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Aktuelle Urol 2017; 48(05): 452-458
DOI: 10.1055/s-0043-103501
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Akute Flankenschmerzen im Kindes- und Jugendalter

Acute Flank Pain in Children and Adolescents
Anne-Karoline Ebert
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Publication History

Publication Date:
05 September 2017 (online)

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Zusammenfassung

Akute Flankenschmerzen im Kindes- und Jugendalter stellen eine klinisch anspruchsvolle Differenzialdiagnose dar. Neben einer sorgfältigen Anamnese und klinischen Untersuchung sowie Urin- und Laboruntersuchungen ist im Kindesalter der Ultraschall oft wegweisend. Im vorliegenden Artikel werden die möglichen zugrundeliegenden Krankheitsbilder mit spezifisch diagnostischen und therapeutischen Überlegungen dargestellt.

Abstract

Acute flank pain in children and adolescents is a clinically demanding symptom requiring profound diagnostic work-up. Thorough history taking, careful clinical examination as well as urine and laboratory tests in addition to ultrasound are required to guide towards the diagnosis. This article presents possible underlying conditions with specific diagnostic and therapeutic considerations.

Schlüsselwörter

Akute Flankenschmerzen - Kindesalter

Key words

acute flank pain - children
 

  • Literatur

  • 1 Hyams ES, Korley FK, Pham JC. et al. Trends in Imaging Use During the Emergency Department Evaluation of Flank Pain. J Urol 2011; 186: 2270-2274
    CrossrefPubMedGoogle Scholar
  • 2 Polito C, Cioce F, Signoriello G. et al. Central/diffuse abdominal perception of urological pain in children. Acta Paediatr 2006; 95: 82-85
    CrossrefPubMedGoogle Scholar
  • 3 Stein R, Dogan HS, Hoebeke P. et al. European Association of Urology; European Society for Pediatric Urology. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 2015; 67: 546-558
    CrossrefPubMedGoogle Scholar
  • 4 Karavanaki KA, Soldatou A, Koufadaki AM. et al. Delayed treatment of the first febrile urinary tract infection in early childhood increased the risk of renal scarring. Acta Paediatr 2017; 106: 149-154
    CrossrefPubMedGoogle Scholar
  • 5 Roberts KB. Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128: 595-610
    CrossrefPubMedGoogle Scholar
  • 6 Chen CY, Kuo HT, Chang YJ. et al. Clinical assessment of children with renal abscesses presenting to the pediatric emergency department. BMC Pediatr 2016; 16: 189
    CrossrefPubMedGoogle Scholar
  • 7 Seguias L, Srinivasan K, Mehta A. Pediatric renal abscess: a 10-year single-center retrospective analysis. Hosp Pediatr 2012; 2: 161-166
    PubMedGoogle Scholar
  • 8 Cheng CH, Tsai MH, Su LH. et al. Renal abscess in children: a 10-year clinical and radiologic experience in a tertiary medical center. Pediatr Infect Dis J 2008; 27: 1025-1027
    CrossrefPubMedGoogle Scholar
  • 9 Linder BJ, Granberg CF. Pediatric renal abscesses: A contemporary series. J Pediatr Urol 2016; 12: 99.e1-e5
    CrossrefPubMedGoogle Scholar
  • 10 Wippermann CF, Schofer O, Beetz R. et al. Renal abscess in childhood: diagnostic and therapeutic progress. Pediatr Infect Dis J 1991; 10: 446-450
    CrossrefPubMedGoogle Scholar
  • 11 Speer CP, Gahr M. Pädiatrie. 3. Aufl. Heidelberg: Springer Medizin Verlag; 2009. Kap.22, S481
    Google Scholar
  • 12 Janssen LJ, Voorhoeve PG, van den Wildenberg FJ. et al. Acute abdominal pain in children caused by pneumonia. [Article in Dutch]. Ned Tijdschr Geneeskd. 2016; 160: D533
    PubMedGoogle Scholar
  • 13 S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (043/025), Knoll T, Bach T, Humke U, Neisius A, Stein R, Schönthaler M, Wendt-Nordahl G 2015
    PubMed
  • 14 Hoppe B, Kemper M. Diagnostic examination of the child with urolithiasis or nephrocalcinosis. Pediatr Nephrol 2010; 25: 403-413
