• Childhood Kidney Diseases
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• 제5권1호
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• pp.69-72
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• 2001

대부분의 정상 소아는 하루에 수7회 정도씩 배뇨를 한다. 일부 소아에서는 하루에 2회 이하로 배뇨를 하는데, 이 경우를 infrequent voiding이라 지칭한다. 이들의 경우 대개 장기간 수의적으로 소변을 참아오는 경우가 대부분이다. 이러한 비정상적인 배뇨습관으로 인하여 종종 방광 용적이 증가되며, 잔뇨량이 늘어나고 배뇨의 욕구가 감소됨으로써 만성적인 방광확장과 함께 재발성 요로감염 및 신손상까지 초래될 수 있다. 본 보고자들은 13세의 여아에서 하루 2차례 이하로 매우 드물게 배뇨를 하는(가뭄뇨) 습관으로 인하여 요로감염과 신손상이 초래된 증례를 경험하였기에 문헌고찰과 함께 보고하고자 한다.

• Childhood Kidney Diseases
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• 제8권2호
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• pp.239-243
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• 2004

저자들은 두통, 안면 부종, 고열 및 옆구리 통증 등을 주소로 내원한 5세 여아에서 특징적인임상 양상과 검사 소견 등을 통하여 첫 발병시에 E. coli 감염에 의한 급성 신우신염이 병발한 급성 연쇄상구균 감염후 사구체신염으로 진단하고 치료한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Childhood Kidney Diseases
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• 제16권1호
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• pp.63-67
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• 2012

소아에서 급성 신우신염은 상대적으로 흔한 세균 감염 질환이다. 이전에 건강했던 소아에서 요로계의 폐쇄, 저혈압에 의한 신장 허혈, 신장 독성물질에의 노출 등이 없이는 급성 신우신염의 결과로 급성 신부전이 생기기는 매우 드물다. 저자들은 이전에 건강했던 소아에서 방광요관 역류가 동반된 급성 신우신염과 신장 농양에 따른 급성 신부전이 발생한 예를 보고하는 바이다. 환자는 적절한 수액 치료와 항생제 치료를 통해 호전되었다. 증례를 통해 저자들은 급성 신우신염이 급성 신부전의 감별진단에포함되어야 하며, 신장기능의 완전한 회복을 위해서는 적절한 항생제 치료가 수반되어야 함을 제시하는 바이다.

• BMB Reports
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• 제30권2호
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• pp.101-105
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• 1997

Extracellular phospholipase $A_2$ activity has been detected in urine of patients with acute pyelonephritis (APN). This enzyme required micromolar $Ca^{2+}$ ion for its maximum activity and showed a broad range of pH (4.5~10) optimum. Urine enzyme hydrolyzed phosphatidylethanolamine (PE) and phosphatidylserine (PS) more effectively than phosphatidylcholine (PC). $PLA_2$ activity in the urine of patients with APN was about 5-fold higher than that of healthy individuals. When urine was subjected to heparinSepharose column chromatography, phospholipase $A_2$ activity was detected in both heparin-non-binding and binding fractions. Both phospholipase $A_2$ activities were sensitive less than a micromolar calcium concentration and did not react with anti-human 14-kDa group II phospholipase $A_2$ monoclonal antibody, HP-l. These findings suggest that two kinds of novel extracellular phospholipase $A_2$. which may not belong to the 14-kDa group II phospholipase $A_2$ family, exist in the urine of patients with APN.

• Clinical and Experimental Pediatrics
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• 제54권5호
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• pp.212-218
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• 2011

Purpose: The diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of $^{99m}Tc$-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). Methods: We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and ${\geq}$2 years (n=36). Results: Among total 81 patients with MDCT-proven APN, DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male and most of them, 19 (73.1%) were <2 years of age. Conclusion: DMSA scan holds obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.179-185
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• 2007

결론적으로 출력 도플러 신초음파는 급성신우신염의 병변을 찾는데에 특이도나 민감도가 그리 높지 않았으나 하부요로감염과 급성신우신염을 감별하는데에 어느 정도 유용하였으며, 특히 DMSA 스캔을 같이 실시하는 경우에는 신손상을 찾는데 더 도움이 될 수 있었다. 소아들의 상부요로감염의 진단을 위하여 출력 도플러 신초음파가 DMSA 스캔을 대체하는 영상검사로서는 한계가 있어 향후 보다 많은 시술로 진단을 위한 검사의 질을 높이는 방법을 찾아보아야 할 것이다.

