Use of Fever Duration to Guide Management of Urinary Tract Infection.

BACKGROUND: The appropriate duration of antimicrobial therapy for febrile urinary tract infection (fUTI) in children has not been established. This study examined the optimal duration of treatment for fUTI in children. METHODS: We created a protocol that used fever duration to determine the duration of antibiotic administration. Transvenous antibiotics were administered until 3 days after resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine yielded a bacteria count of ≥5 × 104. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed on the basis of contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed treatment outcomes. RESULTS: Of the 78 patients treated according to our protocol, data from 58 were analyzed-49 children (30 boys) had PN and nine (three boys) had AFBN. Blood test results showed that patients with AFBN had significantly higher white blood cell counts and C-reactive protein levels than did those with PN; however, urinary findings and causative bacteria did not differ between groups. Time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported administration period of 3 weeks. No recurrence was observed in AFBN patients. CONCLUSIONS: A protocol that used fever duration to determine the duration of antimicrobial treatment was useful. Invasive examinations, such as eCT, were not required.

Diagnosis and treatment for emphysematous pyelonephritis: analysis of 14 cases from a single centre / 中华外科杂志

Objective: To examine the modalities of treatment and clinical outcomes of emphysematous pyelonephritis (EPN), in order to improve the survival rate of EPN patients. Methods: Totally 14 patients diagnosed as EPN between October 2011 and November 2020 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this article. Data collection including patient demographics, clinical manifestations, management and clinical outcomes were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 11 females and 3 males with a median age of 59 years (range: 52 to 73 years). The lesions were located on the left side in 10 patients and right side in 4 patients. All the 14 patients suffered from fever, and present with severe sepsis or septic shock. The median time from symptom onset to admission to hospital was 3 days(range: 2 to 5 days). All cases had diabetes mellitus. Escherichia coli was the most common organism been cultured (11 cases), while Klebsiella pneumonia was the second (3 cases). CT scan showed bubbly or located gas in the renal parenchyma in 5 cases and presence of steaky or mottled gas in the renal parenchyma in 9 cases. All patients had been admitted to ICU for anti-septic shock therapy. Three patients had undergone percutaneous catheter drainage along with broad-spectrum antibiotics therapy while 3 patients had immediate nephrectomy, the other 8 cases had a combination of an initial percutaneous catheter drainage and second stage nephrectomy. Results: In this case series, 3 patients were died from EPN while the other 11 were survived. The median ICU stay time was 6 days (range: 3 to 11 days). Of the 3 patients died from EPN, 2 had undergone percutaneous catheter drainage along and 1 had received immediate nephrectomy. Among the 11 patients who were survived, only 1 had received percutaneous catheter drainage while the other 10 received nephrectomy (8 patients had staged nephrectomy). Follow-up was performed 6 months after discharge. Of the 11 surviving patients, 2 were lost to follow-up, and the remaining 9 patients had an creatine level of (118.4±29.4) μmol/L (range: 89 to 176 μmol/L). Conclusions: For patients coupled with diabetes who were initially diagnosed as acute pyelonephritis, the possibility of EPN should be considered when the disease progressed rapidly especially septic shock occurred. On the basis of empirical broad-spectrum antibiotics therapy and standardized anti-septic shock treatment, a combination of an initial percutaneous catheter drainage and second stage nephrectomy could be efficacious.

Pyelonephritis (acute): antimicrobial prescribing

This guideline sets out an antimicrobial prescribing strategy for acute pyelonephritis (upper urinary tract infection) in children, young people and adults who do not have a catheter. It aims to optimise antibiotic use and reduce antibiotic resistance.

