Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical study of urinary tract infection, natural courses, and prenatal ultrasonographic results according to the grades of hydronephrosis

수신증의 정도와 요로감염 및 자연경과, 산전초음파상의 수신증 여부와의 관련성에 대한 임상적 고찰

  • Lee, Jee-Hee (Department of Pediatrics, Chungbuk National University College of Medicine) ;
  • Kim, Jun-Woo (Department of Pediatrics, Chungbuk National University College of Medicine) ;
  • Yoon, Ji-Eun (Department of Pediatrics, Chungbuk National University College of Medicine) ;
  • Ha, Tae-Sun (Department of Pediatrics, Chungbuk National University College of Medicine)
  • 이지희 (충북대학교 의과대학 소아과학교실) ;
  • 김준우 (충북대학교 의과대학 소아과학교실) ;
  • 윤지은 (충북대학교 의과대학 소아과학교실) ;
  • 하태선 (충북대학교 의과대학 소아과학교실)
  • Received : 2008.09.12
  • Accepted : 2009.02.25
  • Published : 2009.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Although renal ultrasonography (USG) has improved the detection rate of hydronephrosis (HN), its clinical courses and postnatal management remains controversial. Here, we reviewed the clinical features of patients with HN according to the grades. Methods : We retrospectively studied 207 patients who were regularly followed-up among 367 patients with HN detected by renal USG postnatally between April 1998 and December 2007. These patients were grouped into four groups, grades 1-4, according to renal pelvic diameter (RPD). For analysis, each group was merged into two categories (mild: grade 1, 2; severe: grade 3, 4). Results : During follow-up, 128 episodes of urinary tract infection (UTI) occurred in 91 patients. According to grades from 1 to 4, 35/89 (39.3%), 41/88 (46.5%), 11/22 (50%), and 4/8 (50%), respectively, had UTI, without any significance between the mild and severe groups. However, the severe group presented a higher risk in cumulative episodes of UTI per year (P=0.041). The spontaneous resolution of HN was observed in 103 (58.8%) of the 175 mild group patients and in 3 (10.7%) of the 28 severe group patients (P<0.001). Furthermore, the detection rate of prenatal HN by prenatal USG was much higher in patients with severe RPD (P<0.001). Conclusion : We found that the severer the grade of HN, the lower was the rate of spontaneous resolution and higher was the frequency of UTI. Therefore, the establishment of guidelines for managing treatments such as antibiotic prophylaxis for patients with HN is needed to improve renal prognosis.

목 적 : 신초음파검사는 수신증의 발견을 향상 시켰지만, 수신증의 임상 경과 및 치료에 대해서는 많은 이견이 있다. 이에 저자들은 수신증의 정도에 따른 환아들의 임상적 특징을 연구하였다. 방 법 : 1998년 4월부터 2007년 12월까지 신초음파검사에서 수신증이 발견된 총 367명의 환아들 중에 추적 관찰된 207명을 대상으로 후향적으로 조사하였다. 신우전후직경에 따라 대상을 grade 1-4까지 분류하고, 분석을 위해 이를 다시 mild 군 및 severe 군으로 나누었다. 결 과 : 추적기간 동안 요로감염은 207명 중 91명(44%)의 환아에서 총 128회 발생하였고, 수신증 정도에 따라서는 grade 1이 89명 중 35명(39.3%), grade 2는 88명 중 41명(46.5%), grade 3은 22명 중 11명(50%), grade 4는 8명 중 4명(50%)으로 요로감염의 발생 유무에 대해서는 mild 군과 severe 군 사이에 유의한 차이는 없었다. 그러나 요로감염의 누적 빈도 및 년당 발생한 요로감염의 횟수를 비교 해볼 때 severe 군이 mild 군보다 유의하게 높았다(P=0.041). Mild 군은 175명 중 103명(58%)이 완해를 보여 28명 중 3명(10.7%)의 완해를 보였다(P<0.001). 또한 산전초음파에서 수신증의 발견될 확률은 심한 신우전후직경을 나타낸 환아에서 더 높았다(P<0.001). 결 론 : 저자들은 수신증의 정도가 심할수록 자연완해는 더 적게 일어나며, 요로감염은 더 빈번하게 발생하는 것을 알게 되었다. 따라서 수신증을 가진 환아에 대해 신장 예후를 증진시키기 위하여 예방적 항생제 등의 치료 지침의 확립이 필요하다.

