Çocuk nefroloji polikliniğinde vezikoüreteral reflü tanısı ile takipli hastaların değerlendirilmesi ve izlemi
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Vezikoüreteralreflü (VUR), üreterovezikal birleşkedeki kapak mekanizmasındaki yetersizlik sebebiyle idrarın mesaneden böbrek ve üretereretrograd olarak geri kaçışıdır. VUR çocuklarda böbrek hasarına sebep olan tekrarlayan idrar yolu enfeksiyonlarının (İYE) en önemli nedenlerindendir. Erken tanı ve uygun tedavinin uygulanması ile komplikasyonların önüne geçilebilir. Günümüzde VUR' da tedavinin amacı böbrek hasarına engel olmak için idrar yolu enfeksiyonlarını önlemektir. Bu çalışmadaki amacımız VUR tanısı almış hastaların klinik, laboratuar, görüntüleme bulguları ve takip sonuçlarının ortaya konması ve böylece söz konusu hastaların tedavisinin planlanması ve prognozun saptanması amaçlandı. Materyal ve Metod:Çalışma 2010-2017 tarihleri arasında Selçuk Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Nefroloji Bilim Dalı'nda başvurup vezikoüreteral reflü tanısı alan 0-18 yaş arası 353 hastanın dosyaları retrospektif olarak incelendi. Çalışmaya 0- 18 yaş arası çocuk polikliniğine başvuran, üriner sistem ultrasonografisi, VCUG ve Tc-99m DMSA sintigrafi tetkikleri yapılmış olan, VCUG'da VUR saptanan hastalar alındı. Bulgular: Çalışmada incelenen 353 çocuktan 120 (%34)'si erkek ve 233 (%66)'ü kız idi. Hastaların başvuru esnasındaki yaşı ay olarak 64,7±50,3 ay idi. Hastalarımızın ortalama takip süresi ay olarak 37,2±34,1 idi. Erkek hastalarda orta ve yüksek dereceli VUR sayı olarak daha yüksek tespit edilirken; kızların VUR dereceleri sayı olarak homojen idi. Antenal dönemde hidronefroz nedeniyle takip edilen hastaların VUR derecelerinin dağılımının 7 (%17,5)'sinde düşük, 6 (%15)'sında orta ve 27 (%67,5)'sinde ise yüksek dereceli olduğu saptanmıştır. 353 VUR hastasının 139'unda (%39,4) yüksek dereceli VUR saptandı. İşeme disfonksiyonu ile yüksek dereceli VUR arasında istatistiksel olarak anlamlı bir ilişki tespit edilmiştir (p:0,029). DMSA'da skar olan hastaların %48,6'sınde yüksek dereceli VUR tespit edildi. DMSA ile yüksek dereceli VUR arasında istatistiksel olarak anlamlı bir ilişki tespit edilmiştir (p:0,001). DMSA' da renal skarı olan ve ABPM takibine alınan 61 hastanın 13'inde (%21) hipertansiyon tespit edilmiştir. Kapalı operasyon yapılan hastaların 137'sinde (%73,3) düzelme gözlendi. Operasyonu açık olan hastaların 64'ünde (%97) düzelme gözlendi. Sonuç: VUR tanısı konulmasında gecikme veya yetersiz tedavi uygulanması rekürren idrar yolu enfeksiyonlarına, böbrekte skara, reflü nefropatisine, hipertansiyona ve kronik böbrek yetmezliğine sebep olmaktadır. Çalışmamızda da görüldüğü üzere tekrarlayan üriner sistem enfeksiyonu öyküsü olan ve antenatal hidronefrozu olan hastalarda VUR açısından araştırma yapılması gerekmektedir. Düşük dereceli VUR'un genellikle spontan düzeldiği ve renal skar oranının daha düşük olduğu görüldü. DMSA'da skar tespit edilen hastaların skarı olmayanlara kıyasla VUR dereceleri daha yüksek bulundu. Cerrahi uygulanan hastalarda açık operasyonun başarı oranı kapalı operasyonlara oranla daha yüksek bulundu.
