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역류성 신병증에 대한 임상적 고찰 |
구본상 , 이준수 , 김병길 |
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Abstract |
Reflux nephropathy is defined as renal scarring associated with vesicoureteral reflux, and consists of calyceal clubbing or deformity with overlying corticomedullary scarring. Reflux nephropathy is the inclusive term Bailey introduced in 1973 for the various clinical and pathological entities that appear to be consequent to the renal injury sustained when urine flows retrograde into the ducts of Bellini-intrarenal reflux. As vesicoureteral reflux progresses, renal scarring change can occur. The damage of the kidney may progress to end stage renal disease in reflux nephropathy. So, early detection and proper treatment are important to prevent renal damage. We studied 62 children with vesicoureteral reflux admitted at Young Dong Severance Hospital from April, 1983 to Decemher, 1991. Intravenous pyelography, voiding cystourethrography and DMSA scan were performed in all patients with vesicoureteral reflux. Reflux nephropathy was seen in 24 children. 1) Vesicoureteral refiux was seen in 51 children among 472 patients with urinary tract infection and the incidence was 10.8%. Vesicoureteral refiux was seen in 11 children without urinary tract infection. 2) In general, there was no significant difference in incidence by sex and age but under 1 year of age, male infants predominate, and from 1 to 5 years of age, female children predominate. 3) Chief complaints on admission were fever, urinary frequency, dysuria in frequency. 4) Bilateral vesicoureteral reflux was seen in 29 children among 62 patients, so there was 91 refluxing ureters and renal units. There was no significant difference in incidence by both sides. 5) 44 (48.4%) of 91 refluxing ureters and renal units revealed the renal scarring. 6) The prevalence of renal scarring was related to the severity of vesicoureteral reflux. 7) Treatment was tried medically in 39 patients and surgically 22 patients, respectively. Amoung 39 patients, treated medically, 22 were improved, 17 were aggravated. Amoung 39 patients, treated surgically, including 17 patients of medically treated failure, all refluxes were stopped. |
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