Keywords

Acknowledgement

Supported by : Chungbuk National University

References

  1. Capolicchio G, Leonard MP, Wong C, Jednak R, Brzezinski A, Salle JL. Prenatal diagnosis of hydronephrosis : Impact on renal function and its recovery after pyeloplasty. J Urol 1999;162:1029-32 https://doi.org/10.1016/S0022-5347(01)68055-8
  2. Roth JA, Diamond DA. Prenatal hydronephrosis. Curr Opin Pediatr 2001;13:138-41 https://doi.org/10.1097/00008480-200104000-00009
  3. Shokeir AA, Nijman RJ. Antenatal hydronephrosis : changing concepts in diagnosis and subsequent management. BJU int 2000;85:987-94 https://doi.org/10.1046/j.1464-410x.2000.00645.x
  4. Peters CA. Urinary tract obstruction in children. J Urol 1995;154:1874-83 https://doi.org/10.1016/S0022-5347(01)66815-0
  5. Brown T, Mandell J, Lebowitz RL. Neonatal hydronephrosis in the era of sonography. AJR Am Roentgenol 1987;148: 959-63
  6. Yoon HY, Kim JH, Lee JS, Kim PK, Kim MJ. The neonatal follow up and correlative analysis of fetal hydronephrosis. J korean Soc Pedatr Nephrol 1998;2:60-8
  7. Disandro MJ, Kogan BA. Neonatal management : role for early intervention. Urol Clin North Am 1998;25:187-97 https://doi.org/10.1016/S0094-0143(05)70007-0
  8. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis : natural history of poorly functioning kidneys. J Urol 1994;152:593-5
  9. Conrnford PA, Rickowood AM. Functional results of pyeloplasty in patients with antenatally diagnosed pelvi-ureteric junction obstruction. Br J Urol 1998;81:152-5 https://doi.org/10.1046/j.1464-410x.1998.00519.x
  10. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis : introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993;23:478-80 https://doi.org/10.1007/BF02012459
  11. Dudley JA, Haworth JM, McGraw ME, Frank JD, Tizard EJ. Clinical relevance and implications of antenatal hydronephrosis. Arch Dis Child Fetal Neonatal Ed 1997;76:F31-4 https://doi.org/10.1136/fn.76.1.F31
  12. Lim DJ, Park JY, Kim JH, Paick SH, Oh SJ, Choi H. Clinical Characteristics and Outcome of Hydronephrosis Detected by Prenatal Ultrasonography. J Korean Med Sci 2003;18:859-62
  13. Miyakita H, Ueno S, Nomura M. Neonatal hydronephrosis detected on routine health check-up. Tokai J Exp Clin Med 2001;26:101-5
  14. Rushton HG. Urinary tract infections in children. Epidemiology, evaluation and management. Pediatr Clin North Am 1997;44:1133-69 https://doi.org/10.1016/S0031-3955(05)70551-4
  15. Merrick MV, Notghi A, Chalmers N, Wilkinson AG, Uttley WS. Long term follow up to determine the prognostic value of imaging after urinary tract infections. Part 2. Scarring. Arch Dis Child 1995;72:393-6 https://doi.org/10.1136/adc.72.5.393
  16. Jahnukainen T, Honkinen O, Ruuskanen O, Mertsola J. Ultrasonography after the first febrile urinary tract infection in children. Eur J Pediatr 2006;165:556-9 https://doi.org/10.1007/s00431-006-0113-4
  17. Stull TL, LiPuma JJ. Epidemiology and natural history of urinary tract infections in children. Med Clin North Am 1991; 75:287-97
  18. Coelho GM, Bouzada MC, Pereira AK, Figueiredo BF, Leite MR, Oliveira DS, et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 2007;22:1727-34 https://doi.org/10.1007/s00467-007-0539-6
  19. Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: a systematic review and meta- analysis. Pediatr Nephrol 2006;21:218-24 https://doi.org/10.1007/s00467-005-2100-9
  20. Yoon HS, Yum MS, Lee JH, Park YS, Kim KS, Yoon CH, et al. 1 year follow-up results of prenatally diagnosed unilateral hydronephrosis according to renal sonographic findings at 1 month of age. Korean J Pediatr 2006;49:64-70 https://doi.org/10.3345/kjp.2006.49.1.64
  21. Kang HS, Sung JS, Kim SH, Back HJ, Kim YO, Kim CJ, et al. Frequency and clinical characteristics of prenatally diagnosed congenital hydronephrosis and outcomes of ureteropelvic junction stenosis. Korean J Pediatr 2006;49:870-4 https://doi.org/10.3345/kjp.2006.49.8.870
  22. Ahamad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstet Gynaecol 2005;25:119-22 https://doi.org/10.1080/01443610500041446
  23. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int 2002;89:149-56 https://doi.org/10.1046/j.1464-4096.2001.woodward.2578.x
  24. Kang YS, Han SW, Choi SK. The ultrasonographic follow up results and the prognosis of prenatal hydronephrosis. Korean J Urol 1995;36:1100-5
  25. Chevalier RL, Klahr S. Therapeutic approaches in obstructive uropathy. Semin Nephrol 1998;18:652-8
  26. Capello SA, Kogan BA, Giorgi LJ J, Kaufman RP Jr. Prenatal ultrasound has led to earlier detection and repair of ureteropelvic junction obstruction. J Urol 2005;74:1425-8 https://doi.org/10.1097/01.ju.0000173130.86238.39
  27. Nelson. Textbook of Pediatrics. 18th ed. Philadelphia : WB Saunders Co, 2007:2223-8

Cited by

  1. 발열성 요로 감염 환아에서 발견된 수신증의 임상적 의의 vol.14, pp.1, 2009, https://doi.org/10.3339/jkspn.2010.14.1.71
  2. 발열성 소아 요로감염에서 농뇨의 임상적 의의 vol.15, pp.1, 2009, https://doi.org/10.3339/jkspn.2011.15.1.66