??

1
??µe??p??f??a?? ?p?t??p?a???s?? ???????µ??e??
?a?, ??? ?a? µe t?

• ?a???aµp?? ??ta??p?????
• 3? ?a?d?at???? ??????? ??T

2
???????µ??e??

• S????? ßa?t???a??? ???µ??e?? t?? pa?d???? ?????a?
• ???d?a?es???? pa?????te? (??ste?????t?????
  pa???d??µ?s?, s???e?e?? a??µa??e?, ?e????e???
  ??st?)
• ?a????????e? ep?pt?se?? (?ef????? ?????, ??pt?s?
  ?ef????? ?e?t?????a?)
• ??a?s??t?p???s? t?? pa?d??t???!
• ????? a???? de?aet?a? 2000 se eµp??ete?
  ???????µ??e?? e?d?f??ß?a ?e?ape?a, ??e???? µe
  ?pe???????f?µa (U/S), ??ste???af?a (???G?),
  sp?????????f?µa (DMSA). ??µe??p??f??a?? (?/?) se
  pa?d?? µe ??ste?????t????? pa???d??µ?s? (????)

3
??µe??p??f??a??

• ??????s? a?t?µ????ß?a??? d?ast???? ??a?t?
  ????pa??????? se µ????? d?se??
• ?a?a??te?a se ???e pa?d? µe ???? ? a?at?µ???? /
  ?e?t???????? a??µa??e? t?? ????p???t????
• ?/? ? p?????? ???????µ??e?? ? p?????? ?ef?????
  ????? ? d?at???s? ?ef????? ?e?t?????a?
• ?e?e?ta?a s?st?µat??? d?e?e???s? t??
  ap?te?esµat???t?ta? t?? ?/? st?? p?????? t??
  ???????µ??e?? ?a? t?? ?ef????? ?????
• Evidence-based medicine, p??ß??µa a?t???? sta
  a?t?ß??t???

4
??µe??p??f??a?? se pa?d?? µe ??ste?????t?????
pa???d??µ?s?

• ???et?? µe??te? ap? t? 2000 ?a? µet?
• ?te?????e?a (s?ed?asµ??, p????sµ?? as?e???,
  ßa?µ?? ????, µe?et??µe???
  pa??µet???)
• ???sµ??e? µ??? e?e???µe?e?-t??a??p???µ??e?, ?aµ?a
  t?f??
• ?????e? 0-18 et??
• S?????? pa?d?? µe ???? ?-??? ßa?µ??, p???
  ????te?a µe IV-V
• ??ßas? a???µ?? ???????µ??e?? (s??????? /
  eµp??et??), sp???a s??µat?sµ?? ?ef????? ?????

5
??µe??p??f??a?? se pa?d?? µe ??ste?????t?????
pa???d??µ?s?

• ?µe???a???? ??ad?µ?a ?a?d?at????? (2011)
  µeta-a????s? s?µa?t???te??? µe?et??
• ? ??????s? ?/? de? s?s?et?s???e µe stat?st???
  s?µa?t??? µe??s? t?? ?p?t??p?? t?? eµp??et??
  ???????µ??e??, a?e???t?ta ap? t? ßa?µ? t?? ????
  (I, II, III, IV)
• ?µ?? ?s? a????e? ? ßa?µ?? t?? ???? t?s?
  e?att??eta? ? a???µ?? t?? pa?d??? p?? µe?et????a?
  ?a??? ?a? ? s?et???? ???d???? eµf???s??
  p?e???ef??t?da? µe ??????s? ?/?

Finnell SM, Pediatrics 2011, 128e749, Montini G,
Pediatrics 2008, 1221064 Garin EH, Pediatrics
2006, 117626, Pennesi M, Pediatrics 2008,
121e1489 Craig JC, N Engl J Med 2009, 3611748,
Roussey-Kesler G, J Urol 2008, 179674 Brandström
P, J Urol 2010, 184286
6
S?et???? ???d???? ?p?t??p?? eµp??et??
???????µ???? se pa?d?? p?? ?aµß?????
??µe??p??f??a?? a?????a µe t? ßa?µ? t?? ????
?a?µ?? ???? ????µ?? pa?d??? ????µ?? µe?et?? S?et???? ???d???? (95 ???a a???p?st?a?)
0 549 3 0,62 (0,30-1,27)
I-II 455 5 0,94 (0,49-1,80)
III 347 6 0,74 (0,42-1,29)
IV 122 3 0,69 (0,39-1,20)
V 5 1 0,40 (0,08-1,90)
Finnell SM, Pediatrics 2011, 128e749
7
?fe??? ap? ??????s? ??µe??p??f??a??? se ????ts?a
1-2 et?? µe ???? III-IV ßa?µ??
Brandström et al, J Urol 2010, 184286
8
??µe??p??f??a?? se pa?d?? µe ??ste?????t?????
pa???d??µ?s?