Purpose: Vesicoureteral reflux (VUR) is the urinary escape of urine from the bladder as kidney and uretere retrograd due to the inadequate valve mechanism in the ureterovesical junction. VUR is one of the most important causes of recurrent urinary tract infections (UTIs) that cause kidney damage in children. Complications can be prevented by early diagnosis and appropriate treatment. Nowadays, the purpose of treatment in VUR is to prevent urinary tract infections in order to prevent kidney damage. Our aim in this study was to reveal the clinical, laboratory, imaging findings and follow-up results of patients diagnosed with VUR, thereby planning the treatment of these patients and determining the prognosis. Materials and methods: The study of the files of 353 patients aged 0-18 years who were admitted to Selcuk University Faculty of Medicine, Department of Child Health and Diseases, Department of Pediatric Nephrology between 2010 and 2017, were analyzed retrospectively. Patients who were admitted to the pediatric outpatient clinic between 0-18 years, who underwent urinary system ultrasonography, VCUG and Tc-99m DMSA scintigraphy tests, and who had VUR in VCUG were included in the study. Results: Of the 353 children examined in the study, 120 (34%) were boys and 233 (66%) were girls. The mean age of patients at admission was 64.7 months in months. The mean follow-up period of our patients was 37.2 months. While middle and high-grade VUR numbers were higher in male patients; VUR degrees of the girls were homogeneous in number. It was determined that the distribution of VUR degrees of the patients who were followed up due to hydronephrosis during the antenatal period was low in 7 (17.5%), medium in 6 (15%) and high in 27 (67.5%). High-grade VUR was detected in 139 (39.4%) of 353 VUR patients. A statistically significant relationship was found between voiding dysfunction and high-grade VUR (p:0.029). High-grade VUR was detected in 48.6% of patients with scarring in DMSA. A statistically significant relationship was detected between DMSA and high-grade VUR (p: 0.001). Hypertension was detected in 13 (21%) of 61 patients who had renal scar in DMSA and were followed up for ABPM. Improvement was observed in 137 (73.3%) of the patients undergoing closed surgery. Improvement was observed in 64 (97%) of the patients whose operation was ureteroneocystostomy. Conclusion: Delay in the diagnosis of VUR or insufficient treatment causes recurrent urinary tract infections, kidney scar, reflux nephropathy, hypertension and chronic kidney failure. As seen in our study, research should be done in terms of VUR in patients with a history of recurrent urinary tract infections and antenatal hydronephrosis. Low grade VUR was generally seen to improve spontaneously and had a lower rate of renal scar.
Purpose: Vesicoureteral reflux (VUR) is the urinary escape of urine from the bladder as kidney and uretere retrograd due to the inadequate valve mechanism in the ureterovesical junction. VUR is one of the most important causes of recurrent urinary tract infections (UTIs) that cause kidney damage in children. Complications can be prevented by early diagnosis and appropriate treatment. Nowadays, the purpose of treatment in VUR is to prevent urinary tract infections in order to prevent kidney damage. Our aim in this study was to reveal the clinical, laboratory, imaging findings and follow-up results of patients diagnosed with VUR, thereby planning the treatment of these patients and determining the prognosis. Materials and methods: The study of the files of 353 patients aged 0-18 years who were admitted to Selcuk University Faculty of Medicine, Department of Child Health and Diseases, Department of Pediatric Nephrology between 2010 and 2017, were analyzed retrospectively. Patients who were admitted to the pediatric outpatient clinic between 0-18 years, who underwent urinary system ultrasonography, VCUG and Tc-99m DMSA scintigraphy tests, and who had VUR in VCUG were included in the study. Results: Of the 353 children examined in the study, 120 (34%) were boys and 233 (66%) were girls. The mean age of patients at admission was 64.7 months in months. The mean follow-up period of our patients was 37.2 months. While middle and high-grade VUR numbers were higher in male patients; VUR degrees of the girls were homogeneous in number. It was determined that the distribution of VUR degrees of the patients who were followed up due to hydronephrosis during the antenatal period was low in 7 (17.5%), medium in 6 (15%) and high in 27 (67.5%). High-grade VUR was detected in 139 (39.4%) of 353 VUR patients. A statistically significant relationship was found between voiding dysfunction and high-grade VUR (p:0.029). High-grade VUR was detected in 48.6% of patients with scarring in DMSA. A statistically significant relationship was detected between DMSA and high-grade VUR (p: 0.001). Hypertension was detected in 13 (21%) of 61 patients who had renal scar in DMSA and were followed up for ABPM. Improvement was observed in 137 (73.3%) of the patients undergoing closed surgery. Improvement was observed in 64 (97%) of the patients whose operation was ureteroneocystostomy. Conclusion: Delay in the diagnosis of VUR or insufficient treatment causes recurrent urinary tract infections, kidney scar, reflux nephropathy, hypertension and chronic kidney failure. As seen in our study, research should be done in terms of VUR in patients with a history of recurrent urinary tract infections and antenatal hydronephrosis. Low grade VUR was generally seen to improve spontaneously and had a lower rate of renal scar.
Açıklama
Anahtar Kelimeler
Child, Vesicoureteral Reflux, Renal Scarring, Çocuk, Vezikoüreteral Reflü, Böbrek Yara İzi
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yılmaz, N. (2020). Çocuk nefroloji polikliniğinde vezikoüreteral reflü tanısı ile takipli hastaların değerlendirilmesi ve izlemi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
