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1.
Arch. argent. pediatr ; 118(1): e16-e21, 2020-02-00. tab
Artigo em Inglês, Espanhol | LILACS (Américas), BINACIS | ID: biblio-1095573

RESUMO

Introducción. El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU.Población y métodos. Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes.Resultados. Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05).Conclusiones. A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.


Introduction. The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.Population and methods. Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.Results. Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Urinárias/diagnóstico , Refluxo Vesicoureteral/diagnóstico , Sinais e Sintomas , Turquia/epidemiologia , Sistema Urinário/anormalidades , Infecções Urinárias/cirurgia , Refluxo Vesicoureteral/cirurgia , Estudos Retrospectivos , Dados Demográficos , Hidronefrose
4.
Rev. cuba. pediatr ; 87(1): 40-49, ene.-mar. 2015. ilus, tab
Artigo em Espanhol | LILACS (Américas), CUMED | ID: lil-740957

RESUMO

INTRODUCTION: renal and/or urinary pathway malformations are the frequent cause of chronic renal disease at pediatric ages worldwide. OBJECTIVE: to describe the alteration of the renal functioning in these patients, by age, at the time of diagnosis of renal and urinary pathway malformations. METHODS: a cross-sectional descriptive study of patients diagnosed with renal and urinary duct malformations was made in Villa Clara province from January 2012 through December 2013. RESULTS: forty patients were diagnosed at prenatal phase, 75 % of them were males; 85 were diagnosed after birth and 38 of them after one year of age, 60 % were girls. One hundred and twenty five renal units had reflux and 60 % of them located on the left kidney. It was observed that left kidney malformations prevailed, with 57 patients (45.6 %), but in 28 of patients, the renal damage was bilateral. CONCLUSIONS: vesicoureteral reflux, mainly on the left one, was the most diagnosed malformation; postnatal diagnosis predominated and although there was no difference in terms of sex, males prevailed in patients with prenatal diagnosis and females were the most diagnosed after birth. The left kidney was more frequently affected, but the renal damage was detected more often in bilateral condition.


INTRODUCCIÓN: las malformaciones renales y/o de vías urinarias constituyen una causa frecuente de enfermedad renal crónica en la edad pediátrica a nivel mundial. OBJETIVO: describir la afectación del funcionamiento renal que tenían estos pacientes, según la edad, al diagnóstico de las malformaciones renales y de vías urinarias. MÉTODOS: se realizó un estudio descriptivo, de corte transversal en Villa Clara, con pacientes con diagnóstico de malformaciones renales y de vías urinarias en el período comprendido desde enero de 2012 a diciembre de 2013. RESULTADOS: se diagnosticaron 40 pacientes en etapa prenatal, de ellos 75 % eran del sexo masculino, 85 después del nacimiento y de ellos 38 posterior al año de vida, el 60 % eran niñas; 125 unidades renales tenían reflujo, de los cuales el 60 % correspondía al izquierdo. Se apreció un predominio de las malformaciones en el riñón izquierdo, con 57 pacientes (45,6 %), pero 28 de los enfermos con daño renal tenían afectación bilateral. CONCLUSIONES: el reflujo vesicoureteral, fundamentalmente el izquierdo, fue la malformación más diagnosticada; predominó el diagnóstico posnatal, y aunque de manera general no hubo diferencia en cuanto al sexo, fue más frecuente el masculino en los pacientes con diagnóstico prenatal, y el femenino en los que se realizó el diagnóstico tras el nacimiento. El riñón izquierdo se afectó con mayor frecuencia, pero el daño renal fue más frecuente cuando la afectación fue bilateral.


Assuntos
Humanos , Criança , Pediatria/métodos , Diagnóstico Pré-Natal/métodos , Sistema Urinário/anormalidades , Técnicas e Procedimentos Diagnósticos , Insuficiência Renal Crônica/complicações , Rim/anormalidades , Epidemiologia Descritiva , Estudos Transversais
5.
Repert. med. cir ; 24(1): 27-34, 2015. Cuadros
Artigo em Espanhol | LILACS (Américas) | ID: lil-795693

RESUMO

La hematuria es un hallazgo clínico observado por el paciente o un familiar cuando es macroscópica o bien incidental en un parcial de orina rutinario. La prevalencia es baja pero el enfoque diagnóstico al cual está enfrentado el clínico es amplio. La hematuria indica enfermedad, lesión o malformación del tracto urinario, por ello el médico general y el pediatra deben estar en capacidad de determinar a tiempo algunas de las causas con pronóstico grave o diagnóstico complejo que requieren la remisión al nefrólogo pediatra. Se hace énfasis en diferenciar si es o no de origen glomerular, adoptando un algoritmo de enfoque diagnóstico que orienta al clínico. Se realizó una búsqueda limitada de 2001-2014 en las principales bases de datos en inglés y español encontrando revisiones de la literatura, consensos de expertos y guías de práctica clínica basadas en la opinión de pediatras, nefrólogos y urólogos pediatras, así como de radiólogos que ofrecen una aproximación real a la imagenología. Está dirigida a personal de la salud, médicos generales y pediatras quienes enfrentan a diario esta condición clínica...(AU)


