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3.
J Urol ; 204(3): 572-577, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32243241

RESUMO

PURPOSE: The vesicoureteral reflux index is a simple, validated tool for predicting resolution of reflux. Along with likelihood of spontaneous resolution identification of children at risk for febrile urinary tract infection impacts management. We evaluated the usefulness of the vesicoureteral reflux index as a predictive factor for breakthrough febrile urinary tract infection compared to reflux grade and distal ureteral diameter ratio. MATERIALS AND METHODS: Children with primary vesicoureteral reflux and detailed voiding cystourethrogram data were identified. A 1 to 6-point index was assigned, and ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 to L3 vertebral bodies. Random forest modeling and logistic multivariable regression were employed to estimate the predictive ability of grade, ureteral diameter ratio and vesicoureteral reflux index with regard to breakthrough febrile urinary tract infection. RESULTS: We analyzed 94 girls and 45 boys with a mean±SD age of 5.4±4.7 months at diagnosis. Mean±SD length of followup was 32.1±24.5 months. A total of 13 children (9.4%) experienced breakthrough febrile urinary tract infection. On univariate analysis ureteral diameter ratio (p=0.01) and vesicoureteral reflux index (p=0.0005) were associated with breakthrough urinary tract infection, while grade (p=0.09) did not reach significance. Area under the curve was generated as a measure of accuracy for each variable and was 0.77 for the vesicoureteral reflux index, 0.71 for ureteral diameter ratio and 0.68 for grade, indicating superiority of the vesicoureteral reflux index for predicting breakthrough febrile urinary tract infection. CONCLUSIONS: Children with higher vesicoureteral reflux index are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. The vesicoureteral reflux index provides valuable prognostic information about infection risk, facilitating improved clinical decision making.


Assuntos
Ureter/patologia , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações , Doença Aguda , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Masculino , Valor Preditivo dos Testes , Fatores de Risco
4.
J Korean Med Sci ; 35(10): e65, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32174064

RESUMO

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL), a bacteriostatic agent, is known to inhibit erythropoiesis leading to anemia. We aimed to investigate the associations of NGAL, anemia, and renal scarring in children with febrile urinary tract infections (UTIs). METHODS: We retrospectively reviewed the medical records of 261 children with febrile UTIs. The relationship between the presence of anemia and plasma NGAL levels was investigated. NGAL performance in comparison with serum C-reactive protein (CRP) at admission and after 72 hours of treatment was also evaluated for the prediction of renal scarring as well as acute pyelonephritis (APN) and vesicoureteral reflux (VUR). RESULTS: Plasma NGAL levels were elevated in patients with anemia compared with those without anemia. Multiple linear regression analysis showed an inverse relationship between NGAL levels and erythrocyte counts (standard ß = -0.397, P < 0.001). Increased NGAL, but not CRP, was independently associated with the presence of anemia (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.07-5.27; P < 0.05). Receiver operating curve analyses showed good diagnostic profiles of pre- and post-treatment NGAL for identifying APN, VUR, and renal scarring (all P < 0.05). For detecting renal scars, the area under the curve of post-treatment NGAL (0.730; 95% CI, 0.591-0.843) was higher than that of post-treatment CRP (0.520; 95% CI, 0.395-0.643; P < 0.05). The presence of anemia and elevated NGAL at admission (> 150 ng/mL) were independent risk factors for renal scarring in children with febrile UTIs. With anemia, NGAL levels increased consecutively in children with febrile UTI without renal involvement, with APN without scar, and with APN with renal scarring. CONCLUSION: Increased plasma NGAL levels may be associated with the presence of anemia and renal scarring in children with febrile UTIs.


