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[Diagnosis and therapy of pyonephrosis in infancy and childhood]
K Schneider1, F J Helmig, R Eife
1Röntgenabteilung, Universitäts-Kinderklinik München im Dr. von Haunerschen Kinderspital.
Insights
Early diagnosis of pyonephrosis in children is crucial. Renal pelvis tapping is the most effective method for suspected cases, aiding timely intervention and improving outcomes.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Pyonephrosis, a serious kidney infection, requires prompt diagnosis and management in pediatric patients.
- Urinary tract obstruction is a common underlying cause of pyonephrosis in children.
Purpose of the Study:
- To evaluate a diagnostic schedule for pyonephrosis in infants and children.
- To assess the efficacy of different diagnostic modalities in identifying pyonephrosis.
- To determine the optimal diagnostic approach for suspected pyonephrosis.
Main Methods:
- A diagnostic schedule was applied to thirteen pediatric patients with suspected pyonephrosis.
- Diagnostic imaging included sonography and excretory urography.
- Interventional procedures such as percutaneous nephrostomy and nephrectomy were performed as needed.
Main Results:
- Urinary tract obstruction was identified in 12 out of 13 patients.
- Sonography diagnosed pyonephrosis in 8 patients (64.3%).
- Excretory urography was not helpful in any of the cases evaluated.
- Renal pelvis tapping proved to be the most effective diagnostic tool.
Conclusions:
- A renal pelvis tap is the gold standard for early diagnosis of pyonephrosis in children when clinically suspected.
- Prompt diagnosis and intervention are critical for managing pediatric pyonephrosis.
- Sonography is a valuable tool, but renal pelvis aspiration offers definitive early diagnosis.
Abstract:
A diagnostic schedule in pyonephrosis was followed in thirteen infants and children. Obstruction of the urinary tract could be demonstrated in 12 patients, non-obstructive pyonephrosis was present in one case. Congenital obstructive malformation of the urinary tract was found in 7 patients, obstruction was acquired in 5. Sonographically, pyonephrosis could be diagnosed in 8 patients (64.3%). Excretory urography (10/13) was helpful in no actual case. Sonographical-guided percutaneous nephrostomies were performed in 5 patients and operative nephrostomies in 4. Emergency-nephrectomies were done in 4 patients. A tap of the renal pelvis is the best way for early diagnosis whenever pyonephrosis is clinically suspected.