Hematuria is a clinical finding observed by the patient or a relative if it is macroscopic, or is an incidental finding in a routine urinalysis. Prevalence rate is low but the range of differential diagnoses faced by the physician is broad. Hematuria indicates disease, lesion or malformation of the urinary tract, thus the general practitioner and the pediatrician must be capable to determine the etiologies that have a poor prognosis or are difficult to diagnose which require prompt referral to a pediatric nephrologist. We emphasize on the development of a diagnostic algorithm to help the physician distinguish glomerular from non-glomerular hematuria. A limited search from 2001-2014 was conducted in the major data bases in English and Spanish finding literature reviews, expert consensus and clinical practice guidelines based on the opinion of pediatricians, and pediatric nephrologists and urologists, as well as radiologists who offer a real approach to imaging. It is oriented toward health care providers, general practitioners and pediatricians who face this clinical condition in their daily practice...


Assuntos
Humanos , Hematúria , Zona Glomerulosa , Sistema Urinário/anormalidades
6.
Repert. med. cir ; 24(2): 113-122, 2015. tab
Artigo em Espanhol | LILACS (Américas) | ID: lil-795707

RESUMO

La infección de las vías urinarias es una patología frecuente en la edad infantil, por lo que el médico general, el pediatra y los involucrados en el diagnóstico y manejo del niño afectado están en la obligación de conocer las actualizaciones sobre el mecanismo fisiopatológico, métodos diagnósticos y tratamientos actuales. Se hace énfasis en la prevención, el uso racional de antibioticoterapia y los nuevos enfoques terapéuticos que se pueden ofrecer...


Urinary tract infection (UTI) is a common illness in children, thus the general practitioner, the pediatrician and those involved in the diagnosis and management of the affected child must keep updated on UTI physiopathology, diagnostic methods and current treatments. We emphasize on prevention, rational use of antibiotic therapy and new therapeutic approaches available...


Assuntos
Humanos , Sistema Urinário/anormalidades , Anormalidades Urogenitais , Pielonefrite , Sepse
8.
Rev. panam. salud pública ; 36(6): 376-382, dic. 2014. ilus, tab
Artigo em Inglês | LILACS (Américas) | ID: lil-742266

RESUMO

OBJECTIVE: To describe the distribution of pediatric chronic kidney disease (CKD) in Guatemala, estimate incidence and prevalence of pediatric end-stage renal disease (ESRD), and estimate time to progress to ESRD. METHODS: This study analyzed the registry of the only pediatric nephrology center in Guatemala, from 2004-2013. Incidence and prevalence were calculated for annual periods. Moran's index for spatial autocorrelation was used to determine significance of geographic distribution of incidence. Time to progress to ESRD and associated risk factors were calculated with multivariate Cox regression. RESULTS: Of 1 545 patients from birth to less than 20 years of age, 432 had chronic renal failure (CRF). Prevalence and incidence of ESRD were 4.9 and 4.6 per million age-related population, respectively. Incidence was higher for the Pacific coast and Guatemala City. The cause of CRF was undetermined in 43% of patients. Average time to progress to ESRD was 21.9 months; factors associated with progression were: older age, diagnosis of glomerulopathies, and advanced-stage CKD at consultation. CONCLUSIONS: Prevalence and incidence of ESRD in Guatemala are lower than in other countries. This may reflect poor access to diagnosis. Areas with higher incidence and large proportion of CKD of undetermined cause are compatible with other studies from the geographic subregion. Findings on progression to ESRD may reflect delayed referral.


