Úvod: Cílem studie bylo určit rozsah renálního poškození podle gradingu 99mTc-DMSA scanu u dětí s vezikoureterálním refluxem (VUR) III. stupně, který je částí odborné veřejnosti považován spolu s VUR I. a II. stupně za nízkostupňový. Metody: Celkem bylo vyšetřeno 132 pacientů (56 chlapců a 76 dívek ve věku 6 měsíců až 11 let) s diagnózou VUR různého stupně 6 měsíců po akutní pyelonefritidě. Statická scintigrafie ledvin byla provedena 2 hodiny po i.v. podání 18–80 MBq 99mTc-DMSA. Stanovení stupně postižení ledvin bylo provedeno podle počtu postižených segmentů ledviny (0–12) na základě gradingu 99mTc-DMSA G0-G4 (Mattoo et al), s naší modifikací stupně G4. V každé postižené ledvině byl hodnocen počet patologických segmentů/jizev. Průměr hodnot v rámci každého stupně VUR byl vyhodnocen pomocí Studentova t-testu. Výsledky: Hodnoceno celkem 201 ledvin s VUR, významně vyšší počet jizev byl prokázán u VUR III. stupně než u zbylých nízkostupňových stupňů (2,88 vs. 1,58, p = 0,002). Na druhou stranu, ve srovnání se IV. stupněm VUR, se jednalo o nevýznamně nižší hodnotu (2,88 vs. 3,51, p = 0,08). Ve srovnání s VUR IV. a V. stupně byla hodnota statisticky významně nižší (3,99 vs. 2,88, p = 0,004). Závěr: VUR III. stupně je spojen s vyšším rozsahem parenchymových změn (podle 99mTc-DMSA gradingu) ve srovnání s VUR I. a II. stupně. 99mTc-DMSA grading může demaskovat závažnější případy VUR III. stupně, který proto doporučujeme vyčlenit a hodnotit jako samostatný stupeň. Korespondující autorka: MUDr. Daniela Chroustová, Ph.D. Ústav nukleární medicíny VFN a 1. LF UK Praha U nemocnice 5 128 08 Praha 2

Introduction: The aim of this study was to determine the risk of renal damage in children diagnosed with vesico-ureteral reflux (VUR) grade III, which is generally considered as a low-grade VUR, according to the occurrence of renal changes using the 99mTc-DMSA scan grading. Methods: A total of 132 patients with VUR were examined (56 boys, 76 girls aged 6 months -11 years) 6 months after acute pyelonephritis with. Static renal scintigraphy was performed 2 h after i.v. administration of 18-80 MBq 99mTc-DMSA. Determination of the degree of kidney involvement according to the 99mTc-DMSA grading G0-G4 (Mattoo et al) was based on the number of affected segments (0-12). The number of pathological segments/scars was assessed in each involved kidney. Mean values within each VUR grade were evaluated using Student’s t-test. Results: 200 kidneys were evaluated. VUR III. grade demonstrated significantly higher value of scars (2.88 vs 1.58, p = 0.002) than the remaining low-risk grades I and II. On the other hand, when compared with high-risk grade IV, the value was not significantly lower (2,88 vs. 3,51, p = 0,08). In comparing VUR III. with VUR IV.-V. grades, there was a significantly higher number of scars in high-grade VUR. (3.99 vs. 2.88, p = 0.004). Conclusion: VUR III. grade is associated with a higher extend of parenchymal changes (according to 99mTc-DMSA grading) compared to low grades VUR I. and II. 99mTc-DMSA grading can unmask more severe cases of VUR III. degree, which we therefore recommend separating and evaluating as a separate degree.

