小児無菌性膀胱尿管逆流現象の臨床的検討

Abstract

1)当科に過去6年間に入院した小児膀胱尿管逆流現象(VUR) 19症例のうち, sterile VURは5例でinfected VURは14例であった.2) sterile VUR症例は主訴が高血圧, 蛋白尿, 遺尿(昼間のみ, または昼夜とも)であり, infected VUR症例の主訴は発熱, 排尿痛, 頻尿であり, sterile VUR症例では診断までの期間が長い傾向がみられた.3) VURの程度はsterile VUR症例で高度である傾向がみられた.4)腎瘢痕はsterile VUR症例では7腎すべてにみとめられたが, infected VUR症例では23腎中15腎にみられた

A clinical study of 5 children (3 boys and 2 girls) with primary sterile vesicoureteral reflux is presented. Their ages ranged from 8 to 11 years old. During the same period, we saw 14 children (6 boys and 8 girls) with primary infected vesicoureteral reflux. Their ages ranged from 1 to 13 years old. There were several distinctions between these two reflux groups. Manifestations of the infected reflux group were mainly fever attacks, while those of the sterile reflux group were hypertension, proteinuria and enuresis. The duration from onset to diagnosis was longer in the sterile reflux group because their manifestations did not appear to be severe especially in cases of enuresis. The grade of reflux tended to be more advanced in sterile reflux group. The renal scarrings were identified in all involved kidneys in the sterile reflux, while in 65.2% in the infected reflux group. It is difficult to detect sterile reflux early because the manifestations are not related with urinary tract infection. Recently, reflux nephropathy is a subject of frequent discussion and end stage of reflux nephropathy has been sporadically reported. Therefore, an effort should be made for early detection of sterile reflux. Based on our experiences as well as review of the literature, possible clues to detect sterile reflux are abnormal voiding patterns, such as nocturnal enuresis, incontinence, frequency and so on.