ABSTRACT
OBJETIVO: Analizar el manejo del urinoma prenatal y de la estenosis de la unión pieloureteral postnatalmente mediante el estudio de un caso y revisión bibliográfica. MÉTODOS: Se presenta el caso de neonato con EUPU y urinoma. Se comprueba función renal anulada, realizándose nefrectomía. Se ha revisado la literatura desde 1985 hasta la actualidad. DISCUSIÓN: Analizando la literatura, se observa mayoritariamente que el tratamiento de la EUPU y urinoma prenatales es conservador. Tras el nacimiento existen diversas actitudes, independientemente de la función renal remanente, como son la cirugía radical, la reconstructiva o el tratamiento conservador. CONCLUSIONES: La manipulación intraútero no está indicada sistemáticamente. La derivación urinaria sólo en casos sintomáticos y los secundarios a traumatismo o manipulación endoscópica. En riñones anulados estaría indicada la nefrectomía (AU)
OBJECTIVE: To analyze the management of prenatal urinoma and Ureteropelvic Junction Obstruction (UPJO) postnatally by a case report and literature review. METHODS: We report a case of an UPJO and urinoma in a newborn. After birth, renal function was absent, and nephrectomy was performed. The literature from 1985 to date has been reviewed. DISCUSSION: By the analysis of the literature, we can observe mainly, that prenatally diagnosed urinoma and UPJO are managed conservatively. After birth, different attitudes have been carried out, independently of residual renal function, such as radical or reconstructive surgery, or conservative treatment. CONCLUSION: Intrauterine management is not indicated. Urinary diversion is indicated in symptomatic cases secondary to renal trauma or endoscopic procedure. In non-functional kidney, nephrectomy is indicated (AU)
Subject(s)
Humans , Male , Infant, Newborn , Urinoma/etiology , Urethral Stricture/complications , Ureteral Obstruction/complications , Pyelocystitis/complications , Urinary DiversionABSTRACT
OBJECTIVES: The American Academy of Pediatrics recommendation for febrile infants and young children suspected of having a urinary tract infection is early antibiotic treatment, given parenterally if necessary. In support of this recommendation, data suggesting that delay in treatment of acute pyelonephritis increases the risk of kidney damage are cited. Because the risk was not well defined, we investigated renal scarring associated with delayed versus early treatment of acute pyelonephritis in children. METHODS: The research findings are derived from 2 multicenter, prospective, randomized, controlled studies, Italian Renal Infection Study 1 and 2, whose primary outcomes dealt with initial antibiotic treatment and subsequent prophylaxis, respectively. From the 2 studies, we selected the 287 children with confirmed pyelonephritis on acute technetium-99m-dimercaptosuccinic acid scans who underwent repeat scanning to detect scarring 12 months later. The children were 1 month to <7 years of age when they presented with their first recognized episode of acute pyelonephritis in northeast Italy. RESULTS: Progressive delay in antibiotic treatment of acute pyelonephritis from <1 to >/=5 days after the onset of fever was not associated with any significant increase in the risk of scarring on technetium-99m-dimercaptosuccinic acid scans obtained 1 year later. The risk of scarring remained relatively constant at 30.7 +/- 7%. Clinical and laboratory indices of inflammation were comparable in all groups, as was the incidence of vesicoureteric reflux. CONCLUSIONS: Early treatment of acute pyelonephritis in infants and young children had no significant effect on the incidence of subsequent renal scarring. Furthermore, there was no significant difference in the rate of scarring after acute pyelonephritis when infants and young children were compared with older children.