OBJETIVO: Describir la distribución de enfermedad renal crónica en niños en Guatemala, y calcular la incidencia y la prevalencia de nefropatía terminal en niños, así como el tiempo de progresión hasta la nefropatía terminal. MÉTODOS: Este estudio analizó el registro del único centro de nefrología pediátrica de Guatemala, del 2004 al 2013. La incidencia y la prevalencia se calcularon por períodos anuales. Se utilizó el índice de Moran como medida de la autocorrelación espacial con objeto de determinar la significación de la distribución geográfica de la incidencia. El tiempo de progresión a la nefropatía terminal, así como los factores de riesgo asociados, se calcularon mediante la regresión de Cox de variables múltiples. RESULTADOS: De 1 545 pacientes menores de 20 años, 432 padecían insuficiencia renal crónica. La prevalencia y la incidencia de nefropatía terminal fueron de 4,9 y 4,6 por millón de habitantes de esa misma edad, respectivamente. La incidencia fue mayor en la costa del Pacífico y en la Ciudad de Guatemala. En 43% de los pacientes la causa de la insuficiencia renal crónica era indeterminada. El tiempo promedio de progresión a una nefropatía terminal fue de 21,9 meses; los factores asociados con esa progresión fueron: la edad mayor, el diagnóstico de glomerulopatía y la enfermedad renal crónica en etapa avanzada en el momento de la consulta. CONCLUSIONES: La prevalencia y la incidencia de la nefropatía terminal en Guatemala son inferiores a las de otros países. Ello podría reflejar un acceso limitado al diagnóstico. La mayor incidencia y la amplia proporción de enfermedad renal crónica de causa indeterminada en algunas zonas son compatibles con las de otros estudios de la subregión geográfica. Los resultados en cuanto a progresión a una nefropatía terminal podrían ser el reflejo de la tardanza en la derivación.


Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem , Insuficiência Renal Crônica/epidemiologia , Bases de Dados Factuais , Progressão da Doença , Guatemala/epidemiologia , Incidência , Falência Renal Crônica/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Insuficiência Renal Crônica/etiologia , Sistema Urinário/anormalidades
9.
Rev. cuba. pediatr ; 86(1): 77-85, abr.-jun. 2014.
Artigo em Espanhol | LILACS (Américas) | ID: lil-709195

RESUMO

Introducción: el ultrasonido diagnóstico prenatal realizado en los embarazos normales ha demostrado que por cada 500 embarazos debe aparecer una anomalía importante del tracto urinario. En diferentes situaciones puede sugerirse o recomendarse la interrupción del embarazo, que puede ser aceptado o rechazado por los padres. Objetivos: comparar el diagnóstico pre y posnatal, y valorar la evolución en 8 pacientes en los que se propuso la interrupción, pero el embarazo continuó. Resultados: en 6 de los fetos se propuso la interrupción por el diagnóstico de hidronefrosis bilateral; en uno, por quistes renales bilaterales, y en otro por hidronefrosis unilateral y displasia renal multiquística contralateral. En 2 recién nacidos hubo coincidencia total entre el diagnóstico prenatal y el posnatal, en uno con reflujo de alto grado se encontró ureterohidronefrosis bilateral en el estudio prenatal, mientras que en 2 solamente hidronefrosis; un paciente tiene megauréter bilateral no obstructivo, y otro pielectasia bilateral. En el feto que se plantearon los quistes renales bilaterales, el estudio posnatal mostró un doble sistema excretor derecho con el superior obstruido, y reflujo vesicoureteral grado III del inferior con riñón izquierdo normal. Durante el tiempo de seguimiento la conducta médica varió de acuerdo con el diagnóstico posnatal. Al concluir el período de seguimiento, un paciente tiene una enfermedad renal crónica etapa 3, y los 7 restantes tienen función renal conservada. Conclusiones: la indicación de interrupción del embarazo por el diagnóstico ultrasonográfico prenatal de una anomalía renal o de tracto urinario tiene un margen de error que es necesario seguir estudiando y buscar indicadores de alto riesgo vital, porque los factores predictivos no están bien precisados


Introduction: prenatal ultrasound diagnosis performed in normal pregnancies has shown that one significant urinary tract anomaly occurs per 500 pregnancies. Under different circumstances, termination of pregnancy may be suggested or recommended, which may be accepted or rejected by parents. Objectives: to compare the pre-and postnatal diagnoses, and to assess the progress in 8 patients who were recommended to terminate their pregnancies, but they rejected this idea. Results: in 6 cases, the termination of pregnancy was suggested on account of bilateral hydronephrosis diagnosis in their fetuses; in one case due to bilateral renal cysts diagnosis and in the other case due to unilateral hydronephrosis and contralateral multicystic renal dysplasia. There was full agreement between the prenatal and postnatal diagnoses in 2 newborns; in a neonate with high grade reflux, the prenatal study revealed bilateral ureterohydronephrosis whereas this study showed just hydronephrosis for other two fetuses. One patient has non-obstructive bilateral megaureter and the other presents bilateral pyelectasy. The fetus with bilateral renal cysts presented, according to the postnatal study, a double right excretory system, being the upper obstructed and the lower with grade III vesicoureteral reflux, but his left kidney was normal. In the follow-up period, the medical behavior varied according to the postnatal diagnoses. Upon finishing this period, one patient had phase III chronic renal disease and the other seven had preserved renal function. Conclusions: the indication of termination of pregnancy based on the prenatal ultrasonographic diagnosis of a renal or urinary tract anomaly has an error index that must be further studied, and it is necessary to look for high life risk indicators because the predictive factors are not well detailed