• ?e? µp??e? ?a ap???e?s?e? ?fe??? ap? t? ??????s?
  ?/? se pa?d?? µe ???? III ßa?µ??, ?d?a?te?a se
  ???sµ??e? ?µ?de? (µ???? ?????a, ????ts?a)
  a????? µe??t?? µe?a??te??? a???µ?? pa?d???
• ?????? p??s????s? (a?aµ????ta? pe??ss?te?a
  ded?µ??a, µe??t? RIVUR) ??? ?/? se pa?d?? µe
  ???? I II ßa?µ??, ??a µe?a??te??? ßa?µ?? ????
  p??a??? ?a ??e? ??s?
• ?e??t? RIVUR d?p??-t?f??, p????e?t????,
  t??a??p???µ???, ???????????e p??sfata
• - 607 pa?d?? (558 ????ts?a, 49 a????a)
• - ???µes? ?????a 12 µ??e?
• - ???? I, II, III IV ßa?µ?? se 11, 42,
  38 ?a? 8 a?t?st???a

Carpenter MA, Pediatrics 2013, 132e34
9
??µe??p??f??a?? se pa?d?? µe ?e????e??
??st?

• ?te??? ????s? ??st?? ? st?s? ????? ? a??pt???
  µ????ß??? ? as?µpt?µat??? ßa?t???????a / ap??et?
  ???????µ??? (ep?tas? a???te?a? ?????, d?s?sµa
  ???a) / eµp??et? ???????µ???
• ??????? d?a?e?p??te? ?a?et???asµ??,
  a?t??????e????? f??µa?a (ap?ß??? ?????)
• ?/? ???s?µ?p??e?ta? s????, ?st?s? p??ß??µa
  a??pt???? a?t???? ????pa??????? (?????e?
  ?atast?se??)
• ????????s? p??a??? ?f????? ap? ?/?
• - as?µpt?µat??? ßa?t???????a
• - ap??et? ???????µ???
• - eµp??et? ???????µ???

de Jong T, Pediatr Nephrol 2008, 23889
10
???a??p???µ??? e?e???µe?? µe??t? se 176 pa?d?? µe
d?s??d? ????
Zegers, J Urol 2011, 1862365
11
???a??p???µ??? e?e???µe?? µe??t? se 176 pa?d?? µe
d?s??d? ????

• ??a??p? ?/? ? stat?st??? s?µa?t??? a???s?
  epe?s?d??? as?µpt?µat???? ßa?t???????a? /
  ap??et?? ???????µ????
• ?? s?µa?t??? a???s? t?? epe?s?d??? eµp??et??
  ???????µ???? (?st?s? µ????? a???µ?? epe?s?d???
  ???a pa?d?? µe ????)
• ? Se pa?d?? µe ?e????e?? ??st? ?a? µ???? a???µ?
  eµp??et?? ???????µ??e??, ? d?a??p? t?? ?/?
  fa??eta? asfa???.

Zegers, J Urol 2011, 1862365
12
??µe??p??f??a?? se pa?d?? µe s???e?? ?d????f??s?

• ?e? ??e? te?µ?????e? ep?st?µ????? ? ??????s? t??
  se ??a ta pa?d?? µe s???e?? ?d????f??s?
• 2009, ?µe???a???? ?????????? ???s? ?/?
  e?de????ta? ??a s?ßa?? ?d????f??s? (ßa?µ?? III-IV
  ?at? SFU, Society for Fetal Urology)
• ?a?ad??? ?????????? ???s? ????? ?/?
  aµf??e??µe???

13
??µe??p??f??a?? se pa?d?? µe s???e?? ?d????f??s?

