Vezikoüretral reflüsü olan hastaların izlem ve sonuçları
Yükleniyor...
Dosyalar
Tarih
2013
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Zamanında tanısı konmayan ya da yeterli tedavi uygulanmayan ülkemiz çocuklarında en sık kronik böbrek yetmezliği nedeni olan vezikoüreteral reflü tanılı hastaların tanı, tedavi ve izlem sonuçlarının belirlenmesini amaçladığımız bu çalı?mada, Nisan 2005-Ağustos 2011 tarihleri arasında Anabilim Dalımız Çocuk Nefrolojisi?ne başvuran olgular retrospektif olarak incelenmiştir. Vezikoüreteral reflü, idrar yolu enfeksiyonu ve renal skar ilişkisi, konservatif tedaviyle vezikoüreteral reflünün gösterdiği gidiş, vezikoüreteral reflünün cerrahi tedavisine alınan yanıt, komplikasyonlar, büyüme gelişme araştırılmıştır. Çalışma için 125 vezikoüreteral reflü tanılı hasta retrospektif olarak değerlendirildi. Hastaların tümünün vezikoüreteral reflü tanısı miksiyo sistoüretrografi ile konuldu. vezikoüreteral reflü tanısı konulan bu hastaların yaş ortalamaları, cinsiyet dağılımları, vezikoüreteral reflü dağılımları, VURşun tek ya da çift taraflı olduğu, vezikoüreteral reflü tanı yaşı, başvuru yakınmaları, başvuru yakınmalarında enürezis varsa bunun başlama zamanına göre dağılımı, İYE geçirme sıklığı, DMSA skarları, USG bulguları ek üriner sitem anomalileri, intrauterin hidronefroz varlığı, tartı ve boy persentilleri, tansiyon bulguları, dansiteleri, GFRİleri, mikroalbumin düzeylerine tanı anında, tıbbı tedavi sonrası ve cerrahi uygulananlarda cerrahi sonrası bakıldı. Çalışmamızdaki 125 vezikoüreteral reflülü hastanın 66?sının (%52.8) tek taraflı, 59?unun (%47.2) çift taraflı vezikoüreteral reflü mevcuttu. Tek taraflı olanlarda düşük vezikoüreteral reflülü hastaların,çift taraflı olanlarda yüksek dereceli vezikoüreteral reflü sıklığının daha fazla olduğu görüldü. Vezikoüreteral reflü tespit yaşı ilk bir ya?ta daha fazladır. Bunun nedeni ateşli ya da tekrarlayan idrar yolu enfeksiyonu sonrası pediatri polikliniklerine başvurmalarıdır. Bizim çalışma grubumuzda yaş ve vezikoüreteral reflü ağırlığı istatistiksel olarak bakıldı; 1 yaş altı çocuklarda yüksek dereceli vezikoüreteral reflü sıklığının daha fazla olduğu görüldü. Cinsiyetlere göre VUR dereceleri değerlendirildi; kızlarda düşük dereceli VUR oranı yüksekken, erkeklerde yüksek dereceli VUR oranı yüksek saptandı. Çalışmamızdaki 125 VUR?lu hastanın 91?inde (%74) skar mevcuttu. Reflü nefropatisi açısından risklere bakıldığında, yüksek vezikoüreteral derecesinin anlamlı risk faktörü olduğu görülmüştür. Vezikoüreteral reflü derecesi düşük olmasına rağmen skar olan olgularda vezikoüreteral reflünün geç tespiti ya da tekrarlayan, özellikle ateşli idrar yolu enfeksiyonu geçirdiği görülmüştür. Tıbbı tedavi ile VUR ağırlığında azalma görülmesine rağmen, komplikasyon geliştikten sonra tıbbı tedavi ile düzelme olmamıştır. Bu da erken tanı ve tedavinin önemini bir kez daha göstermektedir. Mesane disfonkisyonu olan hastalarda tıbbı tedavi ile VUR ağırlığı çok değişmesede T.?YE sıklığı ve skar riskinin mesane disfonksiyonu olan hastalarda fazla olması nedeniyle, bu hastaların tanısı ve tedavisi önemlidir. Cerrahi yöntemlerin etkinliğini etkileyen birçok faktör olması nedeniyle ( tanı ya?ı, VUR derecesi, T.?YE varlığı, DMSA?da skar varlığı, ek anomali, tartı-boy persentilleri) net bir açıklama yapılamasa da kabaca bakılacak olursa açık cerrahinin VUR remisyonu açısından daha etkili olduğu sonucuna varıldı. Sonuç olarak vezikoüretrel reflünün, reflü nefropatisi açısından erken tespit edilmesi ve nefropatiye neden olacak risklere karşı erken tedbir alınması gerekir. Hipertansiyon ve kronik böbrek yetmezliği açısından da uzun dönem takiplerin yapılması gerekmektedir.
