21 Günlük İdrar Yolu Enfeksiyonu ile Başvuran Kız Bebek
Özet
Bu olgu sunumunda, 21 günlük bir kız bebeğin beslenememe, uykuya meyil ve yüksek ateş şikayetleriyle başvurması üzerine ürosepsis ve Escherichia coli kaynaklı ciddi bir idrar yolu enfeksiyonu tanıları alması incelenmektedir. Yapılan ultrasonografik ve sintigrafik değerlendirmelerde hastada sağ renal agenezi (soliter sol böbrek) ve sol evre 4-5 vezikoüreteral reflü (VUR) saptanmıştır. Antibiyotik profilaksisi altında enfeksiyonun tekrarlaması üzerine cerrahi operasyonlarla başarılı şekilde düzeltme yapılan olgu, üç yıldır çocuk nefrolojisinde takip edilmektedir. Soliter böbrek anomalisi günümüzde fetal ultrasonografilerle %64 oranında saptanabilse de sıklıkla postnatal dönemde rutin taramalarda veya enfeksiyon sonrası rastlantısal olarak teşhis edilir. Tek fonksiyonel böbreğe en sık eşlik eden anomali %24 oranla VUR'dur. Yaşamın erken dönemlerinde tek böbrekli kalmak, soliter böbrekte kompansatuvar nefron oluşumu ve hızlı GFR artışına yol açarak glomerüler hiperfiltrasyona neden olur. Bu durum uzun vadede podosit hasarı, proteinüri, hipertansiyon ve kronik böbrek hastalığı riskini artırır. Bu hastaların yönetiminde protein ve tuzdan fakir diyet, obeziteden kaçınma, aktif sporun teşvik edilmesi ile yıllık böbrek boyutu, kan basıncı, proteinüri ve GFR kontrollerinin yapılması kritik önem taşımaktadır.
In this case report, a 21-day-old female infant who presented with poor feeding, lethargy, and high fever is examined after being diagnosed with urosepsis and a severe urinary tract infection caused by Escherichia coli. Ultrasonographic and scintigraphic evaluations revealed right renal agenesis (solitary left kidney) and left grade 4-5 vesicoureteral reflux (VUR). Following the recurrence of infection under antibiotic prophylaxis, successful surgical corrections were performed, and the case has been followed in pediatric nephrology for three years. Although solitary kidney anomalies can be detected at a rate of 64% using modern fetal ultrasonography, they are often diagnosed postnatally during routine screenings or incidentally after an infection. The most common anomaly accompanying a solitary functioning kidney is VUR at a rate of 24%. Having a solitary kidney early in life leads to compensatory nephron formation and a rapid increase in GFR, resulting in glomerular hyperfiltration. In the long term, this condition increases the risk of podocyte injury, proteinuria, hypertension, and chronic kidney disease. In the management of these patients, a low-protein and low-salt diet, avoiding obesity, encouraging active sports, and conducting annual checks for kidney size, blood pressure, proteinuria, and GFR levels are of critical importance.
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