요로감염 환아의 임상적 관찰

Abstract

[한글]

요로감염증은 소아에서 흔히 볼 수 있는 질환으로서 진단과 치료가 지연되는 경우에 심한 신기능 장애의 원인이 되기도 한다.

저자는 1978년 1월부터 1981년 12월까지 연세대학교부속 세브란스병원에 요로감염증으로 입원한 96명의 환아를 대상으로 임상적 관찰을 하여 다음과 같은 결과를 얻었다.

1. 연령별 발생빈도는 1 - 6세군이 43예로 44.8%를 차지하였고 남녀 비는 1.7 : 1이었다.

2 .입원당시의 임상증상으로 1세미만에서는 고열 ,구토, 발육부진, 황달등을, 1세 이상에서는 고열, 혈뇨, 빈뇨, 요통, 배뇨통등을 볼 수 있었다.

3. 혈액검사 소견은 혈색소치의 감소가 23예 (24.0%), 백혈구, 증가가 27예 (28.1%), 혈침치상승이 23예. C반응성단백 양성이 22예이었으며 8예에서 혈중요소질소의 증가를 보였다.

4. 요검사상 농뇨는 67예 (69.8%), 헐뇨는 58예 (58.3%), 단백뇨는 36예 (37.5%)에서 볼 수 있었다.

5. 농뇨와 colony count와의 상관관계를 보면 농뇨가 없었던 29예 (30.2%)에서 의의있는 세균뇨를 보였으며, 농뇨가 있었던 18예(18.8%)에서 의의있는 세균뇨를 볼 수 없었다.

6. 요배양검사상 78예 (81.2%)에서 의의있는 세균뇨를 보였으며 원인균으로는 E. co1i가 45예 (56.2%)로 가장 많았고 다음으로 Klebeiella species, Staphylococcue aureus, entrococcus의 순이었다.

7. 감수성 검사에서 E.coli는 gentamicin 에 84.4%가 감수성을 보여 가장 높았으며 Klebeiella species는 gentamicin, colistin등에, Staphrylococcus aureus는 cephalothin, methicillin등에 높은 감수성을 나타내었다.

8. 정맥신우조영술을 시행한 74예중 44예 (59.5%)에서 이상소견을 볼 수 있었으며 중복요로, 신수종 또는 요관수종 및 뚜렷하게 조영되지않은 예가 가가 B예로 많았다. 이상소견을 보였던 환아는 남아25예. 여아가 19예로 남녀 비는 1. 3 : 1 이었다.

9. 방광요관역류는 16예에서 볼 수 있었으며 양측 역류가 4예, 우측역류가 5예, 좌측역류가 7예 이었다. Internatioual Refliux Study Committee의 분류법에 의한 역류정도는 grade Ⅱ가 3예, grade Ⅲ가 7예, grade가 2예, grade Ⅴ가 4예이었다.

Clinical studies of Urinary Tract Infection in Infants and Children

Kwan Hwooy Cho

Department of Medical Science The Graduate School, Yonsei University

(Directed by Assistant Professor Jae Seung Lee, M. D. )

Clinical studies on the 96 cases of urinary tract infection who were admitted to

the Pediatric department of Severance Hospital from Jan. 1978 to Dec. 1981 were

subjected in this study.

The results were as follows:

1. The incidental ratio to total inpatients was 0.7%, and difference of annual

incidence was not remarkable.

2. Seasonal difference and monthly distribution were not significant.

3. Age incidence disclosed under 1 year in 19 cases(19.8%), 1 to 6 year in 43

cases (44.8%), 7 to 12 years in 30 cases(31.3%)and above 13 years in 3 cases

(3.1%).

4. Thirty-eight cases (39.6%) were male and 58 cases (60.4%) were femal with male

to female ratio of 1 : 1.5.

Under one year of age, male (12 cases) as more commonly affected than the femal

(7 cases).

5. Fever was the most common chief complaint and hematuria vomiting, urinary and

flank pain were also common.

In infants, nonspecific symptoms such as fever, vomiting, failure to thrive and

jaundic were more common, but in the patients above one year of age, urinary

symptoms such as hematuria, urinary frequency, dysuria and turbid urine were more

common.

6. Urinalysis disclosed pyuria in 67 cases (69.8%), hematuria in 56 cases (58.3%)

and proteinuria in 36 cases (37.5%).

7. Hematologic findings showed low hemoglobin in 24.0%, leucocytosis in 28.1%,

elevated ESR in 40.4%, positive CRP in 55% and BUN over 20 mg/dl in 10.7%.

8. Relation between pyruria and colony count showed significant bacteriuria with

WBC ≥ 20/HPF on urinalysis was most common (34 cases, 35.4%) .

However, 29 cases(30.4%) showed significant bacteriuria.

9. Escherichia coli was the most common strain (45 cases, 56.2%) and Klebsiella

species, Staphylococcus aureus, enterococcus were common in descending order.

10. The Sensitivity test showed Escherichia Coli was sensitive to gentamicin,

cephalothin and amikacin..

11. Intravenous pyelography was performed in 74 cases, and 44 cases (59.5%) of

then showed abnormal findings such as double collecting systems hydronephrosis

and/or hydroureter, poor visualization of kidney and renal scarring.

12. Vesicocystourethrography findings in 33 cases showed vesicoureteral reflux in

16 cases (48.5%).

[영문]

Clinical studies on the 96 cases of urinary tract infection who were admitted to the Pediatric department of Severance Hospital from Jan. 1978 to Dec. 1981 were subjected in this study.

The results were as follows:

1. The incidental ratio to total inpatients was 0.7%, and difference of annual incidence was not remarkable.

2. Seasonal difference and monthly distribution were not significant.

3. Age incidence disclosed under 1 year in 19 cases(19.8%), 1 to 6 year in 43 cases (44.8%), 7 to 12 years in 30 cases(31.3%)and above 13 years in 3 cases (3.1%).

4. Thirty-eight cases (39.6%) were male and 58 cases (60.4%) were femal with male to female ratio of 1 : 1.5.

Under one year of age, male (12 cases) as more commonly affected than the femal (7 cases).

5. Fever was the most common chief complaint and hematuria vomiting, urinary and flank pain were also common.

In infants, nonspecific symptoms such as fever, vomiting, failure to thrive and jaundic were more common, but in the patients above one year of age, urinary symptoms such as hematuria, urinary frequency, dysuria and turbid urine were more

common.

6. Urinalysis disclosed pyuria in 67 cases (69.8%), hematuria in 56 cases (58.3%) and proteinuria in 36 cases (37.5%).

7. Hematologic findings showed low hemoglobin in 24.0%, leucocytosis in 28.1%, elevated ESR in 40.4%, positive CRP in 55% and BUN over 20 mg/dl in 10.7%.

8. Relation between pyruria and colony count showed significant bacteriuria with\ WBC ≥ 20/HPF on urinalysis was most common (34 cases, 35.4%) .

However, 29 cases(30.4%) showed significant bacteriuria.

9. Escherichia coli was the most common strain (45 cases, 56.2%) and Klebsiella species, Staphylococcus aureus, enterococcus were common in descending order.

10. The Sensitivity test showed Escherichia Coli was sensitive to gentamicin, cephalothin and amikacin..

11. Intravenous pyelography was performed in 74 cases, and 44 cases (59.5%) of then showed abnormal findings such as double collecting systems hydronephrosis and/or hydroureter, poor visualization of kidney and renal scarring.

12. Vesicocystourethrography findings in 33 cases showed vesicoureteral reflux in 16 cases (48.5%).