Resumen

ALCONCHER, Laura  y  TOMBESI, Marcela. Relación entre pielonefritis aguda, daño renal y reflujo vesicoureteral. Arch. argent. pediatr. [online]. 2007, vol.105, n.3, pp.211-215. ISSN 0325-0075.

Introduction. The relationship between acute pyelonephritis, vesicoureteral reflux and renal damage is controversial. Objectives. To determine: 1) prevalence of renal damage in children with acute pyelonephritis, 2) relationship between reflux, age, number of recurrences and renal damage, 3) evolution of patients with renal damage. Population, material and methods. We studied 95 patients with acute pyelonephritis. All of them were investigated with ultrasonography, cystouretrography and renal scintigraphy. Patients with antenatal diagnosis of vesicoureteral reflux or other non-reflux urologic abnormalities were excluded. Renal damage was defined as focal defects and /or a diffuse reduction of the uptake with a relative renal function below 45%, 6 months after the acute pyelonephritis. Blood pressure, proteinuria and creatinine clearance in patients with renal damage were evaluated. We used Chi square, p< 0.05 was considered statistically significant. Results. Sixty seven patients (70.6%) had vesicoureteral reflux and 48 (50.5%) renal damage. Renal damage was present in 49% and 54% of patients with and without reflux (p= 0.70) pNS. Forty per cent and 72% of patients younger and older than 2 year old had renal damage (p= 0.003). Renal damage was observed in 30%, 53% and 61% of patients with 1, 2 and more acute pyelonephritis. During the follow-up of patients with renal damage 7 developed hypertension, 14 proteinuria and 1 decreased renal function. Conclusions. Half of the patients with acute pyelonephritis had renal damage. There was reflux without renal damage and renal damage without reflux. Renal damage increased with age and recurrences of acute pyelonephritis. Hypertension and proteinuria developed in 15% and 29% of patients with renal damage, respectively.

Palabras clave : Acute pyelonephritis; Vesicoureteral reflux; Renal damage; Renal scintigraphy.

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