damage associated with urinary tract infection. Acta Ped Scand 69, 709-15, 1980.
12. Hambury DC, Calvin J: Proteinuria and enzymuria in vesicoureteric reflux. Br J Urol 70, 603-9, 1992.
13. Portman RJ, Kissane JM, Robson AM, Peterson LJ, Richardson A: Use of -2 microglobulin to diagnose tubulo interstitial renal lesions in children. Kidney Int 30, 91-98, 1986.
14. Goldraich NP: Reflux nephropathy: the place of the DMSA renal scan. In: Bailey RR (ed), Second CJ Hodson Symposium on reflux nephropathy.Typeshop, Christchurch, 9-13, 1991.
15. Jakobsson B, Soderlundh S, Berg U: Diagnostic significance of 99m-Tc-DMSA scintigraphy in urinary tract infection. Arch Dis Child 67, 1338-42, 1992.
16. Kass EJ, Fink-Bennet D, Cacciarelli AA, Balon H, Pavlock S: The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis. J Urol 148, 606- 8, 1992.
17. Rosenberg AR, Rossleigh MA, Brydon MP, Bass SJ, Leighton DM, Farnsworth RH: Evaluation of acute urinary tract infection in children by dimercaptosuccinic acid scintigraphy: a prospective study. J Urol 148, 1746- 49, 1992.
18. de Man P, Claesson I, Johanson IM, Jodal U, Svanborg Eden C: Bacterial attachment as a predictor of renal abnormalities in boys with urinary tract infection. J Pediat 115, 915- 22, 1989.
19. Lomberg H, Hanson LA, Jacobsson B, Jodal U, Leffler H, Svanborg Eden C: Correlation of P blood group, vesicoureteral reflux and bacterial attachment in patients with recurrent pyelonephritis. N Engl J Med 308, 1189-92, 1983.
20. Smellie JM, Normand ICS: Urinary infections in children. Arch Dis Child 61, 895-905, 1985.
21. Kenda R, Kenig T, Silc M, Zupancic Z: Renal ultrasound and excretory urography in infants and young children with urinary tract infection. Pediatr Radiol 19, 299-301, 1989.
22. Rickwood AM, Carty HM, McKendrick T, Williams MPL, Jackson M, Pilling DW, Sprigg A: Current imaging of childhood urinary infections: prospective survey. BMJ 304, 663-65, 1992.
23. Noe HN: The long-term results of prospective sibling reflux screening. J Urol 148, 1739-42, 1992.
24. Van den Abbeele AD, Treeves ST, Lebowitz RL, Bauer SB, Davis RT, Retik A, Colodny A: Vesicoureteral reflux in asymptomatic siblings of patients with known reflux: radionuclide cystography. Pediatrics 79, 147-53, 1987.
25. Kramer MS, Tange SM, Drummond KN, Mills EL: Urine testing in young febrile children: a risk-benefit analysis. J Pediatr 125, 6- 13, 1994.