fa پیشگویی اسکار کلیه با سونوگرافی در مقایسه با Dimercapto Succinic Acid در کودکان مبتلا به پیلونفریت و ریفلاکس وزیکویورترال نفرولوژی کودکان Pediatric Nephrology پژوهشي-کامل Research(Original) <span style="font-size:12pt"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="FA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">سونوگرافی به عنوان ابزار در دسترس، ارزان، غیرتهاجمی و بدون اشعه را شاید بتوان جایگزین </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">Dimercapto Succinic Acid</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> (</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">) برای ارزیابی آسیب کلیه در نظر گرفت. این مطالعه با هدف مقایسه پیشگویی آسیب کلیه با سونوگرافی نسبت به روش استاندارد </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در کودکان مبتلا به پیلونفریت و ریفلاکس انجام شد.<span style="color:#0e101a"></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">این مطالعه مقطعی روی کودکان یک ماه تا 18 سال با تشخیص پیلونفریت و ریفلاکس وزیکویورترال </span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">درجه 2 و بالاتر بستری در بیمارستان کودکان امیرکلا در سال</span></span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">&lrm;</span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">های 1399-1390 انجام شد. </span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">در زمان بستری سونوگرافی از کلیه</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> کودکان و چهار تا شش ماه پس از عفونت ادراری، </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> انجام شد. حساسیت، ویژگی و ارزش اخباری مثبت و منفی سونوگرافی با </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> تعیین و ضریب توافق کاپا نیز بین سونوگرافی و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">سنجش شد. سطح معنی</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">داری 05/0</span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">P</span></span><i><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><</span></span></i><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در نظر گرفته شد.</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">از 220 کودک مبتلا به پیلونفریت و ریفلاکس، 153 کودک وارد مطالعه شدند. در سونوگرافی، از 306 واحد کلیه، بترتیب 262 (85/6 درصد) و 44 (15/1 درصد) واحد طبیعی و غیر طبیعی بودند و در<i> </i></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">، به</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">ترتیب 128 <span style="letter-spacing:-.2pt">(41/8درصد)، 178 (58/2 درصد) واحد طبیعی و غیرطبیعی بودند. حساسیت و ویژگی سونوگرافی در پیشگویی آسیب کلیه</span></span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">&lrm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.2pt">ها</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> به ترتیب 19درصد (</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black">27-12 درصد</span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black">CI:</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">) و 86 رصد (</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black">97-74 درصد</span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black">CI:</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">) بود. ارزش اخباری مثبت و منفی سونوگرافی <span style="letter-spacing:-.1pt">نسبت به </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="letter-spacing:-.1pt">DMSA</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt"> در پیشگویی آسیب کلیه</span></span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">&lrm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">ها به ترتیب 82 درصد (</span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">96-68 درصد</span></span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black"><span style="letter-spacing:-.1pt">CI:</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">) و 24درصد (</span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">31-17 درصد</span></span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="color:black"><span style="letter-spacing:-.1pt">CI:</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">) بود</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">.<span style="color:black"></span></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">سونوگرافی به تنهایی قادر به پیشگویی آسیب کلیه</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">ها به دنبال عفونت ادراری و ریفلاکس وزیکویورترال نیست و در موارد نیاز باید از </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> استفاده کرد. ولی در صورت طبیعی بودن سونوگرافی احتمال وجود آسیب کلیه</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">ها توسط </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%">DMSA</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> بسیار کم</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">تر می</span></span><span lang="AR-BH" style="line-height:90%"><span b="" style="font-family:" zar="">&lrm;</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">باشد.</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span></span> <span style="font-size:12pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:"><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">Ultrasound is easily available, cheap, non-invasive and radiation-free that could be considered as an alternative to Dimercaptosuccinic Acid (DMSA) in evaluation of kidney damage. The aim of this study was to determine the prediction of kidney damage in ultrasound compared with DMSA (standard method) in children with pyelonephritis and vesicoureteral reflux.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">This cross-sectional study was performed in children aging one month to 18 years old with pyelonephritis and vesicoureteral reflux grade 2 and higher admitted in Amirkola Children&#39;s Hospital, 2011-2020.</span></span><span style="font-size:10.0pt"><span style="line-height:150%"> Renal ultrasound was done in all children at admission and DMSA was done after at least 4-6 months. Then, </span></span><span style="font-size:10.0pt"><span style="line-height:150%">sensitivity, specificity, and positive and negative predictive values of </span></span><span style="font-size:10.0pt"><span style="line-height:150%">ultrasound </span></span><span style="font-size:10.0pt"><span style="line-height:150%">were studied. The kappa coefficient was determined for the percentage agreement between ultrasound and DMSA. </span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">Out of 220 children with pyelonephritis and reflux, 153 were included in the study.</span></span> <span style="font-size:10.0pt"><span style="line-height:150%">In </span></span><span style="font-size:10.0pt"><span style="line-height:150%">ultrasound</span></span><span style="font-size:10.0pt"><span style="line-height:150%">, out of 306 kidneys, 262 (85.6%) and 44 (15.1%) were normal and abnormal, respectively, but DMSA showed 128 (41.8%) normal and 178 (58.2%) abnormal kidneys. The sensitivity and specificity of ultrasound in predicting kidney damage compared with DMSA were 19% (CI: 12-27%) and 86% (CI: 97-74%), respectively. The positive and negative predictive values of ultrasound compared with DMSA in predicting kidney damage were 82% (CI: 68-68%) and 24% (CI: 17-31%), respectively.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span style="vertical-align:top"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Conclusion:</span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">Based on current study, ultrasound alone is not able to predict kidney damage following pyelonephritis and vesicoureteral reflux and DMSA should be performed. If the ultrasound is normal, the chances of detecting kidney damage are much lower in DMSA.</span></span><i><span style="font-size:10.0pt"><span style="line-height:150%"></span></span></i></span></span></span></span> سونوگرافی, Dimercapto Succinic Acid, پیلونفریت, ریفلاکس وزیکویورترال, کودکان, آسیب کلیه ultrasound, kidney damage, Dimercaptosuccinic Acid, pyelonephritis, vesicoureteral reflux 62 70 http://jmums.mazums.ac.ir/browse.php?a_code=A-10-15424-1&slc_lang=fa&sid=1 Mohsen Mohammadi محسن محمدی dr.mohamadi61@yahoo.com 1003194753284600150341 1003194753284600150341 No Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran مرکز تحقیقات بیماری های غیر واگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Shiva Yousefi شیوا یوسفی shivausefi1372@yahoo.com 1003194753284600150342 1003194753284600150342 No Medical Student, Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran دانشجوی پزشکی، کمیته تحقیقات دانشجویی، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل ایران Maryam Nikpour مریم نیک پور maryamnikpour19@yahoo.com 1003194753284600150343 1003194753284600150343 No Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran مرکز تحقیقات بیماری های غیر واگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران Hadi Sorkhi هادی سرخی hadisorkhi@yahoo.com 1003194753284600150344 1003194753284600150344 Yes Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran مرکز تحقیقات بیماری های غیر واگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل، بابل، ایران