Assuntos
Humanos , Masculino , Feminino , Gravidez , Aborto , Cuidado Pós-Natal/métodos , Diagnóstico Pré-Natal/métodos , Sistema Urinário/anormalidades , Sistema Urinário , Ultrassonografia Pré-Natal/métodos , Evolução Clínica/métodos
10.
J. pediatr. (Rio J.) ; 90(1): 58-64, jan-feb/2014. tab
Artigo em Inglês | LILACS (Américas) | ID: lil-703628

RESUMO

OBJECTIVE: To determine the frequency of different phenotypes for congenital anomalies of the kidney and urinary tract (CAKUT) in a Brazilian sample, and to evaluate the association between the CAKUT phenotypes and the BMP4 gene. METHODS: In this study, 457 Brazilian individuals were analyzed in an attempt to establish the association between the BMP4 gene and the CAKUT diagnosis. A case-control sample was genotyped for three BMP4 gene polymorphisms. RESULTS: Association data was established with CAKUT sample as a whole and with the three most important CAKUT phenotypes: multicystic dysplastic kidney disease (MDK), ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR). When the sample was segregated in these three phenotypes, associations between the BMP4 gene were observed with UPJO and with MDK. Conversely, VUR was not associated to the polymorphisms of the BMP4 gene. CONCLUSIONS: The present data suggest that Brazilian individuals with polymorphisms of the BMP4 gene have a higher risk to develop CAKUT, especially the malformations related to nephrogenesis and initial branching such as MDK and UPJO. Conversely, VUR appeared not to be related to BMP4 gene. .


OBJETIVO: Determinar a frequência de diferentes fenótipos de anomalias congênitas do rim e trato urinário (CAKUT) em uma amostra brasileira e avaliar a associação entre os CAKUT e o gene BMP-4. MÉTODOS: Neste estudo, analisamos 457 indivíduos brasileiros em uma tentativa de estabelecera associação entre o gene BMP-4 e o diagnóstico de CAKUT. As amostras de caso e de controle foram genotipadas em busca de três polimorfismos do gene BMP-4. RESULTADOS: Os dados de associação foram estabelecidos com a amostra de CAKUT como um todo e com os três fenótipos de CAKUT mais importantes: rim displásico multicístico (RDM), obstrução da junção ureteropélvica (UPJO) e refluxo vesico-ureteral (VUR). Quando a amostra foi separada nesses três fenótipos, encontramos associações entre o gene BMP-4 com UPJO e com RDM. Por outro lado, o VUR não foi associado aos polimorfismos do gene BMP-4. CONCLUSÕES: Esses dados sugerem que os indivíduos brasileiros com polimorfismos do gene BMP-4 apresentam maior risco de desenvolver CAKUT, principalmente as malformações relacionadas a nefrogênese e ramificação inicial, como RDM e UPJO. Por outro lado, o VUR parece não estar relacionado ao gene BMP-4. .


Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , /genética , Rim/anormalidades , Sistema Urinário/anormalidades , Refluxo Vesicoureteral/genética , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos de Associação Genética , Marcadores Genéticos , Rim Displásico Multicístico/epidemiologia , Rim Displásico Multicístico/genética , Estudos Prospectivos , Amostragem , Obstrução Ureteral/epidemiologia , Obstrução Ureteral/genética , Refluxo Vesicoureteral/epidemiologia
11.
Urology Annals. 2014; 6 (1): 36-40
em Inglês | IMEMR (Mediterrâneo Oriental) | ID: emr-141855

RESUMO

To study the prevalence, pattern of distribution, and the outcome of different types of kidney and urinary tract anomalies [CAKUT] diagnosed during the antenatal period. The second objective is to test the accuracy of antenatal diagnosis of CAKUT. In a cross-sectional hospital-based study, all cases diagnosed antenatally with urinary tract anomalies at King Abdulaziz University Hospital [KAUH], Jeddah, Kingdom of Saudi Arabia, were studied. The prevalence, pattern of distribution, and immediate postnatal outcomes, in addition to the accuracy of antenatal diagnosis, of those cases are reported. One hundred and forty-one cases of urinary tract anomalies were antenatally diagnosed; postnatal diagnosis was confirmed in 128 cases [90.1%]. The prevalence of CAKUT in our population is 3.26 per 1000 births. The most common abnormalities detected were hydronephrosis, polycystic kidney disease, multicystic dysplastic kidney, and renal agenesis, in descending order of frequency. The perinatal mortality rate among fetuses with CAKUT is 310 per 1000, the majority of these cases [90%] occurred in cases with renal parenchyma involvement. The prevalence of different types of CAKUT is higher than that reported in developed countries. Urinary tract anomalies can be accurately diagnosed and classified in the antenatal period using ultrasonography imaging. Antenatal diagnosis is a helpful tool in planning immediate postnatal care and deciding the place for delivery. This might prevent or slow renal function deterioration and help in early identification of patients who need early surgical intervention


