Tekrarlayan İdrar Yolu Enfeksiyonu Olan Çocuklarda Tuvalet Alışkanlıklarının Değerlendirilmesi ve Böbrek Hasarı Gelişmesinde Rol Oynayan Risk Faktörlerinin Araştırılması

Yıl 2022, Cilt: 11 Sayı: 2, 243 - 249, 31.08.2022

Nuran Cetın , Aslı Kavaz Tufan

https://doi.org/10.47493/abantmedj.1094312

Öz

Amaç: İdrar yolu enfeksiyonu çocukluk çağında sık görülen enfeksiyonlardan biridir. Tekrarlayan enfeksiyonu olan çocuklar yaşamın ilerleyen dönemlerinde kalıcı böbrek hasarı açısından risk altındadır. Bu çalışmada doğumsal böbrek ve üriner sistem anomalisi olmayan tekrarlayan idrar yolu enfeksiyonlu çocuklarda tuvalet alışkanlıklarının ve skar gelişmesinde rol oynayan risk faktörlerinin araştırılması amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışmaya tuvalet eğitimi olan tekrarlayan idrar yolu enfeksiyonu tanılı 6 ve 18 yaş arasındaki hastalar dahil edildi. Doğumsal böbrek ve üriner sistem anomalisi olan hastaların verileri çalışma dışı bırakıldı. Hastaların idrar erteleme alışkanlığı, azalmış idrar sıklığı, tutma manevrası ve skar hakkındaki bilgileri dosya kayıtlarından elde edildi.
Bulgular: Çalışmaya 208 (146 kız, 62 erkek) hasta dahil edildi. Hastaların yarıdan fazlasında (n=132, %63.5) idrar erteleme alışkanlığı, üçte birinde idrarını tutma manevrası (n=65, %31.3) mevcuttu. Azalmış idrar sıklığı hastaların 47’sinde (%22.6) saptandı. Hastaların 38’inde (%18.3) DMSA sintigrafide skar olduğu belirlendi. İdrar erteleme alışkanlığı, idrar tutma manevrası ve azalmış idrar sıklığı oranı skar olan hastalarda olmayanlara göre anlamlı olarak daha yüksek bulundu [sırası ile 30 (%78,9)/102 (%60), p=0,048; 12 (%31,6)/53 (%21,2), p=0,039; 15 (%39,5)/32 (%18,8), p=0,009]. İdrar erteleme alışkanlığı ve azalmış idrar sıklığı ile skar arasında anlamlı pozitif bir ilişki olduğu belirlendi [sırası ile Odds oranı=3,21, p=0,.011; Odds oranı=1,46, p=0,021; Odds oranı=3,43, p=0,001].
Sonuç: Tekrarlayan idrar yolu enfeksiyonlu çocuklarda tuvalet alışkanlıklarının sorgulanarak gerekli önlemlerin alınması skar gelişiminin önlenmesinde rol oynayabilir.

Anahtar Kelimeler

Çocukluk Çağı, İdrar Yolu Enfeksiyonu, Renal Skar, Tuvalet Alışkanlıkları

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

-

Evaluation of Toilet Habits in Children with Recurrent Urinary Tract Infections and Investigation of Risk Factors That Play a Role in The Development of Kidney Damage

Öz

Objective: Urinary tract infection is one of the common infections in children. The patients with recurrent infection are at risk for permanent renal damage in later life. In this study, it was aimed to investigate the toilet habits and risk factors for renal scarring in children with recurrent urinary tract infection without congenital anomalies of the kidney and urinary tract.
Materials and Methods: Patients between the ages of 6 and 18 with a diagnosis of recurrent urinary tract infection who were toilet trained were included in this study. Data of patients with congenital anomalies of kidney and urinary tract were excluded from the study. The detailed information on the voiding postponement, infrequent voiding, holding maneuvers and renal scarring were obtained from file records.
Results: The 208 patients (146 girls, 62 boys) were included in this study. The more than half of the patients (n=132, 63.5%) had a habit voiding postponement, and one third (n=65, 31.3%) had holding maneuver. There was infrequent voiding in 47 (22.6%) patients. Renal scarring was determined in 38 (18.3%) patients. The frequencies of voiding postponement, holding maneuver and infrequent voiding were higher in patients with renal scarring than those of without [30 (78.9%)/102 (60%), p=0.048; 12 (31.6%)/53 (21.2%), p=0.039; 15 (39.5%)/32 (18.8%), p=0.009, respectively]. It was determined a significant positive association between renal scarring and voiding postponement with infrequent voiding [Odds ratio=3.21, p=0.011; Odds ratio=1.46, p=0.021; Odds ratio=3.43, p=0.001, respectively].
Conclusion: Toilets habits should be questioned in routine follow-up program in children with recurrent urinary tract infection. The development of true toilet habits may be useful to prevent the development of renal scarring in children.

