Fieberhafter Harnwegsinfekt im Kindesalter

Justus König1, Bernhard Haid2, Josef Oswald2
1Abteilung für Urologie, Asklepios Stadtklinik Bad Tölz, Bad Tölz, Deutschland
2Abteilung für Kinderurologie, Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern, Linz, Österreich

Tóm tắt

Harnwegsinfekte im Kindesalter sind ein ernst zu nehmendes Erkrankungsbild. Abgesehen von der Akutmorbidität, welche häufig eine stationäre Krankenhausbehandlung notwendig macht, können sie zu langfristigen Nierenfunktionseinschränkungen führen. Insbesondere der Harnwegsinfekt im Säuglingsalter und der rezidivierende fieberhafte Harnwegsinfekt des Kindes sollten besondere Beachtung hinsichtlich der langfristigen Einschränkung der Nierenfunktion finden. Die Indikation für eine weiterführende Diagnostik sollte einer sinnvollen Prüfung unterzogen werden. Fehlbildungen des Harntraktes in Kombination mit fieberhaften Harnwegsinfekten stellen einen relevanten Risikofaktor für die Entstehung einer späteren dialysepflichtigen Niereninsuffizienz dar. Zur primären Diagnostik eines Harnwegsinfekts zählen neben Anamnese und klinischer Untersuchung die adäquate Urin- sowie Laboruntersuchung und eine Sonographie der Harnorgane. Eine weiterführende Abklärung ist bei anatomischen Auffälligkeiten oder einem gesicherten fieberhaften Harnwegsinfekt indiziert und besteht, je nach Alter des Kindes und Befundkonstellation, primär entweder aus einem Miktionszystourethrogramm oder einer statischen Nierenszintigraphie. Diese Untersuchungen können einen relevanten vesikoureteralen Reflux, mögliche assoziierte Risikofaktoren und/oder eine bereits bestehende Nierenparenchymschädigung feststellen. Diese Information ist zur Entscheidung über eine weitere Behandlung, ggf. inklusive antibiotischer Prophylaxe oder operativer Behandlung, zur Verhinderung weiterer Harnwegsinfekte und einer möglichen dauerhaften Nierenfunktionseinschränkung essenziell.

Tài liệu tham khảo

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