Los microorganismos en la infección febril del tracto urinario y su relación con el reflujo vesicoureteral y el daño renal permanente

María Caridad Duarte Pérez, Mairim León López, Ana Guillén Dosal, Magalys Martínez Silva, Esther Cristina Acosta Moya, Ernesto Hernández Robledo

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Introducción: la infección febril del tracto urinario en la infancia se asocia a la presencia de malformaciones nefro-urológicas y a un mayor riesgo de cicatrices renales.
Objetivo: indagar si existe o no relación entre el agente etiológico aislado, la presencia de reflujo vesicoureteral y el daño renal permanente, posterior a la primera infección febril del tracto urinario en lactantes.
Métodos: se realizó un estudio descriptivo, prospectivo, longitudinal en 191 lactantes que ingresaron en el servicio de Nefrología del Hospital Pediátrico "Juan Manuel Márquez", desde mayo de 2007 a diciembre de 2011. Las variables utilizadas fueron: la edad, el sexo, el agente etiológico, el reflujo vesicoureteral, el grado de reflujo y el daño renal permanente. Para la asociación de variables se usó el chi cuadrado y el test exacto de Fisher.
Resultados: la pielonefritis aguda estuvo presente en un poco más de la mitad de los pacientes con la primera infección febril del tracto urinario, pero menos de la cuarta parte de los pacientes evolucionó a un daño renal permanente. La infección por un microorganismo diferente a Escherichia coli se asoció significativamente a la presencia de reflujo vesicoureteral, al alto grado de reflujo y al daño renal permanente.
Conclusiones: estar infectado por un microorganismo diferente de Escherichia coli es un hallazgo que orienta hacia la presencia de malformación renal y daño renal permanente.

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