Anahtar Kelimeler

Children, Urinary Tract Infection, Renal Scarring, Toilet Habits

Proje Numarası

-

Kaynakça

• Referans1 Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. New Engl J Med 2011;365:239-250.
• Referans2 Shaikh N, Borrell JL, Evron J, Leeflang MM. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2015;1:CD009185.
• Referans3 Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013;25:88-94.
• Referans4 Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis 2011;18:348-354.
• Referans5 Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children. Pediatrics 2021;147:e2020012138.
• Referans6 Barroso U Jr, Barroso DV, Jacobino M, Vinhaes AJ, Macedo A Jr, Srougi M. Etiology of urinary tract infection in scholar children. Int Braz J Urol 2003;29:450-454.
• Referans7 Austin PF, Bauer S, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of bladder function in children and adolescents: update report from the Standardization Committee of the International Childrenʼs Continence Society (ICCS). Neurourol Urodyn 2016;35:471-481.
• Referans8 Ayazi P, Mahyar A, Daneshi MM, Jahani Hashemi H, Pirouzi M, Esmailzadehha N. Diagnostic Accuracy of the Quantitative C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Urinary Tract Infections among Infants and Children. J Med Sci 2013;20:40-46.
• Referans9 Quigley R. Diagnosis of urinary tract infections in children. Curr Opin Pediatrics 2009;21:194-198.
• Referans10 Keren R, Carpenter MA, Hoberman A, Shaikh N, Matoo TK, Chesney RW, et al. Rationale and design issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study. Pediatrics 2008;122 Suppl 5:240-250.
• Referans11 Beetz R. May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 2006;21:5–13.
• Referans12 Mishra OP, Abhinay A, Prasad R. Urinary infections in children. Indian J Pediatr 2013;80:838-843.
• Referans13 Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 2007;298:179-186.
• Referans14 Vasudeva P, Madersbacher H. Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Neurourol Urodyn 2014;33:95-100.
• Referans15 Lettgen B, von Gontard A, Olbing H, Heiken-Löwenau C, Gaebel E, Schmitz I. Urge incontinence and voiding postponement in children: somatic and psychosocial factors. Acta Paediatr 2002;91:978-984.
• Referans16 Kuhn S, Natale N, Siemer S, Stoeckle M, von Gontard A. Clinical difference in daytime wetting subtypes: urge incontinence and postponed voiding. J Urol 2009;182:1967-1972.
• Referans17 Glassberg KI, Combs AJ. Lower urinary tract dysfunction in childhood: what’s really happening with these children? Curr Bladder Dysfunct Rep 2014;9:389-400.
• Referans18 Lin AT, Juan YS. Ischemia, Hypoxia and Oxidative Stress in Bladder Outlet Obstruction and Bladder Overdistention Injury. Low Urin Tract Symptoms 2012;4 Suppl 1:27-31.
• Referans19 Juan YS, Chuang SM, Jang MY, Huang CH, Chou YH, Wu WJ, Long CY. Basic research in bladder outlet obstruction. Incont Pelvic Floor Dysfunct 2011; 5:1-6.
• Referans20 Metcalfe PD, Wang J, Jiao H, Huang Y, Hori K, Moore RB, Tredget EE. Bladder outlet obstruction: progression from inflammation to fibrosis. BJU Int 2010;106:1686-1694.
• Referans21 von Gontard A, Niemczyk J, Thomé-Granz S, Nowack J, Moritz A, Equit M. Incontinence and parent reported oppositional defiant disorder symptoms in young children—a population-based study. Pediatr Nephrol 2015;30:1147–1155.
• Referans22 Neveus T, von Gontard A, Hoebeke P, Hja¨lmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006;176:314.
• Referans23 Filler G, Gharib M, Casier S, Lodige P, Ehrich JH, Dave S. Prevention of chronic kidney disease in spina bifida. Int Urol Nephrol 2012;44:817-27.