Profilaktična primjena antibiotika u djece s vezikoureteralnim refluksom

master's thesis

• Title (english): Continued antibiotic prophylaxis in children with vesicoureteral reflux
• Author: Martin Đevenica
• Mentor: Lovro Lamot (mentor)
• Committee member: Lorna Stemberger Marić (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Lovro Lamot (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Vezikoureteralni refluks (VUR) najčešća je kongenitalna anomalija mokraćnog sustava u dječjoj dobi, koja se obično dijagnosticira prilikom evaluacije djece s infekcijom mokraćnog sustava (engl. urinary tract infection, UTI). Zlatni standard za dijagnozu VUR-a je mikcijska cistouretrografija, premda se danas zbog izbjegavanja izlaganja ionizirajućem zračenju više koristi kontrastna mikcijska urosonografija. VUR je povezan s ponavljajućim infekcijama mokraćnog sustava (engl. recurrent urinary tract infection, rUTI) i bubrežnim ožiljkavanjem, odnosno refluksnom nefropatijom (RN). RN može rezultirati kroničnom bubrežnom bolešću s progresivnim opadanjem bubrežne funkcije, koja u konačnici zahtijeva bubrežnu nadomjesnu terapiju. Kirurškim i konzervativnim pristupom nastoje se spriječiti ove posljedice, međutim izbor optimalne terapije u djece s VUR-om usprkos brojnim istraživanjima još je uvijek uzrok kontroverzi. Kirurškim pristupom vršimo korekciju refluksa, dok profilaktičnom primjenom antibiotika (engl. continued antibiotic prophylaxis, CAP) nastojimo prevenirati UTI-je i tako zaštititi bolesnika od novog bubrežnog ožiljkavanja. S obzirom na veliku učestalost spontane rezolucije, osobito kod nižih stupnjeva VUR-a, opravdano je odlučiti se za konzervativni pristup, koji osim CAP-a uključuje i pomno praćenje. Multicentrične randomizirane kliničke studije na velikom broju ispitanika pokazale su značajnu korist CAP-a u prevenciji rUTI-ja. K tome, djeca s VUR-om i dodatnim rizičnim čimbenicima za rUTI, poput disfunkcije mokraćnog mjehura i crijeva, imaju još izraženiju korist od CAP-a, koji je preporučena terapija u toj populaciji. S druge strane, trenutno nema uvjerljivih dokaza da CAP može učinkovito spriječiti nastanak ili progresiju RN-a. K tome, CAP može dovesti do neželjenih pojava poput antimikrobne rezistencije i multirezistentnih bakterija. Stoga je potrebno prepoznati individualne čimbenike rizika u djeteta s VUR-om, procijeniti korist CAP-a naspram drugih intervencija te uključiti obitelj u zajedničko donošenje odluke o liječenju.

Abstract (english)

Vesicoureteral reflux (VUR) is the most common congenital anomaly of the urinary tract in childhood, typically diagnosed during the evaluation of children with urinary tract infections (UTIs). The gold standard for diagnosing VUR is voiding cystourethrography, although to avoid radiation exposure, contrast enhanced urosonography is nowadays becoming the preferred method. VUR is associated with recurrent urinary tract infections (rUTIs) and renal scarring, also known as reflux nephropathy (RN). RN can lead to chronic kidney disease with progressive decline in renal function, ultimately requiring renal replacement therapy. Both surgical and conservative approaches aim to prevent these consequences; however, the choice of optimal therapy in children with VUR is a subject of considerable debate. Surgical intervention corrects the reflux, while continued antibiotic prophylaxis (CAP) aims to prevent UTIs and thus protect the patient from further renal scarring. Given the high rate of spontaneous resolution, particularly in lower grades of VUR, a conservative approach, including CAP and close monitoring, is justified. Multicentric randomized clincal trials with large cohorts have shown significant benefits of CAP in preventing rUTIs. Moreover, children with VUR and additional risk factors for rUTIs, such as bladder and bowel dysfunction, have even greater benefit from CAP, which is the recommended therapy for this population. On the other hand, there is currently no compelling evidence that CAP can effectively prevent the development or progression of RN. Additionally, CAP can lead to adverse effects such as antimicrobial resistance and multidrug-resistant bacteria. Therefore, it is essential to identify individual risk factors in children with VUR, assess the benefits of CAP against other interventions, and involve the family in the shared decision-making process regarding treatment.

• Keywords: vezikoureteralni refluks; refluksna nefropatija; profilaktična primjena antibiotika
• Keywords (english): vesicoureteral reflux; reflux nephropathy; continued antibiotic prophylaxis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:505330
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-06-24 17:16:24