第一次尿道感染后的肾超声:系统检查结果和元分析

Q4 Medicine Quaderni ACP Pub Date : 2023-01-01 DOI:10.53141/peqacp.2023.3.am1
Daniele De Brasi
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引用次数: 0

摘要

儿童首次发热性尿路感染(UTI)后肾脏超声检查的临床应用存在很大争议,指南(LG)的建议往往不同。本研究的目的是确定儿童首次发热尿路感染后超声检测尿路异常的患病率。使用医学研究数据库检索有关首次尿路感染儿童超声应用研究的文章。主要观察结果是尿路异常的发生率和肾超声检查发现的临床重要异常。纳入29项研究,共纳入9170名儿童。在27项报告参与者性别的研究中,男性的平均比例为60%(范围为11% -80%)。肾脏超声检查发现异常的患病率约为22%,而临床重要异常的患病率约为4%。最常见的异常是肾积水、肾盂扩张和输尿管扩张。0.4%的病例确诊为尿路梗阻,1.4%的病例行手术治疗。没有研究报告父母报告的结果。结果表明,4-5例首次发热尿路感染的儿童中有1例在肾脏超声检查中发现尿路异常,32例中有1例异常改变了他们的临床处理。考虑到研究的异质性和缺乏全面的结果测量,作者建议需要设计良好的前瞻性纵向研究,以充分评估首次发热尿路感染后肾脏超声的临床应用。
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Ecografia renale dopo il primo episodio di infezione delle vie urinarie: risultati di una revisione sistematica e metanalisi
Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis The clinical utility of renal ultrasound after the first febrile urinary tract infection (UTI) is much debated, and guideline (LG) recommendations often differ. The objective of this study was to determine the prevalence of urinary tract abnormalities detected by ultrasound after the first febrile UTI in children. Medical research databases were used to search for articles on studies on the use of ultrasound in children with first UTI. Primary outcome was the prevalence of urinary tract abnormalities and clinically important abnormalities detected on renal ultrasound. Twenty-nine studies were included, with a total of 9.170 children studied. Of the 27 studies that reported the sex of participants, the average percentage of males was 60% (range, 11% -80%). The prevalence of abnormalities detected on renal ultrasound was about 22%, while the prevalence of clinically important abnormalities was about 4%. The most detected abnormalities were hydronephrosis, pyelectasis, and ureter dilatation. Urinary tract obstruction was identified in 0.4% of cases, and surgery was performed in 1.4% of cases. No studies reported parent-reported outcomes. The results suggest that 1 in 4-5 children with first febrile UTI have a urinary tract abnormality detected on renal ultrasound and 1 in 32 an abnormality that changes their clinical management. Given the considerable heterogeneity of the studies and the lack of comprehensive outcome measurement, the authors suggest the need for well-designed prospective longitudinal studies to fully evaluate the clinical utility of renal ultrasound after the first febrile UTI.
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Quaderni ACP
Quaderni ACP Medicine-Pediatrics, Perinatology and Child Health
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