renal scar
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Objective: To determine the rate and the type of recurrent UTI in ventriculoperitoneal shunted children's admitted to Azady Teaching Hospital, Kirkuk.. Methods: From mid 2015 to end of 2020; UTI in ventriculoperitoneal shunted children's . Once infection was suspected , CSF (from shunt reservoir or from ventricular tapping), blood, and urine samples, analysis, and culture taken and empirical antibiotics were recommended. Results: 25.9% of patients with VP shunts had infections which represents 29.3% of the procedures. 40% of infected patients had recurrent episodes. 59.1% of infections occurred throughout the first two months following insertion. Single pathogen was isolated in each episode. E.coli represented 50% of isolated pathogens compared with 18.2% with Staphylococcus epidermidis. Conclusions: There is a high incidence of recurrent UTI in ventriculoperitoneal shunted children's in Azady Teaching Hospital, Kirkuk. when compared withother international centres. Gram negative organisms are the most common cause of the infection. Keywords: Urinary tract infection= UTI ,Renal scar.,BBD = Bladder Bowel Dysfunction; DMSA = dimercaptosuccinic acid; IV

Abstract Background Acute focal bacterial nephritis (AFBN) is a seldom infection in children kidney disease,Vesicoureteral reflux(VUR) often exist in infants who are easy to have urinary tract infection(UTI).In this study,we summarize the clinical features ,imaging and therapy. Methods eleven patients with AFBN and VUR aged from two months to eight months treated at this hospital from January 2017 to August 2019 were reviewed.The manifestations,urine and blood tests, imagings,treatments of patients were analyzed retrospectively. Results Fever was the common symptom,blood CRP was higher than normal(25 mg/L-200 mg/L),The percentage of neutrophils in blood was 52%-85%.The ratio of neutrophils to lymphocytes was 1.39–11.6,Routine urine microscopic examination of leukocyte was +∽3+/HP,Urine culture samples were 42, 34 samples were positive, the positive rate was 80.95%.Diagnosis was set by CT combined MCU.Enhanced CT conducted for all patients showed hypoperfused wedged-shaped or round and space-occupying lesions in kidney.MCU conducted showed I-V grade VUR in single or both sides.9 cases were treated with prophylactic antibiotics, DxHA injection was operated on 1 case, cohen operation for another patient.Relapses were rarely occur after insisting on treatment. Conclusion AFBN in children are rare and associated with VUR. Patients with AFBN should perform MCU to find out VUR and insist on prophylactic antibiotic until the VUR disappeared, patients with recurrent infection and serious VUR need urological treatment in order to prevent the formation of renal scar.

Introduction Detecting renal scar is important in pediatric patients with vesicoureteral reflux (VUR) for deciding on treatment option. The aim of this study is to detect whether freehand elastosonography technique could be an alternative to dimercaptosuccinic acid (DMSA) scan in determining renal scar formation. Materials and Methods Between November 2015 and April 2016, 25 VUR patients, age ranging from 3 to 17 years admitted to our clinic, had urinary ultrasound and elastosonography, and data of approximately 147 renal region were recorded. Data were upper, middle, and lower pole renal parenchymal thickness and echogenicities obtained by ultrasound and these poles strain target (ST), strain reference (SR), and strain index (SI) values obtained by freehand elastosonography. DMSA scan data (differential function and upper, middle, and lower pole parenchymal scar formation) were recorded. Results Scar formation and more than 10% reduction in differential function in renal scan were statistically higher in renal regions in which parenchymal thinning and echogenicity increase was detected by ultrasound. There was no elastosonographic data difference between renal units with and without differential function decrease. Also, there was no elastosonographic data difference between renal units with and without scar formation. Conclusion In this study, we could not find any significant difference in term of tissue tension values (ST and SI) measured by freehand elastosonography between renal units with and without scar formation in renal scan.