Medical management of vesicoureteral reflux--quiz within the article. Don't overlook placebos.
Medical management of vesicoureteral reflux--quiz within the article. Don't overlook placebos.
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DOI：
10.1007/s00467-007-0485-3
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发表时间：
2007-08
期刊：
影响因子：
--
通讯作者：
Mattoo TK
中科院分区：
文献类型：
--
作者：
Mattoo TK
儿童膀胱输尿管反流（VUR）与尿路感染（UTI）风险增加相关。存在VUR时复发性UTI被认为会导致肾瘢痕形成，这会带来后续高血压、妊娠毒血症和显著肾损伤（包括终末期肾病）的风险。VUR的自然史是随着时间的推移在大多数患者中改善或完全消退。传统的管理包括及时治疗UTI，长期抗菌预防直至VUR消退，或对持续高度VUR、尽管使用抗菌剂预防但复发性UTI、对抗菌剂过敏以及患者/父母不依从医疗管理的患者进行手术干预。排尿功能障碍和便秘起着重要的作用，其诊断和适当的管理有助于减少UTI的频率和促进VUR的解决。需要监测肾瘢痕形成患者的潜在并发症，如高血压、蛋白尿和肾损害进展。在高血压和/或蛋白尿患者中，血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）是首选药物，因为它们具有肾脏保护特性。最近的研究表明，没有令人信服的证据表明，在VUR的存在下，UTI可以预测肾损伤，或者使用长期的抗微生物预防或手术干预可以预防肾瘢痕形成或其进展。然而，除非通过前瞻性、安慰剂对照、随机研究证明并非如此，否则建议谨慎行事，考虑VUR和UTI风险因素对肾瘢痕形成的影响，并对每例患者进行个体化治疗。
Vesicoureteral reflux (VUR) in children is associated with increased risk of urinary tract infection (UTI). Recurrent UTI in the presence of the VUR is believed to cause renal scarring, which carries a risk of subsequent hypertension, toxemia of pregnancy, and significant renal damage, including end-stage renal disease. The natural history of VUR is to improve or resolve completely with time in most of the patients. The traditional management consists of prompt treatment of UTI, long-term anti-microbial prophylaxis until the VUR resolves, or surgical intervention in those with persistent high grade VUR, recurrent UTI in spite of prophylaxis with anti-microbial agent, allergy to anti-microbial agents, and patient/parent non-compliance with the medical management. Voiding dysfunction and constipation play an important role, and their diagnosis and appropriate management helps reduce the frequency of UTI and promote the resolution of the VUR. Patients with renal scarring need to be monitored for potential complications such as hypertension, proteinuria, and progression of the renal damage. In patients with hypertension and/or proteinuria, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) are the drugs of choice, because of their reno-protective properties. Recent studies have revealed that there is no convincing evidence that UTI in the presence of VUR predicts renal injury or that the use of long-term anti-microbial prophylaxis or surgical intervention prevents renal scarring or its progression. However, until proven otherwise by a prospective, placebo-controlled, randomized study, it is advisable to err on the side of caution and consider VUR and UTI risk factors for renal scarring and treat each patient on individual basis.
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影响因子：
6.6
作者：
Herndon, CDA;Decambre, M;McKenna, PH
通讯作者：
McKenna, PH
影响因子：
3
作者：
Karlen, J;Linne, T;Aperia, A
通讯作者：
Aperia, A
DOI：
10.1046/j.1464-410x.1997.00447.x
发表时间：
1997-11-01
期刊：
BRITISH JOURNAL OF UROLOGY
影响因子：
--
作者：
Glazier, DB;Murphy, DP;Barone, JG
通讯作者：
Barone, JG
影响因子：
6.6
作者：
BAILEY, RR;LYNN, KL;SMITH, AH
通讯作者：
SMITH, AH
影响因子：
6.6
作者：
JERKINS, GR;NOE, HN
通讯作者：
NOE, HN