Advertisement

Der Radiologe

, Volume 56, Issue 11, pp 997–1012 | Cite as

Bildgebende Diagnostik bei akuten Harnwegsinfektionen im Kindesalter

  • B. ZiegerEmail author
CME
  • 455 Downloads

Zusammenfassung

Die diagnostischen Strategien zur weiterführenden morphologischen und funktionellen Abklärung nach symptomatischen Harnwegsinfektionen (HWI) im Kindesalter sind im Fluss. Verbesserte Kenntnis der Pathogenese von pyelonephritischen Parenchymschäden und eine veränderte Sichtweise der Dignität des vesikoureteralen Refluxes haben zu Paradigmenwechseln in den zurückliegenden Jahren beigetragen. Mit dem vorliegenden Fortbildungsbeitrag wird beabsichtigt, aktuelle Diskussionen zu Ursachen und Folgen kindlicher HWI, konkurrierende Methoden in der bildgebenden Diagnostik und verschiedene diagnostische Strategien darzustellen.

Schlüsselwörter

Harnwegsinfekte Vesikoureteraler Reflux Kind Bildgebung Strahlendosis 

Imaging in urinary tract infections in childhood

Abstract

Diagnostic strategies for extended morphological and functional clarification after symptomatic urinary tract infections in children are changing. Improved knowledge of the causes for development of renal scarring and a changing view on the importance of vesicoureteral reflux have led to a change in paradigm in recent years. The purpose of this article is to present the ongoing discussions of the causes and outcome of childhood urinary tract infections, competing diagnostic imaging methods and different diagnostic algorithms.

Keywords

Urinary tract infections Vesicoureteral reflux Child Imaging Radiation dosage 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

B. Zieger gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Supplementary material

Video 1: 1-jähriges Mädchen mit dilatiertem Ureter: Nach Gabe eines Ultraschallkontrastmittels zeigen sich Kontrastmittelbläschen in der Harnblase und im dilatierten Harnleiter, somit mindestens einem Reflux Grad I entsprechend.

Video 2: Miktionsurosonographie: 6-jähriges Mädchen, Reflux in das Nierenbecken, die Bewegung der bubbles ist im real-time-Bild gut erkennbar

Video 3: Miktionsurosonographie im Kontrastmodus: 6-jähriges Mädchen; Das Nierenbecken ist nicht dilatiert, aber es lassen sich eindeutig die Bewegungen des Kontrastmittels im Nierenbecken erkennen, Reflux Grad 2.

