Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?

Andrioli, Veridiana; Regacini, Rodrigo; Aguiar, Wilson

doi:10.1590/s1677-5538.ibju.2020.02.02

Cited by 6 publications

(2 citation statements)

References 47 publications

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“…The HR increased to 2.27 in patients with diabetes, and 3.79 in patients with kidney infections, implying that these comorbidities increase CKD risk in patients with VUR (Table 3). Few studies and literature [26][27][28] have mentioned that VUR alone might not be the only reason for the deterioration of kidneys that induced CKD. As a result, clinicians should treat the comorbidities to reduce the risk and severity of CKD potentially.…”

Section: Discussionmentioning

confidence: 99%

Vesicoureteral reflux is associated with increased risk of chronic kidney disease: A nationwide cohort study

Lee,

Lai,

Haw

et al. 2023

Medicine

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The association between vesicoureteral reflux (VUR) and chronic kidney disease (CKD) risk remains unestablished. We investigated the incidence of CKD in children with VUR in Taiwan and evaluated whether they had a higher risk of CKD than the general population. A nationwide population-based cohort study was conducted among children with VUR identified using Taiwan’s National Health Insurance Research Database from 2000 to 2013. VUR was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes. We identified the children with VUR and randomly selected comparison children according to a 1:1 ratio, matching them by age, gender, index year and comorbidity using data from the National Health Insurance Research Database. In total, 8648 children with VUR and 8648 comparison children were included. All children were followed from the study date until a diagnosis of CKD, termination of insurance, or the end of 2013. Cox proportional hazards regressions were performed to compare the hazard ratios for CKD between the 2 cohorts. Incident cases of CKD were identified. After adjustment for potential confounders, the study cohort was independently associated with a higher risk of CKD (adjusted hazard ratio, 3.78; 95% confidence interval, 2.10–7.18). This population-based cohort study indicated that children with VUR have a higher risk of CKD than those without VUR.

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Section: Discussionmentioning

confidence: 99%

Vesicoureteral reflux is associated with increased risk of chronic kidney disease: A nationwide cohort study

Lee,

Lai,

Haw

et al. 2023

Medicine

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“…Duplex kidneys are the most common congenital anomalies of the upper urinary tract, with an estimated incidence of 0.8% (1). Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction of the upper pole, megaureter, ureterocele or ectopic ureter, and/ or vesicoureteral refl ux to the lower pole, eventually compromising affected moiety function (2,3).…”

Section: Introductionmentioning

confidence: 99%

Can extended upper pole ureterectomy prevent ureteral stump syndrome after proximal approach for duplex kidneys?

et al. 2021

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Introduction: Symptomatic duplex kidneys usually present with recurrent urinary tract infection due to ureteral obstruction (megaureter, ureterocele or ectopic ureter) and/or vesicoureteral refl ux. Upper-pole nephrectomy is a widely accepted procedure to correct symptomatic duplex systems with poor functioning moieties, also known as upper or proximal approach. The distal ureteral stump syndrome (DUSS) can be a late complication of this approach. There is no consensus upon the length of ureteral dissection and the better approach to symptomatic disease in duplex systems, so we aim to identify if extended ureteral dissection can prevent DUSS in top-down approach. Materials and Methods: Forty-four consecutive patients with symptomatic duplex system were retrospectively classifi ed into two groups: those with limited ureteral excision after heminephrectomy (HN) (group-1) and those with extended ureterectomy after HN (group-2). Patients were followed-up for at least 36 months regarding outcomes of distal ureteral stump. Results: Overall complication was 20%. A total of 8 patients required unplanned further surgery in Group-1 (30%) whereas only 1 patient required unplanned surgery in group 2 (6%) (p=0.07). Subgroup analysis showed that Group-1 presented more DUSS requiring surgery during follow-up than group-2 (p=0.04). Factors possibly affecting complications incidence (such as ureterocele or ectopic ureter) did not differ between groups (p=0.72 and p=0.78). Conclusion:Upper pole nephrectomy should be performed with extended distal ureteral dissection to prevent ureteral stump complications.

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Functional assessment of renal damage in children with primary vesicoureteral reflux

Zhu

Jin

et al. 2022

Preprint

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Objectives: To evaluate the renal function damage in children with primary vesicoureteral reflux (VUR). Methods: A total of 226 children with VUR (65 cases with left, 39 with right, and 122 cases with bilateral VUR) were screened. Eighty-five urinary tract infection (UTI) cases, without urinary malformations, during the same period were collected as controls. Age at diagnosis, body weight, renal ultrasound, VUR grade, serum creatinine level, dimercaptosuccinic acid (DMSA) level, and effective renal plasma flow (ERPF) values were retrospectively analyzed. Results: There were no significant differences in age at diagnosis between study groups. Total ERPF was significantly lower in the bilateral VUR group than in the control group. The ERPF in unilateral VUR was significantly lower than that in the contralateral or ipsilateral side in the control group (P<0.001). The mean split renal function, as assessed by DMSA of VUR, was 28.00% and 29.12% on the left and right sides, respectively, both of which were lower than the control group’s 40.27%. Renal deterioration was also correlated with renal scarring (P=0.003), a VUR grade (P=0.008), a transverse diameter (P=0.002), and renal pelvic separation (P=0.037). Conclusion: Split renal function was impaired in the reflux kidney. The total ERPF in the bilateral VUR group was lower than that in the unilateral VUR group. Renal deterioration was correlated with renal scarring, a VUR grade, a transverse diameter, and renal pelvis separation.

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Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?

Cited by 6 publications

References 47 publications

Vesicoureteral reflux is associated with increased risk of chronic kidney disease: A nationwide cohort study

Vesicoureteral reflux is associated with increased risk of chronic kidney disease: A nationwide cohort study

Can extended upper pole ureterectomy prevent ureteral stump syndrome after proximal approach for duplex kidneys?

Functional assessment of renal damage in children with primary vesicoureteral reflux

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