儿童肾脓肿24例临床分析

Clinical analysis of pediatric renal abscess in 24 cases

目的:分析儿童肾脓肿的临床特点,为早期诊断、治疗和随访提供参考。方法:本研究为回顾性队列研究,共纳入武汉儿童医院肾内科2018年1月至2023年6月诊断为肾脓肿的患儿24例。收集患儿的临床表现、实验室及影像学检查、治疗和随访数据。分类变量的数据采用Fisher′s精确检验,连续变量分析采用Kruskal-Wallis检验。结果:入组患儿中男女各12例,年龄17.96(8.26,49.56)个月。起病症状以发热和纳差/呕吐常见。实验室检查以炎症急性期指标升高为主;13例(54.2%)患儿尿白细胞阴性;病原学阳性率低,血培养阳性者1例,为粪肠球菌;尿培养阳性者4例,其中粪肠球菌2例,屎肠球菌1例,黄曲霉菌1例。影像学检查:肾脏超声提示肾脓肿者15例,提示肾脓肿可疑者9例(其中7例经超声增强检查明确,2例经肾脏CT+增强明确);15例患儿行肾静态显像,均提示肾脏皮质功能受损;14例患儿行逆行尿路造影,9例(64.3%)阳性。21例患儿内科保守治疗成功。肾脓肿3 cm以内的患儿抗生素总疗程2~3周,3 cm以上者为3~4周,3例患儿行外科干预,其中经皮引流2例,1例行患肾及输尿管切除术。肾脓肿≤2 cm者影像学恢复时间为10(7,15)d,2~4 cm者为21(15,30)d。共22例患儿规律门诊随访(1~6个月),均未见脓肿复发。结论:肾脓肿的临床表现及实验室检验均无特异性,肾脏超声是肾脓肿最简单经济的诊断方式。建议肾脓肿患儿完善逆行尿路造影及肾静态显像评估有无膀胱输尿管反流和肾脏瘢痕形成。4 cm以内的肾脓肿可首选内科保守治疗。

Objective To analyze the clinical characteristics of renal abscesses in children and provide references for its early diagnosis,treatment and follow-up.Methods A retrospective cohort study of 24 pediatric patients diagnosed with renal abscesses at the Department of Nephrology,Wuhan Children′s Hospital,from January 2018 to June 2023 was conducted.The data about clinical presentations,laboratory and imaging examinations,treatments,and follow-ups were analyzed.Categorical variables were analyzed by Fisher′s exact test,and continuous variables were analyzed by Kruskal-Wallis test.Results There were 12 boys and 12 girls in this study,with the age of 17.96(8.26,49.56)months.Common initial symptoms included fever,poor appetite,and vomiting.Laboratory investigations primarily showed elevated inflammatory markers during the acute phase.Thirteen cases(54.2%)had negative urine leukocyte counts.The rate of pathogen detection was low,with one blood culture positive for Enterococcus faecalis and four urine cultures positive for Enterococcus faecalis(2 cases),Enterococcus faecium(1 case),and Aspergillus flavus(1 case).Renal ultrasound suggested that there were 15 cases of renal abscesses and 9 cases with suspicious renal abscesses(7 cases were confirmed by contrast-enhanced ultrasound and 2 cases by renal contrast-enhanced CT).Renal static scintigraphy was performed in 15 cases,all of which indicated compromised renal cortical function.Retrograde urography was conducted in 14 cases,with 9 positive cases(64.3%).Twenty-one patients achieved successful medical treatment.Children with renal abscesses smaller than 3 cm received 2-3 weeks of antibiotic treatment,while those with renal abscesses larger than 3 cm received 3-4 weeks of antibiotic treatment.Surgical interventions were performed in 3 cases,including percutaneous drainage in 2 cases and nephrectomy with urethrectomy in 1 case.The median recovery time was 10(7,15)days for renal abscesses within 2 cm and 21(15,30)days for renal abscesses within 2-4 cm.A total of 22 children were regularly followed up as outpatients for 1-6 months,and no abscess recurrence was seen.Conclusions The clinical manifestations and laboratory tests of renal abscesses are not specific,and renal ultrasound is the simplest and cheapest way to diagnose renal abscesses.Retrograde urography and renal static scintigraphy are recommended to evaluate vesicoureteral regurgitation and renal scarring.Abscesses smaller than 4 cm can be treated conservatively.