Fieberhafter Harnwegsinfekt im Kindesalter

Ist eine invasive Diagnostik immer notwendig?

Febrile urinary tract infections in children

Are invasive diagnostics always necessary?

Zusammenfassung

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.

Abstract

Urinary tract infections (UTI) in childhood are a serious illness concerning acute morbidity, inpatient hospital treatment and—ultimately—their association with end-stage renal disease. The indication for further, more invasive diagnostics should be subjected to a critical review. Congenital anomalies of the urinary system in combination with febrile urinary infections are a relevant risk factor for the development of renal disease. In addition to patient history and clinical examination, the primary diagnosis of a urinary tract infection includes appropriate urine and laboratory examination and a urologic sonography. Further investigation is indicated in the presence of anatomical abnormalities or after a confirmed, clinically relevant febrile urinary tract infection. Further diagnostic workup primarily includes voiding cystourethrography and/or a dimercaptosuccinic acid (DMSA) scan. After assessment of relevant vesicoureteral reflux and/or renal parenchyma damage, the decision of further surgical treatment can be made to prevent further UTIs and renal disease.

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Correspondence to Justus König.

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J. König, B. Haid und J. Oswald geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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König, J., Haid, B. & Oswald, J. Fieberhafter Harnwegsinfekt im Kindesalter. J. Urol. Urogynäkol. AT 27, 59–65 (2020). https://doi.org/10.1007/s41972-019-00091-5

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Schlüsselwörter

  • Fieberhafter Harnwegsinfekt
  • Kind
  • Invasive Diagnostik
  • MCU
  • Nierenfunktionseinschränkung

Keywords

  • Febrile urinary tract infection
  • Pediatrics
  • Invasive diagnostics
  • Voiding cystourethrography
  • End-stage renal disease