• Childhood Kidney Diseases
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• 제25권2호
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• pp.133-139
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• 2021

Herein, we report two rare cases of renal infection. The first case was renal subcapsular urine reflux in a 8-month-old girl with recurrent urinary tract infection and the second was subcapsular abscess in a 14-year-old girl with diabetes, who was successfully treated with percutaneous drainage. It has been suggested that renal subcapsular abscesses could be caused by the direct reflux of urine into the subcapsular space, rather than spread of infection from an existing parenchymal lesion, and that complete recovery can be achieved if percutaneous drainage is performed in a timely manner. We propose primary subcapsular reflux, in which urine directly refluxes upwards into the subcapsular space of the kidney, as one of the mechanisms for development of renal subcapsular abscesses.

• Clinical and Experimental Pediatrics
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• 제55권10호
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• pp.367-370
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• 2012

Urinary tract infection (UTI) is a common bacterial illness in children. Acute pyelonephritis in children may lead to renal scarring with the risk of later hypertension, preeclampsia during pregnancy, proteinuria, and renal insufficiency. Until now, vesicoureteral reflux (VUR) has been considered the most important risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. However, reflux nephropathy is not always acquired; rather, it reflects reflux-associated congenital dysplastic kidneys. The viewpoint that chronic kidney disease results from renal maldevelopment-associated VUR has led to questioning the utility of any regimen directed at identifying or treating VUR. Despite the recognition that underlying renal anomalies may be the cause of renal scarring that was previously attributed to infection, the prevention of renal scarring remains the goal of all therapies for childhood UTI. Therefore, children at high risk of renal scar formation after UTI should be treated and investigated until a large clinical study and basic research give us more information.

• Journal of Medicine and Life Science
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• 제19권2호
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• pp.66-69
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• 2022

Patients with vesicoureteral reflux (VUR), the retrograde flow of urine from the bladder to the kidney, are known to experience renal scarring; this results in the worsening of renal function. Reflux nephropathy is a cause of chronic kidney disease, and VUR has also been observed in dialysis patients. VUR is a major underlying precursor condition of urinary tract infection (UTI) and is sometimes accompanied by hydronephrosis. However, there are no guidelines for the management of UTI due to VUR-associated hydronephrosis in patients with end-stage kidney disease. Herein, we report a case of UTI caused by VUR-associated hydronephrosis in a dialysis patient treated with percutaneous nephrostomy.

• Childhood Kidney Diseases
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• 제26권2호
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• pp.111-115
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• 2022

Kleefstra syndrome is a rare genetic disease characterized by mental retardation, hypotonia, and a characteristic facial appearance. Furthermore, in some cases, Kleefstra syndrome is associated with various anorectal and genitourinary complications, including imperforated anus, vesicoureteral reflux, hydronephrosis, and chronic kidney disease. Herein, we present a case of Kleefstra syndrome with recurrent urinary tractinfections associated with vesicoureteral reflux and rectourethral fistula, which was treated by a multidisciplinary approach.

• Clinical and Experimental Pediatrics
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• 제56권4호
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• pp.145-150
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• 2013

Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

• Childhood Kidney Diseases
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• 제3권1호
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• pp.72-79
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• 1999