Literatur

  1. 1.
    Beetz R, Mannhardt-Laakman W, Schulte-Wissermann H (2011) Harnwegsinfektionen. In: Stein R, Beetz R, Thüroff JW (Hrsg) Kinderurologie in Klinik und Praxis, 3. Aufl. Georg Thieme, Stuttgart, New York, S 149–173Google Scholar
  2. 2.
    Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (2007) Diagnostic significance of clinical and laboratory findings to localize site of urinary infection. Pediatr Nephrol 22(7):1002–1006CrossRefPubMedGoogle Scholar
  3. 3.
    Shaikh N, Borrell JL, Evron J, Leeflang MMG (2015) Procalcitonin, c‑reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 1:CD009185PubMedGoogle Scholar
  4. 4.
    Liao P, Ku M, Tsai J, Choa Y, Hung T, Lue K, Sheu J (2014) Comparison of procalcitonin and different guidelines for first febrile urinary tract infection in children by imaging. Pediatr Nephrol 29(9):1567–1574CrossRefPubMedGoogle Scholar
  5. 5.
    Pecile P, Miorin E, Romanello C, Falleti E, Valent F, Giacomuzzi F, Tenore A (2004) Procalcitonin: a marker of severity of acute pyelonephritis among children. Pediatrics 114(2):e249–e254CrossRefPubMedGoogle Scholar
  6. 6.
    Sillén U, Brandström P, Jodal U, Holmdahl G, Sandin A, Sjöberg I, Hansson S (2010) The Swedish reflux trial in children: v. Bladder dysfunction. J Urol 184(1):298–304CrossRefPubMedGoogle Scholar
  7. 7.
    Shaikh N, Hoberman A, Wise B, Kurs-Lasky M, Kearney D, Naylor S, Haralam MA, Colborn DK, Docimo SG (2003) Dysfunctional elimination syndrome: is it related to urinary tract infection or vesicoureteral reflux diagnosed early in life? Pediatrics 112(5):1134–1137CrossRefPubMedGoogle Scholar
  8. 8.
    Tullus K (2015) Vesicoureteric reflux in children. Lancet 385(9965):371–379CrossRefPubMedGoogle Scholar
  9. 9.
    Peters C, Rushton HG (2010) Vesicoureteral reflux associated renal damage: congenital reflux nephropathy and acquired renal scarring. J Urol 184(1):265–273CrossRefPubMedGoogle Scholar
  10. 10.
    Gobet R, Cisek LJ, Zotti P, Peters CA (1998) Experimental vesicoureteral reflux in the fetus depends on bladder function and causes renal fibrosis. J Urol 160(3 Pt 2):1058–1062 (discussion 1079)CrossRefPubMedGoogle Scholar
  11. 11.
    Garin EH, Campos A, Homsy Y (1998) Primary vesicoureteral reflux: review of current concepts. Pediatr Nephrol 12(3):249–256CrossRefPubMedGoogle Scholar
  12. 12.
    Brandström P, Esbjörner E, Herthelius M, Swerkersson S, Jodal U, Hansson S (2010) The Swedish reflux trial in children: III. urinary tract infection pattern. J Urol 184(1):286–291CrossRefPubMedGoogle Scholar
  13. 13.
    Brandström P, Nevéus T, Sixt R, Stokland E, Jodal U, Hansson S (2010) The Swedish reflux trial in children: IV. renal damage. J Urol 184(1):292–297CrossRefPubMedGoogle Scholar
  14. 14.
    Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA (2014) Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 370(25):2367–2376CrossRefPubMedGoogle Scholar
  15. 15.
    Mattoo TK, Chesney RW, Greenfield SP, Hoberman A, Keren R, Mathews R, Gravens-Mueller L, Ivanova A, Carpenter MA, Moxey-Mims M, Majd M, Ziessman HA (2016) Renal scarring in the randomized intervention for children with vesicoureteral reflux (RIVUR) trial. Clin J Am Soc Nephrol 11(1):54–61CrossRefPubMedGoogle Scholar
  16. 16.
    Keren R, Shaikh N, Pohl H, Gravens-Mueller L, Ivanova A, Zaoutis L, Patel M, deBerardinis R, Parker A, Bhatnagar S, Haralam MA, Pope M, Kearney D, Sprague B, Barrera R, Viteri B, Egigueron M, Shah N, Hoberman A (2015) Risk factors for recurrent urinary tract infection and renal scarring. Pediatrics 136(1):13–21CrossRefGoogle Scholar
  17. 17.
    Snodgrass WT, Shah A, Yang M, Kwon J, Villanueva C, Traylor J, Pritzker K, Nakonezny PA, Haley RW, Bush NC (2013) Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients. J Pediatr Urol 9(6 Pt A):856–863CrossRefPubMedGoogle Scholar
  18. 18.
    Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng NDC, Fettich J, Chaiwatanarat T, Sonmezoglu K, Kumar D, Park YH, Samuel AM, Sixt R, Bhatnagar V, Padhy AK (2004) Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. results of a coordinated research project. Pediatr Nephrol 19(10):1122–1126CrossRefPubMedGoogle Scholar
  19. 19.
    Salo J, Ikäheimo R, Tapiainen T, Uhari M (2011) Childhood urinary tract infections as a cause of chronic kidney disease. Pediatrics 128(5):840–847CrossRefPubMedGoogle Scholar
  20. 20.
    Patzer L, Seeman T, Luck C, Wühl E, Janda J, Misselwitz J (2003) Day- and night-time blood pressure elevation in children with higher grades of renal scarring. J Pediatr 142(2):117–122CrossRefPubMedGoogle Scholar