Daño renal cortical en niños con primera infección del tracto urinario alto / Cortical renal damage in children with a first infection of the high urinary tract

Introducción: entre el 5 y 22 por ciento de los niños que padecen pielonefritis aguda desarrollarán cicatriz renal. Objetivo: describir los aspectos clínico-epidemiológicos del daño renal cortical en niños con la primera infección del tracto urinario alto. Métodos: estudio observacional prospectivo y longitudinal sobre el daño renal cicatricial en niños con la primera infección urinaria alta, ingresados en el servicio de nefrología del Hospital Pediátrico Universitario William Soler , entre el 1º de enero de 2008 y diciembre 31 de 2009. Se diagnosticaron 50 pacientes, y 38 reunieron criterios para incluirlos en el estudio. Los pacientes tenían una edad media de 18 meses. A los 38 pacientes se les realizó ultrasonido renal durante la fase aguda de la enfermedad, y gammagrafía renal estática entre 6 y 12 meses después del cuadro agudo, para precisar la lesión renal cortical. En los casos con cicatriz renal, ausencia o disminución de captación del radiofármaco (99mTc-DMSA), se les realizó uretrocistografía miccional para precisar la existencia de reflujo vesicoureteral. Resultados: 28 pacientes (73,7 por ciento) son del sexo femenino, 17 (44,7 por ciento) menores de 6 meses, 17 (44,7 por ciento) tienen entre 6 y 36 meses, y 4 (10,6 por ciento) > 3 años. La infección urinaria fue atípica en 23 (60,5 por ciento), y el germen aislado, la Escherichia coli en 33 (86,8 por ciento). El ultrasonido de la fase aguda demostró dilatación pélvica renal en 3 (7,9 por ciento) y asimetría renal en 1 (2,6 por ciento). En 2 pacientes (5,2 por ciento) se demostró cicatriz renal y en 11 (28,4 por ciento) hipofunción de la corteza renal. La uretrocistografía miccional demostró reflujo vesicoureteral grado III en una niña, que además, tenía cicatriz renal. No existió relación entre el inicio de los síntomas, comienzo de la terapeútica y lesión cortical. Conclusiones: los factores de riesgo para desarrollar cicatriz renal pospielonefrítica fueron: sexo femenino, edad ...(AU)

Introduction: between the 5 and the 22 percent of children suffering acute pyelonephritis will develop a renal scar. Objective: to describe the clinical-epidemiological features of the cortical renal damage in children with a first infection of high urinary tract. Methods: a longitudinal, prospective and observational study was conducted on the cicatricial renal damage admitted in the Nephrology services of the William Soler University Children Hospital from January 1, 2008 to December 31, 2009. Fifty patients were diagnosed and 38 fulfilled the inclusion criteria to study. Patients had a mean age of 18 months and underwent renal ultrasound during the acute phase of disease and static renal scintigraphy between 6 and 12 months after the acute picture, to specify exactly the cortical renal injury. In cases of renal scar, lack or decrease of the radioactive drug capture (99mTc-DMSA) authors carried out miction uretrocystography to specify exactly the presence of vesicoureteral reflux. Results: twenty six patients (73.7 percen) are females, 17 (44.7 percen) aged under 6 months, 17 (44.7 percen) have between 6 and 36 months and 4 (10.6 percen) > 3 years old. The urinary infection was atypical in 23 (60.5 percen) and as a isolated germ the Escherichia coli in 33 (86.8 percen). Ultrasound of acute phase demonstrated a renal pelvis dilation in 3 (7.9 percen) and renal asymmetry in 1 (2.6 percen). In 2 patients (5.2 percen) there was renal scar and in 11 (28.4 percen) an decreased function of the renal cortex. The miction uretrocystography demonstrated the presence of grade III vesicoureteral reflux in a girl, who also had a renal scar. There was not relation between the onset of symptoms, the onset of therapeutics and the cortical injury. Conclusions: the risk factors to develop a post-pyelonephritis renal scar were: female sex, be aged under 3 and grade III vesicoureteral reflux(AU)

Supervivencia de un catéter: un reto y un logro de enfermería / No disponible

No disponible

Infecciones del tracto urinario / Urinary tract infections

La infección del tracto urinario (ITU), con sus múltiples presentaciones clínicas, está entre las enfermedades infecciosas más frecuentes, tanto en pacientes ambulatorios como hospitalizados. El uso del examen de orina completa y de urocultivo debe ser racional. La bacteriuria asintomática no debe ser buscada ni tratada, en parte porque esto favorece el desarrollo de bacterias resistentes a antibióticos. Distintos cuadros clínicos requieren de distintas duraciones de terapia antibiótica, y tanto el exceso de días de tratamiento como su falta deben evitarse. Se requiere investigación en la búsqueda de estrategias más efectivas para prevenir las ITU recurrentes y en el desarrollo de nuevos antibióticos orales para las ITU resistentes.