Assuntos
Anemia/complicações , Lipocalina-2/sangue , Infecções Urinárias/complicações , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Feminino , Febre , Humanos , Rim/patologia , Masculino , Razão de Chances , Pielonefrite/complicações , Refluxo Vesicoureteral/complicações
7.
Urologe A ; 59(3): 255-260, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32077973

RESUMO

In infants and children, the strategy of antibacterial long-term infection prophylaxis is more widely used in the protection against urinary tract infections (UTIs) than for hardly any other indication. Development of resistance, side effects of chemotherapeutic agents and acceptance problems require an intensive search for alternatives in the prophylaxis of UTIs. In this context, substances such as D­mannose, probiotics and herbal preparations are gaining increasing attention, whereby the effectiveness of which, especially in children, still needs proof through therapy studies. This also applies to approaches to vaccine prevention. However, prophylaxis must not be limited to the prescription of medicines. Equally important are the treatment of bladder dysfunction and constipation as well as the elimination of other predisposing factors. There are alternatives to antibiotic prophylaxis for UTIs. However, in cases with a high risk of recurrence and pyelonephritis, it is still currently the better alternative.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Pielonefrite/tratamento farmacológico , Pielonefrite/prevenção & controle , Infecções Urinárias/tratamento farmacológico , Criança , Humanos , Lactente , Prevenção Primária/métodos , Refluxo Vesicoureteral/complicações
8.
Clin Pediatr (Phila) ; 59(3): 259-265, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31888378

RESUMO

It is a common practice to monitor blood tests in patients receiving long-term trimethoprim-sulfamethoxazole (TMP-SMZ) prophylaxis for recurrent urinary tract infections. This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2 to 71 months with vesicoureteral reflux diagnosed after symptomatic urinary tract infection. Study participants received TMP-SMZ (n = 302) or placebo (n = 305) and were followed for 2 years. Serum electrolytes (n ≥ 370), creatinine (n = 310), and complete blood counts (n ≥ 206) were measured at study entry and at the 24-month study conclusion. We found no significant electrolyte, renal, or hematologic abnormalities when comparing the treatment and placebo groups. We observed changes in several laboratory parameters in both treatment and placebo groups as would normally be expected with physiologic maturation. Changes were within the normal range for age. Long-term use of TMP-SMX had no treatment effect on complete blood count, serum electrolytes, or creatinine. Our findings do not support routine monitoring of these laboratory tests in children receiving long-term TMP-SMZ prophylaxis.


Assuntos
Anti-Infecciosos Urinários/efeitos adversos , Biomarcadores/sangue , Monitoramento de Medicamentos/métodos , Prevenção Secundária/métodos , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/complicações , Anti-Infecciosos Urinários/uso terapêutico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/sangue , Infecções Urinárias/diagnóstico , Infecções Urinárias/etiologia
9.
J Pediatr ; 216: 73-81.e1, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31402140

RESUMO

OBJECTIVE: To estimate the cost-effectiveness of routine, screening renal bladder ultrasound (RBUS) for children age 2-24 months after a first febrile urinary tract infection (UTI), as recommended by the American Academy of Pediatrics. STUDY DESIGN: We developed a decision analytic model that simulates a population of children after a first febrile UTI. The model incorporates the diagnostic utility of RBUS to detect vesicoureteral reflux and genitourinary anomalies. We adopted a health-system perspective, 5-year horizon, and included 1-way and 2-way sensitivity analyses. Costs were inflated to 2018 US dollars, and our model incorporated a 3% discounting rate. We compared routine RBUS after first, febrile UTI compared with routine RBUS after second UTI (ie, control arm). Our main outcomes were recurrent UTI rate and incremental cost per quality-adjusted life-year (QALY). RESULTS: Among children 2-24 months after a first febrile UTI, RBUS had an overall accuracy (true positives + true negatives) of 64.4%. The recurrent UTI rate in the intervention arm was 19.9% compared with 21.0% in the control arm. Thus, 91 patients would need to be screened with RBUS to prevent 1 recurrent UTI. RBUS increases QALYs by +0.0002 per patient screened, corresponding to an incremental cost-effectiveness ratio of $803 000/QALY gained. In the RBUS arm, 20.6% of children would receive unnecessary voiding cystourethrograms compared with 12.2% of children in the control group. CONCLUSIONS: Screening RBUS after a first, febrile UTI in children age 2-24 months does not meet cost-effectiveness guidelines. Our findings support deferred screening until a second UTI.