• Childhood Kidney Diseases
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• 제22권2호
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• pp.47-51
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• 2018

Purpose: Urinary tract infection (UTI) is one of the common infectious diseases in children. Several imaging modalities can be used to confirm the presence of acute pyelonephritis (APN). Among them the 99mTcdimercaptosuccinic acid renal scan (DMSA scan) is used as a gold standard for diagnosis. Ultrasonography technology is evolving. Therefore, in this study, we investigated the sensitivity and specificity of Power Doppler ultrasonography (PDU) compared to the results from the previous study. Methods: There were 260 patients included in this study, aged between 1 and 12 months old. The patients were admitted to the Yeungnam University Medical Center between January 2008 and December 2015. All patients underwent both DMSA scan and PDU within 5days of admission. Voiding cystourethrography (VCUG) was performed in 195 patients with abnormal DMSA scan or PDU. Results: The diagnostic sensitivity of APN using PDU was 45.5% and specificity was 85.5% in 260 patients following detection of a defect on DMSA scan that was defined as APN. The diagnostic sensitivity and specificity of PDU for VUR were 65.5 % and 60.1%, respectively. The diagnostic sensitivity and specificity of DMSA scan for VUR were 95.7% and 14.1%, respectively. Conclusion: PDU has a high specificity but low sensitivity, so there are limitations in using it to replace a DMSA scan for the diagnosis of APN in children. DMSA scan and PDU have different sensitivity and specificity in diagnosis of VUR, respectively. Therefore, we suggest that the sensitivity and specificity of each test can be helpful in diagnosing APN and VUR when used in conjunction.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권1호
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• pp.54-60
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• 2016

Purpose: The aim of this study is to investigate the association between elevated alanine aminotransferase (ALT) and urosepsis in children with acute pyelonephritis (APN). Methods: We retrospectively identified all children who were managed in our hospital with APN during a decade period. In our study a diagnosis of APN was defined as having a positive urine culture and a positive (99m)Tc-dimercaptosuccinic acid scintigraphy. We compared those with elevated ALT and those with normal ALT according to the following variables: age, gender, duration of fever prior to admission, presence of hypotension, C-reactive protein (CRP), creatinine, presence of anemia, white blood cells count, platelet count, blood culture result, and grades of vesicoureteral reflux. In addition, the correlation between elevated ALT and positive blood culture was analyzed in detail. Results: A total of 996 children were diagnosed with APN, of which 883 were included in the study. ALT was elevated in 81 children (9.2%). In the analysis of demographic characteristics, the number of children with elevated ALT was higher in children between 0 to 3 months, boys, and in those with positive blood culture (p=0.002, 0.036, and 0.010, respectively). In multivariate analysis of variables associated with positive blood culture, age younger than 3 months, elevated ALT, elevated CRP, and elevated creatinine showed statistical significance (p=0.004, 0.030, 0.043, and 0.044, respectively). Conclusion: Our study demonstrates the association between elevated ALT and increased prevalence of urosepsis in addition to elevated CRP, elevated creatinine, and age younger than 3 months in children with APN.

• Childhood Kidney Diseases
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• 제24권2호
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• pp.98-106
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• 2020

Purpose: The aim of this study is to evaluate the clinical utility of late 6-month dimercapto-succinic acid (DMSA) renal scan in predicting vesicoureteral reflux (VUR) and long-lasting renal scars in children with first acute pyelonephritis (APN). Methods: A retrospective case study of children admitted with APN from January 2010 to July 2017 was performed. The study included patients with voiding cystourethrography (VCUG) and acute and late 6-month DMSA scan. We analyzed the clinical, laboratory and imaging findings of patients with and without late cortical defects at 6 months and those with or without VUR. Results: Among 145 children with APN, 50 (34.5%) had cortical defects on the late DMSA renal scan and 60 (41.4%) showed VUR. Thirteen of 38 (34.2%) children undergoing 18-month DMSA renal scan showed a long-lasting renal scars. Compared with children without late cortical defects, patients with late 6-month cortical defects had a higher incidence of VUR and long-lasting renal scars, and relapse of UTI (all P<0.05). In a multivariable analysis, both high-grade VUR and relapse of UTI were independently correlated with the presence of late 6-month cortical defects (P<0.05). Late cortical defects and relapse of UTI were also associated with the presence of VUR (P<0.05). Only the late 6-mo cortical defects was an independent predictor of long-lasting renal scars in children with APN (P<0.05). Conclusion: An abnormal late 6-month DMSA renal scan may be useful in identifying VUR and long-lasting renal scars in children diagnosed with APN.

• Journal of Korean Medical Science
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• 제33권49호
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• pp.310.1-310.11
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• 2018

Background: Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. Methods: From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. Results: The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). Conclusion: The epidemiology of APN in Korea has been changing with an increasing incidence rate.