• MeSH
• Child MeSH
• Infant MeSH
• Humans MeSH
• Kidney Diseases diagnostic imaging   classification   pathology   MeSH
• Child, Preschool MeSH
• Pyelonephritis diagnosis   etiology   prevention & control   MeSH
• Radionuclide Imaging classification   methods   MeSH
• Renal Insufficiency diagnostic imaging   diagnosis   etiology   classification   MeSH
• Retrospective Studies MeSH
• Technetium Tc 99m Dimercaptosuccinic Acid * analysis   metabolism   MeSH
• Vesico-Ureteral Reflux * diagnostic imaging   diagnosis   classification   complications   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Child, Preschool MeSH

V předloženém textu je shrnuta problematika infekcí horních cest močových především z pohledu klinického mikrobiologa. Jsou zde prezentovány základní principy diagnostiky a léčby uroinfekcí s ohledem na současnou epidemiologickou situaci. Doporučení pro antibiotickou léčbu reflektují aktuální evropské a české doporučené postupy.

The presented text summarizes the issue of upper urinary tract infections, especially from the perspective of a clinical microbiologist. The basic principles of diagnosis and treatment of urinary tract infections with regard to the current epidemiological situation are presented. Recommendations for antibiotic treatment reflect current European and Czech guidelines.

• MeSH
• Diagnosis, Differential MeSH
• Escherichia coli pathogenicity   MeSH
• Urinary Tract Infections * diagnosis   etiology   drug therapy   classification   MeSH
• Klebsiella pneumoniae pathogenicity   MeSH
• Humans MeSH
• Microbial Sensitivity Tests classification   methods   MeSH
• Emergencies * classification   MeSH
• Pyelonephritis diagnosis   drug therapy   classification   microbiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

BACKGROUND: Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management. METHODS: We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post-transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate. RESULTS: A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd-generation cephalosporin (37%) or piperacillin-tazobactam (21%) monotherapy. Several patient-level factors dictated the selection of broader-spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended-spectrum ß-lactamase-producing organisms, 90% for carbapenemase-producing organisms, and 94% for Pseudomonas aeruginosa). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries. CONCLUSION: High-quality studies are needed to guide the empirical management of post-transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post-transplant pyelonephritis.

• MeSH
• Anti-Bacterial Agents * therapeutic use   MeSH
• beta-Lactamases MeSH
• Cephalosporins therapeutic use   MeSH
• Adult MeSH
• Piperacillin, Tazobactam Drug Combination therapeutic use   MeSH
• Practice Patterns, Physicians' statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Transplant Recipients statistics & numerical data   MeSH
• Surveys and Questionnaires MeSH
• Pseudomonas aeruginosa drug effects   isolation & purification   MeSH
• Pyelonephritis * drug therapy   microbiology   MeSH
• Kidney Transplantation * adverse effects   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Keywords
• cefepin/enmetazobactam,
• MeSH
• Anti-Bacterial Agents pharmacology   MeSH
• Anticonvulsants classification   MeSH
• Autistic Disorder etiology   MeSH
• Child MeSH
• Pharmacogenetics methods   MeSH
• Fertilization MeSH
• Urinary Tract Infections drug therapy   complications   MeSH
• Valproic Acid * adverse effects   toxicity   MeSH
• Medical Informatics MeSH
• Humans MeSH
• Neurodevelopmental Disorders MeSH
• Fathers MeSH
• Pyelonephritis drug therapy   MeSH
• Randomized Controlled Trials as Topic MeSH
• Artificial Intelligence * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH

Cíl: Prezentovat zkušenosti našeho pracoviště se zaváděním nefrostomických drénů pod ultrazvukovou kontrolou vzhledem k nízkému počtu prací s touto tématikou. Materiál a metody: Ve sledovaném období 2018–2021 bylo provedeno 592 perkutánních nefrostomií pod ultrazvukovou kontrolou u 363 pacientů. Retrospektivně byla provedena analýza dat. Byly hodnoceny indikace k zajištění drenáže horních cest močových, úspěšnost punkce a komplikace. Výsledky: Nejčastější indikací k zavedení nefrostomie byl útlak nebo infiltrace močovodu v souvislosti s onkologickým onemocněním 284 (47,97 %) a z non‐onkologických indikací obstrukční pyelonefritida 156 (26,35 %). V hodnoceném období byla úspěšnost 90 %. Nejčastěji zaznamenanou komplikací byla dislokace drénu, celkem 105 v časovém rozmezí 11 týdnů od zavedení. Signifikantně častější byla opakovaná dislokace drénu u pacientů s bilaterálně zavedenými nefrostomiemi. Závěr: Zavádění nefrostomie pod ultrazvukovou kontrolou je bezpečná alternativa drenáže horních cest močových.

