Ethnic factors in the variability of primary vesico-ureteral reflux with age

Melhem, Rafic E.; Harpen, Michael D.

doi:10.1007/s002470050217

Cited by 26 publications

(26 citation statements)

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“…In spite of the notably conservative approach applied in group 2, this study reveals that the traditional concept of surgery as the therapy of choice to prevent kidney damage in patients with increased risk for unfavorable clinical course, high-grade VUR, and nephropathy at diagnosis [8][9][10][11] is, and still is for some health care professionals, the cause for the selection of surgery as the initial therapeutic option for these patients. It has been observed how, in spite of a trend towards conservative treatment in the pre-guideline era, patients with VUR IV-V and nephropathy at diagnosis tended to be excluded from the sequential treatment algorithm.…”

Section: Discussionmentioning

confidence: 82%

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

et al. 2017

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Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions:The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

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Section: Discussionmentioning

confidence: 82%

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

et al. 2017

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“…In addition, the prevalence of VUR in the pediatric age group varies in different countries. Different studies in Western countries found that the prevalence of VUR ranges from 41% and up to 63% (5,19). Interestingly, the lowest VUR prevalence was reported in Black Americans and Jamaicans, indicting racial variations (20,21).…”

Section: Discussionmentioning

confidence: 95%

Effects of Methanol Extract of Green Tea on Biofilm Formation of Staphylococcus aureus

et al. 2016

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Background: Recurrent urinary tract Infection (UTI) is a common problem in pediatric age group. Vesicoureteral reflux (VUR) is a common cause for recurrent UTI. Objectives: This study was conducted to determine the prevalence of VUR in children who presented with recurrent UTIs and to assess the effect of endoscopic treatment in patients with grade III-V VUR. Methods: This was a prospective study recruiting 1232 patients who presented with recurrent UTI during April 2008 and January 2012. We used voiding cystourethrogram to diagnose VUR, and treated grades III-V VUR by bulking agent. One to 2 sessions were performed and the participants were followed-up postoperatively at first, second, third, and 12th months postoperatively. Results: VUR was found in 437 (35.5%) of the patients. Amongst those, 197 (16%) patients were diagnosed with VUR grade I and II. Additionally, 240 (19.5%) cases were diagnosed with VUR III-V. Two sessions were required to correct the reflux in all patients with grade III. The success rate of correction of grade IV was 79% after the second session. The success rate was 71% in grade V. New contralateral reflux with low grade (I and II) de novo VUR was found in 28/240 (11.7%) cases. After successful correction of VUR, UTI occurred in 12/203 (5.9%) of the patients. Conclusions: VUR was common in children with recurrent UTI with a good prognosis after endoscopic correction. Further study is needed to follow-up the participants who did not respond to treatment.

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“…UU., el Reino Unido e Italia, y las tasas más bajas varían entre el 6% y el 12% en los niños afroamericanos y son del 10% en los niños jamaiquinos. 3,[11][12][13][14] En nuestro país, en un estudio con 300 pacientes, Yılmaz y col. determinaron que la tasa de RVU era del 30,9%. 15 En el estudio actual, se observó que la tasa de RVU coincidía con la bibliografía relevante y que era estadísticamente significativa cuando se analizaron los grupos por separado.…”

Section: Discussionunclassified

“…2 El reflujo vesicoureteral (RVU) es la anomalía detectada con más frecuencia en los pacientes pediátricos con infección urinaria (IU), con una incidencia del 30% al 50%, mientras que se observa nefroesclerosis en el 30% al 40% de los pacientes. 3,4 Por lo tanto, es necesario estudiar cada caso de IU pediátrica para determinar la presencia de RVU. A c t u a l m e n t e , l a g a m m a g r a f í a con ácido dimercaptosuccínico (dimercaptosuccinic acid, DMSA) es la mejor técnica de diagnóstico por imágenes disponible para detectar lesiones renales asociadas con la pielonefritis aguda.…”

Section: Introductionunclassified

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

2018

Arch Argent Pediatr

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Arch Argent Pediatr 2018;116(4):e542-e547 / e542Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias Conflicto de intereses:Ninguno que declarar.Recibido: 19-10-2017 Aceptado: 19-2-2018 RESUMEN Introducción. El objetivo del estudio fue investigar la relación entre reflujo vesicoureteral (RVU) y daño renal en pacientes con infección urinaria (IU) sin fiebre, primera IU febril e IU recurrente. El objetivo secundario, determinar si la proteína C-reactiva (PCR) actuaría como predictor de nefroesclerosis en las IU febriles. Población y métodos. Estudio prospectivo; pacientes pediátricos con IU sin fiebre, primera IU febril e IU recurrente. Los análisis de laboratorio de rutina incluyeron hemograma completo, urea, creatinina, análisis de orina completamente automatizado, urocultivo y PCR. Se realizó ecografía urológica luego del diagnóstico de IU, cistouretrografía miccional tras seis semanas y gammagrafía renal estática con ácido dimercaptosuccínico marcado con 99mTc tras seis meses a todos los participantes. Resultados. Participaron 47 niños con IU sin fiebre, 48 con primera IU febril y 61 con IU recurrente. Hubo una diferencia estadísticamente significativa entre los grupos respecto de RVU y nefroesclerosis (p= 0,001 y p= 0,011, respectivamente). También hubo una diferencia estadísticamente significativa respecto de nefroesclerosis entre los pacientes con y sin RVU (p= 0,001). Además, se estableció una diferencia estadísticamente significativa respecto de nefroesclerosis (p < 0,05) en los pacientes con PCR cinco veces mayor o menor que el valor de corte aceptado (5 mg/dl). Conclusión. La proporción de nefroesclerosis fue paralela a la frecuencia de RVU. Cuanto mayor era el grado de RVU, mayor era el daño renal. Se determinó una correlación positiva entre PCR elevada y nefroesclerosis, lo que señala esclerosis durante el diagnóstico de pielonefritis. INTRODUCCIÓNLas infecciones urinarias, en especial en los niños menores de t r e s a ñ o s , s e e n c u e n t r a n e n t r e las infecciones bacterianas más frecuentes. 1 En el 10% al 64% de los casos de pielonefritis aguda (PA) se notifica daño del parénquima renal, con casos de pacientes con infección recurrente y tratamiento inadecuado que presentan riesgos de morbilidad, tales como hipertensión e insuficiencia renal crónica (IRC). 2 El reflujo vesicoureteral (RVU) es la anomalía detectada con más frecuencia en los pacientes pediátricos con infección urinaria (IU), con una incidencia del 30% al 50%, mientras que se observa nefroesclerosis en el 30% al 40% de los pacientes. 3,4 Por lo tanto, es necesario estudiar cada caso de IU pediátrica para determinar la presencia de RVU. A c t u a l m e n t e , l a g a m m a g r a f í a con ácido dimercaptosuccínico (dimercaptosuccinic acid, DMSA) es la mejor técnica de diagnóstico por imágenes disponible para detectar lesiones renales asociadas con la pielonefritis aguda. 5 Se ha informado que la lesión renal detectada por g a m m a g r a f í a c o n D M S A e n e l transcurso de una p...

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Ethnic factors in the variability of primary vesico-ureteral reflux with age

Abstract: The possibility of delayed maturation of the antireflux mechanism in whites is considered as a possible explanation, and the possibility of an ethnic basis for this is suggested.

Cited by 26 publications

References 7 publications

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Effects of Methanol Extract of Green Tea on Biofilm Formation of Staphylococcus aureus

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

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