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Der Urologe

, Volume 56, Issue 2, pp 247–262 | Cite as

Harnwegsinfekte bei Kindern

  • E. LelligEmail author
  • M. ApfelbeckEmail author
  • J. Straub
  • A. Karl
  • S. Tritschler
  • C. G. Stief
  • M. Riccabona
CME

Zusammenfassung

Harnwegsinfekte (HWI) sind die häufigsten bakteriellen Infektionen im Kindesalter. Diese imponieren jedoch häufig mit unspezifischen Symptomen wie Trinkschwäche, Unterbauchschmerzen oder einer neu aufgetretenen Enuresis nocturna. Die Art der Uringewinnung spielt eine entscheidende Rolle zur Diagnosesicherung. Bei nicht toilettentrainierten Kindern sollte die Uringewinnung mittels Katheterurin oder suprapubischer Punktion erfolgen. Bei toilettentrainierten Kindern ist Mittelstrahlurin zur mikrobiologischen Untersuchung ausreichend. Die rasche Einleitung einer antibiotischen Therapie ist essenziell zur Verhinderung von Parenchymnarben der Nieren. Mittel der Wahl sind hierbei Cephalosporine der 3. Generation. Viele Kinder mit rezidivierenden HWI weisen einen vesikoureteralen Reflux (VUR) auf. Die Vorgehensweise zur Diagnosesicherung eines VUR wird in den einzelnen Ländern unterschiedlich gehandhabt. In Deutschland wird überwiegend die „Bottom-up“-Strategie verfolgt. Diese beinhaltet zunächst die Durchführung eines Miktionszystourethrogramms und im Falle eines Refluxnachweises im Anschluss den Ausschluss oder Nachweis von Parenchymnarben mittels DMSA-Szintigraphie.

Schlüsselwörter

Harnwegsinfekte Uringewinnung Miktionszystourethrographie DMSA-Szintigraphie Antibiotische Therapie 

Urinary tract infections in children

Abstract

Urinary tract infections (UTI) are the most common bacterial infections in children. The symptoms are not very specific and range from abdominal pain, poor feeding to nocturnal urinary incontinence. The technique of collecting urine plays an important role for securing the diagnosis. The best way to obtain urine in non-toilet-trained children is catheterization or suprapubic bladder aspiration. In toilet-trained children midstream urine is an acceptable alternative after cleaning the foreskin or labia. In the case of an infection a prompt empirical antibiotic therapy is necessary to reduce the risk of parenchymal scarring of the kidneys. There are different approaches to diagnose vesicoureteral reflux in different countries. The commonly used standard approach in Germany is voiding cystourethrography. In the case of reflux dimercaptosuccinic acid (DMSA) scintigraphy should be performed additionally to exclude renal scarring (bottom-up approach).

Keywords

Urinary tract infections Urine sampling Voiding cystourethrography DMSA scintigraphy Antibiotic therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

E. Lellig, M. Apfelbeck, J. Straub, A. Karl, S. Tritschler, C. G. Stief und M. Riccabona geben an, dass kein Interessenkonflikt besteht.

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

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Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Urologische Klinik und PoliklinikLudwig-Maximilians-Universität München, Campus GroßhadernMünchenDeutschland

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