OBSTRUCTIVE UROPATHY

In our article we repeatedly emphasize the importance of sonographic renal screening in newborns, and we also want to point out the possibilities of further diagnostic and treatment in the case of a positive screening test. Despite the fact that neonatal kidney screening in the Slovak Republic is done nationwide, there are certain problems at the various stages of its implementation. We believe that the proven and proposed procedures should be standard as these procedures are a useful tool for improving the quality of health care of the population and also affect public health. The aim of this article is to emphasize the need for screening sonography of the kidneys in newborns and also to introduce the proposed standard diagnostic and therapeutic procedure to the professional public.

ARTICLE INFO ______________________________________________________________ ______________________ Purpose: To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography. Materials and Methods: 60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated. B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys. Results: The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction. Conclusion: Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.

Background: Improper use and increased consumption of antibiotics is one of the main causes of microbial resistance spreading. The spread of multi-resistant bacterial isolates poses a serious threat to public health. Escherichia coli is part of the normal intestinal microflora in humans but is also a frequent cause of severe infections and is the most common cause of febrile urinary tract infections in all age groups. The aim of the retrospective study was the analysis of microbiological agents and the effectiveness of antimicrobial therapy of urinary tract infections in 34 children. The results were evaluated according to various criteria, including the presence of congenital malformations of the uropoetic tract. We point to the rising trend of antibiotic resistance in Europe towards Escherichia coli, which is partly different from our results.
Patients and methods: retrospectively were analyzed 34 patients with urinary tract infections, which were treated on III. Children's Clinic of the Slovak Medical University in Luchenec from January 2018 to December 2018.
Results: the most common developer of febrile urinary tract infection in all age groups was Escherichia coli (27 children, 79.4%). In a group of patients with E. coli infection and without congenital malformations of the uropoetic tract, resistance to selected antibiotics was minimal. Patients with congenital kidney malformations had higher rates of non-Escherichia coli infections and higher resistance to antibiotics tested.
Conclusion: treatment of febrile urinary tract infections by third generation cephalosporins is appropriate in our workplace because the bacterial strains of these antibiotics show good sensitivity. In most cases, monotherapy with bactericidal antibiotics is sufficient. Treatment with second-generation cephalosporins was effective in some patients with uncomplicated lower urinary tract infection. Patients with congenital malformations of the uropoetic tract have more frequent non-E.coli infections and higher resistance to antimicrobial agents.
Key words: antibiotics, Escherichia coli, congenital malformations of the uropoetic tract, pyelonephritis, resistance, urinary tract infections, urosepsis.