Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
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Clinical Significance of Pyuria in Pediatric Patients with Febrile Urinary Tract Infection

발열성 소아 요로감염에서 농뇨의 임상적 의의

  • Choi, Lim (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Cho, Sea-Eun (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Yim, Hyung-Eun (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Yoo, Kee-Hwan (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Hong, Young-Sook (Department of Pediatrics, Guro Hospital, Korea University) ;
  • Lee, Joo-Won (Department of Pediatrics, Guro Hospital, Korea University)
  • 최림 (고려대학교 의과대학 소아과학교실) ;
  • 조세은 (고려대학교 의과대학 소아과학교실) ;
  • 임형은 (고려대학교 의과대학 소아과학교실) ;
  • 유기환 (고려대학교 의과대학 소아과학교실) ;
  • 홍영숙 (고려대학교 의과대학 소아과학교실) ;
  • 이주원 (고려대학교 의과대학 소아과학교실)
  • Received : 2011.03.19
  • Accepted : 2011.04.25
  • Published : 2011.04.30
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Abstract

Purpose: Early diagnosis and treatment of febrile urinary tract infection (UTI) in children is important to prevent kidney damage. This study aims to evaluate the relationship between the presence of pyuria, the severity, and underlying genitourinary anomalies in patients with UTI. Methods: We retrospectively reviewed 293 patients with febrile UTI who were admitted to Korea University Guro Hospital during the period from June, 2007 until January, 2010. We divided the patients into two groups, one with the finding of pyuria at admission, and the other without, and compared the fever duration, white blood cell counts (WBC) and C-reactive protein (CRP) in peripheral bloods, hydronephrosis, cortical defects, vesicoureteral reflux and admission period. Results: Among the 293 patients with febrile UTI, 189 patients showed findings of pyuria whereas 104 patients did not. Patients with pyuria showed an increment of WBC ($14,694{\pm}485.2$ vs. $11,374{\pm}451.2/uL$, P <0.05) and CRP ($46.9{\pm}3.9$ vs $17.1{\pm}3.6$ mg/L, P <0.05) in peripheral blood sample. The presence of cortical defects (21.7 Vs 5.8%, P <0.05) and vesicoureteral reflux (15.9 Vs 6.7%, P <0.05) was also increased in patients with pyuria compared to patients without pyuria. There were no specific differences in fever duration, admission period, and hydronephrosis. Within the group with pyuria, CRP in peripheral blood sample increased proportionally with the increment of pyuria (P <0.05). Conclusion: In patients with febrile UTI, the increment of WBC in the urine sample can be a helpful predictor for increased CRP in peripheral blood and acute pyelonephritis.

목 적: 발열성 소아 요로감염에서 조기 진단과 신속한 치료는 신손상을 예방한다는 점에서 매우 중요하다. 본 연구에서는 발열성 요로감염 환자에서 입원당시의 농뇨의 여부가 요로감염의 중증도 및 동반 비뇨기계 기형과 연관이 있는지 알아보고자 하였다. 방 법: 2007년 6월부터 2010년 1월 까지 고대구로병원에서 발열성 요로감염으로 입원 치료한 환아 중 소변 배양검사상 단일 세균이 105 CFU/mL 이상으로 배양된 293명의 환아를 대상으로 하였다. 입원 당시 소변검사상 농뇨를 동반한 군과 동반하지 않은 군으로 나누어 두 군간의 발열기간, 말초 혈액백혈구수, C-반응단백, 복부 초음파 소견, 신스캔, 방광요관역류검사 및 입원기간을 후향적으로 비교분석 하였다. 결 과: 발열성 요로감염환아 총 293명중 농뇨를 동반한 군은 189명, 동반하지 않은 군은 104명이었다. 무균 채뇨백으로 검사를 진행한 환아는 113명이었으며 이를 제외한 환아는 180명이었다. 이 중 농뇨가 확인되지 않은 군은 36명이었으며 농뇨가 확인된 군은 144명이었다. 농뇨를 동반한 군에서 동반하지 않은 군에 비해 말초 혈액 백혈구수 및 C-반응단백이 유의하게 증가하였고 신스캔, 방광요관역류검사 상 이상소견도 증가하였다. 양군간 발열기간, 입원기간, 수신증의 유무는 유의한 차이를 보이지 않았다. 퇴원 후 시행한 신스캔 검사상 신 반흔의 차이도 유의하지 않았다. 농뇨군 내에서는 농뇨의 증가에 따라 C-반응단백이 비례하여 증가하였다. 무균성 채뇨백을 이용한 환자 군을 제외한 연구에서는 농뇨 군에서 신결손의 유무가 유의한 차이를 보였으며 농뇨의 증가에 따라 C-반응단백이 비례하여 증가하였다. 결 론: 발열성 요로감염 소아에서 초기 소변의 백혈구 수 증가는 말초 혈액의 염증성 표지자 및 급성신우신염을 예측하는 데 도움을 줄 수 있음을 제시하는 바이다.

Keywords

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