Assuntos
Ultrassonografia/economia , Infecções Urinárias/diagnóstico por imagem , Estudos de Casos e Controles , Pré-Escolar , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Humanos , Lactente , Rim/diagnóstico por imagem , Valor Preditivo dos Testes , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/diagnóstico
10.
Transplantation ; 104(1): 137-144, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30946218

RESUMO

BACKGROUND: Improved management of growth impairment might have resulted in less growth retardation after pediatric kidney transplantation (KT) over time. We aimed to analyze recent longitudinal growth data after KT in comparison to previous eras, its determinants, and the association with transplant outcome in a large cohort of transplanted children using data from the European Society for Paediatric Nephrology/European Renal Association and European Dialysis and Transplant Association Registry. METHODS: A total of 3492 patients transplanted before 18 years from 1990 to 2012 were included. Height SD scores (SDS) were calculated using recent national or European growth charts. We used generalized equation models to estimate the prevalence of growth deficit and linear mixed models to calculate adjusted mean height SDS. RESULTS: Mean adjusted height post-KT was -1.77 SDS. Height SDS was within normal range in 55%, whereas 28% showed moderate, and 17% severe growth deficit. Girls were significantly shorter than boys, but catch-up growth by 5 years post-KT was observed in both boys and girls. Children <6 years were shortest at KT and showed the greatest increase in height, whereas there was no catch-up growth in children transplanted >12. CONCLUSIONS: Catch-up growth post-KT remains limited, height SDS did not improve over time, resulting in short stature in nearly half of transplanted children in Europe.


Assuntos
Estatura/fisiologia , Transtornos do Crescimento/epidemiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Anormalidades Urogenitais/cirurgia , Refluxo Vesicoureteral/cirurgia , Adolescente , Fatores Etários , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Recém-Nascido , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/etiologia , Estudos Longitudinais , Masculino , Sistema de Registros/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento , Anormalidades Urogenitais/complicações , Refluxo Vesicoureteral/complicações
11.
Urology ; 136: 225-230, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31758980

RESUMO

OBJECTIVE: To determine pediatric urologists' antibiotic prophylaxis prescribing practices for children with vesicoureteral reflux (VUR) and other congenital anomalies of the kidney and urinary tract (CAKUT). METHODS: Web-based survey of pediatric urologists about their practice of antibiotic prophylaxis in children with CAKUT. RESULTS: We had a response rate of 17.8% (n = 73). The majority of respondents always or often prescribe prophylactic antibiotics for grade IV or V VUR, while greater variability was seen for lower grades of VUR. 47.9% of respondents report that they often or always prescribe antibiotics for patients with grade 4 hydronephrosis, and most respondents report that they never or rarely prescribe antibiotics for grade 1 or 2 hydronephrosis. The majority of respondents never or rarely prescribe antibiotics for horseshoe or solitary kidney (88% and 86%, respectively), but frequently prescribed antibiotic for ureterocele. For ectopic ureter, almost half of respondents prescribe prophylactic antibiotics always or often, whereas only 18% prescribe antibiotics always or often for duplication anomalies. Only 11% reported prescribing antibiotics for prophylaxis always or often for children with myelomeningocele. CONCLUSION: We report notable variability in antibiotic prescribing patterns for children with CAKUT. Given the lack of guidelines around the use of prophylaxis in the majority of these conditions, standardization of care may be warranted to decrease this variability.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Prescrições de Medicamentos/estatística & dados numéricos , Pediatria , Padrões de Prática Médica , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Anormalidades Urogenitais/complicações , Urologia , Refluxo Vesicoureteral/complicações , Criança , Pesquisas sobre Serviços de Saúde , Humanos
12.
J Pediatr Urol ; 15(6): 668-671, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31564587