서 론 : 방광요관역류로 인한 신조직의 손상은 소아에서 말기신부전 및 신성 고혈압의 중요한 원인중 하나이며 방광요관역류에 의한 신장변화는 조기에 발견될 경우 그 예방이 가능하다. 현재까지는 주로 반복적이며 항생제 치료에 잘 조절되지 않는 요로감염에서 방광요관역류를 의심하고 진단을 위한 방사선학적 진단법을 시행하였으나, 단발성의 요로감염 환아에서도 역류가 진행되어있는 경우를 경험하게 되므로, 요로감염이 있는 환아에서 방광요관역류를 조기에 의심할 수 있는 진단방법이 요구되고 있다. 본 연구에서는 요로감염이 있는 환아를 대상으로하여 방광요관역류가 있는 군과 방광요관역류가 없는 군에서 뇨중 ${\beta}_2$-microglobulin(${\beta}_2$-MG)을 측정하여 의미있는 차이가 있는지를 알아보고 그 차이가 요로감염이 진행중인 환아에서 방광요관역류의 존재의 지표로 이용될 수 있는지 여부를 확인하고자 하였다. 대상 및 방법 : 요로감염으로 처음 내원하여 치료를 시작하였던 57명의 환아를 대상으로 하였으며, 전례에서 방사선학적인 검사(복부초음파, DMSA scan 및 VCUG)를 시행하여, 단순 요로감염환아군과 요로감염이 있으면서 방광요관역류가 발견되었던 환아군으로 구분하였고, 각 군간의 무작위 추출 뇨중 ${\beta}_2$-MG치와 뇨중 creatinine치의 비율로 그 배설율을 비교하였다. 대상환아중 신독성 약물을 사용하였던 환아 및 ${\beta}_2$-MG의 생성 및 배출에 영향을 미칠 수 있는 질환을 앓고있는 환아는 본 연구에서 제외하였다. 결 과 : 전체 대상환아 57명중 남녀비는 28:29였고 평균연령은 $4.27{\pm}4.24$세 였다 요로감염이 배양검사상 확진된 례가 44례 였고, 임상적으로 요로감염이 의심되었던 례가 13례 였으며 배양된 균주는 E.coli($43.9\%$)와 Enterococcus($15.8\%$)가 가장 많았다. 방광요관역류는 12례($21.1\%$)에서 발견되었으며 평균연령은 $2.97{\pm}2.82$세로 단순 요로감염 환아군의 평균연령 $4.62{\pm}4.51$세에 비하여 낮은 경향을 보였고, 남녀비는 3:1로 남아가 많았다. 무작위 추출뇨중 평균 ${\beta}_2$-MG치는 단순 요로감염군 $0.19{\pm}0.16mg/dL$, 방광요관역류군 $2.2{\pm}5/91,g/dL$로 두군간에 의미있는 차이를 보였으며(P=0.03), ${\beta}_2$-MG/creatinine비는 단순 요로감염군은 $3.93{\pm}3.44$, 방광요관역류동반군은 $32.41{\pm}25.7$로 두군간에 의미있는 차이를 나타내었다(P=0.007). 두군간의 배양된 균주 및 균배양 양성율과 혈청 크레아틴치의 의미있는 차이는 없었다. 결 론 : 요로감염환자에서 무작위 추출뇨중 ${\beta}_2$-MG치와 배설율은 방광요관역류의 존재를 조기에 의심할 수 있게하는 검사법이며, 기존의 24시간뇨를 이용하여 측정하는 방법보다 간편하고 비용이 저렴하여 방광요관역류의 검색진단법으로서 유용하리라 생각되며 소아 고혈압과 말기신부전의 원인 질환중 많은 부분을 차지하고 있는 방광뇨관역류의 조기진단 및 조기치료로 그 이행율을 감소시키는데 많은 기여를 할 수 있을 것으로 기대된다.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.121-123
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• 2019

Urinary tract infection is common in the pediatric population. The most common causative agents are bacteria, among which Escherichia coli is the most frequent uropathogen. Although fungal urinary tract infection is rare in the healthy pediatric population, it is relatively common among hospitalized patients. Fungus may be isolated from the urine of immunocompromised patients or that of patients with indwelling catheters. The most common cause of funguria is Candida albicans. Although more than 50% of Candida isolates belong to non-albicans Candida, the prevalence of non-albicans candiduria is increasing. Herein, we report a case of community-acquired candiduria in a 4-month-old immunocompetent male infant who had bilateral vesicoureteral reflux and was administered antibiotic prophylaxis. He was diagnosed with urinary tract infection caused by Candida lusitaniae and was managed with fluconazole.

• Childhood Kidney Diseases
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• 제22권2호
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• pp.71-74
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• 2018

Endoscopic subureteral injection for treatment of vesicoureteral reflux (VUR) is known to be safe and efficient due to its minimal invasive nature. Being non-migratory, non-antigenic, and biocompatible, Macroplastique (Polydimethylsiloxane) is likely to be stable over time. A 5-year-old boy with a past history of subureteral administration of Macroplastique for unilateral Grade V VUR 4 years ago presented with recurrent gross and microscopic hematuria, along with suprapubic pain. On computed tomography (CT) abdomen, calcified material, suspected to be a stone, was visualized in the bladder. On diagnostic cystoscopy, calcification was seen around the orifice site where Macroplastique injection had been performed. We removed the calcific material by Holmium laser. Endoscopic subureteric implantation has several advantages, but nevertheless, vigilance is needed to detect long-term complications, especially in patients with gross or microscopic hematuria.

• Childhood Kidney Diseases
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• 제26권1호
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• pp.46-51
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• 2022

Purpose: Delta neutrophil index (DNI) indicates immature granulocytes in peripheral blood and has been confirmed to be effective as a prognostic factor for neonatal sepsis. Also, it has been reported to have diagnostic value in acute pyelonephritis and in predicting vesicoureteral reflux (VUR) in the infant. We conducted the study to verify whether DNI is also helpful in the entire pediatric age group with febrile urinary tract infection (UTI). Methods: Medical records of children hospitalized for febrile UTIs were analyzed retrospectively. All subjects underwent kidney ultrasound and voiding cystourethrography. In the group with and without VUR, we compared sex and age, and the following laboratory values: the white blood cell count, neutrophil, polymorphonuclear leucocyte, eosinophil, hemoglobin, platelet count, C-reactive protein, DNI value, and the finding of ultrasound. Results: A total of 315 patients (163 males and 152 females; range, 0-127 months) were eligible, and 41 patients (13%) had VUR. As a result of univariate analysis, the white blood cell count, neutrophil, DNI, and ultrasonic abnormalities were high in the reflux group, and the hemoglobin and lymphocyte fraction values were low. The value of DNI and the abnormal ultrasound were significantly higher in the reflux group on the multivariate analysis. The area under the curve value of the receiver operating curve was higher in DNI (0.640; 95% confidence interval, 0.536-0.744; P=0.004), and the DNI cutoff value for VUR prediction was 1.85%. Conclusions: We identified that ultrasound findings and DNI values were helpful predictors of VUR in pediatric febrile UTIs.

• Childhood Kidney Diseases
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• 제2권2호
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• pp.169-177
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• 1998

목 적 : 중복요관은 전체 인구의 약 $0.8\%$에 이르는 비교적 발생 빈도가 높은 기형의 하나로 최근에는 산전 초음파를 통해 발견되기도 하지만, 혈뇨나 복통, 요로감염의 증상으로 진단되어지며, 다른 비뇨기 계통의 기형을 동반하는 경우가 있다. 저자들은 중복요관 환아들을 대상으로 진단의 단서가 되었던 임상양상과 동반 질환 여부 및 치료 등에 대하여 알아보고자 하였다. 방 법 : 18세 미만의 61례의 중복요관 환아를 대상으로 후향적 고찰을 시행하였다. 결 과 : 61명의 전체환아의 진단당시의 평균연령은 5.6세였고, 추적관찰의 평균기간은 3년 7개월이었으며, 여아가 42명이었고 남아가 19명으로 남녀 비는 1:2.2였다. 양측 중복요관 환아는 16명($26.2\%$), 완전 중복요관 환아는 24명($39.3\%$)이었다. 산전 초음파상 이상소견으로 발견된 경우가 8례($13\%$)있었고, 요로감염을 단서로 진단되었던 경우가 19례($31.1\%$)로 가장 많았다. 동반질환은 비뇨기 계통이 아닌 기형이나 질환이 11례($18\%$)있었고, 50명($82\%$)은 중복요관 이외의 비뇨기계 다른 질환을 동반하였다. 편측 중복요관환아 45명의 경우 좌측이 23명($51.1\%$)이었고, 이들중 21명($46.7\%$)이 완전 중복요관으로 진단되었다. 전체환아중 비뇨기계의 문제를 동반하여 수술을 받았던 환아는 37명($60.6\%$)이었고, 이 중 방광 요관역류를 동반한 예가 27명($44.3\%$)으로 가장 많았다. 결 론 : 중복요관 환아의 $60.6\%$가 수술을 요하는 비뇨기계의 다른 질환들을 동반하였으며, 특히 요로감염이 선행하는 경우가 많다는 것을 알 수 있었다. 비뇨기계증상 없이 산전진찰이나 우연히 발견되었던 경우가 전체 대상 환아의 $42.6\%$를 차지하므로, 따라서 산전초음파에서 비뇨기계의 비정상적인 소견이 발견되었거나 요로감염, 혈뇨, 복통 등의 증상이 있는 소아들은 반드시 방사선학적 검사를 통하여 중복요관 및 다른 기형이 동반되는지를 확인하여 조기진단 및 적절한 치료를 시행하고, 복부초음파, 배설성 방광요도조영술, 소변 배양검사 등의 주기적인 추적관찰로 향후 발생할수 있는 합병증을 예방할 수 있을 것으로 생각된다.