Renal Abscess in Children: A Clinical Retrospective Study

兒童腎膿瘍是一罕見而嚴重之腎臓發炎疾病，且臨床病症多爲非特異性且不易發現。爲評估兒童時期腎膿瘍之診斷與治療特性，吾人將5年內所收集經腎臓電腦斷層(CT)確認之8例病童共9例腎臓予以回溯性分析探討。8例患童除一爲男童（6個月齡）外於皆爲女童（皆大於12個月齡）；所有患童皆表現較長時期之發燒；治療前之發燒史約持續6.1±2.6天且治療後發燒仍維持14.3±4.1天。半數患童會表現腸胃症狀（腹痛，或伴隨嘔吐），並無一人主訴腰痛。血液與尿液中之白血球數目則變異性相當大，但CRP顯示明顯上昇爲220.1±161.6mg/L。尿液培養除兩例爲陰性反應外，於6例皆爲大腸桿菌且其中一例伴隨大腸桿菌菌血症。腎臓超音波於早期僅確認了4例腎臓膿瘍，而鎝-99m DMSA腎皮質單光子核子醫學造影(DMSA)則確認5例雙側腎孟腎炎，其中四例於CT僅偵測出單側腎膿瘍。於追蹤之匒-99m DMSA腎皮質單光子核子醫學造影得知5例腎結疤而另2例則於抗生素治療後並無腎結疤後遺症。故我們建議臨床上長時間發燒之急性腎孟腎炎若對抗生素反應不如預期，需攷慮腎膿瘍之可能性。而腎膿瘍預後並不一定會腎結疤且治療上除大範圍區域需引流外，大多只需持續性抗生素即可痊癒。

關鍵字

腎膿瘍；泌尿道感染

並列摘要

A renal abscess is rare in children and diagnosis is not readily apparent before hospitalization, because symptoms are often insidious and nonspecific. To evaluate the diagnostics and therapy of renal abscess in the pediatric group, we will report eight cases of renal abscess in children to illustrate the variable features of this condition. Eight patients, 6 to 156 (mean, 45.9) months old, with renal abscesses in 9 kidneys were identified. Ultrasound and computed tomography proved to be the most valuable diagnostic tool, revealing a hypoechoic or hypodense mass. Fever, abdominal pain, and leukocytosis were common presenting features, but no child presented symptoms of loin pain. Escherichia coli was identified in the urine culture among the 6 cases and blood culture in one case. Three children were associated with mild to moderate vesicoureteral reflux. All patients had an intensive antibiotic treatment, which led to resolution of the abscess in eight of the nine kidneys. In one case, the abscess had to be drained using the CT-guided percutaneous drainage. During follow-up, seven children received 99nTDMSA renal SPECT and only two of them had complete remission without sequelae of renal scar. We concluded that the renal abscesses must be assumed, especially, in children with prolonged fever, abdominal pain, and a high value of CRP. Ultrasonography is just a screening test to detect renal swelling, bulging, and enlargement; however, a CT scan is more sensitive and can detect abscess formation, as well as define the extent of the disease for planning conservative antibiotic treatment or additional drainage. Finally, DMSA renal SPECT is the best and the most sensitive examination for detecting the extension area of renal inflammation and correlated with the renal outcome.

並列關鍵字

renal abscess ； urinary tract infection

國際替代計量

Renal Abscess in Children: A Clinical Retrospective Study

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