Goal: We would like to present the experiences of our department with nephrostomy tube placement under ultrasound guidance, considering the low number of articles on this topic. Materials and Methods: In years 2018-2021, a total of 592 ultrasound-guided percutaneous nephrostomies were performed in 363 patients. The data was analyzed retrospectively. We evaluate the indications for the drainage of the upper urinary tract, the technical success rate and the number and type of complications. Results: The most common oncological indication was the obstruction or infiltration of a ureter 284 (47,97 %); and the most common non-oncological indication was obstructive pyelonephritis 156 (26,35 %). During the observed period, the success rate was 90 %. The most frequent complication was nephrostomy drain dislodgment in 105 cases within 11 weeks after the insertion. Repeated dislodgement of percutaneous nephrostomies was significantly more common in patients with bilateral nephrostomies. Conclusion: Percutaneous nephrostomy insertion under ultrasound guidance is a safe method for achieving upper urinary tract drainage.

• MeSH
• Humans MeSH
• Ureteral Obstruction complications   therapy   MeSH
• Nephrostomy, Percutaneous * MeSH
• Pyelonephritis complications   therapy   MeSH
• Retrospective Studies MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Cystitis diagnosis   drug therapy   prevention & control   MeSH
• Child MeSH
• Urinary Tract Infections * diagnostic imaging   diagnosis   etiology   pathology   MeSH
• Humans MeSH
• Pyelonephritis diagnosis   drug therapy   complications   prevention & control   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Anti-Bacterial Agents administration & dosage   adverse effects   therapeutic use   MeSH
• Drug Resistance, Microbial MeSH
• Bacterial Infections drug therapy   MeSH
• Bacteriuria diagnosis   MeSH
• Cystitis diagnosis   etiology   drug therapy   MeSH
• Urinary Tract Infections * diagnosis   etiology   drug therapy   MeSH
• Amoxicillin-Potassium Clavulanate Combination administration & dosage   poisoning   therapeutic use   MeSH
• Humans MeSH
• Nitrofurantoin administration & dosage   adverse effects   therapeutic use   MeSH
• Pyelonephritis diagnosis   etiology   drug therapy   MeSH
• Check Tag
• Humans MeSH

• MeSH
• Aminoglycosides administration & dosage   pharmacology   MeSH
• Drug Resistance, Bacterial MeSH
• Cystitis epidemiology   drug therapy   MeSH
• Fluoroquinolones administration & dosage   pharmacology   adverse effects   MeSH
• Fosfomycin administration & dosage   pharmacology   MeSH
• Urinary Tract Infections * epidemiology   microbiology   MeSH
• Community-Acquired Infections * epidemiology   microbiology   MeSH
• Pregnancy Complications, Infectious drug therapy   microbiology   MeSH
• Humans MeSH
• Male Urogenital Diseases drug therapy   microbiology   MeSH
• Nitrofurantoin administration & dosage   pharmacology   adverse effects   MeSH
• Postmenopause MeSH
• Pyelonephritis drug therapy   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH

• MeSH
• Fever etiology   MeSH
• Caliciviridae Infections * epidemiology   complications   pathology   therapy   MeSH
• Humans MeSH
• Child, Preschool MeSH
• Pyelonephritis complications   MeSH
• Check Tag
• Humans MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Review MeSH
• Geographicals
• Czech Republic MeSH

• MeSH
• Cysts diagnosis   complications   MeSH
• Diagnostic Imaging methods   MeSH
• Amoxicillin-Potassium Clavulanate Combination administration & dosage   pharmacology   therapeutic use   MeSH
• Kidney diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Low Back Pain etiology   MeSH
• Pyelonephritis * diagnosis   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH