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Journal of the Korean Society of Pediatric Nephrology 2005;9(1): 56-63.
소아의 첫 발열성 요로감염에서 신 반흔에 영향을 미치는 인자
정석원, 정경훈, 김명현, 홍영진, 손병관, 이지은
1인하대학교 의과대학 소아과학교실
2인하대학교 의과대학 소아과학교실
3인하대학교 의과대학 소아과학교실
4인하대학교 의과대학 소아과학교실
5인하대학교 의과대학 소아과학교실
6인하대학교 의과대학 소아과학교실
Factors associated with Renal Scarring in Children with a First Episode of Febrile Urinary Tract Infection
Suk-Won Jung, Kyeong-Hun Jung, Myung-Hyun Kim, Young-Jin Hong, Byong-Kwan Son, Ji-Eun Lee
1Department of Pediatrics, College of medicine, inha University
2Department of Pediatrics, College of medicine, inha University
3Department of Pediatrics, College of medicine, inha University
4Department of Pediatrics, College of medicine, inha University
5Department of Pediatrics, College of medicine, inha University
6Department of Pediatrics, College of medicine, inha University
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ABSTRACT
Purpose : Development of renal scarring is associated with delayed diagnosis and treatment of urinary tract infection(UTI). This study was performed to clarify how soon treatment should be started to Inhibit renal scarring after onset of UTI and the factors associated with renal scarring in children with a first episode of febrile UTI.
Methods : We retrospectively reviewed 163 patients with a first episode of febrile UTI under the age of 2 years from April 2000 to Ap,il 2004. All patients had a DMSA renal scan and voiding cystourethrogram done in the diagnostic period, 6 months after which a follow-up renal scan was done. After patients wet-e divided into 2 groups according to the duration of fever prior to start of treatment, the duration of fever after start of treatment, and total duration of fever, initial and follow-up DMSA scan findings were analyzed among the different groups. We compared the factors associated with renal scars between the groups with and without renal scars.
Results : The initial DMSA renal scan identified abnormal finding in 23% of the patients who were treated $leq$24 hr from the onset of disease and in 43% of those with fever more than 24 hr. Renal scars developed in 33% of patients who were treated $leq$24 hr and 38% of those with fever >24 hr prior to treatment. Renal scars developed in 34% of patients with remission of fever $leq$48 hr after treatment and ill 50% of those with fever >48 hr after treatment. The risk for renal scars was significantly higher in children who had total duration of feyer >72 hr(67%) than in those with shorter duration(19%). In children with renal scars, VUR was most highly associated with an increased risk of renal scar formation.
Conclusion : Although children with a first episode of febrile UTI are treated within 24 hr after onset of the fever, renal damage cannot be prevented completely and it is mainly associated with VUR.
Key words: Duration of fever | Renal scar | urinary tract infection | Vesicoureteral reflux
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