Arbtract
Our goal in doing this thesis, is early diagnosis and adequate treatment of patients with vesico-ureteral reflux which is the most common cause of chronic renal failure in our country; to determine the follow-up and the results of these patients in all over country and also in our region were aimed. In our study, patients who were admitted to our department between April 2005-August 2011 were examined retrospectively in terms of relationship between vesicoureteral reflux, urinary tract infection and renal scarring, progression of vesicoureteral reflux with conservative treatment and the response to surgical treatment of vesicoureteral reflux, complications, its growth and development were investigated. In the study, 125 patients were evaluated retrospectively which were all diagnosed vesico-ureteric reflux. All patients with vesico-ureteral reflux, were diagnosed , by voiding cystourethrography. The mean age of the patients diagnosed with VUR, gender distribution, the distribution of reflux, VUR is a single or double-sided, VUR, age at diagnosis, presenting symptoms, nocturnal symptoms in the application, one or the distribution of the time of onset, the occurrence of UTI, DMSA scars, USG findings addition to the urinary system abnormalities, intrauterine presence of hydronephrosis, weight and height percentiles, blood pressure symptoms, densities, GFR, microalbumin levels at time of diagnosis, medical and surgical underwent surgery after treatment were measured.In our study, 125 patients with VUR, 66 of 125 single-sided, 59 of 125 had bilateral VUR. Patients with VUR is low in patients with single-sided, double-sided ones was more in the frequency of high-grade VUR. An age greater than the age of vesicoureteral reflux. The reason for this, or recurrent urinary tract infection in febrile pediatric clinics have resorted to post. In our study group age and VUR weighht was statistically views, incidence of high grade VUR in children under 1 year of age was more. VUR grades were evaluated according to sex, girls higher rate of low-grade VUR, high-grade VUR were higher in men. In our study, 125 patients with VUR in 91 (74%) had a scar. High degree reflux nephropathy was defined as the significant risk factor of renal scarring. But in some cases, we detected also renal scars although they have low degree VUR. We accepted them as late- detected renal scars or as results of recurrent febrile infections of urinary tract. The time of diagnosis in 26 patients (20.8%), medicine after treatment in 25 patients (20%) had microalbuminuria. Occurrence of microalbuminuria was no statistically significant difference was found in terms of grades of VUR. DMSA'da in terms of microalbuminuria in patients with non-scarring there was no significant difference between the incidence of scarring were more frequent in patients with microalbuminuria. Urodynamics of pathology in cases of VUR groups, and no statistically significant difference was found for the presence of scar DMSA. Urodynamics pathology cases with no statistically significant difference was found between the presence of UTI, UTI incidence was higher in patients with urodynamic pathology. After medical treatment of VUR grades were evaluated statistically significant difference was detected before treatment was 17.2% compared to in complete remission of VUR and 24.1% when the degree of VUR was decreased. 43 Patients who underwent surgical treatment of female (72.9%), 16 (27.1%) were male. Surgical treatment of girls and boys in terms of implementation there was no statistically significant difference. Due to the many factors affecting the effectiveness of the surgical procedures (diagnosis, age, VUR grade, T.?YE the presence of scar DMSA'da the presence of additional anomalies, weight-height percentiles) a clear statement can be made a matter of roughly 74 renal units 25 renal endoscopic surgery (33.8%) improvement in the unit, 25 renal units (33.8%) reduction in the degree of VUR was detected; open method applied in 10 renal units 28 renal units (35.7%), improvement in 4 (14.3%) reduction in the degree of VUR was detected VUR remission of open surgery It was concluded that more effective respect. As a result vesicourethral is a condition, that should be detected early in terms of reflux nephropathy and taking measures against risks of nephropathy. Hypertension and chronic renal failure must be taken into consideration in terms of long-term follow-up.