• ?eta-a????s? µe?et?? ap? 1990-2010
• ? ?/? e??a? s??p?µ? se pa?d?? µe ?????? ßa?µ??
  ?d????f??s? (III IV ?at? SFU)
• 7 pa?d?? µe ?????? ßa?µ?? ?d????f??s? ?a p??pe?
  ?a ??ß??? ?/? ??a ?a p????f?e? ??a epe?s?d??
  ???????µ????
• ? ep?d?as? s?µa?t???? pa?a???t?? (f???, ????,
  pe??t?µ?) st? ap?t??esµa t?? ?/? de? ?ta? d??at?
  ?a p??sd????ste? µe a???ße?a

Braga LH, Pediatrics 2013, 131e251
14
??µe??p??f??a?? ep????? a?t?µ????ß?a???
fa?µ????

• ??t??µ??a???? (t??µe??p??µ? s???faµe???a????),
  ??t??f???a?t????
• ??ast???t?ta ??a?t? ????pa???????, µe????? ??????
  ??, ?????? s???e?t??se?? st? ????p???t???. O?? se
  ???e??? G6PD
• ??t??µ??a???? pa?d?? 2 µ????, d?s? 2 mg/kg ?S
  t??µe??p??µ??, x 1 (ß??d?)
• ??t??f???a?t???? pa?d?? 1 µ????, d?s? 1-2
  mg/kg ?S, x 1 (ß??d?)
• ?e? ep????? t?? a??pt??? a?t???? se ???e? ?µ?de?
  a?t?µ????ß?a??? (se a?t??es? µe ta ß-?a?taµ???
  a?t?ß??t???)

15
??t??µ??a???? ??a?t? ?efa??sp?????? 2??
?e???? ?? ??µe??p??f??a??

• ????pt??? t??a??p???µ??? µe??t? se pa?d?? 1 µ????
  6 et?? p?? ??aßa? ?/? ??a p?????? ???????µ??e??
• ???a??p???s? µeta?? ??t??µ??a?????
  ?efa??sp?????? 2?? ?e???? (11), a??a?? ???e 6
  µ??e? (1 course)
• S?????s? ap?te?esµat???t?ta?
• S?????s? e?d??? ?a? e?a?s??s?a? µ????ß??? ap?
  ?a??????e?e? ????? ? ap? t? st?µ?? t?? ??????a?
• N97 pa?d??, d??µes? ?????a 7,7 µ??e?, 153
  courses

Ioannidou M, ESPID 2012, Thessaloniki
16
??t??µ??a???? ??a?t? ?efa??sp?????? 2??
?e???? ?? ??µe??p??f??a??
p0,62
S?????s? ?p?t??p?? ???????µ??e??
Ioannidou M, ESPID 2012, Thessaloniki
17
??t??µ??a???? ??a?t? ?efa??sp?????? 2??
?e???? ?? ??µe??p??f??a??
?p?te??sµata ?/?? ap????sµ?? / ????? ap? t?? 2
?µ?de? (p0,002 ??a ??e? t?? d?af????)
Ioannidou M, ESPID 2012, Thessaloniki
18
??t??µ??a???? ??a?t? ?efa??sp?????? 2??
?e???? ?? ??µe??p??f??a??
??af???? st?? epa???? µ????ß?a??? a?t????
Ioannidou M, ESPID 2012, Thessaloniki
19
??µe??p??f??a?? ep????? a?t?µ????ß?a???
fa?µ????

• ?a ß-?a?taµ??? a?t?ß??t??? (aµ???pe????????e? µe
  a?ast??e?? ß-?a?taµas??, ?efa??sp????e?) de?
  s???st??ta? ?e???? ?? ?/? ??a p??????
  ???????µ??e?? (de? ?pe?????? ?? p??? t??
  ap?te?esµat???t?ta, µe???? p??ß??µa ? a??pt???
  a?t????)
• ???a??? e?a???se?? ?e????-ß??f? 2 µ????,
  ???e??? G6PD
• 1/3 s???????? ?µe??s?a? d?s??, 1 f??? t?? ?µ??a
  (ß??d?)

20
??µe??p??f??a?? ep????? a?t?µ????ß?a???
fa?µ????

