Kroni̇k Hastalığı Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

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DOI :10.26650/B/CH32.2024.010.030   IUP :10.26650/B/CH32.2024.010.030    Tam Metin (PDF)

Üri̇ner Si̇stem İnfeksi̇yonu Ve Hi̇dronefroz Olan Çocuğun İzlemi̇ ve Toplumda Bakımı

Alev Yılmaz

Üriner sistem infeksiyonu, ateşli çocuklarda en sık görülen bakteriyel enfeksiyondur. Kız çocukların %8’i ve erkek çocukların %2’si yedi yaşına ulaşana kadar en az bir kez üriner sistem infeksiyonu geçirmektedir. Özellikle üriner sistem infeksiyonuna zemin hazırlayan anatomik anomaliler ve/veya mesane disfonksiyonu varlığında tekrarlayan üriner sistem enfeksiyon atakları sonucunda renal skarlaşma ve kronik böbrek hastalığı gelişebilir. Ateş yakınmasıyla başvuran iki yaşından küçük tüm çocuklarda üriner sistem infeksiyonu düşünülmelidir. Tanıyı doğrulamak için, semptomlara ek olarak, tam idrar tetkikinde bulgu ve idrar kültüründe anlamlı üreme olması gerekir. İdrar kültürü için örnek alma yöntemleri arasında idrar torbası, temiz yakalama, orta akım idrarı, mesane kateteri veya suprapubik aspirasyon sayılabilir. İdrar kültürü sonucu değerlendirilirken kontaminasyon ve asemptomatik bakteriüri ile ayırıcı tanı yapılmalıdır. Çocuklarda üriner sistem infeksiyonu ataklarının %80-85’inden Escherichia coli sorumludur. Vezikoüreteral reflüsü olan çocukların üriner sistem enfeksiyonu tekrarlarını önlemek için uzun süreli antibiyotik profilaksisi kullanılabilir. Üriner sistem infeksiyonu geçiren tüm çocuklar, üriner sistemin konjenital anomalileri açısından ultrasonografi ile değerlendirilmelidirler. Üriner sistem dilatasyonu, antenatal ultrasonografilerde en sık görülen anormalidir. Doğum sonrası ultrasonografide üriner sistem dilatasyonu, hidronefroz ve hidroüreteronefroz olarak sınıflandırılabilir. Hidronefrozun nedenleri arasında tıkayıcı olmayan dilatasyon, vezikoureteral reflü ve üreteropelvik bileşke obstrüksiyonu yer alır. Hidroüreteronefroza vezikoüreteral reflü, üreterovezikal bileşke tıkanıklığı , üreterosel veya posterior üretral kapakçık neden olabilir. Antenatal hidronefrozu olan çocuklar yaşamın ilk haftasında ultrasonografi ile değerlendirilmelidirler. Üriner sistem dilatasyonunun derecelendirilmesi, renal pelvisin antero-posterior çapı ve Fetal Üroloji Derneği (Society for Fetal Urology) kriterlerine ek olarak “UTD (Urinary Tract Dilatasyonu) sınıflandırma sistemi” kullanılarak belirlenmelidir.


Anahtar Kelimeler: Üriner sistem infeksiyonu, idrar yolu infeksiyonu, vezikoüreteral reflü, hidronefroz, çocuk
DOI :10.26650/B/CH32.2024.010.030   IUP :10.26650/B/CH32.2024.010.030    Tam Metin (PDF)

Follow-up and Community Care of the Child with Urinary Tract Infection and Hydronephrosis

Alev Yılmaz

Urinary tract infection is the most common bacterial infection in children with fever. Approximately 8% of girls and 2% of boys develop urinary tract infection at least once until they reach the age of 7 years. Renal scarring and chronic kidney disease may eventually develop, especially in the presence of anatomical anomalies and/or bladder dysfunction that predisposes to a urinary system infection. Urinary tract infection should be considered in all children younger than 2 years who present with fever. The diagnosis can be confirmed based on not only the symptoms but also the findings in the urine analysis and significant growth in the urine culture collected by a urine collection bag, clean catch, midstream urine, bladder catheter, or suprapubic aspiration. A differential diagnosis should be made with contamination and asymptomatic bacteriuria. Escherichia coli is responsible for 80%–85% of urinary tract infections in children. Long-term antibiotic prophylaxis prevents relapses of urinary tract infection in children with vesicoureteral reflux. Ultrasonography should be conducted to check for congenital anomalies of the urinary system. Urinary tract dilatation (UTD) is the most common abnormality detected by antenatal ultrasonography. In postpartum ultrasonography, it can be classified as UTD, hydronephrosis (results from non-obstructive dilatation, vesicoureteral reflux, and ureteropelvic junction obstruction), and hydroureteronephrosis (caused by vesicoureteral reflux, vesicoureteral reflux, ureterovesical junction obstruction, ureterocele, or posterior urethral valve). Children with antenatal hydronephrosis should be evaluated by ultrasonography in the first week of life. Grading of urinary tract dilatation urinary tract dilatation should be determined using the “UTD classification system” in addition to the anteroposterior diameter of the renal pelvis and the Society for Fetal Urology criteria.


Anahtar Kelimeler: Urinary tract infection, UTI, vesicoureteral reflux, hydronephrosis, hydroureteronephrosis, child

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