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CNAA / Theses / 2008 / June /

Urinary tract infection in malformative uropathies in children. Clinic - paraclinic and medico-surgical aspects


Author: Jana Bernic
Degree:doctor habilitat of medicine
Speciality: 14.00.40 - Urology
Year:2008
Scientific consultant: Boris Curajos
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 12 June, 2008
Approved by NCAA on the 19 June, 2008

Abstract

Adobe PDF document2.39 Mb / in romanian

Thesis

CZU 616. 6-022-053.2-07-08

Adobe PDF document 3.79 Mb / in romanian
338 pages


Keywords

Surgical infection contamination, congenital malformation of kidneys and urinary system, coupled kidneys, hydronephrosis, megauretero-hydronephrosis, kidneys «in a horseshoe», a renal hypoplasia, kidney lithiasis, pyonephrosis, renal polycystosis, vesicoureteral reflux.

Summary

The study is based on the analysis of 28.985 patients, children of 0 - 18 years with urinary tract infection in malformative uropathies who were treated in the clinic of pediatric urology during 1990 - 2007. There were 6685 patients with malformative uropathies. The number of patients with congenital anomalies of kidneys constantly increases and comparative with 1990 is higher with 440. The statistical data of Pediatric Urology Clinic have taped, that children with following congenital anomalies prevailed: vesicoureteral reflux - 24,70 %, a hydronephrosis - 24,48 %, the coupled kidneys - 10,19 %, a depressive megaureterohydronephrosis of an ureter bunch 4-5 - 7,70 %, an obstructive megaureterohydronephrosis of an ureter - 7,46 %, a renal hypoplasia - 5,10 %. 354 Patients with malformative uropathies age from 0-18 undergone special examination for detecting urinary tract infection contamination. The diagnostic algorithm included clinical, general blood analysis, biochemical survey of erythrocytes, blood serum, urine and bacteriological examination of urine. Bacteriological examination of urine has shown the presence of anaerobic flora, prevailing E.coli (50 % of cases).

Malonic dialdehyde (MDA), lipid hydroperoxides, superoxid dismutase (SOD), catalase (CAT), glutathione cycle, cytoplasmic and lysosomal enzymes and endotoxin markers were determinated in erythrocytes and blood serum. The urine were tested for pseudocolinesterase, neutral alfa-glycosidase, N-acetyl-glucoseaminidase-beta, alkaline phosphates, gamma-glutamiltranspeptidase, lactate dehydrogenase, elastase, carnosine, NO, endotoxin markers. Strong correlations between blood and urine parameters were found. This correlation is a predisposing factor for urinary tract infection in malformative uropathies.

The algorithm that was proposed and included non-invasive clinical and paraclinical methods of investigation is optimal for prevention, early detection of urinary tract infection in malformative uropathies in children and establishment of the correct diagnosis. It was proved the necessity of this monitoring during the homeostasis redressation.

Ultrasound examination of the urinary tract in the intrauterine period, in newborns and in infants is necessary for detection of congenital uropathies. All children in the remission period were submitted to abdominal X-ray examination, excretory urography, cystourethrography, renal scintigraphy, computer tomography to establish the final diagnosis and for differential diagnosis. Pathomorphologic examination of patients revealed a number of heterogeneous changes such as dysplasia’s of renal tissue, lack of differentiation of embryonic structure of the tissue, presence of infection (cytomegalovirus), which in complex are a significant risk in kidney disembriogenesis, congenital uropathies and renal functional abnormalities.

The late establishment of the diagnosis of urinary tract infection in malformative uropathies in 28 % of children leaded to retardation of fizical development (low body mass and high).

Restoring the homeostatic equilibrium and elimination of risk factors of infection development in children with malformative uropathies were the purpose of the conservative treatment.

Surgical treatment was binding for all surveyed patients. Dispite the correct clinico-surgical management of the pacients, in 70 % from cases chronic pyelonephritis developed. Cronical renal failure developed in 4 patients that determined their dependence on hemodialysis.