    CrossrefPubMedGoogle Scholar
  • 15 Serdaroglu E, Aydogan M, Ozdemir K et al. Incidence and causes of urolithiasis in children between 0–2 years. Minerva Urol Nefrol. 2016 [Epub ahead of print]
    PubMed
  • 16 Kalorin CM, Zabinski A, Okpareke I. et al. Pediatric urinary stone disease – does age matter?. J Urol 2009; 181: 2267-2271
    CrossrefPubMedGoogle Scholar
  • 17 Sternberg K, Greenfield SP, Williot P. et al. Pediatric stone disease: an evolving experience. J Urol. 2005; 174 4 Pt 2 1711-1714
    PubMedGoogle Scholar
  • 18 Koyuncu H, Yencilek F, Erturhan S. et al. Clinical course of pediatric urolithiasis: follow-up data in a long-term basis. Int Urol Nephrol. 2011; 43: 7-13
    CrossrefPubMedGoogle Scholar
  • 19 Polito C, La Manna A, Signoriello G. et al. Recurrent abdominal pain in childhood urolithiasis. Pediatrics 2009; 124: e1088-e1094
    CrossrefPubMedGoogle Scholar
  • 20 Polito C, Marte A, La Manna A. Appendectomy in children with hypercalciuria/hyperuricosuria. J Pediatr Urol 2005; 1: 279-282
    CrossrefPubMedGoogle Scholar
  • 21 Cambareri GM, Giel DW, Bayne AP. et al. Do Overweight and Obese Pediatric Stone Formers Have Differences in Metabolic Abnormalities Compared With Normal-weight Stone Formers?. Urology 2016; pii: S0090-4295(16)30608-2 DOI: 10.1016/j.urology.2016.09.011.. [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 22 Bevill M, Kattula A, Cooper CS. et al. The Modern Metabolic Stone Evaluation in Children. Urology 2016; pii: S0090-4295(16)30804-4 DOI: 10.1016/j.urology.2016.09.058.. [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 23 Persaud AC, Stevenson MD, McMahon DR. et al. Pediatric urolithiasis: clinical predictors in the emergency department. Pediatrics 2009; 124: 888-894
    CrossrefPubMedGoogle Scholar
  • 24 Palmer JS, Donaher ER, O’Riordan MA. et al. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol 2005; 174: 1413-1416
    CrossrefPubMedGoogle Scholar
  • 25 Velázquez N, Zapata D, Wang HH. et al. Medical expulsive therapy for pediatric urolithiasis: Systematic review and meta-analysis. J Pediatr Urol 2015; 11: 321-327
    CrossrefPubMedGoogle Scholar
  • 26 Shahat A, Elderwy A, Safwat AS. et al. Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study. J Urol. 2016; 195 4 Pt 2 1284-1288
    CrossrefPubMedGoogle Scholar
  • 27 Rubenwolf P, Herrmann-Nuber J, Schreckenberger M. et al. Primary non-refluxive megaureter in children: single-center experience and follow-up of 212 patients. Int Urol Nephrol. 2016; 48: 1743-1749
    CrossrefPubMedGoogle Scholar
  • 28 Braga LH, D’Cruz J, Rickard M. et al. The Fate of Primary Nonrefluxing Megaureter: A Prospective Outcome Analysis of the Rate of Urinary Tract Infections, Surgical Indications and Time to Resolution. J Urol 2016; 195 4 Pt 2 1300-1305
    CrossrefPubMedGoogle Scholar
  • 29 Chertin B, Pollack A, Koulikov D. et al. Long-term follow up of antenatally diagnosed megaureters. J Pediatr Urol 2008; 4: 188-191
    CrossrefPubMedGoogle Scholar
  • 30 Anderson CB, Tanaka ST, Pope 4th JC. et al. Acute pain crisis as a presentation of primary megaureter in children. J Pediatr Urol 2012; 8: 254-257
    CrossrefPubMedGoogle Scholar
  • 31 Dorairajan LN, Hemal AK, Gupta NP. et al. Primary obstructive megaureter in adults: need for an aggressive management strategy. Int Urol Nephrol 1999; 31: 633-641
    CrossrefPubMedGoogle Scholar
  • 32 Hemal AK, Ansari MS, Doddamani D. et al. Symptomatic and complicated adult and adolescent primary obstructive megaureter – indications for surgery: analysis, outcome, and follow-up. Urology 2003; 61: 703-707
    CrossrefPubMedGoogle Scholar
  • 33 Zajaczkowski T. Joseph Dietl (1804–1878) Reformer der Medizin und sein Bei trag für die Urologie. Urologe 2006; 45: 85-94
    PubMedGoogle Scholar
  • 34 Alagiri M, Polepalle SK. Dietl’s crisis: an under-recognized clinical entity in the pediatric population. Int Braz J Urol 2006; 32: 451-453
