Çocuklarda İdrar Yolu Enfeksiyonları, Etiyolojisi, İmmünolojisi, Tanısı ve Tedavisi
Özet
Bu derleme, çocukluk çağında en sık görülen enfeksiyonlardan biri olan idrar yolu enfeksiyonlarının (İYE) etiyolojisi, immünolojisi, tanısı ve tedavisini ele almaktadır. Tekrarlayan İYE, kalıcı renal kortikal hasar, hipertansiyon ve kronik böbrek yetmezliği gibi ciddi komplikasyonlara yol açabilir. En sık saptanan patojen Escherichia coli (%85) olup Klebsiella, Proteus, Enterococcus ve Candida da etkenler arasındadır. Konak savunmasında tek yönlü idrar akımı, üroepitelyal bariyer, Tamm-Horsfall proteini, Toll-like reseptörler (TLR-2, TLR-4, TLR-11), kemokinler (IL-8) ve defensinler rol oynar. Genetik polimorfizmler (TLR-4, TGF-β1, ACE DD) duyarlılığı ve renal skar riskini artırmaktadır. Klinik semptomlar yaşa göre farklılık gösterir; yenidoğanlarda sarılık, kusma ve kilo alamama öne çıkarken, daha büyük çocuklarda ateş, dizüri, karın ağrısı ve yeni başlayan inkontinans saptanır. Tanı, idrar analizi (lökosit esteraz, nitrit), suprapubik aspirasyon, kateter veya orta akım idrar kültürü ile konulur. Görüntülemede ultrasonografi, VSUG ve DMSA sintigrafisi kullanılır. Tedavide 3 aydan küçük veya toksik hastalara intravenöz ampirik antibiyotik (ampisilin, gentamisin) başlanırken, 3 aydan büyük stabil olgular oral antibiyotikler ile tedavi edilir. Rekürensi önlemede antibiyotik profilaksisi, sünnet, yaban mersini (kızılcık) suyu, probiyotikler ve işeme/bağırsak alışkanlıklarının düzeltilmesi uygulanmaktadır.
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