  21. 21.
    Riccabona M, Schweintzger G, Hahn H, Schmitz-Stollbrink A, Leidig E, Deeg KH, Feldkamp A (2006) Dokumentationsempfehlungen für abdominelle Sonografie im Kindes- und Jugendalter. www.degum.de/fileadmin/dokumente/sektionen/paediatrie/dokumentationsempfehlungen/P__08__Abdo_Dokumentationsempfehlung_Abdomenl__Text_.pdf. Zugegriffen: 08. April 2016Google Scholar
  22. 22.
    Daneman A, Navarro OM, Somers GR, Mohanta A, Jarrín JR, Traubici J (2010) Renal pyramids: focused sonography of normal and pathologic processes. Radiographics 30(5):1287–1307CrossRefPubMedGoogle Scholar
  23. 23.
    Leung VY, Chu WC, Yeung C, Metreweli C (2007) Doppler waveforms of the ureteric jet: an overview and implications for the presence of a functional sphincter at the vesicoureteric junction. Pediatr Radiol 37(5):417–425CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Hitzel A, Liard A, Véra P, Manrique A, Ménard J, Dacher J (2002) Color and power doppler sonography versus DMSA scintigraphy in acute pyelonephritis and in prediction of renal scarring. J Nucl Med 43(1):27–32PubMedGoogle Scholar
  25. 25.
    Bush NC, Keays M, Adams C, Mizener K, Pritzker K, Smith W, Traylor J, Villanueva C, Snodgrass WT (2015) Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. J Pediatr Urol 11(3):126.e1–126.e7CrossRefGoogle Scholar
  26. 26.
    Sinha MD, Gibson P, Kane T, Lewis MA (2007) Accuracy of ultrasonic detection of renal scarring in different centres using DMSA as the gold standard. Nephrol Dial Transplant 22(8):2213–2216CrossRefPubMedGoogle Scholar
  27. 27.
    Riccabona M, Avni FE, Blickman JG, Dacher J, Darge K, Lobo ML, Willi U (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38(2):138–145CrossRefPubMedGoogle Scholar
  28. 28.
    Rettinger T Dosisreduktion durch den Einsatz der gepulsten Durchleuchtungbei der Miktionszysturethrographie im Kindesalter [Dissertation Ludwig-Maximilians-Universität zu München. https://edoc.ub.uni-muenchen.de/16449/1/Rettinger_Tobias.pdf. Zugegriffen: 8. Apr. 2016
  29. 29.
    Ward VL, Strauss KJ, Barnewolt CE, Zurakowski D, Venkatakrishnan V, Fahey FH, Lebowitz RL, Taylor GA (2008) Pediatric radiation exposure and effective dose reduction during voiding cystourethrography. Radiology 249(3):1002–1009CrossRefPubMedGoogle Scholar
  30. 30.
    Alzen G, Benz-Bohm G (2011) Kinderradiologie – Besonderheiten des Strahlenschutzes. Dtsch Arztebl Int 108(24):407–414PubMedPubMedCentralGoogle Scholar
  31. 31.
    Seidenbusch M (2006) Rekonstruktion von Organ- und Effektivdosen bei konventionellen Röntgenuntersuchungen am Dr. von Haunerschen Kinderspital der Universität München mit einer Berechnung neuer Konversionsfaktoren für die pädiatrische Radiologie. https://edoc.ub.uni-muenchen.de/6110/1/Seidenbusch_Michael.pdf. Zugegriffen: 08. März 2016Google Scholar
  32. 32.
    ?>Hellström M, Jacobsson B (1999) Diagnosis of vesico-ureteric reflux. Acta Paediatr Suppl 88(431):3–12CrossRefPubMedGoogle Scholar
  33. 33.
    Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE (1985) International system of radiographic grading of vesicoureteric reflux. International reflux study in children. Pediatr Radiol 15(2):105–109CrossRefPubMedGoogle Scholar
  34. 34.
    Doganis D, Mavrikou M, Delis D, Stamoyannou L, Siafas K, Sinaniotis K (2009) Timing of voiding cystourethrography in infants with first time urinary infection. Pediatr Nephrol 24(2):319–322CrossRefPubMedGoogle Scholar
  35. 35.
    Kassis I, Kovalski Y, Magen D, Berkowitz D, Zelikovic I (2008) Early performance of voiding cystourethrogram after urinary tract infection in children. Isr Med Assoc J 10(6):453–456PubMedGoogle Scholar
  36. 36.
    Spencer JD, Bates CM, Mahan JD, Niland M, Staker SR, Hains DS, Schwaderer AL (2012) The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection. J Pediatr Urol 8(1):72–76CrossRefPubMedGoogle Scholar
  37. 37.
    Papadopoulou F, Ntoulia A, Siomou E, Darge K (2014) Contrast-enhanced voiding urosonography with intravesical administration of a second-generation ultrasound contrast agent for diagnosis of vesicoureteral reflux: prospective evaluation of contrast safety in 1,010 children. Pediatr Radiol 44(6):719–728CrossRefPubMedGoogle Scholar
  38. 38.
    Darge K (2010) Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol 40(6):956–962CrossRefPubMedGoogle Scholar
  39. 39.
    Darge K (2008) Voiding urosonography with US contrast agents for the diagnosis of vesicoureteric reflux in children. II. comparison with radiological examinations. Pediatr Radiol 38(1):54–63CrossRefPubMedGoogle Scholar
  40. 40.