    CrossrefPubMedGoogle Scholar
  • 35 Belman AB. Ureteropelvic junction obstruction as a cause for intermittent abdominal pain in children. Pediatrics 1991; 88: 1066-1069
    PubMedGoogle Scholar
  • 36 Tsai JD, Huang FY, Lin CC. et al. Intermittent hydronephrosis secondary to ureteropelvic junction obstruction: clinical and imaging features. Pediatrics 2006; 117: 139-146
    CrossrefPubMedGoogle Scholar
  • 37 Braga LH, Liard A, Bachy B. et al. Ureteropelvic junction obstruction in children: two variants of the same congenital anomaly?. Int Braz J Urol 2003; 29: 528-534
    CrossrefPubMedGoogle Scholar
  • 38 Rigas A, Karamanolakis D, Bogdanos I. et al. Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and imaging features. BJU Int 2003; 92: 101-103
    PubMedGoogle Scholar
  • 39 Cain MP, Rink RC, Thomas AC. et al. Symptomatic ureteropelvic junction obstruction in children in the era of prenatal sonography – is there a higher incidence of crossing vessels?. Urology 2001; 57: 338-341
    CrossrefPubMedGoogle Scholar
  • 40 Parida GK, Tripathi M, Kumar K. et al. Objective improvement in renal function post-Dietl’s crisis: Documented on renal dynamic scintigraphy. Indian J Nucl Med 2016; 31: 240-241
    CrossrefPubMedGoogle Scholar
  • 41 Parikh KR, Hammer MR, Kraft KH. et al. Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels?. Pediatr Radiol 2015; 45: 1788-1795
    CrossrefPubMedGoogle Scholar
  • 42 Menon P, Rao KL, Sodhi KS. et al. Hydronephrosis: Comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure. J Pediatr Urol 2015; 11: 80.e1-e6
    CrossrefPubMedGoogle Scholar
  • 43 Esposito C, Bleve C, Escolino M. et al. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr 2016; 5: 256-261
    PubMedGoogle Scholar
  • 44 Chiarenza SF, Bleve C, Fasoli L. et al. Ureteropelvic junction obstruction in children by polar vessels. Is laparoscopic vascular hitching procedure a good solution? Single center experience on 35 consecutive patients. J Pediatr Surg 2016; 51: 310-314
    CrossrefPubMedGoogle Scholar
  • 45 Sun JS, Zhang G, Lin T. Retrocaval Ureter in Children: A Report of Eight Cases. West Indian Med J 2015; 64: 397-399
    PubMedGoogle Scholar
  • 46 Liu E, Sun X, Guo H. et al. Retroperitoneoscopic ureteroplasty for retrocaval ureter: report of nine cases and literature review. Scand J Urol 2016; 50: 319-322
    PubMedGoogle Scholar
  • 47 Scholbach T. From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Med Hypotheses 2007; 68: 1318-1327
    CrossrefPubMedGoogle Scholar
  • 48 Altugan FS, Ekim M, Fitöz S. et al. Nutcracker syndrome with urolithiasis. J Pediatr Urol 2010; 6: 519-521
    CrossrefPubMedGoogle Scholar
  • 49 Tanaka H, Waga S. Spontaneous remission of persistent severe hematuria in an adolescent with nutcracker syndrome: seven years’ observation. Clin Exp Nephrol 2004; 8: 68-70
    CrossrefPubMedGoogle Scholar
  • 50 Ullery BW, Itoga NK, Mell MW. Transposition of the left renal vein for the treatment of nutcracker syndrome in children: a short-term experience. Ann Vasc Surg. 2014; 28: 1938.e5-e8
    CrossrefPubMedGoogle Scholar
  • 51 Dong W, Yao Y, Huang H. et al. Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: a novel approach. J Pediatr Urol 2014; 10: 424-429
    CrossrefPubMedGoogle Scholar
  • 52 Li H, Sun X, Liu G. et al. Endovascular stent placement for nutcracker phenomenon. J Xray Sci Technol 2013; 21: 95-102
    PubMedGoogle Scholar
  • 53 MacDonald J, Stuart E, Rodenberg R. Musculoskeletal Low Back Pain in School-aged Children: A Review. JAMA Pediatr. 2017; DOI: 10.1001/jamapediatrics.2016.3334.. [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 54 Karademir M, Eser O, Karavelioglu E. Adolescent lumbar disc herniation: Impact, diagnosis, and treatment. J Back Musculoskelet Rehabil. 2016 [Epub ahead of print]
    PubMed