Urinary tract infection, with its multiple clinical presentations, is one of the most common infectious diseases in both ambulatory and hospitalized patients. The urinalysis and urine culture should be used when appropriate. Asymptomatic bacteriuria should not be screened or treated, in part because of a concern for the selection of antibiotic resistant bacteria. The appropriate duration of treatment of urinary tract infection should be completed. Research is needed in newstrategies for prevention of recurrent urinary tract infections and development of new oral antibiotics for drug resistant bacteria.

Pielonefrite enfisematosa: revisão e atualização da abordagem terapêutica / Emphysematous pyelonephritis: review and update of the therapeutic

A pielonefrite enfisematosa é uma grave e rara infecção renal aguda, caracterizada por presença de ar no parênquima renal e tecidos circunvizinhos, levando a alterações sistêmicas importantes, mais comumente observadas em pacientes diabéticos, apresentando mortalidade significativa. Mudanças no manejo desta doença foram introduzidas ao longo dos anos estabelecendo uma nova abordagem terapêutica através, de técnicas menos invasivas, que resultaram em redução da morbidade e da mortalidade. Em concordância com as publicações mais recentes, alguns fatores prognósticos devem ser levados em consideração bem como o grau de extensão da lesão à tomografia computadorizada e a evolução clínica do paciente, objetivando o plano terapêutico mais adequado. O caso relatado expõe epidemiologia incomum (idade, sexo) em relação à apresentação típica da doença e mostra que a pielonefrite enfisematosa deve estar em mente como diagnóstico diferencial das infecções urinárias complicadas. Por fim, confirmamos que a abordagem conservadora, com tratamento através de antibioticoterapia e drenagem percutânea, é efetiva desde que observada criteriosamente a indicação terapêutica para cada caso.

The emphysematous pyelonephritis is a severe and rare acute renal infection, characterized by renal parenchyma and adjacent tissues air presence, inducing to important systemic complications, observed mainly in diabetic patients , bringing out significative mortality. Changes on the management of this disease had occurred over the years, turning possible a new therapeutic strategy using less invasive procedures wich resulted in a reduction of the morbity and mortality. According to the most recent publication some prognostic factors most be considered, as well as the extension of the lesions observed on the computerized tomography and clinical patient's evolution, to reach the best therapeutic strategy. This clinical case presents an uncommon epidemiology (age, sex) and show as the importance of keeping the emphysematous pyelonephritis as a possible diagnose in complicated urinary infection cases. Finally, was possible to conclude that conservative treatment using antibiotics and percutaneous drainage is effective once observed the appropriated therapy indication for each case.

Características de la pielonefritis aguda en una unidad de corta estancia / Characteristics of acute pyelonephritis at a short-stay medical unit

Objetivos: Analizar las características epidemiológicas de la población ingresada por pielonefritis aguda en una unidad de corta estancia (UCE) durante el año 2005. Describir y analizar los aspectos microbiológicos registrados en estas infecciones y su implicación clínica. Material y método: Se realizó un estudio retrospectivo de una cohorte de 208 pacientes que ingresaron durante el año 2005 en la UCE de nuestro centro a consecuencia de una pielonefritis aguda (PNA). Se incluyeron datos epidemiológicos, clínicos y microbiológicos. Análisis estadístico: SPSS v.14.0. Resultados: Se incluyeron 208 pacientes, siendo el 74% mujeres, con una edad media de 43,6 (16-87). La estancia media fue de 4,7 ± 1,2 días. El 96,6% fueron dados de alta con éxito desde la UCE. El urocultivo se consideró válido en 173 pacientes, siendo positivo el 51,4%. Escherichia coli representó el 93,2% de los patógenos aislados en la orina. Los hemocultivos válidos fueron 178, siendo positivos en 37 pacientes. E. coli se aisló en el 64,8% de ellos. De las resistencias a antibióticos analizadas para E. coli en urocultivo, el 68,7% fueron para ampicilina; 22,9% para cotrimoxazol; 18,1% para ciprofloxacino; 16,9% para amoxicilina-clavulánico y el 2,4% para fosfomicina. Siete pacientes fueron trasladados a hospitalización domiciliaria y no hubo ningún fallecimiento. Conclusiones: La pielonefritis aguda con criterios de ingreso puede manejarse con éxito en una UCE según las recomendaciones terapéuticas vigentes en nuestro medio, en función de los datos microbiológicos registrados y la baja incidencia de complicaciones (AU)