RESUMO

In this edition of Mythbusters we critically examine the premise that, because women with history of vesicoureteric reflux (VUR) are at higher risk of urinary tract infection (UTI) and other morbidity during pregnancy, persistent VUR in older girls should be considered an indication for surgical correction. The literature is very limited in that there are essentially no methodologically robust comparisons of pregnancy outcomes among women whose childhood VUR was or was not surgically repaired. Most of the case series and cohorts find relatively high incidence of UTI and pyelonephritis among pregnant women with a history of VUR, but there is very little to suggest that persistent VUR is itself a risk factor for infection during pregnancy. Indeed, some studies suggest that UTI risk is actually higher among women who previously underwent anti-reflux surgery compared to those who did not, although these data are compromised by significant selection bias. In contrast, there is relatively strong evidence that maternal and fetal morbidity is higher when the mother is known to have renal scarring; such women probably merit close surveillance during pregnancy for infection, hypertension and pre-eclampsia, and other problems. Overall, current evidence is insufficient to support routine anti-reflux surgery in girls with the sole purpose of decreasing complications during future pregnancy, particularly for girls with lower-grades of VUR and no renal scarring. The verdict for this urolegend: it contains a a "teeny, tiny nugget of truth."


Assuntos
Complicações na Gravidez/prevenção & controle , Procedimentos Cirúrgicos Urológicos/métodos , Refluxo Vesicoureteral/cirurgia , Feminino , Saúde Global , Humanos , Incidência , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Estudos Retrospectivos , Fatores de Risco , Refluxo Vesicoureteral/complicações , Adulto Jovem
13.
Turk J Pediatr ; 61(1): 71-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31559724

RESUMO

Gültekin ND, Benzer M, Tekin-Neijmann S. Is there any relation between connective tissue growth factor and scar tissue in vesicoureteral reflux. Turk J Pediatr 2019; 61: 71-78. Vesicoureteral reflux (VUR) is the most common uropathy in childhood which leads to increased frequency of urinary tract infection (UTI) and renal scarring. Connective tissue growth factor (CTGF) plays an important role in the development of glomerular and tubulointerstitial fibrosis in progressive kidney diseases. The aim of this study was to investigate the relation between urinary CTGF and renal damage resulted from VUR. This cross sectional study included 70 patients with VUR and 62 healthy sex and age matched children. Urinary creatinine and CTGF (uCTGF) concentrations were analysed in all cases and CTGF to creatinine ratio were calculated. The records of radiologic evaluations of the patients including ultrasound, voiding cystouretrography and 99m-technetium dimercaptosuccinic acid (DMSA) scintigraphy were obtained retrospectively. The patient group was further divided into two groups according to the existence of renal cortical scarring in the DMSA scan. The study consisted of three groups; Group 1 (control group) 62 children, Group 2 (VUR positive, scar negative) 24 patient, Group 3 (VUR positive, scar positive) 46 patient (VUR+scar). The medians of uCTGF and uCTGF to creatinine ratio of the three groups were significantly different (p < 0.001). Pairwise group comparisons revealed that Group 1 had significantly lower uCTGF level and uCTGF/creatinine ratio, as compared to Groups 2 and 3 (p < 0.001 and p=0.002, respectively). There was no statistically significant difference between Groups 2 and 3 (p=0.052). uCTGF is significantly increased in children with VUR, independent on the presence of renal scarring. Increased uCTGF, even in the absence of the renal scarring, could be interpreted as development and a progression of glomerular and tubulointerstitial fibrosis in vesicoureteral reflux. Further experimental and clinical investigations are required to fully elucidate the mechanism of CTGF in vesicoureteral reflux.