• ???f?? 9 µ???? ?p? ?/? µe ??t??µ??a???? ???? ????
  pa???s???e? eµp??et? ???????µ??? ap? Escherichia
  coli, a??e?t??? se aµp????????, ??t??µ??a???? ?a?
  e?a?s??t? se aµ?????????? / ??aß???a???? ???,
  ?efa??sp????e? 2?? ?a? 3?? ?e????. ?f??
  ?????????e? ? ?e?ape?a t?? s???e???µ????
  epe?s?d??? ???????µ????, t? ?a p??pe? ?a
  ap?fas?se? ? pa?d?at??? s?et??? µe t? ?/? t??
  pa?d??? st? s????e?a
• 1. ???a?? ap? ??t??µ??a???? se ??p??? ????
  d?ast??? a?t?ß??t??? µe ß?s? t? a?t?ß????aµµa
  (p?, ?efa??sp????? 2?? ?e????)
• 2. S?????s? ?/? µe ??t??µ??a????

21
??µe??p??f??a?? ep????? a?t?µ????ß?a???
fa?µ????

• ???f?? 9 µ???? ?p? ?/? µe ??t??µ??a???? ???? ????
  pa???s???e? eµp??et? ???????µ??? ap? Escherichia
  coli, a??e?t??? se aµp????????, ??t??µ??a???? ?a?
  e?a?s??t? se aµ?????????? / ??aß???a???? ???,
  ?efa??sp????e? 2?? ?a? 3?? ?e????. ?f??
  ?????????e? ? ?e?ape?a t?? s???e???µ????
  epe?s?d??? ???????µ????, t? ?a p??pe? ?a
  ap?fas?se? ? pa?d?at??? s?et??? µe t? ?/? t??
  pa?d??? st? s????e?a
• 1. ???a?? ap? ??t??µ??a???? se ??p??? ????
  d?ast??? a?t?ß??t??? µe ß?s? t? a?t?ß????aµµa
  (p?, ?efa??sp????? 2?? ?e????)
• 2. S?????s? ?/? µe ??t??µ??a????

22
??µ?? / e?????sµa ap? ????a (cranberries)

• ????? st?? p?????? ???????µ??e?? e?d?af??e?
  ?d?a?te?a ???? t?? p??ß??µat?? µ????ß?a???
  a?t????
• ???a?????a??d??e? a?ast??? p??s?????s??
  e?te??ßa?t????e?d?? st? ep?????? t??
  ????p???t????, p??a??? ep?d?as? ?a? st?
  f?e?µ???d? a?t?d?as?
• 2012, µeta-a?a??se?? Cochrane (?), Wang et al
  (?)
• 2012, t?e?? t??a??p???µ??e? e?e???µe?e? µe??te?
  (µ?a se pa?d?? µe ?e????e?? ??st?) p??state?t???
  d??s? ??a?t? t?? ?p?t??p??

Jepson RG, Cochrane Database Syst Rev 2012,
10CD001321, Wang CH, Arch Intern Med 2012,
172988, Salo J, Clin Infect Dis 2012,
54340 Mutlu H, ISRN Pediatr 2012, 2012317280,
Afshar K, J Urol 2012, 188 (4 Suppl) 1584
23
??µ?? / e?????sµa ap? ????a (cranberries)

• ?e? e??a? ???st? ? ß??t?st? d?s? ??a t?? p??????
  t?? ???????µ??e??
• ?e? e??a? ???st? ? ß??t?st? µ??f? (??µ?? ?
  e?????sµa se d?s??a)
• Salo ?a? s??., d?s? 5 ml/kg ?S/?µ??a ??µ?? se
  µ?a ? d?? d?se?? (µ???st? 300 ml/?µ??a) (µ?s?
  ?????a 4,2 ?t?).
• Mutlu ?a? s??., d?s? 1 ??????a e?????sµat?? (500
  mg)/?µ??a (µ?s? ?????a as?e??? 7,25 ?t?)
• Afshar ?a? s??., d?s? 2 ml/kg ?S ??µ?? 37 se
  p??a?????a??d??? (d??µes? ?????a as?e??? 7 ?t?)

Salo J, Clin Infect Dis 2012, 54340 Mutlu H,
ISRN Pediatr 2012, 2012317280 Afshar K, J Urol
2012, 188 (4 Suppl) 1584
24
???a??st? ??a t?? p??s??? sa?