Assuntos
Humanos , Sistema Urinário/anormalidades , Diagnóstico Pré-Natal , Gravidez , Doenças Fetais , Prevalência , Estudos Transversais , Anormalidades Congênitas , Hidronefrose/congênito , Rim Displásico Multicístico , /congênito
12.
Saudi Medical Journal. 2014; 35 (10): 1264-1266
em Inglês | IMEMR (Mediterrâneo Oriental) | ID: emr-148901

RESUMO

To describe 8 cases of renal artery stenosis [RAS] in children with congenital anomalies of the renal tract. We conducted a retrospective chart review of 78 children with RAS who were followed up at Great Ormond Street Hospital, London, United Kingdom between 2003 and 2012. We used an interventional radiology database to identify all patients who had RAS confirmed by digital subtraction angiography and examined all cases of congenital anomaly of the renal tract that had been diagnosed during childhood. We documented the following renal anomalies: multicystic dysplastic kidney [n=2], renal hypoplasia [n=1], congenital solitary kidney with hydronephrosis [n=1], and unilateral vesicoureteric reflux with poorly functioning kidneys [n=2]. The anomaly was unknown in 2 cases. Seven children had unilateral nephrectomy at a median age of 2.5 years [range, 0.4-10 years] for various urological abnormalities. All children were confirmed to have RAS after presentation with hypertension at a median age of 10 [3.5-16.2] years. Angioplasty was performed in 7 children, of which 6 achieved control of their blood pressure on reduced medications. We highlight the association between RAS and other renal anomalies, which indicates that they could share a common genetic background


Assuntos
Humanos , Masculino , Feminino , Constrição Patológica/diagnóstico , Refluxo Vesicoureteral , Rim , Sistema Urinário/patologia , Rim/anormalidades , Sistema Urinário/anormalidades
13.
Rev. cuba. pediatr ; 85(2): 180-191, abr.-jun. 2013.
Artigo em Espanhol | LILACS (Américas) | ID: lil-678130

RESUMO

Objetivo: verificar si existe asociación entre tipo de microorganismo aislado en recién nacidos que inician una infección del tracto urinario y la presencia de anomalías del tracto urinario. Métodos: estudio observacional, prospectivo, desde 1992 hasta 2010, de una cohorte de 427 recién nacidos que ingresaron con la primera infección del tracto urinario, de localización alta, por criterios clínicos, y que se realizaron ultrasonido renal y uretrocistografía miccional. Se analizó la asociación entre la presencia de reflujo vésico-ureteral y otras anomalías del tracto urinario, con el tipo de microorganismo causal de la infección del tracto urinario. Resultados: los aislamientos bacterianos en los urocultivos correspondieron en 402 de los pacientes a microorganismos del género Enterobacteriaceae (94,1 por ciento), liderados por la E. coli en 276 (64,6 por ciento). La prevalencia de anomalías del tracto urinario resultó ser de 23,6 x 100. El problema más prevalente fue el reflujo vésico-ureteral, presente en 82 pacientes (19,2 x 100). Se comprobó que la presencia de reflujo vésico-ureteral tuvo asociación de riesgo estadísticamente significativa con el microorganismo causal diferente a E. coli (RR: 1,56; p< 0,05). De igual manera, se relacionó la presencia de reflujo vésico-ureteral o de otro tipo de anomalía del tracto urinario, con el microorganismo causal de la infección del tracto urinario, y los resultados del análisis fueron similares (RR:1,64; p< 0,01). Conclusiones: aunque la E. coli es el microorganismo causal más frecuente de la infección del tracto urinario neonatal, cuando se obtiene un aislamiento diferente a E. coli es muy probable que el paciente sea portador de una anomalía del tracto urinario, dado que la presencia de reflujo vésico-ureteral y otras anomalías del tracto urinario se asocian significativamente a aquellos diferentes a E. coli