Objectives: To analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. Material and method: A retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. Results: 208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7±1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to co-trimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. Conclusions: Acute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications (AU)

Análisis actualizado sobre la efectividad de las opciones terapéuticas del reflujo vesico-ureteral primario / Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux

Objetivo: El propósito principal de nuestro trabajo fue realizar una Revisión Sistemática (RS) sobre el manejo terapéutico del Reflujo Vésico Ureteral Primario (RVUP). Métodos: Para ello se ha realizado una RS de los artículos aparecidos en todas las bases de datos disponibles, aplicando unos criterios de inclusión y exclusión de calidad mínima imprescindible. Resultados: Se ha realizado lectura crítica de los artículos seleccionados y el estudio estadístico correspondiente de los datos agrupados, según el tipo de tratamiento y beneficios aportados, así como sus efectos indeseables. Conclusiones: El tratamiento médico y el quirúrgico presentan la misma efectividad en la resolución de los grados I, II y III de RVUP, recomendándose el primero de ellos como tratamiento inicial tras el diagnóstico. El manejo endoscópico es igual de efectivo que la cirugía abierta, con menores efectos secundarios, sin haber encontrado diferencias entre las distintas sustancias analizadas para la inyección. Para los reflujos de alto grado IV y V no existen evidencias suficientes que aconsejen o desaconsejen cualquiera de los tratamientos. El tratamiento quirúrgico abierto, para cualquier grado de RVU, sólo presenta superioridad con respecto al tratamiento médico en el número de episodios de pielonefritis aguda durante el seguimiento. Esta afirmación no es posible aplicarla para el tratamiento endoscópico (AU)

Objectives: The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology. Methods: A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. Results: A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects. Conclusions: The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This con-clusion cannot be applied on endoscopic treatment (AU)

Pielonefritis enfisematosa: reporte de dos casos y revisión de la literatura / Emphysematous pyelonephitis: report of two cases and review

Presentamos dos pacientes mujeres diabéticas con Pielonefritis enfisematosa bilateral atendidas en nuestro hospital. Ambas tenían más de 50 años de edad. El diagnóstico se realizó por la presencia de gas a nivel de amos riñones, en la tomografía axial computarizada (TAC) abdominal. Una de las pacientes fue sometida a nefrectomía bilateral y la otra a nefrectomía derecha. Ambas pacientes tuvieron mala evolución pese al tratamiento antibiótico y quirúrgico. Debido a su alta mortalidad hacemos énfasis en el diagnóstico y tratamiento precoz.

Pielonefrite enfisematosa em enxerto renal: relato de caso / Emphysematous pyelonephritis in renal: allograft-case report

Pielonefrite enfisematosa é uma rara complicação após o transplante renal. Este é um relato de caso de uma paciente diabética de 42 anos de idade, do sexo feminino, que se apresentou após uma semana de tratamento de infecção do trato urinário causada por Escherichia coli, referindo uma massa palpável sobre o enxerto. A tomografia computadorizada de abdome mostrou coleção perirrenal contendo ar. Tratada com antibióticos e drenagem percutânea. Após 20 dias de drenagem, recebeu alta hospitalar com função renal estável.

Emphysematous pyelonephritis is a rare post renal transplant complication. This is a case report of a 42 year-old diabetic female, who presented a urinary tract infection caused by Escherichia coli and a palpable mass above the graft approximately 1 week after treatmtent, A computer tomography scan of the abdomen showed peri-renal collection containing air. The patient was treated with antibiotics and a percutaneous nephrostomy was performed. After 20 days of drainage, renal function was considered stable and she was discharged from the hospital.

