Parvex, Willi, Kossovsky, Girardin, pediatric nephrology, Geneva University, Switzerl in addition to The spectrum of renal scarring Background Background

Parvex, Willi, Kossovsky, Girardin, pediatric nephrology, Geneva University, Switzerl in addition to The spectrum of renal scarring Background Background www.phwiki.com

Parvex, Willi, Kossovsky, Girardin, pediatric nephrology, Geneva University, Switzerl in addition to The spectrum of renal scarring Background Background

Ralph, Nate, Contributing Writer has reference to this Academic Journal, PHwiki organized this Journal Parvex, Willi, Kossovsky, Girardin, pediatric nephrology, Geneva University, Switzerl in addition to The spectrum of renal scarring Background UTI is common condition in childhood with a prevalence of 3%, the prevalence of pyelonephritis (PNA) is not clearly reported Infant in addition to children presenting unexplained fever of 38° in addition to positive urine culture will be diagnosed with PNA Background The goal of medical management of PNA Initiate early treatment to decrease renal inflammation in addition to subsequently scars Identify risk factor to avoid new infections episodes in addition to prevent scars development Exclude urologic anomalies (renal echography) Detect vesico-ureteral reflux (cystography)

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Pathogenesis of scars It is important to differentiate acquired segmental scarring associated with VUR in addition to PNA From congenital “scars” corresponding to an anomaly in the metanephric development in boys in addition to associated with high grade VUR Histological analyses of these later lesions showed renal dysplasia which may mimic scarring without an acute episode of PNA Renal scintigraphy Since 1980, renal scintigraphy with TechnetiumTc labeled with dimercapto-succinyl-acid DMSA replaced IVP in addition to improved in the detection of renal scars has been validated to be the most sensitive method as long as imaging in the diagnosis of acute PNA in addition to as long as renal scars Normal kidney Renal scars Acute PNA

What is known as long as m the literature Did early antibiotic treatment avoid scar as long as mation How important is the grade of VUR Is the risk to do scars related to age Are scars leading to hypertension (HTA) in adulthood Early treatment (T) Recent data suggest that if early T decrease renal inflammation in the acute phase However in this patients (n=186) early T seems not to decrease the risk of later scars (T<24H or T>24H) Doganis, D. et al. Pediatrics 2007;120:e922-e928 Role of VUR VUR is considered to be the principal risk factor to favor PNA in addition to there as long as e renal scars The incidence of VUR in children presenting PNA varies among studies from 30 to 50% Even if scars can develop without VUR or low grade VUR however the risk increased with high grade VUR

VUR in addition to severity of scars Gonzalez et al. The Journal of Urology , Volume 173 , Issue 2 , Pages 571 – 575 Age in addition to risk factor Benador et al Vol 379, January 1997, Pages 17-19 Vol 379, January 1997, Pages 17-19

HTA One of the main concern are further development of hypertension in children presenting scars Hypertension affects among series 5-27% of children; however the literature have not showed strong evidence until known A 15 years follow-up of BP studied 78 Pts with reflux nephropathy All were normal BP at time of inclusion 18/78 pts became HTA(>95th) during the following 15 years; 6 from them had a family history as long as HTA Risk as long as the future: HTA Systolic in addition to diastolic BP at 5,10,15 years follow-ups Chulan in addition to a et al. Vol 347, March 9,1996

The following recorded 24HBP in 61 pts classified in different groups according to the severity of DMSA lesions Type 1: normal reni as long as me shape but polar area with photon deficiency Type 2: focal defect in a nonde as long as med kidney Type 3: Smaller kidney compared to controlateral Type 4a:Loss of renal contour with normal size kidney Type 4b:similar from above with small kidney Risks as long as the future: HTA J Pediatr. Patzer et al 2003 Feb;142(2):117-22. Is this increase of BP at night a sign of further evolution of HTA in adulthood needs to be confirmed by long term studies

What is the long term significance of scars Background The presence of lesions on DMSA 6 month after PNA are considered to be definitive kidney scars According to the literature the rate of acute lesions in addition to later scars varies among studies

Questions Did these lesions still have the potential to evolve after 6 month Did this lesions interfere with normal renal growth Aim of the study To analyze long term progression of renal lesions in children with presence of scars on the first DMSA To assess long term renal growth To identify variables which could impact on renal growth in this children Material This prospective study was conducted over two years in addition to included Children from 0-18 years with a diagnosis of PNA in addition to who presented renal scars 6 month after the first episode of PNA Exclusion criteria Children with complex uro-genital mal as long as mations, dysplastic kidneys, megaurether, hydronephrosis

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Methods Each patient with scars was contacted to have a repeated DMSA 3 years later At the same time we repeated a renal echography to measure kidney size To analyze progression of DMSA defects, RU was divided in 3 areas Scar progression was analyzed separately as long as each area by 3 observers in a blinded fashion in addition to classified as follow No change Partial resolution Total disappearance Upper pole Mid zone Lower pole b 1A 1B a b a b 2A 2B 2A DMSA 6 month 2B DMSA 3 years later: we observe a) disappearance of mid-zone lesion of left kidney b) no change in lower lesion of right kidney 1A DMSA 6 month after PNA 1B DMSA 3 years later: we observe 2 types of lesions: a) the lesion situated in the mid-zone of left kidney did not change b) The lesion located in the right upper pole improved. a 2A a b Parvex et al The Journal of Urology on Press

(cm) Kidney growth Kidney size was measured Time 0 corresponding to the PNA (T0) in addition to 3 years later Time 3 (T3) at the same time of the repeated DMSA Renal size was measured at T0 in addition to T 3 in addition to values compared to st in addition to ard deviation score (SDS ) renal sizes relative to age The following equation were usedto calculate Z-score <1 year length (cm)= 4.98+0.55 x age(mths)(t90 = 6.86, p<0.001;SD=0.69;r2=0.3437 1 year length (cm)= 6.79+0.22 x age(years)(t326 = 28, <0.001;SD=0.79;r2=0.7077 Renal growth between T0 in addition to T3 was calculated with the z-score = or + z-score correspond to adequate renal growth - z-score correspond in loss of renal growth AJR Am J Roentgenol 1984;142(3):467-9. Results 50 (30G:20B) children; M age of 4.1 Boys were younger 15/20 2years(75%) against 9/30 (30%) girls VUR was present in 36% of patients in addition to 25% of renal units (RU) Thanks' as long as your attention

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