Estudios de imagenes y pruebas funcionales renales

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Abstract

Las infecciones del tracto urinario son causa frecuente de morbilidad en la edad pediátrica y un porcentaje importante de ellas se asocian con malformaciones de las vías urinarias, por lo que su temprana detección y manejo adecuado podría incidir positivamente sobre la prevención de cicatrices renales, hipertensión arterial y enfermedad renal crónica. La importancia de los métodos de imágenes radica en la posibilidad de identificar precozmente aquellos niños con factores de riesgo de desarrollar cicatrices renales, permitiendo prevenir la progresión del daño preexistente. El protocolo inicial de estudios debería incluir ultrasonido renovesical, uretrocistografía miccional y gammagrama renal con DMSA. En esta revisión se comentan adicionalmente, las pruebas funcionales necesarias para determinar el grado de afectación glomerular y tubular como consecuencia de las infecciones urinarias.

Translated abstract

Urinary tract infections are frequent causes of morbidity in children and a significant percentage of them are associated with malformations of the urinary tract. Their early detection and proper management could have a positive impact on the prevention of scarring, hypertension and chronic renal disease. The importance of imaging methods is the possibility to identify those children with risk factors for the development of renal scarring, which would allow prevention of the progression of renal damage. The initial study protocol should include renovesical ultrasound, cystography and DMSA renal scintigraphy. This review also discusses the necessary functional test to assess the degree of glomerular and tubular involvement as consequence of urinary tract infections.

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Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease.

Giuseppe Coppolino, Richard Fazio, G Nicocia … (2009)

Chronic kidney disease (CKD) has recently assumed epidemic proportion, becoming a troubling emerging cause of morbidity, especially if it progresses to terminal stage (ESRD). The authors aimed to evaluate whether neutrophil gelatinase-associated lipocalin (NGAL), a novel specific biomarker of acute kidney injury, could predict the progression of CKD. Serum and urinary NGAL levels, together with a series of putative progression factors, were evaluated in a cohort of 96 patients (mean age: 57 +/- 16 years) affected by nonterminal CKD (eGFR > or =15 ml/min/1.73 m(2)) of various etiology. Progression of CKD, assessed as doubling of baseline serum creatinine and/or onset of ESRD, was evaluated during follow-up. At baseline, both serum and urinary NGAL were inversely, independently, and closely related to eGFR. After a median follow-up of 18.5 mo (range 1.01 to 20), 31 patients (32%) reached the composite endpoint. At baseline, these patients were significantly older and showed increased serum creatinine, calcium-phosphate product, C-reactive protein, fibrinogen, daily proteinuria, and NGAL levels, whereas eGFR values were significantly lower. Univariate followed by multivariate Cox proportional hazard regression analysis showed that urinary NGAL and sNGAL predicted CKD progression independently of other potential confounders, including eGFR and age. In patients with CKD, NGAL closely reflects the entity of renal impairment and represents a strong and independent risk marker for progression of CKD.

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Imaging studies after a first febrile urinary tract infection in young children.

Jerry M. Baskin, R Wald, Kimberly Hickey … (2003)

Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary tract infection; renal scanning with technetium-99m-labeled dimercaptosuccinic acid has also been endorsed by other authorities. We investigated whether imaging studies altered management or improved outcomes in young children with a first febrile urinary tract infection. In a prospective trial involving 309 children (1 to 24 months old), an ultrasonogram and an initial renal scan were obtained within 72 hours after diagnosis, contrast voiding cystourethrography was performed one month later, and renal scanning was repeated six months later. The ultrasonographic results were normal in 88 percent of the children (272 of 309); the identified abnormalities did not modify management. Acute pyelonephritis was diagnosed in 61 percent of the children (190 of 309). Thirty-nine percent of the children who underwent cystourethrography (117 of 302) had vesicoureteral reflux; 96 percent of these children (112 of 117) had grade I, II, or III vesicoureteral reflux. Repeated scans were obtained for 89 percent of the children (275 of 309); renal scarring was noted in 9.5 percent of these children (26 of 275). An ultrasonogram performed at the time of acute illness is of limited value. A voiding cystourethrogram for the identification of reflux is useful only if antimicrobial prophylaxis is effective in reducing reinfections and renal scarring. Renal scans obtained at presentation identify children with acute pyelonephritis, and scans obtained six months later identify those with renal scarring. The routine performance of urinalysis, urine culture, or both during subsequent febrile illnesses in all children with a previous febrile urinary tract infection will probably obviate the need to obtain either early or late scans. Copyright 2003 Massachusetts Medical Society

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Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE).

R E Portman, R E Hogg, F Ingelfinger … (2000)

The development of this review article evolved from a National Kidney Foundation consensus conference on recent advances in the importance of evaluating and treating proteinuria. From this conference, a series of recommendations for the evaluation of adults with proteinuria was published. Because specific pediatric aspects of the problem were outside the scope of the original National Kidney Foundation publication, an ad hoc committee of 6 pediatric nephrologists who were active participants in the National Kidney Foundation conference was established to provide primary care physicians with a concise, up-to-date reference on this subject. The recommendations that are given represent the consensus opinions of the authors. These are based on data from controlled studies in children when available, but many of the opinions are, by necessity, based on uncontrolled series in children or controlled trials performed in adults, because controlled trials in children have not been performed to evaluate many of the treatments described. These recommendations are intended to provide primary care physicians with a useful reference when they are faced with a young child or teenager who presents with proteinuria, whether this is mild and asymptomatic or more severe, leading to nephrotic syndrome.

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Author and article information

Contributors

Issis Lunar Solé: Role: ND

Wendy Serrano Puebla: Role: ND

Nury Caviedes Robles: Role: ND

José Antonio Trujillo: Role: ND

Carlos Rendón Bartolozzi: Role: ND

Journal

Journal ID (publisher): avpp

Title: Archivos Venezolanos de Puericultura y Pediatría

Abbreviated Title: Arch Venez Puer Ped

Publisher: Sociedad Venezolana de Puericultura y Pediatría (Caracas )

ISSN: 0004-0649

Publication date (Print): March 2011

Volume: 74

Issue: 1

Pages: 41-47

Affiliations

[1 ] Hospital Universitario Dr. Manuel Núñez Tovar Venezuela

[2 ] Hospital J.M. de Los Ríos Venezuela

[3 ] Instituto Médico La Floresta Venezuela

[4 ] Centro Policlínico La Viña Venezuela

[5 ] Complejo Hospitalario Docente Asistencial Ruíz y Páez Venezuela

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Publisher ID: S0004-06492011000100009

SO-VID: 1c3b6b12-6782-44f0-a890-dfd1e565f869

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http://creativecommons.org/licenses/by/4.0/

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Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0649&lng=en

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Cistatina C: la necesidad de su conocimiento en la atención preventiva de daño renal
Authors: Adialys Alemán Zamora, Lutgarda María Pérez de Alejo Rodriguez, Yusimí Gonzales Álvarez …

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Estudios de imagenes y pruebas funcionales renales Translated title: Imaging and functional studies in urinary tract infections

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SciELO Venezuela

Most cited references 78

Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease.

Imaging studies after a first febrile urinary tract infection in young children.

Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE).

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