Korean Journal of Nephrology 1986;5(1):61-68.
소아의 방광요관 역류에 대한 임상적 고찰
김병길 , 김흥동 , 최승강 , 오기근
Abstract
As vesicoureteral reflux(VUR) progresses, renal scarring change can occur. The damage of the kidney may progress to end stage renal disease in reflux nephropathy. So, the treatment against reflux is very important, but the approaches on the treatment are still different by many authors. We studied 107 children with urinary tract infection(UTI) admitted at Young Dong Severance Hospital from April, 1983 to January, 1986. Intravenous pyelography(IVP) were performed in boys with 1st episode of UTI and girls with 1st recurrence of UTI. Voiding cystourethrography (VCUG) were performed in children with abnormal findings on IVP and persistent pyuria of frequent recurrence despite of normal IVP. Vesicoureteral reflux was seen in 20 children- 9 boys and 11 girls. Under 1 year of age, male infants predominate, but from 1 to 6 years of age, female children predominate. After that age, sex ratio was nearly equal. Both sides of ureters were equally affected in general, and bilaterality was seen in 8 children. Fever, dysuria and urinary frequency were com- monly associated in VUR, as the findings of general UTI patients. In 9 patients, one or more previous UTI episodes were noticed. Primary causes of VUR were present in 3 cases. All cases of grade IV and V VUR except 1 case who discharged against advice, and 3 cases of grade g VUR, were treated by surgical procedures. The others were treated medically except 1 case combined with ureteropelvic junctional stenosis, who received surgical treatment, ureteroneocystos- tomy was done in 10 cases, and suprapubic cystos- tomy was done in the others. The follow up IVP and VCUG during the period of 3 months to 18 months, was done in 5 cases treated with ureteroneocystostomy, 2 cases treated with suprapubic cystostomy and 3 cases received medical therapy. In cases treated with suprapubic cystostomy, refluxes continued but further renal damages were not found. And, all other cases had no more re- fluxes in follow up radiologic studies. We strongly suggest the aggressive approach to find out urinary tract abnormalities in UTI children.
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