Nefronía focal aguda bacteriana: diagnóstico, tratamiento y evolución / Acute lobar nephronia: diagnosis, treatment and prognosis

La nefronía focal aguda (NA) es una infección bacteriana aguda localizada en el riñón. La prevalencia de esta enfermedad es escasa. Presentamos 4 casos de nefronía bacteriana aguda. De ellos, 3 pacientes fueron diagnosticados entre 77 pacientes ingresados por pielonefritis aguda y hubo un caso atípico, asociado con una epidermólisis bullosa. El diagnóstico se realizó por ecografía renal y se confirmó con tomografía computarizada ante la mala evolución de dos de los casos, detectando un pequeño absceso en uno de ellos. El urocultivo fue positivo en 3 de los 4 pacientes. La NA es un diagnóstico radiológico que precisa tratamiento más agresivo y seguimiento más estrecho por el riesgo de evolucionar a absceso renal. Dado que la clínica es insidiosa y las pruebas de laboratorio dispares, es preciso sospecharla ante una evolución tórpida de una pielonefritis o alteraciones en la ecoestructura renal. El tratamiento médico es suficiente y el pronóstico, en general, bueno

Acute lobar nephronia is a focal form of acute bacterial renal infection. The prevalence of this disease is low. We report four cases of acute lobar nephronia. Three patients were diagnosed among 77 patients admitted to hospital for acute pyelonephritis. The fourth case was atypical and associated with epidermolysis bullosa. All cases were diagnosed by renal ultrasonography and the diagnosis was confirmed by computed tomographic examination in two patients with poor clinical course. A small abscess was detected in one patient. Urine cultures were positive in three of the four patients. Acute lobar nephronia is a radiological diagnosis and requires aggressive treatment and strict follow-up due to the risk of renal abscesses. Because the clinical manifestations are insidious and laboratory findings can be contradictory, this entity should be suspected in patients with poor clinical course or alterations on renal ultrasonography. Medical treatment is usually sufficient and prognosis is generally good

Pielonefritis enfisematosa aguda bilateral: un desafío terapéutico / Acute bilateral emphysematous pyelonephritis: a therapeutic challenge

La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.

Emphysematous pyelonephritis is a rare form of kidney infection characterized by the presence of gas-forming coliform bacteria which affects more frequently diabetic subjects. We report the case of a 57-years-old diabetic woman, who was admitted in septic shock, signs of acute bilateral emphysematous pyelonephritis, and diabetic ketoacidosis. Both blood and urine cultures yielded Escherichia coli. The patient was successfully treated using longterm broad-spectrum antibiotics, diabetic control and supportive measures alone. Catheter drainage and nephrectomy were not necessary to overcome this life threatening situation.

Pielonefritis enfisematosa aguda bilateral: un desafío terapéutico / Acute bilateral emphysematous pyelonephritis: a therapeutic challenge

La pielonefritis enfisematosa es una forma poco común de infección renal, caracterizada por la presencia de bacterias coliformes productoras de gas que afecta preferentemente a los pacientes diabéticos. Comunicamos el caso de una mujer diabética de 57 años de edad que ingresó en el hospital por un shock séptico, signos de pielonefritis enfisematosa aguda bilateral y cetoacidosis diabética. En los cultivos de las muestras de orina y sangre desarrolló Escherichia coli. La paciente fue tratada exitosamente con antibióticos de amplio espectro por un tiempo prolongado, control diabético y medidas de sostén solamente. No fue necesario el drenaje con catéteres o la nefrectomía para superar esta situación potencialmente letal.(AU)

Emphysematous pyelonephritis is a rare form of kidney infection characterized by the presence of gas-forming coliform bacteria which affects more frequently diabetic subjects. We report the case of a 57-years-old diabetic woman, who was admitted in septic shock, signs of acute bilateral emphysematous pyelonephritis, and diabetic ketoacidosis. Both blood and urine cultures yielded Escherichia coli. The patient was successfully treated using longterm broad-spectrum antibiotics, diabetic control and supportive measures alone. Catheter drainage and nephrectomy were not necessary to overcome this life threatening situation.(AU)

Pielonefrite enfisematosa / Emphysematous pyelonephritis

Pielonefrite enfisematosa é uma infecção necrotizante renal, mais freqüentemente diagnosticada em diabéticos. A taxa de mortalidade é elevada. Relatamos um caso de pielonefrite enfisematosa bilateral em paciente diabética que se apresentou em insuficiência renal aguda e choque séptico, evoluindo para óbito após seis dias de tratamento conservador.