Assuntos
Cicatriz/diagnóstico por imagem , Fator de Crescimento do Tecido Conjuntivo/urina , Córtex Renal/diagnóstico por imagem , Refluxo Vesicoureteral/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Creatinina/urina , Estudos Transversais , Feminino , Humanos , Masculino , Cintilografia , Estudos Retrospectivos , Urografia
14.
Cir Cir ; 87(S1): 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501627

RESUMO

Due the shortage of organ donors and the increase in the waiting list of kidney transplant recipients (KTR), alternative strategies have been considered with the aim of increasing the number of organs available. The use of kidneys from donors with acute renal failure and elevated serum creatinine has been considered as a way to increase the number of donors. The objective of this work is to report the 3-year follow-up of three KTR patients of a deceased donor with serum creatinine greater than or equal to 5 mg/dL.


Assuntos
Lesão Renal Aguda/sangue , Creatinina/sangue , Transplante de Rim , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/normas , Adulto , Cadáver , Carcinoma de Células Renais/cirurgia , Nefropatias Diabéticas/complicações , Feminino , Seguimentos , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/fisiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Neoplasias Renais/cirurgia , Masculino , Nefrectomia , Reoperação , Transplantes/fisiologia , Resultado do Tratamento , Refluxo Vesicoureteral/complicações , Adulto Jovem
15.
Pediatr Nephrol ; 34(11): 2409-2415, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31309282

RESUMO

BACKGROUND: Congenital anomalies of the kidney and urinary tract (CAKUT) are a leading cause of end-stage kidney failure in the young. However, there is limited information on long-term outcomes after kidney transplantation in this group. We explored the outcomes of kidney transplant in patients with the 3 most common severe forms of CAKUT: posterior urethral valves (PUV), reflux nephropathy and renal hypoplasia/dysplasia. METHODS: Data were extracted from the Australian & New Zealand Dialysis & Transplant Registry on first kidney transplants performed between 1985 and 2015 in recipients with a primary diagnosis of PUV, renal hypoplasia/dysplasia or reflux nephropathy (under the age of 30 years). Using multivariate Cox regression, we compared death-censored graft survival between the three groups. RESULTS: One hundred twenty-seven patients with PUV, 245 with hypoplasia/dysplasia and 727 with reflux nephropathy were included. A 10-year graft survival in PUV, hypoplasia/dysplasia and reflux nephropathy was 70%, 76% and 70%, respectively and a 20-year graft survival was 30%, 53% and 49%. After adjusting for age at transplant, graft source and HLA matching, there was evidence for poorer graft survival in PUV (HR, 1.65; 95% CI, 1.15 to 2.38). CONCLUSIONS: Graft survival of the first transplant in CAKUT is favourable at 10 years; however, recipients with PUV have increased risk of graft loss beyond a 10-year post-transplant, which may be related to bladder dysfunction.


Assuntos
Sobrevivência de Enxerto , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Anormalidades Urogenitais/cirurgia , Refluxo Vesicoureteral/cirurgia , Adolescente , Adulto , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Falência Renal Crônica/etiologia , Transplante de Rim/efeitos adversos , Masculino , Nova Zelândia/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Anormalidades Urogenitais/complicações , Refluxo Vesicoureteral/complicações , Adulto Jovem
16.
Investig Clin Urol ; 60(4): 295-302, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31294139

RESUMO

Purpose: We aimed to determine the impact of de novo vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. Materials and Methods: We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding de novo VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function. Results: Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). De novo VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes. Conclusions: After endoscopic ureterocele puncture, de novo VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct de novo VUR after endoscopic puncture of the ureterocele.