Objective: to confirm whether the type of microorganism isolated in newborns with initial urinary tract infection and the anomalies of the urinary tract are associated or not. Methods: prospective and observational study of a cohort of 427 newborns, who were admitted to the hospital with their first urinary infection in the upper tract based on clinical criteria, and they underwent renal ultrasound and urethrocystography. The relationship between the vesicourethral reflux and other anomalies of the urinary tract with the type of causative microorganism of the urinary tract infection was analyzed. Results: bacterial isolates in uricultures were Enterobacteriaceae genus microorganisms in 402 patients (94.1 percent), led by E. coli in 276 (64.6 percent ). The prevalence of anomalies of the urinary tract was 23.6 x 100. The most prevalent problem was vesicourethral reflux found in 82 patients (19.2 x 100). It was confirmed that the presence of vesicourethral reflux had statistically significant association, in terms of risk, with causative microorganism other than E.coli (RR: 1.56; p< 0.05). Similarly, the presence of vesicourethral reflux or of other type of anomalies in the urinary tract was related to the causative microorganism of the urinary tract infection and the results of the analysis were similar (RR:1.64; p< 0.01). Conclusions: although E.coli is the most frequent causative microorganism of the neonatal urinary tract infection, when an isolate different from E. coli is obtained, it is very likely that the patient carries some anomaly of the urinary tract since the presence of the vesicourethral reflux and other anomalies of the urinary tract are significantly associated to microorganisms other than E.coli


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Doenças Urológicas/complicações , Doenças Urológicas , Sistema Urinário/anormalidades , Sistema Urinário/microbiologia , Infecções por Escherichia coli/etiologia , Estudos Observacionais como Assunto , Estudos Prospectivos
14.
Radiol. bras ; 46(1): 43-50, jan.-fev. 2013. ilus
Artigo em Português | LILACS (Américas) | ID: lil-666114

RESUMO

Congenital upper urinary tract abnormalities imply a variable clinical spectrum of morphofunctional changes ranging from asymptomatic conditions to renal failure and incompatibility with life. Computed tomography, which has overcome excretory urography imaging, has been playing a key role in the diagnosis of congenital anomalies, serving as a better guidance in the therapeutic and surgical decision-making process, besides acting as an essential tool in the identification of associated complications and aiding in the performance of minimally invasive surgery techniques.


As anomalias congênitas do trato urinário superior implicam modificações morfofuncionais com espectro clínico variável, desde manifestações assintomáticas até falência renal e incompatibilidade com a vida. A tomografia computadorizada, além de ter superado o método de imagem da urografia excretora, tem desempenhado papel fundamental no diagnóstico das anomalias congênitas, orientando melhor nas decisões terapêuticas clínicas e cirúrgicas, além de atuar como ferramenta essencial na identificação de complicações associadas e no melhor desempenho de técnicas operatórias menos invasivas.


Assuntos
Humanos , Anormalidades Congênitas/diagnóstico , Tomografia Computadorizada Multidetectores , Sistema Urinário/anatomia & histologia , Sistema Urinário/anormalidades
15.
Acta cir. bras ; 28(supl.1): 33-36, 2013. ilus
Artigo em Inglês | LILACS (Américas) | ID: lil-663889

RESUMO

PURPOSE: Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS: 116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS: In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION: Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.


OBJETIVO: Com a ampla utilização dos exames ultrassonográficos na avaliação pré-natal, é frequente o diagnóstico da hidronefrose fetal. A definição de obstrução do trato urinário no periodo pós-natal necessita da confirmação de redução da função renal além da hidronefrose. Neste estudo, acompanhamos uma série de pacientes consecutivos com hidronefrose intra-útero que persistiu no periodo pós-natal. MÉTODOS: 116 recém-nascidos com hidronefrose pré-natal diagnosticada pela ultrassonografia foram submetidos a protocolo específico de avaliação e companhados pelo periodo de 06 anos. RESULTADOS: Em 46 (38,8%) dos 116 pacientes foi confirmado o diagnóstico de estenose da junção ureteropiélica (JUP). Conforme os resultados do protocolo aplicado a correção cirúrgica da estenose da JUP foi realizada em 19 pacientes. Das 26 crianças encaminhadas inicialmente para observação clínica, apenas 6 (23%) necessitaram cirurgia durante o seguimento ambulatorial. Na análise geral, o procedimento cirúrgico para correção da estenose da JUP foi indicado em 25 pacientes. Nas outras 20 crianças não houve necessidade da realização da cirurgia. CONCLUSÃO: a hidronefrose fetal requer cuidadosa avaliação pós-natal. A estenose da junção pielo-ureteral é a anomalia mais frequente como causa da hidronefrose, e sua correção cirúrgica tem indicações precisas. O protocolo aplicado foi útil em diferenciar pacientes que não necessitaram cirurgia para tratamento da estenose da JUP.


Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Hidronefrose/etiologia , Obstrução Ureteral/complicações , Hidronefrose , Hidronefrose/terapia , Hidronefrose , Estudos Prospectivos , Ultrassonografia Pré-Natal , Obstrução Ureteral , Obstrução Ureteral/cirurgia , Obstrução Ureteral , Sistema Urinário/anormalidades , Sistema Urinário , Sistema Urinário
16.
RMJ-Rawal Medical Journal. 2013; 38 (1): 44-47
em Inglês | IMEMR (Mediterrâneo Oriental) | ID: emr-146853

RESUMO

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound


Assuntos
Humanos , Masculino , Feminino , Doenças Urológicas/diagnóstico por imagem , Doenças Urológicas/diagnóstico por imagem , Cálculos Urinários/diagnóstico , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/diagnóstico por imagem , Sistema Urinário/anormalidades , Sistema Urinário/diagnóstico por imagem , Sistema Urinário/diagnóstico por imagem , Urografia , Estudos Transversais
17.
J. bras. nefrol ; 34(4): 395-400, out.-dez. 2012.
Artigo em Português | LILACS (Américas) | ID: lil-660555

RESUMO

Avanços recentes no diagnóstico pré-natal têm permitido o aprimoramento da detecção e o manejo das anormalidades do trato urinário. A ultrassonografia pré-natal permite o reconhecimento de anormalidades urológicas que somente seriam identificadas tardiamente, após o aparecimento de sintomas ou complicações. A uretrocistografia miccional pode ser reservada para casos selecionados. Exames de medicina nuclear devem ser realizados em casos de hidronefrose moderada e grave. O estudo consistiu de uma revisão da literatura atual sobre a abordagem pós-natal da hidronefrose fetal. Os dados obtidos foram confrontados com a experiência da Unidade de Nefrologia Pediátrica do HC/UFMG na conduta e no seguimento de crianças com diagnóstico de uropatias detectadas na investigação de hidronefrose fetal.


Recent advances in prenatal diagnosis resulted in an improvement of detection and management of urinary tract abnormalities. Prenatal ultrasonography allows to identify urological abnormalities that otherwise would not be seen until later in life, when complications occur. The voiding cystourethrogram can be reserved for selected patients. Nuclear medicine exams should be performed in cases of moderate and severe hydronephrosis. A review of the current literature on postnatal approach of prenatal hydronephrosis was performed. Data obtained were compared with the records of the Pediatric Nephrology Unit HC/UFMG regarding management and follow-up of children with uropathies detected while investigating for fetal hydronephrosis.


Assuntos
Humanos , Recém-Nascido , Doenças Fetais , Hidronefrose/complicações , Hidronefrose , Ultrassonografia Pré-Natal , Sistema Urinário/anormalidades , Anormalidades Congênitas/diagnóstico , Diagnóstico por Imagem
18.
Int. braz. j. urol ; 38(2): 235-241, Mar.-Apr. 2012. ilus, tab
Artigo em Inglês | LILACS (Américas) | ID: lil-623338

RESUMO

PURPOSE: Duplex system is one of the most common anomalies of upper urinary tract. Anatomical and clinical presentation determine its treatment. Usually, the upper moiety has a poor function and requires resection, but when it is not significantly impaired, preservation is recommended. Laparoscopic reconstruction with upper pole preservation is presented as an alternative treatment. MATERIALS AND METHODS: Four female patients with duplex system, one presenting with recurrent urinary tract infection and the others with urinary incontinence associated to infrasphincteric ectopic ureter, were treated. Surgical procedure envolved a laparoscopic ureteropyeloanastomosis of the upper pole ureter to the pelvis of the lower moiety, with prior insertion of a double J stent. RESULTS: Surgical time varied from 120 to 150 minutes, with minimal blood loss in all cases. Follow-up varied from 15 to 30 months, with resolution of the clinical symptoms and preservation of the upper moiety function. CONCLUSION: Laparoscopic ureteropyeloanatomosis is a feasible and safe minimally invasive option in the treatment of duplex system.


Assuntos
Adolescente , Criança , Feminino , Humanos , Adulto Jovem , Rim/anormalidades , Laparoscopia/métodos , Ureter , Sistema Urinário/anormalidades , Rim/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Duração da Cirurgia , Resultado do Tratamento , Ureter/anormalidades , Ureter/cirurgia , Infecções Urinárias/terapia , Sistema Urinário/cirurgia , Refluxo Vesicoureteral/cirurgia
19.
Rev. chil. pediatr ; 82(6): 512-519, dic. 2011. ilus
Artigo em Espanhol | LILACS (Américas) | ID: lil-612184

RESUMO

Introduction: Congenital abnormalities of the Urinary Tract are frequent and prevalence has increased since the introduction of routine prenatal sonogram. Objectives: To determine the prevalence rate of congenital urinary malformations at birth at Hospital Clínico de la Universidad de Chile. These data will be compared to other Chilean hospitals participating in ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas - Latin American Collaborative Study of Congenital Malformations). A longitudinal study will serve to evaluate if significant variation has occurred, and risk factors will be investigated. Patients and Methods: All births occurring between January, 1998 and December, 2010 were included. Prevalence rate of urinary malformations were calculated, and compared to those obtained in previous years. Statistical analysis of proportions was calculated through mean and average comparison was made through Student t test. Results: Urinary anomalies appeared at a rate of 64.5 per 10.000 births. This represents a significant increase from previous studies. Highest risk factor seemed to be "other family members with disease". Most frequent anomaly was Hydroureteronphrosis (24,2 percent) followed by Hypospadias (17 percent). The rate of these malformations in ECLAMC participating Chilean hospitales was 23.37/10.000 births. Conclusion: A significant increase in the diagnosis of these anomalies was shown, being the most important risk factor the presence of family members with similar congenital disorders.


