RESUMEN
Hematuria is one of the most common disorders in children. Bladder tumors are rare in children, and inflammatory pseudotumor (IP) is especially rare. We report a case of inflammatory pseudotumor of the bladder in a 13-year-old girl manifested as acute onset of non-traumatic and painless gross hematuria with impending hypovolemic shock. A huge intravesicular mass (6.5 x 3.8 cm) was noted on renal-bladder ultrasound, cystoscopy, and computed tomography. Partial cystectomy was performed to remove the mass. Pathology led to a diagnosis of leiomyoma and subsequent confirmation as an IP. To our knowledge, our case is the first presentation of bladder IP in Taiwan among the reported pediatric cases.
Asunto(s)
Granuloma de Células Plasmáticas/patología , Enfermedades de la Vejiga Urinaria/patología , Adolescente , Femenino , Granuloma de Células Plasmáticas/complicaciones , Granuloma de Células Plasmáticas/cirugía , Hematuria/etiología , Humanos , Choque/etiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/cirugíaRESUMEN
A renal abscess is rare in children and diagnosis is not readily apparent before hospitalization, because symptoms are often insidious and nonspecific. To evaluate the diagnostics and therapy of renal abscess in the pediatric group, we will report eight cases of renal abscess in children to illustrate the variable features of this condition. Eight patients, 6 to 156 (mean, 45.9) months old, with renal abscesses in 9 kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tool, revealing a hypoechoic or hypodense mass. Fever, abdominal pain, and leukocytosis were common presenting features, but no child presented symptoms of loin pain. Escherichia coli was identified in the urine culture among the 6 cases and blood culture in one case. Three children were associated with mild to moderate vesicoureteral reflux. All patients had an intensive antibiotic treatment, which led to resolution of the abscess in eight of the nine kidneys. In one case, the abscess had to be drained using the CT-guided percutaneous drainage. During follow-up, seven children received 99mTc DMSA renal SPECT and only two of them had complete remission without sequelae of renal scar. We concluded that the renal abscesses must be assumed, especially, in children with prolonged fever, abdominal pain, and a high value of CRP. Ultrasonography is just a screening test to detect renal swelling, bulging, and enlargement; however, a CT scan is more sensitive and can detect abscess formation, as well as define the extent of the disease for planning conservative antibiotic treatment or additional drainage. Finally, DMSA renal SPECT is the best and the most sensitive examination for detecting the extension area of renal inflammation and correlated with the renal outcome.
Asunto(s)
Absceso/diagnóstico , Enfermedades Renales/diagnóstico , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Enfermedades Renales/tratamiento farmacológico , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine if glucocorticoids can prevent renal scar formation after acute pyelonephritis in pediatric patients. METHODS: Patients younger than 16 years diagnosed with their first episode of acute pyelonephritis with a high risk of renal scar formation (ie, inflammatory volume ≥ 4.6 mL on technetium-99m-labeled dimercaptosuccinic acid scan [DMSA] or abnormal renal ultrasonography results) were randomly assigned to receive either antibiotics plus methylprednisolone sodium phosphate (1.6 mg/kg per day for 3 days [MPD group]) or antibiotics plus placebo (placebo group) every 6 hours for 3 days. Patients were reassessed by using DMSA 6 months after treatment. The primary outcome was the development of renal scars. RESULTS: A total of 84 patients were enrolled: 19 in the MPD group and 65 in the placebo group. Patient characteristics were similar between the 2 groups, including the acute inflammatory parameters and the initial DMSA result. Renal scarring was found in 33.3% of children treated with MPD and in 60.0% of those who received placebo (P < .05). The median cortical defect volumes on follow-up DMSA were 0.0 mL (range: 0-4.5 mL) and 1.5 mL (range: 0-14.8 mL) for the MPD and placebo groups, respectively (P < .01). Patients in the MPD group experienced faster defervescence after treatment than the placebo group. CONCLUSIONS: Adjunctive oral MPD therapy reduced the occurrence and/or severity of renal scarring after acute pyelonephritis in these hospitalized children who had a high risk of renal scar formation.
Asunto(s)
Antibacterianos/administración & dosificación , Cicatriz/prevención & control , Glucocorticoides/administración & dosificación , Metilprednisolona/administración & dosificación , Pielonefritis/complicaciones , Pielonefritis/tratamiento farmacológico , Enfermedad Aguda , Administración Oral , Quimioterapia Combinada , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Análisis Multivariante , Factores de RiesgoRESUMEN
To investigate the incidence of acute pyelonephritis (APN) and renal scarring in children with febrile urinary tract infection (UTI), 191 of 216 (88%) children with their first episode of UTI received (99m)Tc-dimercaptosuccinic acid renal single-photon emission computed tomography. They were investigated within 7 days of admission and were followed for 6 months. One hundred and six patients (49.1%) underwent a voiding cystourethrogram. The incidence of vesicoureteric reflux (VUR) in group I (=1 year old) was 22%, group II (1-5 years old) 69%, and group III (5-17 years old) 44%. The overall incidence of APN in febrile UTI was 70% (male 66%, female 76%, P=0.110). Children had a higher incidence of APN than infants ( P<0.05 in group I vs. II and group I vs. III). Of patients with APN, 57% (35/61) showed renal scar formation. VUR was found in 31%(24/78) of children with APN and 58% (14/24) of children with renal scar. In addition, children with high-grade VUR were more susceptible to APN and scar formation than those with low-grade VUR ( P<0.05). Older children with a first febrile UTI had a higher incidence of APN than infants (=1 year), and half of the children with APN developed a renal scar.