Emphysematous pyelonephritis is a necrotizing renal infection most frequently seen in patients with diabetes mellitus that is associated with a high mortality rate. We report a case of bilateral emphysematous pyelonephritis who presented with renal failure and septic shock. The patient died after six days of conservative therapy.

Infecções do trato urinário / Urinary tract infections

As infecções do trato urinário representam problema de grande relevância clínica, não só pela elevada frequência com que acometem mulheres e homens vivendo na comunidade, mas também por representar a primeira causa de infecção em pacientes hospitalizados. Na presente revisão, o autor apresenta os conceitos atuais sobre a epidemiologia, os fatores etiopatogênicos, as manifestações clínicas e os métodos de diagnóstico / Urinary tract infections have an extremely high clinical prevalence in both the community as well as in nosocomial patients. This behavior justifies the efforts that habe been made to disseminate the present knowledge on urinary tract infections to the members of most clinical specialities. In the present review the authors discuss and treatment of urinary tract infections, with emphasis on the practical clinical approach to such cases...

Tratamiento del reflujo vesico-ureteral primario en la infancia: comparación de dos revisiones sistemáticas / Primary vesicoureteral reflux treatment in chilhood: comparison of two systematic review

Muchas prácticas médicas se continúan realizando sin conocer su efectividad ni el impacto real que tienen en la salud de los pacientes, por lo tanto es necesario fundamentar las recomendaciones profesionales en la evidencia científica. Propósito principal: realizar una revisión sistemática (RS) sobre el manejo terapéutico del reflujo vésico-ureteral primario (RVUP) en urología pediátrica. Objetivos: 1. Definir un tratamiento ideal para cada grado de RVUP, 2. Aclarar incertidumbres sobre diversos aspectos no abordables mediante estudios aislados. Material y métodos: Se ha realizado una RS de los artículos aparecidos en todas las bases de datos disponibles, aplicando unos criterios de inclusión y exclusión de calidad mínima imprescindible. Resultados y discusión: Tras la lectura crítica de más de 320 artículos y el estudio estadístico correspondiente de los datos agrupados, según el tipo de tratamiento y beneficios aportados, así como sus efectos indeseables y comparado nuestras conclusiones con las aportadas por el trabajo recogido recientemente en The Chocrane Library, hemos alcanzado las siguientes conclusiones: El tratamiento médico y el quirúrgico presentan la misma efectividad en la resolución de los grados I, II y III de RVUP, recomendándose el primero de ellos como tratamiento inicial tras el diagnóstico. El manejo endoscópico es igual de efectivo que la cirugía abierta, con menores efectos secundarios, sin haber encontrado diferencias entre las distintas sustancias analizadas para la inyección. Para los reflujos de alto grado IV y V no existen evidencias suficientes que aconsejen o desaconsejen cualquiera de los tratamientos. El tratamiento quirúrgico abierto, para cualquier grado de RVU, sólo presenta superioridad con respecto al tratamiento médico en el número de episodios de pielonefritis aguda durante el seguimiento. Esta afirmación no es posible aplicarla para el tratamiento endoscópico (AU)

Many medical practices are being carried out unawares of their efficiency, or of their actual impact on the health of the patients, therefore it is necessary to consider the support of professional recommendations with scientific evidence. The primary objective: to perform a systematic review (SR) of the therapeutic management of primary VUR in pediatric urology. Material and Methods: A systematic review has been performed, including scientific evidence-based medicine criteria, of the articles published in all of the available databases. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles. Results and discussion: Subsequently, and following the critic reading of greater than 320 articles, statistical study of the grouped data was performed according to the type of treatment and to the benefits contributed by each treatment, and also to their undesirable effects. Finally we have made a comparison between our results and recent Cochrane Systematic Review. The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present with similar effectiveness concerning resolution of grades I, II and III of VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable effects secondary. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow up. This conclusion cannot be applied on endoscopic treatment (AU)

Síndrome de distrés respiratorio del adulto durante el embarazo / Adult respiratory distress syndrome in pregnancy

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