Arbtract
Our goal in doing this thesis, is early diagnosis and adequate treatment of patients with vesico-ureteral reflux which is the most common cause of chronic renal failure in our country; to determine the follow-up and the results of these patients in all over country and also in our region were aimed. In our study, patients who were admitted to our department between April 2005-August 2011 were examined retrospectively in terms of relationship between vesicoureteral reflux, urinary tract infection and renal scarring, progression of vesicoureteral reflux with conservative treatment and the response to surgical treatment of vesicoureteral reflux, complications, its growth and development were investigated. In the study, 125 patients were evaluated retrospectively which were all diagnosed vesico-ureteric reflux. All patients with vesico-ureteral reflux, were diagnosed , by voiding cystourethrography. The mean age of the patients diagnosed with VUR, gender distribution, the distribution of reflux, VUR is a single or double-sided, VUR, age at diagnosis, presenting symptoms, nocturnal symptoms in the application, one or the distribution of the time of onset, the occurrence of UTI, DMSA scars, USG findings addition to the urinary system abnormalities, intrauterine presence of hydronephrosis, weight and height percentiles, blood pressure symptoms, densities, GFR, microalbumin levels at time of diagnosis, medical and surgical underwent surgery after treatment were measured.In our study, 125 patients with VUR, 66 of 125 single-sided, 59 of 125 had bilateral VUR. Patients with VUR is low in patients with single-sided, double-sided ones was more in the frequency of high-grade VUR. An age greater than the age of vesicoureteral reflux. The reason for this, or recurrent urinary tract infection in febrile pediatric clinics have resorted to post. In our study group age and VUR weighht was statistically views, incidence of high grade VUR in children under 1 year of age was more. VUR grades were evaluated according to sex, girls higher rate of low-grade VUR, high-grade VUR were higher in men. In our study, 125 patients with VUR in 91 (74%) had a scar. High degree reflux nephropathy was defined as the significant risk factor of renal scarring. But in some cases, we detected also renal scars although they have low degree VUR. We accepted them as late- detected renal scars or as results of recurrent febrile infections of urinary tract. The time of diagnosis in 26 patients (20.8%), medicine after treatment in 25 patients (20%) had microalbuminuria. Occurrence of microalbuminuria was no statistically significant difference was found in terms of grades of VUR. DMSA'da in terms of microalbuminuria in patients with non-scarring there was no significant difference between the incidence of scarring were more frequent in patients with microalbuminuria. Urodynamics of pathology in cases of VUR groups, and no statistically significant difference was found for the presence of scar DMSA. Urodynamics pathology cases with no statistically significant difference was found between the presence of UTI, UTI incidence was higher in patients with urodynamic pathology. After medical treatment of VUR grades were evaluated statistically significant difference was detected before treatment was 17.2% compared to in complete remission of VUR and 24.1% when the degree of VUR was decreased. 43 Patients who underwent surgical treatment of female (72.9%), 16 (27.1%) were male. Surgical treatment of girls and boys in terms of implementation there was no statistically significant difference. Due to the many factors affecting the effectiveness of the surgical procedures (diagnosis, age, VUR grade, T.?YE the presence of scar DMSA'da the presence of additional anomalies, weight-height percentiles) a clear statement can be made a matter of roughly 74 renal units 25 renal endoscopic surgery (33.8%) improvement in the unit, 25 renal units (33.8%) reduction in the degree of VUR was detected; open method applied in 10 renal units 28 renal units (35.7%), improvement in 4 (14.3%) reduction in the degree of VUR was detected VUR remission of open surgery It was concluded that more effective respect. As a result vesicourethral is a condition, that should be detected early in terms of reflux nephropathy and taking measures against risks of nephropathy. Hypertension and chronic renal failure must be taken into consideration in terms of long-term follow-up.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Vezikoüreteral Reflü, Skar, Tekrarlayan İdrar Yolu İnfeksiyonu, Böbrek Hasarı, Vesicourethral Reflux, Scar, Recurrent Urinary Tract Infection