    Duran C, Valera A, Alguersuari A, Ballesteros E, Riera L, Martin C, Puig J (2009) Voiding urosonography: the study of the urethra is no longer a limitation of the technique. Pediatr Radiol 39(2):124–131CrossRefPubMedGoogle Scholar
  41. 41.
    Fettich J, Colarinha P, Fischer S, Hahn K, Porn U, Frökier J, Gordon I, Kabasakal L, Mann M, Mitjavila M, Olivier P, Piepsz A, Roca I, Sixt R, van Velzen J (2002) Empfehlungen zur Durchführung der direkten Radionuklid-Zystographie bei Kindern. www.nuklearmedizin.de/leistungen/leitlinien/html/kinder_dir_zys.php?navId=53 Zugegriffen: 08. April 2016Google Scholar
  42. 42.
    Hadjidekov G, Hadjidekova S, Tonchev Z, Bakalova R, Aoki I (2011) Assessing renal function in children with hydronephrosis – additional feature of MR urography. Radiol Oncol 45(4):248–258CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Claudon M, Durand E, Grenier N, Prigent A, Balvay D, Chaumet-Riffaud P, Chaumoitre K, Cuenod C, Filipovic M, Galloy M, Lemaitre L, Mandry D, Micard E, Pasquier C, Sebag GH, Soudant M, Vuissoz P, Guillemin F (2014) Chronic urinary obstruction: evaluation of dynamic contrast-enhanced MR urography for measurement of split renal function. Radiology 273(3):801–812CrossRefPubMedGoogle Scholar
  44. 44.
    Dickerson EC, Dillman JR, Smith EA, DiPietro MA, Lebowitz RL, Darge K (2015) Pediatric MR Urography: indications, techniques, and approach to review. Radiographics 35(4):1208–1230CrossRefPubMedGoogle Scholar
  45. 45.
    Stenzel M, Darge K, John U, Menzel H (2015) Funktionelle MR-Urografie (fMRU) bei Kindern und Jugendlichen – Indikationen, Technikenund Anforderungen. Radiol Up2date 13(1):75–92Google Scholar
  46. 46.
    Cerwinka WH, Grattan-Smith JD, Jones RA, Haber M, Little SB, Blews DE, Williams JP, Kirsch AJ (2014) Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux. J Pediatr Urol 10(2):344–351CrossRefPubMedGoogle Scholar
  47. 47.
    Koçyiğit A, Yüksel S, Bayram R, Yılmaz İ, Karabulut N (2014) Efficacy of magnetic resonance urography in detecting renal scars in children with vesicoureteral reflux. Pediatr Nephrol 29(7):1215–1220CrossRefPubMedGoogle Scholar
  48. 48.
    Hahn K, Fischer S (2002) Strahlenexposition und Strahlenschutz bei nuklearmedizinischen Untersuchungen in der Pädiatrie. Nuklearmediziner 25:90–100CrossRefGoogle Scholar
  49. 49.
    Jang SJ (2015) Nuclear medicine in pediatric urology. Child Kidney Dis 19:14–22CrossRefGoogle Scholar
  50. 50.
    Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I, Sixt R, van Velzen J (2001) Guidelines for 99mTc-DMSA scintigraphy in children. Eur J Nucl Med 28(3):BP37–BP41PubMedGoogle Scholar
  51. 51.
    Lassmann M, Treves ST (2014) Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging. doi:10.1007/s00259-014-2731-9Google Scholar
  52. 52.
    Mori R, Lakhanpaul M, Verrier-Jones K (2007) Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. doi:10.1136/bmj.39286.700891.ADGoogle Scholar
  53. 53.
    Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJM, Radmayr C, Tekgül S (2015) Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. doi:10.1016/j.eururo.2014.11.007Google Scholar
  54. 54.
    Peters CA, Skoog SJ, Arant BS, Copp HL, Elder JS, Hudson RG, Khoury AE, Lorenzo AJ, Pohl HG, Shapiro E, Snodgrass WT, Diaz M (2010) Summary of the AUA guideline on management of primary Vesicoureteral reflux in children. J Urol 184(3):1134–1144CrossRefPubMedGoogle Scholar
  55. 55.
    Newman TB (2011) The new american academy of pediatrics urinary tract infection guideline. Pediatrics. doi:10.1542/peds.2011-1818PubMedCentralGoogle Scholar
  56. 56.
    Routh JC, Bogaert GA, Kaefer M, Manzoni G, Park JM, Retik AB, Rushton HG, Snodgrass WT, Wilcox DT (2012) Vesicoureteral reflux: current trends in diagnosis, screening, and treatment. Eur Urol 61(4):773–782CrossRefPubMedGoogle Scholar
  57. 57.
    La Scola C, de Mutiis C, Hewitt IK, Puccio G, Toffolo A, Zucchetta P, Mencarelli F, Marsciani M, Dall’Amico R, Montini G (2013) Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics. doi:10.1542/peds.2012-0164PubMedGoogle Scholar
  58. 58.
    AWMF064/007, S1-Leitlinie: Leitlinie der Gesellschaft für Pädiatrische Radiologie (GPR) in Zusammenarbeit mit der Deutschen Röntgengesellschaft: Harnwegsinfekt – Bildgebende Diagnostik. www.awmf.org/uploads/tx_szleitlinien/064-007l_S1_Harnwegsinfekt__Bildgebende_Diagnostik_2013-03_01.pdf. Zugegriffen: 8. Apr. 2016

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Abteilung für Radiologie und NuklearmedizinSchwarzwald-Baar-KlinikumVillingen‑SchwenningenDeutschland

Personalised recommendations