Introducción: Las anomalías congénitas del Aparato Urinario son frecuentes y ha aumentado su prevalencia al nacimiento con la introducción rutinaria del estudio prenatal por ultrasonografía. Objetivos: Determinar la Tasa de prevalencia al nacimiento de las malformaciones urinarias en el Hospital Clínico de la Universidad de Chile. Compararlas con las del resto de los hospitales chilenos que participan en el ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas). Estudiarlas a lo largo del tiempo para ver si han tenido variaciones significativas. Investigar factores de riesgo que pueden influir en la aparición de ellas. Pacientes y Método: Se estudió todos los nacimientos ocurridos entre Enero de 1998 y Diciembre de 2010 en el Hospital Clínico de la Universidad de Chile. Se calculó las tasas de prevalencia al nacimiento de las malformaciones urinarias y se las comparó con las obtenidas en períodos anteriores. El análisis estadístico de comparación de proporciones se realizó mediante la prueba de c² y las comparaciones entre promedios se hicieron mediante prueba t de Student. Resultados: La tasa de Anomalías urinarias fue 64,5 por 10 000 nacimientos. Ellas aumentaron significativamente al compararlas con los períodos estudiados anteriormente. El factor de riesgo más influyente fue "otros malformados en la familia". La anomalía más frecuente fue Hidroureteronefrosis (24,2 por ciento) seguida por Hipospadias (17 por ciento). La tasa de estas malformaciones en los hospitales chilenos participantes del ECLAMC fue 23,37/10 000 nacimientos. Conclusión: Se demuestra un incremento significativo del diagnóstico de estas anomalías, siendo el factor de riesgo más importante el antecedente de otros malformados en la familia.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Doenças Urológicas/congênito , Doenças Urológicas/epidemiologia , Anormalidades Congênitas/epidemiologia , Chile/epidemiologia , Doenças Renais Policísticas/congênito , Doenças Renais Policísticas/epidemiologia , Falência Renal Crônica/congênito , Falência Renal Crônica/epidemiologia , Hidronefrose/congênito , Hidronefrose/epidemiologia , Hipospadia/epidemiologia , Prevalência , Fatores de Risco , Sistema Urinário/anormalidades
20.
New Iraqi Journal of Medicine [The]. 2011; 7 (2): 9-16
em Inglês | IMEMR (Mediterrâneo Oriental) | ID: emr-129832

RESUMO

Urinary tract infections [UTI] are among the most common infections in children. UTI related morbidity remains high despite the use of numerous effective antibacterial agents. The aim of this study was to determine how many patients had underlying urological abnormalities, the specific type of abnormality, and the microorganism causing the UTI in the patients with or without urological anomalies. The sample of this study was conducted in the pediatric surgery unit at The maternity and Children Teaching Hospital, Al-Qadisiya, Iraq and from the 1[st] of august 2005 to the end of July 2008, all the patients presenting with UTI to the outpatient clinic or to the surgical ward were investigated prospectively. There were 78 [70.9%] girls and 32 [29%] boys, 19 [17.2%] were between 0-1 year, 68 [61.8%] were at an age between 1-5 years, and 23 [20.9%] were more than 5 years of age. Forty seven [42.7%] of these patients had abnormal urological findings. Of 78 girls, 31 [39.7%] had urological abnormalities. Sixteen children had VUR as an only abnormality. The distribution of abnormalities showed some changes by age and sex. Bacteriuria [>10[5] bacteria per milliliter of urine] was found in 44 [40%] of patients. The most common bacterial agent of urinary infections was E. coli [61.3%] of total isolates in both sexes; it was the most common pathogen among all patients [those with urological abnormalities and those without]. There was no difference in the distribution of microorganisms in patients with and without urological anomalies. The diagnosis of UTI in young children is important as it is a marker for urinary tract abnormalities. A child with a suspected UTI should have a urine culture and colony count performed in order to identify organisms for confirmation of diagnosis and recommend prompt treatment to reduce UTI related morbidity and mortality in children


Assuntos
Humanos , Feminino , Masculino , Lactente , Pré-Escolar , Criança , Infecções Urinárias/etiologia , Actinobacteria , Sistema Urinário/anormalidades , Escherichia coli , Estudos Prospectivos
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