Abstract:
INTRODUCTION:In 1999, the American Academy of Pediatrics (AAP) recommended perform a renal ultrasonography and avoiding cystourethrography to all infants between 2 and 24 months of age after their first urinary tract infection (UTI). In 2011, the AAP restricted voiding cystourethrography to children with a pathological ultrasonography, recurrent and/ or atypical infections. Our objective was to compare, in patients with vesicoureteral reflux (VUR) and normal renal ultrasonography, the prevalence of a relevant pathology as if patients had been studied as per the 1999 guidelines (for first UTI) or the 2011 guidelines (for recurrent and/or atypical UTI). POPULATION AND METHODS:We conducted a retrospective analysis of patients with UTI, aged between 2 and 24 months old, seen at our department between January 2010 and August 2014 and who had a normal renal ultrasonography and VUR. A relevant pathology was defined as a finding of grade III VUR or higher and/or pathological renal scintigraphy. RESULTS:Forty-five patients (31 girls) were included and were grouped as if they had been treated as per the 1999 or 2011 guidelines. The prevalence of a relevant pathology among patients studied as per the 1999 guidelines (9 out of 24 cases, 3 with atypical UTI) or as per the 2011 guidelines (11 out of 21 cases) was similar (37.5% versus 52%, respectively; p= 0.31). Six patients (25%) with a relevant pathology diagnosed as per the 1999 guidelines would not have been identified in a timely manner with the 2011 version. CONCLUSIONS:The prevalence of a relevant pathology identified in children with VUR and normal renal ultrasonography was similar with both guidelines. However, considering the present guidelines, one out of four patients would have been exposed to a delayed or potentially missed diagnosis if recurrence would have been expected to complete the assessment. INTRODUCCIÓN:En 1999, la Academia Americana de Pediatría recomendó realizar una ecografía renal y una cistouretrografía miccional a todos los niños de entre 2 y 24 meses con un primer episodio de infección del tracto urinario (ITU). En 2011, limitó la cistouretrografía miccional a aquellos con ecografía patológic infecciones recurrentes y/o atípicas. Nuestro objetivo fue comparar, en pacientes con reflujo vesicoureteral (RVU) y ecografía renal normal, la prevalencia de patología relevante según hubieran sido estudiados con las guías de 1999 (en la primera ITU) o de 2011 (ante ITU recurrente y/o atípica). POBLACIÓN Y MÉTODOS:Estudiamos retrospectivamente pacientes con ITU de entre 2 y 24 meses atendidos entre enero de 2010 y agosto de 2014 con ecografía renal normal y RVU. Consideramos patología relevante al hallazgo de RVU > grado III y/o centellograma renal patológico. RESULTADOS:Incluimos 45 pacientes (31 niñas), que fueron agrupados según hubieran sido estudiados con las guías de 1999 o de 2011. La prevalencia de patología relevante entre los estudiados con las guías de 1999 (9 de 24 casos, 3 con ITU atípica) o de 2011 (11 de 21 casos) fue comparable (37,5% vs. 52%, respectivamente; p= 0,31). Seis pacientes (25%) con patología relevante diagnosticados con las guías de 1999 no se hubieran identificado oportunamente con las de 2011. CONCLUSIONES:La prevalencia de patología relevante identificada en niños con RVU y ecografía renal normal con ambas guías fue comparable. Sin embargo, con las guías actuales, uno de cada cuatro pacientes hubiera estado expuesto a la demora o eventual pérdida diagnóstica si se hubiera esperado la recurrencia para completar la evaluación.
journal_name
Arch Argent Pediatrjournal_title
Archivos argentinos de pediatriaauthors
Capone MA,Balestracci A,Toledo I,Martin SMdoi
10.5546/aap.2016.eng.129subject
Has Abstractpub_date
2016-04-01 00:00:00pages
129-34issue
2eissn
0325-0075issn
1668-3501journal_volume
114pub_type
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journal_title:Archivos argentinos de pediatria
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doi:10.5546/aap.2018.e688
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2020.eng.132
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journal_title:Archivos argentinos de pediatria
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2020.eng.418
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journal_title:Archivos argentinos de pediatria
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doi:10.5546/aap.2018.e139
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2018.e300
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2019.eng.164
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章,随机对照试验
doi:10.5546/aap.2016.eng.526
更新日期:2016-12-01 00:00:00
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doi:10.5546/aap.2020.e53
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2015.e88
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2014.e222
更新日期:2014-10-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2015.341
更新日期:2015-08-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2020.e300
更新日期:2020-06-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章,多中心研究
doi:10.5546/aap.2016.426
更新日期:2016-10-01 00:00:00
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pub_type: 杂志文章
doi:10.5546/aap.2020.358
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.1590/S0325-00752011000200012
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journal_title:Archivos argentinos de pediatria
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doi:10.1590/S0325-00752011000100007
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pub_type: 指南
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journal_title:Archivos argentinos de pediatria
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journal_title:Archivos argentinos de pediatria
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
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更新日期:2020-08-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
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更新日期:2019-04-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2017.e24
更新日期:2017-02-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2012.341
更新日期:2012-08-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2017.eng.148
更新日期:2017-04-01 00:00:00
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journal_title:Archivos argentinos de pediatria
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
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更新日期:2016-08-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.5546/aap.2018.eng.e442
更新日期:2018-06-01 00:00:00
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journal_title:Archivos argentinos de pediatria
pub_type: 杂志文章
doi:10.1590/S0325-00752011000200006
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