Assuntos
Nefropatias/etiologia , Complicações Pós-Operatórias/etiologia , Ureterocele/complicações , Ureterocele/cirurgia , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/complicações , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Nefropatias/fisiopatologia , Masculino , Punções/métodos , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia , Uretra , Procedimentos Cirúrgicos Urológicos/métodos
17.
J Pediatr Urol ; 15(4): 387.e1-387.e8, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31182400

RESUMO

BACKGROUND: Continuous antimicrobial prophylaxis (prophylaxis) is associated with a reduction in recurrent urinary tract infections in children with vesicoureteral reflux. However, adherence to daily medications has been shown to be poor. OBJECTIVE: To determine patient/caregiver factors associated with non-adherence and to determine whether adherence alters the effect of prophylaxis on recurrent UTIs and renal scarring. STUDY DESIGN: We conducted a secondary analysis of the Randomized Intervention for Children with Vesicoureteral Reflux trial. We stratified adherence scores into quartiles to assess trends within the data. We assessed predictors of non-adherence using ordinal logistic regression. We then examined the efficacy of prophylaxis stratified by adherence quartiles. RESULTS: Six hundred patients were included in the analysis. The quartiles of adherence were as follows: 1st quartile-0-70% adherence; 2nd quartile-71-91% adherence; 3rd quartile-92-96% adherence; and 4th quartile->96% adherence. Neither demographic factors nor disease severity was associated with non-adherence. In the subanalysis of patients who were toilet trained at baseline, increasing bladder and bowel dysfunction (BBD) symptom score was associated with non-adherence (adjusted odds ratio, aOR = 1.1, 95% confidence interval [CI] 1.0-1.2). Patients least adherent were 2.5 times more likely (95%CI 1.1-5.6) to have a recurrent UTI compared with patients most adherent. After controlling for treatment arm, age, sex, degree of reflux, BBD, and number of UTIs, patients least adherent (taking the study medication less than <70% of the time) were at highest risk for renal scarring (aOR = 24.2, 95%CI 3.0-197). In contrast, among the most adherent quartile, the probability of renal scarring was highest in those assigned prophylaxis (16.2% compared with 1.7% in those most adherent to placebo). CONCLUSIONS: Adherence is distinctly related to clinical outcomes in children with VUR. Non-adherence is common and represents a distinct clinical entity that is associated with renal scarring. Adherence should be assessed in prophylaxis management algorithms.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Adesão à Medicação/estatística & dados numéricos , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/complicações , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Incidência , Modelos Logísticos , Estudos Longitudinais , Masculino , Análise Multivariada , Recidiva , Medição de Risco , Resultado do Tratamento , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/diagnóstico
18.
Saudi J Kidney Dis Transpl ; 30(3): 706-709, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249237

RESUMO

Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. The diagnosis of these cases is frequently delayed because the clinical manifestations are generic and not different from the typical triad of upper UTI, which include fever, flank pain, and pyuria. A middle-aged female with DM and chronic kidney disease stage IV was admitted with recurrent UTI with extended-spectrum beta-lactamase-producing Escherichia coli. At presentation, she was afebrile, clinically stable, had no flank pain and there was no leukocytosis. Laboratory test for C- reactive protein done twice and was only mildly elevated at 7 and 11 mg/dL. A computed tomography scan of kidney-ureter-bladder (CT-KUB) was recommended and reported as "no KUB stone but small atrophic left kidney with dilatation of the pelvicalycial system and ureter and the presence of air in the collecting system suggestive of EP." Thus, commonly associated with DM, especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Air in the kidney is not always due to EPN. UTI with a gas-producing organism can ascend to the kidney in the presence of vesicoureteral reflux.


Assuntos
Complicações do Diabetes/mortalidade , Enfisema/microbiologia , Infecções por Escherichia coli/microbiologia , Pielite/microbiologia , Infecções Urinárias/microbiologia , Refluxo Vesicoureteral/complicações , Doenças Assintomáticas , Complicações do Diabetes/diagnóstico , Enfisema/diagnóstico por imagem , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Pielite/diagnóstico por imagem , Recidiva , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Refluxo Vesicoureteral/diagnóstico
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