선택한 단어 수는 입니다.
최소 단어 이상 선택하여야 합니다.
최소 단어 이상 선택하여야 합니다.
선택한 단어 수는 30입니다.
최대 10 단어까지만 선택 가능합니다.
최대 10 단어까지만 선택 가능합니다.
문제 정의
- The aim of this study was to evaluate the diagnostic values of various lab tests and imaging studies for early renal parenchymal changes in children first admitted for clinically suspected APN. We compared the sensitivities of imaging techniques for the assessment of renal abnormalities and correlated the clinical and laboratory manifestations of acute pyelonephritis with the imaging studies.
제안 방법
- DMSA renal scan was performed 3 hr after injection of 99mTc-DMSA, taking one posterior, one anterior, and two posterior oblique images by rectangular-headed, rotating gamma camera (SOPHA DSX; Sopha Medical Systems, Columbia, MD) with the patient in the prone position. The fractional left and right activities were calculated for each kidney after background correction.
- The criteria of renal abnormality were: focal or diffuse areas of decreased uptake of labeled DMSA or diffusely decreased uptake in an enlarged kidney. DMSA renal scan was performed no later than 15 days following the diagnosis of UTI in order to assess the acute lesion.
- The duration of fever prior to admission was evaluated for the possible risk factor of renal damage. For laboratory assessments, the causative organism confirmed by urine culture, white blood count (WBC), CRP, and ESR levels were evaluated. The result of CRP level was missing in 1 case, and ESR level in 5 cases.
- Those studies not taken were either because the physician did not order the study or the patient's guardians neglected the order. Prior to evaluating the relations of patient's age, sex, fever duration, causative organism, and laboratory results to the findings of imaging studies, the sensitivity of each imaging study was statistically compared to choose the best parameter for the detection of renal abnormalities. Children in the study were divided into two groups as follows: group I, age less than 1 year and group Ⅱ, age greater than 1 year.
- The causative organisms of APN were evaluated to compare the influence of each organism's virulence on renal damage. E.
- As the diagnosis of APN is often difficult in neonates and infants, the risk factors of pyelonephritis, reliability of the diagnostic parameters, and the "gold standard'* method for diagnosis are still being debated. The retrospective study we present was addressed to evaluate the risk factors of early renal damage in childhood after first .APN.
대상 데이터
- The records of the pediatric patients aged 0-15 years who were admitted to Guro Hospital and Anam Hospital, Korea University Medical Center between January, 1998 and December, 2002 were reviewed. 85 male and 30 female patients were eligible for the study. They were highly suggestive of APN (fev&*>385C, white blood cells in urine 25 per high power field on microscopy and positive urine culture >105 microorganisms per mL for voided urine, >103 for suprapubic collection).
- A total of 115 Korean children, 85 males and 30 females, were enrolled in the study. The mean age was 12 months.
데이터처리
- The results were analyzed with chi-square test, Fischer's exact test, t test, and rank sum test. The relations of sex and age with the imaging studies were mainly tested using chi-square test, while the other risk factors were tested by t test and rank sum test, as needed.
성능/효과
- Furthermore, the DMSA renal scan findings were evaluated in 4 different combinations of groups by sex and age. As a result, the rate of positive findings on the initial DMSA ren게 scan was significantly higher in the group of children who are concurrently female and older in age (age group II); 12 of 14 (85.7%) children who are female and in age group Ⅱ, 3 of 5 (60.0%) who are female and in age group Ⅱ, 8 of 16 (50.0%) who are male and in age group Ⅱ, and 30 of 80 (37.5 %) who are male and in age group I, showed positive findings consistent with APN in DMSA renal scan (F=0.008). The positive findings on follow-up DMSA renal scan, however, were not significantly related to such combination groups.
- Howard et al [27] reported the presence of VUR in 39% of symptomatic Chinese children with UTI. In addition, the results of our study were in accordance with many other reports that noted the increased risk of renal scarring with the grade of VUR [28], The positive rate of DMSA renal scan increased as the grade of VUR increased (VUR; no reflux 41.8%, grade I-Ⅲ 69.2%, grade IV-V 100%, P<0.05).
- In conclusion, this study demonstrates that children who have DMSA renai changes on initial scanning, whether they were congenital or acquired in origin, were more likely to develop APN and that DMSA renal scan and VCUG showed higher positive rates of abnormalities in females and in older children. The radiological evaluation of urinary tract after the clinical suspicion of APN should not be limited to male infants or children of younger age, particularly if CRP or ESR level is markedly increased.
- There have been various imaging studies performed for the evaluation of APN in children, inchiding renal US, IVP, DMSA renal scan, and VCUG. In this study, the children with clinical and laboratory manifestation of pyelonephritis showed the highest positive rate of abnormal findings in DMSA renal scan, suggesting DMSA renal scan to be the most sensitive imaging study to assess renal parenchymal lesion (DMSA renal scan 46.0%, renal US 32.1%, IVP 28.0%, VCUG 22.1%).
- 5%) children with initial renal damage showed persistent lesions. On the initial DMSA renal scan, 33 of 85 (38.8%) males and 20 of 30 (66.6%) females had positive findings; females had a significantly higher proportion of renal parenchymal damage on DMSA renal scan (P= 0.014) (Fig. 1). 38 of 96 (39.
- The relation of patients' laboratory results with the findings of imaging studies were evaluated, and as a result, both CRP and ESR levels were significantly elevated in children with positive DMSA renal scan. Ghiro et al [15] reported that children with evidence of scars on DMSA scan had significantly higher levels of CRP, therefore suggesting a high risk of parenchymal involvement and the development of scar lesions in febrile children with UTI and increased CRP.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.